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Marinho AV, Ferreira MJ, Silva R, Elvas L, Gonçalves L. The culprit was inside myocardium. J Nucl Cardiol 2021; 28:1785-1787. [PMID: 32350766 DOI: 10.1007/s12350-020-02060-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ana Vera Marinho
- Cardiology Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Maria João Ferreira
- Cardiology Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Rodolfo Silva
- Nuclear Medicine Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Cardiology Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitario de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
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2
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Domingues C, Ferreira MJV, Ferreira JM, Marinho AV, Alves PM, Ferreira C, Fonseca I, Gonçalves L. Prognostic Value of Isolated Elevated Troponin I Levels in Patients without Acute Coronary Syndrome Admitted to the Emergency Department. Arq Bras Cardiol 2021; 116:928-937. [PMID: 34008817 PMCID: PMC8121477 DOI: 10.36660/abc.20190356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
Fundamento: Embora a elevação não isquêmica da troponina seja frequentemente observada em pacientes admitidos no pronto-socorro (PS), não há consenso quanto ao seu manejo. Objetivos: Este estudo teve como objetivo caracterizar os pacientes admitidos no PS com elevação da troponina não-isquêmica e identificar potenciais preditores de mortalidade nessa população. Métodos: Este estudo observacional retrospectivo incluiu pacientes do PS com resultado positivo no teste da troponina entre junho e julho de 2015. Pacientes com diagnóstico clínico de síndrome coronariana aguda (SCA) foram excluídos. Os dados demográficos dos pacientes e as variáveis clínicas e laboratoriais foram extraídos dos prontuários médicos. Os dados do seguimento foram obtidos por 16 meses ou até a ocorrência de morte. O nível de significância estatística foi de 5%. Resultados: A elevação da troponina sem SCA foi encontrada em 153 pacientes no PS. A mediana (IIQ) de idade dos pacientes foi de 78 (19) anos, 80 (52,3%) eram do sexo feminino e 59 (38,6%) morreram durante o seguimento. A mediana do período de seguimento (IIQ) foi de 477 (316) dias. Os sobreviventes eram significativamente mais jovens 76 (24) vs. 84 (13) anos; p=0,004) e apresentaram uma maior proporção de elevação da troponina isolada (sem elevação da creatina quinase ou mioglobina) em duas avaliações consecutivas: 48 (53,9%) vs. 8 (17,4%), p<0,001. Os sobreviventes também apresentaram menor taxa de tratamento antiplaquetário e internação no mesmo dia. Na regressão logística multivariada com ajuste para variáveis significativas na análise univariada, a elevação isolada da troponina em duas avaliações consecutivas mostrou hazard ratio = 0,43 (IC95% 0,17–0,96, p=0,039); hospitalização, tratamento antiplaquetário anterior e idade permaneceram independentemente associados à mortalidade. Conclusões: A elevação isolada da troponina em duas medidas consecutivas foi um forte preditor de sobrevida em pacientes no PS com elevação da troponina, mas sem SCA.
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Affiliation(s)
- Célia Domingues
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal
| | - Maria João Vidigal Ferreira
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal.,Universidade de Coimbra - Faculdade de Medicina, Coimbra - Portugal
| | | | - Ana Vera Marinho
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal
| | | | - Cátia Ferreira
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal
| | - Isabel Fonseca
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal
| | - Lino Gonçalves
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra - Portugal.,Universidade de Coimbra - Faculdade de Medicina, Coimbra - Portugal
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3
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Mendes SL, Moreira N, Batista M, Ferreira AR, Marinho AV, Prieto D, Baptista R, Costa S, Franco F, Pego M, Antunes MDJ. Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil. Arq Bras Cardiol 2021; 116:219-226. [PMID: 33656068 PMCID: PMC7909968 DOI: 10.36660/abc.20190047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. OBJECTIVE This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. METHODS This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. RESULTS After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). CONCLUSION In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226).
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Affiliation(s)
| | - Nadia Moreira
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Manuel Batista
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Ana Rita Ferreira
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Ana Vera Marinho
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - David Prieto
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Rui Baptista
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Susana Costa
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Fatima Franco
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
| | - Mariano Pego
- Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal
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Marques-Alves P, Marinho AV, Almeida JP, Gonçalves T, Costa M, Ferreira M, Baptista R, Costa S, Franco F, Fonseca I, Gonçalves L. Real-world analysis of acute decompensated heart failure outcomes in Portugal. ESC Heart Fail 2020; 7:551-558. [PMID: 32022445 PMCID: PMC7160503 DOI: 10.1002/ehf2.12599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
Aims In Portugal, in the last 5 years, no study has published recent data regarding outcomes of patients with acute decompensated heart failure (ADHF). We aimed to determine the characteristics and outcomes of a large contemporaneous Portuguese cohort of ADHF patients admitted to our emergency department (ED). Methods and results We conducted a retrospective, study of all 1024 patients admitted to our ED with a discharge diagnosis of ADHF from November 2016 to December 2017. Baseline clinical data and outcomes {in‐hospital, 30 day, and follow‐up all‐cause mortality, and readmissions; median follow‐up, 5 months; interquartile range [(IQR), 3–11 months]} were determined. Mean age was 78 ± 10 years, and 53% were male; of the 1024 patients, 554 (54%) were hospitalized. The median hospitalization length was 9 (IQR, 5–15) days, and in‐hospital mortality was 12.7%. Hospitalized patients were predominantly men (56% vs. 47%; P < 0.001), younger (77 ± 9 vs. 79 ± 11 years; P = 0.002) and had higher creatinine values and B‐type natriuretic peptide values (P < 0.001) than discharged patients. Patients with prior hospitalization had lower 30 day readmission rate (8% vs. 14%; P = 0.01), same overall readmission rate (30% vs. 32%), and higher 30 day (13% vs. 5%; P < 0.001) and overall mortality rates (28% vs. 15%; P < 0.001). Conclusions Approximately half of the patients admitted to the ED were hospitalized. Of these, only 8% were readmitted in the ED within 30 days. The clinical and analytical status in the ED are important predictors of hospitalization.
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Affiliation(s)
- Patrícia Marques-Alves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Vera Marinho
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Paulo Almeida
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Tatiana Gonçalves
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Costa
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mafalda Ferreira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,iCBR, University of Coimbra, Coimbra, Portugal
| | - Susana Costa
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fátima Franco
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Fonseca
- Emergency Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,iCBR, University of Coimbra, Coimbra, Portugal
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Alves P, Marinho AV, Ferreira JA, Milner J, Freitas A, Ferreira C, Almeida JP, Martinho S, Baptista R, Martins R, Goncalves L. P320 Left atrial mechanics in moderate mitral valve disease: earlier markers of damage. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.173] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Left atrial (LA) mechanics is impaired in mitral valve disease, but it is not clear whether reservoir, conduit or contractile functions are differentially impaired in stenosis (MS) or regurgitation (MR). We aimed to study LA mechanics in patients with moderate MR or moderate MS and identify discriminators of disease.
METHODS
We conducted a prospective, observational study of 100 patients with isolated moderate MR and 100 patients with moderate MS. LA mechanics with speckle tracking echocardiography (STE) assessed LA reservoir (LA ɛsys and SRs), conduit(LAɛe, SRe), and contractile (LAɛa, SRa) functions. Left ventricle (LV) functional parameters were assessed as well, including LV ejection fraction (LVEF), LV end-diastolic diameter (LVDD) and LV global longitudinal strain (LV-GLS).
RESULTS
The mean age was 67 ± 14 years and 75% were female. Mean left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), LV global longitudinal strain (LV-GLS) and systolic pulmonary artery pressure (sPAP) did not differ between MR and MS (table 1).LA indexed volume (LAVi) and LA strain did not vary between MR and MS, but strain rate did. SRs and SRe had better values in MR, whereas SRa had worse values in MR (table 1). SRe (<-0.7%) had the superior discriminative power for MR, with an area under the curve of 0.85, sensitivity of 76% and specificity of 85%.
CONCLUSIONS
LA strain rate phases were the only parameters that varied between MR and MS. Contractile phase strain rate was more impaired in MR and conduit phase strain rate in MS. This highly specific data reflect the earlier hemodynamic changes occurring in LA in the setting of mitral valve disease.
mMR mMS P value LVEF (±SD,%) 57.4 ± 6.4 59.6 ± 4.6 0.145 LV-GLS (±SD, %) -17.7 ± 4.5 -17.1 ± 3.5 0.587 sPAP (±SD, mmHg) 30.3 ± 10.5 32.4 ± 8.3 0.387 LAVi (± SD, ml/m2) 46.3 ± 6.4 48.2 ± 7.4 0.281 LAɛs (± SD, %) 15.8 ± 7.3 13.3 ± 9 0.062 LAɛe (± SD, %) 8.4 ± 4.7 7.1 ± 5.4 0.074 LAɛa (± SD, %) 6.3 ± 4.8 7.4 ± 4.5 0.081 LA SRs (± SD, %) 0.8 ± 0.4 0.6 ± 0.3 0.004 LA SRe (± SD, %) -0.9 ± 0.5 -0.5 ± 0.3 <0.001 LA SRa (± SD, %) -0.5 ± 0.4 -0.8 ± 0.5 0.007
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Affiliation(s)
- P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J A Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Freitas
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J P Almeida
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Marques-Alves P, Marinho AV, Teixeira R, Baptista R, Castro G, Martins R, Gonçalves L. Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity. BMC Cardiovasc Disord 2019; 19:215. [PMID: 31601185 PMCID: PMC6785856 DOI: 10.1186/s12872-019-1204-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. METHODS We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6-50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). RESULTS In our sample set, values of LV-GLS (- 18.5% vs - 17.1, p = 0.025), E/e' ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78-0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75-0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70-0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r2 = 0.6, p < 0.001) and mean LV/aortic gradient (r2 = 0.55, p < 0.001) than LV-GLS (r2 = 0.3 and r2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e' ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. CONCLUSIONS LA global strain was the best discriminator of severity, surpassing E/e' ratio and LV-GLS, and a significant predictor of prognosis in AS.
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Affiliation(s)
- Patrícia Marques-Alves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal. .,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.
| | - Ana Vera Marinho
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rogério Teixeira
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Rui Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Graça Castro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rui Martins
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
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7
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Marques-Alves P, Marinho AV, Domingues C, Baptista R, Castro G, Martins R, Gonçalves L. Left atrial mechanics in moderate mitral valve disease: earlier markers of damage. Int J Cardiovasc Imaging 2019; 36:23-31. [PMID: 31388814 DOI: 10.1007/s10554-019-01683-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2019] [Indexed: 12/01/2022]
Abstract
While the impairment of left atrial (LA) mechanics in mitral valve disease is well known, the exact onset of reservoir, conduit, and contractile dysfunction in mitral stenosis (MS) and mitral regurgitation (MR) remains unclear. We aimed to clarify the LA deformation mechanics in patients with moderate mitral valve disease. We conducted a prospective observational study of 80 patients with moderate isolated MR, 80 patients with moderate isolated MS, and 64 age-matched controls without mitral valve disease. Strain (ɛ) and strain rate (SR) on speckle tracking echocardiography were assessed as indicators of LA and right atrium (RA) reservoir (ɛsys, SRs), conduit (ɛe, SRe), and contractile (ɛa, SRa) functions. Conventional echocardiographic parameters of the left ventricle (LV) were also assessed. Comparisons were conducted according to mitral valve pathology (MR patients, MS patients, controls). The mean LV ejection fraction, end-diastolic diameter, and global longitudinal strain did not differ across the groups. The pulmonary artery systolic pressure, LA volume indexed to body surface area, and LA mechanics were significantly impaired in mitral valve disease (patients vs controls). While LA ɛ did not vary between MR and MS, MR patients had better LA SRs and SRe but worse SRa (p < 0.01). SRe > - 0.65% had higher specificity for MS, with an area under the curve of 0.85 (p < 0.01). RA mechanics were significantly impaired in mitral valve disease (patients vs controls) but did not vary significantly with disease pathology (MS vs MR). Patients with moderate mitral valve disease exhibit early and pathology-specific changes in the LA deformation mechanics, manifesting mainly as impaired contractile-phase SR in MR and impaired conduit-phase SR in MS. Our findings highlight SR as a potentially useful early marker of LA dysfunction in relation to mitral valve disease.
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Affiliation(s)
- Patrícia Marques-Alves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.
| | - Ana Vera Marinho
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Célia Domingues
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rui Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
- ICBR Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Graça Castro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rui Martins
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
- ICBR Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
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8
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Domingues C, Vidigal Ferreira MJ, Martins H, Almeida J, Alves P, Marinho AV, Cunha MJ, Costa G, Goncalves L. P143Echocardiography and 99mTc-DPD scintigraphy on cardiac amyloidosis investigation. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Domingues
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | | | - H Martins
- University Hospitals of Coimbra, Nuclear Medicine Service, Coimbra, Portugal
| | - J Almeida
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M J Cunha
- University Hospitals of Coimbra, Nuclear Medicine Service, Coimbra, Portugal
| | - G Costa
- University Hospitals of Coimbra, Nuclear Medicine Service, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Nuclear Medicine Service, Coimbra, Portugal
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Milner J, Teixeira RN, Marinho AV, Silva N, Calretas S, Ferrão J, Furtado E, Telo MJ, Ventura M, Cristóvão J, Elvas L, Pêgo GM, António N. Pacemaker implantation in familial amyloid polyneuropathy: when and for whom? J Interv Card Electrophysiol 2019; 55:207-211. [PMID: 30852744 DOI: 10.1007/s10840-019-00517-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite the important role of cardiac pacing in preventing syncope and sudden cardiac death in familial amyloid polyneuropathy (FAP), we lack clear guidelines as to the ideal timing and indications for permanent pacemaker implantation. PURPOSE The purpose of this study was to evaluate the ideal timing for pacemaker implantation in FAP patients submitted to liver transplantation. METHODS Retrospective study of 258 FAP patients submitted to liver transplantation between 1992 and 2012. Comparison of three groups: (A) patients without pacemaker (N = 122); (B) patients submitted to pacemaker implantation after liver transplantation, with documented conduction disorders (N = 73); and (C) patients submitted to "prophylactic" pacemaker implantation before transplantation, (N = 73). Patients were followed up for 12.2 ± 6.7 years. RESULTS The majority of patients (57%) were referred for pacemaker implantation, which occurred before liver transplantation in 50% of cases. Patients who required pacemaker after transplantation presented significantly higher Machado-Joseph Score during pre-transplant evaluation than those who did not require pacemaker (24 ± 10 vs 20 ± 10, p = .025), and also exhibited higher levels of hepatic cytolysis enzymes and hyperbilirubinemia. The most common indication for permanent pacemaker was first degree atrioventricular block, with a mean time between transplantation and pacemaker implantation of 8.7 ± 4.2 years. During long-term follow-up, all-cause mortality was 27% and was lowest in the group submitted to pacemaker implantation only after liver transplantation (p = 0.002). CONCLUSION The majority of FAP patients submitted to liver transplantation will need a pacemaker at some time of follow-up. However, it seems that there is no benefit in "prophylactic" cardiac pacing before liver transplantation.
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Affiliation(s)
- James Milner
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
| | | | - Ana Vera Marinho
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Nuno Silva
- Pediatric and Adult Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Suzana Calretas
- Pediatric and Adult Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - José Ferrão
- Pediatric and Adult Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Emanuel Furtado
- Pediatric and Adult Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Maria João Telo
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Miguel Ventura
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - João Cristóvão
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Luís Elvas
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | | | - Natália António
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Fernandes L, Sargento-Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Pego GM, Cunha L, António N. Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen? Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2018.06.007] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Fernandes L, Sargento‐Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Mariano Pego G, Cunha L, António N. Acidente vascular cerebral isquémico em doentes previamente anticoagulados por fibrilhação auricular não valvular: por que acontece? Rev Port Cardiol 2019; 38:117-124. [DOI: 10.1016/j.repc.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/21/2018] [Accepted: 06/03/2018] [Indexed: 10/27/2022] Open
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12
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Alves P, Marinho AV, Ferreira JA, Milner J, Oliveira-Santos M, Baptista R, Martins R, Pego M. P5458Left atrial mechanics in aortic stenosis: a marker of severity and prognosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J A Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | | | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Pego
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Oliveira-Santos M, Oliveira Santos E, Marinho AV, Leite L, Guardado J, Matos V, Pego GM, Marques JS. Patient-specific 3D printing simulation to guide complex coronary intervention. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2018.02.018] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Oliveira-Santos M, Oliveira Santos E, Marinho AV, Leite L, Guardado J, Matos V, Pego GM, Marques JS. Patient-specific 3D printing simulation to guide complex coronary intervention. Rev Port Cardiol 2018; 37:541.e1-541.e4. [PMID: 29748151 DOI: 10.1016/j.repc.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/02/2018] [Accepted: 02/18/2018] [Indexed: 02/07/2023] Open
Abstract
The field of three-dimensional printing applied to patient-specific simulation is evolving as a tool to enhance intervention results. We report the first case of a fully simulated percutaneous coronary intervention in a three-dimensional patient-specific model to guide treatment. An 85-year-old female presented with symptomatic in-stent restenosis in the ostial circumflex and was scheduled for percutaneous coronary intervention. Considering the complexity of the anatomy, patient setting and intervention technique, we elected to replicate the coronary anatomy using a three-dimensional model. In this way, we simulated the intervention procedure beforehand in the catheterization laboratory using standard materials. The procedure was guided by optical coherence tomography, with pre-dilatation of the lesion, implantation of a single drug-eluting stent in the ostial circumflex and kissing balloon inflation to the left anterior descending artery and circumflex. Procedural steps were replicated in the real patient's treatment, with remarkable parallelism in angiographic outcome and luminal gain at intracoronary imaging. In this proof-of-concept report, we show that patient-specific simulation is feasible to guide the treatment strategy of complex coronary artery disease. It enables the surgical team to plan and practice the procedure beforehand, and possibly predict complications and gain confidence.
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Affiliation(s)
- Manuel Oliveira-Santos
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Eduardo Oliveira Santos
- Departamento de Engenharia Mecânica, Faculdade de Ciências e Tecnologia da Universidade de Coimbra, Coimbra, Portugal
| | - Ana Vera Marinho
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Leite
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Guardado
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Matos
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilherme Mariano Pego
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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