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Aguiar-Neves I, Carvalho AS, Diaz SO, Silva MR, Silva GS, Teixeira R, Fernandes SL, Cruz I, Almeida JG, Fonseca P, Oliveira M, Gonçalves H, Saraiva F, Barros AS, Ferreira N, Sampaio F, Primo J, Fontes-Carvalho R. Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation. Int J Cardiol 2024:132161. [PMID: 38744339 DOI: 10.1016/j.ijcard.2024.132161] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/29/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume (CATV) was not associated with increased LR risk. CONCLUSIONS Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.
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Affiliation(s)
| | - Augusto Sá Carvalho
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | | | | | | | - Inês Cruz
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | | | | | | | - Francisca Saraiva
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | - Francisco Sampaio
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Primo
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE
| | - Ricardo Fontes-Carvalho
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Martinho M, Machado B, Cruz I, Fernandes I, Pereira H. The challenging approach of a young patient with a primary intimal sarcoma of the heart: a case report. Eur Heart J Case Rep 2024; 8:ytae071. [PMID: 38374987 PMCID: PMC10875919 DOI: 10.1093/ehjcr/ytae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/04/2023] [Revised: 10/14/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
Background Primary intimal sarcomas of the heart are extremely rare and have a dismal prognosis. Their management represents a complex clinical challenge since complete surgical resection is the only reliable possibility of cure but is only possible in 50% of patients. In non-resectable disease, anthracycline-based therapy is the most effective treatment, but pazopanib may be used in patients unfit to receive anthracyclines. Case summary A 38-year-old man presented with acute right heart failure symptoms due to a primary intimal sarcoma of the heart. A definite diagnosis was made after cardiac surgery. Multi-modality cardiac imaging showed early recurrence of disease with mitral valve and pulmonary veins' invasion, and the patient was deemed inoperable. Due to chronic kidney disease and previous heart failure symptoms, he was started on first-line pazopanib palliative treatment. After 11 months of chemotherapy, there was good clinical tolerance and no evidence of disease progression, which occurred after 13 months. Discussion This case highlights the value of a multi-modality imaging approach for cardiac masses. Most importantly, it reports the successful treatment of a young patient with a primary intimal sarcoma of the heart who was started on palliative pazopanib, with a significantly higher progression-free survival than is reported in the literature. This finding may support pazopanib as a good alternative as first-line treatment when there is contraindication for anthracycline-based chemotherapy.
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Affiliation(s)
- Mariana Martinho
- Serviço de Cardiologia, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada 2805-267, Portugal
| | - Bárbara Machado
- Serviço de Oncologia Médica, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Inês Cruz
- Serviço de Cardiologia, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada 2805-267, Portugal
| | - Isabel Fernandes
- Serviço de Oncologia Médica, Hospital CUF Descobertas, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada 2805-267, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Centro Académico Médico de Lisboa, Universidade de Lisboa, Lisboa, Portugal
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Vale N, Ribeiro E, Cruz I, Stulberg V, Koksch B, Costa B. New Perspective for Using Antimicrobial and Cell-Penetrating Peptides to Increase Efficacy of Antineoplastic 5-FU in Cancer Cells. J Funct Biomater 2023; 14:565. [PMID: 38132819 PMCID: PMC10744333 DOI: 10.3390/jfb14120565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
This study explores the effectiveness of the antineoplastic agent 5-FU in cancer cells by leveraging the unique properties of cationic antimicrobial peptides (CAMPs) and cell-penetrating peptides (CPPs). Traditional anticancer therapies face substantial limitations, including unfavorable pharmacokinetic profiles and inadequate specificity for tumor sites. These drawbacks often necessitate higher therapeutic agent doses, leading to severe toxicity in normal cells and adverse side effects. Peptides have emerged as promising carriers for targeted drug delivery, with their ability to selectively deliver therapeutics to cells expressing specific receptors. This enhances intracellular drug delivery, minimizes drug resistance, and reduces toxicity. In this research, we comprehensively evaluate the ADMET (absorption, distribution, metabolism, excretion, and toxicity) properties of various AMPs and CPPs to gain insights into their potential as anticancer agents. The peptide synthesis involved a solid-phase synthesis using a Liberty Microwave Peptide Synthesizer. The peptide purity was confirmed via LC-MS and HPLC methods. For the ADMET screening, computational tools were employed, assessing parameters like absorption, distribution, metabolism, excretion, and toxicity. The cell lines A549 and UM-UC-5 were cultured and treated with 5-FU, CAMPs, and CPPs. The cell viability was measured using the MTT assay. The physicochemical properties analysis revealed favorable drug-likeness attributes. The peptides exhibited potential inhibitory activity against CYP3A4. The ADMET predictions indicated variable absorption and distribution characteristics. Furthermore, we assessed the effectiveness of these peptides alone and in combination with 5-FU, a widely used antineoplastic agent, in two distinct cancer cell lines, UM-UC-5 and A549. Our findings indicate that CAMPs can significantly reduce the cell viability in A549 cells, while CPPs exhibit promising results in UM-UC-5 cells. Understanding these multifaceted effects could open new avenues for antiviral and anticancer research. Further, experimental validation is necessary to confirm the mechanism of action of these peptides, especially in combination with 5-FU.
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Affiliation(s)
- Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal; (E.R.); (I.C.); (B.C.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Eduarda Ribeiro
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal; (E.R.); (I.C.); (B.C.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Inês Cruz
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal; (E.R.); (I.C.); (B.C.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Valentina Stulberg
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Arnimallee 20, 14195 Berlin, Germany; (V.S.); (B.K.)
| | - Beate Koksch
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Arnimallee 20, 14195 Berlin, Germany; (V.S.); (B.K.)
| | - Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal; (E.R.); (I.C.); (B.C.)
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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Cardoso I, Viegas JM, Rosa SA, Brás PG, Grazina A, Cruz I, Branco LM, Galrinho A, Fiarresga A, Lopes LR, Ferreira RC. Three-dimensional echocardiography for the evaluation of hypertrophic cardiomyopathy patients: relation to symptoms and exercise capacity. Int J Cardiovasc Imaging 2023; 39:2475-2481. [PMID: 37821713 PMCID: PMC10691975 DOI: 10.1007/s10554-023-02952-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Patients with hypertrophic cardiomyopathy may exhibit impaired functional capacity, associated with increased morbidity and mortality. Systolic function is one of the determinants of functional capacity. Early identification of systolic disfunction may identify patients at risk for adverse outcomes. Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to assess left ventricular systolic function, and are often abnormal before a decline in ejection fraction is seen. The aim of this study was to evaluate the correlation between myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with hypertrophic cardiomyopathy. Seventy-four hypertrophic cardiomyopathy adult patients were prospectively evaluated. All patients underwent a dedicated 2D and 3D echocardiographic examination and cardiopulmonary exercise testing (CPET). Values of 3D global radial (GRS), longitudinal (3DGLS) and circumferential strain (GCS) were overall reduced in our population: 99% (n = 73) of the patients had reduced GLS, 82% (n = 61) had reduced GRS and all patients had reduced GCS obtain by 3DSTE. Average peak VO2 was 21.01 (6.08) ml/Kg/min; 58% (n = 39) of the patients showed reduced exercise tolerance (predicted peak VO2 < 80%). The average VE/VCO2 slope was 29.0 (5.3) and 16% (n = 11) of the patients had impaired ventilatory efficiency (VE/VCO2 > 34). In multivariable analysis, 3D GLS (β1 = 0.10, 95%CI: 0.03;0.23, p = 0.014), age (β1 = -0.15, 95%CI: -0.23; -0.05, p = 0.002) and female gender (β1 = -5.10, 95%CI: -7.7; -2.6, p < 0.01) were independently associated with peak VO2. No association was found between left ventricle ejection fraction obtain and peak VO2 (r = 0.161, p = 0.5). Impaired myocardial deformation parameters evaluated by 3DSTE were associated with worse functional capacity assessed by peak VO2.
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Affiliation(s)
- Isabel Cardoso
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal.
| | - José Miguel Viegas
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Sílvia Aguiar Rosa
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Pedro Garcia Brás
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - André Grazina
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Inês Cruz
- Hospital Garcia de Orta, Almada, Portugal
| | - Luísa Moura Branco
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Ana Galrinho
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - António Fiarresga
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
| | - Luís R Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre, St Bartholomew´s Hospital, London, UK
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Rui Cruz Ferreira
- Department of Cardiology, Santa Marta Hospital, Rua de Santa Marta, n.50, Lisbon, 1169-024, Portugal
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Queirós C, Paiva E Silva MATC, Gomes J, Neves H, Cruz I, Brito A, Cardoso A, Pereira F. Self-care nursing interventions: A qualitative study into electronic health records' contents. Int Nurs Rev 2023; 70:383-393. [PMID: 36639928 DOI: 10.1111/inr.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/24/2022] [Indexed: 01/15/2023]
Abstract
AIMS This study aims to (1) analyse all self-care-related interventions Portuguese nurses documented, (2) determine potential issues that may impair semantic interoperability and (3) propose a new set of interventions representing nursing actions regarding self-care that may integrate any HER application. BACKGROUND As populations age and chronic diseases increase, self-care concerns rise. Individuals who seek healthcare, regardless of context, need prompt access to accurate health information. Healthcare professionals need to understand the information in all places where care is provided, creating the need for semantic interoperability within electronic health records. METHODS A qualitative descriptive and exploratory study was conducted in two phases: (1) a content analysis of nursing interventions e-documentation and (2) a focus group with fifteen registered nurses exploring latent criteria or insights gleaned from the findings of content analysis. The COREQ statement was used to guide research reporting. RESULTS We extracted 1529 nursing intervention sentences from the electronic health records and created 209 intervention categories. We identified the main issues with semantic interoperability in nursing intervention identification. CONCLUSION According to the findings, nurses cooperate with clients, offering physical aid and encouraging them to overcome functional limitations to self-care tasks hampered by their conditions. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY This article provides evidence to warn policy makers against decisions to use locally customised electronic health records, as well as evidence on the importance of policy promoting the adoption of a nursing ontology for electronic health records. And, as a result, the harmonisation and effective provision of high-quality nursing care and the reduction of healthcare costs across nations.
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Affiliation(s)
- Carmen Queirós
- PhD student, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Invited Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
- Researcher, Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School (ESEnfC), Coimbra, Portugal
| | - Maria Antónia Taveira Cruz Paiva E Silva
- Assistant Professor, Nursing School of Porto, Porto, Portugal
- Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
| | - João Gomes
- PhD student, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Invited Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
| | - Hugo Neves
- Invited Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
- Researcher, Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School (ESEnfC), Coimbra, Portugal
- PhD student, Universidade Católica Portuguesa, Institute of Health Sciences, Porto, Portugal
- Assistant Professor, Nursing School of Coimbra, Coimbra, Portugal
| | - Inês Cruz
- PhD student, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Assistant Professor, Nursing School of Porto, Porto, Portugal
- Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
| | - Alice Brito
- Assistant Professor, Nursing School of Porto, Porto, Portugal
- Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
| | - Alexandrina Cardoso
- Assistant Professor, Nursing School of Porto, Porto, Portugal
- Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
| | - Filipe Pereira
- Assistant Professor, Nursing School of Porto, Porto, Portugal
- Researcher, CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Nursing School of Porto, Porto, Portugal
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Fernandes S, Cruz I, Faria R, Almeida J, Fonseca P, Ferreira N, Primo JJ, Fontes-Carvalho R, Ladeiras-Lopes R. Impact of Coronary Artery Calcium Score Screening on Cardiovascular Risk Stratification of Patients with Atrial Fibrillation Undergoing Ablation. Cardiology 2023; 148:427-433. [PMID: 37487471 DOI: 10.1159/000532018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/03/2022] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION There is a well-established association between atrial fibrillation (AF) and coronary artery disease. Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular (CV) risk stratification and inform on the best strategies for primary CV prevention. This study aims to evaluate the impact of opportunistic screening with CACS on risk stratification and decision of preventive therapies, in patients with AF. METHODS Cross-sectional study including patients with AF or atrial flutter undergoing cardiac computed tomography for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. CACS was assessed in patients without coronary artery disease using the Agatston method. RESULTS A total of 474 patients were included (93% with AF, mean age of 58 ± 10 years, 62% male). CACS >0 was present in 254 (54%) patients. According to CACS and the Society of Cardiovascular Computed Tomography recommendations, 25% of the patients would be candidates for statin therapy and 17% would be candidates for changes in the current statin intensity; in 11 patients (8%), acetylsalicylic acid would be recommended. CONCLUSION In our study, more than half of the patients undergoing cardiac computed tomography before AF catheter ablation had CACS above zero. Our findings suggest that an opportunistic evaluation of CACS at the time of ablation can be an important tool to improve CV risk stratification, with important clinical and therapeutic implications.
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Affiliation(s)
- Sara Fernandes
- Department of Cardiology, Leiria Hospital Centre, Leira, Portugal
| | - Inês Cruz
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rita Faria
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - João Almeida
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - João José Primo
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
- Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Gaia Hospital Centre, Vila Nova de Gaia, Portugal
- Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Garcia Brás P, Rosa SA, Cardoso I, Branco LM, Galrinho A, Gonçalves AV, Thomas B, Viegas JM, Fiarresga A, Branco G, Pereira R, Selas M, Silva F, Cruz I, Baquero L, Ferreira RC, Lopes LR. Microvascular Dysfunction Is Associated With Impaired Myocardial Work in Obstructive and Nonobstructive Hypertrophic Cardiomyopathy: A Multimodality Study. J Am Heart Assoc 2023; 12:e028857. [PMID: 37066817 DOI: 10.1161/jaha.122.028857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Two-dimensional speckle tracking echocardiography has been shown to correlate with microvascular dysfunction, a hallmark of hypertrophic cardiomyopathy (HCM). We hypothesized that there is an association between myocardial work and left ventricular ischemia, with incremental value to global longitudinal strain, in patients with HCM. Methods and Results We performed a prospective assessment of patients with HCM, undergoing 2-dimensional speckle tracking echocardiography and stress perfusion cardiac magnetic resonance. Results were stratified according to obstructive or nonobstructive HCM and the presence of significant replacement fibrosis (late gadolinium enhancement ≥15% of left ventricular mass). Seventy-five patients with HCM (63% men, age 55±15 years) were evaluated, 28% with obstructive HCM (mean gradient 89±60 mm Hg). Perfusion defects were found in 90.7%, involving 22.5±16.9% of left ventricular mass, and 38.7% had late gadolinium enhancement ≥15%. In a multivariable analysis, a lower global work index (r=-0.519, β-estimate -10.822; P=0.001), lower global work efficiency (r=-0.379, β-estimate -0.123; P=0.041), and impaired global constructive work (r=-0.532, β-estimate -13.788; P<0.001) significantly correlated with ischemia. A segmental analysis supported these findings, albeit with lower correlation coefficients. A global work index cutoff ≤1755 mm Hg% was associated with hypoperfusion with a sensitivity of 88% and a specificity of 71%, while the best cutoff for global longitudinal strain (>-15.5%) had a sensitivity of 64% and a specificity of 57%. The association between myocardial work and perfusion defects was significant independently of late gadolinium enhancement ≥15% and obstructive HCM. Conclusions Impaired myocardial work was significantly correlated with the extent of ischemia in cardiac magnetic resonance, independently of the degree of left ventricular hypertrophy or fibrosis, with a higher predictive power than global longitudinal strain.
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Affiliation(s)
| | - Sílvia Aguiar Rosa
- Department of Cardiology Santa Marta Hospital Lisbon Portugal
- Heart Center, Red Cross Hospital Lisbon Portugal
| | - Isabel Cardoso
- Department of Cardiology Santa Marta Hospital Lisbon Portugal
| | | | - Ana Galrinho
- Department of Cardiology Santa Marta Hospital Lisbon Portugal
| | | | - Boban Thomas
- Heart Center, Red Cross Hospital Lisbon Portugal
| | | | | | | | | | - Mafalda Selas
- Department of Cardiology Santa Marta Hospital Lisbon Portugal
| | - Filipa Silva
- Department of Cardiology Santa Marta Hospital Lisbon Portugal
| | - Inês Cruz
- Hospital Garcia de Orta Almada Portugal
| | - Luís Baquero
- Heart Center, Red Cross Hospital Lisbon Portugal
| | | | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre St Bartholomew's Hospital London UK
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science University College London London UK
- Cardiovascular Centre University of Lisbon, Cidade Universitária, Alameda da Universidade Lisbon Portugal
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Cruz I, Lopes Fernandes S, Diaz SO, Saraiva F, Barros AS, Primo J, Sampaio F, Ladeiras-Lopes R, Fontes-Carvalho R. El tejido adiposo epicárdico no es un predictor independiente de recurrencia de fibrilación auricular tras ablación con catéter. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.11.006] [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: 03/16/2023]
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Lopes Fernandes S, Ladeiras-Lopes R, Silva M, Silva G, Cruz I, Diaz SO, Barros AS, Saraiva F, Faria R, Almeida J, Fonseca P, Gonçalves H, Oliveira M, Ferreira N, Primo J, Fontes-Carvalho R. Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablation. J Cardiovasc Comput Tomogr 2023; 17:22-27. [PMID: 36372722 DOI: 10.1016/j.jcct.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/25/2022] [Revised: 10/04/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Coronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation. METHODS Retrospective study of patients with AF undergoing cardiac computed tomography (CCT) before ablation (2017-2019). Patients with coronary artery disease (CAD), significant valvular heart disease and previous catheter ablation were excluded. A cut-off of CACS ≥ 100 was used according to literature. RESULTS A total of 311 patients were included (median age 57 [48, 64] years, 65% men and 21% with persistent AF). More than half of the patients had a CACS > 0 (52%) and 18% a CACS ≥ 100. Patients with CACS ≥ 100 were older (64 [59, 69] vs 55 [46, 63] years, p < 0.001), had more frequently hypertension (68% vs 42%, p < 0.001) and diabetes mellitus (21% vs 10%, p = 0.020). During a median follow-up of 34 months (12-57 months), 98 patients (32%) had AF recurrence. CACS ≥ 100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 2.0; 95% confidence interval [CI], 1.3-3.1, p = 0.002). After covariate adjustment, CACS ≥ 100 and persistent AF remained independent predictors of AF recurrence (HR, 1.7; 95% CI, 1.0-2.8, p = 0.039 and HR, 2.0; 95% CI, 1.3-3.2, p = 0.004, respectively). CONCLUSION An opportunistic evaluation of CACS could be an important tool to improve clinical care considering that CACS ≥ 100 was independently associated with a 69% increase in the risk of AF recurrence after first catheter ablation.
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Affiliation(s)
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Mariana Silva
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Gualter Silva
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Inês Cruz
- Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Rita Faria
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - João Almeida
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Helena Gonçalves
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - João Primo
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Gaia Hospital Centre, 4434-502 Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
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Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Cruz I, Lopes Fernandes S, Diaz SO, Saraiva F, Barros AS, Primo J, Sampaio F, Ladeiras-Lopes R, Fontes-Carvalho R. Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation. Rev Esp Cardiol (Engl Ed) 2022:S1885-5857(22)00315-2. [PMID: 36442797 DOI: 10.1016/j.rec.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Previous studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. METHODS A total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. RESULTS After a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). CONCLUSIONS EAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation.
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Affiliation(s)
- Inês Cruz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sílvia O Diaz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Primo
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Ladeiras-Lopes
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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12
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Braganca B, Oliveira I, Cruz I, Lopes RG, Queiros C, Pinto P, Andrade A. The workload-indexed blood pressure response predicts cardiovascular events and all-cause mortality in coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2259] [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
Abnormal blood arterial pressure response to exercise (BPR) is a cardiovascular (CV) risk factor (CVRF). The concept of pathological BPR, believed to be an excessive raise or decrease, has been challenged. The workload-indexed blood pressure response (WBPR) recently emerged in an attempt to normalize hypertensive responses to exercise. However, it remains to be explored its value in high-risk CV subjects.
Purpose
Evaluation of the predictive value of WBPR in the occurrence of CV events and death in coronary artery disease (CAD) patients.
Methods
A cohort of 318 patients with known CAD, who underwent Bruce protocol treadmill testing between 2009–2010, were retrospectively followed to 11/2021 (9.9±2.3 years) to assess the predictive value of WBPR for the occurrence of death and CV events. The WBPR is the ratio between systolic blood pressure variation from rest to peak exercise (ΔSBP) and metabolic equivalent of task (MET-1). High and low WBPR groups were created based on median value for this sample (5.2 mmHg/MET). Data presented: mean ± standard deviation; 95% confidence interval (CI) for hazard ratios (HR); significance between groups p<0.05.
Results
Low vs high WBPR groups were similar at baseline for sex (88% male, p=0.67), hypertension (63%, p=0.18), diabetes (32%, p=0.34); dyslipidemia (72%, p=0.62), myocardial infarction (75%, p=0.39) and heart failure (HF) (9.9%, p=0.07), with exception for overweight/obesity (90% vs 82%, p=0.009) and age (57±11 vs 61±8 years, p=0.009) that were higher in the high-WBPR group. No significant differences were found between groups for medication at baseline, including anti-hypertensive, anti-thrombotic or anti-ischemic drugs. In the follow-up period occurred 43 deaths (12 CV deaths), 58 reinfarctions, 94 worsening/de novo HF and 29 strokes. A non-linear J-shaped relationship was observed between WBPR and most events. In the event-free survival analyses using Cox regression, the high-WBPR group was associated with all death (HR 2.0 (CI 1.0–3.9, p=0.042), reinfarction (HR 2.3 (CI 1.2–4.1, p=0.008), and worsening/de novo HF (HR 1.7 (CI 1.0–2.9, p=0.043) after adjusting for baseline age, CVRFs and medication. In receiver operating characteristic curves, adding WBPR to a model with other cardiac stress variables (double product, ST-T changes, symptoms, and test positivity) significantly improved the power to predict all death, with an area under curve of 0.73 (CI 0.66–0.80, p=0.037).
Conclusions
Data shows that WBPR is a powerful independent predictor of future cardiovascular events and deaths in CAD patients. This highlights cardiac exercise stress testing as an important risk assessment tool in secondary prevention of cardiovascular disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Braganca
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - I Oliveira
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - I Cruz
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - R G Lopes
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - C Queiros
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - P Pinto
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
| | - A Andrade
- Hospital Centre do Tamega e Sousa , Penafiel , Portugal
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Garcia Brás P, Aguiar Rosa S, Thomas B, Fiarresga A, Cardoso I, Pereira R, Branco G, Cruz I, Baquero L, Cruz Ferreira R, Mota Carmo M, Rocha Lopes L. Associations between perfusion defects, tissue changes and myocardial deformation in hypertrophic cardiomyopathy, uncovered by a cardiac magnetic resonance segmental analysis. Rev Port Cardiol 2022; 41:559-568. [DOI: 10.1016/j.repc.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
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Fernandes S, Cruz I, Ladeiras-Lopes R, Diaz S, Silva M, Barros A, Saraiva F, Faria R, Almeida J, Fonseca P, Goncalves H, Oliveira M, Ferreira N, Primo J, Fontes-Carvalho R. Role of epicardial adipose tissue volume as predictor of atrial fibrillation recurrence. Europace 2022. [DOI: 10.1093/europace/euac053.146] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Several studies have demonstrated the relation between general obesity and atrial fibrillation (AF). Epicardial adipose tissue (EAT), due to its local paracrine effect and the intimate relation with the atrium, could influence AF recurrence rates, but very few studies have explored this association.
Purpose
In this study we aimed to evaluate if EAT could be a predictor of AF recurrence after an AF ablation procedure.
Methods
We included all consecutive patients submitted to AF ablation (2017-2019) who performed a computed tomography scan prior to the procedure. EAT volume was semi-automatically reconstructed by manually tracing the pericardium. Adipose tissue was defined in the range between -150 and -50 Hounsfield units. Recurrence was defined as any documented (ECG/Holter) episode of AF, atrial flutter or atrial tachycardia after 3 months of the procedure. Logistic regression with a restricted cubic polynomial transformation was used to model the non-linear relationship between recurrence and EAT volumes. Inspection of the partial effect curves suggested that a cutoff for EAT volume ≥80mL could stratify patients at risk of recurrence and a Time-to-event analysis was carried.
Results
A total of 354 patients (66% male, median age 57 years [IQR 48–65] and 21% persistent AF) were included. During a median follow-up of 34 months [IQR 24-43], 117 patients (33%) had AF recurrence. These patients had a significantly greater EAT volume (76 mL [IQR 55-111] vs 72 mL [IQR 48-95], p=0.03) when compared to those without recurrence. Also, patients with higher EAT volume (≥ 80mL) had a higher risk of recurrence compared to patients with lower volume (Figure 1, log-rank test p=0.007). After adjusting for clinical risk factors (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atrial enlargement), higher EAT volume did not remain an independent predictor of AF recurrence (Figure 2, HR 1.25 [95% CI, 0.83-1.86] p=0.3).
Conclusion
In this cohort of patients with AF submitted to catheter ablation, EAT volume ≥80mL was associated with increased risk of AF recurrence. However, it was not an independent predictor of AF recurrence after adjustment to clinical risk factors.
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Affiliation(s)
| | - I Cruz
- Faculty of Medicine University of Porto, Porto, Portugal
| | - R Ladeiras-Lopes
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Diaz
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - M Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Barros
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - F Saraiva
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - R Faria
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - H Goncalves
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Oliveira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - N Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Fernandes S, Ladeiras-Lopes R, Cruz I, Silva G, Diaz S, Barros A, Saraiva F, Faria R, Almeida J, Fonseca P, Goncalves H, Oliveira M, Ferreira N, Primo J, Fontes-Carvalho R. Higher coronary calcium score is associated with increased risk of atrial fibrillation recurrence. Europace 2022. [DOI: 10.1093/europace/euac053.140] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients with atrial fibrillation (AF) referred for catheter ablation routinely undergo cardiac computed tomography (CCT) for procedure planning. An opportunistic evaluation of coronary artery calcium score (CACS) can be an important tool to improve clinical care. It is already known that CACS is associated with a high risk of AF development, particularly if values are above 100, but few data are available regarding the impact of CACS in AF recurrence after ablation.
Purpose
To assess the impact of CACS on atrial fibrillation recurrence following catheter ablation.
Methods
Retrospective, single-centre cohort study of consecutive patients with AF undergoing CCT for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. Patients with known history of coronary artery disease (CAD) and moderate to severe valvular heart disease were excluded. CACS was assessed using the Agatston method. Recurrence was defined as any documented episode of AF, atrial flutter or atrial tachycardia after 3 months from procedure. Patients were stratified in CACS<100 and CACS≥100. Explorative analysis incorporated Kaplan-Meier survival curves and Cox regression.
Results
A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. More than half of the patients had a CACS>0 (n=185, 52%) and 63 patients (18%) had a CACS≥100. Patients with CACS≥100 were older (63 ± 7 vs 54 ± 12 years, p<0.001), had higher prevalence of hypertension (68% vs 43%, p<0.001) and diabetes mellitus (21% vs 10%, p=0.012) and higher left atrial volume (39 ± 9 vs 35 ± 9 ml/m2, p=0.018). After a median observation time of 34 months (IQR 24-43), 117 patients (33%) had AF recurrence.
CACS≥100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.23-2.79, p=0.003) (Fig. 1). After covariate adjustment (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atria enlargement) CACS≥100 remained an independent predictor of the risk of AF recurrence (HR, 1.68; 95% CI, 1.05-2.70, p=0.03) as well as persistent AF (HR, 1.91; 95% CI, 1.23-3.00, p=0.004) (Fig. 2).
Conclusion
In patients with AF undergoing catheter ablation, without previous history of CAD, a CACS≥100 was independently associated with a 68% increase in the risk of AF recurrence.
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Affiliation(s)
| | - R Ladeiras-Lopes
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - I Cruz
- Faculty of Medicine University of Porto, Porto, Portugal
| | - G Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Diaz
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - A Barros
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - F Saraiva
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - R Faria
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - H Goncalves
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Oliveira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - N Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Fernandes S, Ladeiras-Lopes R, Cruz I, Silva G, Silva M, Queiros P, Diaz S, Barros A, Saraiva F, Faria R, Almeida J, Fonseca P, Ferreira N, Primo J, Fontes-Carvalho R. Association of epicardial adipose tissue and coronary artery calcium score in patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.300] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Both coronary artery calcium (CAC) and epicardial adipose tissue (EAT) had been implicated in coronary artery disease (CAD) and risk of future adverse cardiovascular events. There are scarce data regarding the assessment and association of EAT volume and CAC score (CACS) in atrial fibrillation (AF) patients.
Purpose
To assess the association between EAT volume and the presence and severity of CAC in patients with AF.
Methods
Retrospective and single-centre study including consecutive patients with AF undergoing contrast-enhanced cardiac computed tomography for catheter ablation planning, from 2017 to 2019. Patients with known history of CAD and moderate to severe valvular heart disease were excluded. Baseline clinical and demographical data were collected, as well as their cardiovascular risk, based on the SCORE (Systematic Coronary Risk Evaluation) system and cardiovascular risk categories. We assessed CACS (Agatston method) and EAT volume and analysed their association. EAT was defined as the adipose tissue accumulated between the visceral pericardium and the myocardium and was semi-automatically reconstructed by manually tracing the pericardium. Patients were split into three groups according to CACS: 0, 1-99 and ≥100. A logistic regression (LR) analysis was performed to explore the relationship between EAT volume and the presence of CAC (CACS>0), adjusted for age, gender, obesity, diabetes mellitus and hypertension.
Results
A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. A CHA2DS2-VASc score ≥2 was present in 130 (37%) patients and most patients had low to moderate cardiovascular risk (n=213, 82%). More than half of the patients had a CACS>0 (n=185, 52%), of which 63 patients (18%) had a CACS≥100. The mean EAT volume was 79 ± 39 ml. There was a significant association between EAT volume and the presence of CAC: CACS=0 69 ± 34 ml vs CACS 1-99 84 ± 38 ml vs CACS ≥100 95 ± 45 ml (p<0.001) (Fig. 1). After covariate adjustment (LR model R2 = 0.373, p <0.0001), the presence of CAC was not associated with EAT volume (OR 1.00, 95%CI 1.00 - 1.01, p=0.2) or obesity, and only with higher age, male gender, hypertension and diabetes mellitus (Fig. 2).
Conclusion
In our cohort of patients with AF undergoing catheter ablation we observed an association between EAT and CACS. Nevertheless, EAT volume was not an independent predictor of CACS and only the classical cardiovascular risk factors remained significant.
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Affiliation(s)
| | - R Ladeiras-Lopes
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - I Cruz
- Faculty of Medicine University of Porto, Porto, Portugal
| | - G Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Queiros
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Diaz
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - A Barros
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - F Saraiva
- Faculty of Medicine University of Porto, Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Porto, Portugal
| | - R Faria
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - N Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Rosa SA, Lopes LR, Branco L, Galrinho A, Fiarresga A, Thomas B, Brás P, Gonçalves A, Cardoso I, Papoila A, Alves M, Rio P, Cruz I, Selas M, Silva F, Silva A, Ferreira RC, Carmo MM. Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in hypertrophic cardiomyopathy. Int J Cardiol 2022; 359:61-68. [DOI: 10.1016/j.ijcard.2022.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 01/22/2023]
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Lamounier Junior A, Guitián González A, Rodríguez Vilela A, Repáraz Andrade A, Rubio Alcaide Á, Berta Sousa A, Benito López C, Alonso García D, Fernández Ferro G, Cruz I, Cárdenas Reyes IJ, Salazar-Mendiguchía García J, Larrañaga-Moreira JM, Ochoa JP, Palomino-Doza J, de la Higuera Romero L, Nicolás Cicerchia M, Restrepo Córdoba MA, Peña-Peña ML, Noël Brögger M, Loureiro M, Mogollón Jiménez MV, Bilbao Quesada R, Franco Gutiérrez R, García Hernández S, Ripoll-Vera T, Fernández X, Azevedo O, García Pavía P, Lopes LR, Ortiz M, Brito D, Barriales-Villa R, Monserrat Iglesias L. Correlación genotipo-fenotipo en miocardiopatía hipertrófica: un estudio multicéntrico en Portugal y España sobre la variante p.Arg21Leu de TPM1. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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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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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Normal flow, low gradient aortic stenosis - is LVOT the determinant? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). These patients present with a lower mean gradient (<40mmHg) and area (AVA ≤1cm2). However, the treatment strategies focus on the population with a reduced indexed stroke volume (≤35mL/m2). There is less clarity concerning those with a normal stroke volume. An important determinant of the area and stroke volume is the LVOT diameter, which may have a significant impact in the classification of the severity. There is some literature supporting an expected diameter according to the body surface area.
Purpose
This paper aims to analyse the population with normal flow, low gradient aortic stenosis, as well as compare the impact of the expected LVOT diameter in the classification of patients.
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed as well as echocardiographic variables to properly characterize aortic stenosis.
Results
A total of 79 patients met the criteria for normal flow, low gradient aortic stenosis with a valvular area ≤1cm2. Mean age was 79.5 ± 8.6 years-old and 38% was male. The mean LVOT diameter was 2.11 ± 0.18 cm which correlated to a mean AVA of 0.88 ± 0.10 cm2. Should the LVOT diameter align with the expected diameter according to the formula [(5,7× BSA +12,1)/10], the mean LVOT diameter would be 2.18 ± 0.11 cm, which correlated to a mean AVA of 0.96 ± 0.22cm2. This represents a statistically significant difference in the value, with the expected diameter being 0.075cm higher than the measured (p = 0.002), which translates in a statistically significant higher AVA (+0.085, p < 0,001). With the above data, 31 (38.8%) patients would have been reclassified as moderate aortic stenosis, according to the recalculated AVA alone. Taking into account the indexed AVA, only 22 (27.8%) patients would be reclassified. 8 other patients (10.1%) would have been reclassified as low flow, low gradient aortic stenosis as the recalculated stroke volume would be lower than 35mL/m2.
Conclusion
This paper reminded us of the importance of an appropriately measured LVOT diameter, and the potential impact in reclassification of valvular heart disease. This is more important when the classification may alter our conduct. Other imaging techniques, such as transoesophageal echocardiogram or CT scan, may obviate the squared error of the LVOT measurement as well as account for the geometry of the LVOT, especially in dubious cases. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Is flow better in mL/m2 or mL/s - a practical reflection on aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (<40mmHg) and area (AVA ≤1cm2). This states are explained by a low flow (indexed SV ≤35ml/m2). Some studies demonstrated that a flow rate (determined by dividing SV by ejection time) inferior to 200 mL/s is also associated with poor prognosis. Can this be an alternative in stratifying patients with an AVA ≤1cm2?
Purpose
This paper aims to compare flow assessment by the conventional way with flow calculated in ml/s in patients with AVA ≤1cm2
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis.
Results
A total of 118 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 18 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 32 patients with preserved ejection fraction. The other 68 patients represented patients with a normal flow, low gradient aortic stenosis. There is a strong correlation between the variable SVi and Flow Rate (r = 0,796, p < 0,001). A linear regression shows that the flow rate equivalent to a SVi of 35mL/m2 in our sample is 203mL/s, near the value of other studies. 10 (31.3%) patients with severe aortic stenosis low flow, low gradient with preserved ejection fraction, 3 (16.7%) patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 53 (77.9%) patients with normal flow, low gradient aortic stenosis would have a flow superior to 200mL/s.
Conclusion
The use of flow rate systematically would downgrade the severity of valvular lesions with possible need for intervention. However, in certain dubious cases its application may identify a subpopulation with need for further study and probable treatment, such as the patients with normal flow, low gradient aortic stenosis. Further studies of this subgroup of patients are warranted to reach any final conclusions. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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D"alfonso MG, Tesic M, Peteiro J, Palinkas ED, Re F, Losi MA, Palinkas A, Cruz I, Torres MAR, Van De Heyning CM, Djordjevic-Dikic A, Mori F, Ciampi Q, Olivotto I, Picano E. Adverse prognostic value of supernormal left ventricular force noninvasively assessed by resting transthoracic echocardiography in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Stress Echo 2030 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).
Background The excessive cross-bridging of cardiac myosin and actin, resulting in increased left ventricular (LV) force development, is one of the biomechanical abormalities inhypertrophic cardiomyopathy (HCM).
Purpose
To assess the prognostic value of increased LV force development at rest in patients with HCM
Methods
We enrolled 918 HCM patients (age 48 ± 16 years, 502 males, New York Heart Association I or II, Class III in 48 patients, 6% and with LVOTG >30 mmHg in 211patients, 23%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 10 quality-controlled labs from 7 countries (Belgium, Hungary, Italy, Portugal, Serbia, Spain, Brazil). The maximal wall thickness was 21 ± 5 mm. TTE assessment included left ventricular outflow tract gradient (LVOTG, mmHg), EF (%), and LV force (systolic arterial pressure + LVOTG/LV endsystolic volume assessed with 2-D, mmHg/mL). All patients were followed-up. An age- and gender matched control group of 95 healthy subjects was also evaluated.
Results. Compared to normals, HCM showed higher values of EF (68 ± 8 vs 65 ± 5%, p < 0.001) and force (7.2 ± 5.5 vs 4.0 ± 1.8 mmHg/mL, p < 0.001). At a median follow-up of 94 months [interquartile range 40-140 months], 95 all-cause deaths occurred. Mortality was significantly increased in the force highest quartile compared to other quartiles (see figure). At multivariable Cox analysis, increased Force (highest quartile >8.5 mmHg/mL hazard ratio= 2.189 95% CI = 1.095-4.377, p = 0.027 and the intermediate quartile: Force 5.7-8.5 mmHg/mL hazard ratio= 2.525 95% CI = 1.2205.228, p = 0.013) were independent predictors of mortality with age (hazard ratio= 1.065 95% CI = 1.047-1.084, p < 0.001) and maximal wall thickness (hazard ratio= 1.094, 95% CI = 1.055-1.135, p < 0.001). At univariate analysis neither LVOTG (hazard ratio= 1.430, 95% CI = 0.920-2.222, p = 0.112) nor quartiles of EF (hazard ratio= 1.497, 95% CI = 0.868-2.582, p = 0.147) were significant.
Conclusion
HCM patients with preserved baseline LV function and higher values of resting LV force ("too good to be normal") show a worse survival, highlighting the dark prognostic side of an excess of force. The hypercontractile phenotype possibly indicates an increased activity of myosin resulting in increased force production at the sarcomere and cellular levels that propagates at the whole-organ level with unfavorable long-term effects on outcome.
Figure
Mortality rate based on quartiles of resting LV Force in HCM. Abstract Figure. Mortality rate
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Affiliation(s)
- MG D"alfonso
- Careggi University Hospital (AOUC), Florence, Italy
| | - M Tesic
- Clinical center of Serbia and School of medicine University of Belgrade, Belgrade, Serbia
| | | | | | - F Re
- San Camillo Forlanini Hospital, Rome, Italy
| | - MA Losi
- Federico II University Hospital, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Palinkas
- Elisabeth Hospital of Csongrad, Internal Medicine Department, Hodmezovasarhely, Hungary
| | - I Cruz
- Hospital Garcia de Orta, Lisbon, Portugal
| | - M A R Torres
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - CM Van De Heyning
- Antwerp University Hospital, Department of Cardiology, Edegem, Belgium
| | - A Djordjevic-Dikic
- Clinical center of Serbia and School of medicine University of Belgrade, Belgrade, Serbia
| | - F Mori
- Careggi University Hospital (AOUC), Florence, Italy
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Benevento, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Picano
- Institute of Clinical Physiology (IFC), CNR, Pisa, Italy
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Dias Claudio F, Santos M, Custodio P, Ferreira B, Quadrado M, Manuel A, Francisco AR, Neves B, Cruz I, Almeida AR, Fazendas P, Joao I, Pereira H. Low gradient aortic stenosis - is survival that different between types and strategies. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (<40mmHg) and a small area (AVA ≤1cm2). They encompass a population with specific characteristics and rather heterogeneous treatment approach and different prognosis
Purpose
This paper aims to enlighten to the prognosis of the different subpopulation of low gradient aortic stenosis, alone and according to the treatment strategies in a center without surgical ou percutaneous valvular intervention.
Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis and employed strategy and death.
Results
A total of 135 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 19 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 36 patients with preserved ejection fraction. The other 80 patients represented patients with a normal flow, low gradient aortic stenosis. Groups were similar in terms of age, sex, BMI, hypertension, dyslipidaemia, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease and chronic coronary syndrome. In terms of diabetes there was a statistically significant difference (p = 0.019) with a lower prevalence in the group with low flow, low gradient and preserved ejection fraction. There was a statistically significant difference in survival at 24 months between groups (p = 0,004), with a mean survival of 13.6 months, 17.6months and 21 months for low flow low gradient with depressed ejection fraction, low flow low gradient with preserved ejection fraction and normal flow, low gradient patients, respectively. When analysing the treatment strategies, there were also statistically significant differences between the whole population of patients (p = 0.001) and each subgroup (low flow, low gradient with depressed ejection fraction – p <0,001; and normal flow low gradient – p = 0,005), with exception of patients with low flow low gradient and preserved ejection fraction (p = 0,081).
Conclusion
Our analyses brings to our attention a clear difference in prognosis between the subgroups analysed with a worse mean survival at 24 months in patients with low flow, low gradient and depressed ejection fraction. Furthermore, there seems to be a clear impact of treatment strategies in each group of patients and still some margin of improvement especially in patients without a clearly defined treatment strategy. Abstract Figure. Abstract Figure.
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Affiliation(s)
| | - M Santos
- Centro Hospitalar Barreiro-Montijo, Cardiology, Barreiro, Portugal
| | - P Custodio
- Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Francisco
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - B Neves
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - P Fazendas
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Aguiar Rosa S, Thomas B, Fiarresga A, Papoila AL, Alves M, Pereira R, Branco G, Cruz I, Rio P, Baquero L, Ferreira RC, Mota Carmo M, Lopes LR. The Impact of Ischemia Assessed by Magnetic Resonance on Functional, Arrhythmic, and Imaging Features of Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 8:761860. [PMID: 34977179 PMCID: PMC8718511 DOI: 10.3389/fcvm.2021.761860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/20/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Aims: The aim of the study is to investigate the association between the degree of ischemia due to coronary microvascular dysfunction (CMD) and the left ventricular (LV) tissue characteristics, systolic performance, and clinical manifestations in hypertrophic cardiomyopathy (HCM). Methods and Results: This prospective study enrolled 75 patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential, and radial strains analysis. Electrocardiogram, 24-h Holter recording, and cardiopulmonary exercise testing (CPET) were performed to assess arrhythmias and functional capacity. In total, 47 (63%) patients were men with the mean age of 54.6 (14.8) years, 51 (68%) patients had non-obstructive HCM, maximum wall thickness (MWT) was 20.2 (4.6) mm, LV ejection fraction (LVEF) was 71.6 (8.3%), and ischemic burden was 22.5 (16.9%) of LV. Greater MWT was associated with the severity of ischemia (β-estimate:1.353, 95% CI:0.182; 2.523, p = 0.024). Ischemic burden was strongly associated with higher values of native T1 (β-estimate:9.018, 95% CI:4.721; 13.315, p < 0.001). The association between ischemia and LGE was significant in following subgroup analyses: MWT 15–20 mm (β-estimate:1.941, 95% CI:0.738; 3.143, p = 0.002), non-obstructive HCM (β-estimate:1.471, 95% CI:0.258; 2.683, p = 0.019), women (β-estimate:1.957, 95% CI:0.423; 3.492, p = 0.015) and age <40 years (β-estimate:4.874, 95% CI:1.155; 8.594, p = 0.016). Ischemia in ≥21% of LV was associated with LGE >15% (AUC 0.766, sensitivity 0.724, specificity 0.659). Ischemia was also associated with atrial fibrillation or flutter (AF/AFL) (OR-estimate:1.481, 95% CI:1.020; 2.152, p = 0.039), but no association was seen for non-sustained ventricular tachycardia. Ischemia was associated with shorter time to anaerobic threshold (β-estimate: −0.442, 95% CI: −0.860; −0.023, p = 0.039). Conclusion: In HCM, ischemia associates with morphological markers of severity of disease, fibrosis, arrhythmia, and functional capacity.
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Affiliation(s)
- Sílvia Aguiar Rosa
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal.,NOVA Medical School, Faculty of Medical Science of Lisbon, New University, Lisbon, Portugal.,Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Boban Thomas
- Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | | | - Ana Luísa Papoila
- NOVA Medical School, Faculty of Medical Science of Lisbon, New University, Lisbon, Portugal.,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário de Lisboa Central and Centre of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
| | - Marta Alves
- NOVA Medical School, Faculty of Medical Science of Lisbon, New University, Lisbon, Portugal.,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário de Lisboa Central and Centre of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
| | - Ricardo Pereira
- Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Gonçalo Branco
- Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Inês Cruz
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Pedro Rio
- Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal
| | - Luis Baquero
- Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | | | - Miguel Mota Carmo
- NOVA Medical School, Faculty of Medical Science of Lisbon, New University, Lisbon, Portugal
| | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom.,Cardiovascular Centre, University of Lisbon, Lisbon, Portugal
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Grade Santos J, Budzak K, Simoes J, Martinho M, Ferreira B, Briosa A, Pereira AR, Cruz I, Almeida AR, Fazendas P, Joao I, Almeida S, Pereira H. Left atrial appendage velocity as an instrument of predicting atrial fibrillation recurrence after successful catheter ablation – a useful tool? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Catheter ablation for the treatment of Atrial Fibrillation (AF) is a modality of treatment in growing expansion. However the sustained long term response in preventing AF recurrence is poor for most patients, namely in those with a dilated left atrium.
Purpose
Our aim was to assess the utility of an echocardiographic parameter for left atrium function, the left atrial appendage velocity (LAAV), in predicting recurrences after catheter ablation.
Methods
We performed a 9 year retrospective analysis of all patients who underwent a successful catheter ablation for the treatment of atrial fibrillation and had a valid pre-procedural transesophagic echocardiogram in a single expert centre. Medical records were analysed for demographic, procedural data and outcomes.
Results
Seventy-three (73) patients fulfilled all inclusion criteria and were analysed. The mean age was 62±11 with a male preponderance (58,7%). The majority of patients (82,7%) had preserved left ventricle ejection fraction. Only 46% of patient had a volumetric assessment of the left atrium dimensions prior to ablation, with slight, moderate and severe dilation of the left atrium in 20%; 8,6% and 28,6% of patients. Of the patients subjected to an AF ablation the average LAAV was 50,6±19 cm/s, with 78% of patients with normal atrial appendage velocities.
Patients with low LAAV (<40cm/s) had a higher proportion of AF recurrences at 3 and 6 months (58,3 vs 12,8% and 89% vs 21,7%; p<0,05 for all) with a linear correlation between the presence of recurrences and LAAV (LAAV of 39,1 vs 57,5 cm/s; p<0,05 OR 0,91 (CI 95% = 0,85–0,97); r2=0,34 at 3 months and LAAV of 43,5 vs 59 cm/s; p=0,01; OR 0,94 (CI 95% = 0,89–0,99); r2=0,24 at 6 months respectively). There was a trend towards association with recurrences at 1 year although it did not reach statistical significance. There was no significant difference in the use of antiarritmic drugs, either prior or post ablation, in both groups. It was not possible to assess the additive predictive value to the left atrium dimensions due to the low percentage of volumetric assessment of left atrium prior to AF ablation.
Conclusions
Patients with low left atrial appendage velocities had a lower long term success rate of catheter ablation, with higher rates of recurrence at 3 and 6 months and a trend towards higher recurrences at 1 year, with linear correlation which hypothesises the use of the left atrial appendage velocity as novel predictive parameter for an integrative model.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - K Budzak
- Hospital Garcia de Orta, Almada, Portugal
| | - J Simoes
- Hospital Garcia de Orta, Almada, Portugal
| | - M Martinho
- Hospital Garcia de Orta, Almada, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Almada, Portugal
| | - A Briosa
- Hospital Garcia de Orta, Almada, Portugal
| | | | - I Cruz
- Hospital Garcia de Orta, Almada, Portugal
| | | | - P Fazendas
- Hospital Garcia de Orta, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Almada, Portugal
| | - S Almeida
- Hospital Garcia de Orta, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Almada, Portugal
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Aguiar Rosa S, Thomas B, Fiarresga A, Papoila A, Alves M, Pereira R, Branco G, Cruz I, Baquero L, Cruz Ferreira R, Mota Carmo M, Rocha Lopes L. Coronary microvascular dysfunction in hypertrophic cardiomyopathy – impact from tissue characteristics to clinical manifestations. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is an important pathophysiological feature in hypertrophic cardiomyopathy (HCM).
Purpose
This study investigated the role of CMD in tissue characteristics, left ventricular (LV) systolic performance and clinical manifestations in HCM.
Methods
This prospective study enrolled patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential and radial strains analysis. Electrocardiogram and 24 hours Holter recording were performed to assess arrhythmias.
Results
75P were enrolled, 47 (63%) males, mean age 54.6 (14.8) years; 51 patients (68%) had non obstructive HCM, mean maximum wall thickness (MWT) was 20.2 (4.6)mm, LV ejection fraction 71.6 (8.3)%, ischemic burden 22.5 (16.9)% of LV.
Greater MWT was associated the severity of ischemia (β-estimate: 1.809, 95% CI: 1.073; 2.545; p<0.001).
Ischemic burden was strongly associated with higher values of native T1 (β-estimate: 9.018, 95% CI: 4.721, 13.315; p<0.001).
An association between ischemia and the extent of LGE was found (β-estimate: 2.02, 95% CI: 0.93, 3.10; p<0.001). Ischemia in ≥21% of LV was associated with LGE >15% (AUC 0.766, sensitivity 0.724, specificity 0.659).
In multivariable analysis, in the overall population, MWT and LGE were independently associated with ischemia, however the evidence of association between ischemia and extent of LGE became weaker (β-estimate: 1.070, 95% CI: −0.106; 2.245; p=0.074).
In subgroup analysis, the association between ischemia and LGE remained significant in individuals with MWT 15–20mm, non-obstructive HCM, female and age <40 years.
The severity of ischemia was not associated with markers of LV systolic function, namely LVEF, longitudinal, radial and circumferential strain
A strong evidence of association was found between ischemia and atrial fibrillation/flutter (AF/AFL) (OR: 1.481, 95% CI: 1.020,2.152; p=0.039), but no association was verified with non-sustained ventricular tachycardia.
Conclusion
In HCM, CMD is related to the severity of LV hypertrophy. Ischemia secondary to CMD promotes fibrosis and is associated with an increase in the odds of AF/ALF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - B Thomas
- Hospital N.S. Rosario, Barreiro, Portugal
| | | | - A Papoila
- Nova Medical School, Lisbon, Portugal
| | - M Alves
- Nova Medical School, Lisbon, Portugal
| | - R Pereira
- Hospital Cruz Vermelha, Cardiology, Lisbon, Portugal
| | - G Branco
- Hospital Cruz Vermelha, Cardiology, Lisbon, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Almada, Portugal
| | - L Baquero
- Hospital Cruz Vermelha, Cardiology, Lisbon, Portugal
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Gomes J, Sousa P, Pereira F, Queirós C, Neves H, Silva C, Silva APE, Parente P, Sousa P, Brito A, Silva APE, Morais EJ, Cardoso A, Cruz I, Machado N, Oliveira F, Bastos F, Prata P, Sequeira C. Nursing knowledge on skin ulcer healing: a living scoping review protocol. JBI Evid Synth 2021; 20:164-172. [PMID: 34149023 DOI: 10.11124/jbies-20-00512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review aims to continuously map the nursing knowledge on skin ulcer healing in any context of care. INTRODUCTION Chronic wounds are an increasing concern for society and health care providers. Pressure ulcers and venous ulcers, among others, have devastating effects on morbidity and quality of life and require a systematic approach. The nursing process is an important method that allows a better organization and overall care quality for a systematic and continuous professional approach to nursing management of skin ulcers. The integration of this nursing knowledge in informatics systems creates an opportunity to embed decision-support models in clinical activity, promoting evidence-based practice. INCLUSION CRITERIA This scoping review will consider articles that focus on nursing data, diagnosis, interventions, and outcomes focused on the person with skin ulcers in all contexts of care. This review will include quantitative, qualitative, and mixed methods study designs as well as systematic reviews and dissertations. METHODS JBI's scoping review guidance, as well as the Cochrane Collaboration's guidance on living reviews, will be followed to meet the review's objective. Screening of new literature will be performed regularly, with the review being updated according to new findings. The search strategy will map published and unpublished studies. The databases to be searched include: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier), JBI Library of Systematic Reviews, and Cochrane Central Register of Controlled Trials. Searches for unpublished studies will include OpenGrey and Repositórios Científicos de Acesso Aberto de Portugal. Studies published in English and Portuguese since 2010 will be considered for inclusion. REGISTRATION Open Science Framework: https://osf.io/f6s4e/.
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Affiliation(s)
- João Gomes
- Abel Salazar Biomedical Sciences Institute - University of Porto, Porto, Portugal CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Porto Nursing School, Porto, Portugal Porto Nursing School Porto, Portugal Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal Universidade Católica Portuguesa, Institute of Health Sciences, Porto, Portugal ACES Alto Ave, Guimarães, Portugal
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Alegria S, Marques A, Cruz I, Broa AL, Pereira ARF, João I, Simões O, Pereira H. Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre. Arq Bras Cardiol 2021; 116:682-691. [PMID: 33886711 PMCID: PMC8121414 DOI: 10.36660/abc.20190586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/18/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.
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Affiliation(s)
- Sofia Alegria
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Marques
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Inês Cruz
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Luísa Broa
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | | | - Isabel João
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Otília Simões
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Hélder Pereira
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
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30
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Marques A, Cruz I, Briosa A, João I, Almeida S, Pereira H. Isolated Right Ventricle Myocardial Infarction - Is the Right Ventricle Still the Forgotten Ventricle? Arq Bras Cardiol 2021; 116:32-35. [PMID: 33567001 PMCID: PMC8118633 DOI: 10.36660/abc.20200164] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ana Marques
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
| | - Inês Cruz
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
| | - Alexandra Briosa
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
| | - Isabel João
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
| | - Sofia Almeida
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
| | - Hélder Pereira
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada - Portugal
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Martinho M, Pereira AR, Marques A, Cruz I, Cale R, Almeida AR, Lopes L, Lourenco C, Sebaiti D, Briosa A, Santos JG, Ferreira B, Pereira H. Predictors of the presence of septal late gadolinium enhancement in follow-up cardiac magnetic resonance imaging and its relation to acute myocarditis prognosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Acute myocarditis (AM) is generally a self-limited and benign disease. However, a minority of patients (pts) present or develop adverse outcomes. It has been proposed that the presence of late gadolinium enhancement (LGE) in the septum is associated with worse prognosis. Also, the presence of LGE without oedema in follow-up cardiac magnetic resonance imaging (CMR) seems to reflect more permanent lesions.
Purpose
The aim of this study was to determine if the presence of septal LGE in acute-phase CMR was associated with higher extent of disease in follow-up CMR and if initial laboratory tests help to predict the evolution to more permanent lesions.
Methods
Prospective single-centre study of pts admitted with AM diagnosed according to clinical findings, troponin T elevation and CMR criteria (Lake Louise), since 1/2013. Selection of those who underwent acute-phase (CMR-I) and follow-up CMR (CMR-II).
Results
Of 88 pts admitted with AM, 46 fulfilled our inclusion criteria: median age 31 ± 13 years, 85% males. CMR-I was performed at 6 ± 5days and LGE was present in 43 pts (93.5%). CMR-II was performed at 8 ± 4.3 months and 29 pts (63%) improved the number of LGE-positive segments, 10 pts (21.8%) had stable disease and 7 pts (15.2%) worsened CMR findings. Septal-LGE was detected in 10 pts (21.7%) in CMR-I and in 6 pts (13.0%) in CMR-II. Logistic regression analysis identified septal-LGE in CMR-I as a predictor of higher extent of LGE in CMR-II (OR 1.4, 95%CI 1.1-1.9, p = 0.020). Although median values of maximum high-sensitivity troponin and reactive-C protein (RCP) were not associated with septal LGE in CMR-I, increasing values of such tests were univariate predictors of a higher likelihood of septal involvement in CMR-II: maximum troponin (886 vs 1852ng/L; OR 1.00, 95%CI 1.00-1.00 p = 0.017) and RCP (4.2 vs 13.9mg/dL; OR 1.17, 95%CI 1.04-1.33, p = 0.012). After multivariate analysis, RCP was the independent predictor of septal LGE in CMR-II (AUC 80.8, 0.97-0.91, p = 0.012). RCP cut-off value >10.2mg/dL identified patients with septal LGE in CMR-II with a sensitivity and specificity of 83.3% and 85.0%, respectively. The presence of cardiovascular risk factors, clinical presentation and B-type natriuretic peptide values were not predictors of septal LGE in either CMR. In a mean clinical follow-up of 757 ± 476days, no patient died, 3 pts (6.5%) developed new-onset heart failure (NYHA class II functional symptoms) and 2 pts (4.3%) developed ventricular arrhythmias. Due to a small number of adverse events, neither laboratory tests nor LGE septal pattern predicted adverse outcomes.
Conclusions
In this population, septal LGE pattern was able to predict higher extent of LGE in follow-up CMR. Increased cardiac biomarkers and inflammatory proteins in the acute setting were also associated with septal involvement in follow-up and can potentially help to establish the risk of adverse events for patients admitted with acute myocarditis.
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Affiliation(s)
- M Martinho
- Hospital Garcia de Orta, Almada, Portugal
| | - AR Pereira
- Hospital Garcia de Orta, Almada, Portugal
| | - A Marques
- Hospital Garcia de Orta, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Almada, Portugal
| | - R Cale
- Hospital Garcia de Orta, Almada, Portugal
| | - AR Almeida
- Hospital Garcia de Orta, Almada, Portugal
| | - L Lopes
- Hospital Garcia de Orta, Almada, Portugal
| | - C Lourenco
- Hospital Garcia de Orta, Almada, Portugal
| | - D Sebaiti
- Hospital Garcia de Orta, Almada, Portugal
| | - A Briosa
- Hospital Garcia de Orta, Almada, Portugal
| | - JG Santos
- Hospital Garcia de Orta, Almada, Portugal
| | - B Ferreira
- Hospital Garcia de Orta, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Almada, Portugal
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Neto A, Oliveira I, Cruz I, Seabra D, Pontes Dos Santos R, Andrade A, Azevedo J, Pinto P. What if HCM Risk-SCD was assessed with CMR maximum LV wall thickness measurements? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The HCM Risk-SCD estimates the risk of sudden cardiac death at 5 years in patients (pts) with hypertrophic cardiomyopathy (HCM). According to ESC Guidelines, in pts with a 5-year risk of SCD <4%, an implantable cardioverter defibrillator (ICD) is generally not indicated, in pts with a risk of 4 to less than 6%, an ICD may be considered and in pts with a 5-year risk ≥6%, an ICD should be considered. The association between the degree of LVH and sudden cardiac death (SCD) has been based on measurements of maximum LVWT by echocardiography which is part of HCM Risk-SCD score. However, cardiac magnetic resonance (CMR) has shown a superior resolution in characterization of cardiac structures, with additional role in SCD risk stratification. Whether measurements of LVWT by echocardiography and CMR are interchangeable has been brought to question.
Purpose
We sought to evaluate the incidence of discrepant measurements of maximal LVWT between echocardiography and CMR and determine its implication in HCM Risk-SCD score and ICD indication.
Methods
Unicentric, retrospective analysis of pts submitted to CMR who had HCM as definitive diagnosis, between 1/2013 and 9/2019. CMR and echocardiographic measures were compared, as well as HCM Risk-SCD score calculated with these values (maximum LVWT was the only variable that differed between measures). Subsequently, pts were divided in three groups according to HCM Risk-SCD score: pts with a 5-year risk of SCD <4% (G1), risk of 4 to less than 6% (G2) and risk ≥6% (G3).
Results
Out of the 781 CMR studies evaluated, 59 pts were found to have HCM (7.6%) with mean age of 62 ± 11 years and female predominance (50.8%). 12 pts had obstructive phenotype (20.3%). Mean LVWT was 20.0 ± 4.6mm when measured by CMR and 18.8 ± 4.6mm by echo; when comparing the measures by echo with CMR, there was a positive correlation between them (p < 0.001; r 0.719). Mean HCM Risk-SCD was 2.80 ± 1.51% when measured by CMR and 2.69 ± 1.53% by echo; there was a positive correlation between these measures too (p < 0.001; r 0.963). Maximum LV thickness evaluated by CMR showed a positive correlation (p = 0.006, r 0.384) with the HCM risk-score assessed by CMR. Only 1 pt changed risk group with CMR measurement of maximum LVWT (from G1 to G2). Conclusion: In this cohort, there was a positive, linear relationship between maximum LVWT and HCM Risk-SCD score measured by CMR and echocardiogram. Only 1 pt changed risk stratification group (5-year risk of SCD <4% to 4 to less than 6%). Although CMR measurements, when interpreted correctly, are more precise compared with echocardiography, in this cohort there was no impact on the patient"s future clinical orientation regarding ICD implantation.
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Affiliation(s)
- A Neto
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - I Oliveira
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - I Cruz
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - D Seabra
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | | | - A Andrade
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - J Azevedo
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
| | - P Pinto
- Hospital Centre do Tamega e Sousa, Cardiology, Penafiel, Portugal
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Queirós C, Silva MATCP, Cruz I, Cardoso A, Morais EJ. Nursing diagnoses focused on universal self-care requisites. Int Nurs Rev 2021; 68:328-340. [PMID: 33539567 DOI: 10.1111/inr.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/18/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023]
Abstract
AIMS (1) To identify and analyse diagnoses documented by nurses in Portugal within the scope of universal self-care requisites; (2) to determine the main problems with nursing diagnoses syntaxes for semantic interoperability purposes; and (3) to suggest unified nursing diagnoses syntaxes within the scope of universal self-care requisites. BACKGROUND/INTRODUCTION Ageing societies and the increase in chronic diseases have led to significant concern regarding individuals' dependence to ensure self-care. ICNP is widely used by Portuguese nurses in electronic health records for documentation of nursing diagnoses and interventions. METHODS A qualitative study using inductive content analysis and focus group: 1. nursing e-documentation content analysis and 2. focus group to explore implicit criteria or insights from content analysis results. RESULTS From a corpus of analysis with 1793 nursing diagnoses, 432 nursing diagnoses centred on universal self-care requisites emerged from the content analysis. One hundred ten nursing diagnoses resulted from the application of new encoding criteria that emerged after a focus group meeting. CONCLUSION Results reveal that nursing diagnoses related to universal self-care requisites can emphasize the impairment or potentialities of the individuals performing self-care. It also shows a lack of consensus on nominating the nursing diagnoses of people with a deficit in universal self-care requisites, resulting in different diagnoses to express the same needs. IMPLICATIONS FOR NURSING PRACTICE Representation of most relevant nursing diagnoses within the scope of universal self-care requisites. IMPLICATIONS FOR HEALTH POLICY Incorporating standardized language into electronic health records is not enough for improving quality and continuity of care and semantic interoperability achievement. Electronic health records need to work with a nursing ontology in the backend to meet these requirements.
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Affiliation(s)
- Carmen Queirós
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,CIDESI: ICN-Accredited Centre for Information Systems and ICNP® Research and Development, Nursing School of Porto, Porto, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School (ESEnfC), Coimbra, Portugal.,Department of Ortho-physiatry, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria Antónia Taveira Cruz Paiva Silva
- CIDESI: ICN-Accredited Centre for Information Systems and ICNP® Research and Development, Nursing School of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Inês Cruz
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,CIDESI: ICN-Accredited Centre for Information Systems and ICNP® Research and Development, Nursing School of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Alexandrina Cardoso
- CIDESI: ICN-Accredited Centre for Information Systems and ICNP® Research and Development, Nursing School of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Ernesto J Morais
- CIDESI: ICN-Accredited Centre for Information Systems and ICNP® Research and Development, Nursing School of Porto, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
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Melro E, Antunes FE, da Silva GJ, Cruz I, Ramos PE, Carvalho F, Alves L. Chitosan Films in Food Applications. Tuning Film Properties by Changing Acidic Dissolution Conditions. Polymers (Basel) 2020; 13:polym13010001. [PMID: 33374920 PMCID: PMC7792621 DOI: 10.3390/polym13010001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 11/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Food contamination due to the presence of microorganisms is a serious problem. New food preservation systems are being studied to kill or inhibit spoilage and pathogenic microorganisms that contaminate food and reduce the shelf life of products. Chitosan films with potential application to food preservation have witnessed great developments during the last years. Chitosan is a cationic polysaccharide with the ability to form films and possess antimicrobial properties. It is water-insoluble but can be dissolved in acidic solutions. In the present work, three different acids (acetic, lactic and citric) were used in chitosan dissolution and both, the resultant solutions and formed films were characterized. It was observed that chitosan water-acetic acid systems show the highest antimicrobial activity due to the highest chitosan charge density, compared to the mixtures with lactic and citric acid. This system showed also the higher solution viscosity compared to the other systems. Chitosan-acetic acid films were also the ones presenting better mechanical properties; this can be attributed to the fact that lactic and citric acids remain in the films, changing their properties, which does not happen with acetic acid. Films produced from chitosan dissolved in water/acetic acid system are resistant, while very fragile but elastic films are formed when lactic acid is used. It was demonstrated that a good selection of the type of acid not only facilitates the dissolution of chitosan but also plays a key role in the properties of the formed solutions and films.
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Affiliation(s)
- Elodie Melro
- CQC, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal; (E.M.); (F.E.A.)
| | - Filipe E. Antunes
- CQC, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal; (E.M.); (F.E.A.)
| | - Gabriela J. da Silva
- Center for Neurosciences and Cell Biology and Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Inês Cruz
- Primor Charcutaria—Prima S.A., Avenida Santiago de Gavião, 1142, 4760-003 Vila Nova de Famalicão, Portugal; (I.C.); (P.E.R.); (F.C.)
| | - Philippe E. Ramos
- Primor Charcutaria—Prima S.A., Avenida Santiago de Gavião, 1142, 4760-003 Vila Nova de Famalicão, Portugal; (I.C.); (P.E.R.); (F.C.)
| | - Fátima Carvalho
- Primor Charcutaria—Prima S.A., Avenida Santiago de Gavião, 1142, 4760-003 Vila Nova de Famalicão, Portugal; (I.C.); (P.E.R.); (F.C.)
| | - Luís Alves
- CIEPQPF, Department of Chemical Engineering, University of Coimbra, Rua Sílvio Lima, Pólo II, 3030-790 Coimbra, Portugal
- Correspondence:
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Benito Gonzalez T, Freixa X, Godino C, Taramasso M, Estevez-Loureiro R, Pascual I, Serrador A, Nombela L, Grande D, Cruz I, San Antonio R, Galasso M, Gavazzoni M, Portoles A, Fernandez-Vazquez F. Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR.
Methods
We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.
Results
93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed.
Conclusion
PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.
Proportion of patients who presented ven
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - X Freixa
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Godino
- San Raffaele Hospital, Milan, Italy
| | - M Taramasso
- University Hospital Zurich, Zurich, Switzerland
| | | | - I Pascual
- University Hospital Central de Asturias, Oviedo, Spain
| | - A Serrador
- University Hospital Clinic of Valladolid, Valladolid, Spain
| | - L Nombela
- Hospital Clinico San Carlos, Madrid, Spain
| | - D Grande
- University Hospital Virgen de la Victoria, Malaga, Spain
| | - I Cruz
- Hospital Clinico Universitario, Salamanca, Spain
| | | | | | - M Gavazzoni
- University Hospital Zurich, Zurich, Switzerland
| | - A Portoles
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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Marques A, Pereira A, Cruz I, Almeida A, Alegria S, Briosa A, Grade Santos J, Sebaiti D, Lopes L, Joao I, Pereira H. Prevalence and prognostic value of right ventricular dysfunction in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2084] [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
Introduction
Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict.
Objectives
To assess the prevalence, predictors and prognostic value of right ventricular (RV) dysfunction in patients (pts) with HCM.
Methods
Retrospective single-center study of consecutive pts with HCM evaluated in a specialized medical appointment. Selected those submitted to cardiac magnetic resonance imaging (MRI) as the gold-standard for RV function assessment. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned heart failure admission.
Results
Were included 112 pts (mean age at first appointment 57±15 years, 63% male). Septal asymmetric phenotype was the most frequent (75%), with a mean septal wall thickness of 18±4 mm. Late gadolinium enhancement was observed in 82%, mostly intramyocardial (67%) and in joint points (47%).
RV dysfunction was detected in 6 pts (5.4%) and RV free wall hypertrophy in 3 pts (2.7%); no patient presented RV dilation.
Factors associated with RV dysfunction were left atria area (HR 1.07/unit, 95% CI 1.01–1.12, p=0.02), left ventricular ejection fraction (HR 0.91/unit, 95% CI 0.86–0.97, p=0.02) and the presence of left ventricle wall motion abnormalities (HR 7, 95% CI 1.3–38, p=0.03) in cardiac MRI.
During a mean follow-up of 60±31 months, the combined primary endpoint occurred in 15 pts (13%), significantly more in pts with RV dysfunction (HR 5.1, 95% CI 1.1–24, p=0.038) (graphic 1). Patients with RV dysfunction also presented more atrial fibrillation / flutter episodes during follow-up (HR 6.4, 95% CI 2.1–20, p=0.001).
Conclusions
Although not common, right ventricular dysfunction was associated with a higher rate of cardiovascular events. These results support a potential role of right ventricular function in the risk stratification of patients with hypertrophic cardiomyopathy.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Marques
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A.R Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - I Cruz
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A.R Almeida
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Briosa
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | | | - D Sebaiti
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - L Lopes
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Marques N, Azevedo O, Almeida AR, Bento D, Cruz I, Correia E, Lourenço C, Lopes LR. Specific Therapy for Transthyretin Cardiac Amyloidosis: A Systematic Literature Review and Evidence-Based Recommendations. J Am Heart Assoc 2020; 9:e016614. [PMID: 32969287 PMCID: PMC7792401 DOI: 10.1161/jaha.120.016614] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The emergence of specific therapies for transthyretin cardiac amyloidosis (CA) warrants the need for a systematic review of the literature. Methods and Results A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A systematic search was performed on MEDLINE, PubMed, and Embase databases on November 29, 2019. Studies were selected based on the following predefined eligibility criteria: English‐language randomized controlled trials (RCTs), non‐RCTs, or observational studies, which included adult patients with variant/wild‐type transthyretin‐CA, assessed specific therapies for transthyretin‐CA, and reported cardiovascular outcomes. Relevant data were extracted to a predefined template. Quality assessment was based on National Institute for Health and Care Excellence recommendations (RCTs) or a checklist by Downs and Black (non‐RCTs). From 1203 records, 24 publications were selected, describing 4 RCTs (6 publications) and 16 non‐RCTs (18 publications). Tafamidis was shown to significantly improve all‐cause mortality and cardiovascular hospitalizations and reduce worsening in 6‐minute walk test, Kansas City Cardiomyopathy Questionnaire—Overall Summary score, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) in variant/wild‐type transthyretin‐CA. Patisiran showed promising results in a subgroup analysis of patients with variant transthyretin‐CA, which have to be confirmed in RCTs. Inotersen showed conflicting results on cardiac imaging parameters. The one study on AG10 had only a 1‐month duration and cardiovascular end points were exploratory and limited to cardiac biomarkers. Limited evidence from noncomparative single‐arm small non‐RCTs existed for diflunisal, epigallocatechin‐3‐gallate (green tea extract), and doxycycline+tauroursodeoxycholic acid/ursodeoxycholic acid. Conclusions This systematic review of the literature supports the use of tafamidis in wild‐type and variant transthyretin‐CA. Novel therapeutic targets including transthyretin gene silencers are currently under investigation.
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Affiliation(s)
- Nuno Marques
- Algarve Biomedical Center Algarve Portugal.,Biomedical and Medical Department Algarve University Algarve Portugal.,Cardiology Department Centro Hospitalar Universitário do Algarve Algarve Portugal
| | - Olga Azevedo
- Cardiology Department Hospital Senhora da Oliveira Guimarães Portugal.,Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal.,ICVS/3Bs PT Government Associate Laboratory Braga/Guimarães Portugal
| | | | - Dina Bento
- Algarve Biomedical Center Algarve Portugal.,Biomedical and Medical Department Algarve University Algarve Portugal.,Cardiology Department Centro Hospitalar Universitário do Algarve Algarve Portugal
| | - Inês Cruz
- Cardiology Department Hospital Garcia de Orta Almada Portugal
| | - Emanuel Correia
- Cardiology Department Centro Hospitalar Tondela Viseu Viseu Portugal
| | - Carolina Lourenço
- Cardiology Department Centro Hospitalar Universitário de Coimbra Coimbra Portugal
| | - Luís Rocha Lopes
- St. Bartholomew's Hospital-Barts Heart Centre Barts Health NHS Trust London United Kingdom.,Centre for Heart Muscle Disease Institute of Cardiovascular Science University College of London United Kingdom.,Centro Cardiovacular Universidade Lisboa Lisboa Portugal
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Marques A, Cruz I, João I, Almeida AR, Fazendas P, Caldeira D, Alegria S, Pereira AR, Briosa A, Cotrim C, Lopes LR, Pereira H. The Prognostic Value of Exercise Echocardiography After Percutaneous Coronary Intervention. J Am Soc Echocardiogr 2020; 34:51-61. [PMID: 33036819 DOI: 10.1016/j.echo.2020.09.001] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exercise echocardiography (EE) is a valuable noninvasive method for diagnostic and prognostic assessment of ischemic cardiac disease. The prognostic value of a negative EE test is well known overall, but its role in patients who undergo percutaneous coronary intervention remains poorly validated. The aim of this study was to ascertain the prognostic value of treadmill EE and to determine predictors of cardiac events in this population, with an emphasis on nonpositive (negative or inconclusive) test results. METHODS A retrospective single-center study was performed. It included 516 patients (83% man; mean age, 62 ± 9 years) previously subjected to percutaneous coronary intervention who underwent treadmill EE between 2008 and 2017. Demographic, clinical, echocardiographic, and angiographic data were collected. The occurrence of cardiac events (cardiac death, acute coronary syndrome, or coronary revascularization) during follow-up was investigated. A multivariate Cox regression analysis was used to evaluate predictors of cardiac events. The Kaplan-Meier method was used to evaluate event-free survival rates. RESULTS The results of EE were negative for myocardial ischemia in 245 patients (47.5%), inconclusive in 144 (27.9%), and positive in 127 (24.6%). During a mean follow-up period of 40 ± 34 months, cardiac events occurred in 152 patients (29.5%). The positive and negative predictive values of EE were 81.6% and 85.3%, respectively. The sensitivity of the exercise test was 73.9%, with specificity of 90.1%. Predictors of cardiac events were typical angina (hazard ratio [HR], 1.95; 95% CI, 1.16-3.27; P = .011), a positive ischemic response detected by electrocardiographic monitoring during EE (HR, 2.01; 95% CI, 1.21-3.34; P = .007), and the test result (inconclusive result: HR, 1.06; 95% CI, 0.51-2.19; P = .878; positive result: HR, 4.35; 95% CI, 2.42-7.80; P < .001). Patients with inconclusive (log-rank P = .038) and positive (log-rank P < .001) results had significantly more cardiac events during follow-up than those with negative EE test results. Focusing on those patients with nonpositive results, cardiac event-free survival rates at 1, 3, and 5 years were 96.6 ± 0.9%, 88.3 ± 1.9%, and 79.5 ± 2.6%, respectively. In this subpopulation, an inconclusive test result (HR, 1.67; 95% CI, 1.03-2.70; P = .039), more extensive coronary artery disease (two vessels: HR, 1.37; 95% CI, 0.75-2.30; P = .304; three vessels: HR, 2.59; 95% CI, 1.38-4.87; P = .003), and arterial hypertension (HR, 2.07; 95% CI, 1.10-3.91; P = .025) were significantly associated with the occurrence of cardiac events. CONCLUSION Patients with known coronary disease with negative results on EE are at low risk for hard events. Patients with inconclusive results are at higher risk for cardiac events than those with negative results. The detection of patients with low-risk results on EE should decrease the number of unnecessary repeat invasive coronary angiographic examinations.
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Affiliation(s)
- Ana Marques
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
| | - Inês Cruz
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Isabel João
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Almeida
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Paula Fazendas
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Daniel Caldeira
- Centro Cardiovascular da Universidade de Lisboa, CAML, Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Alegria
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Alexandra Briosa
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Carlos Cotrim
- Department of Cardiology, Hospital da Cruz Vermelha, Lisbon, Portugal
| | - Luís Rocha Lopes
- Centro Cardiovascular da Universidade de Lisboa, CAML, Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hélder Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
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Barbosa AR, Dias Ferreira N, Martins O’Neill C, Ruivo C, Cruz I, Rocha Lopes L. Deformación miocárdica basada en resonancia magnética cardiaca y riesgo arrítmico en la miocardiopatía hipertrófica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.02.016] [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: 11/27/2022]
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Costa AR, Lança de Oliveira M, Cruz I, Gonçalves I, Cascalheira JF, Santos CRA. The Sex Bias of Cancer. Trends Endocrinol Metab 2020; 31:785-799. [PMID: 32900596 DOI: 10.1016/j.tem.2020.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
In hormone-dependent organs, sex hormones and dysregulated hormone signaling have well-documented roles in cancers of the breast and female reproductive organs including endometrium and ovary, as well as in prostate and testicular cancers in males. Strikingly, epidemiological data highlight significant differences between the sexes in the incidence of various cancers in nonreproductive organs, where the role of sex hormones has been less well studied. In an era when personalized medicine is gaining recognition, understanding the molecular, cellular, and biological differences between men and women is timely for developing more appropriate therapeutic interventions according to gender. We review evidence that sex hormones also shape many of the dysregulated cellular and molecular pathways that lead to cell proliferation and cancer in nonreproductive organs.
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Affiliation(s)
- Ana Raquel Costa
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| | | | - Inês Cruz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| | - Isabel Gonçalves
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| | - José Francisco Cascalheira
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal; Department of Chemistry, University of Beira Interior, Covilhã, Portugal
| | - Cecília R A Santos
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Covilhã, Portugal.
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Pereira AR, Almeida AR, Cruz I, Lopes LR, Loureiro MJ, Pereira H. [A Complicated "One Segment" Myocardial Infarction: The Role of Cardiovascular Imaging]. Arq Bras Cardiol 2020; 115:25-30. [PMID: 32935761 PMCID: PMC8386952 DOI: 10.36660/abc.20190323] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ana Rita Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Almada - Portugal
| | - Ana Rita Almeida
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Almada - Portugal
| | - Inês Cruz
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Almada - Portugal
| | - Luis Rocha Lopes
- Barts Heart Centre, Barts Health NHS Trust, Londres - Inglaterra.,Institute of Cardiovascular Science, University College London,Londres - Inglaterra.,Centro Cardiovascular, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisboa - Portugal
| | | | - Hélder Pereira
- Serviço de Cardiologia, Hospital Garcia de Orta EPE, Almada - Portugal.,Centro Cardiovascular, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisboa - Portugal
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Marques A, Caldeira D, Alegria S, Pereira AR, Briosa A, Cruz I, Almeida AR, João I, Pereira H. Multimodality imaging in the recurrence of left ventricular pseudoaneurysm after surgical correction. Cardiol J 2020; 27:437-438. [PMID: 32929709 DOI: 10.5603/cj.2020.0117] [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] [Received: 03/01/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ana Marques
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal.
| | - Daniel Caldeira
- Faculdade de Medicina, Universidade de Lisboa, Portugal, Lisboa, Portugal
| | - Sofia Alegria
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Ana Rita Pereira
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Alexandra Briosa
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Inês Cruz
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Ana Rita Almeida
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Isabel João
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
| | - Hélder Pereira
- Hospital Garcia de Orta, Av. Torrado da SIlva, 2805-267 Almada, Portugal
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Gomes AC, Lopes LR, Cruz I, Almeida AR, Miranda R, Almeida S, Brandão L, Pereira H. Arrhythmogenic Right Ventricular Cardiomyopathy: An Exuberant Case Affecting Both Ventricles. Circ Cardiovasc Imaging 2020; 13:e010243. [PMID: 32873069 DOI: 10.1161/circimaging.119.010243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Catarina Gomes
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Luís Rocha Lopes
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.).,St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (L.R.L.).,Institute of Cardiovascular Science, UCL, London, United Kingdom (L.R.L.).,Centro Cardiovascular da Universidade de Lisboa, Portugal (L.R.L.)
| | - Inês Cruz
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Ana Rita Almeida
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Rita Miranda
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Sofia Almeida
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Luís Brandão
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
| | - Hélder Pereira
- Hospital Garcia de Orta, Almada, Portugal (A.C.G., L.R.L., I.C., A.R.A., R.M., S.A., L.B., H.P.)
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Azevedo O, Marques N, Reis L, Cruz I, Craveiro N, Antunes H, Lourenço C, Gomes R, Guerreiro RA, Faria R, Sá F, Lima R, Gaspar P, Faria R, Miltenberger-Miltenyi G, Sousa N, Cunha D. Predictors of Fabry disease in patients with hypertrophic cardiomyopathy: How to guide the diagnostic strategy? Am Heart J 2020; 226:114-126. [PMID: 32531501 DOI: 10.1016/j.ahj.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fabry disease (FD) is a treatable cause of hypertrophic cardiomyopathy (HCM). We aimed to determine the independent predictors of FD and to define a clinically useful strategy to discriminate FD among HCM. METHODS Multicenter study including 780 patients with the ESC definition of HCM. FD screening was performed by enzymatic assay in males and genetic testing in females. Multivariate regression analysis identified independent predictors of FD in HCM. A discriminant function analysis defined a score based on the weighted combination of these predictors. RESULTS FD was found in 37 of 780 patients with HCM (4.7%): 31 with p.F113L mutation due to a founder effect; and 6 with other variants (p.C94S; p.M96V; p.G183V; p.E203X; p.M290I; p.R356Q/p.G360R). FD prevalence in HCM adjusted for the founder effect was 0.9%. Symmetric HCM (OR 3.464, CI95% 1.151-10.430), basal inferolateral late gadolinium enhancement (LGE) (OR 10.677, CI95% 3.633-31.380), bifascicular block (OR 10.909, CI95% 2.377-50.059) and ST-segment depression (OR 4.401, CI95% 1.431-13.533) were independent predictors of FD in HCM. The score ID FABRY-HCM [-0.729 + (2.781xBifascicular block) + (0.590xST depression) + (0.831xSymmetric HCM) + (2.130xbasal inferolateral LGE)] had a negative predictive value of 95.8% for FD, with a cut-off of 1.0, meaning that, in the absence of both bifascicular block and basal inferolateral LGE, FD is a less probable cause of HCM, being more appropriate to perform HCM gene panel than targeted FD screening. CONCLUSION FD prevalence in HCM was 0.9%. Bifascicular block and basal inferolateral LGE were the most powerful predictors of FD in HCM. In their absence, HCM gene panel is the most appropriate step in etiological study of HCM.
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Marques A, Cruz I, Caldeira D, Alegria S, Gomes AC, Broa AL, João I, Pereira H. Risk Factors for In-Hospital Mortality in Infective Endocarditis. Arq Bras Cardiol 2020; 114:1-8. [PMID: 31751437 PMCID: PMC7025303 DOI: 10.36660/abc.20180194] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 03/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is associated with severe complications and high mortality. The assessment of mortality rates and predictors for fatal events is important to identify modifiable factors related to the pattern of treatment, in order to improve outcomes. OBJECTIVES We sought to evaluate clinical outcomes of patients with IE and to determine predictors of in-hospital mortality. METHODS Retrospective single-center study including patients with IE admitted during a 10-year period (2006-2015). Data on comorbidities, clinical presentation, microbiology and clinical outcomes during hospitalization were evaluated. Risk factors of in-hospital death were analyzed. A p-value < 0.05 was considered significant. RESULTS A total of 134 cases were included (73% males, mean age of 61 ± 16 years-old). Half of them had previous valvular heart disease. Healthcare-associated IE and negative blood-cultures occurred in 22% and prosthetic IE in 25%. The aortic valve was the one most often affected by infection. Staphylococcus aureus was the most commonly isolated microorganism. Forty-four (32.8%) patients underwent cardiac surgery. The in-hospital mortality rate was 31.3% (42 patients). The identified risk factors for in-hospital mortality were Staphylococcus aureus etiology (OR 6.47; 95% CI: 1.07-39.01; p = 0.042), negative blood-cultures (OR 9.14; 95% CI: 1.42-58.77; p = 0.02), evidence of valve obstruction in echocardiography (OR 8.57; 95% CI: 1.11-66.25; p = 0.039), clinical evolution with heart failure (OR 4.98; 95%CI: 1.31-18.92; p = 0.018) or septic shock (OR 20.26; 95% CI: 4.04-101.74; p < 0.001). Cardiac surgery was a protective factor of mortality (OR 0.14; 95% CI 0.03-0.65; p = 0.012). CONCLUSION The risk factors for in-hospital mortality were clinical (heart failure, septic shock), evidence of valve obstruction in echocardiography, Staphylococcus aureus etiology or negative blood cultures. Invasive treatment by surgery significantly decreased the mortality risk.
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Affiliation(s)
- Ana Marques
- Hospital Garcia de Orta EPE Almada - Portugal
| | - Inês Cruz
- Hospital Garcia de Orta EPE Almada - Portugal
| | - Daniel Caldeira
- Hospital Garcia de Orta EPE Almada - Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa Lisbon, Portugal
| | | | | | | | - Isabel João
- Hospital Garcia de Orta EPE Almada - Portugal
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Cruz I, Serna C, Rué M, Real J, Galván L, Pifarré J. Comparative exposure to antipsychotic medications in immigrant and native-born populations of a Spanish health region. Eur Psychiatry 2020; 27:477-82. [DOI: 10.1016/j.eurpsy.2011.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/01/2011] [Accepted: 02/05/2011] [Indexed: 10/18/2022] Open
Abstract
AbstractBackgroundRaised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.ObjectiveTo compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.MethodDescriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.Results1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.ConclusionsAll immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.
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Gomes AC, Barbosa PS, Coutinho A, Cruz I, Carmo-Fonseca M, Lopes LR. Whole-genome DNA sequencing: The key to detecting a sarcomeric mutation in a ‘false genotype-negative’ family with hypertrophic cardiomyopathy. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2019.03.015] [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] Open
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Barbosa AR, Dias Ferreira N, Martins O'Neill C, Ruivo C, Cruz I, Rocha Lopes L. Impaired myocardial deformation assessed by cardiac magnetic resonance is associated with increased arrhythmic risk in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2020; 73:849-851. [PMID: 32201275 DOI: 10.1016/j.rec.2020.02.008] [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] [Received: 11/03/2019] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ana Raquel Barbosa
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
| | - Nuno Dias Ferreira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | | | - Catarina Ruivo
- Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Inês Cruz
- Cardiology Department, Hospital Garcia de Orta, Lisbon, Portugal
| | - Luís Rocha Lopes
- Barts Heart Centre, Barts Health NHS Trust; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Cruz I. Sudden cardiac death in hypertrophic cardiomyopathy: Improved risk stratification strategies are needed. Rev Port Cardiol 2020; 38:855-857. [PMID: 32061432 DOI: 10.1016/j.repc.2020.01.007] [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: 10/25/2022] Open
Affiliation(s)
- Inês Cruz
- Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal.
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Raimundo AF, Félix F, Andrade R, García-Conesa MT, González-Sarrías A, Gilsa-Lopes J, do Ó D, Raimundo A, Ribeiro R, Rodriguez-Mateos A, Santos CN, Schär M, Silva A, Cruz I, Wang B, Pinto P, Menezes R. Combined effect of interventions with pure or enriched mixtures of (poly)phenols and anti-diabetic medication in type 2 diabetes management: a meta-analysis of randomized controlled human trials. Eur J Nutr 2020; 59:1329-1343. [PMID: 32052147 DOI: 10.1007/s00394-020-02189-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/02/2019] [Accepted: 01/24/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE (Poly)phenols have been reported to confer protective effects against type 2 diabetes but the precise association remains elusive. This meta-analysis aimed to assess the effects of (poly)phenol intake on well-established biomarkers in people with type 2 diabetes or at risk of developing diabetes. METHODS A systematic search was conducted using the following selection criteria: (1) human randomized controlled trials involving individuals with prediabetes and type 2 diabetes; (2) one or more of the following biomarkers: glucose, glycated haemoglobin (HbA1c), insulin, pro-insulin, homeostatic model assessment of insulin resistance (HOMA-IR), islet amyloid polypeptide (IAPP)/amylin, pro-IAPP/pro-amylin, glucagon, C-peptide; (3) chronic intervention with pure or enriched mixtures of (poly)phenols. From 488 references, 88 were assessed for eligibility; data were extracted from 27 studies and 20 were used for meta-analysis. The groups included in the meta-analysis were: (poly)phenol mixtures, isoflavones, flavanols, anthocyanins and resveratrol. RESULTS Estimated intervention/control mean differences evidenced that, overall, the consumption of (poly)phenols contributed to reduced fasting glucose levels (- 3.32 mg/dL; 95% CI - 5.86, - 0.77; P = 0.011). Hb1Ac was only slightly reduced (- 0.24%; 95% CI - 0.43, - 0.044; P = 0.016) whereas the levels of insulin and HOMA-IR were not altered. Subgroup comparative analyses indicated a stronger effect on blood glucose in individuals with diabetes (- 5.86 mg/dL, 95% CI - 11.34, - 0.39; P = 0.036) and this effect was even stronger in individuals taking anti-diabetic medication (- 10.17 mg/dL, 95% CI - 16.59, - 3.75; P = 0.002). CONCLUSIONS Our results support that the consumption of (poly)phenols may contribute to lower glucose levels in individuals with type 2 diabetes or at risk of diabetes and that these compounds may also act in combination with anti-diabetic drugs.
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Affiliation(s)
- Ana F Raimundo
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2781-901, Oeiras, Portugal.,CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157, Oeiras, Portugal
| | - Filipa Félix
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2781-901, Oeiras, Portugal.,Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157, Oeiras, Portugal
| | - Rita Andrade
- APDP, Associação Protectora Dos Diabéticos de Portugal, Lisbon, Portugal
| | - María-Teresa García-Conesa
- Research Group On Quality, Safety and Bioactivity of Plant Foods, Department of Food Science and Technology, CEBAS-CSIC, Murcia, Spain
| | - Antonio González-Sarrías
- Research Group On Quality, Safety and Bioactivity of Plant Foods, Department of Food Science and Technology, CEBAS-CSIC, Murcia, Spain
| | - João Gilsa-Lopes
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Dulce do Ó
- APDP, Associação Protectora Dos Diabéticos de Portugal, Lisbon, Portugal
| | - Ana Raimundo
- APDP, Associação Protectora Dos Diabéticos de Portugal, Lisbon, Portugal
| | - Rogério Ribeiro
- CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,APDP, Associação Protectora Dos Diabéticos de Portugal, Lisbon, Portugal.,iBiMed-UA, Aveiro, Portugal
| | - Ana Rodriguez-Mateos
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Cláudia N Santos
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2781-901, Oeiras, Portugal.,CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157, Oeiras, Portugal
| | - Manuel Schär
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, UK
| | - Ana Silva
- Instituto Politécnico de Santarém, Escola Superior Agrária, S. Pedro, 2001-904, Santarém, Portugal
| | - Inês Cruz
- Instituto Politécnico de Santarém, Escola Superior Agrária, S. Pedro, 2001-904, Santarém, Portugal
| | - Brian Wang
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paula Pinto
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157, Oeiras, Portugal. .,Instituto Politécnico de Santarém, Escola Superior Agrária, S. Pedro, 2001-904, Santarém, Portugal. .,Life Quality Research Centre, Avenida Dr. Mário Soares N.º 110, 2040-413, Rio Maior, Portugal.
| | - Regina Menezes
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2781-901, Oeiras, Portugal. .,CEDOC, Chronic Diseases Research Centre, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal. .,Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157, Oeiras, Portugal.
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