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Browsing by Author "Gonçalves, I."

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  • Difference of late potentials detected by signal-averaged ECG in patients with spontaneous or drug-induced type 1 electrocardiogram pattern of Brugada syndrome
    Publication . Agostinho, J. A. Ribeiro; António, P.; Dias, N. Cortez; Silva, G. Lima da; Guimarães, T.; Francisco, A. R.; Gonçalves, I.; Paixão, A.; Paiva, S.; Carpiteiro, L.; Pinto, Fausto J.; Sousa, J. de
    Introduction: Brugada syndrome (BrS) patients (pts) with spontaneous type 1 electrocardiographic (ECG) pattern (sT1ECGp) have a greater arrhythmic risk compared to those with fleicainide-induced type 1 ECG pattern (iT1ECGp). However, when the analysis is restricted to asymptomatic pts, the type 1 spontaneous pattern loses its independent prognostic value. Late potentials (LP) obtained by signal-averaged ECG (SA-ECG) are associated with regions of delayed myocardial depolarization and consequent abnormal electrical conduction. There is a higher prevalence of LP obtained by SA-ECG in pts with BrS and their detection showed a strong prognostic predictor value in several studies. Objective: To evaluate the presence of LP by SA-ECG in pts with BrS and assess differences between patients with spontaneous or drug-induced type 1 ECG pattern. Methods: This was a single-center prospective study of consecutive pts diagnosed with BrS, including sT1ECGp and iT1ECGp. The patients were submitted to SA-ECG study to detect LP, with determination of the duration of filtered QRS (fQRS), root-mean-square voltage of the terminal 40ms of the filtered QRS (RMS40) and the duration of low-amplitude signal (<40 μV) in the terminal part of the filtered QRS complex (LAS40), using conventional and right modified leads. The presence of LP was considered positive when ≥2 of the following were present: fQRS ≥114 ms, RMS40 <20 μV or LAS40 ≥38ms. The results were displayed using medians and interquartile ranges, obtained using the Mann-Whitney test. Results: The presence of LP by SA-ECG was studied in 29 pts (75.9% male, mean age 44±12 years), 18 with sT1ECGp and 11 iT1ECGp. Only 3 pts (10.3%) had symptoms related with BrS (unexplained syncope) and none had documented malignant ventricular arrhythmias. Known or potential pathogenic mutations were identified in 5 pts (17.2%). The presence or absence of LP showed no statistically significant difference according to clinical, electrocardiographic or genetic characteristics of the pts. However, in conventional leads, pts with sT1ECGp showed significantly higher values of fQRS and lower values of RMS40 [fQRS 108 (103–112) vs. 97 (89–103), p=0.016; RMS40 19 (10–22) vs. 22 (16–40), p=0.028]. In addition, in modified right leads, pts with sT1ECGp had significantly higher values of fQRS, lower RMS40 and longer LAS40 [fQRS 108 (101 -111) vs. 98 (89–102), p=0.0005; RMS40 15 (11–21) vs. 25 (18–33), p=0.007; LAS40 41 (34–49) vs. 31 (28- 39), p=0.007]. Conclusion: Patients with the spontaneous type 1 electrocardiographic (ECG) pattern revealed a higher detection of late potentials, which may partially explain the higher arrhythmogenic risk classically described in this subgroup of BrS patients.
    2017Journal article Open access Show more
  • Implantation of ICD and CRT-D in the elderly population : will it be a limiting factor?
    Publication . Ricardo, I. Aguiar; Dias, Nuno Cortez; Marques, P.; Magalhães, A.; Gonçalves, I.; Agostinho, J.; Silva, G. Lima da; Guimarães, T.; Santos, I.; Francisco, A. R.; Bernardes, A.; Costa, H. C.; Carpinteiro, L.; Pinto, J. Fausto; Sousa, J. de
    Introduction: Implantable cardioverter defibrillator (ICD) and cardiac resynchronization (CRT-D) implantation in elderly patients is effective in preventing sudden death, although limited by the natural shorter life expectancy. The different device brands present very variable survival estimates and it has been discussed the availability of less expensive, less longevity generators for the elderly population. Purpose: To determine if the expected survival rate in the elderly patient population (≥75 years) should influence the selection of the desired longevity of the devices. Methods: A retrospective single-center study of consecutive patients who underwent implantation of ICD or CRT-D after November 1995. The mean survival of patients undergoing 1st implant or generator replacement at an advanced age (≥75 years) was evaluated and compared to the effective longevity of the generators. Cumulative survival analyzes using the Kaplan Meier method were used. Results: A total of 1312 cardiac devices were implanted, of which 163 generators in elderly patients (53% CDI and 47% CRT-D). Of these, 77% corresponded to the 1st implant. The median survival after implantation of the elderly patients was 6.8 years, not differing according to the type of device (Log-rank P = NS). The median longevity of CDI generators was 6.9 years, in line with the expected survival of elderly patients. Conversely, the median CRT-D longevity was 5.8 years, lower than the average survival of the elderly. For this reason, 21% of these CRT-D carriers were subsequently subjected to generator replacement, due to battery exhaustion. Conclusion: The effective longevity of ICDs is in agreement with an expected survival of elderly patients, for which it will not make sense to provide generators of shortened longevity for this population. The effective longevity of the CRTs is lower than the survival expectancy of the treatments, so that, paradoxically, generators with increased longevity should be favored.
    2017Journal article Open access Show more
  • Prognostic impact of invasive hemodynamic evaluation in patients with pulmonary arterial hypertension
    Publication . Ricardo, I. Aguiar; Plácido, R.; Gonçalves, I.; Agostinho, J.; Silva, G. Lima da; Menezes, M. Nobre; Francisco, A. R.; Santos, R.; Ferreira, A.; Guimarães, T.; Martins, S. Robalo; Pinto, J. Fausto
    Introduction: Invasive hemodynamic evaluation is a fundamental diagnostic method in patients with pulmonary hypertension (PH). However, its prognostic value in this group of patients is not fully established. Purpose: To assess the prognostic impact of hemodynamic parameters of right catheterization in patients with PH. Methods: Prospective observational study of patients with PH undergoing right and left catheterization for diagnostic confirmation and functional evaluation during vasoreactivity test. Only patients with mean pulmonary arterial pressure (PAP) >25 mmHg considered not secondary to left heart disease were included. A basal evaluation of the conventional hemodynamic parameters, left and right ventricular function indexes, pulmonary and systemic vascular resistance indexes were performed and they were re-evaluated during vasoreactivity test. The parametres were analysed and related with overall mortality and with cardiac death or hospitalization during clinical follow-up by Multivariate regression analysis of Cox. Results: A total of 68 patients were included (71% females, mean age 53±17 years), 81% of whom were from group 1 (NICE) and 15% from group IV. The mean value of mean pulmonary artery pressure was 47±16mmHg and mean right atrial pressure was 11±7mmHg. During a median follow-up of 34 months, 7 patients (10%) died and 25 (37%) were hospitalized for heart failure. Of all hemodynamic parameters, the only independent predictor of mortality was the mean right atrial pressure, for each 1mmHg rise, mortality risk increased by 12% (hazard ratio (HR): 1, 12; 95% CI 1.02–1.23; p=0.018) and the risk of death or hospitalization for cardiac causes was 17% (HR: 1.17, 95% CI: 1.00–1.37, P=0.050). The prognosis was not influenced by the demonstration of pulmonary arterial vasoreactivity, magnitude of PAP elevation or pulmonary vascular resistance. Conclusion: In patients with PH, invasive hemodynamic evaluation offers an addictional value in prognostic stratification. In particular, measurement of mean right atrial pressure has been shown to be an independent predictor of mortality. On the other hand, other parameters such as pulmonary arterial vasoreactivity, although important in the definition of the therapeutic strategy, did not have an impact on the risk of death or hospitalization.
    2017Conference object Open access Show more
  • Prognostic value of NT-proBNP, adrenomedullin, copeptin and proenkephalin in patients with pulmonary hypertension
    Publication . Agostinho, J. A. Ribeiro; Plácido, R.; Gonçalves, I.; Guimarães, T.; Ferreira, P. Carrilho; Marques, J. S.; Silva, D.; Lousada, N.; Pinto, F. J.; Martins, S.
    Introduction: Pulmonary hypertension (PH) comprises a group of progressive diseases characterized by an increase in pulmonary vascular resistance, leading to right ventricular dysfunction. Risk stratification is essential for prognostic evaluation and therapeutic decision, making the determination of new biomarkers important. Purpose: To assess the prognostic value of new biomarkers in the prognostic evaluation of patients with PH. Methods: Prospective cohort study of patients (pts) with PH confirmed by hemodynamic evaluation. Pts underwent clinical and laboratory evaluations at baseline and every 3 months. Follow-up lasted for 18 months. NTproBNP and the new biomarkers (adrenomedullin, copeptin and proenkephalin) were measured. The Mann-Whitney test, Kaplan-Meier survival analysis and Cox regression were used for statistical analysis. Results: Fifty one pts (75% males, mean age: 54±15 years) belonging to all groups of the WHO PH classification were included. At inclusion, all pts were in WHO functional class II or III. During the study period, 17 pts (33%) died. Baseline NTproBNP values were significantly higher in the non-survivors group (1327; 1061–2703pg/ml vs. 353.5; 190–1661pg/ml; p=0.022). The same did not occur for adrenomedullin, copeptin and proenkephalin baseline levels. The maximum NTproBNP, adrenomedullin and copeptin levels recorded during the follow-up period were significantly higher in the non-survivors group [2347.5 (1667–5073.25) pg/ml vs. 642.5 (208.25–4109.5) pg/ml, p=0.007; 53.6 (38.8- 94.2) pg/ml vs. 33.4 (27–48.8) pg/ml, p=0.0075; 20.69 (13.18–35.69) pmol/L vs. 9.97 (6.18–14.74) pmol/L, p=0.022, respectively]. This did not occur for the maximum proenkephalin level. The NT-proBNP level at admission and adremedullin level at 3 months were independent predictors of mortality (HR 2.78, CI95 1.23–6.30, p=0.01; HR 4.36, CI95 1.17–16.2, p=0.03).Conclusion: The maximum level of NTproBNP, adrenomedullin and copeptin during the follow up were associated with higher mortality in pts with PH. NTproBNP level proved to be an independent predictor of mortality in those patients. These results suggest the prognostic importance of these biomarkers in the approach of pts with PH.
    2017Journal article Open access Show more