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Garcia Bras P, Mano T, Rito T, Castelo A, Ferreira V, Teixeira B, Teixeira R, Jacinto S, Agapito A, Ferreira R, Sousa L. Non-vitamin K antagonist oral anticoagulants in adult congenital heart disease: a single-center study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Adults with congenital heart disease (ACHD) are at an increased risk for thromboembolic events and atrial arrhythmias are common in this population. Non-vitamin K anatagonist oral anticoagulants (NOACs) prescription is increasing, however data on efficacy and safety in ACHD is unclear, particularly in patients (P) with complex CHD. The aim of the study was to review the use of NOACs in various types of ACHD and assess its safety and efficacy.
Methods
Evaluation of consecutive ACHD P started on NOAC therapy from 2014 to 2020. P were followed-up for bleeding or thromboembolic events and mortality. CHA2DS2-VASc and HASBLED scores were calculated and risk factors for bleeding were identified.
Results
93 ACHD P were included, mean age 52±15 years, 58% female, 44% with complex CHD (3.2% with Fontan circulation), with diagnosis of: 22.2% atrial septal defect, 20% tetralogy of Fallot, 11.1% transposition of the great arteries, 10% Ebstein's anomaly, 8.9% ventricular septal defect, 7.8% pulmonary stenosis, 5.6% ductus arteriosus, 4.4% AV septal defect, 3.4% univentricular heart, 3.4% coarctation of aorta, 2.2% supra-aortic stenosis and 1% with Uhl disease.
Most P were anticoagulated with rivaroxaban (43%), followed by edoxaban (24%), apixaban (20%), and dabigatran (13%). The indications for anticoagulation were: atrial arrhythmias (81%), pulmonary embolism (PE) (6.3%), atrial thrombi (4.3%), thromboprophylaxis in Fontan circulation (3.2%), deep vein thrombosis (3.2%) and stroke (2%). 66% of P had a CHA2DS2-VASc score ≥2 and 82% HASBLED score ≤2.
In a mean follow-up of 41±21 months (400.4 patient-years), there were embolic events in 2P (1 splenic infarction and 1 PE) albeit both were in the context of oral anticoagulation interruption. The cardiovascular mortality was 2% and allcause mortality 5%, however with no relation to thrombosis or bleeding events.
6 P (6.5%) suffered a minor and 3 P (3.2%) suffered a major bleeding, a median time of 12 (IQR 15) months after starting NOAC therapy. The annual risk for bleeding was 2.2%/patient/year. P with bleeding events showed no significant difference regarding age (55±16 vs 52±15 years, p=0.587), gender (13% female vs 5.1% male, p=0.295) or CHD type (p=0.582). 8.6% of P required dose reduction, mostly for bleeding (3.2%) or renal impairment (2.2%).
Renal disease was a strong risk factor for major bleeding (HR 14.6 [95% CI 1.23–73.6], p=0.033 and multivariate analysis showed that an increased HASBLED score was an independent predictor of minor (adjusted HR 3.44 [95% CI 1.13–10.52], p=0.030) and major (adjusted HR 5.29 [95% CI 1.14–24.45], p=0.033) bleeding complications.
Conclusion
Anticoagulation with NOACs is a safe and effective option for selected ACHD P, although bleeding complications were not negligible, particularly in P with renal disease. Larger scale research studies are required, especially regarding complex CHD such as P with Fontan circulation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Jacinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Viegas J, Bras P, Rito T, Agapito A, Pinto F, Cruz Ferreira R, De Sousa L. Trends in mortality of adult congenital heart disease patients in the last 4 decades. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Medical, surgical, and technological advances over the past decades increased the life expectancy of congenital heart disease (CHD) patients (pts), with >90% reaching adulthood. Nonetheless, mortality for adults with CHD (ACHD) is still higher than for the general population.
Purpose
To analyse trends in mortality and causes of death of ACHD.
Methods
Retrospective analysis of pts followed in an ACHD outpatient clinic, in one tertiary center, who died between 1980 and December 2020. Data relating to the cardiac diagnosis, symptoms, interventions, comorbidities, and causes of death were analysed.
Results
During a median follow-up of 8.9 years (IQR 2.2–17), 251 pts of 3725 (6.7%) died during the study period: 127 males (51%), mean age at death 44.9±18.1 years, 54% with severe CHD. The majority of these death was CHD-related (171 pts – 68.1%) with no statistically significant differences over the years vs non-cardiovascular death (Table 1). However, a paradigm shift was noticed: in the first years the main cardiac cause was sudden-death that was replaced by heart failure in the last decade. Also, the mean age at death increased over the years (33±14.9 years until 2000 vs 52.3±17 years after the year 2010, p<0.001) as the number of implantable devices (4 vs 20, p=0.05).
Conclusion
Causes of death of ACHD patients are in the majority still CHD-related. However, in the last decade, according to the increase in life expectancy, heart failure became the leading cause of death.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Ferreira V, Moreira RI, Teixeira B, Agapito A, Rito T, Pinto F, Cruz Ferreira R, De Sousa L. Fetal and maternal outcomes in patients with tetralogy of Fallot. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Women with tetralogy of Fallot (TOF) have an increased risk of adverse cardiac and neonatal events during pregnancy. The aim was to assess fetal and maternal outcomes in patients (pts) with uncorrected and corrected TOF.
Methods
Retrospective analysis of cardiological and obstetric data in women with TOF followed at our institution. Pregnancy and neonatal outcomes were compared in patients (pts) submitted to corrective surgery vs pts with no previous intervention and in pts with or without cyanosis.
Results
51 women (median age 27 years; median number of previous interventions of 2), 22% with cyanosis, who experienced 126 pregnancies resulting in 73 live births A previous corrective surgery was found in 78% (40 pts), while 4% (2 pts) had previous palliative surgery and 18% (9 pts) no previous procedure. We found that women that were not submitted to previous intervention had a significant higher incidence of preterm birth (56% vs 17.5%, p=0.029), spontaneous abortion (56% vs 10%, p=0.006) and stillbirth (22% vs 0%). No difference was found for obstetric complications between groups. Cyanotic pts also demonstrated higher incidence of low birth weight (LBW) (36% vs 7.5%, p=0.031), preterm birth (54% vs 17.5%, p=0.021), spontaneous abortion (55% vs 10%, p=0.004) and stillbirth (18% vs 0%). There were no cardiac complications during pregnancy nor evident deterioration on cardiac status. Congenital heart disease was reported in 2 infants (3% of live births).
Conclusions
Pregnancy is well tolerated in pts with TOF. In our population, even in uncorrected TOF and in pts with cyanosis, there were no cardiac complications during pregnancy, although those pts had worse fetal outcomes. An explanation for the low incidence of cardiac events may be less severe forms of the disease, allowing survival into adulthood without intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Branco Mano T, Rito T, Ilhao Moreira R, Agapito A, Pinto F, Sousa L. Pregnancy outcomes in women with severe congenital heart disease – a specialized centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Progress in pediatric cardiology and cardiac surgery has dramatically raised the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy (P) in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding P and neonatal outcomes in women with SC-CHD.
Methods
Retrospective analysis of obstetric data in women with CHD followed at our institution. P and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity CHD (MMC-CHD), according to ESC guidelines CHD complexity classification.
Results
The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD pts was cyanotic tetralogy of Fallot (19.0%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedure (13.8%) – Figure 1.
Pts with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p<0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p<0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD P (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1st trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis.
Conclusion
Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Severe CHD
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Garcia Bras P, Sousa L, Mano T, Monteiro A, Rito T, Ilhao Moreira R, Rio P, Silva S, Martins C, Coito S, Capile E, Agapito A, Ferreira R. Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction and purpose
The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.
Methods
A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.
Results
Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.
Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025).
VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR.
Conclusion
Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.
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Affiliation(s)
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Monteiro
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Silva
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Martins
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Coito
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Capile
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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6
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Dias Ferreira Reis JP, Branco L, Nogueira M, Morais L, Sousa L, Galrinho A, Agapito A, Ferreira R. Right atrial strain by speckle-tracking echocardiography as a prognostic predictor in a pulmonary hypertension cohort. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Right atrial (RA) strain is as a promising technique for assessment of RA function and several studies have suggested it is a powerful prognostic marker in pulmonary hypertension (PH) patients (pts). Our aim was to assess the prognostic power of RA strain in Pulmonary Arterial Hypertension (PAH) and Chronic Thromboembolic Pulmonary Hypertension (CTEPH) pts.
Methods
Pts with PH were prospectively studied and several clinical/demographic/echocardiographic were retrieved as well as data from six-minute walk test (6MWT) and brain natriuretic peptide (BNP). Correlation between RA strain and other variables was tested with Pearson"s correlation analysis. Regression and survival analysis were performed to assess the combined endpoint of all-cause mortality or hospitalization in the first follow-up year (MH1).
Results
A total of 51 PH pts (mean age 54 ± 46 years, 33.3% male, baseline BNP of 342.4 ± 439.9pg/mL and baseline pulmonary artery systolic pressure – PASP - of 78 ± 26mmHg), of which 64.7% had PAH and 35.3% presented CTEPH. 19 ots (37.3%) met the primary endpoint. The mean RA strain was -21.9 ± -4.9%, with no significant difference between groups (-23.4% vs -17.8%, p = 0.150), however male pts had a significantly lower RA strain (-15.9% vs -25.1%, p = 0.014). There was a statistically significant (p < 0.05) correlation between RA strain and age (r = -0.287), indexed RA area (r = -0.539), index RA volume (r = -0.522) and right ventricular strain (r = -0.453). There was no correlation between RA strain and BNP value (p = 0.150), 6MWT distance (p = 0.145) or PASP (p = 0.072). RA strain was a predictor of MH1 (OR = 0.94, 95% CI: 0.894-0.998, p = 0.048). Pts who met the primary endpoint had a significantly worse RA strain (-17.0 vs -24.6%, p = 0.032). Those with a RA strain worse than -19% presented a significantly lower survival free of events during the first follow-up year (log rank p = 0.022).
Conclusion
RA strain is a powerful predictor of adverse events in a PH population and should be systematically assessed in order to improve risk stratification.
Abstract Figure.
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Affiliation(s)
| | - L Branco
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L Morais
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Almeida Morais L, Sousa L, Fiarresga A, Martins J, Timoteo A, Viveiros Monteiro A, Loureiro P, Soares C, Castelo A, Garcia Bras P, Reis J, Pinto F, Agapito A, Cruz Ferreira R. New onset atrial fibrillation after percutaneous Patent Foramen Ovale closure: how serious is this problem? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous Patent Foramen Ovale (pPFO) closure benefits for secondary prevention after cardio-embolic stroke have recently been proved. With the increasing number of cases and procedures, a concern with new onset atrial fibrillation (NOAF) has been raised.
Purpose
To evaluate long-term outcome regarding NOAF rate and to identify its predictors and clinical impact, in a real population submitted to pPFO closure.
Methods
From 2000 to 2017, consecutive patients (P) submitted to pPFO closure in a tertiary centre were prospectively enrolled. The primary endpoint was NOAF rate and secondary endpoints were all-cause, neurologic and cardiac mortality rates and recurrent ischemic events. Previous and follow-up electrocardiographic, echocardiographic and 24-hour heart rhythm monitoring data were analysed. Follow-up was performed through medical visits, medical charts consultation and a phone call based system, in order to assess clinical status, on-going treatment and events.
Results
496 patients were submitted to pPFO. Immediate success was achieved in 98.8% and 9.1% presented a residual shunt on the 1st year TEE. Mean age was 45.0±11.2 years-old with 50.2% of males. The prevalence of hypertension, hypercholesterolemia and atrial septum aneurysm (ASA) was 25.7%, 45.0% and 46.3%, respectively. Pre-procedural mean left atrial (LA) diameter was 36.0±5.3 mm. FU data was available for 490 (98.6%), for a mean FU time of 7.41±3.51 years. 34 P (6.9%) presented ischemic events recurrence (26 strokes and 8 TIA). The primary endpoint was observed in 21 P (4.3%) during the FU period.
Median time to 1st AF episode since PFO closure was 5.90±5.53 years. 11 P (52.3%) initiated oral anticoagulation. In univariate analysis, age (44.6±11.3 vs 51.8±6.0 years, p=0.005) and hypertension (24.7% vs 47.6%, p=0.019) were predictors of NOAF in this population. In multivariated analysis, only age remained a predictor of NOAF (OR 1.05 (1.007–1.101), p=0.025). LA pre pPFO closure dimensions, ASA, device type or size and the presence of residual shunt in TEE were not determinants of AF occurrence. The incidence of NOAF was associated with the need for hospitalization due to cardiac causes (19% vs 3.2%, p=0.001) and a trend towards higher rate of recurrent stroke (4.9% vs 14.3%, p=0.06).
Conclusion
Despite being a highly successful and safe procedure in most patients, pPFO closure was associated with a non-negligenciable rate of NOAF during long-term follow-up. NOAF predictors were related with classical cardiovascular risk factors, such as age and hypertension. None of the procedure or device features were associated with NOAF. Yet, a clinical impact was attributed to NOAF, with more hospitalizations and a trend towards ischemic events recurrence.
As young patients submitted to pPFO closure grow older, prevention strategies to diagnose and treat NOAF should be endeavoured.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | | | - P Loureiro
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
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Branco Mano T, Moura Branco L, Aguiar Rosa S, Agapito A, Timoteo AT, Galrinho A, Rio P, Leal A, Gameiro F, Coutinho Cruz M, Ferreira Reis J, Cruz Ferreira R. P747 Echocardiographic evaluation of haemoglobinopathies patients and their correlation with haematologic determinants. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although heart disease in haemoglobinopathy have dramatically reduced with modern therapy, cardiac complications are still a leading cause of morbimortality. It became essential to detect cardiac complications in early stages in order to provide specific therapy and to improve prognosis. Transthoracic echocardiography (TTE) has a paramount role in this field.
Purpose
To evaluate cardiac function in haemoglobinopathy patients and to correlate echocardiographic parameters with haematological determinants.
Methods
Retrospective analysis of haemoglobinopathy patients (pts) referred to a tertiary centre for cardiac evaluation and transthoracic echocardiography. Epidemiological, clinical, laboratory and echocardiographic data were analysed. Comparations between echocardiographic data and haemoglobin and serum ferritin levels were performed (independent T test). P value <0.05 was considered statistically significant.
Results
55 pts were included: 58% female, mean age 37.9 ± 10.9 years, 85% with sickle cell disease, 13% (N = 7) with previous thromboembolic event and 20% (N = 11) with documented hemosiderosis. 36% (N = 20) were symptomatic (9 pts with palpitations, 6 pts with thoracic pain and 5 pts with exertion dyspnea – New York Heart Association class II). The mean haemoglobin level was 8.96 ± 1.91 g/dL and serum ferritin 1335.5 ± 2452 ng/mL. All patients had preserved left and right ventricular systolic function (TAPSE 27.1 ± 4.9mm) The mean left ventricular (LV) end-diastolic diameter indexed to body surface area (female 32.2 ± 4.7mm/m2; male: 31.2 ± 4.0mm/m2) and LV mass index (female 105.6 ± 31.4g/m2; male: 134.7 ± 97.3g/m2) were increased in both genders, although interventricular septum thickness was in the superior normal range (mean 9.3 ± 1.6mm). Left atrium enlargement was also present (29.9 ± 8.4mm/m2). The mean global ratio between early mitral inflow velocity and mean (septal and lateral) mitral annular early diastolic velocity (E/e") was 7.5 ±2.3, and 12 pts (21.8%) had impairment of LV diastolic function. Global longitudinal strain (GLS) was assessed in 35 pts, with a mean value of 19.6 ± 2.9%. 40% (14 pts) had GLS > -18%, being the septal wall the most frequently affected. Pulmonary hypertension was rare (3 pts), with mean arterial pulmonary pressure of 27.7 ± 7.0mmHg. An agreement was found between serum ferritin levels and GLS impairment defined as GLS > -18% (2649ng/ml vs 549ng/ml, p = 0.04). Pts with diastolic dysfunction had a trend to higher serum ferritin levels (2753ng/ml vs 1001ng/ml, p = 0.06). The haemoglobin levels did not correlate with echocardiographic parameters.
Conclusion
In the study population of haemoglobinopathy pts, mainly constituted by cardiac asymptomatic individuals, LV diastolic dysfunction and LV global longitudinal strain were impaired in 22% and 40%, respectively. These echocardiographic parameters revealed to be related to serum ferritin levels.
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Affiliation(s)
| | | | | | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Leal
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Gameiro
- Hospital de Santa Marta, Lisbon, Portugal
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9
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Timoteo AT, Moura Branco L, Galrinho A, Ilhao Moreira R, Sousa L, Agapito A, Cruz Ferreira R. P1774 Myocardial work indices in adult patients with repaired aortic coartation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial strain analysis is a tool that allows a more precise assessment of cardiac performance. However, strain is relatively load dependent. New tools have been developed, with afterload adjustment. It was our objective to assess myocardial work (MW) in patients with repaired aortic coartation (ACo).
Methods
Study of consecutive adult patients with corrected ACo submitted to a routine transthoracic echocardiogram in 2018 at our centre. Patients with an aortic valve prosthesis, more than mild aortic stenosis / regurgitation, with pacemakers, with other non-corrected congenital heart diseases (with the exception of bicuspid aortic valve) were excluded from the analysis. A semi-automated strain analysis was performed with speckle tracking technology and both global longitudinal strain (GLS) and MW were estimated using GE software™. Blood pressure was simultaneously measured in the patient’s right arm. We specifically assessed: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE)
Results
Twenty patients were included in the study, mean age of 36 ± 9 years, 30% males. Mean body surface area was 1.7. In this group of patients, 40% were hypertensives and in 55% there was a concomitant bicuspid aortic valve. Mean maximum aortic valve gradient was 11 mmHg and mean descending aortic gradient was 19 mmHg. Compared to recently published reference values for a normal population, repaired ACo patients had lower values of MW (Table). In multivariate linear regression analysis, independent predictors of GWI are systolic blood pressure (β=0.441) and let atrial volume indexed (LAVI) (β=0.507). For GCW, male gender (β=-0.605), LAVI (β=0.530) and diastolic blood pressure (β=-0.742). For GWE, the only predictor was LAVI (β=0.498) and no predictor was identified for GWW. The presence of bicuspid aortic valve, aortic valve gradient and descending aortic gradient did not have any influence in MW parameters, although higher aortic valve gradients were excluded from this study.
Conclusion
Adult patients with repaired ACo, present lower MW indices and the main determinant for that difference are LAVI and blood pressure. GWW is the most independent parameter.
Results Variable Reference population n = 226 Patients with repaired ACo n = 20 p-value GWI (mmHg%) 1896 ± 308 1782 ± 389 <0.001 GCW (mmHg%) 2232 ± 331 2154 ± 390 <0.001 GWW (mmHg%) 78 (53-122) 76 (56-197) <0.001 GWE (mmHg%) 96 (94-97) 95 (91-97) <0.001
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Affiliation(s)
- A T Timoteo
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - A Galrinho
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - L Sousa
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - A Agapito
- Hospital Santa Marta, CHLC, Lisbon, Portugal
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Coutinho Cruz M, Viveiros-Monteiro A, Portugal G, Delgado AS, Lousinha A, Valente B, Silva-Cunha P, Sousa L, Oliveira JA, Agapito A, Cruz-Ferreira R, Martins-Oliveira M. P771Very long-term follow-up of patients with congenital heart disease and an implantable cardioverter-defibrillator. Europace 2018. [DOI: 10.1093/europace/euy015.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Coutinho Cruz
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | | | - G Portugal
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - A S Delgado
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - A Lousinha
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - B Valente
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - P Silva-Cunha
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - J A Oliveira
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
| | - R Cruz-Ferreira
- Hospital de Santa Marta, Serviço de Cardiologia, Lisbon, Portugal
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Mas-Stachurska A, Slieker MG, Rosner A, Bonello B, Cieplucha A, Almeida Morais L, Morillas Climent H, Nogueira MA, Guasch E, Sitges M, Batlle M, Meirelles T, Castillo N, Rudenick P, Bijnens B, Egea G, Meza JM, Mccrindle BW, Karamlou T, Tchervenkov CI, Jacobs ML, Decampli WM, Burch PT, Mertens L, Khalapyan T, Dalen H, Mc Elhinney D, Chen S, Haeffele C, Fernandes S, Bijnens B, Friedberg M, Lui GK, Carr M, Iriart X, Ciliberti P, Christov G, Sullivan I, Derrick G, Kostolny M, Tsang V, Bull C, Giardini A, Marek J, Trojnarska O, Pyda M, Kociemba A, Lanocha M, Barczynski M, Kramer L, Grajek S, Abreu A, Agapito A, De Sousa L, Oliveira JA, Viveiros Monteiro A, Modas Daniel P, Antonio M, Jalles Tavares N, Cruz-Ferreira R, Osa Saez A, Cano Perez O, Domingo Valero D, Igual Munoz B, Martinez-Dolz L, Serrano Martinez F, Montero Argudo A, Plaza Lopez D, Rueda Soriano J, Branco LM, Timoteo AT, Oliveira M, Agapito A, Portugal G, Sousa L, Oliveira JA, Cruz Ferreira R. Rapid Fire Abstract: Congenital heart disease470Impact of training on aortic and cardiac remodelling in a murine model of Marfan syndrome: an echocardiographic study471Pre-intervention morphologic and functional echocardiographic characteristics of 651 neonates with critical left ventricular outflow tract obstruction472Ventricular geometry and function in adult patients with Fontan surgery473Long term functional and myocardial assessment of patients with critical aortic valve stenosis474Late gadolinium enhancement and exercise capacity in adults with Ebstein's anomaly475Exercise echocardiography value in the evaluation of operated aortic coarctation patients476Functional evolution of the right ventricle after pulmonary valve replacement due to significant regurgitation. Implications in the surgical moment decision477Independent predictors of arrhythmias in adult patients with surgically corrected tetralogy of fallot: role of two-dimensional and speckle-tracking echocardiography. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tojino AL, Laymouna R, Monteiro A, Velcea A, Almeida Morais L, Enzan N, Wang TL, Kemaloglu Oz TUĞBA, Mursa A, Pfeiffer B, Tomaszewski M, Cuddy S, Giubertoni A, Rojo Prieto N, Ruivo C, Saito M, Dorobantu DM, Kemal HS, Sta Maria HF, Tiongco RP, Elsharkawy E, Morsy Y, Elshafei M, Elgowelly M, Almaghraby A, Branco L, Agapito A, Sousa L, Galrinho A, Pinto F, Rio P, Rosa S, Portugal G, Ferreira R, Mihaila S, Patrascu N, Adronic A, Cinteza M, Vinereanu D, Fiarresga A, Cacela D, Sousa L, Galrinho A, Branco L, Rodrigues R, Banazol N, Ferreira L, Ferreira R, Tsutsumi T, Matsumoto T, Uchida T, Yamada A, Hsiung MC, Eren MEHMET, Zarma L, Popescu BA, Ginghina C, Jurcut R, Neugebauer A, Rigopoulos A, Seggewiss H, Czekajska-Chehab E, Pietura R, Tomaszewski A, Sullivan V, Cosgrave J, Daly C, Murphy R, Zanaboni J, Gravellone M, Piccinino C, Marino PN, Lezcano Pertejo C, Hernandez Diez C, Alvarez Roy L, Martinez Paz E, Ascencio Lemus MG, Lopez Benito M, Fernandez-Vazquez F, Martin Gutierrez E, Castano Ruiz M, Guardado J, Santos L, Montenegro Sa F, Saraiva F, Correia J, Morais J, Mahara K, Ueda T, Ishii T, Hamamichi Y, Katsuragi S, Enache R, Platon P, Vladaia A, Popescu BA, Ginghina CD, Gunsel A, Cerit L, Duygu HS. Clinical Case Poster session 2P608Infective endocarditis in an adult female with bicuspid aortic valve, hypertrophic cardiomyopathy and amyopathic dermatomyositisP609Left ventricular massP610A rare case of mitral stenosis - Shones syndromeP611The added value of three-dimensional echocardiography in the late diagnosis of a pacemaker complication in a patient with severe congestive heart failureP612Percutaneous paravalvular leak closure - procedure pitfallsP613A case of late left ventricular pseudoaneurysm after aortic valve replacement for infective endocarditis.P614Pseudoaneurysm of right ventricle and acute heart failure caused by prosthetic aortic valve endocarditisP615A misclassification of pulmonary stenosis severity during pregnancyP616A problematic case of left ventricular hypertrophyP617High variability of dynamic obstruction in a patient with hypertrophic obstructive cardiomyopathy and tako-tsubo-cardiomyopathyP618Arterio-venous pulmonary fistula in patient after cerebral strokeP619Rapid myocardial calcification in acute sepsisP620Acute right heart failure after delivery in patient with new-diagnosed pulmonary arterial hypertensionP621When the right ventricle plays hide-and-seekP622Adult congenital heart disease: when what grows wrong goes wrongP623Prenatal diagnosis of mixed type total anomalous pulmonary venous connection in aspleniaP624Uncorrected single ventricle in an adult patient: do coexisting valvular abnormalities matter?P625Ventricular septal aneurysm associated with bicuspid aorta: a case report. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ilhao Moreira R, Cambronero Cortinas E, Giannakopoulos G, Wong CY, Maria Joao Vieira MJV, Neves Pestana G, Andjelkovic K, Pavon AG, Nunes A, Portero Portaz JJ, Stefan C, Namitokov A, Chivulescu M, Wojtkowska A, Gomes AC, Jurko T, Cazzoli I, Valente F, Moura Branco L, Coutinho Cruz M, Pinto Teixeira P, Almeida Morais L, Viveiros Monteiro A, Oliveira M, Ramos R, Agapito A, Cruz Ferreira R, Racugno P, Escribano D, Mendez J, Paya A, Bonanad C, Valle Munoz A, Corbi Pascual MJ, Chorro FJ, Bodi V, Mueller H, Catia Costa CC, Beatriz Saldanha Santos BSS, Kevin Domingues KD, Nuno Craveiro NC, Maria Luz Pitta MLP, Miguel Alves MA, Margarida Leal ML, Bernardo-Almeida P, Sousa C, Tavares-Silva M, Almeida R, Lima R, Amorim MJ, Almeida J, Macedo F, Maciel MJ, Kalimanovska Ostric D, Boricic Kostic M, Petrovic O, Petrovic M, Vujisic Tesic B, Mikic A, Kalangos A, Marini C, Rosa I, Stella S, Ancona F, Spartera M, Margonato A, Colombo A, Agricola E, Nascimento H, Maia Araujo P, Ferreira A, Pinho T, Andre Rodrigues R, Bernardo Almeida P, Campelo M, Dias P, Julia Maciel M, Tercero Martinez A, Corbi Pascual MJ, Prieto Mateos D, Urraca Espejel C, Calero Nunez S, Fuentes Manso R, Gallego Page JC, Garcia Lopez JC, Barambio Ruiz MJ, Iancovici S, Ianovici E, Zamfir D, Dorobantu M, Kizhvatova N, Kolodina M, Skaletsky K, Soroka N, Mayngart S, Kosmacheva E, Barbukhatti K, Porhanov V, Jurcut C, Enache R, Popescu BA, Ginghina C, Spirito P, Jurcut R, Tomaszewski A, Czekajska-Chehab E, Tomaszewski M, Stettner D, Wysokinski A, Fazendas P, Carvalho J, Ferreira F, Sousa L, Fiarresga A, Martins JD, Pereira H, Jurko A, Krsiakova J, Jurko AJR, Matasova K, Zibolen M, Babu-Narayan S, Senior R, Gatzoulis MA, Li W, Maldonado G, Cuellar H, Marti G, Roque A, Teixido G, Gonzalez-Alujas MT, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares JF. Clinical Case Poster session 4P1046An unexpected findingP1047Coronary artery ectasia in the setting of subacute Inferior STEMIP1048Diagnosis through the back door: the utility of the subscapular acoustic windowP1049A challenging case of paravalvular leakage closureP1050A life-threatning asymptomatic incidental findingP1051Acute heart failure due to intermittent aortic prosthesis regurgitation - case reportP1052Role of echocardiography in a patient with sequels after surgical treatment of infective endocarditis on a bicuspid aortic valveP1053MitraClip to treat systolic anterior motion-induced outflow tract obstruction in hypertrophic obstructive cardiomyopathyP1054Acute heart failure by parvovirus B19P1055Multimodality assessment of myocardial involvement in female carriers of the Duchenne diseaseP1056Cardiovascular complications in hypereosinophilic syndrom-a case reportP1057Giant false left ventricle aneurysm in the myocardial infarction outcomeP1058From syncope to the diagnosis of systemic disease: the importance of a high index of suspicionP1059A total anomalous pulmonary venous return in 60-year-old patientP1060Atrial septal defect occluder fracture - diagnostic challenge in asymptomatic patientP1061Marfan syndrome in two newborn infantsP1062Isolated pulmonary valve regurgitation as a cause of severe right heart dilatation in an adult patientP1063Multimodality imaging - how to find the missing leak. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mandes LA, Sedky Y, Aguiar Rosa S, Militaru C, Kalcik M, Cuddy S, Ciudin R, Platon P, Gurzun M, Mateescu AD, Lacau S, Ginghina C, Coman I, Popescu BA, Romeih S, Simary W, Van Doorn C, Agapito A, Antonio M, Branco L, Sousa L, Oliveira JA, Laranjo S, Martins S, Jalles Tavares N, Cruz Ferreira R, Popara A, Beyer R, Gurzun MM, Zarma L, Popescu BA, Ginghina C, Jurcut R, Dogan T, Yetim M, Bekar L, Karaarslan O, Celik O, Cicek M, Camkiran V, Karavelioglu Y, Kolcow W, Da Costa M, Mylotte D, Smyth Y. Clinical Cases: Congenital heart disease800Late diagnosis of double chambered right ventricle in an adult: diagnostic pitfalls and the role of multimodality imaging801Anomalous origin of left pulmonary artery from ascending aorta: an unusual cause of cardiac failure802An uncommon cause of right ventricular failure803Staged severe evolution and treatment dilemmas in a patient with Marfan syndrome804A rare presentation of coarctation of the aorta: transient ischemic attack due to thrombus formation in the coarcted segment which was treated with oral anticogulation805Penetrating cardiac trauma resulting in a ventricular septal defect, a flail mitral valve leaflet and a right middle cerebral artery infarct, with percutaneous closure of the ventricular septal defect. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stella S, Li H, Stathogiannis K, Stojkovic S, Ondrus T, Plaza Lopez D, Jinno S, Verseckaite R, Oliveira Da Silva C, Altin C, Krestjyaninov MV, Izci S, Santos M, Urbano-Moral JA, Spartera M, Gonzalvez-Garcia A, Miskowiec D, Hagrass MUHAMMAD, Rady M, Reskovic Luksic V, Castaldi B, Silva T, Silva T, Silva T, Kolossvary M, Basuoni A, Miskowiec D, Peovska Mitevska I, Aguiar Rosa S, Rosa I, Marini C, Ancona F, Spagnolo P, Latib A, Romano V, Colombo A, Margonato A, Agricola E, Yuan L, Xie MX, Jin XY, Toutouzas K, Drakopoulou M, Latsios G, Synetos A, Sanidas E, Kaitozis O, Trantalis G, Gerckens U, Tousoulis D, Tesic M, Stojkovic S, Stepanovic J, Trifunovic D, Beleslin B, Giga V, Nedeljkovic I, Djordjevic Dikic A, Bartunek J, Vanderheyden M, Stockman B, Mirica C, Kotrc M, Van Praet F, Van Camp G, Penicka M, Igual Munoz B, Sanchez Lacuesta ME, Lopez Vilella R, Domenech Tort MD, Sepulveda Sanchis P, Ten Morro F, Calvillo Batlles P, Montero Argudo JA, Martinez Dolz LV, Yamada A, Sugimoto K, Ito S, Kato M, Inuzuka H, Sugiyama H, Takada K, Ozaki Y, Ishii J, Mizariene V, Gaileviciute K, Bieseviciene M, Jonkaitiene R, Jurkevicius R, Gunyeli E, Winter R, Back M, Settergren M, Manouras A, Shahgaldi K, Ozsoy HM, Gezmis E, Yilmaz M, Tunc E, Sade LE, Muderrisoglu H, Gimaev RH, Melnikova MA, Olezov NV, Ruzov VI, Dogan C, Acar R, Cetin G, Bakal RB, Unkun T, Cap M, Erdogan E, Kaymaz C, Ozdemir N, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Gutierrez-Garcia-Moreno L, Rodriguez-Palomares JF, Galuppo V, Maldonado-Herrera G, Teixido-Tura G, Gruosso D, Gonzalez-Alujas T, Evangelista-Massip A, Stella S, Rosa I, Ancona F, Marini C, Latib A, Giannini F, Colombo A, Margonato A, Agricola E, Urbano-Moral JA, Matabuena-Gomez-Limon J, Grande-Trillo A, Rojas-Bermudez C, Rodriguez-Puras MJ, Martinez-Martinez A, Lopez-Pardo F, Lopez-Haldon JE, Kupczynska K, Kasprzak JD, Lipiec P, Abdelrahman Sharaf El Dein AHMED, Shawky El Serafy AHMED, Rajan RAJESH, Sveric K, Kvakan H, Strasser RH, Cekovic S, Veceric S, Separovic Hanzevacki J, Romanato S, Callegari A, Bernardinello V, Reffo E, Milanesi O, Agapito A, Sousa L, Oliveira JA, Branco LM, Timoteo AT, Galrinho A, Thomas B, Tavares NJ, Cruz Ferreira R, Agapito A, Sousa L, Oliveira JA, Branco LM, Timoteo AT, Galrinho A, Thomas B, Tavares NJ, Cruz Ferreira R, Agapito A, Sousa L, Oliveira JA, Soares R, Aguiar Rosa SA, Morais L, Thomas B, Tavares NJ, Cruz Ferreira R, Szilveszter B, Elzomor H, Karolyi M, Raaijmakers R, Benke K, Celeng C, Bagyura Z, Merkely B, Maurovich-Horvat P, Shaheen S, Abdelkader M, Rasheed T, Kasprzak JD, Lipiec P, Srbinovska E, Pop Gorceva D, Zdravkovska M, Galrinho A, Moura Branco L, Timoteo AT, Agapito A, Sousa L, Oliveira JA, Rodrigues I, Viveiros Monteiro A, Cruz Ferreira R. HIT Poster session 3Transcatheter procedures (TAVI/MitralClip)P937Comparison between 3d transesophageal echocardiography and multislice computed tomography for the aortic annulus sizing in tavi patients: implication for prosthesis sizingP938Left ventricular remodelling in chronic mitral regurgitation: from geometry to mechanics by speckle tracing imageP939Direct TAVI of a self-expanding bioprosthesis: long-term clinical outcomes.P940Prognostic value of coronary flow reserve in the culprit artery following previous myocardial infarctionP941Both MitraClip and heartport surgery prevent progressive left ventricular remodeling in very severe systolic heart failureP942Predictors for the development of microvascular obstruction in patients with acute myocardial infarction treated with primary percutaneous coronary intervention.P943Usefulness of exercise stress echocardiography in asymptomatic or mildly symptomatic patients with chronic degenerative mitral regurgitationP944Left ventricular myocardial deformation changes after aortic valve repair and replacement for aortic regurgitationP945Transcatheter aortic valve implantation: a view of the right side.P946Assessment of epicardial fat thickness and carotid intima media thickness in preeclemsiaP947Gender differences in the remodelling of left and right chambers of the heart in patients with uncontrolled hypertensionP948The five-year course of the left ventricular conventional and advanced echocardiographic parameters in patients with anterior and inferior myocardial infarction revascularized by percutaneouslyP949Aortic regurgitation and 2D derived-speckle tracking left ventricle global longitudinal strain: a connection with symptoms beyond ejection fractionP950Hypertrophic cardiomyopathy: structural abnormalities beyond hypertrophy from a prospective echocardiographic evaluationP952Echocardiographic findings of thrombosis vs endocarditis in tavi patients: a single centre experienceP953Prospective examination of the prevalence and significance of causal mechanisms of low gradient aortic valve stenosisP954Echocardiographic assessment of regional left atrial longitudinal strain by tissue Doppler and speckle tracking method - a comparison studyP955Pattern of atherosclerosis in extracranial and intracranial vessles in non diabetic, non stroke patient with atherosclerotic CADP9563D volume time curves of the left ventricle and exercise capacity testing in patients with dilated cardiomyopathy- old parameters revisedP957Left ventricular longitudinal function in hypertensive patients with septal bulgeP958Integrated imaging to evaluate cardiac performance in Fontan patientsP959The value of right ventricular global longitudinal strain in the evaluation of adult patients with repaired tetralogy of FallotP960Accurate transthoracic echocardiography parameters for the evaluation of adult patients with repaired tetralogy of Fallot: validation with cardiac magnetic resonance imagingP961Cardiac magnetic resonance imaging and cardiopulmonary exercise testing in the functional evaluation of adult patients with repaired tetralogy of FallotP962Model based iterative reconstruction techniques cause modest change in calcium scoresP963Assesment of diastolic heart function by using multi detector computed tomography ( MDCT) in comparison with tissue dopplerP964Bicuspid aortic valve morphology and its impact on aortic diameter - a meta-analysisP965Prognostic value of moderate and severe myocardial ischemia in patients with suspected coronary artery disease and normal coronary angiogramsP966Predictors of aortic dilation in patients with bicuspid aortic valve. 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Timoteo AT, Moura Branco L, Ramos R, Aguiar Rosa S, Agapito A, Sousa L, Oliveira J, Leal A, Cruz Ferreira R, Kutty S, Li L, Danford D, Houle H, Xiao Y, Pedrizzetti G, Porter T, Leren IS, Hasselberg N, Saberniak J, Haland T, Kongsgard E, Smiseth O, Edvardsen T, Haugaa K, Ben Moussa N, Cinteza E, Giugno L, Butera G, Piazza L, Micheletti A, Saracino A, Negura DG, Carminati M, Chessa M, Kubik M, Dabrowska-Kugacka A, Lewicka E, Danilowicz-Szymanowicz L, Szalewska D, Kutniewska-Kubik M, Raczak G, Enache R, Mateescu A, Nastase O, Popescu B, Ginghina C, Karsenty C, Hadeed K, Hascoet S, Amadieu R, Dulac Y, Acar P, Ammirati A, Palmieri R, Silvetti M, Drago F. Oral Abstract session: Advanced echo techniques - New eyes on congenital heart disease: Thursday 4 December 2014, 08:30-10:00 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Coelho P, Banazol N, Sousa L, Agapito A, Fragata J. [Takayasu's cardiac disease]. Rev Port Cir Cardiotorac Vasc 2005; 12:127. [PMID: 16077887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- P Coelho
- Serviço de Cirurgia Cardiotorácica, Hospital de St Marta, Lisboa
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Cavaco BM, Domingues R, Bacelar MC, Cardoso H, Barros L, Gomes L, Ruas MMA, Agapito A, Garrão A, Pannett AAJ, Silva JL, Sobrinho LG, Thakker RV, Leite V. Mutational analysis of Portuguese families with multiple endocrine neoplasia type 1 reveals large germline deletions. Clin Endocrinol (Oxf) 2002; 56:465-73. [PMID: 11966739 DOI: 10.1046/j.1365-2265.2002.01505.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the spectrum of MEN1 mutations in Portuguese kindreds, and identify mutation-carriers. PATIENTS, DESIGN AND RESULTS Six unrelated MEN1 families were studied for MEN1 gene mutations by single-strand conformational polymorphism (SSCP) and DNA sequence analysis of the coding region and exon-intron boundaries of the MEN1 gene. These methods identified 4 different heterozygous mutations in four families: two mutations are novel (mt 1539 delG and mt 655 ims 11 bp) and two have been previously observed (mt 735 del 46p and mt 1656 del C) all resulting in a premature stop codon. In the remaining two families, in whom no mutations or abnormal MEN1 transcripts were detected, segregation studies of the 5' intragenic marker D11S4946 and codon 418 polymorphism in exon 9 revealed two large germline deletions of the MEN1 gene. Southern blot and tumour loss of heterozygosity analysis confirmed and refined the limits of these deletions, which spanned the MEN1 gene at least from: exon 7 to the 3' untranslated region, in one family, and the 5' polymorphic site D11S4946 to exon 9 (obliterating the initiation codon), in the other family. Twenty-six mutant-gene carriers were identified, 6 of which were asymptomatic. CONCLUSIONS These results emphasize the importance of the detection of MEN1 germline deletions in patients who do not have mutations of the coding region. Important clues indicating the presence of such deletions may be obtained by segregation studies using the intragenic polymorphisms D11S4946 and at codon 418. The detection of these mutations will help in the genetic counselling of clinical management of the MEN1 families in Portugal.
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Affiliation(s)
- B M Cavaco
- Centro de Investigação de Patobiologia Molecular e Serviço de Endocrinologia, Instituto Português de Oncologia de Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisbon, Portugal
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Pinto FF, Sousa L, Abreu J, Agapito A, Quininha J, Kaku S, Antunes AM. Percutaneous occlusion of patent foramen ovale in patients with paradoxical embolism. Rev Port Cardiol 2001; 20:747-57; discussion 759-62. [PMID: 11582625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
INTRODUCTION A patent foramen ovale can be found in about one quarter of adults and in a small percentage it is a wide opening and may be associated with aneurysmal formation. The association between a wide patent foramen ovale and paradoxical embolism is well established. In such cases percutaneous closure is indicated, as an alternative to life-long anticoagulant therapy or surgery. Percutaneous closure is an attractive technique and is more advantageous than other methods. METHODOLOGY We describe the first cases of percutaneous occlusion of patent foramen ovale performed in Portugal, using the Amplatzer PFO occluder, in three female patients with documented cerebrovascular accidents due to paradoxical embolism. We also analyze the rationale for using this technique in such patients and its preliminary results. RESULTS All three patients submitted to percutaneous occlusion of patent foramen ovale had a similar history of ischemic cerebrovascular accident. Transesophageal echocardiography showed a wide-open foramen ovale ranging from 9 to 12 mm, with spontaneous right-to-left shunt in all patients, and one of them also had an aneurysmal formation. Total procedure time ranged from 30 to 55 minutes and fluoroscopic time from 9 to 12 minutes. There were no complications and during the short follow up all patients are asymptomatic and free of recurrent events. CONCLUSIONS Percutaneous closure of patent foramen ovale is a safe and promising technique in the prevention of recurrent systemic thromboembolism in appropriately selected patients. Prospective studies comparing antithrombotic therapy or surgery with percutaneous closure should clarify its efficacy and therapeutic value.
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Affiliation(s)
- F F Pinto
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Lisboa
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Cogan JD, Wu W, Phillips JA, Arnhold IJ, Agapito A, Fofanova OV, Osorio MG, Bircan I, Moreno A, Mendonca BB. The PROP1 2-base pair deletion is a common cause of combined pituitary hormone deficiency. J Clin Endocrinol Metab 1998; 83:3346-9. [PMID: 9745452 DOI: 10.1210/jcem.83.9.5142] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Combined pituitary hormone deficiency (CPHD) has an incidence of approximately 1 in 8000 births. Although the proportion of familial CPHD cases is unknown, about 10% have an affected first degree relative. We have recently reported three mutations in the PROP1 gene that cause CPHD in human subjects. We report here the frequency of one of these mutations, a 301-302delAG deletion in exon 2 of PROP1, in 10 independently ascertained CPHD kindreds and 21 sporadic cases of CPHD from 8 different countries. Our results show that 55% (11 of 20) of PROP1 alleles have the 301-302delAG deletion in familial CPHD cases. Interestingly, although only 12% (5 of 42) of the PROP1 alleles of our 21 sporadic cases were 301-302delAG, the frequency of this allele (in 20 of 21 of the sporadic subjects given TRH stimulation tests) was 50% (3 of 6) and 0% (0 of 34) in the CPHD cases with pituitary and hypothalamic defects, respectively. Using whole genome radiation hybrid analysis, we localized the PROP1 gene to the distal end of chromosome 5q and identified a tightly linked polymorphic marker, D5S408, which can be used in segregation studies. Analysis of this marker in affected subjects with the 301-302delAG deletion suggests that rather than being inherited from a common founder, the 301-302delAG may be a recurring mutation.
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Affiliation(s)
- J D Cogan
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2578, USA
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Martins S, Branco L, Abreu J, Luz Pitta M, Agapito A, Cotrim C, Sousa L, Soares RM, Salomão S, Antunes AM. [Aneurysms of the interauricular septum diagnosed with transesophageal echocardiography: relationship with cerebrovascular events]. Rev Port Cardiol 1998; 17:191-5. [PMID: 9587217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- S Martins
- Serviço de Cardiologia, Hospital de Santa Marta, Lisboa
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Galrinho A, Branco L, Pitta ML, Agapito A, Cotrim C, Cacela D, Oliveira M, Antunes AM. [Mitral prosthesis dysfunction--report of 3 clinical cases with unusual ultrasonography features]. Rev Port Cardiol 1996; 15:731-6, 696. [PMID: 9115767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Prosthetic valve obstruction is one of the most serious complications of mechanical cardiac valves. Clinicians must be aware of this diagnosis in patients with a worsening of functional NYHA class. Over the past years, echocardiography has imposed itself as the method of choice to diagnose and evaluate patients with suspected prosthetic valve obstruction. We present three clinical reports of prosthetic valve malfunction that have unusual echocardiographic features.
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Affiliation(s)
- A Galrinho
- Serviço de Cardiologia do Hospital de Santa Marta, Lisboa
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Sérgio MR, Godinho C, Guerra L, Agapito A, Fonseca F, Costa C. [TSH anti-receptor antibodies in Graves' disease]. ACTA MEDICA PORT 1996; 9:229-31. [PMID: 9005701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the sensitivity, specificity and predictive value of thyrotropin receptor antibody (TRAb) in the diagnosis of Graves disease. TRAb was tested by an isotopic receptor assay-TRAK Henning-in 80 newly diagnosed, untreated Graves disease patients (group I), 63 with other thyroid diseases (group II) and 60 controls (group III). In group I, 11 patients were TRAb negative and 7 were considered in the gray area (TRAb between 9 and 14 U/L). In group II, only 2 patients had TRAb 9 U/l and all controls were TRAb negative. For statistical analysis patients with TRAb in gray area were excluded. Sensitivity and specificity for this assay were 84.5 and 100% respectively. Predictive value of 100% affords certainty that a hyperthyroid patient with a positive TRAb has Graves disease, not sequining a scintigram.
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Affiliation(s)
- M R Sérgio
- Laboratório Endocrinologia, Serviço Patologia Clínica, Unidade Endocrinologia do Hospital Curry Cabral, Lisboa
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Pereira H, Cotrim I, Abreu A, Pitta ML, Oliveira JA, Branco L, Agapito A, Gonçalves JM, Antunes AM. [Heart failure due to a postlaminectomy arteriovenous fistula]. Rev Port Cardiol 1995; 14:579-82. [PMID: 7669334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The authors report a case of congestive heart failure as a consequence of traumatic postlumbar laminectomy arteriovenous fistula. A 49 years old female with the diagnosis of atrial septal defect was admitted at the hospital, complaining of dyspnea and peripheral edema. A hemodynamic study was performed and an arteriovenous fistula was detected between the iliac artery and vein, and arterial septal defect was excluded. Surgery for fistula closure was performed with great clinical improvement.
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Affiliation(s)
- H Pereira
- Serviço de Cardiologia, Hospital de Santa Marta
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Oliveira M, Agapito A, Rosário L, Galrinho A, da Silva N, Prates A, Antunes AM. [Holt-Oram syndrome. Review and report of 2 familial cases]. Rev Port Cardiol 1994; 13:929-32, 893. [PMID: 7873223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In 1960 Holt and Oram reported a family in which upper extremity malformations were associated with a secundum atrial septal defect. Since then, more than 200 cases have been reported with a wide spectrum of phenotypes. The authors present the cases of one mother and daughter with Holt-Oram Syndrome (SHO).
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Affiliation(s)
- M Oliveira
- Serviço de Cardiologia, Hospital de Santa Marta, Lisboa
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Branco L, Agapito A, Ramos JM, Patrício L, Monteiro I, Galrinho A, Ferreira R, Quininha J, Gonçalves JM, Atunes AM. [Coronary fistula --clinical and angiographic review]. Rev Port Cardiol 1994; 13:243-52, 193-4. [PMID: 8049092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate clinical and angiography date of patients (pts) in whom coronary arteriovenous fistula were detected. STUDY DESIGN Retrospective study of diagnostic coronary angiographies done between 1988 and 1993 in whom coronary arteriovenous fistula were detected. SETTING Patients submitted to cardiac catheterisation in the Cardiology Department of Santa Marta Hospital in whom coronary arteriovenous were detected. PATIENTS Fourteen pts, 10 male and 4 female, with a mean age of 49 years (21-72). INTERVENTIONS A retrospective analysis of clinical data and coronary artery anomalies was done. Whenever available, the Pulmonary Artery and the shunt (calculated through oximetries) were evaluated. RESULTS The following pathologies were associated: rheumatic valve heart disease (3 pts), Tetralogy of Fallot (2 pts), atrial septal defect--ostium primum (1 pt), dilated cardiomyopathy (1 pt), hypertrophic cardiomyopathy (1 pt), atherosclerotic coronary artery disease (2 pts). Four pts were in atrial fibrillation and the others in sinus rhythm. Four pts had normal ECG. In 6 pts there was cardiomegaly on the chest X-rays. The fistula was single in 11 pts, double in one and multiple in 2 other pts. The fistula originated from the right coronary artery in 6 pts, the left anterior descending coronary artery in 5 pts, the circumflex coronary artery in 3 pts and the left main coronary artery in one pt. Eight drained to the pulmonary artery (or its branches), 2 to the coronary sinus, one directly to the right atrium, one to the right ventricle and one to the left atrium. In only 2 pts the fistula was closed. In 6 pts the associated anomalies were corrected. With a mean follow up of 24 months (1-72), 8 pts are asymptomatic, 4 complain of slight heart failure, 3 of angina pectoris and the pt with dilated cardiomyopathy died 1 year after being studied. CONCLUSION A male predominance was found. Most fistulae were single. The artery mostly involved was the right coronary artery and the fistula drained more often to the pulmonary artery or its branches.
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Affiliation(s)
- L Branco
- Serviço de Cardiologia, Hospital de Santa Marta
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Pereira H, Branco L, Abreu A, Patrício L, Valério L, Nunes H, Agapito A, Quininha J, Gonçalves JM, Salomão S. [The pulsed Doppler evaluation of patients with dilated cardiopathy]. Rev Port Cardiol 1993; 12:521-5, 507-8. [PMID: 8333989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate, by 2D-Doppler echocardiography, the patterns of left ventricular filling in groups of patients with left ventricular systolic disfunction and different pulmonary wedge pressures. STUDY DESIGN perspective study of different indexes of left ventricular diastolic filling measured by Doppler echocardiography and compare them with a normal group. SETTING Patients studied in the Cardiology Department of the Santa Marta Hospital with a diagnosis of dilated cardiopathy and submitted to cardiac catheterisation. PATIENTS Twenty-four patients, aged 39 years old, submitted to hemodynamic study (group A) and nineteen subjects, aged 34 years old (group B). Pulmonary capillary wedge pressure (PWP) was determined in group A and the patients were divided in two groups: group A1 (with PWP < 16 mmHg) and group A2 (with PWP > or = 16 mmHg). INTERVENTIONS Every patient was submitted to cardiac catheterisation. The echocardiographic study showed global decrease of left ventricular systolic function. With pulsated Doppler left ventricular diastolic flow indexes were determined. The following parameters were studied: peak protodiastolic flow velocity (Vel E), peak telediastolic flow velocity (Vel A), E/A ratio, protodiastolic acceleration time (O-E) and diastolic flow time (O-C). MEASUREMENTS AND RESULTS There were no statistical differences between group A as a whole and group B. However in group A1, with a lower PWP there was a decrease of E flow velocity in relation to the control group (54.6 cm/sec +/- 14 vs 66.4 cm/seg +/- 12.8 p < 0.05) or to the group A2 (75.3 cm/sec +/- 29.9 p < 0.05). In the group A1 there was an increase of the flow velocity A in relation to group B (56.1 cm/sec +/- 15.9 vs 36.4 cm/sec +/- 7.3 p < 0.05) and to the group A2 (56.1 cm/sec +/- 15.5 vs 28.2 +/- 9.1 p < 0.05). The relation E/A in group A1 was deceased in relation to group B (1.0 +/- 0.4 m vs 1.8 +/- 0.6 p < 0.05) and in group A2 its increased in relation to B (2.6 +/- 0.9 vs 1.8 +/- 0.6 p < 0.05). The E-D time was increased in group A1 in relation to group B (162.1 +/- 8.7 cm/sec vs 140.5 +/- 42.0 cm/sec p < 0.05) and slightly reduced in group A2 (134.5 +/- 78 msec vs 140.5 +/- 42.0 msec NS). All the patients with mitral regurgitation belonged to group A2. There was only statistical difference in the velocity between the patients in group A with and without mitral regurgitation (29.6 +/- 17.4 cm/sec vs 26.4 +/- 8.5 cm/sec p < 0.05). CONCLUSIONS In spite of some limitations, Doppler echocardiography is useful in the evaluation of left ventricular filling of patients with dilated cardiomyopathy. It shows different patterns that vary according to the hemodynamic states of the patient.
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Affiliation(s)
- H Pereira
- Hospital de Santa Marta, Serviço de Cardiologia, Lisboa
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Pereira H, Branco L, Agapito A, Quininha J, Gonçalves JM, Velho V, Roquette J, Antunes AM, Rato JA, Bento R. [Successful operation of aortic abscess ruptured into left atrium. Diagnostic importance of color coded Doppler echocardiography]. Rev Port Cardiol 1993; 12:249-53. [PMID: 8512717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Myocardial abscesses are a serious complication of infectious endocarditis. A 60 years old male patient with subaortic ring abscess is reported. A fistula developed between the left ventricular outflow tract and the left atrium. Doppler echocardiography was of outmost importance for diagnosis. Surgery was successfully performed.
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Affiliation(s)
- H Pereira
- Servico de Cardiologia Hospital de Santa Marta, Lisboa
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30
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Fonseca F, Cortez L, Guerra L, Afonso A, Agapito A, Malheiro F, da Costa C. [Myxedema coma]. ACTA MEDICA PORT 1992; 5:613-5. [PMID: 1293958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Five patients, 4 female and 1 male, aged 45 to 73, were observed in myxedema coma between 1984 and 1992. In three patients hypothyroidism was not known. Depressed consciousness, hypothermia, bradycardia and no goiter were common to all and a precipitating factor could be identified in 3 of them. Therapy included L-thyroxine and/or triiodothyronine by nasogastric tube, hydrocortisone and supportive measures. Outcome was good in the 2 patients with known precipitating event, less impaired consciousness and normalization of body temperature by the third day of treatment.
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Affiliation(s)
- F Fonseca
- Unidade de Endocrinologia, H. Curry Cabral, Lisboa
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31
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Bento L, Fok S, Abreu A, Agapito A, Pinto L, Ferreira F. [Persistent ductus arteriosus in the adult--report of a case]. Rev Port Cardiol 1992; 11:987-91. [PMID: 1290645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The authors describe a case of congenital heart disease no longer frequent in adults, due to an early diagnosis and surgical treatment. The patent ductus arteriosus in adults who received no therapy can present several forms of evolution, depending on its own hemodynamic profile. The present case is an example of a congenital heart disease not diagnosed during the childhood, that developed pulmonary hypertension and congestive heart failure. These clinical situations have a bad prognosis and place this patient in a group of high surgical risk. Thus, surgery is not advisable considering the bad prognosis and early high mortality rate.
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Affiliation(s)
- L Bento
- Serviço de Medicina I, Hospital Distrital de Setúbal
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32
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Valério L, Catarino C, Nunes H, Agapito A, Ramos S, da Cruz G. [Pulmonary stenosis in adults. Report of a clinical case]. Rev Port Cardiol 1992; 11:255-9. [PMID: 1610611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The authors report a case of valvular pulmonary stenosis in a 60 years old patient, admitted to hospital with heart failure and angor pectoris. Four years previously a VVI pacemaker had been implanted for complete heart block. At the time of the admission he had two pacemakers leads in the right ventricle; one of them was retained and functionless since the changing of the generator which occurred 1 year before. The usual complications of endocardial pacemakers are discussed, as well as the natural course and surgery indications for valvular pulmonary stenosis in adults.
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Affiliation(s)
- L Valério
- Serviço de Cardiologia, Hospital de Santa Marta, Lisboa
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33
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Agapito A, Guerra L, Afonso A, Fonseca F, Malheiro F, da Costa C. [Hyperthyroidism caused by non-neoplastic inappropriate TSH secretion]. ACTA MEDICA PORT 1992; 5:104-6. [PMID: 1595367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a case of hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion in a 31 year old woman. Increased T3 and THS levels after thyroidectomy led us to suspect the diagnose. Serum levels were further increased by TRH and only partially suppressed by triiodothyronine and computerised axial tomography showed a normal sellar region. These features are characteristic of inappropriate TSH secretion due to thyrotroph resistance to thyroid hormones. Bromocriptine and octreotide were ineffective in lowering TSH levels. Pregnancy and breastfeeding postponed 3,5,3'-triiodothyroacetic acid therapy.
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Affiliation(s)
- A Agapito
- Unidade de Endocrinologia, Hospital Curry Cabral, Lisboa
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34
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Catarino C, de Oliveira M, Quininha J, Ramos JM, Antunes E, Oliveira JA, Agapito A, Salomão S. [Value of two-dimensional echocardiography in the prognosis of patients after acute myocardial infarction]. Rev Port Cardiol 1991; 10:743-7. [PMID: 1781992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the prognostic importance of two-dimensional echocardiography in patients (pts) with acute myocardial infarction. SETTING Department of Cardiology in a Central Hospital. METHODS In 71 pts (63 men and 8 women) aged 35 to 75 years interned with a proved myocardial infarction, a score of left ventricular segmental wall motion was used on echocardiographic examination performed during the late hospital phase, to evaluate left ventricular function. Two groups of pts were considered: group A constituted by 38 pts with complication detected during follow-up that ranged 4 to 18 months; group B by 33 pts with no cardiac events for the same period. The relation of the wall motion score with each group and the location of myocardial infarction was performed. RESULTS In group A, the mean score index was 1.67 in pts with angina, 1.08 in pts with heart failure and 0.82 in pts who died. The mean score index was 1.25, 1.57 and 1.18 respectively in pts with an anterior, inferior and antero-inferior infarction. In group B, the mean score index was 1.70 in pts with an anterior infarction, 1.85 in those with an inferior infarction and 1.33 in the patient with an antero-inferior infarction. Patients with a non-Q wave infarction had a mean score index of 2. The mean score index was significantly different between group A and B (respectively 1.33 vs 1.79; p less than 0.00001) and a mean score index of 1.53 was considered the mean risk value. CONCLUSIONS Two-dimensional echocardiography performed during hospital predischarge permits risk stratification after acute myocardial infarction, specially for death and heart failure.
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Affiliation(s)
- C Catarino
- Serviço de Cardiologia, Hospital de Santa Marta - Hospitais Civis de Lisboa
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35
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Vargas M, Abreu A, Agapito A, Mata Antunes A. [Exudative enteropathy in heart insufficiency--apropos of 3 clinical cases]. Rev Port Cardiol 1990; 9:145-51. [PMID: 2346665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Severe hypoproteinaemia due to increased intestinal protein losses, known as exudative enteropathy, was seen in three patients (two with rheumatic valvular heart disease and one with congenital heart disease). The authors review the relationship between serum proteins and cardiac disease, describing the diagnostic methods and the prognosis. From a clinical point of view, protein-losing enteropathy should be suspected in patients with right heart failure and severe hypoalbuminaemia. Recognition of this syndrome is important because the treatment of the cardiac lesion may reduce or remove this rare complication.
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Affiliation(s)
- M Vargas
- Hospitais Civis de Lisboa Hospital de Santa Marta, Serviço de Cardiologia
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