Rodrigo Saavedra

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated.

Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar

Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. Aim: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. Patients and methods: One hundred fifteen patients aged 43 ± 15.6 years (85 % females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ±14 mm Hg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. Results: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. Conclusions: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.

Human resource allocation in business process management and process mining: A systematic mapping study

Purpose Human resource allocation is considered a relevant problem in business process management (BPM). The successful allocation of available resources for the execution of process activities can impact on process performance, reduce costs and obtain a better productivity of the resources. In particular, process mining is an emerging discipline that allows improvement of the resource allocation based on the analysis of historical data. The purpose of this paper is to provide a broad review of primary studies published in the research area of human resource allocation in BPM and process mining. Design/methodology/approach A systematic mapping study (SMS) was conducted in order to classify the proposed approaches to allocate human resources. A total of 2,370 studies published between January 2005 and July 2016 were identified. Through a selection protocol, a group of 95 studies were selected. Findings Human resource allocation is an emerging research area that has been evolving over time, generating new proposals that are increasingly applied to real case studies. The majority of proposed approaches relate to the period 2011-2016. Journals and conference proceedings are the most common venues. Validation research and evaluation research are the most common research types. There are two main evaluation methods: simulation and case studies. Originality/value This study aims to provide an initial assessment of the state of the art in the research area of human resource allocation in BPM and process mining. To the best of the authors’ knowledge, this is the first research that has been conducted to date that generates a SMS in this research area.

Potential adverse cardiac remodelling in highly trained athletes: still unknown clinical significance

Abstract Moderate endurance exercise has long been considered an essential element to maintain cardiovascular health, and sedentary behaviour in the general population has been related to a significant increase in all-causes of mortality, cardiovascular disease mortality and cardiovascular disease incidence. However, a growing group of people performs an intense exercise that leads to multiple heart adaptive changes that are collectively called “athlete’s heart”. In this review, we discussed the evidence of cardiac remodelling process secondary to repetitive and strenuous exercise in some predisposed athletes that produces intense and probably deleterious changes in cardiac morphology and function with no clear clinical significance in long-term follow-up. Moreover, we also discussed the individual biological response to exercise assessed by myocardial damage, inflammation, oxidative stress, fibrosis and ventricular hypertrophy biomarkers showing different intensities with equivalent exertion.

“Gigantic” biatrial myxoma with right heart functional impairment

Cardiac myxomas are frequently located in the left or right atria, with multiple locations being rare. We report a 59‐year‐old healthy female with 5 months of cough and exertional dyspnea. A transthoracic echocardiography (TTE) exhibits a 9 × 5 cm nonpedunculated tumor arising from the interatrial septum (IAS) and inhabiting both atria, but was unable to depict the relation with the IAS. Transesophageal echocardiography exposes a single tumor crossing the IAS through an ostium secundum atrial septal defect (ASD) causing right heart functional impairment. Uneventful cardiac surgery allowed complete resection of the lesion and ASD closure. Pathology reported a myxoma.

Big thrombus “sitting” in an atrial septal aneurysm

A 79 year‐old‐man presented three episodes of upper gastrointestinal bleeding and weight loss. Endoscopy revealed bleeding and extrinsic compression at the pyloric region. Computed tomography scan showed a pancreatic tumor, peritoneal carcinomatosis, vascular infiltration, and incidentally found a partially calcified hypodense lesion of 35 mm in the left atrium, suggesting a myxoma or a thrombus. Echocardiography revealed moderate left atrium enlargement, dilated left atrial appendage with spontaneous echo contrast, moderate dilatation and dysfunction of the left ventricle, ejection fraction was 39%, and an atrial septal aneurysm in which a piriform, mass of 35×33×25 mm, was “sitting,” suggesting an organized thrombus.

Reparación de una perforación valvular mitral como secuela de endocarditis, aporte de la ecocardiografía tridimensional

Resumen Reportamos un caso de reparacion de perforacion valvular mitral en un joven de 18 anos que consulta por disnea de esfuerzos y con el an-tecedente remoto de una artritis septica de rodilla tratada. En el examen fisico se encontro un soplo holosistolico 4/6 en el foco mitral. Se realizo un ecocardiograma transtoracico (ETT) que objetivo una insuficiencia mitral severa, con un jet de recorri-do muy excentrico originado desde anterior, sospe-chando una perforacion del velo anterior, sin lograr caracterizarla por dicha tecnica. Se complemento el estudio con un ecocardiograma transesofagico (ETE) en una plataforma EPIQ 7 cv (PHILIPS), que identifico en el cuerpo del segmento 2 del velo an-terior mitral (A2) una posible perforacion. El anali-sis de la valvula mediante ETE tridimensional (3D), confirmo una perforacion circular de bordes netos, de dimensiones maximas 6x6 mm, localizada en el cuerpo de A2. El analisis 3D aporto valiosa informa-cion para programar la reparacion valvular, la cual se efectuo mediante un parche de pericardio autolo-go fresco (sin fijacion en glutaraldehido) y una anu-loplastia con un anillo rigido, con optimo resultado y sin complicaciones.

Remodelado auricular derecho y niveles plasmáticos de Galectina-3 se relacionan con la capacidad funcional de pacientes con hipertensión arterial pulmonar

Introduccion: En pacientes con hipertension arterial pulmonar (HAP) Galectina- 3, biomarcador de fibrosis miocardica, se ha asociado a marcadores ecocardiograficos de remodelado ventricular derecho. La relacion entre Galectina- 3, remodelado auricular derecho (AD) y capacidad funcional (CF) en pacientes con HAP no ha sido explorado. El objetivo fue medir niveles de Galectina-3 y su relacion con CF y remodelado AD en pacientes con HAP Metodos: Estudio prospectivo observacional en que se incluyeron 14 pacientes con HAP En todos los pacientes se midieron los niveles de Galectina-3, proBNP, se evaluo la CF mediante test de caminata 6 minutos (TC6M) y se evaluo remodelado AD. Se consideraron para el analisis dos grupos segun la distancia caminada en TC6M (> 200 m vs. ≤ 200 m). Resultados: La edad promedio fue 43 ± 10 anos, el 84% mujeres. Los niveles de Galectina-3 fueron 16,1 ± 7,4 ng/mL y el TC6M fue 371 ± 142 mts. Los pacientes con TC6M< 200 m presentaron mayores niveles de Galectina-3 (27,3 ± 4,6 vs 13,7 ± 3,8; p=0,006) y mayor volumen AD (151 ± 21 vs 94 ± 43; p=0,04). Ademas, se observo una correlacion inversa entre el area AD y TC6M (-0,71; p=0,03). Conclusion: Niveles elevados de Galectina-3 y parametros de remodelado adverso en AD se relacionan con una menor CF en pacientes con HAP. Estos hallazgos apuntan a una mejor caracterizacion de pacientes con HAP y eventualmente la busqueda de nuevos objetivos terapeuticos.