Papers by Luigi Gabrielli
Revista chilena de cardiología, 2018
Introducción: El ejercicio físico reduce la mortalidad cardiovascular y genera remodelado cardíac... more Introducción: El ejercicio físico reduce la mortalidad cardiovascular y genera remodelado cardíaco. Altas cargas de entrenamiento pueden generar remodelado cardíaco adverso. Biomarcadores (BMC) de inflamación Interleukina 6 (IL-6) y de estrés oxidativo Malondialdehído (MDA), potencialmente pueden caracterizar la respuesta al esfuerzo. Objetivo: Evaluar actividad de IL-6 y MDA en respuesta a una maratón en atletas con distinto nivel de entrenamiento y remodelado cardíaco asociado. Sujetos y Métodos: Estudio prospectivo, simple ciego, incluyó 16 atletas que completaron la maratón de Santiago (42 k), separados según entrenamiento previo, grupo 1 (G1, n: 8): Alto ≥ 100 km/semana y grupo 2 (G2, n: 8): Bajo <100 km/semana). Se obtuvo pre y post maratón: niveles de IL-6, MDA y ecocardiografía Doppler transtorácica (ETT); cuantificando cámaras cardíacas izquierdas, derechas y deformación del ventrículo izquierdo (strain longitudinal). Se utilizaron las pruebas de Mann-Whitney, Wilcoxon y Krus-kal-Wallis.
European journal of sport science, Jan 12, 2018
Moderate endurance exercise has long been considered an essential element to maintain cardiovascu... more 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 equi...
Echocardiography, 2016
Right atrium function and ventricular function have significant prognostic value in pulmonary art... more 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. Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.
Revista chilena de cardiología, 2016
Methods: This is a prospective observational study and 14 PAH patients were included. Galectin-3 ... more Methods: This is a prospective observational study and 14 PAH patients were included. Galectin-3 and proBNP levels were measured in all patients. FC was estimated by the 6-minute walk test (6MWT) and used to define 2 groups of subjects (≤200m or >200m). RA area and volume were measured by echocardiography from a 4 chamber view. Results: The average age was 43±10 years, 84% of patients were female. Galectin-3 levels were 16.1±7.4 ng / mL and 6MWT was 371±142 m. We observed an inverse correlation between RA area and 6MWT (-0.71;p=0.03). Conclusions: Higher Galectin-3 concentrations and RA adverse remodeling are related to a decreased FC in PAH patients. These findings may lead to a better characterization of PAH patients and eventually new therapeutic targets.
European heart journal cardiovascular Imaging, 2015
Pathophysiology of heart failure (HF) with preserved ejection fraction (HFPEF) remains unclear. L... more Pathophysiology of heart failure (HF) with preserved ejection fraction (HFPEF) remains unclear. Left atrial (LA) function has been related to HF symptoms. Our purpose is to analyse LA function in outpatients with new onset symptoms of HF. An observational study was performed including 138 consecutive outpatients with suspected HF referred to a one-stop clinic. Final diagnosis [HF with reduced EF (HFREF), HFPEF, or non-HF] was established according to current recommendations. Echocardiography was performed in all patients. LA function was analysed using strain derived from speckle tracking in sinus rhythm patients (n = 83). Results were analysed with ANOVA and Bonferroni statistical tests. Receiver operating characteristic (ROC) curves were constructed to investigate the predictive ability of LA parameters for the final diagnosis of HF. Patients were 75 ± 9 years and 63% women. Final diagnosis was 23.2% HFREF, 45.7% HFPEF, and 31.2% non-HF. Left ventricular strain rate showed no diff...
Echocardiography, 2015
PurposeHeart failure (HF) with preserved ejection fraction (HFPEF) is the most prevalent type of ... more PurposeHeart failure (HF) with preserved ejection fraction (HFPEF) is the most prevalent type of HF in nonhospitalized patients, but its pathophysiology remains poorly understood. The aim of our study was to assess the existence of interatrial dyssynchrony (IAD), a potentially treatable condition, in the development of HF symptoms.MethodsConsecutive patients with new onset of shortening of breath, referred for suspected HF, were screened. In all cases, a transthoracic echocardiography, ECG, and determination of plasma BNP level were performed at initial consultation. Patients were diagnosed according to current guidelines. Patients with HF and reduced ejection fraction were excluded. Later, the time from P‐wave onset on the ECG to peak negative strain (atrial contraction) was determined using speckle tracking echocardiography; the time difference between both atria (ms) was used as an index of IAD.ResultsSixty‐six patients were included. Mean age was 74 ± 8 years (74% female, 77% hy...
Revista chilena de cardiología, 2010
1. OLIVARES-REYES A, AL-KAMME A. Lutembacher’s Syndrome with small atrial septal defect diagnosed... more 1. OLIVARES-REYES A, AL-KAMME A. Lutembacher’s Syndrome with small atrial septal defect diagnosed by transthoracic and tran-sesophageal echocardiography that underwent mitral valve replace-ment. J Am Soc Echocardiogr 2005; 18: 1105.2. PATIL CV, VIJAYKUMAR M, PANDE AV, SHAH LS. Familial Lutembacher’s syndrome in mother and daughter. Indian Heart J 1997; 49: 415-7.
American Journal of Hypertension, 2013
There is experimental evidence on the role of Rho-kinase (ROCK) activation in cardiac hypertrophy... more There is experimental evidence on the role of Rho-kinase (ROCK) activation in cardiac hypertrophy but no information on its role in human hypertension and left ventricular hypertrophy (LVH). We hypothesized that ROCK activity is higher in hypertensive patients with LVH compared with hypertensive patients without LVH. We conducted a cross-sectional study comparing untreated hypertensive patients with (n = 41) and without LVH (n = 46) determined by echocardiography with a healthy normotensive control group (n = 51). Measurements included LV mass, dimensions, and function and ROCK activity determined in circulating leukocytes by measuring Western blot levels of phosphorylated to total myosin light chain phosphatase 1 (MYPT1-p/t). Compared with normotensive subjects, MYPT1-p/t was significantly increased by 4.5-fold in the hypertensive patients without LVH and by 9-fold in the hypertensive patients with LVH. Compared with the hypertension without LVH group, MYPT1-p/t was significantly increased by 2-fold in the hypertension with LVH gorup. In patients with eccentric LVH, the mean MYPT1-p/t ratio was significantly higher by 4-fold compared with hypertensive patients without eccentric LVH. Patients with an E/e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ratio ≥15 (n = 6) showed a higher MYPT1-p/t ratio (by 26%) compared with patients with a lower E/e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ratio (P ≤ 0.01). ROCK activity is higher in hypertensive patients with LVH compared with hypertensive patients without LVH, and it is further increased when eccentric LVH is present. Thus, in hypertension, ROCK activation is related to pathological cardiac remodeling and might have a role as an LVH marker.
Revista chilena de cardiología, 2012
Revista chilena de cardiología, 2011
Figura 3. Vision ecocardiografica transesofagica en esofago medio a fin de diastole. Se observan ... more Figura 3. Vision ecocardiografica transesofagica en esofago medio a fin de diastole. Se observan la valvula tricuspide con velos engrosados, retraidos y con falta de apertura. La valvula pulmonar se observa retraida y practicamente incorporada a la pared pulmonar. A la derecha se observa la imagen con doppler color que mues
Revista chilena de cardiología, 2009
Journal of the American College of Cardiology, 2012
Background: Highly trained athletes have an increased risk of atrial fibrilation (AF) as compared... more Background: Highly trained athletes have an increased risk of atrial fibrilation (AF) as compared to the general population of the same age. Left atrial (LA) dilation and dysfunction might be the underlying substrate responsible for the increased risk. The objective was to analyse LA size and function with deformation imaging in a selected group of highly trained professional athletes. Methods: Twenty four professional handball male players and 20 healthy males matched by age (27±1 y) were compared. All subjects underwent a standard transthoracic echocardiography including evaluation of LA dimensions and LA myocardial deformation by strain (LASs and LASa) and strain rate (LASRs, LASRe, LASRa) derived from 2D grey-scale images (speckle tracking). Results: mean ± SE, T-student. Globally, LA volumes were significantly larger in athletes as compared to controls (36 ± 1.7 vs 24 ± 1 mL/m2, p < 0.01) while no differences existed in LA contractile function measured by LASRa (-1.5 ± 0.1 vs-1.7 ± 0.1 sec-1, p = 0.4) or LASa (-2.5 ± 0.4 vs-2.9 ± 0.4 %, p = 0.1); A wave duration was also the same (133 ± 3 vs 140 ± 4 msec, p = 0.2). LASs, LASRs and LASRe were also similar between groups. Athletes with LA volume ≥ 40 mL/m2 (n = 7, figure) showed reduced LASRa and A wave duration as compared to athletes with LA volume < 40 mL/ m2 (-1.08 ± 0.09 vs-1.69 ± 0.1 s-1, p = 0.01 and 120 ± 5 vs 143 ± 3 msec, p < 0.01 respectively). Conclusions: A proportion of athletes with enlarged LA showed LA contractile dysfunction. This may act as a substrate for AF development.
Expert Review of Cardiovascular Therapy, 2012
Cardiac resynchronization therapy (CRT) has become an alternative for patients with systolic dysf... more Cardiac resynchronization therapy (CRT) has become an alternative for patients with systolic dysfunction and persistence of heart failure symptoms despite optimal medical therapy. The role of noninvasive cardiac imaging before device implantation still remains controversial, but they are essential to provide an objective evidence of reverse remodeling of the heart which is, in turn, also related to the outcome of patients treated with CRT. The objective of this review is to highlight the acute and long-term CRT benefits as assessed by imaging, with special focus in cardiac reverse remodeling and its impact on prognosis.
European Journal of Applied Physiology, 2014
atrial (rA) dimensions and deformation by strain (Sa) and strain rate (Sra). Atrial performance w... more atrial (rA) dimensions and deformation by strain (Sa) and strain rate (Sra). Atrial performance was assessed from the atrial stroke volume (SV). With computational geometrical models, we studied the relation between atrial volumes, strains and SV and compared atrial working conditions. We estimated the functional reserve and a resulting average wall stress. Results lA and rA volumes were larger in athletes than in controls (35.2 ± 8.8 vs. 24.8 ± 4.3 ml/m 2 , p < 0.01 and 29.0 ± 8.4 vs. 19.0 ± 5.1 ml/m 2 , p < 0.01 respectively). lASa and rASa during active atrial contraction were decreased in athletes (−12.2 ± 2.0 vs. −14.5 ± 2.1 %, p < 0.01 and −12.1 ± 1.8 vs. −14.2 ± 1.5 %, p < 0.01 respectively). lASV was similar between groups (6.6 ± 1.4 vs. 7.3 ± 1.1 ml, p = 0.19) and rASV was lower in athletes (6.2 ± 1.3 vs. 7.2 ± 1.1 ml, p < 0.01). computational models showed that this different operational mode potentially increases performance reserve, but at the cost of higher atrial wall stress. Conclusion A proportion of athletes with enlarged lA and rA showed different atrial contractile performance, likely resulting in atria working at higher wall stress. Keywords Atrial strain • Atrial function • Echocardiography • Wall stress • Exercise Abbreviations AF Atrial fibrillation cMr cardiac magnetic resonance lA left atrium lASa Peak negative left atrial strain during active atrial contraction lASra Peak negative left atrial strain rate during active atrial contraction lASre lA early diastolic peak strain rate Abstract Purpose Highly trained athletes have an increased risk of atrial arrhythmias. Atrial geometrical and functional remodeling may be the underlying substrate. We analyze and relate atrial size, deformation and performance in professional handball players compared with non-sportive subjects. Methods 24 Professional handball players and 20 nonsportive males were compared. All subjects underwent an echocardiographic study with evaluation of left (lA), right communicated by Keith Phillip george.
Echocardiography, 2012
Background: Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and d... more Background: Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and differentiating this condition from the nonpathological “athlete's heart” remains a challenge. The development of pathological left ventricular hypertrophy (LVH) is associated with left atrial (LA) dilatation and dysfunction. LA strain and strain rate by two‐dimensional (2D) speckle tracking are novel indices of LA function and might contribute to differentiate physiological from pathological LVH among athletes with underdiagnosed HCM. Methods: We evaluated 20 patients with nonobstructive HCM, 20 highly trained athletes and 20 healthy controls matched for age, gender, and body surface area. All patients underwent a transthoracic echocardiogram with evaluation of LA strain: s‐wave (LASs); and strain rate: s‐wave (LASRs) and a‐wave (LASRa). Results: LV mass index, LA volume index, and ejection fraction were comparable between patients with HCM and athletes. Patients with HCM had a signi...
Rev. chil. cardiol, 2008
... Fonte: Rev. chil. cardiol;27(4):444-448, dic. 2008. tab. Idioma: Es. Resumo: Antecedentes: El... more ... Fonte: Rev. chil. cardiol;27(4):444-448, dic. 2008. tab. Idioma: Es. Resumo: Antecedentes: El foramen oval permeable (FOP) es un hallazgo frecuente en pacientes con accidente vascular encefálico criptogénico (AVEC), y se discute la utilidad de su cierre percutáneo (CP). ...
Echocardiography, 2016
Right atrium function and ventricular function have significant prognostic value in pulmonary art... more 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. Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P&amp;amp;lt;.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.
Revista médica de Chile, 2016
Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary ... more Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies 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 mmHg 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.
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Papers by Luigi Gabrielli