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Browsing by Author "Francisco, A. R. Gaspar Lopes"

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  • Cardiotoxicity in haematological diseases : are the tyrosine kinase inhibitors imatinib and nilotinib safe?
    Publication . Francisco, A. R. Gaspar Lopes; Alves, D.; Gonçalves, I. S.; Menezes, M. N.; Silva, G. Lima da; Guimarães, T.; David, C.; Braga, J.; Guerra, L.; Pinto, Fausto J.; Almeida, A. G.
    Introduction: Chemotherapy-induced cardiotoxicity is a growing concern. The true cardiotoxic impact of new drugs such as tyrosine kinase inhibitors is unknown, especially the ones used for chronic myeloid leukaemia. We aim to evaluate nilotinib and imatinib induced cardiotoxicity. Methods: Single-center prospective study of consecutive patients with chronic myeloid leukaemia treated with tyrosine kinase inhibitors during 2015. Patients underwent an initial clinical, laboratorial and echocardiographic evaluation, repeated one year after therapy initiation. Results: Eleven patients were included [60.0 (11) years, 63.6% of males; 7 patients treated with imatinib and 4 with nilotinib]. After one year of follow-up, all patients remained in functional NYHA class I, with a similar Minnesota quality of life score [21 (20) vs. 21 (19), p = NS]. Also there was no difference in the biomarkers evaluated: cystatin-C [0.9 (0.2) vs. 0.8 (0.2) mg/L, p = NS; NT-proBNP 46.0 (45.0) vs. 42.0 (34.0) pg/mL, p = NS]. Previous to the TKI treatment, all patients had normal left ventricular ejection fraction (LVEF) [(median 67% (63–69)], without structural abnormalities. During the follow-up, there weren't differences regarding the LVEF, left atrium volume, E/A ratio, deceleration time, septal e', lateral e', E/e' ratio and tricuspid annular plane systolic excursion. With regard to myocardial deformation, all patients presented normal values of longitudinal, circumferential and radial strain in the baseline study, without changes during follow-up [DML -21.3 (6, 1) vs. -21.7 (6.0)%, p = NS; DMC -20.0 (9.3) vs. -22.3 (5.3)%, p = NS; DMR 36.9 (21.3) vs. 39.2 (19.2)%, p = NS]. In addition, there were no differences between the two tyrosine kinase inhibitors used, considering all the aforementioned variables. Conclusion: No clinical, laboratory or echocardiographic evidence of nilotinib and imatinib induced cardiotoxicity was observed, even when myocardial deformation analysis was performed. However, these results should be confirmed in larger studies, ideally multicentre, given the low incidence of chronic myeloid leukaemia.
    2017Journal article Open access Show more
  • Transcatheter aortic valve implantation: efficacy, safety and mortality at 30-­days to 1- year from a nationwide eight year registry
    Publication . Silva, P. Canas da; Francisco, A. R. Gaspar Lopes; Ferreira, P. Carrilho; Nobre, A.; Teles, R. Campante; Ribeiro, V. Gama; Patrício, L.; Silva, J. C.; Batista, J.; Uva, M. Sousa; Abecassis, M.; Neves, J. P.; Cacela, D.; Laranjeira, A.; Rodrigues, A.
    Background: Transcatheter aortic valve implantation (TAVI) is currently an established therapy in patients with symptomatic severe aortic stenosis who are deemed inoperable or of very high surgical risk. Large population registries provide invaluable real world data. Purpose: To analyse the 30 days to 1­year results of all TAVI procedures performed throughout 8 years in an entire country. Methods: Nationwide TAVI registry from 2007 to 2015. Endpoints were defined according to the Valve Academic Research Consortium­2. Long­term composite endpoints were clinical efficacy (after 30 days) and time­related valve safety. Other non­composite enpoints, namely cardiovascular mortality and all­cause mortality were concomitantly assessed. For statistical analysis we used the univariate and multivariate Cox regression and Kaplan­Meier Survival. Results: 819 patients underwent TAVI (mean age 80±8 years, 47% male). The most common diagnosis was aortic stenosis (94,7%), followed by bioprosthesis dysfunction (3,4%) and aortic disease (1,8%). Mean valve area was 0,65±0,18 cm2 . The mean Euroscore II was 5,8±4,4 and the mean STS score was 6,6±5,8. 61% of patients were considered high­risk and the remainder inoperable. The implanted prosthesis was a Medtronic CoreValve® in 467 (57%) patients, an Edwards Sapien® model in 319 (39%) patients or another type in the remainder. The transfemoral route was used in 83% of cases, a transapical approach in 11,8% a transaortic route in 1,7% and a subclavian approach in 3,2%. Device success was achieved in 88,4% of patients. Mean follow­up was 585±611 days. After implantation, 92% of patients were in NYHA functional class I or II. Clinical efficacy (after 30 days) was 75%. Between 30 days and 1 year, all­cause mortality was 11,8% (cardiovascular mortality was 6,3%) and prosthesis dysfunction was 14,4%. The variables associated with 30­days to 1­year mortality were age (p=0,042) STS mortality score (p=0.034), non­transfemoral route (p=0.006), indication for TAVI other than aortic stenosis (p=0,015), chronic pulmonary disease (p=0,036), chronic renal disease (p=0,043), acute kidney injury (p<0,001), NYHA class > II after TAVI (p<0,001), stroke after TAVI (p=0,031), and hospital readmission (p<0,001). Independent predictors of 30­days to 1­year mortality by multivariate Cox regression were hospital readmission (HR 4,73; 95% CI 2,52–8,89; p<0,001) and indication for TAVI other than aortic stenosis (HR 2,64; 95% CI 1,03–6,78; p=0,043). By Kaplan­Meier analysis survival was significantly lower in both groups (Log Rank 32,48 p<0,001 for the former; Log Rank 6,67 p=0,010 for the latter). Conclusions: A nationwide TAVI registry demonstrated very good long­term results. Clinical efficacy was very high and mortality low. The only independent predictors of non short­term mortality (after 30 days) were hospital readmission and TAVI for an indication other than aortic stenosis, such as aortic regurgitation.
    2016Conference object Restricted access Show more