Rodolfo Pizarro

Hospital Italiano de Buenos Aires, Buenos Aires, Buenos Aires F.D., Argentina

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Publications (26)112.87 Total impact

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    ABSTRACT: Objective. To assess how the quality of communication is perceived during patient handoff in areas of intensive care. Materials and Methods. Cross-sectional study conducted at a university hospital. The study assessed the perception of the quality of information received during patient handoff and the chance of physicians working on-call shifts in intensive care areas mistaking the information of one patient with that of another one. Results. Information was perceived as being "good" quality when patient handoff took place in pediatric areas (85.7%), it was conducted in a calm environment (74.4%), it was performed according to a case presentation system (82.9%), the physician was responsible for less than 17 patients (91%), and training on handoff communication had been provided (87.5%). No significant association with the rest of the analyzed outcome measures was observed. The chance of mistaking information of one patient with that of another one was perceived as "low" when handoff took place in pediatric areas (95.2%), it was performed according to a case presentation system (80%), there were not more than three interruptions (84.6%), the physician was responsible for less than 17 patients (90.9%), training on handoff communication had been provided (91.7%), and the physician was a staff doctor (77.1%). Conclusions. The quality of information received during patient handoff and the chance of mistaking the information of one patient with that of another one were associated with environmental, organizational and educational aspects that can potentially be improved.
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    ABSTRACT: BACKGROUND: Basal left atrial volume (LAV) indexed to body surface area (LAVI) predicts adverse events in patients with organic mitral regurgitation, but information is lacking regarding change in left atrial volume during follow-up. METHODS: One hundred forty-four asymptomatic patients (mean age, 71 ± 12 years; 66% women; mean ejection fraction, 66 ± 4.8%) with moderate to severe mitral regurgitation were prospectively included, with a median follow-up period of 2.76 years (interquartile range, 1.86-3.48 years). RESULTS: Fifty-four patients (37.50%) reached the combined end point of dyspnea and/or systolic dysfunction. Both basal and change in LAV were independently associated with the combined end point on multivariate analysis: for basal LAVI ≥ 55 mL/m(2), odds ratio, 2.26 (95% confidence interval, 1.04-4.88; P = .038), and for change in LAV ≥ 14 mL, odds ratio, 7.32 (95% confidence interval, 3.25-16.48; P < .001), adjusted for effective regurgitant orifice area and deceleration time. Combined event-free survival at 1, 2, and 3 years was significantly less in patients with basal LAVI ≥ 55 mL/m(2) (75%, 58%, and 43%) than in those with basal LAVI < 55 mL/m(2) (95%, 89%, and 77%) (log-rank test = 15.38, P = .0001). The incidence of the combined end point was highest (88%) in patients with basal LAVI ≥ 55 mL/m(2) and change in LAV ≥ 14 mL. CONCLUSIONS: Measurement of basal LAV and its increase during follow-up predict an adverse course in patients with moderate and severe asymptomatic mitral regurgitation. Hence, its assessment could be incorporated into the currently used algorithm for risk stratification and decision making in this group of patients.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 04/2013; DOI:10.1016/j.echo.2013.03.020 · 3.99 Impact Factor
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    12/2012; 32(2):157-160. DOI:10.4067/S0718-85602013000200011
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    ABSTRACT: The purpose of this study was to determine the independent and additive prognostic value of B-type natriuretic peptide (BNP) in patients with severe asymptomatic aortic regurgitation and normal left ventricular function. Early surgery could be advisable in selected patients with chronic severe aortic regurgitation, but there are no uniform criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied for this purpose. We prospectively evaluated 294 consecutive patients with severe asymptomatic organic aortic regurgitation and left ventricular ejection fraction above 55%. The first 160 consecutive patients served as the derivation cohort and the next 134 patients served as a validation cohort. The combined endpoint was the occurrence of symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up. The endpoint was reached in 45 patients (28%) of the derivation set and in 35 patients (26%) of the validation cohort. Receiver-operator characteristic curve analysis yielded an optimal cutoff point of 130 pg/ml for BNP that was able to discriminate between patients at higher risk in both cohorts. BNP was the strongest independent predictor by multivariate analysis in the derivation set (odds ratio: 6.9 [95% confidence interval: 2.52 to 17.57], p < 0.0001) and the validation set (odds ratio: 6.7 [95% confidence interval: 2.9 to 16.9], p = 0.0001). Among patients with severe asymptomatic aortic regurgitation and normal left ventricular function, BNP ≥130 pg/ml categorizes a subgroup of patients at higher risk. Because of its incremental prognostic value, we believe BNP assessment should be used in the routine clinical evaluation of these patients.
    Journal of the American College of Cardiology 10/2011; 58(16):1705-14. DOI:10.1016/j.jacc.2011.07.016 · 15.34 Impact Factor
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    ABSTRACT: La amiloidosis es una enfermedad infiltrativa sistémica que compromete el corazón y representa una causa importante de miocardiopatía restrictiva. En esta presentación se describe el caso de una paciente con insuficiencia cardíaca (IC) secundaria a miocardiopatía infiltrativa por depósito amiloide y obstrucción dinámica del tracto de salida del ventrículo izquierdo. El diagnóstico hematológico fue de mieloma múltiple por cadenas livianas y se demostró amiloidosis en dos tejidos extracardíacos. El ecocardiograma reveló aumento de los espesores parietales con obstrucción dinámica subaórtica significativa y la resonancia cardíaca mostró un patrón compatible con infiltración amiloide. La biopsia endomiocárdica confirmó la amiloidosis cardíaca. La publicación de este caso constituye la primera comunicación en nuestro país de esta forma de presentación atípica de amiloidosis cardíaca.
    10/2011; 79(5):453-456.
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    Circulation 09/2011; 124(12):e312-5. DOI:10.1161/CIRCULATIONAHA.110.008557 · 14.95 Impact Factor
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    ABSTRACT: Aim. To validate an instrument to assess research critical appraisal skills in residents in a university hospital by the extreme groups method. Subjects and methods. 272 residents completed the questionnaire. The mean of correct answers was 45%. Results. No significant differences between gender, specialty or post-graduate year were found. Reliability (alpha = 0.83) was acceptable and difference between extreme groups was significant (0.45 vs. 0.91). Conclusions. Residents showed poor skills to interpret typical results of clinical studies, finding consistent with other countries.
    Educacion Medica 09/2011; 14(3):171-179. DOI:10.4321/S1575-18132011000300007
  • Rodolfo Pizarro
    08/2011; 79(4):312-313.
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    ABSTRACT: Antecedentes El foramen oval permeable (FOP) se ha asociado con el accidente cerebrovascular criptogénico (ACVC). El mejor tratamiento para evitar la recidiva en pacientes con ACVC y FOP es controversial. No existen datos de costo-utilidad en nuestra región para el manejo de estos pacientes.Objetivos Construir un modelo de decisión para el manejo de pacientes con ACVC y FOP y establecer la relación costo-utilidad de tres estrategias alternativas.Material y métodos Se realizó un análisis de costo-utilidad basado en un árbol de decisión con un horizonte temporal de 4 años considerando tres estrategias: aspirina (AAS), anticoagulación (ACO) o cierre percutáneo del FOP con dispositivo. Los beneficios se expresaron en QALYs. Se fijó un umbral de pago de $28.000 argentinos y se realizó un análisis de sensibilidad.Resultados En comparación con la AAS, la anticoagulación fue más costosa ($1.315 adicionales) y generó menos beneficios (QALY incremental -0,063). El cierre con dispositivo comparado con el tratamiento con AAS costaría $89.876 adicionales por QALY ganado. Dicho monto supera el umbral de pago predeterminado. Luego del análisis de sensibilidad, la AAS se mantuvo como la estrategia con mejor relación costo-utilidad, salvo cuando la probabilidad de recidiva con esta droga aumenta al 35%, en donde la anticoagulación presenta una tasa de costo-utilidad incremental de $1.356/QALY.Conclusión De acuerdo con este modelo, para pacientes con ACVC y FOP, la AAS sería la estrategia con mejor relación costo-utilidad en nuestro medio, salvo cuando la probabilidad de eventos se eleva sustancialmente, en cuyo caso sería apropiado el uso de anticoagulantes.
    08/2011; 79(4):337-343.
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    ABSTRACT: El tratamiento invasivo de la fibrilación auricular en pacientes con miocardiopatía dilatada con sospecha de taquicardiomiopatía representa una decisión difícil y controversial. En esta presentación se describe el caso de un paciente de 57 años, internado por insuficiencia cardíaca congestiva progresiva. En el electrocardiograma se evidenció fibrilación auricular de alta respuesta ventricular y en el ecocardiograma, miocardiopatía dilatada con deterioro grave de la función del ventrículo izquierdo e insuficiencia mitral grave sin compromiso orgánico valvular. Se descartó enfermedad coronaria. Se planteó la ablación por radiofrecuencia como la mejor alternativa para su cuadro. El paciente recuperó ritmo sinusal, con el cual permanece desde hace 2 años, con evolución asintomática y mejoría de todos los parámetros ecocardiográficos.
    02/2011; 79(1):59-61.
  • Journal of Cardiac Failure 08/2010; 16(8). DOI:10.1016/j.cardfail.2010.06.056 · 3.07 Impact Factor
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    ABSTRACT: The purpose of the study was to determine the independent and additive prognostic value of brain natriuretic peptide (BNP) in patients with severe asymptomatic mitral regurgitation and normal left ventricular function. Early surgery could be advisable in selected patients with chronic severe mitral regurgitation, but there are no criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied in asymptomatic patients with severe mitral regurgitation; hence, its prognostic value remains unclear. We prospectively evaluated 269 consecutive patients with severe asymptomatic organic mitral regurgitation and left ventricular ejection fraction above 60%. The first 167 consecutive patients served as the derivation cohort, and the following 102 patients served as a validation cohort. The combined end point was the occurrence of either symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up. The end point was reached in 35 (21%) patients of the derivation set and in 21 (20.6%) patients of the validation cohort. The receiver-operating characteristics curve yielded an optimal cutoff point of 105 pg/ml of BNP that was able to discriminate patients at higher risk in both cohorts (76% vs. 5.4% and 66% vs. 4.0%, respectively). In both sets, BNP was the strongest independent predictor by multivariate analysis. Among patients with severe asymptomatic organic mitral regurgitation, BNP > or =105 pg/ml discriminates a subgroup of patients at higher risk. Because of its incremental prognostic value, BNP assessment should be considered in clinical routine workup for risk stratification.
    Journal of the American College of Cardiology 09/2009; 54(12):1099-106. DOI:10.1016/j.jacc.2009.06.013 · 15.34 Impact Factor
  • Journal of Cardiac Failure 08/2009; 15(6):S103. DOI:10.1016/j.cardfail.2009.06.128 · 3.07 Impact Factor
  • 08/2007; 75(4):304-323.
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    ABSTRACT: To date, few studies have evaluated asymptomatic patients with organic mitral regurgitation (MR). The goal of the present study was to assess the presence of independent predictive factors for progression of symptoms and/or left ventricular dysfunction (SLVSD) in this population. We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% men; ejection fraction 66 +/- 3%) who were asymptomatic, with severe organic MR. Mean follow-up was 29 +/- 12 months. The combined end point was SLVSD. Clinical and echocardiographic variables were evaluated. Follow-up data were also estimated considering the annualized rate (?) of the echocardiographic indices. Thirty-seven patients (29%) had SLVSD during follow-up. Cox regression model identified the effective regurgitant orifice area (EROA) >55 mm2 (risk ratio 6.3, 95% CI 2.3-8.1, P < .001) and end-systolic diameter >22 mm/m2 (risk ratio 4.5, 95% CI, 1.8-9.4, P < .02) as the only independent predictors of SLVSD. When the follow-up data were added, the ?EROA (>15 mm2/y) was independently associated with the end point. In asymptomatic patients with organic MR, the EROA and the end-systolic diameter are independent predictors of SLVSD and allow a better risk stratification in this group of patients. ANALYTICAL SUMMARY: The goal of this study was to determine the presence of independent predictors of symptomatic progression, and/or left ventricular dysfunction in asymptomatic patients with severe mitral regurgitation. We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% male; ejection fraction 66 +/- 3%). During follow-up (mean 29 +/- 12 months). The end point occurred in 37 patients (29%). Multivariate analysis using Cox model identified the effective regurgitant orifice area (EROA) >55 mm2 (RR: 6.3; 95% CI: 2.3-8.1; P < .001) and an end-systolic diameter (ESD) >22 mm/m2 (RR: 4.5; 95%CI: 1.8-9.4; P < .02) as the only independent predictors of the end point. When the follow-up data were added, the annualized change rate of the EROA (>15 mm2/year) was independently associated with the end point. In asymptomatic patients with organic mitral regurgitation, the EROA and ESD at study entry were independent predictors of the combined end point and allowed a better risk stratification in this group of patients.
    American heart journal 11/2006; 152(5):1004.e1-8. DOI:10.1016/j.ahj.2006.01.015 · 4.56 Impact Factor
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    ABSTRACT: The objective of this study is to test the hypothesis that the absence of flow communication in aortic intramural hematoma (IMH) involving the descending aorta may have a different clinical course compared with aortic dissection (AD). We prospectively evaluated clinical and echocardiographic data in AD (76 patients) and IMH (27 patients) of the descending thoracic aorta. Patients did not differ with regard to age, gender, or clinical presentation. IMH and AD had the same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Surgical treatment was more frequently selected in AD (39% vs. 22%, P < 0.01) and AD patients who underwent surgical treatment had higher mortality than those with IMH (36% vs. 17%, P < 0.01). There was no difference in mortality with medical treatment (14% in AD vs. 19% in IMH, P = 0.7). During follow-up, of 23 patients with IMH, 11 (47%) showed complete resolution or regression, 6 (26%) increased the diameter of the descending aorta, and typical AD developed in 3 patients (13%). No changes occurred in 14% of the group. Three-year survival rate did not show significant differences between both groups (82 +/- 6% in IMH vs. 75 +/- 7% in AD, P = 0.37). IMH of the descending thoracic aorta has a relatively frequent rate of complications at follow-up, including dissection and aneurysm formation. Medical treatment with very frequent imaging and timed elective surgery in cases with complications allows a better patient management.
    Echocardiography 09/2005; 22(8):629-35. DOI:10.1111/j.1540-8175.2005.04012.x · 1.25 Impact Factor
  • European Heart Journal – Cardiovascular Imaging 07/2002; 3(2):166-7. · 2.65 Impact Factor
  • Journal of the American College of Cardiology 03/2002; 39:370-370. DOI:10.1016/S0735-1097(02)81663-1 · 15.34 Impact Factor
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    ABSTRACT: We assessed the 90-day prognostic value of stress tests and C-reactive protein (CRP) after medical stabilization of unstable angina. We included 139 consecutive patients with unstable angina who were free of complications or did not undergo revascularization during hospitalization. Blinded CRP assays and a stress test (95 exercise electrocardiograms, 44 dobutamine echocardiograms) were performed within the first week after discharge. Of 139 participants, 44 (31.6%) had an ischemic stress test response. CRP was elevated (> 1.5 mg/dl) in 40 patients (28.7%). CRP >1.5 mg/dl was more frequently observed among patients who experienced death or myocardial infarction at 90 days (88.2% vs 20.5%, p <0.0001). Compared with the stress tests, CRP showed greater sensitivity (88% vs 47%) and specificity (81% vs 70%) for increased risk, and higher positive (37.5% vs 18.2%) and negative (98% vs 90%) predictive values. The area under the receiver operating curve of the relation with the 90-day outcome increased from 0.58 +/- 0.07 to 0.83 +/- 0.05 when the CRP data were added to the stress tests results (p <0.001). Elevation of CRP differentiated stress tests negative patients with increased risk of major events during follow-up. In patients who respond to medical treatment for unstable angina, CRP elevation may be a better parameter than the stress test in identifying the presence of persistent plaque instability.
    The American Journal of Cardiology 06/2001; 87(11):1235-9. DOI:10.1016/S0002-9149(01)01511-9 · 3.43 Impact Factor
  • Circulation 11/2000; 102(22):e177-e177. DOI:10.1161/01.CIR.102.22.e177 · 14.95 Impact Factor