Carlos Rapallo - Academia.edu (original) (raw)

Papers by Carlos Rapallo

Circulation. Heart failure, Jan 7, 2015

European Heart Journal, 2018

Results: Additional aortic arch repair, mitral valve repair and CABG were performed in 3,3%, 20% ... more Results: Additional aortic arch repair, mitral valve repair and CABG were performed in 3,3%, 20% and 16,7% of patients of the Group 1 and 24,1%, 10,3% and 22,4% of patients pertained to the Group 2, respectively. Early mortality was 3,4% (1 patient from Group 1 and 2 patients from Group 2). We revealed a significant prevalence of the concomitant ascending aortic and arch procedures in Group 2 patients. The total extracorporeal circulation time affected severity of the postoperative heart failure, respiratory failure and early mortality, and there was no influence of duration of the aortic cross-clamp. We revealed the influence of the preoperative NYHA class and left ventricle end-diastolic volume on the severity of the early postoperative heart failure. Additional CABG also affected risk of the perioperative stroke and early mortality. Follow-up was 88% completed. The duration of follow-up was 43,6±22,7 (6-102) months. Late mortality was 0% in Group 1 and 3,6% (2 patients) in Group 2. There were no late redo operations on the thoracic aorta. Among baseline factors only additional aortic arch repair had an influence on the late mortality rate. Conclusions: In a high-volume aortic center aortic root replacement can be performed with low perioperative risk and good late outcomes. The type of aortic root procedure performed did not affect early or late survival. The preoperative NYHA class, left ventricle end-diastolic volume, additional CABG and duration of the extracorporeal circulation had an influence on the early postoperative period. Complex aortic root and arch procedures were associated with worse late mortality.

European Heart Journal - Cardiovascular Imaging, 2019

Argentine Journal of Cardiology, 2018

Presentamos los resultados a dos anos de seguimiento de la cohorte argentina del estudio EPICOR, ... more Presentamos los resultados a dos anos de seguimiento de la cohorte argentina del estudio EPICOR, un registro internacional, multicentrico, observacional, prospectivo, disenado para determinar los patrones de utilizacion de la terapia antitrombotica en pacientes con sindrome coronario agudo en el contexto de la practica clinica habitual. Se enrolaron 438 pacientes consecutivos con infarto de miocardio con supradesnivel del segmento ST (STEMI, 41%) o SCA sin supradesnivel del segmento ST (NSTE-ACS, 59%), externados vivos de centros hospitalarios publicos, privados y de comunidad. La media de edad fue 62 anos, 76% eran varones, 71% hipertensos, 64% fumadores, 19% diabeticos y 40% tenian antecedentes de patologia cardiovascular previa. La mortalidad global fue de 4,8% al ano, y 7,3% a los 2 anos. El uso de doble antiagregacion plaquetaria fue de 80% al ano y 53% a los 2 anos (p>0.0001), sin diferencias entre aquellos con o sin supradesnivel del ST. La incidencia de eventos isquemic...

Resumen es: Introduccion A pesar de que es tecnicamente mas demandante, el acceso a la valvula mi... more Resumen es: Introduccion A pesar de que es tecnicamente mas demandante, el acceso a la valvula mitral por via tran¬septal permite una exposicion mayor de sus valvas ...

Journal of the American College of Cardiology, 2018

Background: Coronary Flow Reserve (CFR) obtained with positron emission tomography has additional... more Background: Coronary Flow Reserve (CFR) obtained with positron emission tomography has additional prognosis information even in patients with normal perfusion stress test and can restratify for future risk of events. New Cadmium Zinc Telluride Gamma Cameras (CZT-Spect) allows CFR evaluation but there is still small clinical data about it. The aim of this study was to compare CFR in patients with or without risk factors and normal perfusion stress test using a CZT-Spect. Methods: 106 Patients were referred for gated spect perfusion stress test and coronary flow assessment by D-SPECT. CFR was obtained by stress flow / rest flow ratio with 4DM software. Perfusion images were analyzed visually and with database. 63 normal perfusion patients were included and classified in 3 groups for the analysis. Group A= non-diabetic, non-smoking and non-dyslipidemia patients Group B= non-diabetic but smoking and or dyslipidemia patients Group C= diabetic patients Results: 63 patients (39 men) with a median age of 69 years (interquartile range [IQR]: 59, 78). Median CFR between groups was different according the cardiac risk profile (Graphic). Group A CFR was statistically higher than B and C groups (2.58 vs 2.18 vs 2.05) p<0.05 Conclusion: CZT-SPECT CFR in normal perfusion patients varies according different cardiac risk profiles and probably reflects microvascular dysfunction and or multivessel disease.

Revista Argentina de Cardiología, Jan 2, 2019

Echocardiography

The Covid-19 pandemia has many other undesirable consequences apart of virus infection. Less peop... more The Covid-19 pandemia has many other undesirable consequences apart of virus infection. Less people is hospitalized due to acute coronary syndrome and the delay to seek medical attention has increased. Patients with ST segment elevation myocardial infarction arrive at the hospital too late to be timely treated and we have recently seen mechanical complications that were more frequent in the past decades before the use of reperfusion strategies. In this report we describe the presentation, evolution and detailed imaging evaluation of two patients with unusual presentations of cardiac rupture: left ventricular pseudoaneurysm and left ventricular intramyocardial dissecting hematoma.

Journal of the American College of Cardiology

Revista Argentina De Cardiologia, 2008

Coronary artery bypass graft surgery still remains as the treatment of choice of patients with le... more Coronary artery bypass graft surgery still remains as the treatment of choice of patients with left main coronary artery (LMCA) disease; however, there are few previous studies with local data on the outcomes of this type of surgery.

Revista Argentina De Cardiologia, 2000

Nuestro pals carece de datos oficiales acerca de las caracteristicas, el tratamiento y la evoluci... more Nuestro pals carece de datos oficiales acerca de las caracteristicas, el tratamiento y la evolucion de los pacientes asistidos por paro cardiorrespiratorio (PCR) en areas monitoreadas.

Cardiology Journal, 2013

The aim was to assess the incidence of prosthesis-patient mismatch (PPM) after mitral valve repla... more The aim was to assess the incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) in patients receiving Biocor® porcine or mechanical valves, and to evaluate the effect of PPM on long-term survival. All patients undergoing MVR between 2009 and 2013 received either mechanical or bioprosthetic valves (Biocor® porcine). PPM was defined as severe when the indexed effective orifice area was &amp;amp;amp;amp;amp;amp;amp;lt;0.9cm²/m², moderate between 0.9 and 1.2cm²/m² or absent &amp;amp;amp;amp;amp;amp;amp;gt;1.2cm²/m². The primary endpoint was all-cause long-term mortality. Among a total of 136 MVR, PPM was severe in 27%, moderate in 44% and absent in 29% of patients. Implanted valves were 57% mechanical and 43% bioprosthetic. Only 3% of patients with mechanical valves had severe PPM versus 59% with bioprostheses (p&amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Sixty-month survival with moderate mismatch was 0.937 (SE 0.043) and with no mismatch 0.895 (SE 0.058) (p=0.043). Survival of patients suffering from severe mismatch, or moderate mismatch with pulmonary hypertension was 0.749 (SE 0.101); while for patients with no mismatch or with moderate mismatch without pulmonary hypertension, survival was 0.951 (SE 0.028) (p=0.016). About one-fourth of patients had severe PPM and almost all of them had received a bioprosthesis. Sixty-month survival was significantly lower in patients with severe mismatch, or moderate mismatch with pulmonary hypertension. Specifically, when a bioprothesis is chosen and while further evidence on the impact of PPM on clinical outcomes appears, surgeons are recommended to follow a preoperative strategy to implant a mitral prosthesis of adequate size in order to prevent PPM.

SciELO Argentina

A pesar de que es técnicamente más demandante, el acceso a la válvula mitral por vía transeptal p... more A pesar de que es técnicamente más demandante, el acceso a la válvula mitral por vía transeptal permite una exposición mayor de sus valvas y del aparato subvalvular, en especial en aurículas pequeñas, en reoperaciones o cuando se combina con el tratamiento de la válvula tricuspídea.

Journal of the American College of Cardiology, 2003

Background: Left ventricular systolic and diastolic functions have been recognized as important f... more Background: Left ventricular systolic and diastolic functions have been recognized as important factors in cardiovascular diseases. Conductance catheter has high temporal resolution and can provide accurate measurements of cardiac functions. However, it has been difficult to obtain an accurate assessment of left ventricular function by using noninvasive techn;ques. Steady state tine MR imaging is a new MR Imaging technique that can demonstrate improved temporal resolution in the cardiac cycle. In addition, high blood-to-myocardial contrast can be obtained in patients with heart failure. The purpose of this study was to evaluate the accuracy of steady state tine MR imaging for assessing left ventricular volumes and functions by using a conductance catheter method as a gold standard. Methods: Fourteen patients (9 man, mean age 60.4*11.3 years) with heart tailure (7 with dilated cardiomyopathy, 5 with old myocardial infarction, 2 with constrictive pericarditis) were studied. Left ventricular time-volume curves were obtained with steady state tree precession tine MR imaaina and with a smole-field conductance catheter usina a micromanometer. End-diastolic volume (EDV). end-systolic volume (ESV) and ejection fraction (EFI were calculated. In addition. oeak eiection rate (PER\. time to PER. oeak ., _ I. tilling rate (PFR) end time to PFR were assessed by the first derivative curve of the left ventricular time volume curve. Temporal resolutions was 26 msec by MR imaging and 3 msec by conductance catheter. Results: Excellent tine MR images were acquired in all patients by using steady state tine MR imaging. Significant linear correlation between the measurements by MR lmaglng and conductance catheter was found for EDV (r=0.98. pcO.OOi), ESV (r=0.99, pcO.OOl), EF (r&97, pcO.OOl), PER (r=0.76, pcO.Ol), time to PER (r=0.78. p<O.Ol), PFR (r=O.E6, ~~0.05) and time to PFR (rz0.77, p<O.Ol). Conclusion: MR measurements of LV volume, EF, PER and PFR obtained by using a steady state tine MR imagmg demonstrated good correlations with those assessed by conductance catheter. Cardiac MR imaging is a noninvasive method that can provide detailed analysis of the cardiac performance in patients with LV dysfunction.

Journal of Nuclear Cardiology, 1997

In our research we study the myocardial perfusion history, by means of stress-rest Tc-99m-MIBI SP... more In our research we study the myocardial perfusion history, by means of stress-rest Tc-99m-MIBI SPECT, in pts submitted to cardiac mvaseularisation (re',,). Perfu~ion studies are perfomaed 3 times: before rex' (we-rev), as soon as exercise is allowed a:Rer rev (postearly), and a few months later (post-late). The aim of the research is to optimize : (1) patient selection for rev (viability evaluation), and (2) time point for post-rev perfusion evaluatio~ This is a continuation 0fthe work presented preliminary in [1].

Journal of Nuclear Cardiology, 1999

Coronary Artery Disease, 2004

Inflammatory markers have been associated with adverse clinical outcome in patients with acute co... more Inflammatory markers have been associated with adverse clinical outcome in patients with acute coronary syndromes (ACS). In addition, angiographic plaque morphology and extension of coronary artery disease has been related to worse prognosis in this group of patients. The aim of the present study was to determine if the clinical prognostic value of C-reactive protein (CRP), an inflammatory marker, can by associated with the angiographic findings in patients with non-ST elevation ACS. This prospective multicenter cohort study included 1253 patients with non-ST elevation ACS. CRP, which was considered positive (+) if &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=3 mg/l, was measured at a median of 9 h from symptoms onset and were kept blinded until the end of the study. Coronary angiography was performed in 633 patients (50%). The presence of complex coronary lesions (CCLs) was defined as the presence of any of the following: thrombus (+), Thrombolysis In Myocardial Infarction (TIMI) flow &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;/=2, and/or ulcerated plaque (UP). The extension of coronary disease was defined as one, two or three vessel disease. CRP was found to be (+) in 354 patients (60%). CCLs were present in 266 patients (46%), 166 (47%) in CRP (+) and 100 (42%) in CRP negative (-) patients, P=0.31. There was also no association between the extension of coronary disease and the CRP levels. In this large consecutive cohort of non-ST elevation ACS patients, CRP, an inflammatory marker, does not predict either the extension or the complexity of coronary disease. Even though CRP is a strong predictor of worse clinical outcome in patients with ACS, this could not be explained by the angiographic anatomic findings.

Al Director El trabajo de Borracci y colaboradores (1) muestra la evolución de otra de las técnic... more Al Director El trabajo de Borracci y colaboradores (1) muestra la evolución de otra de las técnicas disponibles para el abordaje de la válvula mitral. En 1958, Effler describió básicamente dos accesos: a través de la fosa oval pasando por la aurícula derecha y a través del surco interauricular posterior. (2) El segundo abordaje es técnicamente más fácil y por ello, hoy por hoy, ampliamente utilizado. Sin embargo, la técnica transeptal permite una visión más amplia de la válvula, lo que es preferible en caso de aurículas pequeñas, reoperaciones o hipertrofia ventricular, aunque tiene la desventaja de ser técnicamente más demandante. Varios autores, desde Dubost, (3) han utilizado y refinado esta técnica. Los trabajos son en su mayoría retrospectivos y/o no aleatorizados y heterogéneos en sus poblaciones y técnicas quirúrgicas (tanto del abordaje del tórax como de la válvula mitral), lo que hace difícil la comparación de los distintos trabajos entre sí.