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de Mendonça C, de Macedo D, Nicolai C, Madeira H, Van Dooren E, Norré D, Mata A. Digital full arch implant supported Poly (methyl Methacrylate) interim prosthesis: a practice-based cohort study on survival and quality of life. INT J PROSTHODONT 2023; 0:4500159. [PMID: 37824125 DOI: 10.11607/ijp.8468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE Digitally planned and manufactured PMMA for full arch implant supported immediate loading interim prosthesis are becoming popular comparing with conventional acrylic prosthesis. Studies on prosthodontic performance and patient related outcomes are scarce but needed. The purpose of this study was to evaluate the clinical survival and impact on oral health related quality of life of immediate loading implant supported full arch CAD-CAM milled PMMA interim rehabilitations. METHODS This was a practice based prospective cohort study performed in a Portuguese dental clinic. Eleven patients received a total of seventeen CAD CAM full implant-supported, screw-retained, full arch rehabilitation with milled PMMA and were followed up for 1 year. Primary outcome was Prosthesis survival determined with a modification of the California Dental Association score and a Kaplan Meyer survival function analysis. Secondary outcome was patient's quality of life as defined by application of the OHIP 14 PT questionnaire and standardized effect size variation between two visits. Significance was set at 5%. RESULTS Survival probability at 12 months was 76%, complete fracture of the prosthesis occurred in 17,6 % of the cases and small fractures without lab involvement in 5,9%. There was a significant improvement in oral health related quality of life between visit 1 and 4. Mean difference and effect size for total OHIP-14 PT score were -32.91 (± 3.68 SD) and 3.66 (95% CI -1.83 to -5.80) P < 0.001* Wilcoxon matched paired rank test. CONCLUSIONS Full arch implant supported CAD-CAM milled PMMA interim prosthesis seems a viable approach with good survival rate and great impact on patient's oral health related quality of life.
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Calcagno A, Coelli S, Amendola C, Pirovano I, Re R, Medeiros J, Carvalho P, Madeira H, Bianchi AM. Role of the EEG theta network during software production: a connectivity study. IEEE Trans Neural Syst Rehabil Eng 2023; PP:1-1. [PMID: 37506005 DOI: 10.1109/tnsre.2023.3299834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Software programming is an acquired evolutionary skill originating from consolidated cognitive functions (i.e., attentive, logical, coordination, mathematic calculation, and language comprehension), but the underlying neurophysiological processes are still not completely known. In the present study, we investigated and compared the brain activities supporting realistic programming, text and code reading tasks, analyzing Electroencephalographic (EEG) signals acquired from 11 experienced programmers. Multichannel spectral analysis and a phase-based effective connectivity study were carried out. Our results highlighted that both realistic programming and reading tasks are supported by modulations of the Theta fronto-parietal network, in which parietal areas behave as sources of information, while frontal areas behave as receivers. Nevertheless, during realistic programming, both an increase in Theta power and changes in network topology emerged, suggesting a task-related adaptation of the supporting network system. This reorganization mainly regarded the parietal area, which assumes a prominent role, increasing its hub functioning and its connectivity in the network in terms of centrality and degree.
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Medeiros J, Teixeira C, Couceiro R, Castelhano J, Branco MC, Duarte G, Duarte C, Duraes J, Madeira H, Carvalho P. Software code complexity assessment using EEG features. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:1413-1416. [PMID: 31946157 DOI: 10.1109/embc.2019.8856283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper provides a study using Electroencephalography (EEG) to investigate the brain activity during code comprehension tasks. Three different code complexity levels according to five complexity metrics were considered. The use of EEG for this purpose is relevant, since the existing studies were mostly focused on neuroimaging techniques. Using Leave-One-Subject-Out cross-validation procedure for 30 subjects, it was found that the features related with the Gamma activity were the most common in all the folds. Regarding the brain regions, right parietal was the most frequent region contributing with more features. A Linear Discriminant Analysis Classifier for task classification, obtained a F-Measure of 92.71% for Code complexity easy, 52.25% for Code complexity intermediate and 53.13% for Code complexity advanced, revealing an evidence of mental effort saturation with the code complexity degree. This suggests that current code complexity metrics do not capture cognitive load and might not be the best approach to assess bug risk.
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De Macedo D, Madeira H, Jarry C. Single molar replacement immediately loaded with final crown through Straumann BLX and chairside digital workflow – One tooth one time technique. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.198_13509] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Madeira H, Macedo DD, Mata A. Fully digital bone reduction and guided implant placement for bimaxillary full‐arch rehabilitation: Series of cases. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.465_13509] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hugo Madeira
- ClÌnica de Estètica e Implantologia Dentária Hugo Madeira, Portugal
| | | | - AntÓnio Mata
- Faculdade de Medicina Dentária, Universidade de Lisboa, Portugal
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Brito D, Cardim N, Lopes LR, Belo A, Mimoso J, Gonçalves L, Madeira H. Awareness of Fabry disease in cardiology: A gap to be filled. Rev Port Cardiol 2018; 37:457-466. [DOI: 10.1016/j.repc.2018.03.010] [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] [Received: 10/18/2017] [Revised: 01/24/2018] [Accepted: 03/11/2018] [Indexed: 10/16/2022] Open
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Cardim N, Brito D, Rocha Lopes L, Freitas A, Araújo C, Belo A, Gonçalves L, Mimoso J, Olivotto I, Elliott P, Madeira H. The Portuguese Registry of Hypertrophic Cardiomyopathy: Overall results. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2018.02.008] [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: 10/18/2022] Open
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Madeira H. The freedom of clinicians and the art of the impossible. Rev Port Cardiol 2017; 36:799-800. [PMID: 29162359 DOI: 10.1016/j.repc.2017.10.007] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hugo Madeira
- Ex-presidente da Federação das Sociedades de Cardiologia de Língua Portuguesa; Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal.
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Madeira H. The freedom of clinicians and the art of the impossible. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2017.10.008] [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: 11/16/2022] Open
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Cardim N, Brito D, Rocha Lopes L, Freitas A, Araujo C, Belo A, Goncalves L, Mimoso J, Olivotto I, Elliott P, Madeira H. P2315The Portuguese registry of hypertrophic cardiomyopathy (PRO-HCM): global results. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2315] [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: 11/13/2022] Open
Affiliation(s)
| | - D. Brito
- University Hospital De Santa Maria, Lisbon, Portugal
| | - L. Rocha Lopes
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - A. Freitas
- Hospital Fernando Da Fonseca, Amadora-Sintra, Portugal
| | - C. Araujo
- Hospital of Vila Real, Vila Real, Portugal
| | - A. Belo
- Portuguese Society of Cardiology, Coimbra, Portugal
| | - L. Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - I. Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - P. Elliott
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom
| | - H. Madeira
- University Hospital De Santa Maria, Lisbon, Portugal
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Madeira H. The Freedom of Clinicians and the Art of the Impossible. Arq Bras Cardiol 2017; 109:387-388. [PMID: 29267624 PMCID: PMC5729772 DOI: 10.5935/abc.20170163] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hugo Madeira
- Past-President of the Federation of the Portuguese Language
Societies of Cardiology; Centro Cardiovascular da Universidade de Lisboa, Lisboa
- Portugal
- Mailing Address: Hugo Madeira Faculdade de Medicina da
Universidade de Lisboa - Centro Cardiovascular, piso 2 - Av. Prof. Egas Moniz,
1649 - 028 Lisboa - Portugal. E-mail:
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Borges J, Fernandes S, Vieira V, Cardoso A, Madeira H, Mediavilla M, Leitão R, Silva C, Faustino A. AB1011 Vitamin D Status – A Transversal Evaluation in Rheumatic Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6037] [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: 11/03/2022]
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Fernandes S, Borges J, Silva C, Simões E, Micaelo M, Barcelos F, Madeira H, Vaz Patto J, Cunha Miranda L, Sousa M, Cortes S, Faustino A. THU0536 Remission and Re-Treatment of Patients with Paget's Disease of Bone Treated with Zolendronic Acid – A Single Center 10 Year Experience. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6083] [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: 11/04/2022]
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Silva D, Madeira H, Almeida A, Brito D. Tissue Doppler imaging and plasma N-terminal probrain natriuretic peptide for the identification of hypertrophic cardiomyopathy mutation carriers. Am J Cardiol 2013; 112:996-1004. [PMID: 23831167 DOI: 10.1016/j.amjcard.2013.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 01/09/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
Abstract
Previous studies have shown that tissue Doppler imaging (TDI) is able to identify mutation carriers of hypertrophic cardiomyopathy (HC) before the development of the clinical phenotype. However, data are scarce and have sometimes been controversial. We performed a systematic study that included conventional echocardiography, TDI, and plasma NT-probrain natriuretic peptide (NT-proBNP) measurement to evaluate the parameters that could identify HC mutation carriers. A total of 138 genotyped subjects were included and divided into 3 groups: group 1, those with HC (n = 62); group 2, mutation carriers (first-degree relatives with a positive genotype but negative phenotype; n = 34); and group 3, controls (first-degree relatives with a negative genotype and phenotype; n = 42). An echocardiographic study, including TDI, was performed on all subjects, and a TDI-derived index (global function index) was also determined. The age-adjusted mean differences in the echocardiographic and TDI parameters and NT-proBNP levels were compared among the 3 groups. Compared with the HC group, the carriers had significantly higher mean E' velocities, lower mean E/E' ratio, higher mean S' velocities, and lower mean global function index and NT-proBNP values. The carriers and controls did not differ significantly either in the echocardiographic parameters studied or in the NT-proBNP levels. In conclusion, the echocardiographic and TDI parameters and NT-proBNP levels cannot be used to identify the HC mutation carrier state and therefore do not appear to be reliable for the purpose of making a preclinical diagnosis of the disease.
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Affiliation(s)
- Doroteia Silva
- Cardiology Department, Santa Maria University Hospital, Lisbon, Portugal.
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Silva D, Sargento L, Varela MG, Lopes M, Brito D, Madeira H. Constrictive pericarditis – New methods in the diagnosis of an old disease: A case report. Revista Portuguesa de Cardiologia (English Edition) 2012. [DOI: 10.1016/j.repce.2012.07.008] [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: 11/25/2022] Open
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Silva D, Sargento L, Gato Varela M, Lopes MG, Brito D, Madeira H. [Constrictive pericarditis - new methods in the diagnosis of an old disease: a case report]. Rev Port Cardiol 2012; 31:677-82. [PMID: 22954618 DOI: 10.1016/j.repc.2012.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 01/25/2012] [Indexed: 10/27/2022] Open
Abstract
Constrictive pericarditis is a rare clinical entity that can pose diagnostic problems. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end-diastole, equal in all chambers. The diastolic profile in both ventricles presents the classic dip-and-plateau pattern and the difference between the diastolic pressures of both ventricles should not exceed 3-5mmHg. Unfortunately, these traditional criteria are not always present and in fact the sensitivity and specificity of equalization of diastolic pressures are relatively low and of limited value in individual patients. This highlights the need to use new cardiac imaging techniques to resolve any doubts. The case described here is a good example.
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Affiliation(s)
- Doroteia Silva
- Serviço de Cardiologia I, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
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Brito D, Miltenberger-Miltenyi G, Vale Pereira S, Silva D, Diogo AN, Madeira H. Sarcomeric hypertrophic cardiomyopathy: genetic profile in a Portuguese population. Rev Port Cardiol 2012; 31:577-87. [PMID: 22857948 DOI: 10.1016/j.repc.2011.12.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/15/2011] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Sarcomeric hypertrophic cardiomyopathy has heterogeneous phenotypic expressions, of which sudden cardiac death is the most feared. A genetic diagnosis is essential to identify subjects at risk in each family. The spectrum of disease-causing mutations in the Portuguese population is unknown. METHODS Seventy-seven unrelated probands with hypertrophic cardiomyopathy were systematically screened for mutations by PCR and sequencing of five sarcomeric genes: MYBPC3, MYH7, TNNT2, TNNI3 and MYL2. Familial cosegregation analysis was performed in most patients. RESULTS Thirty-four different mutations were identified in 41 (53%) index patients, 71% with familial hypertrophic cardiomyopathy. The most frequently involved gene was MYBPC3 (66%) with 22 different mutations (8 novel) in 27 patients, followed by MYH7 (22%), TNNT2 (12%) and TNNI3 (2.6%). In three patients (7%), two mutations were found in MYBPC3 and/or MYH7. Additionally, 276 relatives were screened, leading to the identification of a mean of three other affected relatives for each pedigree with the familial form of the disease. CONCLUSIONS Disease-associated mutations were identified mostly in familial hypertrophic cardiomyopathy, corroborating the idea that rarely studied genes may be implicated in sporadic forms. Private mutations are the rule, MYBPC3 being the most commonly involved gene. Mutations in MYBPC3 and MYH7 accounted for most cases of sarcomere-related disease. Multiple mutations in these genes may occur, which highlights the importance of screening both. The detection of novel mutations strongly suggests that all coding regions should be systematically screened. Genotyping in hypertrophic cardiomyopathy enables a more precise diagnosis of the disease, with implications for risk stratification and genetic counseling.
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Affiliation(s)
- Dulce Brito
- Centro de Cardiologia da Universidade de Lisboa, Lisboa, Portugal.
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Friedrich FW, Wilding BR, Reischmann S, Crocini C, Lang P, Charron P, Müller OJ, McGrath MJ, Vollert I, Hansen A, Linke WA, Hengstenberg C, Bonne G, Morner S, Wichter T, Madeira H, Arbustini E, Eschenhagen T, Mitchell CA, Isnard R, Carrier L. Evidence for FHL1 as a novel disease gene for isolated hypertrophic cardiomyopathy. Hum Mol Genet 2012; 21:3237-54. [PMID: 22523091 DOI: 10.1093/hmg/dds157] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by asymmetric left ventricular hypertrophy, diastolic dysfunction and myocardial disarray. HCM is caused by mutations in sarcomeric genes, but in >40% of patients, the mutation is not yet identified. We hypothesized that FHL1, encoding four-and-a-half-LIM domains 1, could be another disease gene since it has been shown to cause distinct myopathies, sometimes associated with cardiomyopathy. We evaluated 121 HCM patients, devoid of a mutation in known disease genes. We identified three novel variants in FHL1 (c.134delA/K45Sfs, c.459C>A/C153X and c.827G>C/C276S). Whereas the c.459C>A variant was associated with muscle weakness in some patients, the c.134delA and c.827G>C variants were associated with isolated HCM. Gene transfer of the latter variants in C2C12 myoblasts and cardiac myocytes revealed reduced levels of FHL1 mutant proteins, which could be rescued by proteasome inhibition. Contractility measurements after adeno-associated virus transduction in rat-engineered heart tissue (EHT) showed: (i) higher and lower forces of contraction with K45Sfs and C276S, respectively, and (ii) prolonged contraction and relaxation with both mutants. All mutants except one activated the fetal hypertrophic gene program in EHT. In conclusion, this study provides evidence for FHL1 to be a novel gene for isolated HCM. These data, together with previous findings of proteasome impairment in HCM, suggest that FHL1 mutant proteins may act as poison peptides, leading to hypertrophy, diastolic dysfunction and/or altered contractility, all features of HCM.
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Affiliation(s)
- Felix W Friedrich
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Santos S, Marques V, Pires M, Silveira L, Oliveira H, Lança V, Brito D, Madeira H, Esteves JF, Freitas A, Carreira IM, Gaspar IM, Monteiro C, Fernandes AR. High resolution melting: improvements in the genetic diagnosis of hypertrophic cardiomyopathy in a Portuguese cohort. BMC Med Genet 2012; 13:17. [PMID: 22429680 PMCID: PMC3359199 DOI: 10.1186/1471-2350-13-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 03/19/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hypertrophic Cardiomyopathy (HCM) is a complex myocardial disorder with a recognized genetic heterogeneity. The elevated number of genes and mutations involved in HCM limits a gene-based diagnosis that should be considered of most importance for basic research and clinical medicine. METHODOLOGY In this report, we evaluated High Resolution Melting (HRM) robustness, regarding HCM genetic testing, by means of analyzing 28 HCM-associated genes, including the most frequent 4 HCM-associated sarcomere genes, as well as 24 genes with lower reported HCM-phenotype association. We analyzed 80 Portuguese individuals with clinical phenotype of HCM allowing simultaneously a better characterization of this disease in the Portuguese population. RESULTS HRM technology allowed us to identify 60 mutated alleles in 72 HCM patients: 49 missense mutations, 3 nonsense mutations, one 1-bp deletion, one 5-bp deletion, one in frame 3-bp deletion, one insertion/deletion, 3 splice mutations, one 5'UTR mutation in MYH7, MYBPC3, TNNT2, TNNI3, CSRP3, MYH6 and MYL2 genes. Significantly 22 are novel gene mutations. CONCLUSIONS HRM was proven to be a technique with high sensitivity and a low false positive ratio allowing a rapid, innovative and low cost genotyping of HCM. In a short return, HRM as a gene scanning technique could be a cost-effective gene-based diagnosis for an accurate HCM genetic diagnosis and hopefully providing new insights into genotype/phenotype correlations.
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Affiliation(s)
- Susana Santos
- Centro de Química Estrutural, Instituto Superior Técnico, Technical University of Lisbon, Lisbon, Portugal
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Kenny C, Adhya S, Dworakowski R, Brickham B, Maccarthy P, Monaghan M, Guzzo A, Innocenti F, Vicidomini S, Lazzeretti D, Squarciotta S, De Villa E, Donnini C, Bulletti F, Guerrini E, Pini R, Bendjelid K, Viale J, Duperret S, Piriou V, Jacques D, Shahgaldi K, Silva C, Pedro F, Deister L, Brodin LA, Sahlen A, Manouras A, Winter R, Berjeb N, Cimadevilla C, Dreyfus J, Cueff C, Malanca M, Chiampan A, Vahanian A, Messika-Zeitoun D, Muraru D, Peluso D, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Almuntaser I, King G, Norris S, Daly C, Ellis E, Murphy R, Erdei T, Denes M, Kardos A, Foldesi C, Temesvari A, Lengyel M, Bouzas Mosquera A, Broullon F, Alvarez-Garcia N, Peteiro J, Barge-Caballero G, Lopez-Perez M, Lopez-Sainz A, Castro-Beiras A, Luotolahti M, Luotolahti H, Kantola I, Viikari J, Andersen M, Ersboell M, Bro-Jeppesen J, Gustafsson F, Koeber L, Hassager C, Moller J, Coisne D, Diakov C, Vallet F, Lequeux B, Blouin P, Christiaens L, Esposito R, Santoro A, Schiano Lomoriello V, Raia R, Santoro C, De Simone G, Galderisi M, Sahlen A, Abdula G, Winter R, Kosmala W, Szczepanik-Osadnik H, Przewlocka-Kosmala M, Mysiak A, O' Moore-Sullivan T, Marwick T, Tan YT, Wenzelburger F, Leyva F, Sanderson J, Pichler P, Syeda B, Hoefer P, Zuckermann A, Binder T, Fijalkowski M, Koprowski A, Galaska R, Blaut K, Sworczak K, Rynkiewicz A, Lee S, Kim W, Jung L, Yun H, Song M, Ko J, Khalifa EA, Szymanski P, Lipczynska M, Klisieiwcz A, Hoffman P, Jorge C, Silva Marques J, Robalo Martins S, Calisto C, Mieiro M, Vieira S, Correia M, Carvalho De Sousa J, Almeida A, Nunes Diogo A, Park C, March K, Tillin T, Mayet J, Chaturvedi N, Hughes A, Di Bello V, Giannini C, Delle Donne M, De Sanctis F, Spontoni P, Cucco C, Corciu A, Grigoratos C, Bogazzi F, Balbarini A, Enescu O, Suran B, Florescu M, Cinteza M, Vinereanu D, Higuchi Y, Iwakura K, Okamura A, Date M, Fujii K, Jorge C, Cortez-Dias N, Silva D, Carrilho-Ferreira P, Silva Marques J, Magalhaes A, Ribeiro S, Goncalves S, Fiuza M, Pinto F, Jorge C, Cortez-Dias N, Silva D, Silva Marques J, Carrilho-Ferreira P, Placido R, Bordalo A, Goncalves S, Fiuza M, Pinto F, Grzywocz P, Mizia-Stec K, Chudek J, Gasior Z, Maceira Gonzalez AM, Cosin Sales J, Dalli E, Igual B, Diago J, Aguilar J, Ruvira J, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Boccalini F, Mattatelli A, Hiramoto Y, Iacoboni C, Agati L, Trifunovic D, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Boricic-Kostic M, Draganic G, Tesic M, Petrovic M, Gavina C, Lopes R, Lourenco A, Almeida J, Rodrigues J, Pinho P, Zamorano J, Leite-Moreira A, Rocha-Goncalves F, Clavel MA, Capoulade R, Dumesnil J, Mathieu P, Despres JP, Pibarot P, Bull S, Pitcher A, Augustine D, D'arcy J, Karamitsos T, Rai A, Prendergast B, Becher H, Neubauer S, Myerson S, Magne J, Donal E, Davin L, O'connor K, Pirlet C, Rosca M, Szymanski C, Cosyns B, Pierard L, Lancellotti P, Calin A, Rosca M, Popescu B, Beladan C, Enache R, Lupascu L, Sandu C, Lancellotti P, Pierard L, Ginghina C, Kamperidis V, Hadjimiltiadis S, Sianos G, Anastasiadis K, Grosomanidis V, Efthimiadis G, Karvounis H, Parharidis G, Styliadis I, Gonzalez Canovas C, Munoz-Esparza C, Bonaque Gonzalez J, Fernandez A, Salar Alcaraz M, Saura Espin D, Pinar Bermudez E, Oliva-Sandoval M, De La Morena Valenzuela G, Valdes Chavarri M, Dreyfus J, Brochet E, Lepage L, Attias D, Cueff C, Detaint D, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Pirat B, Little S, Chang S, Tiller L, Kumar R, Zoghbi W, Lee APW, Hsiung M, Wan S, Wong R, Luo F, Fang F, Xie J, Underwood M, Sun J, Yu C, Jansen R, Tietge W, Sijbrandij K, Cramer M, De Heer L, Kluin J, Chamuleau SAJ, Oliveras Vila T, Ferrer Sistach E, Delgado Ramis L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Garcia Alonso C, Teis Soley A, Ruyra Baliarda X, Bayes Genis A, Negrea S, Alexandrescu C, Bourlon F, Civaia F, Dreyfus G, Paetzold S, Luha O, Hoedl R, Stoschitzky G, Pfeiffer K, Zweiker D, Pieske B, Maier R, Sevilla T, Revilla A, Lopez J, Vilacosta I, Arnold R, Gomez I, San Roman J, Nikcevic G, Djordjevic Dikic A, Djordjevic S, Raspopovic S, Jovanovic V, Kircanski B, Pavlovic S, Milasinovic G, Ruiz-Zamora I, Cabrera Bueno F, Molina M, Fernandez-Pastor J, Pena J, Linde A, Barrera A, Alzueta J, Bremont C, Bensaid A, Alonso H, Zaghden O, Nahum J, Dubois-Rande J, Gueret P, Lim P, Lee SP, Park K, Kim HR, Lee JH, Ahn HS, Kim JH, Kim HK, Kim YJ, Sohn DW, Niemann M, Herrmann S, Hu K, Liu D, Beer M, Ertl G, Wanner C, Takenaka T, Tei C, Weidemann F, Silva D, Madeira H, Mendes Pedro M, Nunes Diogo A, Brito D, Schiano Lomoriello V, Ippolito R, Santoro A, Esposito R, Raia R, De Palma D, Galderisi M, Gati S, Oxborough D, Reed M, Zaidi A, Ghani S, Sheikh N, Papadakis M, Sharma S, Chow V, Ng A, Pasqualon T, Zhao W, Hanzek D, Chung T, Yeoh T, Kritharides L, Florescu M, Magda L, Enescu O, Mihalcea D, Suran B, Jinga D, Mincu R, Cinteza M, Vinereanu D, Ferrazzi E, Segato G, Folino F, Famoso G, Senzolo M, Bellu R, Corbetti F, Iliceto S, Tona F, Azevedo O, Quelhas I, Guardado J, Fernandes M, Pereira V, Medeiros R, Lourenco A, Sousa P, Santos W, Pereira S, Marques N, Mimoso J, Marques V, Jesus I, Rustad L, Nytroen K, Gullestad L, Amundsen B, Aakhus S, Linhartova K, Sterbakova G, Necas J, Kovalova S, Cerbak R, Nelassov N, Korotkijan N, Shishkina A, Gagieva B, Nagaplev M, Eroshenko O, Morgunov M, Parmon S, Velthuis S, Van Gent M, Post M, Westermann C, Mager J, Snijder R, Koyalakonda SP, Anderson M, Burgess M, Bergenzaun L, Chew M, Ohlin H, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Rutz T, Kuehn A, Petzuch K, Pekala M, Elmenhorst J, Fratz S, Mueller J, Hager A, Hess J, Vogt M, Van Der Linde D, Van De Laar I, Wessels M, Bekkers J, Moelker A, Tanghe H, Van Kooten F, Oldenburg R, Bertoli-Avella A, Roos-Hesselink J, Cresti A, Fontani L, Calabria P, Capati E, Severi S, Lynch M, Saraf S, Sandler B, Yoon S, Kim S, Ko C, Ryu S, Byun Y, Seo H, Ciampi Q, Rigo F, Pratali L, Gherardi S, Villari B, Picano E, Sicari R, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Sinicyna J, Gruodyte G, Janonyte K, Laucevicius A, O'driscoll J, Schmid K, Marciniak A, Saha A, Gupta S, Smith R, Sharma R, Bouzas Mosquera A, Alvarez Garcia N, Peteiro J, Broullon F, Prada O, Rodriguez Vilela A, Barge Caballero G, Lopez Perez M, Lopez Sainz A, Castro Beiras A, Kochanowski J, Scislo P, Piatkowski R, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Van De Heyning CM, Magne J, O'connor K, Mahjoub H, Pibarot P, Pirlet C, Pierard L, Lancellotti P, Clausen H, Basaggianis C, Newton J, Del Pasqua A, Carotti A, Di Carlo D, Cetrano E, Toscano A, Iacobelli R, Esposito C, Chinali M, Pongiglione G, Rinelli G, Larsson M, Larsson M, Bjallmark A, Winter R, Caidahl K, Brodin L, Velthuis S, Van Gent M, Mager J, Westermann C, Snijder R, Post M, Gao H, Coisne D, Lugiez M, Guivier C, Rieu R, D'hooge J, Lugiez M, Hang G, D'hooge J, Guerin C, Christiaens L, Menard M, Voigt JU, Coisne D, Dungu J, Campos G, Jaffarulla R, Gomes-Pereira S, Sutaria N, Baker C, Nihoyannopoulos P, Bellamy M, Adhya S, Harries D, Walker N, Pearson P, Reiken J, Batteson J, Kamdar R, Murgatroyd F, Monaghan M, D'andrea A, Riegler L, Scarafile R, Pezzullo E, Salerno G, Bossone E, Limongelli G, Russo M, Pacileo G, Calabro' R, Kang Y, Cui J, Chen H, Pan C, Shu X, Kiotsekoglou A, Saha S, Toole R, Govind S, Gopal A, Crispi F, Bijnens B, Sepulveda-Swatson E, Rojas-Benavente J, Dominguez J, Illa M, Eixarch E, Sitges M, Gratacos E, Prinz C, Faludi R, Walker A, Amzulescu M, Gao H, Uejima T, Fraser A, Voigt J, Esmaeilzadeh M, Maleki M, Amin A, Vakilian F, Noohi F, Ojaghi Haghighi Z, Nakhostin Davari P, Bakhshandeh Abkenar H, Rimbas R, Dulgheru R, Margulescu A, Florescu M, Vinereanu D, Toscano A, Chinali M, D' Asaro M, Iacobelli R, Del Pasqua A, Esposito C, Mizzon C, Parisi F, Pongiglione G, Rinelli G, Jung BC, Lee BY, Kang HJ, Kim S, Kim M, Kim Y, Cho D, Park S, Hong S, Lim D, Shim W, Bellsham-Revell H, Tibby S, Bell AJ, Miller OI, Greil G, Simpson JM, Providencia RA, Trigo J, Botelho A, Gomes P, Seca L, Barra S, Faustino A, Costa G, Quintal N, Leitao-Marques A, Nestaas E, Stoylen A, Fugelseth D, Mornos C, Ionac A, Petrescu L, Cozma D, Dragulescu D, Mornos A, Pescariu S, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Laser K, Faber L, Fischer M, Koerperich H, Kececioglu D, Elnoamany MF, Dawood A, Elhabashy M, Khalil Y, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Piriou N, Warin-Fresse K, Caza M, Fau G, Crochet D, Xhabija N, Allajbeu I, Petrela E, Heba M, Barreiro Perez M, Martin Fernandez M, Renilla Gonzalez A, Florez Munoz J, Fernandez Cimadevilla O, Alvarez Pichel I, Velasco Alonso E, Leon Duran D, Benito Martin E, Secades Gonzalez S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Silva Ferreira A, Bettencourt N, Matos P, Oliveira L, Almeida A, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Lopez Lereu M, Monmeneu J, Estornell J, Tsverava M, Tsverava D, Varela A, Salagianni M, Galani I, Andreakos E, Davos C, Ikonomidis I, Lekakis J, Tritakis V, Kadoglou N, Papadakis J, Trivilou P, Tzortzis S, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Kim G, Youn H, Park C, Ibrahimi P, Bajraktari G, Jashari F, Ahmeti A, Poniku A, Haliti E, Henein M, Pezo Nikolic B, Jurin H, Lovric D, Baricevic Z, Ivanac Vranesic I, Lovric Bencic M, Ernst A, Separovic Hanzevacki J. Poster Session 3: Friday 9 December 2011, 08:30-12:30 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brito D, Carneiro F, Pedro M, Salgueiro L, Palhano M, Nunes J, de Pádua F, Madeira H. Angiosarcoma associated with a vascular graft: Case report. Int J Angiol 2011. [DOI: 10.1007/bf02043213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Villard E, Perret C, Gary F, Proust C, Dilanian G, Hengstenberg C, Ruppert V, Arbustini E, Wichter T, Germain M, Dubourg O, Tavazzi L, Aumont MC, DeGroote P, Fauchier L, Trochu JN, Gibelin P, Aupetit JF, Stark K, Erdmann J, Hetzer R, Roberts AM, Barton PJR, Regitz-Zagrosek V, Aslam U, Duboscq-Bidot L, Meyborg M, Maisch B, Madeira H, Waldenström A, Galve E, Cleland JG, Dorent R, Roizes G, Zeller T, Blankenberg S, Goodall AH, Cook S, Tregouet DA, Tiret L, Isnard R, Komajda M, Charron P, Cambien F. A genome-wide association study identifies two loci associated with heart failure due to dilated cardiomyopathy. Eur Heart J 2011; 32:1065-76. [PMID: 21459883 DOI: 10.1093/eurheartj/ehr105] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [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: 12/15/2022] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) is a major cause of heart failure with a high familial recurrence risk. So far, the genetics of DCM remains largely unresolved. We conducted the first genome-wide association study (GWAS) to identify loci contributing to sporadic DCM. METHODS AND RESULTS One thousand one hundred and seventy-nine DCM patients and 1108 controls contributed to the discovery phase. Pools of DNA stratified on disease status, population, age, and gender were constituted and used for testing association of DCM with 517 382 single nucleotide polymorphisms (SNPs). Three DCM-associated SNPs were confirmed by individual genotyping (P < 5.0 10(-7)), and two of them, rs10927875 and rs2234962, were replicated in independent samples (1165 DCM patients and 1302 controls), with P-values of 0.002 and 0.009, respectively. rs10927875 maps to a region on chromosome 1p36.13 which encompasses several genes among which HSPB7 has been formerly suggested to be implicated in DCM. The second identified locus involves rs2234962, a non-synonymous SNP (c.T757C, p. C151R) located within the sequence of BAG3 on chromosome 10q26. To assess whether coding mutations of BAG3 might cause monogenic forms of the disease, we sequenced BAG3 exons in 168 independent index cases diagnosed with familial DCM and identified four truncating and two missense mutations. Each mutation was heterozygous, present in all genotyped relatives affected by the disease and absent in a control group of 347 healthy individuals, strongly suggesting that these mutations are causing the disease. CONCLUSION This GWAS identified two loci involved in sporadic DCM, one of them probably implicates BAG3. Our results show that rare mutations in BAG3 contribute to monogenic forms of the disease, while common variant(s) in the same gene are implicated in sporadic DCM.
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Santos S, Lança V, Oliveira H, Branco P, Silveira L, Marques V, Brito D, Madeira H, Bicho M, Fernandes AR. Genetic diagnosis of hypertrophic cardiomyopathy using mass spectrometry DNA arrays and high resolution melting. Rev Port Cardiol 2011; 30:7-18. [PMID: 21425739] [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: 05/30/2023] Open
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM), a complex myocardial disorder with an autosomal dominant genetic pattern and prevalence of 1:500, is the most frequent cause of sudden death in apparently healthy young people. The benefits of gene-based diagnosis of HCME for both basic research and clinical medicine are limited by the considerable costs of current genetic testing due to the large number of genes and mutations involved in this pathology. However, coupling two high-throughput techniques--mass spectrometry genotyping (MSG) and high resolution melting (HRM)--is an encouraging new strategy for HCM diagnosis. Our aim was to evaluate the diagnostic efficacy of both techniques in this pathology by studying 13 individuals with a clinical phenotype of HCM. METHODS Peripheral blood samples were collected from: (i) seven subjects with a clinical diagnosis of HCM, all bearing known mutations previously identified by dideoxy sequencing and thus being used as blinded samples (sample type 1); (ii) one individual with a clinical diagnosis of HCM negative for mutations after dideoxy sequencing of the five most common HCM genes, MYH7, MYBPC3, TNNI3, TNNT2 and MYL2 (sample type 2); and (iii) five individuals individual with a clinical diagnosis of HCM who had not previously been genetically studied (sample type 3). RESULTS The 13 samples were analyzed by MSG for 534 known mutations in 32 genes associated with HCM phenotypes and for all coding regions and exon-intron boundaries of the same HCM genes by HRM. The 32 studied genes include the most frequent HCM-associated sarcomere genes, as well as 27 genes with lower reported HCM phenotype association. This coupled genotyping strategy enabled us to identify a c.128delC (p.A43Vfs165) frame-shift mutation in the CSRP3 gene, a gene not usually studied in current HCM genetics. The heterozygous CSRP3 mutation was found in two patients (sample types 2 and 3) aged 50 and 52 years, respectively, both with diffuse left ventricular hypertrophy. Furthermore, this coupled strategy enabled us to find a novel mutation, c.817C >T (p.Arg273Cys), in MYBPC3 in an individual from sample type 3, subsequently confirmed by dideoxy sequencing. This novel mutation in MYBPC3, not present in 200 chromosomes from 200 healthy individuals, affects a codon known to harbor an HCM-causing mutation--p.Arg253His. CONCLUSION In conclusion, in the cohort used in this work coupling two technologies, MSG and HRM, with high sensitivity and low false positive results, enabled rapid, innovative and low-cost genotyping of HCM patients, which may in the short-term be suitable for accurate genetic diagnosis of HCM.
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Affiliation(s)
- Susana Santos
- Centro de Metabolismo e Endocrinologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cortez-Dias N, Varela MG, Sargento L, Brito D, Almeida A, Cerqueira R, Lança V, Fernandes AR, Tavares P, Pereira RA, Fernandes A, Madeira H. Left ventricular non-compaction: a new mutation predisposing to reverse remodeling? Rev Port Cardiol 2009; 28:185-194. [PMID: 19438153] [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: 05/27/2023] Open
Abstract
Left ventricular non-compaction (LVNC) is a rare disorder of endomyocardial morphogenesis that results in multiple trabeculations and deep intertrabecular recesses filled with direct blood flow from the left ventricular cavity. LVNC is attracting increasing interest as a model for the study of cardiomyopathies, since it is a genetically heterogeneous disorder which varies greatly in clinical presentation and age of onset. The authors present the case of a young black male with progressive congestive heart failure of 2-3 years' evolution. The investigation, which included transthoracic echocardiography (contrast and 3D), transesophageal echocardiography and cardiac magnetic resonance imaging, showed LVNC and severe aortic regurgitation, with severe left ventricular systolic dysfunction. The family history was suggestive of genetically transmitted disease and genetic study of the TAZ gene at locus Xq28 identified the mutation p.Phe128Ser (c.383T>C), the first description of this mutation in a patient with LVNC. The patient underwent aortic valve replacement, with excellent clinical evolution, regression of left ventricular dimensions and global systolic functio Aortic regurgitation (not related to LVNC) was the determining factor in the clinical expression. However, the excellent reverse remodeling that occurred after surgery highlights the heterogeneity of myocardial behavior in LVNC patients.
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Affiliation(s)
- Nuno Cortez-Dias
- Serviço de Cardiologia, Hospital de Santa Maria, Lisboa, Portugal
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Velavan P, Khan NK, Goode K, Rigby AS, Loh PH, Komajda M, Follath F, Swedberg K, Madeira H, Cleland JGF. Predictors of short term mortality in heart failure - insights from the Euro Heart Failure survey. Int J Cardiol 2008; 138:63-9. [PMID: 18789548 DOI: 10.1016/j.ijcard.2008.08.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [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] [Received: 02/04/2008] [Revised: 06/16/2008] [Accepted: 08/08/2008] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify factors associated with short term mortality in hospitalised patients with heart failure. BACKGROUND Hospitalisation is frequent in patients with heart failure and is associated with a high mortality. METHODS The Euro Heart Failure survey collected data from patients with suspected heart failure. We searched this data for predictors of short term mortality. RESULTS Of 10,701 patients, 1404 (13%) died within 12 weeks of admission. On univariate analysis, increasing age, hyponatraemia, renal impairment, hyperkalaemia, anaemia, severe mitral regurgitation, severe LV systolic dysfunction(LVSD), increasing QRS and female sex carried adverse prognosis. ACEI, beta-blockers, nitrates, anti-thrombotic and lipid lowering drugs were associated with a better prognosis. On multivariable analysis the following provided independent prognostic information: increasing age (OR per SD=1.5, 95% CI 1.4-1.6), severe LVSD (1.8, 1.5-2.1), serum creatinine (1.2, 1.2-1.3), sodium (0.9, 0.8-0.9), Hb (0.9, 0.8-0.9) and treatment with ACEI (0.5, 0.5-0.6), beta-blockers (0.7, 0.6-0.8), statins (0.6, 0.5-0.7), calcium channel blockers (0.7, 0.6-0.8), warfarin (0.5, 0.4-0.6), heparin (1.7, 1.4-1.9), anti-platelet drugs (0.6, 0.5-0.6) and need for inotropes (5.5, 4.6-6.6). A simple risk score (range 0-11) identified cohorts with a 12 week mortality ranging from 2% to 44%. CONCLUSIONS Simple and readily available clinical variables and a risk score based on medical history and routine tests that all patients admitted with heart failure have, can identify patients with good, intermediate and high short term mortality.
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Martins E, Silva-Cardoso J, Bicho M, Bourbon M, Ceia F, Rebocho MJ, Moura B, Fonseca C, Correia MJ, Brito D, Perdigão C, Madeira H, Abreu-Lima C. Portuguese study of familial dilated cardiomyopathy: the FATIMA study. Rev Port Cardiol 2008; 27:1029-1042. [PMID: 19044174] [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: 05/27/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is a myocardial disease, characterized by ventricular dilatation and impaired systolic function, that in more than 30% of cases has a familial or genetic origin. Given its age-dependent penetrance, DCM frequently manifests in adults by signs or symptoms of heart failure, arrhythmias or sudden death. The predominant mode of inheritance is autosomal dominant, and in these cases mutations are identified in genes coding for cytoskeletal, sarcomeric or nuclear envelope proteins. To date, most studies aimed at molecular diagnosis of DCM have been in selected families, or in larger groups of patients, but screening for mutations in a limited number of genes. Consequently, the epidemiology of mutations in familial DCM remains unknown. There is thus a need for multicenter studies, involving screening for a wide range of mutations in several families and in cases of idiopathic DCM. The present article describes the methodology of a multicenter study, aimed at clinical and molecular characterization of familial DCM patients in the Portuguese population.
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Affiliation(s)
- Elisabete Martins
- Serviço de Cardiologia-Hospital de São João, Faculdade de Medicina do Porto, Porto, Portugal.
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Brito D, Richard P, Komajda M, Madeira H. Familial and sporadic hypertrophic myopathy: differences and similarities in a genotyped population. A long follow-up study. Rev Port Cardiol 2008; 27:147-173. [PMID: 18488914] [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: 05/26/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic disease associated with mutations in genes encoding cardiac sarcomere proteins. A mutation is identified in two-thirds of cases, and more frequently in familial forms. Doubts remain concerning the true identity of the sporadic form. OBJECTIVE To compare, in a genotyped population, the phenotypic expression of the disease over time in patients with familial and sporadic HCM. METHODS 79 patients with HCM, aged 39 +/- 17.8 years at diagnosis, were followed for 12 +/- 9.5 (1-30) years and divided into two groups: G1 (familial)--68 patients (24 unrelated index patients, 44 relatives), follow-up time (FUP) 12 +/- 9.8 (1-30) years; G2 (sporadic)1 index patients (no phenotypic disease in first-degree relatives), FUP 10.8 +/- 8 (2-24) years. Fabry disease was excluded in G2. The two groups were compared regarding clinical, ECG and echocardiographic (echo) features at diagnosis and after FUP. Five sarcomere genes (MYH7, MYBPC3, TNNT2, MYL2 and TNNI3) were screened for mutations by direct sequencing, after PCR amplification with intronic sets of oligonucleotide primers designed according to the published genomic sequence of the genes. RESULTS A) Thirteen different mutations (in 3 genes) were identified in 14 index patients in G1; only in one patient in G2 was a mutation found. B) The two groups differed clinically in age at diagnosis (G1: 37.18 (4-79) years; G2: 51 +/- 14 (19-67) years; p = 0.02), and family history of sudden cardiac death (G1: 12/24 families; G2: 1/11 families; p = 0.04). Age, gender, FUP, symptoms, need for medical treatment, cardiovascular (CV) hospitalization and mortality (CV or any cause) were similar. C) ECG patterns did not differ, although significant (but similar) changes occurred in 45% (G1) and 36% (G2) of patients (p = 0.75). These changes were in the same direction, with a trend in both groups toward the development of atrial fibrillation and/or advanced conduction disease. D) Echo features (only considered in adults) were similar despite significant changes during FUP (in 68% of G1, and 82% of G2; p = 0.48). These changes also followed the same tendency: progression to a more diffuse pattern of ventricular hypertrophy (G1: 52%; G2: 73%; p = 0.33) and development of left atrial dilatation (G1: 37%; G2: 45%; p = 0.52). CONCLUSIONS The similar phenotypic expression and behavior over time in familial and sporadic forms of HCM strongly indicate that the disease is one and the same. Differences in genetic findings, age at diagnosis and family history of sudden death suggest that sporadic forms may be caused by low penetrance de novo mutations in sarcomeric genes other than those associated with familial disease.
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Affiliation(s)
- Dulce Brito
- Clínica Universitária de Cardiologia, Faculdade de Medicina de Lisboa, Portugal.
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Miranda LC, Parente M, Silva C, Clemente-Coelho P, Santos H, Cortes S, Medeiros D, Ribeiro JS, Barcelos F, Sousa M, Miguel C, Figueiredo R, Mediavilla M, Simões E, Silva M, Patto JV, Madeira H, Ferreira J, Micaelo M, Leitão R, Las V, Faustino A, Teixeira A. [Perceived pain and weather changes in rheumatic patients]. Acta Reumatol Port 2007; 32:351-361. [PMID: 18159202] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Rheumatic patients with chronic pain describe in a vivid way the influence of climate on pain and disease activity. Several studies seem to confirm this association. OBJECTIVES To evaluate and compare in a population of rheumatic patients the perceived influence of weather changes on pain and disease activity METHODS This is a retrospective cross-sectional study. For three weeks an assisted self-reported questionnaire with nine dimensions and a VAS pain scale was performed on consecutive out-patients in our clinic. RESULTS 955 patients 787 female 168 male mean age 57.9 years with several rheumatologic diagnosis were evaluated. Overall 70 of the patients believed that the weather influenced their disease and 40 believed that the influence was high. Morning stiffness was influenced in 54 high influenced in 34 . Autumn and Winter were the most influential periods as well as humidity 67 and low temperatures 59 . CONCLUSION In our study as well as in literature we found that a high percentage of patients 70 perceived that weather conditions influenced their pain and disease. Fibromyalgia patients seemed to be strongly influenced by weather changes. Our study confirms that patients perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.
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Sargento L, Brito D, Matias JS, Madeira H. Evaluation of the clinical, hemodynamic and neurohormonal response to levosimendan administration in decompensated heart failure patients. One-month follow-up. Rev Port Cardiol 2007; 26:717-726. [PMID: 17939581] [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: 05/25/2023] Open
Abstract
INTRODUCTION Levosimendan is an inodilatory drug with hemodynamic effects in patients with decompensated chronic heart failure. AIM Short-term (one month) evaluation of clinical, hemodynamic and neurohormonal changes in patients with decompensated chronic heart failure undergoing levosimendan therapy. METHODS Twenty-six (21 male) consecutive patients were studied, corresponding to 32 levosimendan administrations (bolus + 24h infusion), aged 56.7+/-13.0 years, with decompensated chronic heart failure, in NYHA functional class III-IV (78.1% in class IV), and cardiac index (CI) <2.5 l/min/m2. Clinical (NYHA class), non-invasive hemodynamic (echocardiography) and neurohormonal (Elecsys ECLIA NT-ProBNP) evaluations were performed before levosimendan administration and on days 1, 4, 10 and 30. RESULTS 1) Until day 10, there was a progressive decrease in NT-ProBNP values and weight (p<0.001), with an increase in CI (p<0.001); 2) NYHA functional class improved progressively, with 76% of the patients in NYHA class II at day 30; 3) NT-ProBNP values at day 1 correlated inversely (r=-0.414; p=0.024) with CI at day 4; and 4) the absolute decrease in NT-ProBNP values at day 4 (relative to baseline values) correlated with weight loss at day 4 (r=0.495, p=0.005), day 10 (r=0.424, p=0.031) and day 30 (r=0.486, p=0.030). CONCLUSION Levosimendan therapy in patients with decompensated chronic heart failure contributes to progressive NYHA class improvement. The variations seen in NYHA class and hemodynamics was reflected in changes in NT-ProBNP.
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Affiliation(s)
- Luís Sargento
- Clínica Universitária de Cardiologia, Hospital de Santa Maria e Faculdade de Medicina de Lisboa, Lisboa, Portugal.
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Pereira da Silva E, Pedro MM, Varela MG, Cortez-Dias N, Bicho MP, Madeira H, Lopes MG. Heart rate and blood pressure in mitral valve prolapse patients: divergent effects of long-term propranolol therapy. Correlations with catecholamines. J Electrocardiol 2007. [DOI: 10.1016/j.jelectrocard.2007.03.174] [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: 10/23/2022]
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Madeira H. Diastolic heart failure: fact or myth? Rev Port Cardiol 2006; 25:883-6. [PMID: 17190238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
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Velavan P, Khan NK, Rigby AS, Goode K, Komajda M, Follath F, Swedberg K, Madeira H, Clark AL, Cleland JGF. Relation between severity of left ventricular systolic dysfunction and repolarisation abnormalities on the surface ECG: a report from the Euro heart failure survey. Heart 2006; 92:255-6. [PMID: 16415196 PMCID: PMC1860786 DOI: 10.1136/hrt.2005.061200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Brito D, Madeira H. Malignant mutations in hypertrophic cardiomyopathy: fact or fancy? Rev Port Cardiol 2005; 24:1137-46. [PMID: 16335287] [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: 05/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common genetic disease, generally with a benign prognosis. However sudden cardiac death may occur, sometimes as the first manifestation of the disease. More than two hundred different mutations have been described in HCM, in 12 different genes encoding sarcomere proteins. This genetic diversity is accompanied by considerable clinical variability and it is likely that phenotype is partially determined by genotype. In recent years it has been suggested that genetic defects could be the major markers of prognosis. Thus, some mutations would carry a good prognosis whereas others, so-called 'malignant' mutations, would be associated with premature sudden death. In a Portuguese population of 35 index patients with HCM the authors found considerable genetic heterogeneity: seven of the 12 mutations identified were de novo, each family having its own 'private' mutation. Moreover, in two unrelated families with the same mutation (I263T--exon 9, missense) in the beta-myosin heavy chain gene (MYH7), penetrance, clinical expression and prognosis were quite different, particularly regarding the occurrence of sudden cardiac death. In two other also unrelated families, in each index patient a different mutation was identified in the troponin I gene (TNNI3): A157V (missense), exon 7 and S199N (missense), exon 8. Phenotypic expression was different but both patients suffered sudden cardiac death (one survived). This suggests that mutations in this gene carry an adverse prognosis. In conclusion, the considerable genetic and clinical variability found in HCM hinders the interpretation of genotype-phenotype correlations, particularly since all the published data is based on small numbers of families.
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Affiliation(s)
- Dulce Brito
- Clínica Universitária de Cardiologia, Faculdade de Medicina de Lisboa Lisboa, Portugal
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Komajda M, Lutiger B, Madeira H, Thygesen K, Bobbio M, Hildebrandt P, Jaarsma W, Riegger G, Rydén L, Scherhag A, Soler-Soler J, Remme WJ. Tolerability of carvedilol and ACE-Inhibition in mild heart failure. Results of CARMEN (Carvedilol ACE-Inhibitor Remodelling Mild CHF EvaluatioN). Eur J Heart Fail 2004; 6:467-75. [PMID: 15182773 DOI: 10.1016/j.ejheart.2003.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [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] [Received: 10/10/2003] [Accepted: 12/10/2003] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Management guidelines for heart failure recommend ACE-I and beta-blockers. The perception of difficult up-titration might have added to the slow uptake of beta-blockers despite their mortality and morbidity benefits. AIMS CARMEN offered a possibility to study safety and tolerability of enalapril against carvedilol and their combination. METHODS Five hundred and seventy-two patients were blindly up-titrated on carvedilol (target 25 mg bid) and/or enalapril (target 10 mg bid), and continued for 18 months. In the combination arm, carvedilol was up-titrated before enalapril. RESULTS There was no group related difference in adverse events during up-titration. Withdrawal rates were 31, 30 and 30%, and serious adverse events 28, 29 and 34% in the combination, carvedilol and enalapril arms. Mortality was similar in all groups (all-cause N=14, 14 and 14; cardiovascular N=9, 13 and 14). All-cause and cardiovascular hospitalizations occurred in 26, 27 and 32%, and in 12, 16 and 22% in the combination, carvedilol and enalapril arms, respectively. CONCLUSION The safety profile was similar in all treatment arms. In contrast to common perception, there was no difference in tolerability between the ACE-I and carvedilol. This result is even more remarkable as the high prestudy use of ACE-I (65%) might have introduced a bias by selecting ACE-I tolerant patients, who were only switched from their former ACE-I to enalapril.
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Affiliation(s)
- Michel Komajda
- Institut de Cardiologie, Centre Hospitalier GH Pitié-Salpêtrière, 47-83 Bld de l'Hôpital, 75013, Paris Cedex 13, France.
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Madeira H. [Heart failure management: guidelines versus clinical practice]. Rev Port Cardiol 2004; 23 Suppl 3:III39-44. [PMID: 15526613] [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: 05/01/2023] Open
Abstract
In Europe the management of heart failure is largely conducted by primary care physicians and several reports have revealed differences between guidelines and actual practice. The IMPROVEMENT of Heart Failure project was designed to assess how patients with heart failure are managed by those physicians. Two surveys, the "perception survey" and the "actual practice survey" addressed to 1363 physicians, included questions on diagnosis, functional assessment and treatment. The major discrepancies found were: the lack of awareness about the concept of heart failure with preserved systolic function; the low number of echocardiograms requested; the low rate of prescription of beta-blocking agents and spironolactone; and the inappropriately low of angiotensine-converting enzyme inhibitors prescribed.
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Affiliation(s)
- Hugo Madeira
- Faculdade de Medicina de Lisboa, Cadeira de Medicina II Lisboa, Portugal.
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Brito D, Richard P, Isnard R, Pipa J, Komajda M, Madeira H. Familial hypertrophic cardiomyopathy: the same mutation, different prognosis. Comparison of two families with a long follow-up. Rev Port Cardiol 2003; 22:1445-61. [PMID: 15008060] [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: 04/29/2023] Open
Abstract
The gene encoding the beta-myosin heavy chain is one of the most frequently implicated in familial hypertrophic cardiomyopathy. Several mutations have been identified and some genotype-phenotype relationships have been assumed, particularly with regard to prognosis. Nevertheless, phenotypic expression is variable even in affected members of the same family carrying the same mutation. We identified the Ile263Thr mutation in several members of two unrelated Portuguese families. Penetrance, clinical behavior and prognosis were quite different between the two families, particularly concerning the occurrence of sudden death. Additional factors probably exist which account for the differences found. The complexity of hypertrophic cardiomyopathy makes it difficult to accurately determine genotype-phenotype relationships, and the screening and comparison of large affected families carrying the same mutation is warranted.
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Affiliation(s)
- Dulce Brito
- Serviço de Cardiologia do Hospital de Santa Maria, Lisboa, Portugal
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Brito D, Pedro M, Bordalo A, Orgando AL, Aguiar A, Gouveia R, Martins AP, Vagueiro MC, Madeira H. Dilated cardiomyopathy due to endocrine dysfunction. Rev Port Cardiol 2003; 22:377-87. [PMID: 12847879] [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: 03/03/2023] Open
Abstract
Dilated cardiomyopathy can be idiopathic or be caused by many potentially treatable conditions. We report a complex case of peripartum heart failure associated with hypothyroidism and hypoparathyroidism. Myocardial biopsy suggested that hypothyroidism was the main cause for the dilated pattern, but hypocalcemia played a critical role in acute decompensation of heart failure during hospitalization. After a long and clinically complicated hospital stay, correction of hypothyroidism and hypocalcemia resulted in near-normal cardiac function.
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Affiliation(s)
- Dulce Brito
- Serviço de Cardiologia e Ginecologia-Obstetrícia, Hospital de Santa Maria, Lisboa
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Komajda M, Madeira H, Thygesen K, Bobbio M, Jaarsma W, Riegger G, Soler-Soler J, Ryden L, Hildebrandt P, Lutiger B, Remme W. Carvedilol treatment is as well tolerated as angiotensin converting enzyme inhibition in patients with chronic heart failure: Results of the CARMEN (Carvedilol ACE inhibitor remodeling mild CHF evaluation) study. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81540-1] [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: 11/17/2022]
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Abstract
The prevalence of heart failure is increasing all over the world. It is a common and growing public health problem in Portugal as in many other European countries. This article provides a review of health service organization and current heart failure management in Portugal, discusses primary care and ward practices in different hospitals and reports on the use of proven standard therapies for the treatment of heart failure in the community. Despite major advances in diagnosis and treatment, heart failure is only satisfactorily managed. Furthermore efforts are necessary before the beneficial effects observed in trials have a real impact in clinical practice. A broader view and priority for the management of this syndrome on a national level are needed to improve the quality of heart failure care in Portugal.
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Affiliation(s)
- Cândida Fonseca
- Department of Internal Medicine, Hospital de S. Francisco Xavier, Lisboa, Portugal
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Ceia F, Fonseca C, Brito D, Madeira H. Heart failure treatment in Portuguese hospitals: results of a survey. Rev Port Cardiol 2001; 20:1259-66. [PMID: 11865686] [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: 02/23/2023] Open
Abstract
The management of heart failure in Europe is largely conducted by primary care physicians in out-patient clinics and by cardiologists and internists in hospitals. Several reports suggest differences among these specialists regarding knowledge and actual practice, and indicate that the application of guidelines is far from optimal. In order to look for differences between cardiologists and internists in terms of implementation of guidelines a survey was carried out among the directors of 83 hospital departments of cardiology and internal medicine in Portugal. The survey included questions about diagnostic and treatment protocols, special areas for management, and suggestions to improve the quality of heart failure patient treatment. The answers suggest that in Portuguese hospitals at least half of the patients with HF are treated by internists. Treatment protocols exist in about 25% of the cardiology departments but are virtually non-existent in internal medicine. The use and availability of echocardiography are high in cardiology but no more than reasonable in internal medicine. There are neither special in-hospital areas nor specialized nurses for the treatment of HF. Cardiologists recognize the need for greater specialization in this field--doctors, nurses and clinics--but this is not a priority for internists. An effort should be made to improve in-hospital HF treatment.
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Affiliation(s)
- F Ceia
- Serviço Universitário de Medicina I Faculdade de Ciências Médicas Universidade Nova de Lisboa E. Forte do Alto do Duque 1400 Lisboa, Portugal
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Macieira-Coelho E, Madeira H, Coelho P, Garcia-Alves M, Sobrinho L, Pádua F. Hypertrophic subaortic stenosis and hyperparathyroidism. Eur Heart J 1996; 17:1763-4. [PMID: 8922936 DOI: 10.1093/oxfordjournals.eurheartj.a014774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Metrass MJ, Brito D, de Lacerda AP, da Costa BB, de Pádua F, Madeira H. [Electrocardiographic changes after coronary angiography: effect of the contrast media used]. Rev Port Cardiol 1996; 15:639-45, 612. [PMID: 9081317] [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
UNLABELLED Prospective study to evaluate the influence of 2 different iodine contrasts (used in coronariography) on the electrocardiographic changes recorded after intra-coronary injection. MATERIAL AND METHODS Sixty-six patients (pts) - 50 men and 16 women - 59 +/- 4 years underwent coronariography to confirm and/or evaluate coronary artery disease (CAD). Group I (33 pts) received a hyperosmolar contrast; group II received a low osmolarity contrast. The electrocardiograms were recorded during and until 20 seconds after intra-coronary injection, in standard leads and V5. Tracings were analysed regarding the development of: arhythmias, mean axis deviation and QRS enlargement - type A abnormalities; ventricular repolarization (ST/T) changes - type B abnormalities. ECG changes were compared with: 1. contrast used; 2. presence (or absence) of CAD; 3. correlation between type B abnormalities and the arteries affected. RESULTS 1. a) Twenty nine pts (88%) of group I had A and/or B electrocardiographic changes, compared with 16 (48%) of group II (p < 0.01). b) There were type A changes in 13 pts of group I (39%) versus 3 pts (9%) of group II (p < 0.01). c) Type B changes were present in 25 pts (76%) of group I and in 20 pts (60%) of group II (p-NS). 2. a) Type A abnormalities were recorded in 13 of 48 pts with CAD (27%) against 3 of 18 (17%) cases with normal coronariography (p-NS). b) Type B abnormalities were present in 30 of 48 pts (63%) with CAD and in 10 of 18 cases (56%) of people with normal coronariography (p-NS). 3. In 21 pts with isolated right (or left) CAD, contrast injection in the right coronary artery induced type B ECG changes on the homo-lateral supplied territory in 14 cases, no change at all in 4 cases and changes in the contra-lateral area in only 3 pts. Injections in the left coronary artery produced similar results. CONCLUSIONS 1. Hyperosmolar contrast produced significantly more electrocardiographic abnormalities, mainly type A, than low osmolarity contrast. This one may be, therefore, preferable. 2. Both types of electrocardiographic changes were equally recorded in pts with CAD and in people with normal coronariography. 3. Type B changes seem to be related with the location of the injection, irrespective of the presence or absence of coronary artery disease.
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Affiliation(s)
- M J Metrass
- Serviço de Medicina IV, Hospital de Santa Maria, Lisboa
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Brito D, Pedro M, Metrass MJ, de Pádua F, Madeira H. [Chronic heart failure: diastolic dysfunction versus systolic dysfunction]. Rev Port Cardiol 1995; 14:741-4. [PMID: 7492409] [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: 01/25/2023] Open
Affiliation(s)
- D Brito
- Serviço de Medicina IV, Hospital de Santa Maria, Lisboa
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Conduto R, Dos Santos JN, Brito D, Madeira H. [Whipple's disease]. ACTA MEDICA PORT 1992; 5:499-502. [PMID: 1282766] [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
The authors describe a case of Whipple's disease, characterized by arthralgias, chronic diarrhea and weight loss. The diagnosis was established on clinical, laboratorial and radiological grounds and confirmed histologically, through a duodenal biopsy. Rapid improvement occurred, soon after the beginning of antibiotic therapy.
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Affiliation(s)
- R Conduto
- Serviço de Medicina IV, Hospital de Santa Maria/Faculdade de Medicina de Lisboa
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Branco LM, Quininha J, Roquette J, Madeira H, Coelho EM, Bento R, Rato JA. [Hypertrophic non-obstructive cardiomyopathy associated with interauricular communication. Report of a case]. Rev Port Cardiol 1990; 9:449-53. [PMID: 2206590] [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: 12/30/2022] Open
Abstract
It is unusual the association between hypertrophic cardiomyopathy and atrial septal defect. We present in this paper the results of the tests done to one patient with these two diseases and profit to make an update of the bibliography on this subject.
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Affiliation(s)
- L M Branco
- Serviço de Cardiologia do Hospital de Santa Marta
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Macieira-Coelho E, Brito D, Madeira H. [Immunosuppression therapy in peripartum myocardiopathy]. ACTA MEDICA PORT 1990; 3:34-8. [PMID: 2333776] [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]
Abstract
The dramatic clinical recuperation of a thirty years old, Caucasian female, with peripartum cardiomyopathy, treated with azathioprine and prednisolone, is described. The maintenance of the same degree of ventricular dilatation and fractional shortening (14%) on serial echocardiograms inspite of complete regression of cardiac congestion was the most intriguing feature of this clinical case.
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Carvalho M, Brito D, de Lacerda AP, Madeira H. [Maximal values of serum creatine phosphokinase and its myocardial fraction in acute myocardial infarct. Correlation with a previous history of ischemic cardiopathy]. Rev Port Cardiol 1990; 9:25-9. [PMID: 2328136] [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
OBJECTIVE To evaluate the importance of preinfarction angina as a determinant of infarct size. DESIGN Retrospective study of patients (pts) with acute myocardial infarction (AMI). SETTING Patients admitted to an Intensive Care Unit of a University Hospital. PATIENTS The study concerns 224 pts, 161 men women, aged 63.09 +/- 11.92 years, who did not receive thrombolytic or intravenous beta-blocking therapy and in whom it was possible to establish the presence or absence, of previous ischemic heart disease. METHODS Patients, were divided in 2 groups: A (1st AMI, 172 dts - 123 M, 49 F) and B (2nd AMI, 52 dts - 38 M, 14 F). These groups were subdivided according the presence of preinfarction angina (A1, B1) or its absence (A2, B2). The infarct size was evaluated by peak values of CK/CKMB. RESULTS Group A: CK/CKMB--959/101; Group B: CK/CKMB--742/77 (p-NS). Subgroups--A1: CK/CKMB--1143/118; A2: CK/CKMB--725/78 (p less than 0.001); B1: CK/CKMB--635/59; B2: CK/CKMB--818/88 (p-NS). The analysis of CK/CKMB values distribution, according to the affected cardiac wall, has shown an identical correlation. CONCLUSION 1--The larger infarct size in subgroup A1 (1st AMI without angina) suggests a protective effect by collateral circulation in subgroup A2 (1st AMI with angina). 2--The larger infarction (although not significantly) in group A (1st AMI), correlates with less viable muscle in group B (2nd AMI). 3--The higher values of CK/CKMB in group B2 (2nd AMI with angina) can be expected given the presence of residual ischemia. 4--The absence of the protective role by collateral circulation in patients of subgroup A1 (1st AMI without angina) suggests for them a stronger indication for thrombolytic therapy.
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Affiliation(s)
- M Carvalho
- Serviço de Medicina IV, Hospital de Santa Maria
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Brito D, Madeira H. [Indications and limitations of echocardiography in evaluating aortic valve insufficiency]. Rev Port Cardiol 1989; 8:607-13. [PMID: 2698720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Echocardiography (Echo) is the best non-invasive technique to study aortic regurgitation (AR). The authors (AA) start reviewing the place of M-Mode (MM) and two-dimensional (2D) Echo on the identification of AR and its cause, as well as on the assessment of left ventricular function. Secondly, the AA study the role of Doppler (Dp) techniques--pulsed (PDp), continuous (CDp) and colour coded (CCDp)--analysing their relative advantages and complementarity. They conclude that AR is best identified by PDp and MM Echo, its cause may be recognized by MM and 2D Echo, and its importance is correctly judged by CDp and CCDp Echo. Left ventricular function is best appreciated by 2D Echo, helped by CDp and CCDp Echo. The AA also state that, in AR, an haemodynamic study is injustifiable, unless Echo is technically incomplete, there is pluri-valvular disease insufficiently clarified, or coronarography is necessary.
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Abstract
Forty patients, 30 men and 10 women with an average age of 38.47 +/- 11.07 years, suffering from ankylosing spondylitis and attending a Rheumatology Outpatient Clinic, were evaluated for cardiovascular involvement. The evaluation was based on patients' clinical observation, electrocardiography, echocardiography, and chest x-ray. More than a simple review, this study was undertaken with the aim of arriving at a better clinical definition of the cardiovascular manifestations found in ankylosing spondylitis. In fact, of the 40 patients, 8 (20%) had systemic hypertension for which an explanation could not be found, 4 of whom were less than forty-five years old; the echocardiogram showed mitral valve prolapse in 4 patients (10%), 2 of them with a systolic murmur and other 2 with a protosystolic click on auscultation. More significant than the changes in conduction was the finding of a sinus bradycardia in 9 patients (22.5%), and a PR interval below 120 msec in 3 patients (7.5%). The authors conclude that the extension of cardiovascular changes in ankylosing spondylitis is more vast than usually acknowledged.
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Affiliation(s)
- M G Alves
- Department of Cardiology, Sta. Maria University Hospital, Lisbon, Portugal
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