Rodolfo Pizarro

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

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Publications (38)124.17 Total impact

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    ABSTRACT: Background: Acute kidney injury (AKI) is a common complication after cardiac surgery (CS). Recently, neutrophil gelatinase-associated lipocalin (NGAL) was shown to predict AKI development earlier than serum creatinine, but it is not widely used in clinical practice. Fractional excretion of urea (FeU) has been referred to as a useful tool to discriminate between prerenal and established AKI. The aim of our study is to evaluate the sensitivity and specificity of FeU, in the early diagnosis of AKI in patients undergoing CS. Methods: We performed a prospective study on adults undergoing CS. AKI was defined by AKIN criteria. Individuals suffering from CKD, were excluded. Sensitivity and specificity of FeU, fractional excretion of sodium (FeNa) and urine NGAL, measured at 1, 6 and 24 h following CS, were assessed. Results: We included 66 patients (26% female) aging 68 ± 11 years. AKI prevalence was 24% and mortality was 3.28%. Patients with AKI had a significantly lower FeU compared to those without AKI (23.89 ± 0.67% vs. 34.22 ± 0.58%; p < 0.05) 6 h after CS, but not at the 1- and 24-h time points. NGAL was also statistically significant between both groups. FeU showed a 75% sensitivity and 79.5% specificity; the AUC was 0.786. ROC analysis of FeU and NGAL yielded similar values (p = NS). Conclusion: FeU is useful as an early biomarker to predict AKI after CS and it is comparable to the new biomarker NGAL.
    No preview · Article · Sep 2015 · Renal Failure

  • No preview · Article · Jul 2015 · Revista argentina de cardiología

  • No preview · Article · Oct 2014 · Revista argentina de cardiología

  • No preview · Article · Oct 2014 · Revista argentina de cardiología
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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.
    Full-text · Article · Apr 2014 · Archivos argentinos de pediatría

  • No preview · Article · Jan 2014 · Cardiology

  • No preview · Article · Jan 2014 · Cardiology
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    ABSTRACT: Introduction: Hypertrophic cardiomyopathy is the most frequent genetic cardiomyopathy and there is no available information on baseline characteristics and outcome of patients with this disease in our country.
    No preview · Article · Jan 2014 · Revista argentina de cardiología
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    ABSTRACT: MVSAC Life Member of the Argentine Society of Cardiology MTSAC Full Member of the Argentine Society of Cardiology To apply as Affiliated Member of the Argentine Society of Cardiology iVÁn constAntin , sAntiAgo l. Del cAstillo, tomÁs VitA, merceDes Del p. iAcino, JuAn m. VAlle rAleigH, roDolFo piZArro mtsAc , ricArDo g. mArencHino, norberto VulcAno mVsAc , HernAn J. gArcÍA riVello, césAr A. belZiti mtsAc ABSTRACT introduction: Etiologic diagnosis in patients with end-stage cardiomyopathy can be challenging. A large number of patients remain undi-agnosed despite a thorough evaluation, so they are classified as idiopathic dilated cardiomyopathies. objectives: To describe the etiology of cardiomyopathy in heart transplant recipients according to pretransplant clinical diagnosis and its degree of agreement with the anatomopathological diagnosis of the explanted heart. Methods: We performed a retrospective analysis of consecutively transplanted patients in a high complexity hospital of the Autonomous City of Buenos Aires from 2003 to the end of 2013. An agreement analysis between pretransplantation clinical diagnosis and anatomo-pathological diagnosis of the explanted heart was done using the kappa coefficient. results: One-hundred patients with mean age of 49.7 ± 12.5 years at the time of transplantation and median ejection fraction of 26.6% were analyzed. The most common pretransplant clinical diagnosis was idiopathic dilated cardiomyopathy (37%), followed by ischemic-necrotic cardiomyopathy (32%) and Chagas cardiomyopathy (10%). The most common histopathological diagnoses were ischemic-necrotic cardiomyopathy (35%), hypertrophic cardiomyopathy (10%), Chagas cardiomyopathy (10%) and myocarditis (8%); a causal diagnosis was not reached in 25% of cases (idiopathic dilated cardiomyopathy). The kappa coefficient was 0.64 (CI 0.52 -0.76). Conclusions: Approximately one third of patients reach transplantation without an etiologic diagnosis. Anatomopathological analysis al-lows identifying the cause in more than half of these patients. Although the correlation between pretransplant diagnosis and pathological anatomy was statistically adequate, a significant percentage of patients could benefit from a more specific etiologic diagnosis, which may have prognostic, therapeutic and/or family assessment implications.
    No preview · Article · Jan 2014 · Revista argentina de cardiología
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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.
    No preview · Article · Apr 2013 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    Full-text · Article · Dec 2012
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    ABSTRACT: Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD). In patients with acute kidney injury (AKI), this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained. Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments, nor were patients treated with extended therapies. Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that, compared with Kt/V, this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals. The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients, and to evaluate what factors determine this gap using Kt values assessed through ionic dialisance. Data from 394 sessions of renal replacement therapy in 105 adult haemodialysis (HD) patients with oliguric acute kidney injury and admitted to ICU were included in this analysis. RRT was carried out with Fresenius 4008E dialysis machines equipped with on-line clearance monitoring (OCM® Fresenius), which use non-invasive techniques to monitor the effective ionic dialysance, equivalent to urea clearance. The baseline characteristics of the study population as well as the prescription and outcome of RRT were analysed. These variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose (TD). The main baseline characteristics of the study population/treatments were: age 66 ± 15 years, 37% female, most frequent cause of AKI: sepsis (70%). Low BP and/or vasoactive drug requirement (71%), mechanical ventilation (70%) and average individual severity index: 0.7 ± 0.26. Two hundred and one intermittent HD (IHD) and 193 extended HD (EHD) sessions were performed; the most frequently used temporary vascular access was the femoral vein catheter (79%). Prescribed Kt was 53.5 ± 14L and 21% of prescriptions fell below the TD. Sixty-one percent of treatments did not fulfill the TD (31 ± 8L) compared with 56 ± 12L obtained in the subgroup that achieved the target. Compared to IHD, EHD provided a significantly larger Kt (46 ± 16L vs 33L ± 9L). Univariate analysis showed that inadequate compliance was associated with age (>65y), male gender, intra-dialytic hypotension, low Qb, catheter line reversal, and IHD. The same variables with the exception of age and gender were independently associated in the multivariate analysis. The dialysis dose obtained was significantly lower than that prescribed. EHD achieved values closer to the prescribed KT and significantly higher than in IHD. Ionic Kt measurement facilitates monitoring and allows HD treatments to be extended based upon a previously established TD. Besides the chosen strategy to dispense the dose of dialysis, a well-functioning vascular access allowing for optimal blood flow and other approaches aimed at avoiding hemodynamic instability during RRT are the most important factors to achieve TD, mainly in elderly male patients. The dialysis dose should be prescribed and monitored for all critically ill AKI patients.
    Full-text · Article · Apr 2012 · Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
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    ABSTRACT: Background: Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD). In patients with acute kidney injury (AKI), this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained. Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments, nor were patients treated with extended therapies. Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that, compared with Kt/V, this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals. The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients, and to evaluate what factors determine this gap using Kt values assessed through ionic dialisance. Material and Method: Data from 394 sessions of renal replacement therapy in 105 adult haemodialysis (HD) patients with oliguric acute kidney injury and admitted to ICU were included in this analysis. RRT was carried out with Fresenius 4008E dialysis machines equipped with on-line clearance monitoring (OCM® Fresenius), which use non-invasive techniques to monitor the effective ionic dialysance, equivalent to urea clearance. The baseline characteristics of the study population as well as the prescription and outcome of RRT were analysed. These variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose (TD). Results: The main baseline characteristics of the study population/treatments were: age 66±15 years, 37% female, most frequent cause of AKI: sepsis (70%). Low BP and/or vasoactive drug requirement (71%), mechanical ventilation (70%) and average individual severity index: 0.7±0.26. Two hundred and one intermittent HD (IHD) and 193 extended HD (EHD) sessions were performed; the most frequently used temporary vascular access was the femoral vein catheter (79%). Prescribed Kt was 53.5±14L and 21% of prescriptions fell below the TD. Sixty-one percent of treatments did not fulfill the TD (31±8L) compared with 56±12L obtained in the subgroup that achieved the target. Compared to IHD, EHD provided a significantly larger Kt (46±16L vs 33L±9L). Univariate analysis showed that inadequate compliance was associated with age (>65y), male gender, intra-dialytic hypotension, low Qb, catheter line reversal, and IHD. The same variables with the exception of age and gender were independently associated in the multivariate analysis. Conclusions: The dialysis dose obtained was significantly lower than that prescribed. EHD achieved values closer to the prescribed KT and significantly higher than in IHD. Ionic Kt measurement facilitates monitoring and allows HD treatments to be extended based upon a previously established TD. Besides the chosen strategy to dispense the dose of dialysis, a well-functioning vascular access allowing for optimal blood flow and other approaches aimed at avoiding hemodynamic instability during RRT are the most important factors to achieve TD, mainly in elderly male patients. The dialysis dose should be prescribed and monitored for all critically ill AKI patients.
    Full-text · Article · Dec 2011 · Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
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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.
    Full-text · Article · Oct 2011 · Journal of the American College of Cardiology
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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.
    Full-text · Article · Oct 2011
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    Full-text · Article · Sep 2011 · Circulation
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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.
    Full-text · Article · Sep 2011 · Educacion Medica
  • Rodolfo Pizarro

    No preview · Article · Aug 2011
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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.
    No preview · Article · Aug 2011
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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.
    Full-text · Article · Feb 2011