1
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Martins da Costa C, Amador AF, Pinto R, Bragança B, Oliveira I, Silva JC, Rodrigues RA. Same-day discharge after elective percutaneous closure of patent foramen ovale. Monaldi Arch Chest Dis 2024. [PMID: 38305834 DOI: 10.4081/monaldi.2024.2833] [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] [Received: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 02/03/2024] Open
Abstract
Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. Forty-nine (40%) had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this same-day discharge strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.
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Affiliation(s)
- Catarina Martins da Costa
- Department of Cardiology, University Hospital Center of São João, Porto; Faculty of Medicine, University of Porto.
| | - Ana Filipa Amador
- Department of Cardiology, University Hospital Center of São João, Porto; Faculty of Medicine, University of Porto.
| | - Roberto Pinto
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Bruno Bragança
- Department of Cardiology, Tâmega and Sousa Hospital Center, Penafiel.
| | - Inês Oliveira
- Department of Cardiology, Tâmega and Sousa Hospital Center, Penafiel.
| | - João Carlos Silva
- Department of Cardiology, University Hospital Center of São João, Porto.
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2
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Rebelo P, Teixeira A, Pinto R, Santos C, Brooks D, Marques A. Intensity of exercise in people with COPD enrolled in community-based physical activities. Pulmonology 2023:S2531-0437(23)00199-X. [PMID: 38008703 DOI: 10.1016/j.pulmoe.2023.11.001] [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: 07/11/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- P Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - A Teixeira
- City council of Estarreja, Sports division, Estarreja, Portugal
| | - R Pinto
- City council of Estarreja, Sports division, Estarreja, Portugal
| | - C Santos
- City council of Estarreja, Sports division, Estarreja, Portugal
| | - D Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - A Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
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3
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Lino R, Amorim S, Silva C, Neves N, Araújo P, Pinto R, Pinheiro-Torres J, Pinho P, Macedo F, Santos L. Cutaneous Tuberculosis in Heart Transplant. Transplant Proc 2023; 55:1444-1448. [PMID: 37142508 DOI: 10.1016/j.transproceed.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023]
Abstract
Tuberculosis is a disease with a significant global burden in terms of morbidity and mortality. It usually presents as a pulmonary disease but can occasionally have extrapulmonary presentations. Immunosuppressed people are at an increased risk of tuberculosis and more frequently have atypical manifestations of the disease. Cutaneous involvement is estimated to occur in only 2% of extrapulmonary presentations. We report a case of a heart transplant recipient with disseminated tuberculosis who initially presented with cutaneous manifestations in the form of multiple abscesses that were mistaken for a community-acquired bacterial infection. The diagnosis was made after positive nucleic acid amplification testing and cultures for Mycobacterium tuberculosis from the drainage of the abscesses. After initiating antituberculous treatment, the patient had 2 instances of immune reconstitution inflammatory syndrome. A combination of diminished immunosuppression due to discontinuation of mycophenolate mofetil in the setting of acute infection, rifampin drug interactions with cyclosporine, and the beginning of treatment of tuberculosis all contributed to this paradoxical worsening. The patient responded favorably to increased glucocorticoid therapy and showed no signs of treatment failure after 6 months of antituberculous therapy.
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Affiliation(s)
- Rita Lino
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Sandra Amorim
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudio Silva
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nélia Neves
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Araújo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Pinheiro-Torres
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Pinho
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; ESCMID Study Group for Infections in Compromised Hosts, European Society of Clinical Microbiology and Infectious Diseases
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4
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Amorim S, Araújo P, Pinto R, Medas R, Pereira P, Lopes J, Santos L, Pinheiro-Torres J, Macedo F, Pinho P. An Unexpected Cause of Acute Abdomen Late After Heart Transplantation-A Case Report. Transplant Proc 2023; 55:1451-1453. [PMID: 37045702 DOI: 10.1016/j.transproceed.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
Cytomegalovirus (CMV) infection is a frequent complication after a solid organ transplant, and in 86% of the cases, CMV disease occurred during the first 6 months after transplantation. Invasive CMV infections may be present as ulcerative infections of the upper gastrointestinal tract with esophagitis, gastritis, and ulcerations of the duodenum and the small bowel; however, CMV infections of the pancreatobiliary system, especially papillitis, are rarely observed. We present a case report of a man who underwent a heart transplant 6 years before, with a clinical picture of duodenitis and a simultaneous pseudotumor of major duodenal papilla who developed signs of acute abdomen caused by gastrointestinal CMV infection, successfully treated with medical therapy with valganciclovir. There is an urgent need for developments in CMV and solid organ transplantation to stratify the risk of late-onset CMV disease.
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Affiliation(s)
- Sandra Amorim
- Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - Paulo Araújo
- Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Renato Medas
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joanne Lopes
- Pathological Anatomy Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - J Pinheiro-Torres
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paulo Pinho
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
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5
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Beirão B, Pinto M, Vasques J, Charneca S, Pinto R, Pires M, Borges M, Santa-Clara H, Pinto F, Abreu A, Santos I, Sousa Guerreiro C. Changing Dietary Habits In Cardiac Rehabilitation– More Than Nutritional Counselling. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.285] [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: 03/28/2023]
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6
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Costa R, Moreira E, Silva Cardoso J, Azevedo LF, Ribeiro JA, Pinto R. Effectiveness of Exercise-Based Cardiac Rehabilitation for Heart
Transplant Recipients: A Systematic Review and Meta-Analysis. Health Serv Insights 2023; 16:11786329231161482. [PMID: 36968658 PMCID: PMC10034295 DOI: 10.1177/11786329231161482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
Background: Heart Transplant (HTx) is the ultimate chance of life for end stage Heart
Failure (HF). Exercise training has consistently shown the potential to
improve functional capacity in various chronic heart diseases. Still, the
evidence in HTx recipients is scarcer. This study aims to systematically
review the literature to evaluate the effectiveness and safety of
Exercise-based Cardiac Rehabilitation (EBCR) in HTx recipients and to
identify possible moderators of success. Methods: We conducted a systematic review and meta-analysis of randomized controlled
trials on the effect and safety of EBCR in adult HTx recipients. The primary
outcome was functional capacity, measured by Peak Oxygen Uptake (pVO2). We
searched CENTRAL, MEDLINE, Embase, Scopus, and Web of Knowledge databases
until December 2020, reviewed references of relevant articles and contacted
experts. Usual care (UC), the different dosages of exercise regimens and
alternative settings were allowed as comparators. A quantitative synthesis
of evidence was performed using random-effects meta-analyses. Results: A total of 11 studies with 404 patients were included. Nine studies
comprising 306 patients compared EBCR with usual care. They showed that EBCR
improved pVO2 compared to usual care (Mean Difference [MD] 3.03 mL/kg/min,
95% CI [2.28-3.77]; I2 = 32%). In the subgroup
analysis, including length of intervention and timing of enrollment after
HTx, no significant moderator was found. Two trials, with 98 patients total,
compared High Intensity Interval Training (HIIT) and Moderate Intensity
Continuous Training (MICT). HIIT attained a significant edge over MICT (MD
2.23 mL/kg/min, 95% CI [1.79-2.67]; I2 = 0%). No
major adverse events associated with EBCR were reported. Conclusion: We found moderate quality evidence suggesting EBCR has a significant benefit
on functional capacity improvement HTx recipients at the short-term. HIIT
showed superiority when compared to MICT. Research focusing long term
outcomes and standardized protocols are needed to improve evidence on EBCR
effectiveness.
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Affiliation(s)
- Rúben Costa
- Faculty of Medicine, University of
Porto, Porto, Portugal
- Department of Dermatology and
Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Rúben Alexandre Nogueira Costa, Centre for
Health Technology and Services Research, Centro Hospitalar Universitário São
João, Rua Dr. Plácido da Costa, Porto 4200-450, Portugal.
| | - Emília Moreira
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
| | - José Silva Cardoso
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Medicine, Faculty of
Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Community Medicine,
Information and Health Decision Sciences, Faculty of Medicine, University of Porto,
Portugal
| | - João Alves Ribeiro
- Faculty of Engineering, University of
Porto, Porto, Portugal
- MIT Portugal Ph.D. candidate, Faculty
of Engineering, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine, Faculty of
Medicine, University of Porto, Porto, Portugal
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7
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Martins Carvalho M, Proença T, Alves Pinto R, Pinto R, Macedo F. Wernicke encephalopathy and beriberi disease presenting as STEMI-equivalent. Monaldi Arch Chest Dis 2023; 93. [PMID: 36806824 DOI: 10.4081/monaldi.2023.2513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/30/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
Thiamine deficiency is commonly associated with malnutrition, alcoholism and bariatric surgery. Thiamine deficiency can manifest in different ways, especially in developing countries: as peripheric neuropathy, as Wernicke encephalopathy or as beriberi disease. The authors present the case of a 72-year-old male, with a hiatal hernia that led to thiamine deficiency due to malnutrition. The initial clinical manifestation was an ST-elevation myocardial infarct equivalent, an ECG with a shark-fin pattern that evolved to a Wellens type B pattern. The patient evolved with severe altered mental status. A Wernicke encephalopathy diagnosis was confirmed by MRI; the patient was medicated with high-dose thiamine, with quick recovery, both neurologic and cardiac. The clinical history and response to treatment confirm the diagnosis of Wernicke encephalopathy and beriberi disease.
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Affiliation(s)
- Miguel Martins Carvalho
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
| | - Tânia Proença
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Ricardo Alves Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
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8
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Amador F, Mendonça F, da Costa C, Canha M, Neves JS, Pinto R, Amorim S, Souto S, Freitas P, Carvalho D. Total thyroidectomy in a patient awaiting heart transplant with amiodarone-induced thyrotoxicosis: A case report. Clin Case Rep 2023; 11:e6892. [PMID: 36789324 PMCID: PMC9909169 DOI: 10.1002/ccr3.6892] [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: 09/28/2022] [Revised: 11/13/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
Thyroid function may have a severe impact in cardiac function. Herein, we present the case report of a 53-year-old male patient awaiting heart transplant with amiodarone induced thyrotoxicosis that presented a marked improvement of his cardiac function after total thyroidectomy.
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Affiliation(s)
- Filipa Amador
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Catarina da Costa
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Marta Canha
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Roberto Pinto
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Sandra Amorim
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Selma Souto
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
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9
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Pinto R, Tavares-Silva M. Redefining the role of inotropes in advanced heart failure. Rev Port Cardiol 2023; 42:345-347. [PMID: 36639106 DOI: 10.1016/j.repc.2023.01.005] [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: 01/12/2023] Open
Affiliation(s)
- Roberto Pinto
- Serviço de Cardiologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Marta Tavares-Silva
- Serviço de Cardiologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; UnIC@RISE, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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10
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Valente A, Costa M, Pinto R, Cirnes L, Augusto I, Schmitt F. PAM50 genomic test in the management of early breast cancer – the importance of clinical-pathological data. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01559-3] [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: 11/19/2022]
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11
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Pinho AI, de Carvalho MM, Oliveira C, Santos LD, Proença T, Pinto RA, Amador AF, da Costa CM, Calvão J, Cabrita A, Marques C, Nóbrega L, Dias L, Pinto R, Rodrigues RA, Macedo F. Clinical Case 03—Coronary subclavian steal syndrome: an unusual cause of acute myocardial infarction. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac157.119] [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
A 69-year-old male presented with typical angina while showering. He had history of CABG in 2008 (left internal mammary arterial [LIMA] to the first marginal and intermediate arteries and RIMA to the LAD artery), with preserved biventricular systolic function. On physical examination, an upper-arm systolic blood pressure differential >20mmHg and a decreased pulse amplitude on the left side was found. ECG revealed sinus tachycardia with RBBB, ST-segment depression and inverted T-waves in the lateral and inferior leads. Troponin and BNP levels were elevated. Echocardiogram showed reduced left ventricular ejection fraction (22%) and de novo akinesia of the inferior and posterior walls. The diagnosis of non-ST-segment elevation myocardial infarction was assumed. Coronary angiography revealed patent bypass grafts without disease and a 90% stenosis of the left subclavian artery (LSA) proximal to the ostia of the LIMA, with retrograde flow ‘stealing’ the myocardial blood supply. Ultrasound scan detected systolic reversal of flow in the left vertebral artery, suggesting subclavian-vertebral steal phenomenon. CT-angiography revealed a 14-mm stenosis with a useful lumen of 2 mm in the LSA. A percutaneous balloon angioplasty with stenting of the LSA was performed by the Vascular team, restoring the normal blood supply. Coronary subclavian steal syndrome can manifest as myocardial infarction or heart failure, due to functional LIMA graft failure by inadequate blood supply to the myocardium. Anamnesis and physical examination are fundamental in order not to miss the diagnosis. Subclavian angiography is the gold standard to confirm the diagnosis and can be performed during coronary angiography. Revascularization of the LSA is the definitive treatment. Figure 1Coronary angiography revealed chronic occluded native coronary vessels with patency and no significant disease of the bypass grafts, and high grade (90%) left subclavian artery (LSA) stenosis proximal to the ostia of the LIMA, conditioning the blood flow to the left upper limb and ‘stealing’ the myocardial blood supply because of retrograde flow in the LIMA graft.
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Affiliation(s)
- Ana Isabel Pinho
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | | | - Cátia Oliveira
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Luís Daniel Santos
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Tânia Proença
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Ricardo Alves Pinto
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Ana Filipa Amador
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | | | - João Calvão
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - André Cabrita
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Catarina Marques
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Leandro Nóbrega
- Department of Vascular Surgery, São João University Hospital Centre , Porto , Portugal
| | - Lara Dias
- Department of Vascular Surgery, São João University Hospital Centre , Porto , Portugal
| | - Roberto Pinto
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Rui André Rodrigues
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
| | - Filipe Macedo
- Department of Cardiology, São João University Hospital Centre , Porto , Portugal
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12
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Amador A, Martins Da Costa C, Calvao J, Carvalho JM, Proenca T, Pinto R, Marques C, Cabrita A, Santos L, Oliveira C, Pinho A, Palma P, Rocha M, Sousa C, Macedo F. Aortic valve calcium score: does it correlate with mean transaortic gradient? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1550] [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
Aortic valvular calcium score (AVCS) is useful in patients with aortic stenosis for whom echocardiography was not conclusive in grading its severity. Transcatheter aortic valve implantation (TAVI) is an established procedure of treatment in symptomatic severe AS. The burden of aortic valve calcification has been associated with some TAVI related complications (as perivalvular leaks), but at the same time it is well accepted that some degree of calcification is needed to ensure stable anchoring of the prosthesis to the aortic annulus.
Purpose
To assess if there is a correlation between aortic valve calcium score and mean transvalvular gradient 6 months after TAVI – is a higher AVCS correlated with lower mean transaortic gradient after TAVI?
Methods
We performed a single-center, retrospective cohort study including patients who underwent TAVI with a preoperative standardized contrast enhanced MSCT with AVCS available. Clinical and echocardiographic data were collected previously to TAVI (pre-TAVI) and at 6 months follow up (6M-FUP).
Results
A total of 187 patients were included, with 54% female and a mean age of 79.4±9.0 years old. Most patients had tricuspid aortic valve (95.7%); 5 patients had aortic bicuspidy and 3 had aortic valve bioprothesis. Concerning the valve type, 73.3% had new generation prosthesis and the main valve used was the CoreValve Evolut Pro (33.7%). Also, 38,5% needed balloon pre-dilation before TAVI. The mean pre-TAVI aortic transvalvular maximum and mean gradients were 76.5±23.2 mmHg and 48.3±15.5 mmHg, respectively; mean aortic valve area was 0.75±0.16 cm2. The mean AVCS was 2851±1524 AU (Agaston Units); 81.2% of women had AVCS>1300 AU and 74.4% men had AVCS >2000 AU. Comparing transvalvular aortic gradients previously and 6M-FUP after TAVI, there was an average differential of maximum gradient of 61±22 mmHg and of mean gradient of 40±15 mmHg. A negative and weak correlation was found between the AVCS and the maximum gradient (pearson coefficient of −0.181, p=0.02) and between mean gradient at 6M-FUP (pearson coefficient of −0.191, p=0.014).
Discussion and conclusion
AVCS is a significant predictor for death, stroke and perivalvular leaks after TAVI. On the other hand, high AVCS is associated with better seating in the native annulus during deployment. Nevertheless, high AVCS did not strongly correlated with mean transaortic gradient 6 months after TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | | | - J Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J M Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - R Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - L Santos
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Oliveira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Pinho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - P Palma
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - M Rocha
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Sousa
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
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13
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Amador A, Martins Da Costa C, Calvao J, Pinto R, Proenca T, Carvalho JM, Cabrita A, Marques C, Pinho A, Santos L, Oliveira C, Moreira H, Palma P, Sousa C, Macedo F. Reduced 3D-left atrium ejection fraction predicts development of atrial fibrillation in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.097] [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
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, related to left atrial (LA) dilatation and remodeling. HCM patients who develop AF have increased risk of HCM-related death, functional impairment, and stroke. Accurate risk stratification for AF in this population is crucial as contemporary treatments are highly successful.
Purpose
To assess if new echocardiographic parameters can predict the development of AF in HCM patients.
Methods
HCM patients who underwent comprehensive echocardiographic examination during 2011 were followed and checked for “de novo” AF until November 2021. We searched for associations between AF development and novel echocardiographic parameters such as LA Volume index, Left Atrioventricular Coupling Index (LACI, as LAVI/a'), 3D LA volumes and 3D LA ejection fraction (3D-LAEF).
Results
A total of 43 patients were included, with 62.8% male and mean age 56,1±6,2 years old. 55.8% had the septal asymmetric HCM type and mean LV mass was 326±127g. Mean LA diameter and biplane 2D volume was 46±7 mm and 78±37 mL, respectively. 11.6% of patients already had AF. During a median follow-up of 9.4 years, the incidence of “de novo” AF was 31,6%. Within the total 17 patients with AF, 35,2% took warfarin and the remaining direct oral anti-coagulation. No stroke was documented. There were 3 deaths (mortality rate of 7,0%), none from cardiac causes.
No association was found between AF development and LAVI, LACI or 3D LA volumes. We only found a statistically significant difference regarding 3D-LAEF, which was lower in patients who developed AF compared with those without AF (26±12% VS 39±19%, p=0.04).
Binary logistic regression analysis found that reduced 3D-LAEF predicts the development of AF (p=0.019, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0 to 1.1). The area under a receiver operating characteristic curve using 3D-LAEF as a predictive marker for AF development in HCM patients was 0.743 (p=0.004). When the cut-off value of 3D-LAEF was set at 34,5%, the sensitivity and specificity for AF diagnosis were 66% and 86%, respectively.
Conclusion
In our study, 3D LAEF predicted the development of AF in HCM patients – this may be a useful tool to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | | | - J Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - R Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J M Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Pinho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - L Santos
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Oliveira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - H Moreira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - P Palma
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Sousa
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
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14
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Marques C, Cabrita A, Maia Araujo P, Proenca T, Pinto R, Carvalho M, Costa C, Amador AF, Calvao J, Pinho A, Oliveira C, Santos L, Cruz C, Macedo F. Patient delay in acute myocardial infarction: a long journey still ahead. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1473] [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
It is overly known that time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes.
Methods
In this six-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 194 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records.
Results
Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least one cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity ≥7 vs <7 in a 0–10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. After this initial univariate analysis, multiple linear regression was performed to identify possible predictors of PD. Four variables were identified: pts ability to recognize their symptoms as AMI (β −0.199; 95% CI: −277 to −34,87; p=0.012), living in a non-rural residence (β 0.154; 95% CI: 0.12–161.44; p=0.05), presenting associated symptoms (β −0.194; 95% CI: −257.43 to −28.84; p=0.014) and occurrence of symptoms on weekdays (β 0.170; 95% CI: 12.73–259.49; p=0.031) predicted shorter patient delays.
Conclusion
Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts living in rural areas, in order to: 1) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 2) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Marques
- Sao Joao Hospital , Porto , Portugal
| | - A Cabrita
- Sao Joao Hospital , Porto , Portugal
| | | | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - R Pinto
- Sao Joao Hospital , Porto , Portugal
| | | | - C Costa
- Sao Joao Hospital , Porto , Portugal
| | | | - J Calvao
- Sao Joao Hospital , Porto , Portugal
| | - A Pinho
- Sao Joao Hospital , Porto , Portugal
| | | | - L Santos
- Sao Joao Hospital , Porto , Portugal
| | - C Cruz
- Sao Joao Hospital , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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15
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Amador A, Martins Da Costa C, Calvao C, Pinto R, Proenca T, Carvalho JM, Cabrita A, Marques C, Pinho A, Santos L, Oliveira C, Palma P, Paiva M, Silva JC, Macedo F. 20 year-follow up of mitral stenosis patients after percutaneous valve commissurotomy: moderate disease of other valves as predictor for re-intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2126] [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
Percutaneous valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with clinically significant mitral stenosis (MS). About 40% of patients treated with PMC will require at least one reintervention (either PMC or MVS) along time.
Purpose
To evaluate the long-term results of PMC in patients with rheumatic MS.
Methods
We retrospectively analysed all consecutive patients between 1991 and 2008 with clinically significant rheumatic MS undergoing PMC. Clinical and echocardiographic data were collected at baseline and during early and long-term follow-up. MACE was a composite of adverse events defined as all-cause mortality, MV re-intervention or cardiovascular hospitalization.
Results
A total of 124 patients were enrolled: 108 (87%) were female, with a mean age at the time of PMC of 46±11 years.
At baseline, 34% patients were in NYHA class ≥ III and 81% had a Wilkins score ≤8; all patients had preserved biventricular systolic function and 83% presented pulmonary hypertension. Regarding associated valve disease, 46 patients had mild tricuspid regurgitation (TR), 19 mild aortic regurgitation (AR), 14 moderate IT and 5 moderated AR.
Most of the procedures were successful (91%) and without complications (94%), with median improvement in MV area of 0.9 cm2 (IQR 0.5) and median reductions in mean transmitral gradient (MTG) of 6 mmHg (IQR 6) and in pulmonary artery systolic pressure (PASP) of 8 mmHg (IQR 10) early after PMC.
During the mean follow-up of 20±6 years, 52 (42%) of patients had MV re-intervention (86% surgery and 14% re-PMC), 37 (30%) were hospitalized and 30 (24%) died. Concerning time-to-event analysis, approximately 80% of patients kept MACE-free after 10 years; after 30 years, more than 20% continued MACE-uneventful, approximately 50% were alive and about 45% were free from re-intervention.
Considering patients submitted to surgical re-intervention, 9 underwent MV valvuloplasty and the others MV replacement with mechanical (32) or biological prothesis (11). At the same procedure, 23 patients were submitted to tricuspid annuloplasty, 9 to other valve replacement and one to coronary artery bypass graft.
Using Cox regression, we found that the presence of moderate disease of other valves at PMC time was associated with a 2.3-fold greater rate of re-intervention compared to patients with none or mid disease of other valves (HRcrude 2.3; 95% IC 1.221–4.331, p=0.017). After adjusting for the success of the PMC and for mitral regurgitation after PMC, the observed effect remained significant (HRadjusted = 2.7; 95% CI 1.417–5.233, p=0.003).
Conclusion
PMC was safe and effective in clinically significant rheumatic MS. Most of the patients were free from adverse events after 10 years and half were alive after 30 years. Still, about 40% required re-intervention, with moderate disease of other valves as its independent predictor.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | | | - C Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - R Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J M Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Pinho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - L Santos
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Oliveira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - P Palma
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - M Paiva
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J C Silva
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
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16
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Brito J, Silva P, Aguiar-Ricardo I, Cunha N, Pinto R, Raposo M, Gregorio C, Sousa P, Caldeira E, Miguel S, Abreu A. Cardiac Optimal Point: Identifying high risk patients for an optimal approach. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.212] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values > 30 conveyed worse prognosis.
Purpose
To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term.
Methods
Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview.
Results
A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%).
A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p<0.001, r= 0.450) and on follow-up CPET (p= 0.39, r= 0.303).
COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP>30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size).
Conclusion
COP values > 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - M Raposo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - C Gregorio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Sousa
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - S Miguel
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - A Abreu
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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17
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Alves Da Silva P, Brito J, Aguiar-Ricardo I, Cunha N, Abrantes A, Fonseca J, Pinto R, Caldeira E, Sousa P, Pinto FJ, Abreu A, Miguel S. Shorter cardiac rehabilitation programs: taking time is taking effectiveness? Eur J Prev Cardiol 2022. [PMCID: PMC9383979 DOI: 10.1093/eurjpc/zwac056.256] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112). Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.
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Affiliation(s)
- P Alves Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abrantes
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Fonseca
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Sousa
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Miguel
- Hospital de Santa Maria Faculty of Medicine, Serviço Medicina Física Reabilitação, Lisbon, Portugal
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18
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Cunha NPD, Alves Da Silva P, Garcia B, Pinto R, Gregorio C, Fonseca J, Brito J, Pinto FJ, Abreu A. Very acute benefits on physical performance in elderly patients who undergone TAVI. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.290] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter aortic valve implantation (TAVI) emerged as a safe and efficient procedure in patients with high or prohibitive surgical risk or in older patients. The prevalence of severe aortic stenosis is growing up, given de aging of population. These patients are much often frailty and experience low levels of physical activity and functional capacity as a result of their aortic valve disease and comorbidities. When untreated severe aortic stenosis has a poor prognosis so it is of utmost importance to restore the normal hemodynamic condition and consequently to improve functional capacity.
Aim
To assess the acute benefits (in 1 moth) of TAVI on functional capacity and physical performance.
Methods
Single center prospective study of patients submitted to TAVi between April 2021 and September 2021. Patients were evaluated at baseline (before TAVI) and one month after the procedure. To assess physical activity and functional capacity it was used the International Physical Activity Questionnaire (IPAQ) and the short physical performance battery (SPPB) which is a group of measures that combines the results of the gait speed (two timed trials of a 4-m walk – fastest recorded), chair stand (time to raise for a chair 5 times) and balance tests (ability to stand for 10 seconds with feet in 3 different positions). Additionally, patients were submitted to handgrip strength test. Paired sample t-test and Wilcoxon test were used to statistical analysis.
Results
We included 20 patients, with a mean age of 85±5,86 years, 40% (8) male. 19 patients undergone TAVI due severe native aortic stenosis and 1 due to bioprosthetic aortic valve dysfunction. The vascular access site was transfemoral in 19 patients and transapical in 1 patient.
No patient had vigorous physical activity either before or after TAVI, but the daily sitting time was lower after the procedure (mean time: 634 versus 570 minutes), however not statistically significant. Regarding the results of SPPB patients experience improvements in balance (p=0,035) and chair stand (time to raise for a chair 5 times: 19,04 versus 17,05 seconds), p=0,01.
Patients tended to be faster in 4m velocity test, however with no statistical difference (8,49 versus 6,6 seconds). No statistical differences were also observed in handgrip strength test.
Conclusion
In an elderly population, TAVI appears to have an early and beneficial effect (in 1 moth) on some domains oh physical activity and functional capacity.
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Affiliation(s)
- NPD Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Garcia
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - C Gregorio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Fonseca
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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19
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Sevegnani C, Gameiro J, Borges M, Pires ML, Nunes A, Abreu A, Pinto R. Usefulness of the 6-minute walk test vs cardiopulmonary exercise test for exercise prescription in coronary artery disease patients going into a phase III cardiac rehabilitation program. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.040] [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.
Background/Introduction
Determining the intensity of exercise is a very important component to obtain the dose-benefits associated with exercise, while maitaining the safaty of the patient with coronary artery disease (CAD) in a cardiovascular rehabilitation (CR) programme. The cardiopulmonary exercise test (CPET) is the gols standard for exercise prescription according to the intend intensisty of aerobic workout. However, its availability is not a reality in many CR centres. The 6-minute walk test (6MWT) is a valid and widely used method because it is low-cost and simple to apply. Nevertheless, it is still unknown the corresponding intensity reached on a 6MWT compared to the one reached on a CPET in already physically active patients with CAD starting a CR phase III programme.
Purpose
To use the peak heart rate (HR) of the 6MWT as a method to prescribe the intensity of aerobic exercise in CAD patients starting a phase III CR programme and to compare it with the ventilatory threshold (VT) of the CPET.
Methods
In this retrospective study, a cohort of patients with CAD enrolled in a phase III CR programme. At the beginning of the programme, all patients performed a 6MWT and a CPET in the same week with at least 48-hour difference. The HR on the 6MWT was recorded continuously using a HR polar (H10 Polar) and on CPET using a twelve-lead ECG. Other parameters were assessed such as objective physical activity (accelerometer) and body composition.
Results
Eighty patients (87.5% males, 60.8 ± 9.4 years old) with CAD were included in this study. Patients were, on average, physically active (361 ± 182 minutes/week of moderate to vigorous physical activity) and overweight (body mass index: 27.7 ± 3.5 kg/m2). The VO2 peak reached on the CPET was 20.3 ± 5.4 ml/kg/min and the percentage of predicted maximum HR was 78.3 ± 11.4 %. The first and second VT corresponded to 75.6 ± 7.8% and 91.2 ± 4.5% of the peak HR obtained with CPET, respectively. The 6MWT HR peak was 113 ± 16 bpm (90.0 ± 13.0 HR peak CPET) and did not differ from the HR of the second VT with a mean value of 115 ± 16 bpm (91.2 ± 4.5% HR peak CPET), p>0.05. Although, the 6MWT HR peak was significantly higher than the HR oh the first VT (95 ± 14 bpm, p<0.001). In a subgroup analysis, the patients who, during the 6MWT, reached more the 90% of the HR peak CPET (n=35, 44% oof the sample) were the ones with lower functional capacity (VO2 peak: 18.4 ± 5.4 ml/kg/min vs 21.7 ± 5.0 ml/kg/min, p=0.006) and higher age (64.4 ± 8.7 years old vs 60.8 ± 9.4 years old, p=0.002).
Conclusion(s)
In the absence of a CPET, the use of a 6MWT HR peak in physically active patients with CAD starting a phase III CR programme has shown to be an efficient method to prescribe moderate to vigorous exercise intensity, corresponding to the second VT. Higher intensities on the 6MWT might be reached in active elderly patients with reduced functional capacity.
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Affiliation(s)
- C Sevegnani
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - J Gameiro
- Coimbra Hospital and University Center, Coimbra, Portugal
| | - M Borges
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - ML Pires
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - A Nunes
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
| | - R Pinto
- Faculty of Medicine University of Lisbon, Lisbon, Portugal
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Linan Pinto M, Charneca S, Vasques J, Pinto R, Lemos Pires M, Borges M, Santa-Clara H, Abreu A, Sousa Guerreiro C. Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era. Eur J Prev Cardiol 2022. [PMCID: PMC9383980 DOI: 10.1093/eurjpc/zwac056.236] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis.
Purpose
To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era.
Methods
The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA’s Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively.
Results
A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043).
Conclusion
Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.
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Affiliation(s)
- M Linan Pinto
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - S Charneca
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - J Vasques
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - R Pinto
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - M Lemos Pires
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - M Borges
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Exercise and Health Laboratory, CIPER, Cruz Quebrada, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - C Sousa Guerreiro
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
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21
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Lopes J, Pinto R, Borges M, Pires M, Nunes A, Brito J, Silva P, Ricardo I, Pinto F, Abreu A. Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era. Eur J Prev Cardiol 2022. [PMCID: PMC9383978 DOI: 10.1093/eurjpc/zwac056.249] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Pinto
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - M Borges
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - M Pires
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - A Nunes
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - J Brito
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - P Silva
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - F Pinto
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
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22
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Cunha NPD, Alves Da Silva P, Garcia B, Pinto R, Pinto FJ, Abreu A. TAVI, multidimensional early benefits in elderly patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.063] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Aortic stenosis is the most common valvular heart disease in Europe and in symptomatic patients, when untreated presents a high rate of morbidity and mortality. Its prevalence is estimated to grow even more, given the aging of the population. Transcatheter aortic valve implantation (TAVI) emerged as a safe and efficient procedure in patients with high or prohibitive surgical risk or in older patients, who are much often frailty, with impaired cognitive function and have poor quality of life.
Aim
To assess the acute benefits (in 1 moth) of TAVI on cognitive function, anxiety and depression and independence in activities of daily living.
Methods
Single center prospective study of patients submitted to TAVi between April 2021 and September 2021. Patients were evaluated at baseline (before TAVI) and one month after the procedure. To assess cognitive function, anxiety and depression and independence in activities of daily living we used the Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS); Katz Index of Independence in Activities of Daily Living; and Lawton-Brody Instrumental Activities of Daily Living Scale, respectively. Paired sample t-test and Wilcoxon test were used to statistical analysis.
Results
We included 20 patients, with a mean age of 85±5,86 years, 40% (8) male. 19 patients undergone TAVI due severe native aortic stenosis and 1 due to bioprosthetic aortic valve dysfunction. The vascular access site was transfemoral in 19 patients and transapical in 1 patient. The median MMSE results were higher 1 month after TAVI (21,3 versus 23,5, p=0,012), essentially due to a better results in the temporal orientation and evocation domains (p=0,011 and p=0,022, respectively). Patients experienced lower levels of anxiety and depression after TAVI, mean score 5,4 versus 3,9 (p=NS) and 7 versus 4,25 (p=0,002) respectively for anxiety and depression, as assessed by HADS scale. No statistical difference was observed on the results of basal and post TAVI evaluation of Katz and Lawton-Brody scales.
Conclusion
In an elderly population, TAVI appears to have an early and beneficial effect on cognitive function and depression, but no benefits were observed on independence in activities of daily living.
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Affiliation(s)
- NPD Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Garcia
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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23
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Beardo P, Pinto R, Ayerra H, Agüera J, Armijos S, Álvarez-Ossorio JL. Optimizing treatment for non muscle-invasive bladder cancer with an app. Actas Urol Esp 2022; 46:230-237. [PMID: 35307306 DOI: 10.1016/j.acuroe.2021.12.010] [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: 09/28/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate overall and recurrence-progression rate-adjusted concordance of treatment prescription in non-muscle-invasive bladder cancer (NMIBC) of an app based on the best available scientific evidence and the urologist's opinion. METHODS Development of an app (APPv) specifically designed for the treatment and follow-up of NMIBC and validation of the proposed APPv treatment endpoint by means of a prospective double-blind observational concordance study of related samples in 100 patients with initial or successive histological diagnosis of NMIBC. RESULTS The treatment prescribed by the urologist agrees with that proposed by the APPv in 64% of cases (kappa index 0.55, P < 0.0001). Regarding low risk, the agreement is 77% (kappa 0.55, P = 0.002), 63% (kappa 0.52, P < 0.0001) for intermediate risk, 17% (kappa 0.143, P = 0.014) in high risk and 66% (kappa 0.71, P = 0.01) for very high risk. Of patients receiving adjuvant intravesical treatment according to APPv, 89.1% remain free of recurrence vs. 61.1% of those with disagreement (P = 0.0004), with a RR 0.46 (95%CI: 0.25-0.86) vs. RR 2.4 (95%CI: 1.5-3.8, P = 0.001). In the APPv-urologist agreement group, 100% of patients are free of progression and 88.9% in the disagreement group (P = 0.004) with a RR 1 vs. RR 1.125 (95%CI: 1-1.26, P = 0.004). CONCLUSIONS APPv can improve adherence to treatment recommendations according to clinical practice guidelines and health outcomes at NMIBC.
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Affiliation(s)
- P Beardo
- UGC Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - R Pinto
- Servicio de Urología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - H Ayerra
- Servicio de Urología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - J Agüera
- UGC Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - S Armijos
- e-processmed, Vitoria-Gasteiz, Spain
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24
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Costa C, Amador AF, Calvão J, Pinto R, Pereira PR, Torres JP, Amorim S, Macedo F. Late Cardiac Antibody-Mediated Rejection: A Only Heart Duel. Int J Heart Fail 2022; 4:117-121. [PMID: 36263105 PMCID: PMC9383344 DOI: 10.36628/ijhf.2021.0027] [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] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Catarina Costa
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Filipa Amador
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - João Calvão
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - Pedro Rodrigues Pereira
- Department of Pathology, Centro Hospitalar São João, and University of Porto, Faculty of Medicine, Porto, Portugal
| | - José Pinheiro Torres
- Department of Cardio-Thoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Sandra Amorim
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
- University of Porto, Faculty of Medicine, Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar São João, Porto, Portugal
- University of Porto, Faculty of Medicine, Porto, Portugal
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25
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Diogo PG, Resende CX, Torres S, Vasconcelos M, Pinto R. Mycotic coronary aneurysm complicated by left ventricular pseudoaneurysm after everolimus-eluting stent implantation. Rev Esp Cardiol (Engl Ed) 2022; 75:275-277. [PMID: 34711515 DOI: 10.1016/j.rec.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Pedro G Diogo
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Carlos X Resende
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Torres
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mariana Vasconcelos
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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26
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Calvao J, Costa C, Amador A, Pinto R, Carvalho M, Proenca T, Marques C, Cabrita A, Grilo P, Resende C, Torres S, Sousa C, Macedo F. Impact of severe mitral annular calcification on mitral regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.215] [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
Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequent in patients with aortic stenosis, and its presence is associated with increased cardiovascular morbidity and mortality. Not infrequently, it is associated with significant morphologic and functional abnormalities of the mitral valve apparatus.
Purpose
The aim of this work is to evaluate the relationship between severe MAC and the presence and development of significant mitral regurgitation after TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019. Clinical, echocardiographic and procedure-related data were collected until a follow-up of 6 months. Statistical analysis was conducted on IBM SPSS® Statistics software. Descriptive statistics were calculated for all variables. Sample T-test, Chi-square and Wilcoxon sign test were used. A p-value < 0.05 was considered significant. The presence and severity of MAC was defined according to echocardiographic data. Severe MAC was defined by the presence of calcification of more than half of the mitral annular circumference.
Results
A total of 343 patients were enrolled in the study. The mean age of the population was 80 ± 8 years, 45% were male. Mean functional area was 0.75 ± 0.18 cm2, mean transvalvular pressure gradient was 48 ± 15 mmHg and the mean left ventricular ejection fraction (LVEF) was 54 ± 14%. MAC was detected in 231 (67%) patients. In 44 (19%) of these patients, MAC was graded as severe. Patients with severe MAC tended to have higher prevalence of moderate (27.3 vs 20.4%, p = 0.30) as well as severe (4.5 vs 1.8%, p = 0.24) mitral regurgitation at baseline. After TAVI, the prevalence of moderate mitral regurgitation at 6 months was similar between both groups (22.5 vs 20.4%, p = 0.76). Although not reaching statistical significance, patients with severe MAC had higher prevalence of severe mitral regurgitation at 6 months post-procedure (12.2 VS 5.0%, p = 0.07) as well as higher incidence of worsening of mitral regurgitation (34.2 vs 23.7%, p = 0.16). The proportion of patients that had improvement (13.2 vs 15.0%, p = 0.76) or no change (52.6 vs 61.3%, p = 0.31) in the degree of mitral regurgitation was similar in both groups.
Conclusion
The presence of severe MAC at baseline echocardiography in patients undergoing TAVI may be associated with worsening of mitral regurgitation after the procedure. These patients tend to have higher prevalence of severe mitral regurgitation post-TAVI. Further studies are needed in order to further elucidate this association.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | | | - P Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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27
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Costa C, Calvao J, Amador A, Proenca T, Carvalho M, Pinto R, Marques C, Cabrita A, Grilo PD, Resende CX, Torres S, Sousa C, Macedo F. Can aortic calcium score predict new conduction disturbances in pos-transcatheter aortic valve implantation? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.217] [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.
Background
Transcatheter aortic valve implantation (TAVI) may be the first line treatment for severe aortic stenosis according to overall patient characteristics. Semi-quantitative Agatston score (AS), which quantifies aortic calcium by cardiac computed tomography (CCT), has knowledgeable practical and clinical implications, and is performed in TAVI diagnostic workup. Since conduction disturbances continue to be the most frequent complication, further refinements are required to predict high-risk patients.
Purpose
To access if aortic AS relates with new conduction disturbances and permanent pacemaker (PPM) implantation in patients undergoing TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019; patients with previous permanent pacemaker (PPM) or had no aortic AS were excluded. Clinical and electrocardiogram (ECG) data were collected at admission and after the procedure. All categorical variables are reported as numbers and percentages. Continuous variables were analyzed using the two-tailed unpaired Student’s t-test and are reported as mean values and the standard deviation. Statistical analysis was performed using the IBM SPSS.
Results
172 patients with a mean age 79 ± 9.1 years old were included (see table 1 for baseline characteristics). AS was on average 3008 ± 2262 (see table 2 for remaining diagnostic workup and procedure characteristics).
Comparing AS with new conduction disturbances, no statistically significant difference was found for new complete left branch block (LBBB) (no vs new LBBB, AS: 3179 ± 2555 vs 2637 ± 1388, p= 0,15) and with new complete atrioventricular block (AVB) (no vs new AVB, AS: 2834 ± 1520 vs 4485 ± 5285, p = 0.2). Considering PPM implantation after TAVI, there was a tendency for higher AS and PPM implantation (no vs PPM implantation, AS: 2756 ± 1451 vs 4242 ± 4310, p = 0.07).
In patients who had pre-ballooning, there was no difference relating to AS; however, in patients who had no pre-ballooning there was a trend to higher AS and PPM implantation (no vs PPM implantation, AS: 2417 ± 1301 vs 4616 ± 4969, p = 0.06). No statistically significant difference was found when comparing earlier (Portico, CoreValve Evolut R) vs newer valves (CoreValve Evolut Pro; Edward Sapiens 3; Accurate Neo).
Conclusion
Aortic calcium measured by Agatston score did not show a correlation with new LBBB or new AVB after TAVI. Nevertheless, it seems to be a trend for higher AS and PPM implantation; this was more noticeable when pre-ballooning was not performed. Further studies are needed in order to further elucidate this association. Abstract Figure. Patients baseline characteristics Abstract Figure. TAVI diagnostic workup and procedure
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Affiliation(s)
- C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | | | | | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | - PD Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Philpott HT, Carter MM, Birmingham TB, Pinto R, Primeau CA, Giffin JR, Lanting BA, Appleton CT. Synovial tissue perivascular edema is associated with altered gait patterns in patients with knee osteoarthritis. Osteoarthritis Cartilage 2022; 30:42-51. [PMID: 34774789 DOI: 10.1016/j.joca.2021.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore mechanisms of mechanoinflammation, we investigated the association between the presence of knee synovial perivascular edema and gait biomechanics that serve as surrogate measures of knee load in patients with knee osteoarthritis (OA). DESIGN Patients with symptomatic, radiographic knee OA and neutral to varus alignment undergoing total knee arthroplasty or high tibial osteotomy participated in this cross-sectional analysis. All participants underwent 3D gait analysis prior to surgery. Synovial biopsies were obtained during surgery for histopathological assessment. The association between the presence of synovial perivascular edema (predictor) and the external knee moment (outcome) in each orthogonal plane was analyzed using multivariate linear regression and polynomial mixed effects regression models, while adjusting for age, sex, BMI, and gait speed. RESULTS Ninety-two patients with complete gait and histopathological data were included. When fitted over 100% of stance, regression models indicated substantial differences between patients with and without synovial perivascular edema for knee moments in frontal, sagittal and transverse planes. The knee adduction moment was higher in patients with edema from 16 to 74% of stance, with the largest difference at 33% of stance (β = 6.87 Nm [95%CI 3.02, 10.72]); whereas the knee flexion-extension moment differed from 15 to 92% of stance, with the largest difference in extension at 60% of stance (β = -10.80 Nm [95%CI -16.20, -5.40]). CONCLUSIONS In patients with knee OA, the presence of synovial perivascular edema identified by histopathology is associated with aberrant patterns of knee loading throughout stance, supporting the link between biomechanics and synovial inflammation.
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Affiliation(s)
- H T Philpott
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - M M Carter
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - T B Birmingham
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - R Pinto
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - C A Primeau
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada.
| | - J R Giffin
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - B A Lanting
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
| | - C T Appleton
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada.
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Faria MT, Rodrigues S, Campelo M, Dias D, Rego R, Rocha H, Sá F, Tavares-Silva M, Pinto R, Pestana G, Oliveira A, Pereira J, Cunha JPS, Rocha-Gonçalves F, Gonçalves H, Martins E. Does the type of seizure influence heart rate variability changes? Epilepsy Behav 2022; 126:108453. [PMID: 34864377 DOI: 10.1016/j.yebeh.2021.108453] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heart rate variability (HRV), an index of the autonomic cardiac activity, is decreased in patients with epilepsy, and a low HRV is associated with a higher risk of sudden death. Generalized tonic-clonic seizures are one of the most consistent risk factors for SUDEP, but the influence (and relative risk) of each type of seizure on cardiac function is still unknown. Our objective was to assess the impact of the type of seizure (focal to bilateral tonic-clonic seizure - FBTCS - versus non-FBTCS) on periictal HRV, in a group of patients with refractory epilepsy and both types of seizures. METHODS We performed a 48-hour Holter recording on 121 patients consecutively admitted to our Epilepsy Monitoring Unit. We only included patients with both FBTCS and non-FBTCS on the Holter recording and selected the first seizure of each type to analyze. To evaluate HRV parameters (AVNN, SDNN, RMSSD, pNN20, LF, HF, and LF/HF), we chose 5-min epochs pre- and postictally. RESULTS We included 14 patients, with a median age of 36 (min-max, 16-55) years and 64% were female. Thirty-six percent had cardiovascular risk factors, but no previously known cardiac disease. In the preictal period, there were no statistically significant differences in HRV parameters, between FBTCS and non-FBTCS. In the postictal period, AVNN, RMSSD, pNN20, LF, and HF were significantly lower, and LF/HF and HR were significantly higher in FBTCS. From preictal to postictal periods, FBTCS elicited a statistically significant rise in HR and LF/HF, and a statistically significant fall in AVNN, RMSSD, pNN20, and HF. Non-FBTCS only caused statistically significant changes in HR (decrease) and AVNN (increase). SIGNIFICANCE/CONCLUSION This work emphasizes the greater effect of FBTCS in autonomic cardiac function in patients with refractory epilepsy, compared to other types of seizures, with a significant reduction in vagal tonus, which may be associated with an increased risk of SUDEP.
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Affiliation(s)
- Maria Teresa Faria
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Susana Rodrigues
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Manuel Campelo
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Duarte Dias
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal
| | - Ricardo Rego
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Helena Rocha
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Francisca Sá
- Neurophysiology Unit, Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Marta Tavares-Silva
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Gonçalo Pestana
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Ana Oliveira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Jorge Pereira
- Nuclear Medicine Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - João Paulo Silva Cunha
- Institute for Systems Engineering and Computers Technology and Science (INESC TEC), Porto, Portugal; Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Hernâni Gonçalves
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, Faculty of Medicine, University of Porto, Portugal
| | - Elisabete Martins
- Cardiology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Lagorio A, Cimini C, Pinto R, Paris V. Emergent virtual networks amid emergency: insights from a case study. International Journal of Logistics Research and Applications 2021. [DOI: 10.1080/13675567.2021.2020227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. Lagorio
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - C. Cimini
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - R. Pinto
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - V. Paris
- Department of Engineering and Applied Sciences, University of Bergamo, Bergamo, Italy
- FabLab Bergamo, Bergamo, Italy
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Melo X, Pinto R, Angarten V, Coimbra M, Correia D, Roque M, Reis J, Santos V, Fernhall B, Santa-Clara H. Training responsiveness of cardiorespiratory fitness and arterial stiffness following moderate-intensity continuous training and high-intensity interval training in adults with intellectual and developmental disabilities. J Intellect Disabil Res 2021; 65:1058-1072. [PMID: 34713518 DOI: 10.1111/jir.12894] [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] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) prompts antiatherogenic adaptations in vascular function and structure. However, there is an extraordinary interindividual variability in response to a standard dose of exercise, wherein a substantial number of adults with intellectual and developmental disabilities (IDD) do not improve CRF. We (1) evaluated the effects of 12-month of moderate-intensity continuous training (MICT) on CRF and arterial stiffness and (2) tested whether an additional 3-month of high-intensity interval training (HIIT) would add to improvements in CRF responsiveness and arterial stiffness. METHODS Fifteen adults with mild-to-moderate IDD (male adults = 9, 30.1 ± 7.5 years old) met 3 days per week for 30 min MICT for 12 months, after which the incidence of CRF responsiveness was calculated (≥5.0% change in absolute peak VO2 ). Thereafter, responders and non-responders started HIIT for 3 months with identical daily training load/frequency. Peak VO2 , local and regional indices of arterial stiffness were assessed prior to and after each period. RESULTS Sixty per cent of the participants were non-responders following MICT, but the incidence dropped to 20% following HIIT (P = 0.03). Absolute peak VO2 values reached significant difference from pre-intervention (+0.38 ± 0.08 L min-1 , P = 0.001) only when HIIT was added. Lower limb pulse wave velocity (PWV) decreased following MICT (-0.8 ± 1.1 m s-1 , P = 0.049), whereas central PWV only decreased following HIIT (-0.8 ± 0.9 m s-1 , P = 0.013). CONCLUSIONS Cardiorespiratory fitness responsiveness and reductions in PWV to a 12-month MICT period in adults with IDD improved following a period of HIIT programme inducing higher metabolic stress.
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Affiliation(s)
- X Melo
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
| | - R Pinto
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - V Angarten
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - M Coimbra
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - D Correia
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - M Roque
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - J Reis
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - V Santos
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - B Fernhall
- College of Applied Health Sciences, The University of Illinois at Chicago, Integrative Physiology Laboratory, Chicago, IL, USA
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
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Cabral J, Vasconcelos H, Maia-Araújo P, Moreira E, Campelo M, Amorim S, Sousa A, Moura B, Pinto R, Dias C, Silva-Cardoso J. Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic. Cardiovasc Diagn Ther 2021; 11:1217-1227. [PMID: 35070791 PMCID: PMC8748480 DOI: 10.21037/cdt-21-312] [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: 05/12/2021] [Accepted: 09/29/2021] [Indexed: 12/10/2023]
Abstract
BACKGROUND Heart failure (HF) is a growing public health problem. Sacubitril/valsartan is now recommended to be used in persistently symptomatic patients with left ventricular ejection fraction (LVEF) <40%, replacing angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs). In the present study, we aimed to characterise the challenges of sacubitril/valsartan use in everyday clinical practice. METHODS We assessed the medical records of patients with HF and reduced ejection fraction eligible for sacubitril/valsartan attending a HF clinic at a Portuguese University Hospital during 2018 (n=152). The number of eligible patients receiving the drug and the reasons for not prescribing sacubitril/valsartan were evaluated. Additionally, we assessed the tolerability of maximal doses of sacubitril/valsartan. New York Heart Association functional class (NYHA class) and LVEF before and after up-titration to maximal tolerated sacubitril/valsartan dose were compared. Median follow-up was 41 months. RESULTS Of the 152 included patients, 75 (49%) were prescribed the drug. The two main reasons for non-prescription were patient financial barriers (31%) and hypotension (27%). Only 33% of patients on sacubitril/valsartan did reach maximal dose. Hypotension was the main limiting factor for dose optimisation. Duration of sacubitril/valsartan treatment showed a positive association with LVEF improvement during follow-up (6.6% absolute LVEF increase/year). NYHA functional class improved significantly from baseline through the end of follow-up. CONCLUSIONS In every-day clinical practice, although sacubitril/valsartan was associated with a marked improvement in NYHA class and in LVEF, important financial and clinical barriers to the implementation of this therapy were identified.
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Affiliation(s)
- Joana Cabral
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Henrique Vasconcelos
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Paulo Maia-Araújo
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Emília Moreira
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Campelo
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Amorim
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alexandra Sousa
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Brenda Moura
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Hospital das Forças Armadas, Polo do Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Camila Dias
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Galluccio T, Locatelli F, Pinto R, Testa G, Andreani M. Identification of the novel HLA-B allele, HLA-B*44:532 by next-generation sequencing. HLA 2021; 99:210-211. [PMID: 34738333 DOI: 10.1111/tan.14480] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
The novel HLA-B*44:532 allele differs from HLA-B*44:02:01:01 by one nucleotide substitution in Exon 3. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- T Galluccio
- Laboratory of Immunogenetics and Transplant, Department of Oncohematology and cell and Gene Therapy, IRCCS Bambin Gesù Pediatric Hospital, Rome, Italy
| | - F Locatelli
- Department of Pediatrics, Sapienza, University of Rome, Rome, Italy.,Department of Oncohematology and cell and Gene Therapy, IRCCS, Bambin Gesù Pediatric Hospital, Rome, Italy
| | - R Pinto
- Department of Oncohematology and cell and Gene Therapy, IRCCS, Bambin Gesù Pediatric Hospital, Rome, Italy
| | - G Testa
- Laboratory of Immunogenetics and Transplant, Department of Oncohematology and cell and Gene Therapy, IRCCS Bambin Gesù Pediatric Hospital, Rome, Italy
| | - M Andreani
- Laboratory of Immunogenetics and Transplant, Department of Oncohematology and cell and Gene Therapy, IRCCS Bambin Gesù Pediatric Hospital, Rome, Italy
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Costa C, Amador F, Calvao J, Pestana G, Lebreiro A, Pinto R, Proenca T, Carvalho M, Pinho T, Ferreira A, Albuquerque-Roncon R, Adao L, Macedo F. Catheter ablation supported by extracorporeal membrane oxygenation -last resort treatment of arrhythmic storm? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0356] [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
Arrhythmic storm (AS) is associated with high mortality, even with best medical care and hemodynamic support. If medical therapeutic failure, electrophysiological mapping and ablation are potential lifesaving therapies. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support and can be used as a salvage intervention in patients with cardiogenic shock. Considering the seriousness of AS and the technical complexity involved, catheter ablation supported by VA-ECMO is infrequently performed. We sought to assess the safety and effectiveness of emergent catheter ablation procedures performed in patients on VA-ECMO at our hospital.
Methods
Retrospective study of all ventricular tachycardia (VT) catheter ablation procedures performed with VA-ECMO support at a tertiary centre between 2016 and 2020. Follow-up data was obtained from review of electronical records.
Results
Five patients underwent 6 emergent VT ablation procedures due to AS. The median age was 62 years (range, 52) and 4 patients were men. Three patients had VT at admission, while 2 were admitted with an acute coronary syndrome and developed VT during the hospitalization. Four patients had ischemic heart disease, though only 1 had previous history of VT; the remaining patient presented no structural heart disease. Median left ventricle ejection fraction was 11% (range 30).
All patients had incomplete response to amiodarone, lidocaine or overdrive pacing, before being proposed to catheter ablation. Four patients were on ECMO support before ablation, while 1 was cannulated during the procedure due to hemodynamic instability. Ablation was performed using a retrograde approach in 3 patients, and combined retrograde and transeptal access in 2; one patient had epicardial ablation after unsuccessful endovascular approach. Three patients had left ventricle substrate ablation and the remaining 2 of the right ventricle. No major complications were seen directly related to the procedures.
The median length of stay in intensive care unit was 22 days (range 41 days). Weaning of VA-ECMO was accomplished in all patients. Two patient died during the same hospitalization (one due to uncontrolled arrhythmic events). At a median 23 months (range 31) of follow-up of the surviving patients, two had recurrence of VT but no one had return of AS.
Conclusion
In our sample VT ablation on VA-ECMO support was a safe procedure, with no immediate complications. However, as reported in the literature, a high mortality rate was observed both in-hospital and during follow-up, mostly related to advanced structural heart disease. Also, considerable VT recurrence rates were seen, but with no re-hospitalization. Our experience shows that catheter ablation is a life-saving procedure in otherwise uncontrollable AS and allowed absolute success in weaning VA-ECMO.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Costa
- Sao Joao Hospital, Porto, Portugal
| | - F Amador
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | | | | | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | - T Pinho
- Sao Joao Hospital, Porto, Portugal
| | | | | | - L Adao
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Linan Pinto M, Pinto R, Charneca S, Vasques J, Lemos Pires M, Borges M, Rodrigues C, Alves Da Silva P, Ricardo I, Santa-Clara H, Abreu A, Pinto FJ, Sousa Guerreiro C. Body composition, lipid profile and mediterranean diet adherence in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 pandemic. Eur J Prev Cardiol 2021. [PMCID: PMC8136058 DOI: 10.1093/eurjpc/zwab061.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiovascular disease (CVD) is recognized as a major public health issue and remains the leading cause of mortality worldwide. There is a clear association between adiposity, blood lipid profile, and adherence to the Mediterranean diet (MD) with the risk of CVD. However, the assessment of body composition parameters, dietary patterns and nutritional intervention in CVD patients undergoing a cardiovascular rehabilitation (CR) program remains insufficient.
Purpose
to characterize body composition, lipid profile and MD adherence in patients with CVD who were attending an exercise-based CR program during COVID-19 era.
Methods
The study was developed between October 2020 and January 2021 in a phase III centre-based CR program. Body composition was assessed by dual energy x-ray absorptiometry Hologic Explorer-W. Adherence to the MD was assessed by the 14-item MD questionnaire. Fasting blood sample was taken for measurement of lipid profile.
Results
A sample of 41 patients (mean age 64.4 ± 7.9 years, 87.8% male) was evaluated. The most prevalent CVD were coronary artery disease (89.5%) and heart failure (21.1%). The main CVD risk factors at admission in the CR program were dyslipidaemia (71.1%), hypertension (68.4%), physical inactivity (26.3%) and diabetes mellitus (21.0%). In our sample the mean body mass index was 28 ± 3.8 kg/m2, being most patients overweight (75.6%), and having a substantially increased risk of metabolic complications (85.3%) accordingly to waist-hip ratio. Body composition assessment showed that 14.6% of the patients had a body fat mass index above 90th percentile. Although only 9.8% of the patients had reduced fat free mass, 17.1% showed appendicular lean mass below the reference value. In addition, less than one third of the patients (31.7%) revealed a high adherence to the MD pattern. A sub-analysis on blood lipids (n = 26) showed that most patients had levels of LDL cholesterol (76.9%) and non-HDL cholesterol (65.4%) above the therapeutic target and 15.4% had triglycerides higher than 150 mg/dl.
Conclusion
Body composition, lipid profile and dietary patterns, play a major role in CVD secondary prevention. Our findings showed that a substantial number of CVD patients, in COVID-19 era, did not have optimal body composition, were above lipid profile targets, and had a low/medium adherence to the MD. Thus, this study highlights the relevance of nutrition on cardiometabolic status and demonstrates the crucial role of nutritional intervention as an integrated part of a long-term phase III CR program. Moreover, further research about nutritional intervention in patients undergoing CR is warranted.
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Affiliation(s)
- M Linan Pinto
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - R Pinto
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - S Charneca
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - J Vasques
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - M Lemos Pires
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - M Borges
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - C Rodrigues
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - P Alves Da Silva
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Exercise and Health Laboratory, CIPER, Cruz Quebrada, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - FJ Pinto
- Faculty of Medicine, University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CAML, CCUL, Lisbon, Portugal
| | - C Sousa Guerreiro
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
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Lemos Pires M, Borges M, Pinto R, Ricardo I, Cunha N, Alves Da Silva P, Linan Pinto M, Sousa Guerreiro C, Pinto FJ, Santa-Clara H, Abreu A. COVID-19 era in long-term cardiac rehabilitation programs: how did physical activity and sedentary time change compared to previous years? Eur J Prev Cardiol 2021. [PMCID: PMC8136049 DOI: 10.1093/eurjpc/zwab061.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular rehabilitation (CR) was one of the many areas negatively affected by the COVID-19 pandemic. A high number of cardiovascular disease (CVD) patients had their centre-based program suspended. Physical activity (PA) recommendations for CVD patients are well established and its benefits largely documented. However, few studies have objectively measured the PA of these patients throughout the years and specifically during the COVID-19 pandemic. Purpose To objectively measure PA and sedentary time (ST) during COVID-19 pandemic in comparison with the previous 2 years in CVD patients who were attending a phase III centre-based CR program. Methods Before COVID-19, eighty-seven CVD patients (mean age 62.9 ± 9.1, 82.8% male) were attending a face-to-face long-term CR program. Of the 87 patients, 78.2% have been on the program for at least 1 year. Every year, PA and ST were objectively assessed by accelerometery. After the CR centre-based program suspension due to COVID-19, efforts were done to create a CR home-based digital model to maintain the continuum of care and avoid losing the previous acquired benefits. After 7 months of suspension, the face-to-face CR centre was reopened and 57.5% (n = 50) patients returned. We completed the assessment of PA and ST of 37 patients (mean age 64.8 ± 8.1, 89.2% male) and compared it as follows: M1) two assessments before COVID-19; M2) last assessment before COVID-19; M3) 7 months after CR program suspension (last trimester of 2020). Patients wore an ActiGraph accelerometer for 7 consecutive days to assess daily and weekly minutes of light PA, moderate-to-vigorous PA and ST. We used repeated-measures ANOVA and Wilcoxon signed rank as a non-parametric alternative. Results Intention-to-treat analysis showed that in M3 patients decreased their average daily time spent in moderate-to-vigorous PA when compared with M2 (M3: 37.90 ± 3.30 min/day vs M2: 45.01 ± 3.14 min/day, p = 0.035), no changes were found between M1 and M2. Average daily time spent in light PA improved significantly from M1 to M2 (M1: 154.81 ± 7.20 min/day vs M2: 169.17 ± 6.44 min/day, p = 0.042) but did not change from M2 to M3. Despite this, in M3, 81.08% of the patients still met the recommendations for moderate-to-vigorous PA (M1: 89.19% and M2: 91.89%). No changes were found in ST. Conclusion Despite a significant decrease on the amount of moderate-to-vigorous PA during the COVID-19 era, most CVD patients, first in the centre-based CR program and after in the home-based CR program, were able to meet PA recommendations throughout the last years. These findings suggest that CVD patients who attend supervised long-term CR programs might be aware of the importance of reaching PA guidelines. Reducing ST by replacing it by PA of any intensity could be an important and reachable target for long-term CR programs.
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Affiliation(s)
- M Lemos Pires
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - M Borges
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - R Pinto
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - N Cunha
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - P Alves Da Silva
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - M Linan Pinto
- Faculty of Medicine of the University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - C Sousa Guerreiro
- Faculty of Medicine of the University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - FJ Pinto
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Exercise and Health Laboratory, CIPER, Cruz Quebrada, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
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Silva BV, Aguiar Ricardo I, Alves Da Silva P, Rodrigues T, Cunha N, Couto Pereira S, Silverio Antonio P, Brito J, Pinto R, Lemos Pires M, Fiuza S, Correia AL, J Pinto F, Abreu A. Home-based cardiac rehabilitation during COVID-19 pandemic: effectiveness of an educational intervention. Eur J Prev Cardiol 2021. [PMCID: PMC8136065 DOI: 10.1093/eurjpc/zwab061.356] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patient education is considered a core component of cardiac rehabilitation (CR) and nowadays, particularly during the COVID-19 pandemic, online education programs are critical. However, the best strategy for implementing these digital programs to increase patients’ adherence and learning is not fully established.
Purpose
To assess the uptake and effectiveness of an educational intervention transmitted through video sessions integrated into a home-based CR program (CR-HB).
Methods
Prospective cohort study including patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB program during COVID-19 pandemic. The CR-HB program consisted of a multidisciplinary online program with educational videos for pts and family members / caregivers, that aimed to educate on necessary behavioural and lifestyle changes. Weekly, a 15-minute video was uploaded and lectured by the correspondent health professional from the CR team. The educational sessions covered the following topics: COVID-19 and cardiovascular (CV) disease, coronary artery disease, hypertension, dyslipidemia, smoking cessation, diabetes, medical therapy and adherence, healthy diet, exercise and physical activity, sedentary behaviour and sexual dysfunction and CV disease.
At the end of the program we applied a 10 questions questionnaire to evaluate the knowledge of pts about the topics of educational sessions. All the pts answered the questionnaire and results were compared between the pts who attended the educational sessions and the ones who didn’t.
Results
116 pts with CV disease were included in the CR-HB program (62.6 ± 8.9 years, 95 males). Almost 90% (n = 103) of the participants had coronary artery disease and the mean LVEF was 52 ± 11%. Obesity was the most common risk factor (75%) followed by hypertension (60%), family history of CV disease (42%), dyslipidemia (38%), diabetes (18%), and smoking (13%).
The pts participated, on average, in 1.45 ± 2.6 education sessions (rate participation of 13.2%). About half of the pts (49%) attended, at least, one session and these pts attended, on average, 3 sessions (2.96 ± 3.0). The questionnaire results were better in pts who attended at least 1 educational session than in those who did not attend any (7.4 ± 1.9 vs 7,1 ± 1.7), however this difference was not statistically significant.
Regarding education status, 33 pts (45.2%) had a bachelor degree and this group of pts had a significant higher result in questionnaire (7.8 ± 1.9 vs 6.7 ± 1.8; p = 0.015) and tended to participate more often in education sessions (2.13 vs 1.6, p = 0.06).
Conclusions
Our study showed a low rate of participation in sessions, highlighting the importance of developing strategies to increase motivation and adherence to online educational programs. Also, more literate patients had significantly greater health knowledge and adherence to educational sessions, suggesting that this population could benefit more from this type of programs.
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Affiliation(s)
- BV Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar Ricardo
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Lemos Pires
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Fiuza
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - AL Correia
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade Lisboa, Cardiology Department, Lisbon, Portugal
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Cunha NPD, Aguiar-Ricardo I, Rodrigues T, Couto Pereira S, Silverio Antonio P, Valente Silva B, Alves Da Silva P, Brito J, Pinto R, Lemos Pires M, Borges M, Pires S, Ramalhinho M, Pinto FJ, Abreu A. Cardiovascular risk factor control: is it possible with a home-based cardiac rehabilitation program? Eur J Prev Cardiol 2021. [PMCID: PMC8136064 DOI: 10.1093/eurjpc/zwab061.257] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiovascular risk factors (CVRF) control, needing different strategies, through patient education, lifestyle changes and therapeutic optimization is a central core of cardiac rehabilitation. However, further studies are needed to demonstrate effectiveness of home-based Cardiac Rehabilitation (CR-HB) programs in controlling CVRF.
Purpose
To evaluate the effectiveness of a CR-HB program in controlling cardiovascular risk factors.
Methods
Prospective cohort study including patients who were previously participating in a centre-based CR program and accepted to participate in a CR-HB program due to forced closure of the centre-based CR program for COVID-19 pandemic. The CR-HB consisted of a multidisciplinary digital CR program, including patient regular assessment, exercise, educational, and psychological and relaxation sessions. A structured online educational program for patients and family members/caregivers was provided including educational videos, and powerpoints and webinars. A real time Webinar regarding "nutritional myths and facts" was organized with the duration of 90 minutes as a substitution of the regular face-to-face regular workshop provided at our centre-based CR program. Also, self-control of blood pressure and heart rate and of glycemia in diabetics were promoted, as well as smoking cessation.
To assess the impact of the CR-HB on risk factors control, all the patients were submitted to a clinical and analytical evaluation before and after the end of this at distance program.
Results
116 cardiovascular disease patients (62.6 ± 8.9 years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease. Regarding risk factors, obesity was the most prevalent risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).
Regarding the blood pressure control, 80% of the patients stated that almost daily they measured blood pressure at home; baseline systolic pressure decreased from 117 ± 13 to 113 ±12mmHg, p = 0.007, while there was no significant change in diastolic pressure.
The majority (76%) of diabetic patients said they controlled blood glucose; HbA1c decreased from 6.1 ± 1.1 to 5.9 ± 0.9mg/dL (p = 0.047).
Considering the lipid profile, LDL decreased (from 75 ± 30 to 65 ± 26mg/dL, p = 0.012). The Nt-proBNP also decreased (818 ± 1332 vs 414pg/ml ± 591, p = 0.042). There were no other statistically significant differences concerning risk factors modification.
Conclusions
Our study showed that a Home-based Cardiac Rehabilitation program can improve or maintain cardiovascular risk factors control, which has important prognostic implications and is frequently a difficult task to achieve.
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Affiliation(s)
- NPD Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Lemos Pires
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Borges
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Pires
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Ramalhinho
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e Reabilitação, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Pinto R, Lemos Pires M, Borges M, Linan Pinto M, Sousa Guerreiro C, Miguel S, Santos O, Ramalhinho M, Fiuza S, Cordeiro Ferreira M, Ricardo I, Cunha N, Alves Da Silva P, Pinto FJ, Abreu A. Digital home-based multidisciplinary cardiac rehabilitation: the way to counteract physical inactivity during the COVID-19 pandemic? Eur J Prev Cardiol 2021. [PMCID: PMC8136051 DOI: 10.1093/eurjpc/zwab061.329] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested. Purpose To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program. Methods One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse. Results Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred. Conclusion Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.
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Affiliation(s)
- R Pinto
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - M Lemos Pires
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - M Borges
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - M Linan Pinto
- Faculty of Medicine of the University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - C Sousa Guerreiro
- Faculty of Medicine of the University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - S Miguel
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e Reabilitação, Lisbon, Portugal
| | - O Santos
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e Reabilitação, Lisbon, Portugal
| | - M Ramalhinho
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Medicina Física e Reabilitação, Lisbon, Portugal
| | - S Fiuza
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - M Cordeiro Ferreira
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Psiquiatria e Saúde Mental, Unidade de Psicologia, Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - N Cunha
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - P Alves Da Silva
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - FJ Pinto
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine of the University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, Lisbon, Portugal
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Cunha NPD, Aguiar-Ricardo I, Rodrigues T, Silverio Antonio P, Couto Pereira S, Alves Da Silva P, Valente Silva B, Brito J, Pinto R, Lemos Pires M, Borges M, Jordao A, Rodrigues C, Pinto FJ, Abreu A. Left ventricular remodeling: is there a real impact of cardiac rehabilitation? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.366] [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
A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive.
Purpose
Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram.
Methods
Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP.
Results
205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) <40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%).
After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF < 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device.
Conclusions
A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.
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Affiliation(s)
- NPD Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Lemos Pires
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - M Borges
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Jordao
- Centro Hospitalar Universitário Lisboa Norte, Endocrinology Department, Lisbon, Portugal
| | - C Rodrigues
- Centro Hospitalar Universitário Lisboa Norte, Serviço de Psiquiatria e Saúde Mental, Unidade de Psicologia, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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Brito J, Aguiar-Ricardo I, Alves Da Silva P, Valente Da Silva B, Cunha N, Couto Pereira S, Silverio Antonio P, Pinto R, Lemos Pires M, Santos O, Sousa P, J Pinto F, Breu A. Home-based Cardiac Rehabilitation - the real barriers of programs at distance. Eur J Prev Cardiol 2021. [PMCID: PMC8136068 DOI: 10.1093/eurjpc/zwab061.336] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. Home-based CR (CR-HB) programs should offer the same core CR components as Centre-based programs (CR-CB) but several aspects need to be adapted, communication and supervision must be improved. Although CR-HB has been successfully deployed and is a valuable alternative to CR-CB, there is less structured experience with these non-uniform programs and further studies are needed to understand which patients (pts) are indicated to this type of program.
Purpose
To investigate pt-perceived facilitators and barriers to home-based rehabilitation exercise.
Methods
Prospective cohort study which included pts who were participating in a CR-CB program and accepted to participate in a CR-HB program after CR-CB closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including pt risk evaluation and regular assessment, exercise, educational and psychological sessions. The online exercise training sessions consisted of recorded videos and real time online supervised exercise training group sessions. It was recommended to do each session 3 times per week, during 60 min. A pictorial exercise training guidebook was available to all participants including instructions regarding safety, clothing and warm-up, and a detailed illustrated description of each exercise sessions. Also, for questions or difficulties regarding the exercises, an e-mail and telephone was provided. Once a month, real time CR exercise sessions was provided with a duration of 60min.
Results
116 cardiovascular disease pts (62.6 ± 8.9years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. The majority of the pts had coronary artery disease (89%) and 5% valvular disease. Regarding risk factors, obesity was the most common (75%) followed by hypertension (60%), family history (42%), dyslipidaemia (38%), diabetes (18%), and smoking (13%). Almost half (47%) of the participants did at least one online exercise training session per week: 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week. Participants who did less than one exercise session per week reported as cause: lack of motivation (38%), preference of a different mode of exercise training such as exercise in the exterior space (26%), technology barrier such as impossibility to stream online videos (11%), fear of performing exercise without supervision (4%), and limited space at home (4%).
Conclusions
Our study based on real-life results of a CR-HB program shows a sub-optimal rate of participation in exercise sessions due to different causes, but mainly for the lack of motivation to exercise alone or preference for walking in exterior space. The knowledge of the CR-HB program barriers will facilitate to find out strategies to increase the participation rate and to select the best candidates for this type of programs.
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Affiliation(s)
- J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - B Valente Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Couto Pereira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Lemos Pires
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - O Santos
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Serviço de Medicina Física e Reabilitação, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Lisbon, Portugal
| | - P Sousa
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - F J Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Breu
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
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Borges M, Lemos Pires M, Pinto R, De Sa G, Ricardo I, Cunha N, Alves Da Silva P, Linan Pinto M, Sousa Guerreiro C, Pinto FJ, Abreu A, Santa-Clara H. COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients? Eur J Prev Cardiol 2021. [PMCID: PMC8136044 DOI: 10.1093/eurjpc/zwab061.362] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.
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Affiliation(s)
- M Borges
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - M Lemos Pires
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - R Pinto
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - G De Sa
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - N Cunha
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - P Alves Da Silva
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - M Linan Pinto
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - C Sousa Guerreiro
- Faculty of Medicine University of Lisbon, Laboratório de Nutrição, Lisbon, Portugal
| | - FJ Pinto
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine University of Lisbon, Serviço de Cardiologia, Departamento Coração e Vasos, CHULN, CCUL, CAML, Lisbon, Portugal
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Exercise and Health Laboratory, CIPER, Cruz Quebrada, Lisbon, Portugal
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Alves Da Silva P, Aguiar-Ricardo I, Cunha N, Rodrigues T, Valente-Silva B, Silverio-Antonio P, Couto-Pereira S, Brito J, Pinto R, Lemos-Pires M, Borges M, Cordeiro-Ferreira M, Caldeira E, Pinto FJ, Abreu A. Home-based Cardiac Rehabilitation: the patients claim for new strategies but do they adhere? Eur J Prev Cardiol 2021. [PMCID: PMC8136070 DOI: 10.1093/eurjpc/zwab061.335] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) programs are established interventions to improve cardiovascular health, despite asymmetries in referral. With covid 19 outbreak, cardiac rehabilitation home based (CR-HB) programs emerged as an alternative. However, its adherence and implementation may vary greatly with socio-demographic factors.
Purpose
To assess adherence to the various components of a CR-HB program.
Methods
Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.patient clinical and exercise risk assessment; 2.psychological tele-appointments; 3. online exercise training sessions; 4.structured online educational program for patients and family members/caregivers; 5. follow-up questionnaires; 6. nutrition tele-appointments; 7. physician tele-appointments
Adherence to the program was assessed by
drop-out rate; number of exercise sessions in which each patient participated; number of educational sessions attended and a validated questionnaire on therapeutic adherence (composed of 7 questions with minimum punctuation of 7 and maximum of 40 points).
Results
116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure; the mean LVEF was 52 ± 11%. Regarding risk factors, obesity was the most common risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%).
Ninety-eight pts (85.5%) successfully completed the program. Almost half (46.9%) of the participants did at least one online exercise training session per week. Among the pts who did online exercise training sessions, 58% did 2-3 times per week, 27% once per week and 15% more than 4 times per week.
The pts participated, on average, in 1.45 ± 2.6 education sessions (rate of participation of 13,2%) and therapeutic adherence was high (39,7 ± 19; min 35-40).
Regarding educational status of the pts, 33 pts (45,2%) had a bachelor degree. These pts tended to participate more in exercise sessions (1,7 ± 1,7 vs 1,2 ± 1,4 sessions per week) and in education sessions (2.13 vs 1.6), although this difference was not statistically significant. The therapeutic adherence did not vary with patients’ level of education.
Conclusion
Our results showed that a high percentage of patients completed the program and almost half were weekly physically active. However, in regard to educational sessions, the degree of participation was much lower. Educational status seemed to correlate with a higher degree of participation and, in the future, patient selection might offer better results in these kinds of programs.
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Affiliation(s)
- P Alves Da Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - B Valente-Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Couto-Pereira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Lemos-Pires
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Borges
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - M Cordeiro-Ferreira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - E Caldeira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
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Couto Pereira S, Aguiar-Ricardo I, Pinto R, Cunha N, Alves Da Silva P, Rodrigues T, Silverio Antonio P, Valente Silva B, Brito J, Borges M, Lemos Pires M, Miguel S, Salazar F, Pinto FJ, Abreu A. Home-based Cardiac Rehabilitation in Covid Era: Is it a safe option? Eur J Prev Cardiol 2021. [PMCID: PMC8136042 DOI: 10.1093/eurjpc/zwab061.350] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Home-based Cardiac Rehabilitation (CR-HB) models have been shown to be effective, however, there is a large variation of protocols and minimal evidence of effectiveness in higher risk populations, in which exercise at distance might be concerning. In addition, lack of reimbursement models has discouraged the widespread adoption of CR-HB. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has emerged due to the decreased availability of on-site services. Purpose Evaluation of the safety of a CR-HB program during COVID-19 pandemic. Methods Prospective cohort study which included patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB after the centre-based CR program closure due to COVID-19. The CR-HB consisted in a multidisciplinary digital CR program, including: 1.pts regular clinical and exercise risk assessment; 2.psychological tele-appointments and group sessions; 3. online exercise training sessions, which consisted of recorded videos and real time online exercise training sessions (each session recommended 3 times per week, during 60 minutes); 4.structured online educational program for pts and family members/caregivers, including educational videos and webinars; 5. follow-up fortnightly questionnaire to evaluate risk factors control and need for appointments or directing to hospital; 6. nutrition tele-appointments; 7. physician tele-appointments, scheduled according to follow-up questionnaire or at patients request (e-mail or telephone) to avoid unnecessary exposure and overload in the hospital. Minor and major adverse events such as hospitalizations due to cardiac event or other non CV reason, cardiac or noncardiac death, during or immediately after the exercise sessions, were collected. Results 116 cardiovascular disease (CVD) pts (62.6 ± 8.9 years, 95 males) who were attending a Centre-based CR program were included in a CR-HB program. Almost 90% (n = 103) of the participants had coronary artery disease; 13.8% pts had heart failure. The mean LVEF was 52 ± 11%; 31,1% of the population had at least moderate risk. Regarding risk factors, obesity was the most common risk factor (74.7%) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). 98 CVD pts (85.5%) successfully completed all the online assessments. Three male participants dropped out for hospitalization due to knee surgery, pacemaker implantation and in-stent restenosis without relation to exercise sessions. No major events were registered during the exercise training sessions and only one minor adverse event, sprained ankle, was reported during the training sessions. Conclusions This CR-HB program, originated by the need of social distancing during COVID-19 pandemic, revealed to be a valuable and safe strategy to reach at distance most patients previously in a Centre-based CR program.
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Affiliation(s)
- S Couto Pereira
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Pinto
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - T Rodrigues
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - M Borges
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - M Lemos Pires
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Miguel
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - F Salazar
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - A Abreu
- Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Tavares-Silva M, Saraiva F, Pinto R, Amorim S, Silva JC, Leite-Moreira AF, Maciel MJ, Lourenço AP. Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates. ESC Heart Fail 2021; 8:908-917. [PMID: 33621427 PMCID: PMC8006659 DOI: 10.1002/ehf2.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Assessing reversibility of pulmonary vascular changes through vasoreactivity testing (VRT) optimizes end‐stage heart failure patient selection for heart transplant. All efforts should be made to unload the left ventricle and reduce pulmonary vascular resistance to effectively exclude irreversible pulmonary hypertension. Methods and results We reviewed our centre's cardiac transplant registry database (2009–2017) for VRT and compared haemodynamic responses with 40 ppm inhaled NO (n = 14), 14–17 μg inhaled iloprost (n = 7), and 24 h 0.1 μg/kg/min intravenous levosimendan (n = 14). Response to levosimendan was assessed by repeat right heart catheterization within 72 h. Baseline clinical and haemodynamic features were similar between groups. VRT was well tolerated in all patients. All drugs effectively reduced pulmonary artery pressures and transpulmonary gradient while increasing cardiac index, although levosimendan had a greater impact on cardiac index increase (P = 0.036). Levosimendan was the only drug that reduced pulmonary artery wedge pressure (P = 0.004) and central venous pressures (P < 0.001) and increased both left and right ventricular stroke work indexes (P = 0.020 and P = 0.042, respectively) and cardiac power index (P < 0.001) compared with NO and iloprost. Right ventricular end‐diastolic pressures and central venous pressure were only decreased by levosimendan. The rate of positive responses (≥10 mmHg decrease or final mean pulmonary artery pressure ≤40 mmHg with increased/unaltered cardiac index) was lower with inhaled iloprost (14%) than with either levosimendan or NO (71% and 64%, respectively; P < 0.05). Conclusions Levosimendan may be a safe and effective alternative for pulmonary hypertension reversibility assessment or a valuable pre‐test medical optimization tool in end‐stage heart failure patient assessment for heart transplantation offering extended haemodynamic benefits. Whether it increases the rate of positive responses or allows a better selection of candidates to heart transplantation remains to be established.
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Affiliation(s)
- Marta Tavares-Silva
- Department of Cardiology, São João Hospital Centre, E.P.E., Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.,Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, São João Hospital Centre, E.P.E., Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Sandra Amorim
- Department of Cardiology, São João Hospital Centre, E.P.E., Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - João Carlos Silva
- Department of Cardiology, São João Hospital Centre, E.P.E., Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital Centre, E.P.E., Porto, Portugal
| | - Maria Júlia Maciel
- Department of Cardiology, São João Hospital Centre, E.P.E., Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.,Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Anaesthesiology, São João Hospital Centre, E.P.E., Porto, Portugal
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Tavares-Silva M, de Sousa C, Araújo V, Adão L, Pestana G, Pinto R, Macedo F, Maciel MJ. Left ventricular pacing with a temporary pacemaker: Case report. Revista Portuguesa de Cardiologia (English Edition) 2021. [DOI: 10.1016/j.repce.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tavares-Silva M, de Sousa C, Araújo V, Adão L, Pestana G, Pinto R, Macedo F, Maciel MJ. Left ventricular pacing with a temporary pacemaker: Case report. Rev Port Cardiol 2020; 40:141.e1-141.e4. [PMID: 33371966 DOI: 10.1016/j.repc.2020.12.006] [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] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
We report a case of temporary pacemaker lead malposition in the left ventricle crossing the interventricular septum (IVS). The majority of described cases occur due to a patent foramen ovale and are frequently incidental findings. A course across the IVS is rarely found and this complication with temporary leads is not even reported in the literature. This very rare location entails a risk of dangerous complications associated with left-to-right flow after lead removal. Echocardiography was an essential tool to diagnose the lead's course inside the heart and enabled secure removal of the lead with cardiac surgery backup.
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Affiliation(s)
- Marta Tavares-Silva
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal; Department of Surgery and Physiology, Cardiovascular Research & Development Unit, Faculty of Medicine, University of Porto, Portugal.
| | - Carla de Sousa
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Vítor Araújo
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Luís Adão
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal; Department of Surgery and Physiology, Cardiovascular Research & Development Unit, Faculty of Medicine, University of Porto, Portugal
| | - Maria Júlia Maciel
- Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal
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Lagorio A, Zenezini G, Mangano G, Pinto R. A systematic literature review of innovative technologies adopted in logistics management. International Journal of Logistics Research and Applications 2020. [DOI: 10.1080/13675567.2020.1850661] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alexandra Lagorio
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Giovanni Zenezini
- Department of Management and Production Engineering, Politecnico di Torino, Torino, Italy
| | - Giulio Mangano
- Department of Management and Production Engineering, Politecnico di Torino, Torino, Italy
| | - Roberto Pinto
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
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Cardoso Torres S, Vasconcelos M, Resende C, Diogo P, Pinto R, Proenca T, Carvalho J, Calvao J, Amador F, Costa C, Cruz C, Moreira J, Pinho P, Silva J, Maciel M. Coronary artery fistulas: a single-center case series. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1526] [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
Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.
Methods
A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.
Results
We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.
The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).
CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).
The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).
Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.
Conclusion
CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Cardoso Torres
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M Vasconcelos
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C.X Resende
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Diogo
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - R Pinto
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - T Proenca
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.M Carvalho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Calvao
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - F Amador
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Costa
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - C Cruz
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J Moreira
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - P Pinho
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - J.C Silva
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
| | - M.J Maciel
- Centro Hospitalar Universitario de Sao Joao, E.P.E., Porto, Portugal
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Abreu-Mendes P, Pereira P, Vale L, Da Costa D, Silva G, Fonseca J, Cruz F, Dinis P, Pinto R. Refractory bladder pain syndrome/Interstitial cystitis: The role of functional brain MRI. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32897-4] [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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