Browsing by Autor "Daniel Villarreal"

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Ataque cerebrovascular recurrente por fibrilación auricular: perspectivas sobre un problema no resuelto
(Elsevier BV, 2023) Karen Sánchez-Acosta; Lizbeth Galeano; Daniel Villarreal; Angie Montoya; Hernán Bayona
Antecedentes: La tasa de recurrencia en ataque cerebrovascular (ACV) cardioembólico podría ser del 10% en el primer año e incrementar con el tiempo. Existe escasa evidencia del mejor enfoque terapéutico en pacientes anticoagulados que presentan un ACV. Objetivos: Explorar la relación entre el tipo de anticoagulante y el desenlace de ACV isquémico, ataque isquémico transitorio (AIT) o embolia no sistémica en pacientes anticoagulados que presentan ACV recurrente relacionado con fibrilación auricular. Materiales y método: Estudio de corte transversal en el que se incluyeron pacientes atendidos en la unidad ACV entre el 2014 al 2019 por ACV relacionado con fibrilación auricular. Se consideraron solamente pacientes con historia clínica posterior al ACV índice, se categorizaron en recurrentes/no recurrentes y fueron comparados según factores sociodemográficos, comorbilidades y anticoagulante oral usado; el grupo recurrente fue caracterizado en gravedad, dosis y niveles de anticoagulación plasmática. Resultados: Se incluyeron 60 pacientes, 17 de los cuales fueron recurrentes y 43 no recurrentes. De los pacientes recurrentes, 82.2% fueron ACV, 17.6% fueron AIT y embolia no sistémica con una mediana de tiempo en recurrencia de 398 días. No se encontró relación entre el tipo de anticoagulación y los desenlaces de interés, aunque se halló una prevalencia considerable de subdosificación y niveles de anticoagulante subterapéuticos. Conclusión: No es posible determinar una relación entre el tipo de anticoagulante y la recurrencia. Se identificó la presencia de posibles factores explicativos; sin embargo, el estudio y rol de estos factores en la aparición del evento van más allá del objetivo y alcance de esta investigación, por lo que debe dilucidarse en futuros estudios.
Echocardiographic Characteristics and Non-Dipping Blood Pressure Profile: Is There an Association?
(2024) Daniel Villarreal; Federico Ramos; Daniel Gasca; Camilo C. Roa; Mariangela Cardone; Carolina Ayala; Camilo Alvarado
Abstract Background The circadian rhythm of blood pressure is a fundamental aspect of cardiovascular physiology in healthy individuals. Beyond nocturnal hypertension, a blunted or impaired BP circadian variation is linked to heightened target organ damage and elevated cardiovascular disease risk. This includes alterations in cardiac structure and function, atherosclerotic cardiovascular disease, dementia and heart failure. Methods A retrospective cohort study involving 1600 participants enrolled between 2021 and 2023 identified 847 as dippers and 753 as non-dippers based on 24-hour ambulatory blood pressure monitoring. Echocardiographic evaluations were performed to assess cardiac structure and function. Results Non-dipping individuals displayed more signs of adverse cardiac remodeling, including a higher rate of eccentric hypertrophy (1.73 vs. 0.47%), increased left ventricular mass index in both men (75.82 vs. 70.10 g/m 2 ) and women (65.44 vs. 63.92 g/m 2 ), left ventricular internal diameter in diastole (4.38 vs. 4.23 cm), and left ventricular posterior wall thickness (0.82 vs. 0.81 cm). Additionally, non-dipping participants exhibited impaired ventricular relaxation, with higher E/e’ ratios medially (9.45 vs. 8.86) and laterally (7.61 vs. 7.23) and rates of type 1 diastolic dysfunction (9.31 vs. 4.49%). These differences persisted when analysing only participants with hypertension. Conclusions Our study highlights the substantial impact of non-dipping blood pressure patterns on cardiac structure and function. It suggests that non-dipping blood pressure patterns may serve as an independent predictor of adverse cardiac remodelling, irrespective of hypertension diagnosis. These results underscore the necessity of devising monitoring strategies and implementing targeted interventions to address the cardiovascular risks associated with non-dipping BP profile. Graphical abstract
Recurrent stroke due to atrial fibrillation: perspectives on an unsolved problem
(2023) Karen Sánchez-Acosta; Lizbeth Galeano; Daniel Villarreal; Angie Montoya; Hernán Bayona
Introduction:The cardioembolic stroke recurrence rate could be up to 10% in the first year and increase over time.Evidence is lacking concerning the best therapeutic approach in patients with recurrent stroke while on anticoagulation.Objective: To explore the relationship between the type of anticoagulant and the composite outcome of ischemic stroke, transient ischemic attack (TIA) or systemic embolism in anticoagulated patients with a recurrent atrial fibrillation-related stroke. Materials and method:A cross-sectional study involving patients who were treated in the stroke unit from 2014-2019 for atrial fibrillation-related stroke.Patients with clinical records after the index stroke were considered.They were classified as recurrent/non-recurrent and were compared in terms of sociodemographic factors, comorbidities and the oral anticoagulant used.The recurrent group was characterized according to severity, dosing and plasma anticoagulation levels.Results: 60 patients were included (17 with recurrence and 43 without recurrence); in the patients with recurrence, 82.3% of the events were strokes, 17.6% were TIAs, and there were no systemic emboli, with a median recurrence time of 398 days.No relationship was found between the type of anticoagulation and the pre-specified outcomes, although a considerable prevalence of underdosing and subtherapeutic blood anticoagulant levels was found.Conclusion: No relationship can be established between the type of anticoagulant and recurrence.Possible explanatory factors were identified; however, the study of these factors and their role in the occurrence of the event is beyond the aim and scope of the present study and should be elucidated in future studies.
Upper airway bleeding after rt-PA use in stroke management: a case report
(Elsevier BV, 2023) Eder Moreno-Vargas; M. Ortiz-Pereira; Victor Sierra; Daniel Villarreal; Mônica Elinor Alves Gama; Javier Ospina; Hernán Bayona