FM-CCUL-Artigos em Revistas Internacionais
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- Ventricular dysrhythmias during silent myocardial ischemiaPublication . Pinto, Fausto J.; Fiuza, M.; Dias, E.; Correia, J.; Pedro, P.; Ribeiro, F.; Pádua, F. daTo analyze the prevalence of ventricular dysrhythmias (VD) during periods of silent myocardial ischemia (SMI), 71 consecutive patients with SMI (49 men, 22 women; mean age, 6 1 years) were observed during the last 4 years. Coronary artery disease was diagnosed by clinical and ECG data and/or history of myocardial infarction. SMI was detected by ambulatory 24-hour ECG monitoring and VD were compared during periods with and without SML VD were classified in Lown’s grades. The table summarizes the results. Conclusion. High-grade VD were more prevalent during periods of SMI, compared with periods without myocardial ischemia.
- Dynamic three-dimensional reconstruction of the heart by transesophageal echocardiographyPublication . Veiga, Maria de Fátima; Lopes, Mário G.; Pinto, Fausto J.Objective – To evaluate echocardiography accuracy in performing and obtaining images for dynamical threedimensional (3D) reconstruction. Methods – Three-dimensional (3D) image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. Results – Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses – 6 (2 mitral, 2 aortic and 2 mitral and aortic); mitral valve prolapse – 3; mitral and aortic disease – 2; aortic valve disease – 5; congenital heart disease – 3 (2 atrial septal defect –ASD- and 1 transposition of the great arteries -TGA); arteriovenous fistula – 1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD). Fifty five of 60 (91.6%) reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE) alone. Conclusion – 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.
- Heart rate and blood pressure in mitral valve prolapse patients : divergent effects of long-term propranolol therapy. Correlations with catecholaminesPublication . Silva, Emília Pereira da; Mendes Pedro, Mónica; Varela, Manuel Gato; Cortez-Dias, Nuno; Bicho, Manuel; Madeira, Hugo; Lopes, Mario G.Introduction: There is a well-known association between mitral valve prolapse (MVP) and low blood pressure (BP), although patients (P) often have high levels of catecholamines (CAT) and high heart rate (HR). To our knowledge, there are no studies about the effects of long-term adrenergic b-blockade on these parameters. Methods: Twenty normal individuals (N)—8 males (M) (49.9 F 12.9 years) and 12 females (F) (41.8 F 11.8 years); 46 MVP P—15 M (49.3 F 15.5 years) and 31 F (42.0 F 12.8 years). Phase1—in both N and P free of medication, determination of (1) 24H urinary epinephrine (E) and norepinephrine (NE) by HPLC; (2) rest HR by ECG; (3) 24H ambulatory HR and BP (ABM). Phase2—same tests in MVP P while taking propranolol by 10 to 12 months. Results: CAT ng/mg creatinine: E—M 5.1 F 2.5 (N), 9.1 F 3.9 (Ph1), 7.9 F 3.1 (Ph2); F 6.2 F 3.5 (N), 13.0 F 9.7 (Ph1), 10.7 F 6.7 (Ph2). Higher in P ( P b .01), lower under propranolol ( P = .002). NE—M 22.2 F 7.2 (N), 36.8 F 16.8 (Ph1), 27.4 F 10.6 (Ph2); F 28.1 F 7.3 (N), 46.2 F 18.1 (Ph1), 33.0 F 12.9 (Ph2). Higher in P ( P b .01), lower under propranolol ( P b .001). HR—M 75 F 5.4 (N), 79 F 7.2 (Ph1), 65 F 3.8 (Ph2); F 74 F 3.2 (N), 80 F 6.5 (Ph1), 69 F 6.2 (Ph2). Lower under propranolol ( P b .0001). ABM: phase1—HR higher in P. SBP and DBP lower in P. Phase2—lower HR whereas higher SBP and DBP in P under propranolol. No correlation between BP and CAT. Correlation between E levels and rest HR. Conclusions: These MVP patients had high levels of CAT, high HR, and low BP. With long-term b-blockade, HR decreased related to E, but BP raised, supporting the role of b2 receptors supercoupling on low BP in MVP.
- Heart rate and blood pressure in mitral valve prolapse patients : divergent effects of long-term propranolol therapy and correlations with catecholaminesPublication . da Silva, Emilia Pereira; Mendes Pedro, Mónica; Varela, Manuel Gato; Cortez-Dias, Nuno; Bicho, Manuel; Madeira, Hugo; Lopes, Mario G.Objective: There is a well known association between mitral valve prolapse (MVP) and low blood pressure (BP), although patients often have high levels of catecholamines and high heart rate (HR). The main objective of our study was to evaluate the effects of long-term adrenergic beta-blockade on these parameters. Methods: The study population consisted of 46 patients with MVP and the control group consisted of 20 normal individuals. The study had two phases: in the first phase, patients were free of medications. In the second phase, patients were under treatment with propranolol for 10 to 12 months. The tests were performed in normal individuals and patients in the first phase. Only patients underwent the same tests in the second phase. Measurement of urinary epinephrine and norepinephrine levels, by high performance liquid chromatography, was done. Rest HR was determined by electrocardiogram (ECG), and ambulatory blood pressure and HR were evaluated by 24 hours ambulatory blood pressure monitoring (ABPM) using the auscultatory method. Results: The levels of epinephrine and norepinephrine were significantly higher in patients than in normal controls and decreased under propranolol. Rest and ambulatory HR were higher in patients and decreased under propranolol. The 24 hours systolic and diastolic BPs were lower in patients, and their values increased under propranolol. Heart rate decreasing and epinephrine levels reduction were positively correlated. No correlation was found between BP increase and catecholamine levels. Conclusion: The study results show divergent effects of propranolol on blood pressure, which increased, and on heart rate, that decreased, in patients with MVP. Heart rate decrease was an expected result and depends, namely, on b1 receptors blockade. Increase in BP is an unusual response to adrenergic beta-blockade in normal conditions, and this finding supports the preponderance of b2 receptors on the BP control in patients with MVP.
- Abnormal myocardial flow reserve in sickle cell disease : a myocardial contrast echocardiography studyPublication . Almeida, Ana G.; Araújo, Francisco; Rego, Fernanda; David, Cláudio; Lopes, Mário G.; Soares, J. DuclaBackground: Sickle cell disease (SCD) is characterized by obstruction of microvessels leading to ischemia and necrosis. We have aimed to demonstrate whether myocardial contrast echocardiography (MCE) is able to detect myocardial perfusion abnormalities in SCD patients and to assess their relationship with left ventricle (LV) perfusion and systolic function. Methods: A group of 25 patients with SCD and a control group of 19 normal individuals were studied. Using MCE, myocardial perfusion reserve indices (A, β, and A×β) were obtained, before and after hyperemia with dypiridamole. LV function was also analyzed: ejection fraction (EF), index of myocardial performance (IMP), the ratio of transmitral early-diastolic flow velocity E and the pulsed tissue Doppler mitral annular early diastolic velocity Ea (E/Ea) (E/Ea), tissue Doppler mitral annular peak systolic velocity (Sa), and peak systolic strain (S) were obtained. Results: Myocardial velocity (β) and myocardial blood flow (A×β) reserves were lower in the patients than in controls (1.7 ± 0.4 vs. 3.3 ± 0.2, P = 0.000 and 2.1 ± 0.6 vs. 4.1 ± 0.2, P = 0.000, respectively). In SCD patients, a correlation was found between β reserve and EF, IMP, Sa, E/Ea, and S% and between A×β reserve and Sa. Conclusions: MCE detected abnormal perfusion reserve in patients with SCD, which correlated with systolic function indices. This suggests that perfusion plays a role in SCD ventricular dysfunction.
- Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection : a magnetic resonance imaging studyPublication . Almeida, Ana G.; Nobre, Ângelo L.; Pereira, Ricardo A.; Pereira, Altamiro Costa; Tavares, Clara; Cravino, João; Lopes, Mário G.Background: Patients operated on for type A aortic dissection remain at risk of long-term aneurysm development, the main cause for late death. The aim of this study was to identify early predictors for aneurysm formation at three-years after surgery. Methods A study group of 70 consecutive patients (52 ± 10 years-old, 41 male), operated on for aortic dissection with replacement of the ascending segment, was evaluated prospectively for three-years. In order to detect aneurysm formation, the dimension of residual distal aortic segments was obtained soon after surgery and then annually for three years using cardiovascular magnetic resonance. Results: During follow-up (38 ± 2.6 months), aneurysm was found in 25 patients (35%) involving residual segments. Larger initial dimension of segments, higher pulse pressure, lower distensibility of residual segments and the presence of a residual flap were univariately associated with aneurysm. Multivariate analysis identified the initial dimension (mm) of the descending thoracic aorta (OR 1.47, 95%CI: [1.19–1.82]) and pulse pressure (OR 1.43,95%CI: [1.10–1.86]) as independent variables for aneurysm formation. A risk score using pulse pressure and descending thoracic dimension was constructed. Patients with ≤24 points had no late aneurysm formation, while those with a score ≥45 yielded 100% of aneurysm frequency. Conclusions: Type A aortic dissection treated by graft interposition is associated with a high risk of aneurysm formation. Early post-operative pulse pressure and the descending thoracic aortic dimension were independent variables and seem to be the main predictors for the outcome.
- Risk-adjustment model in health outcomes evaluation: a contribution to strengthen assessment towards quality improvement in interventional cardiologyPublication . Sousa, P.; Uva, A. S.; Pinto, Fausto J.Objective: The aim of this study was to develop a risk adjustment model for major adverse cardiac and cerebrovascular events following percutaneous coronary intervention (PCI), using data from a national registry, and to highlight the use of the risk adjustment when we evaluate the quality of care in interventional cardiology. Design: The study design was based on a Coorte study. Bivariate and multivariate logistic regression models were used to identify independent risk factors for these major adverse events. Setting: A total of 19 hospitals from the Portuguese National Registry of Interventional Cardiology. Participants: Data from 10.641 consecutives procedures collected between June 30, 2003 and June 30, 2006. Intervention: Build a risk adjustment model for these major adverse events, following percutaneous coronary intervention. Main Outcome Measure: Factors that were associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention. Results: The rate of in-hospital major adverse cardiac and cerebrovascular events was 1.9%. Factors associated with major adverse cardiac and cerebrovascular events included, among others: age >80 years (adjusted odds ratio = 3.91); female gender (1.72); and cardiogenic shock (6.05). Overall, a good discrimination was achieved with receiver operating characteristics curve = 0.84 and Hosmer-Lemeshow goodness of fit statistic across groups of risk was not significant (P = 0.18) indicating little departure from a perfect fit. Conclusions: These findings will represent an important contribution to quality and safety improvement and should help driving new research and innovative approaches to different subgroups of patients who have higher chances of having an adverse event or poorer outcomes following this intervention.
- Highlights of the 2009 scientific sessions of the European Society of CardiologyPublication . Bax, Jeroen J.; Casadei, Barbara; Di Mario, Carlo; Fagard, Robert; Filippatos, Gerasimos; Fox, Keith A. A.; Metra, Marco; Nihoyannopoulos, Petros; Perk, Joep; Rademakers, Frank; Rosenhek, Raphael; Vardas, Panos E.; Pinto, Fausto J.; Ferrari, RobertoThe annual congress of the European Society of Cardiology (ESC) was held in Barcelona, Spain, August 29 to September 2, 2009. The total attendance was 31,323 participants from 136 different countries. Excellent congress facilities hosted 237 pre-arranged sessions in 30 meeting rooms running in parallel, including several joint sessions in collaboration with other societies (e.g., the American College of Cardiology, the American Heart Association, and the World Heart Federation). A total of 9,848 abstracts from 96 different countries was submitted, and 4,085 (42%) abstracts were selected for presentation.
- Cardiotoxicity associated with trastuzumab treatment of HER2+ breast cancerPublication . Fiúza, ManuelaIntroduction: Although having high clinical efficacy in the treatment of human epidermal growth factor receptor-2 (HER2+) metastatic breast cancer, trastuzumab has been associated with cardiotoxicity, and the etiology and pathogenesis of this condition is currently under investigation. Methods: This paper reviews the cardiotoxicity, associated with trastuzumab use and discusses the risk assessment and management of cardiac dysfunction. Results: The increased risk of cardiotoxicity is lower when trastuzumab is given as monotherapy (3%-7%) compared with anthracyclines + trastuzumab therapy (27%). Type II cardiac changes occur in trastuzumab-treated patients, which do not appear to be dose-related, are not associated with histological changes, and are generally reversible. Several risk factors for cardiac events have been identified and assessing levels of troponin I and N-terminal pro-brain B-type natriuretic peptide before and after treatment with trastuzumab may allow early detection of cardiotoxicity. A symptomatic and functional evaluation scheme for patients indicated for treatment with trastuzumab has also been proposed to work alongside therapeutic options for the treatment of heart failure. Conclusion: The risk of cardiac dysfunction associated with trastuzumab can be justified given the increase in overall survival. This risk is lower when trastuzumab is given as monotherapy. The paradigm for cardiologists remains the same: treat the cancer effectively whilst preventing cardiotoxicity.
- Cardiopulmonary effects following endoscopic thoracic sympathectomy for primary hyperhidrosisPublication . Cruz, Jorge M.; Fonseca, Manuel; Pinto, Fausto J.; Oliveira, Antonio G.; Carvalho, L. SilvaIntroduction: Endoscopic thoracic sympathectomy (ETS) is performed for the treatment of primary hyperhidrosis (PH). The second and third sympathetic thoracic ganglions excised in ETS also innervate the heart and lung. Objective: In the present work we studied the cardiopulmonary effects of ETS in a group of patients with PH. Methods: We performed a prospective study in 38 patients with severe PH. Pulmonary function, echocardiographic assessment of left ventricular function and myocardial contractility and maximal, symptom-limited, incremental exercise tests were evaluated 2 weeks before, and 6 months after ETS. Data were analysed with the paired t-test. Differences were considered significant when p ≪ 0.05. Results: In pulmonary function tests, we found a statistically significant decrease forced expiratory flow in small airways and an increase of residual volume, a significant decrease in heart rate and ejection fraction, a significant decrease of ‘rest’ and ‘peak’ heart rate, and a significant increase of oxygen pulse (O2 pulse) and oxygen peak uptake ( VO2 peak) after ETS (p ≪ 0.05). Conclusions: These cardiopulmonary effects observed 6 months after ETS in the treatment of patients with PH are all in normal ranges and are not relevant in cardiopulmonary function. We concluded that ETS in patients with PH is a safe procedure. Patients must be informed about these cardiopulmonary effects before the operation.