Browsing by Author "Sepulveda, Pablo"
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- ItemBalloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension(SOC MEDICA SANTIAGO, 2019) Sepulveda, Pablo; Ortega, Juan; Armijo, German; Torres, Jose; Ramirez, Pablo; Backhouse, Christian; Vargas, Cesar; Lopez, Leonel; Gonzalez, Felipe; Puentes, Angel; Donoso, Hernan; Bellet, Augusto; Godoy, Diego; Araya, Mario; Luz Andrade, Carmen; Pablo Molina, Juan; Nazzal, CarolinaBackground: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 +/- 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 +/- 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 +/- 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 +/- 377,0 at baseline to 516,6 +/- 323,3 Dynes/sec/cm(-5) (p<0.01) and the cardiac index increased from 2.4 +/- 0.6 at baseline to 2.8 +/- 0.3 L/min/m(2) (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3 +/- 0.5 to 2.5 +/- 0.5 (p<0,01) and six minutes walking distance from 331 +/- 92 to 451 +/- 149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.
- ItemCambios agudos en la función auricular derecha post uso de iloprost inhalatorio en pacientes con hipertensión arterial pulmonar : estudio con técnicas de deformación de imagen(2015) Kanacri, Andres; Gabrielli, Luigi; Vega, Julián; Saavedra Madariaga, Rodrigo Alejandro; Cordova, Samuel; Sepulveda, Pablo; Castro Gálvez, Pablo Federico
- ItemChanges long term prognosis of 17 patients with pulmonary artery hypertension(SOC MEDICA SANTIAGO, 2011) Enriquez, Andres; Castro, Pablo; Sepulveda, Pablo; Verdejo, Hugo; Greig, Douglas; Gabrielli, Luigi; Ferrada, Marcela; Lapostol, CarolinaBackground: Pulmonary artery hypertension (PAR) is a progressive disease with high mortality. Major advances had been made in the treatment of this condition during the last decade. Aim: To characterize the clinical evolution and mortality of a cohort of Chilean patients. Material and Methods: Seventeen patients with PAH diagnosed in the last 10 years in two Chilean hospitals were enrolled. Measurements at diagnosis included hemodynamic variables and 6-minute walk test. The patients were followed clinically for 3 years and the observed mortality was compared with that predicted by the prognostic equation proposed by the historic registry of the National Institutes of Health (NIH). Results: The mean age of patients was 45 years and 80% had an idiopathic PAH. The mean median pulmonary artery pressure was 57 +/- 15 mmHg, the cardiac index was 2.4 +/- 0.7 l/min/m(2) and the right atrial pressure was 12 +/- 8 mmHg. The 6-minute walk distance was 348 +/- 98 m. All patients received anticoagulants. Eighty two percent received ambrisentan, 12% received bosentan, 29% received iloprost and 24% sildenafil. At the end of follow-up only 3 patients had died, with an observed survival rate of 88, 82 and 82% at 1, 2 and 3 years, respectively. In contrast, the survival calculated according to the predictive formula of the NIH was 67, 56 and 45%, respectively. Among surviving patients, an improvement in exercise capacity was observed after one year (p < 0.05). Conclusions: The observed survival rate was significantly better than that estimated according to historical data. Furthermore, therapy was associated with an improvement in functional capacity after one year. This prognostic improvement is consistent with data of other contemporary registries published after the NIH Registry. (Rev Med Chile 2011; 139: 327-333).
- ItemCharacteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction(SOC MEDICA SANTIAGO, 2016) Bartolucci, Jorge; Nazzal N, Carolina; Verdugo, Fernando J.; Carlos Prieto, Juan; Sepulveda, Pablo; Corbalan, Ramon; GEMIBackground: Consumption of illicit drugs (ID) has been associated with an increased risk of acute myocardial infarction (AMI). There is limited national evidence about the impact of substance use over the clinical presentation, management and outcomes of AMI patients. Aim: To describe the prevalence of ID consumption in patients within the Chilean Registry of Myocardial Infarction (GEMI), comparing clinical characteristics, management and outcome according to consumption status. Material and Methods: We reviewed data from the GEMI registry between 2001 and 2013, identifying 18,048 patients with AMI. The sample was stratified according to presence or absence of previous ID consumption, comparing different demographic and clinical variables between groups. Results: Two hundred eighty five patients (1.6%) had history of ID consumption (cocaine in 66%, cannabis in 35% and central nervous system stimulants in 24.0%). Compared with non-users, ID consumers were younger, predominantly male and had a lower prevalence of cardiovascular risk factors, except for tobacco smoking (86.3% and 42.5% respectively, p < 0.01). Among consumers, there was a higher percentage of ST segment elevation (85.2% and 67.8% respectively, p < 0.01) and anterior wall AMI (59.9 and 49.5% respectively, p = 0.01). Additionally, they had a higher rate of primary angioplasty (48.8% and 25.5% respectively, p < 0.01). There was no difference in hospital mortality between groups when stratified by age. Conclusions: A low percentage of patients with AMI had a previous history of ID consumption in our national setting. These patients were younger and had a greater frequency of ST segment elevation AMI, which probably determined a more invasive management.
- ItemChilean results of the international registry of risk factors and treatment of unstable angina and non ST elevation myocardial infarction: ACCORD (ACute CORonary syndrome Descriptive study)(SOC MEDICA SANTIAGO, 2011) Stockins, Benjamin; Albornoz, Francisco; Martinez, Dario; Campos, Pabla; Gajardo, Jorge; Lamich, Ruben; Manriquez, Leopoldo; Perez, Victor; Rojo, Pamela; Sepulveda, Pablo; Gabriela Pumarino, M.; Corbalan, RamonBackground: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however current practices are unknown in Chile. Aim: To evaluate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: One year prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end of the follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures during the hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). During procedures, 31% of patients received clopidogrel, and 4.2% glycoprotein IIb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite having more risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end of the 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%). Conclusions: A high prevalence of multiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and decreases during the one year-follow-up. (Rev Med Chile 2011; 139: 19-26).
- ItemEffect-site target-controlled infusion in the obese : model derivation and performance assessment(2018) Cortínez Fernández, Luis Ignacio; Sepulveda, Pablo; Rolle, Augusto; Cottin, Pauline; Guerrini, Alexandre
- ItemIncreased Oxidative Stress Correlates With Pulmonary Vascular Response to Vasodilators in Pulmonary Artery Hypertension Patients(2009) Castro Gálvez, Pablo Federico; Gabrielli, Luigi; Fasce, Fabrizio; |Verdejo Pinochet, Hugo; Greig, Douglas; Llevaneras, Silvana; Ferrada, Marcela; Hernandez, Claudia; Godoy J., Iván; Garcia, Lorena; Mellado Suazo, Rosemarie; Sepulveda, Pablo; Lavandero, Sergio
- ItemRelationship between mechanical and metabolic dyssynchrony with left bundle branch block: Evaluation by 18-fluorodeoxyglucose positron emission tomography in patients with non-ischemic heart failure(ELSEVIER SCIENCE INC, 2012) Castro, Pablo; Luis Winter, Jose; Verdejo, Hugo; Orellana, Pilar; Carlos Quintana, Juan; Greig, Douglas; Enriquez, Andres; Sepulveda, Luis; Concepcion, Roberto; Sepulveda, Pablo; Rossel, Victor; Chiong, Mario; Garcia, Lorena; Lavandero, SergioBACKGROUND: Ventricular dyssynchrony is a common finding in patients with heart failure (HF), especially in the presence of conduction delays. The loss of ventricular synchrony leads to progressive impairment of contractile function, which may be explained in part by segmental abnormalities of myocardial metabolism. However, the association of these metabolic disarrangements with parameters of ventricular dyssynchrony and electrocardiography (ECG) findings has not yet been studied.