Browsing by Author "Llevaneras S."
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- ItemHeart energy metabolism and its role in the treatment of heart failureMetabolismo energético del corazón y sus proyecciones en el tratamiento de la insuficiencia cardíaca(2010) Castro P.; Gabrielli L.; Verdejo H.; Greig D.; Llevaneras S.; Hernández C.; Godoy I.; Jalil J.E.; Quintana J.C.; Orellana P.; Mellado R.; Concepción R.; Sepúlveda L.; Vukasovic J.L.; García L.; Pizarro M.; Pivet D.; Carrillo C.; Tapia F.; Navarro M.; Troncoso R.; Chiong M.; Lavandero S.; Lavandero S.; Baraona F.It is unknown why heart failure progresses even when patients are treated with the best therapy available. Evidences suggest that heart failure progression is due to loss of neurohumoral blockade in advanced stages of the disease and to alterations in myocardial metabolism induced, in part, by this neurohumoral activation. Alterations in cardiac energy metabolism, especially those related to substrate utilization and insulin resistance, reduce the efficiency of energy production, causing a heart energy reserve deficit. These events play a basic role in heart failure progression. Therefore, modulation of cardiac metabolism has arisen as a promissory therapy in the treatment of heart failure. This review describes myocardial energy metabolism, evaluates the role of impaired energy metabolism in heart failure progression and describes new therapies for heart failure involving metabolic intervention.
- ItemPredictors of acute coronary syndrome without ST segment elevation and risk stratification in the chest pain unitPredictores de síndrome coronario agudo sin supradesnivel del ST y estratificación de riesgo en la unidad de dolor torácico. Experiencia en 1.168 pacientes(2008) Gabrielli L.; Castro G. P.; Verdejo H.; McNab P.; Llevaneras S.; Mardonez J.; Corbalán R.; Castro G. P.Background: Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis. Aim: To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit. Material and methods: Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression. Results: In a four years period, 1,168 patients aged 62±23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29). Conclusions: Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.