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Ferreira V, Garcia Bras P, Castelo A, Santos A, Viveiros A, Ilhao Moreira R, Machado AI, Alves M, Cruz Ferreira R. Outcomes in pregnant women with valvular heart disease from sub Saharan Africa transferred to a developed nation. A distinct care model. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2604] [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
Pregnant women with valvular heart disease (VHD) in African countries still bear a disproportionate burden of maternal morbidity and mortality, due to the reduced accessibility to health care and the scarcity of skilled professionals. It is unclear if outcomes would be improved by care-delivery model changes.
Purpose
We performed a clinical audit of African pregnant women with VHD who were transferred for their care from five countries to our cardio-obstetrics unit, during a twenty-year period, through a memorandum of agreement of international cooperation.
Methods
A retrospective analysis of 81 pregnancies (P) in 45 African women with VHD (median age 24, IQR 22–29 years) from 2001 to 2020. The main outcome measures were major maternal complications and perinatal outcome.
Results
History of rheumatic heart disease was determined in 74.1% of the P. Most women were in NHYA I or II before P (79.0%), 43.2% had previous cardiac medication and 60.5% were anticoagulated (33.3% with acenocoumarol and 27.2% with warfarin). 59.3% of P had at least one valvular prosthesis, including 38 mechanical prosthetic valve (MPV) and 10 biological valves. 22.2% had prior surgical or percutaneous VHD correction, excluding prosthesis implantation. At baseline, impaired left ventricular ejection fraction was found in 12.3%. Previous arrhythmic event, stroke or infectious endocarditis were found in 12.3%, 8.6% and 6.2% of P, respectively.
During P, deterioration in NYHA functional class occurred in 42.0% and 9.9% required initiation or intensified cardiac medication. For MPV, 51% maintained a vitamin K antagonist, 15.7% used LMWH from 6 to 12th weeks and 9.8% used LMWH throughout P. Valve thrombosis occurred in 4 women (4.9% of P), with one maternal death in a patient with double MPV.
Hemorrhagic complications happened in 8.6% of P, all anticoagulated, in immediate postpartum or puerperal period. The 81 P resulted in 56 live births (69.1%), with a medium birth weight of 3026±471g. Delivery by caesarean section was performed in 28.3% of newborns. The incidence of miscarriage was 23.5% and fetal malformations occurred in 14.8%, with warfarin embryopathy in 4 cases. In univariate analysis, the presence of valvular protheses (p=0.001), and anticoagulation (p=0.001) were related to unsuccessful P. In multivariate analysis, VKA therapy was the unique independent predictor of unsuccessful P (p=0.048).
Conclusion
With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful for women transferred from sub–Saharan Africa. However, the presence of a valvular prothesis is associated with unsuccessful pregnancy even in a developed nation. Efforts other than the implantation of a MPV should be pursued vigorously in sub Saharan Africa.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Santos
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Viveiros
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A I Machado
- Maternidade Alfredo da Costa , Lisbon , Portugal
| | - M Alves
- Maternidade Alfredo da Costa , Lisbon , Portugal
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Mano T, Ferreira V, Moreira RI, Teixeira B, Agapito A, Rito T, Pinto F, Cruz Ferreira R, De Sousa L. Fetal and maternal outcomes in patients with tetralogy of Fallot. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Women with tetralogy of Fallot (TOF) have an increased risk of adverse cardiac and neonatal events during pregnancy. The aim was to assess fetal and maternal outcomes in patients (pts) with uncorrected and corrected TOF.
Methods
Retrospective analysis of cardiological and obstetric data in women with TOF followed at our institution. Pregnancy and neonatal outcomes were compared in patients (pts) submitted to corrective surgery vs pts with no previous intervention and in pts with or without cyanosis.
Results
51 women (median age 27 years; median number of previous interventions of 2), 22% with cyanosis, who experienced 126 pregnancies resulting in 73 live births A previous corrective surgery was found in 78% (40 pts), while 4% (2 pts) had previous palliative surgery and 18% (9 pts) no previous procedure. We found that women that were not submitted to previous intervention had a significant higher incidence of preterm birth (56% vs 17.5%, p=0.029), spontaneous abortion (56% vs 10%, p=0.006) and stillbirth (22% vs 0%). No difference was found for obstetric complications between groups. Cyanotic pts also demonstrated higher incidence of low birth weight (LBW) (36% vs 7.5%, p=0.031), preterm birth (54% vs 17.5%, p=0.021), spontaneous abortion (55% vs 10%, p=0.004) and stillbirth (18% vs 0%). There were no cardiac complications during pregnancy nor evident deterioration on cardiac status. Congenital heart disease was reported in 2 infants (3% of live births).
Conclusions
Pregnancy is well tolerated in pts with TOF. In our population, even in uncorrected TOF and in pts with cyanosis, there were no cardiac complications during pregnancy, although those pts had worse fetal outcomes. An explanation for the low incidence of cardiac events may be less severe forms of the disease, allowing survival into adulthood without intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Branco Mano T, Rito T, Ilhao Moreira R, Agapito A, Pinto F, Sousa L. Pregnancy outcomes in women with severe congenital heart disease – a specialized centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Progress in pediatric cardiology and cardiac surgery has dramatically raised the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy (P) in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding P and neonatal outcomes in women with SC-CHD.
Methods
Retrospective analysis of obstetric data in women with CHD followed at our institution. P and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity CHD (MMC-CHD), according to ESC guidelines CHD complexity classification.
Results
The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD pts was cyanotic tetralogy of Fallot (19.0%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedure (13.8%) – Figure 1.
Pts with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p<0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p<0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD P (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1st trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis.
Conclusion
Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Severe CHD
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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4
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Garcia Bras P, Sousa L, Mano T, Monteiro A, Rito T, Ilhao Moreira R, Rio P, Silva S, Martins C, Coito S, Capile E, Agapito A, Ferreira R. Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction and purpose
The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.
Methods
A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.
Results
Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.
Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025).
VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR.
Conclusion
Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.
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Affiliation(s)
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Monteiro
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Silva
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Martins
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Coito
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Capile
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Goncalves AA, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Rio P, Teresa Timoteo A, Abreu J, Soares R, Ilhao Moreira R, Mendonca T, Coutinho Cruz M, Reis J, Mano T, Cruz Ferreira R. P1433 Antiarrhythmic effects of sacubitril-valsartan therapy assessed by mechanical dispersion index. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sacubitril/Valsartan (LCZ696) significantly reduced sudden cardiac death in the PARADIGM-HF trial. However, there is little published data regarding the possible explanations for the antiarrhythmic effects found with LCZ696 therapy.
Previous trials have shown that mechanical dispersion by strain echocardiography can predict arrhythmic events in Heart Failure (HF) patients.
The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index with left ventricular (LV) global longitudinal strain (GLS) analysis before and after LCZ696 therapy.
Methods
Prospective evaluation of chronic HF patients with LV ejection fraction ≤ 40% despite optimized standard of care therapy, in which LCZ696 therapy was started and no additional HF treatment was expected to change.
ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 therapy and 6 months after therapy. A semiautomated analysis of LV GLS was made and mechanical dispersion index was defined as the standard deviation from the 16 time intervals corresponding to each LV segment.
Results
Of the 42 patients, 35 (83.3%) completed the 6 months of follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years.
QTc interval (451.9 vs 426.0msec, p < 0.001) and QRS interval (125.1 vs 120.8msec, p = 0.033) were reduced after 6 months of LCZ696 therapy. Mechanical dispersion index (88.4 vs 78.1msec, p = 0.036) was also significantly reduced after therapy.
Conclusion
LCZ696 therapy is associated with antiarrhythmic effects with a reduction in QTc and QRS intervals in ECG and a reduction in mechanical dispersion index as assessed by LV GLS.
Abstract P1433 Figure.
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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6
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Branco Mano T, Moura Branco L, Ramos R, Fiarresga A, Timoteo AT, Galrinho A, Abreu J, Castro L, Duarte Silva N, Ilhao Moreira R, Valentim Goncalves A, Cruz Ferreira R. P182 Bleeding complications in a rendu-osler-weber syndrome patient with atrial fibrillation - challenging serial transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.052] [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: 11/15/2022] Open
Abstract
Abstract
Rendu-Osler-Weber (ROW) syndrome or hereditary hemorrhagic telangiectasia is a rare autossomic dominant disease characterized by vascular dysplasia involving multiple systems and associated with an increased bleeding risk. The presence of atrial fibrillation in this population becomes a challenge, regarding the evaluation of bleeding and thrombotic risks and the best approach for the patient management.
A 72 years-old female with ROW syndrome, atrial fibrillation and a CHA2DS2-VASc risk score of four, was admitted to our hospital for left atrial appendage (LAA) closure after a period of novel oral anticoagulation crowed with multiple haemorrhagic events and blood transfusions. After the implantation of a Watchman LAA number 33 closure device (Image 1A), and because of the concomitant diagnose of chronic pulmonary embolism, she was restarted on anticoagulation therapy in lower doses, with initial tolerance. For evaluation of LAA closure device during follow-up, after an unsuccessful attempt of transoesophageal echocardiography (TEE) because of severe epistaxis subsequent to oropharyngeal anaesthesia, the patient underwent a Cardiac Computed Tomography (CT) that showed a moderate peri-device leak (4.4x11mm, 0.73cm2) – (Image 1B). For better characterization, the patient underwent a new attempt of TEE with the support of an anaesthesiologist and the need of local vasoconstrictor agents and tranexamic acid for epistaxis and oropharyngeal bleeding control. TEE confirmed a moderate posterior device-leak (7.1mm) with absence of cavitary thrombus (Image 1C). After a year of anticoagulation with new significant bleeding events, TEE was repeated with the anaesthetic and pharmacologic preparation. This TEE showed a decrease in peri-device leak (<5mm wide – Image 1D), which was fundamental for supporting the multidisciplinary team decision of interruption of anticoagulation therapy. With this case we want to highlight the challenging decisions regarding patients with ROW syndrome and atrial fibrillation. Specifically, we must be alert about possible complications in trying to perform TEE in this population, once the frequent occurrence of telangiectasias in the oropharynges that may occur, as in this patient.
Abstract P182 Figure. Image 1
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Affiliation(s)
| | | | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Castro
- Hospital de Santa Marta, Lisbon, Portugal
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Garcia Bras P, Cacela D, Moura Branco L, Ramos R, Vaz Ferreira V, Castelo A, Branco Mano T, Ilhao Moreira R, Ferreira RC. P1330 A rare coronary anomaly in the adult: an extremely large arteriovenous fistula. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.769] [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
Arteriovenous coronary fistulae are a rare coronary anomaly, which can be congenital or acquired. They can be diagnosed in older adults with heart failure symptoms, atherosclerosis or cardiac arrhythmias.
The authors report the case of an adult patient with an extremely large coronary artery fistula of the left main coronary artery (LMCA).
Clinical case
A 57-year-old caucasian male with known background of arterial hypertension, obesity, pulmonary emphysema and bronchiectasis presented to a Cardiology outpatient appointment with symptoms of congestive heart failure and new-onset atrial fibrillation.
A transthoracic echocardiogram was performed which revealed a possible coronary fistula with multiple rosary-like folds between the LMCA and the coronary sinus. Other echocardiographic findings were left ventricular and biatrial enlargement with biventricular systolic dysfunction (left ventricular ejection fraction 44%) and a GLS of -7.8% as well as mild pericardial effusion.
The patient was referred to our hospital for further diagnostic work-up and clarification of the coronary anatomy.
A cardiac computed tomography (CT) scan was done which showed ectasia and calcification of the LMCA, left anterior descending and circumflex arteries and a large caliber tortuous coronary fistula between the LMCA, the right atrium and the coronary sinus comprised of multiple folds covering from the pulmonary artery to the left atrium.
A coronary artery angiography was also performed, which confirmed the detailed anatomy and dimensions of the coronary fistula.
Follow-up magnetic resonance imaging revealed dilation of both left and right cardiac chambers with no significant shunt (QP/QS = 1)
The patient was started on heart failure medical therapy and was referred to the Cardiac Surgery Department and is currently asymptomatic awaiting for surgical correction of the coronary fistula.
Abstract P1330 Figure. CT scan: large caliber coronary fistula
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Affiliation(s)
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
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Valentim Goncalves AA, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Rio P, Teresa Timoteo A, Abreu J, Soares R, Feliciano J, Ilhao Moreira R, Cruz Ferreira R. 1037 Differences in reverse remodelling between ischemic and non-ischemic left ventricular segments as assessed by myocardial work after sacubitril-valsartan therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS), allowing to investigate LV performance even in cases of changes in afterload.
None is known about the effects of Sacubitril-Valsartan (LCZ696) therapy in MW parameters.
Purpose
Compare the changes in MW parameters between ischemic and non-ischemic segments after LCZ696 therapy.
Methods
The study was a prospective evaluation of chronic Heart Failure (HF) patients with optimized standard of care therapy and LV ejection fraction ≤40%, in which LCZ696 therapy was started and no other HF treatment was expected to change.
A TTE study was performed before and 6 months after LCZ696 therapy, using the GE Vivid E95 ultrasound system. A semiautomated analysis of GLS was performed after two-dimensional images were acquired in the standard apical 4-, 3- and 2 chamber views. MW and related indices were estimated using custom software.
Two groups were created according to the 17 segment model TTE study before LCZ696 therapy:
G1 (ischemic group): dyskinesia/akinesia/hypokinesia segments in patients with ischemic HF etiology;
G2 (non-ischemic group): normokinesia segments in patients with ischemic and all segments in patients with non-ischemic HF etiology;
Results
Of the 42 patients, 35 (83.3%) completed the six-months follow-up with LCZ696, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6 ± 11.1 years, with ischemic etiology in 15 (42.9%), resulting in a total of 26.5% segments for G1.
Baseline global MW index (GWI) had no statistical difference between G1 and G2 (566.1 VS 584.8mmHg%, p = 0.257), but baseline MW efficiency (GWE) were significantly lower in G1 (71.9 VS 78.8%, p < 0.001).
The table represents the mean values for MW parameters in G1 and G2 before and 6 months after LCZ696 therapy, with a significantly increase in GWI and GWE values in both groups. Despite no difference in the increase in GWE (p = 0.872), the increase in GWI were higher in G2 than G1 (p < 0.001).
Conclusion
MW seems to be a new tool providing signs of reverse remodelling and better cardiac performance in ischemic and non-ischemic segments after LCZ696 therapy.
Table 1 Time 0 6 months p GWI in ischemic segments (mmHg%) 566.1 ± 364.0 696.5 ± 445.2 <0.001 GWE in ischemic segments (%) 71.9 ± 25.0 78.9 ± 19.1 0.009 GWI in non-ischemic segments (mmHg%) 584.8 ± 434.3 812.3 ± 442.0 <0.001 GWE in non-ischemic segments (%) 78.8 ± 21.2 85.7 ± 15.8 0.004 MW data before and after six months of LCZ696 therapy
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
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9
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Valentim Goncalves AA, Pereira-Da-Silva T, Soares R, De Sousa L, Ilhao Moreira R, Rio P, Feliciano J, Cruz Coutinho M, Reis J, Mano T, Mendonca T, Cruz Ferreira R. P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.858] [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
Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results.
Purpose
The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT.
Methods
Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day.
The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics.
Results
From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.
Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) >12mmHg (p < 0.001), cardiac index <2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p < 0.001), pulmonary vascular resistance > 1,5WU (p = 0.044) and right atrial pressure >5mmHg (p = 0.003).
BNP >500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP >12mmHg and mPAP ≥25mmHg, respectively.
Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT.
BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) > 12mmHg 0.798 <0.001 0.671-0.925 > 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 <0.001 0.714-0.946 > 500pg/ml 87.5% 67.7% Cardiac output < 4L/min 0.833 0.002 0.667-1.000 > 1500pg/ml 77.8% 87.5% Cardiac index (CI) < 2.5L/min/m2 0.810 0.001 0.663-0.957 > 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) > 1,5WU 0.678 0.044 0.509-0.848 > 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) > 5mmHg 0.744 0.003 0.607-0.880 > 500pg/ml 70.8% 65.4% BNP prediction
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Affiliation(s)
| | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
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10
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Timoteo AT, Moura Branco L, Galrinho A, Ilhao Moreira R, Sousa L, Agapito A, Cruz Ferreira R. P1774 Myocardial work indices in adult patients with repaired aortic coartation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial strain analysis is a tool that allows a more precise assessment of cardiac performance. However, strain is relatively load dependent. New tools have been developed, with afterload adjustment. It was our objective to assess myocardial work (MW) in patients with repaired aortic coartation (ACo).
Methods
Study of consecutive adult patients with corrected ACo submitted to a routine transthoracic echocardiogram in 2018 at our centre. Patients with an aortic valve prosthesis, more than mild aortic stenosis / regurgitation, with pacemakers, with other non-corrected congenital heart diseases (with the exception of bicuspid aortic valve) were excluded from the analysis. A semi-automated strain analysis was performed with speckle tracking technology and both global longitudinal strain (GLS) and MW were estimated using GE software™. Blood pressure was simultaneously measured in the patient’s right arm. We specifically assessed: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE)
Results
Twenty patients were included in the study, mean age of 36 ± 9 years, 30% males. Mean body surface area was 1.7. In this group of patients, 40% were hypertensives and in 55% there was a concomitant bicuspid aortic valve. Mean maximum aortic valve gradient was 11 mmHg and mean descending aortic gradient was 19 mmHg. Compared to recently published reference values for a normal population, repaired ACo patients had lower values of MW (Table). In multivariate linear regression analysis, independent predictors of GWI are systolic blood pressure (β=0.441) and let atrial volume indexed (LAVI) (β=0.507). For GCW, male gender (β=-0.605), LAVI (β=0.530) and diastolic blood pressure (β=-0.742). For GWE, the only predictor was LAVI (β=0.498) and no predictor was identified for GWW. The presence of bicuspid aortic valve, aortic valve gradient and descending aortic gradient did not have any influence in MW parameters, although higher aortic valve gradients were excluded from this study.
Conclusion
Adult patients with repaired ACo, present lower MW indices and the main determinant for that difference are LAVI and blood pressure. GWW is the most independent parameter.
Results Variable Reference population n = 226 Patients with repaired ACo n = 20 p-value GWI (mmHg%) 1896 ± 308 1782 ± 389 <0.001 GCW (mmHg%) 2232 ± 331 2154 ± 390 <0.001 GWW (mmHg%) 78 (53-122) 76 (56-197) <0.001 GWE (mmHg%) 96 (94-97) 95 (91-97) <0.001
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Affiliation(s)
- A T Timoteo
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - A Galrinho
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - L Sousa
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - A Agapito
- Hospital Santa Marta, CHLC, Lisbon, Portugal
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11
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Valentim Goncalves AA, Pereira-Da-Silva T, Soares R, Ilhao Moreira R, De Sousa L, Rio P, Feliciano J, Reis J, Mendonca T, Cruz Coutinho M, Mano T, Cruz Ferreira R. P354 Right heart catheterization parameters, echocardiography parameters and B-Type natriuretic peptide prediction of acute cellular rejection in the first year after heart transplant. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.205] [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
Since the mid-1970s, the diagnosis of acute cellular rejection (ACR) has been made by endomyocardial biopsy (EMB). Whether B-Type Natriuretic Peptide (BNP), transthoracic echocardiography (TTE) parameters and right heart catheterization (RHC) parameters can detect rejection in heart transplant (HT) patients have yielded conflicting results and did not overcome the use of EMB in the first year after HT.
Purpose
The aim of this study was to evaluate whether BNP, TTE and RHC parameters can be used to detect ACR in the first year after HT.
Methods
Prospective study of consecutive EMB performed in the first year after HT. Plasma BNP levels, TTE and RHC were performed at the same day.
Clinical significant ACR was defined as ≥ 2R, according to the ISHLT 2004 grading. The area under the curve (AUC) was analysed for statistically significant associations to detect ACR.
Results
From 2017 to 2018, 50 EMB were performed with the following results: 2R - 5 (10.0%); 1R- 29 (58.0%); 0 – 16 (32%). Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml.
AUC results of BNP and several TTE and RHC parameters for the prediction of ACR are represented in the table. Right atrial pressure (RAP) value (p = 0.027) was the only significantly predictor of ACR, while isovolumic relaxation time measured by TTE revealed a borderline significant trend (p = 0.076).
RAP > 10mmHg had a sensitivity of 60.0% and a specificity of 84.4% for detecting ACR.
Conclusion
Detecting ACR without EMB remains a clinical challenge, but RAP measured by RHC was a significant predictor of ACR in the first year after HT, while BNP values did not correlate with ACR.
AUC values PARAMETERS AUC p 95% CI BNP 0.658 0.251 0.405-0.911 Troponin I 0.591 0.507 0.260-0.923 Left ventricular ejection fraction 0.416 0.541 0.218-0.614 E/A 0.480 0.895 0.282-0.678 Deceleration time 0.463 0.463 0.161-0.765 Isovolumic relaxion time 0.745 0.076 0.427-1.000 Cardiac index 0.595 0.488 0.346-0.845 Pulmonary capillary wedge pressure 0.628 0.401 0.329-0.926 Mean pulmonary artery pressure 0.684 0.181 0.511-0.857 Right atrial pressure 0.804 0.027 0.631-0.978 AUC values
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Affiliation(s)
| | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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12
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Dias Ferreira Reis JP, Moura Branco L, Almeida Morais L, Ilhao Moreira R, Rio P, Galrinho A, Fiarresga A, Cacela D, Ferreira R. P198 Long-term outcomes after mitraclip implantation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.066] [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
Background
Mitraclip implantation (MI) is a well-established option for patients (P) with severe mitral regurgitation (MR) noneligible to surgery. Its impact on long term prognosis is being addressed by several recent studies.
Purpose
To identify predictors of morbidity and mortality in P undergoing MI and evaluate if the COAPT, Everest and MITRAFR exclusion criteria (EC) had any impact on the outcome of our population.
Methods
prospective study of P who underwent MI between 2013 and 2018 in one medical center. EC: COAPT: LVEF < 20%, LV end-diastolic diameter > 70mm or pulmonary artery systolic pressure > 70mmHg; Everest: LVEF < 25% or LV end-systolic diameter (LVESD)>55mm; MITRA-FR: LVEF < 15% or >40% or primary MR. An univariate analysis was performed followed by a multivariate Cox analysis to evaluate overall mortality (M), overall mortality/ heart failure hospitalization (MH) and mortality in the first year post-MI(M1). Survival analysis using Kaplan-Meier plots. p < 0.05 were considered significant.
Results
40P, 60% male, mean age 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months. 67.5% presented with MR grade IV and 75% had functional MR. Successful implantation in 97.5%, with 55% presenting mild MR post-procedure. Overall mortality was 30% (12P), mostly due to cardiovascular causes, with 9P dying in the first year (30%). There was no difference between pts with functional and primary MR: M- 33%vs20% (p = 0.6); MH– 53.3%vs30% (p = 0.5). P who met the COAPT exclusion criteria (N-22) presented an inferior 1Ysurvival (64.5%vs86.7%, p = 0.046). The overall outcome was comparable between P who matched and didn"t match Everest and MITRA-FR exclusion criteria. Basal BNP value (p = 0.037), mean preprocedural MAGGIC score (p = 0.040) and EROA (p = 0.039) were associated to M1. Multivariate Cox analysis revealed that basal BNP was an independent predictor of M (p = 0.017), whereas a higher distance in the pre-procedural 6 minute walk test (p = 0.008) and the "reduction in the MR severity and PASP" (p = 0.008) presented a protective effect. LVESD > 55mm was an independent predictor of MH (p = 0.017), but MR of grade 2 or less after procedure was protective (p = 0.006).
Conclusion
There was no M difference between P with functional and primary MR. P with COAPT exclusion criteria had worse 1Ysurvival. A higher distance in 6MWT and a reduction in MR severity and PASP were protective. An LVESD > 55 mm had a worse prognosis. Careful P selection may be crucial to improve MI"s results
Abstract P198 Figure. Kaplan-Meier Plots
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Affiliation(s)
| | | | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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13
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Dias Ferreira Reis JP, Moura Branco L, Almeida Morais L, Ilhao Moreira R, Rio P, Galrinho A, Fiarresga A, Cacela D, Ferreira R. P209 Mitraclip - experience of a portuguese tertiary care center - mid-term review of results. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.077] [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
Mitral regurgitation (MR) is a marker of bad prognosis in heart failure (HF) patients (pts). Mitraclip implantation (MI) leads to a clinical improvement.
Purpose
To characterize the adult population submitted to MI and evaluate its mid-term results.
Methods
Prospective analysis of 40 pts with moderate to severe MR (grades III-IV) submitted to MI between 2013 and 2018. Paired sample t-test to assess the procedure’s effect on several variables. P-values < 0.05 were considered significant.
Results
40pts, 60% male, with a mean age of 66 ± 12 years (Y) and mean follow-up time of 18 ± 15 months (M), of which 67.5% presented with grade IV MR (mean regurgitant volume - 43.5 ± 29 ml; mean EROA - 34.8 ± 13 mm2 ) and 75% with functional MR. Mean LVEF of 35%±10.3, with 55% presenting a LVEF < 35%. Mean Euroscore II of 6.0 ± 7. 27.5% had already undergone a previous cardiac surgery, in most cases CABG (63.6%). 30% had already suffered an acute coronary syndrome and 62.5% had atrial fibrillation. Mean pre-procedural peak VO2 of 14.5mL/kg/min and mean distance in the 6 minute walk test (6MWT) of 321 ± 100m. The device implantation was successful in 39 pts with a device success rate of 85% (successful implantation and reduction in MR to grade 2 or less), with 55% of pts presenting mild MR before discharge. There were immediate complications related to the procedure in 17.5% of pts, with 4pts experiencing tendinous cord rupture and 2pts leaflet tear. There were no cases of pericardial tamponade or embolic complications. Follow-up mortality of 30% (12pts), 9 deaths (D) due to cardiovascular events. 9D in the first-year post-procedure (1D within the first M), with 1 pt referred to cardiac surgery due leaflet tear and 1pt to heart transplantation. Successful MIwas associated with an improvement in NYHA functional class (3.0vs2.0, p < 0.001) and in several echocardiographic variables in the first 6M following the procedure: left ventricular (LV) end diastolic volume: 194.5mLvs168.4mL, p = 0.012; LV end systolic volume: 132.6mLvs106.7mL, p = 0.008; systolic pulmonary artery pressure: 50.5mmHgvs40.8mmHg, p = 0.013. It was also associated with a significant improvement in both 6M peak VO2 (14.4vs15.5, p = 0.028) and 6MWT distance (321.3mvs374m, p < 0.001).
Conclusion
MI is a safe procedure with a low rate of periprocedural complications. It’s associated with a functional class improvement and a significant reverse left ventricular remodeling.
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Affiliation(s)
| | | | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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14
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Valentim Goncalves A, Galrinho A, Pereira-Da-Silva T, Ilhao Moreira R, Soares R, Moura Branco L, Rio P, Feliciano J, Abreu J, Timoteo AT, Mendonca T, Reis J, Mano T, Cruz Coutinho M, Cruz Ferreira R. 4940Early reverse remodelling assessed by myocardial work after sacubitril-valsartan therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0010] [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
Sacubitril/Valsartan (LCZ696) had prognosis benefit demonstrated in PARADIGM-HF trial, however less is known about his effects in cardiac dimensions and function.
Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter. None is known about the effects of LCZ696 therapy in MW parameters.
Purpose
The aim of this study was to prospectively compare several TTE parameters, including MW, before and after LCZ696 therapy.
Methods
Prospective evaluation of chronic HF patients with optimized standard of care therapy and LVEF≤40%, in which LCZ696 therapy was started.
TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of GLS was performed and MW were estimated using custom software of GE Vivid E95 ultrasound system.
Results
Of the 42 patients, 35 (83.3%) completed the 6 months follow-up, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years with 82.9% of male patients.
LV dimensions and atrial volumes were significantly lower at 6 months of treatment. LVEF had a mean absolute raise of 8.9% and GLS a relative decrease of 27.8%. MW had a significant increase in constructive work (720.2mmHg VS 900.6mmHg, p=0.016) and work efficiency (78.6% VS 86.6%, p=0.027), with a non-significant decrease in the wasted work (150.2mmHg VS 136.8mmHg, p=0.441).
TTE data before and after 6 months of LCZ696 treatment Time 0 6 months p LV end-diastolic diameter (mm) 71.3±8.4 66.9±7.6 0.001 LV end-systolic diameter (mm) 57.8±9.4 53.1±9.3 0.002 Interventricular septum (mm) 9.6±1.7 9.9±1.9 0.280 LVEF (%) 29.3±6.4 38.2±8.9 <0.001 GLS (%) −7.0±2.9 −8.9±2.8 0.001 MW – Constructive (mmHg) 720.2±230.5 900.6±343.2 0.016 MW – Wasted (mmHg) 150.2±83.3 136.8±54.2 0.441 MW – Efficiency (%) 78.6±10.8 86.6±12.0 0.027 E/e' 13.7±4.5 12.8±4.9 0.449 Pulmonary artery systolic pressure (mmHg) 38.3±12.2 30.9±10.6 <0.001 Left atrium volume (ml/m2) 51.5±22.6 43.7±15.8 0.004 Right atrium volume (ml/m2) 33.1±4.4 28.5±13.5 0.036 TAPSE (mm) 19.2±4.4 20.0±4.9 0.404
Conclusion
LCZ696 therapy is associated with signs of reverse remodelling in TTE, including an increase in constructive work and work efficiency.
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Affiliation(s)
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
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15
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Dias Ferreira Reis JP, Ramos R, Modas Daniel P, Rosa Aguiar S, Almeida Morais L, Coutinho Cruz M, Ilhao Moreira R, Mendonca T, Viveiros Monteiro A, Leal C, Marques H, Figueiredo L, Cruz Ferreira R. P2722Optimizing diagnosis of obstrutive coronary artery disease by CT angiography and ischemia test: a randomized clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1039] [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
Aim
In patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve patient selection for invasive coronary angiography (ICA) as alternative to functional testing. However, the role of CTA in symptomatic patients after abnormal functional test is incompletely defined.
Methods and results
This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic patients (pts) with mild to moderately abnormal functional test referred to invasive coronary to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Patients with high risk features on functional tests, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR <60 ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic and revascularization yields of ICA in either group were also assessed. Subjects averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA angiography was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, nonobstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (P<0.001). Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, P=0.152), but a greater cumulative contrast dose in the CTA-guided group (87.5±21 vs 77±40, p=0.026) was observed. Both diagnostic (84.4% vs 41.7, p<0.001) and revascularization (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard functional test-guided ICA.
Conclusions
In patients with suspected CAD and mild to moderately abnormal functional test, a diagnostic strategy including computed tomographic angiography as gatekeeper is effective and significantly improves diagnostic and revascularization yields of invasive coronary angiography.
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Affiliation(s)
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | | | | | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - C Leal
- Hospital de Santa Marta, Radiology Department, Lisbon, Portugal
| | - H Marques
- Hospital de Santa Marta, Radiology Department, Lisbon, Portugal
| | - L Figueiredo
- Hospital de Santa Marta, Radiology Department, Lisbon, Portugal
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16
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Ilhao Moreira R, Abreu A, Oliveira L, Oliveira M, Rodrigues I, Coutinho Cruz M, Portugal G, Mano T, Silva Cunha P, Santos V, Santa Clara H, Mota Carmo M, Cruz Ferreira R. 250Risk stratification of heart failure patients submitted to cardiac resynchronization therapy using a combination of renal function and 123I-mIBG scintigraphy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez150.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Abreu
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - L Oliveira
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - M Oliveira
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - I Rodrigues
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | | | - G Portugal
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - P Silva Cunha
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - V Santos
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - H Santa Clara
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - M Mota Carmo
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
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17
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Ilhao Moreira R, Pereira Da Silva T, Goncalves A, Mano T, Mendonca T, Coutinho Cruz M, Morais L, Rodrigues I, Feliciano J, Abreu A, Soares R, Cruz Ferreira R. P6521Comparison of peak oxygen consumption and percent of predicted oxygen consumption for predicting prognosis in young and female heart failure patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - A Goncalves
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | | | - L Morais
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - I Rodrigues
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - J Feliciano
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - A Abreu
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
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18
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Ilhao Moreira R, Pereira Da Silva T, Goncalves A, Reis J, Mano T, Coutinho Cruz M, Morais L, Rodrigues I, Modas Daniel P, Mendonca T, Feliciano J, Abreu A, Soares R, Cruz Ferreira R. 5221Impact of cardiorespiratory fitness in the obesity paradox in heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - A Goncalves
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | | | - L Morais
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - I Rodrigues
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | | | - T Mendonca
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - J Feliciano
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - A Abreu
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Cardiology, Lisbon, Portugal
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19
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Timoteo AT, Moura Branco L, Galrinho A, Cruz M, Ilhao Moreira R, Feliciano J, Abreu J, Rio P, Portugal G, Cruz Ferreira R. P3504Cardiotoxicity and left ventricular function: what about diastolic function? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A T Timoteo
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - A Galrinho
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - M Cruz
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | | | - J Feliciano
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - J Abreu
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - P Rio
- Hospital Santa Marta, CHLC, Lisbon, Portugal
| | - G Portugal
- Hospital Santa Marta, CHLC, Lisbon, Portugal
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20
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Valentim Goncalves A, Abreu A, Soares R, Pereira-Da-Silva T, Feliciano J, Ilhao Moreira R, Rio P, Mendonca T, Coutinho Cruz M, Rodrigues I, Modas Daniel P, Aguiar Rosa S, Morais L, Cruz Ferreira R. P3751Sub-maximal cardiopulmonary exercise test in heart failure patients: value of ve/vco2 slope in 1-year risk stratification. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | | | - L Morais
- Hospital de Santa Marta, Lisbon, Portugal
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Ilhao Moreira R, Abreu A, Rodrigues I, Coutinho Cruz M, Portugal G, Mendonca T, Goncalves A, Santa Clara H, Oliveira L, Cunha P, Mota Carmo M, Oliveira M, Cruz Ferreira R. 4774Cardiac sympathetic activity pre and post resynchronization therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coutinho Cruz M, Timoteo A, Ilhao Moreira R, Aguiar Rosa S, Ferreira L, Cruz Ferreira R. P4650Ischemic and bleeding risk prediction in Acute Coronary Syndrome - The search for an almighty risk score. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coutinho Cruz M, Abreu A, Oliveira M, Delgado A, Santa Clara H, Santos V, Portugal G, Rodrigues I, Almeida Morais L, Ilhao Moreira R, Modas Daniel P, Mendonca T, Mota Carmo M, Cruz Ferreira R. P1117The role of MIBG scintigraphy in anticipating the occurrence of sustained ventricular arrhythmias after CRT in patients with remote monitoring. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ilhao Moreira R, Timoteo A, Coutinho Cruz M, Modas Daniel P, Almeida Morais L, Rodrigues I, Aguiar Rosa S, Mendonca T, Goncalves A, Carvalho R, Ferreira L, Cruz Ferreira R. P6455Prevalence, incidence, treatment and outcomes of atrial fibrillation in acute coronary syndromes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coutinho Cruz M, Abreu A, Oliveira M, Santa Clara H, Santos V, Portugal G, Rodrigues I, Almeida Morais L, Ilhao Moreira R, Modas Daniel P, Aguiar Rosa S, Goncalves A, Mota Carmo M, Cruz Ferreira R. P4344Can we predict adverse events in patients with heart failure with reduced ejection fraction submitted to cardiac resynchronization therapy? The role of MIBG scintigraphy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ilhao Moreira R, Almeida Morais L, Oliveira M, Silva Cunha P, Nogueira Da Silva M, Lousinha A, Valenta BRUNO, Modas Daniel P, Aguiar Rosa S, Rodrigues I, Coutinho Cruz M, Sofia Delgado A, Pimenta R, Braz M, Cruz Ferreira R. P1461Risk of atrial fibrillation after catheter ablation of typical atrial flutter: a long-term outcome study. Europace 2017. [DOI: 10.1093/ehjci/eux158.088] [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: 11/13/2022] Open
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El-Dosouky I, Polte CL, Okubo T, Gonzalez Gomez A, Liu B, Generati G, Drakopoulou M, Olmos C, Trifunovic D, Ilhao Moreira R, Ilhao Moreira R, Morgan HP, Bosseau C, Romano G, Argiolas A, Kuperstein R, Koyuncu A, Sahara E, Spinelli L, Yaneva-Sirakova T, Ben Said R, Nowakowska MA, Ruivo C, Neves Pestana G, Wiligorska N, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Mahara K, Yamamoto H, Shitan H, Abe K, Terada M, Saito M, Nagatomo Y, Takanashi S, Del Val D, Monteagudo JM, Fernandez-Golfin C, Hinojar R, Garcia A, Marco A, Casas E, Jimenez-Nacher JJ, Zamorano JL, Baig S, Hayer M, Edwards N, Steeds R, Bandera F, Alfonzetti E, Guazzi M, Toutouzas K, Stathogiannis K, Michelongona A, Latsios G, Synetos A, Lazaros G, Brili S, Tsiamis E, Tousoulis D, Islas F, Ferrera C, Sanchez-Enrique C, Freitas-Ferraz A, Mahia P, Marcos-Alberca P, Tirado G, Perez De Isla L, Vilacosta I, Marinkovic J, Obrenovic- Kircanski B, Ivanovic B, Kalimanovska-Ostric D, Stevanovic G, Petrovic M, Boricic-Kostic M, Petrovic O, Tutos V, Petrovic I, Petrovic J, Draganic G, Stepanovic J, Vujisic-Tesic B, Coutinho Cruz M, Moura Branco L, Galrinho A, Coutinho Miranda L, Almeida Morais L, Modas Daniel P, Rodrigues I, Fragata J, Cruz Ferreira R, Coutinho Cruz M, Moura Branco L, Galrinho A, Timoteo AT, Viveiros Monteiro S, Aguiar Rosa S, Rodrigues I, Fragata J, Cruz Ferreira R, Nana M, Constantin C, Tarando F, Galli E, Rousseau C, Hubert A, Leclercq C, Donal E, Vitale G, Agnese V, Mina' C, Magro S, Falletta C, Di Gesaro G, Bellavia D, Clemenza F, Elena Reffo ER, Ornella Milanesi OM, Klempfner R, Ben-Zekry S, Maor E, Raanani E, Ofek E, Freimark D, Arad M, Oflar E, Ciftci S, Ungan I, Caglar FM, Ocal L, Kilicgedik A, Toprak C, Kahveci G, Atmadikoesoemah C, Kasim M, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, Cuocolo A, Trimarco B, Tarnovska-Kadreva R, Traykov L, Vassilev D, Vladimirova L, Shumkova M, Gruev I, Zairi I, Mzoughi K, Ben Moussa F, Kammoun S, Fennira S, Kraiem S, Chrzanowski L, Frynas-Jonczyk K, Wdowiak-Okrojek K, Wejner-Mik P, Lipiec P, Krakowska M, Potemski P, Plonska-Gosciniak E, Kasprzak JD, Marques N, Domingues K, Lourenco C, Santos R, Gomes C, Abreu L, Reis L, Moz M, Azevedo O, Tavares-Silva M, Sousa C, Pinto R, Ribeiro V, Vasconcelos M, Bernardo-Almeida P, Macedo F, Maciel MJ, Wiligorska D, Talarowska P, Segiet A, Mozenska O, Kosior DA. P1088Match and mismatch between opening area and resistance in mild and moderate rheumatic mitral stenosisP1089When should cardiovascular magnetic resonance imaging be considered in patients with chronic aortic or mitral regurgitation?P1090Echocardiographic characteristics of aortic valve fenestration with aortic regurgitation for aortic valve repairP1091Aortic regurgitation assessment by 3D transesophageal echocardiography vena contracta area: usefulness and comparison with 2D methods.P1092Characterising cardiomyopathy in mitral regurgitation due to barlow disease: role of CMRP1093Compensatory peripheral increase in artero-venous o2 difference to severe functional mitral regurgitation in heart failureP1094Prognostic impact of concomitant atrioventricular valve regurgitation in patients undergoing transcatheter aortic valve implantationP1095Morphological characterization of vegetations by real-time three-dimensional transesophageal echocardiography in infective endocarditis: prognostic impactP1096Relation between causative pathogen and echocardiographic findings in patients with infective endocarditis: is there an association and is it clinically relevant?P1097Aortic and mitral valve infective endocarditis: different clinical and echocardiographic features and peculiar complication ratesP1098Vegetation size relevance and impact on prognosis in patients with infective endocarditisP1099Causes of death on the valvular heart disease surveillance list- a 5 year auditP1100Left ventricular non-compaction and idiopathic dilated cardiomyopathy: the significant diagnostic value of longitudinal strainP1101The role of echocardiography in the management of diuretics withdrawal in patients with chronic heart failure and severely reduced ejection fraction: a prospective cohort studyP1102Outcomes in paediatric new onset left ventricle dysfunction and dilatation: differences between post-myocarditis and DCMP1103De novo mitral regurgitation as a cause of heart failure exacerbation in hypertrophic cardiomyopathyP1104Correlation of conventional and new echocardiograhic parameters with sudden cardiac death risk score in patients with hypertrophic cardiomyopathyP1105Inverse correlation between myocardial fibrosis and left ventricular function in rheumatic mitral stenosis: a preliminary study with cardiac magnetic resonanceP1106Left ventricular diastolic dysfunction and cardiac sympathetic derangement in patients with Anderson-Fabry disease: a 2D speckle tracking echocardiography and cardiac 123I-MIBG studyP1107Left ventricular hypertrophy and mild cognitive impairment as markers for target organ damage in hypertensive patients with multiple risk factorsP1108Subclinical left ventricular dysfunction in asymptomatic type 1 diabetic childrenP1109Minimal differences shown by echocardiography and NT-proBNP level distinguishing cardiotoxic effect related to breast cancer therapy in patients with or without HER2 expression.P1110Speed of recovery of left ventricular function is not related to the prognosis of takotsubo cardiomyopathy - a portuguese multicenter studyP1111Myocardial dysfunction in Takotsubo cardiomyopathy - more than meets the eye?P1112Obstructive sleep apnea and echocardiographic parameters. Eur Heart J Cardiovasc Imaging 2016; 17:ii227-ii234. [DOI: 10.1093/ehjci/jew262.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ilhao Moreira R, Cambronero Cortinas E, Giannakopoulos G, Wong CY, Maria Joao Vieira MJV, Neves Pestana G, Andjelkovic K, Pavon AG, Nunes A, Portero Portaz JJ, Stefan C, Namitokov A, Chivulescu M, Wojtkowska A, Gomes AC, Jurko T, Cazzoli I, Valente F, Moura Branco L, Coutinho Cruz M, Pinto Teixeira P, Almeida Morais L, Viveiros Monteiro A, Oliveira M, Ramos R, Agapito A, Cruz Ferreira R, Racugno P, Escribano D, Mendez J, Paya A, Bonanad C, Valle Munoz A, Corbi Pascual MJ, Chorro FJ, Bodi V, Mueller H, Catia Costa CC, Beatriz Saldanha Santos BSS, Kevin Domingues KD, Nuno Craveiro NC, Maria Luz Pitta MLP, Miguel Alves MA, Margarida Leal ML, Bernardo-Almeida P, Sousa C, Tavares-Silva M, Almeida R, Lima R, Amorim MJ, Almeida J, Macedo F, Maciel MJ, Kalimanovska Ostric D, Boricic Kostic M, Petrovic O, Petrovic M, Vujisic Tesic B, Mikic A, Kalangos A, Marini C, Rosa I, Stella S, Ancona F, Spartera M, Margonato A, Colombo A, Agricola E, Nascimento H, Maia Araujo P, Ferreira A, Pinho T, Andre Rodrigues R, Bernardo Almeida P, Campelo M, Dias P, Julia Maciel M, Tercero Martinez A, Corbi Pascual MJ, Prieto Mateos D, Urraca Espejel C, Calero Nunez S, Fuentes Manso R, Gallego Page JC, Garcia Lopez JC, Barambio Ruiz MJ, Iancovici S, Ianovici E, Zamfir D, Dorobantu M, Kizhvatova N, Kolodina M, Skaletsky K, Soroka N, Mayngart S, Kosmacheva E, Barbukhatti K, Porhanov V, Jurcut C, Enache R, Popescu BA, Ginghina C, Spirito P, Jurcut R, Tomaszewski A, Czekajska-Chehab E, Tomaszewski M, Stettner D, Wysokinski A, Fazendas P, Carvalho J, Ferreira F, Sousa L, Fiarresga A, Martins JD, Pereira H, Jurko A, Krsiakova J, Jurko AJR, Matasova K, Zibolen M, Babu-Narayan S, Senior R, Gatzoulis MA, Li W, Maldonado G, Cuellar H, Marti G, Roque A, Teixido G, Gonzalez-Alujas MT, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares JF. Clinical Case Poster session 4P1046An unexpected findingP1047Coronary artery ectasia in the setting of subacute Inferior STEMIP1048Diagnosis through the back door: the utility of the subscapular acoustic windowP1049A challenging case of paravalvular leakage closureP1050A life-threatning asymptomatic incidental findingP1051Acute heart failure due to intermittent aortic prosthesis regurgitation - case reportP1052Role of echocardiography in a patient with sequels after surgical treatment of infective endocarditis on a bicuspid aortic valveP1053MitraClip to treat systolic anterior motion-induced outflow tract obstruction in hypertrophic obstructive cardiomyopathyP1054Acute heart failure by parvovirus B19P1055Multimodality assessment of myocardial involvement in female carriers of the Duchenne diseaseP1056Cardiovascular complications in hypereosinophilic syndrom-a case reportP1057Giant false left ventricle aneurysm in the myocardial infarction outcomeP1058From syncope to the diagnosis of systemic disease: the importance of a high index of suspicionP1059A total anomalous pulmonary venous return in 60-year-old patientP1060Atrial septal defect occluder fracture - diagnostic challenge in asymptomatic patientP1061Marfan syndrome in two newborn infantsP1062Isolated pulmonary valve regurgitation as a cause of severe right heart dilatation in an adult patientP1063Multimodality imaging - how to find the missing leak. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nicol AF, Grinsztejn B, Friedman RK, Veloso VG, Cunha CB, Georg I, Pilotto JH, Moreira RI, Castro CAV, Silver B, Viscidi RP. Seroprevalence of HPV vaccine types 6, 11, 16 and 18 in HIV-infected and uninfected women from Brazil. J Clin Virol 2013; 57:147-51. [PMID: 23490398 DOI: 10.1016/j.jcv.2013.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/04/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information on vaccine-type HPV seroprevalence is essential for vaccine strategies; however, limited data are available on past exposure to HPV-quadrivalent vaccine types in HIV-infected woman in Brazil. OBJECTIVES To assess the seroprevalence for HPV types 6, 11, 16 and 18 in HIV-infected and uninfected women, from Rio de Janeiro, Brazil and to investigate potential associations with age and pregnancy status. STUDY-DESIGN 1100-sera were tested by virus-like particle (VLPs)-based ELISA for antibodies to HPV types 16, 18, 6 and 11. Statistical analysis was carried out by STATA/SE 10.1 and comparisons among HIV-infected and HIV-uninfected women were assessed by Poisson regression models with robust variance. RESULTS HPV-6, 11, 16 and 18 seroprevalence was significantly higher among HIV-positive women (29.9%, 8.5%, 56.2% and 38.0%, respectively) compared to HIV-negative women (10.9%, 3.5%, 30.8% and 21.7%, respectively), when adjusted by age and pregnancy status. Overall, 69.4% of HIV-infected and 41.5% of HIV-uninfected women tested positive for any HPV quadrivalent vaccine type. However 4.7% and 1.1%, respectively, tested positive for all HPV vaccine type. In HIV-uninfected women who were pregnant, we found a higher HPV-11 seroprevalence (8.5% vs. 1.5%; P < 0.001) and a lower HPV 16 seroprevalence (22.6% vs. 34.2%; P = 0.010) compared to not pregnant women. HIV-uninfected women, aged 40 or more years old had a higher HPV 16 seroprevalence compared to women aged less than 40 years old. CONCLUSIONS We did not observe a strong association between age and positive HPV antibodies nor an association between pregnancy and HPV seroprevalence. HPV seroprevalence was significantly higher among HIV-infected women compared to HIV negative women. In both populations the seroprevalence to all four HPV vaccine types was low suggesting that women may potentially benefit from the HPV vaccines.
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Affiliation(s)
- A F Nicol
- Laboratory of Interdisciplinary Medicine, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil.
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Luz PM, Velasque L, Friedman RK, Russomano F, Andrade AC, Moreira RI, Chicarino-Coelho J, Pires E, Veloso VG, Grinsztejn B. Cervical cytological abnormalities and factors associated with high-grade squamous intraepithelial lesions among HIV-infected women from Rio de Janeiro, Brazil. Int J STD AIDS 2012; 23:12-7. [PMID: 22362681 DOI: 10.1258/ijsa.2009.009409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although cervical cancer remains a major public health problem in Brazil, knowledge of cervical cytological abnormalities among HIV-infected women remains scarce. At baseline evaluation of a cohort followed in Rio de Janeiro, Brazil, 703 HIV-infected women underwent cytology-based cervical cancer screening and human papillomavirus (HPV) DNA testing. Poisson regression analysis was used to evaluate the association of factors with the presence of high-grade squamous intraepithelial lesions (HSIL). Cervical cytology was abnormal in 24.3% of the women; 4.1% had HSIL. Beyond HPV infection, factors independently associated with the presence of HSIL was age (≥25 and ≤40 years, prevalence ratio [PR] 2.60, 95% confidence interval [CI] 1.11-6.10), and more than three pregnancies was protective (PR 0.33, 95% CI 0.11-0.94). High coverage of cervical cancer screening is warranted to prevent morbidity and mortality from cervical cancer in this population.
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Affiliation(s)
- P M Luz
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Périssé AR, Schechter M, Moreira RI, do Lago RF, Santoro-Lopes G, Harrison LH. Willingness to participate in HIV vaccine trials among men who have sex with men in Rio de Janeiro, Brazil. Projeto Praça Onze Study Group. J Acquir Immune Defic Syndr 2000; 25:459-63. [PMID: 11141246 DOI: 10.1097/00126334-200012150-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evaluation of HIV vaccines requires high-risk individuals willing to participate in a vaccine trial. We investigated the willingness to participate in HIV vaccine trials of initially HIV-seronegative homosexual men enrolled in an HIV seroincidence cohort study. Of 815 initially HIV-seronegative participants, 569 (69.8%) reported willingness to participate in an HIV vaccine trial. Altruism was the primary reason given for wanting to participate. Fear of HIV infection from the study's immunizations and a vaccine-induced positive HIV test result were the main reasons for not wanting to participate. Of the 34 study subjects who eventually had HIV seroconversion, 29 (85%) had indicated a willingness to participate. In a univariate analysis, factors associated with willingness to participate included HIV seroconversion during follow-up (odds ratio [OR]. 2.6; p =.04), low educational level (OR, 1.6; p =.005), low family income (p =.02), and exchanging sex for housing, food, or clothing (OR 6.1; p =.005). Students were less likely to be willing to participate in a trial (OR, 0.7; p = .03), as well as those who reported sex at the first encounter (OR, 0.7; p = .05). In a multivariate analysis, low education level, infection with Condyloma, and exchanging sex for housing, food, or clothing were positively associated with willingness to participate, whereas being a student and reporting sex at first encounter were negatively associated. In general, factors indicative of high-risk of HIV infection were associated with a higher willingness. These data demonstrate that this high-risk homosexual male cohort has a high willingness to participate in HIV vaccine trials.
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Affiliation(s)
- A R Périssé
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Brazil
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Hofer CB, Harrison LH, Struchiner CJ, Moreira RI, do Lago RF, de Melo MF, Schechter M. Acute retrovirus syndrome among prospectively identified homosexual men with incident HIV infection in Brazil. Projecto Praça Onze Study Group. J Acquir Immune Defic Syndr 2000; 25:188-91. [PMID: 11103050 DOI: 10.1097/00042560-200010010-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptoms associated with HIV infection are common among HIV seroconverters, but the acute retroviral syndrome (ARS) is a diagnostic challenge because of the absence of a sensitive and specific case definition. We conducted an analysis of HIV seroconverters in Projeto Praça Onze, a HIVNET HIV seroincidence study among homosexual men in Rio de Janeiro. METHODS Information from study subjects enrolled in Projeto Praça Onze who were documented HIV seroconverters were compared with nonseroconverters. At each semiannual study visit, participants were asked about HIV seroconversion symptoms and sexually transmitted diseases (STDs) during the preceding 6 months. All information was collected before the laboratory evaluation. A classification tree analysis was used to identify an ARS case definition, first using clinical information and then after including risk factor data for seroconversion in our cohort. RESULTS As of July 1998, 674 volunteers were enrolled and 34 of these seroconverted; information was available for 33 of these. Among the seroconverters, 11 (34%) denied any symptoms, and 22 (66%) reported one or more symptoms, the most common of which were fever (25% of seroconverters versus 7% of nonseroconverters; p <.01), night sweats (9% versus 2%, respectively; p =.05), incapacitating disease (ID) for >/=3 days (27% versus 7%, respectively; p <.001), and weight loss of >/=2 kg (21% versus 9%, respectively; p =.05). STDs were more common in seroconverters (gonorrhea: 9% versus 1%, respectively; p <.01 and condyloma: 9% versus 3%, respectively; p =. 08). The first case definition was ID for >3 days, fever, pharyngitis, and myalgia (seroconverters, 3 of 32, versus nonseroconverters, 2 of 640). The second case definition was was ID for >3 days, anti-core hepatitis b-positive, and age <21 years (seroconverters: 6 of 32 versus nonseroconverters 4 of 640). The sensitivity and specificity for the first and second case definitions were: 9.4%, 99.4%, and 18.8%, 99.8%, respectively. CONCLUSIONS Among HIV seroconverters, symptoms consistent with ARS were common. We were unable to identify a sensitive case definition that could be used as a screening tool. Although the clinical case definition was not validated, the specificity of our case definitions was high, suggesting that subjects within this HIV risk group who fulfill the case definition should be tested for HIV.
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Affiliation(s)
- C B Hofer
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Department of Preventive Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Schechter M, do Lago RF, de Melo MF, Sheppard HW, Guimarães NC, Moreira RI, Faulhaber JC, Batista S, Harrison LH. Identification of a high-risk heterosexual population for HIV prevention trials in Rio de Janeiro, Brazil. Projeto Praço Onze Study Group. J Acquir Immune Defic Syndr 2000; 24:175-7. [PMID: 10935694 DOI: 10.1097/00126334-200006010-00013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study of interventions to prevent HIV transmission requires access to populations with a high rate of HIV transmission. We estimated HIV incidence among heterosexual males and females who were seen at an HIV testing site in Rio de Janeiro, Brazil. Stored sera from individuals who visited the site between March and December 1998 were analyzed using the sensitive/less sensitive (S/LS) assay and a chart abstraction was performed. During the study period, 6353 serum samples were tested. Of those tested, 1203 were found to be HIV-seropositive or indeterminate, of which 1050 (87%) remained available for further testing. In addition, 84 serum samples, representing 63 adults, were found to produce results suggesting early HIV infection. Of these, 14 were heterosexual and female (median age, 38 years), and 19 were heterosexual and male (median age, 25 years). The estimated HIV seroincidence was 1.9 (95% confidence limits (CL), 0.9%-3.9%) and 2.8 (95% CL, 1.4%-5.3%) per 100 person-years among heterosexual women and men, respectively. A survey on willingness to participate in future placebo-controlled HIV vaccine trials in this population indicated that 54.5% and 53.9% of heterosexual women and men, respectively, indicated that they would definitely be willing to participate. We have identified a heterosexual population in Rio de Janeiro with a high rate of HIV transmission willing to participate in placebo-controlled vaccine trials. This study demonstrates the usefulness of the newly described S/LS assay, which allows one to estimate HIV incidence from single serum specimens.
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Affiliation(s)
- M Schechter
- Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Brazil.
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