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- A portable device to improve Valsalva Maneuver performance on earth and spacePublication . Rosa, Mauricio Machado da; Rosa, Michele dos Santos Gomes da; Rocha, IsabelThe emphasis on digitizing and computational modelling of physical phenomena began in the telecommunication sector with the appearance of the large-scale integration microprocessors and micro-controllers, them was possible to produce architectures with enough processing and memory capacity to supply the needs of the applications, specially the health applications. One of those is the Valsalva Maneuver (VM), used as a test that verifies the functional integrity of the autonomic nervous system and stands out in scientific research as an instrument to evaluate functions and control of the cardiovascular system. The aim of this device is to improve the execution of VM giving more control of the manoeuvre and reduce the repetitions, in tests that use tilt-table, or bed rest together with the VM, the position of the patient turns hard to visualize the pressure that are doing, this created device gives a one hand solution that integrates all that are need to perform the manoeuvre, and an IEEE 802.11 connection that allows the motorization of the process through a computer or a smartphone, and save the data of intrathoracic pressure at the end for analysis.
- The entrepreneurial university and the training for innovation of the new generationsPublication . Rosa, Michele Dos Santos Gomes Da; Rosa, Mauricio Machado Da; Rocha, IsabelPractices of using active methodologies as facilitating tools in the teaching-learning process in higher education are increasing, especially in bioengineering courses. The university is a good model for facilitating the implementation of innovative processes due to its role and proximity to science, teaching and research. To embrace this challenge, the university is reaching a broader interaction with the community, from the area of scientific education that includes the awakening of children to science and research. Thus, this article reports on the pilot experience of the Laboratory of Cardiovascular Autonomic Function of the Cardiovascular Center of the University of Lisbon, in the approach of different academic and scientific knowledge together with society as a means to stimulate the pleasure of science and research in children.
- The Eustachian valve : a structure not so innocentPublication . Rodrigues, T. E. Graça; Plácido, Rui; David, Cláudio; Gonçalves, Sónia; Pinto, Fausto J.; Almeida, Antonio Bugalho deBackground: The eustachian valve is an embryological remnant of the inferior vena cava (IVC) valve. It is sually absent or inconspicuous and has no known function in the normal adult. However, there are reports suggesting that the EV is not as innocent as we thought. The EV can be a site of infective vegetations or be mistaken for a thrombus or tumor. The EV can also make interventional procedures (closure of ASD (atrial septal defect) or ablation for atrial flutter) more laborious.
- Intermittent low-level lead exposure causes anxiety and cardiorespiratory impairmentPublication . Shvachiy, Liana; Geraldes, Vera; Amaro-Leal, Ângela; Rocha, IsabelAim: To characterize behavioural and cardiorespiratory changes in a new, intermittent low-level lead exposure animal model. Introduction: Lead (Pb) is a cumulative toxic metal affecting all body systems that are particularly vulnerable during developmental phase. Permanent lead exposure has been defined as a cause of behavioural changes, cognitive impairment, sympathoexcitation, tachycardia, hypertension and autonomic dysfunction. However, no studies have been performed to describe a new, intermittent low-level lead exposure profile, that has been increased in the past years. Methods: Foetuses were intermittently (PbI) exposed to water containing lead acetate (0.2%, w/v) throughout life until adulthood (28 weeks of age). A control group (without exposure, CTL), matching in age and sex was used. At 26 weeks, behavioural tests were performed for anxiety (Elevated Plus Maze Test) and locomotor activity (Open Field Test) assessment. Blood pressure (BP), electrocardiogram (ECG), heart rate (HR) and respiratory frequency (RF) rates were recorded at 28 weeks of age. Baroreflex gain (BRG) and chemoreflex sensitivity (ChS) were calculated. Student’s T-test was used (significance p < 0.05) for statistical analysis. Results: An intermittent lead exposure causes hypertension (increased diastolic and mean BP), increased RF, decreased baroreflex function and increased ChS, without significant changes in HR, when compared to CTL group. Regarding behavioral changes, the intermittent lead exposure model showed an anxiety-like behaviour without changes in locomotor activity. Conclusion: Intermittent low-level lead exposure induces changes on the cardiorespiratory profile characterized by hypertension, carotid chemosensitivity and baroreflex impairment. According to behavioural tests results, this study also shows that the exposure to lead during developmental phases causes anxiety in adult animals without locomotor activity impairment. In summary, this study brings new insights on the environmental factors that influence nervous and cardiovascular systems during development, which can help creating public policy strategies to prevent and control the adverse effects of Pb toxicity.
- Association of circulating levels of collagen turnover biomarkers with the phenotype in a population with sarcomeric hypertrophic cardiomyopathyPublication . Brito, D. A.; Pedro, M. M. Mendes; Calisto, C.; Pires, R.; Moldovan, O.; Silva, D.; Francisco, A. R.; Guimarães, T.; Pinto, Fausto J.; Madeira, H. C.Background and aim: In patients (pts) with sarcomeric hypertrophic cardiomyopathy (sHCM) and left ventricular hypertrophy (LVH), cardiac fibrosis and diastolic dysfunction are typical features. Studies suggest that collagen turnover (ColT) is increased in sHCM, but its clinical significance and relationship with cardiac LVH and function is doubtful. In order to address this question, we evaluated the association of circulating levels of biomarkers of ColT (bioColT) with clinical, morphological and functional echocardiographic (echo) features. Methods: Thirty nine sHCM pts (49±17y, 54% female) major echo criteria and positive genotype, nondilated left ventricle (LV) and preserved ejection fraction were enrolled, after exclusion of conditions that might influence circulating levels of bioColT. On the same day, clinical evaluation, ECG, echo study and laboratorial tests (including measurement of 6 bioColT related to collagen synthesis and degradation PICP, PIIINP, CITP, MMP1, MMP9 and TIMP) were performed. Associations were looked for between bioColT and: 1) structural and functional parameters and indices of systolic and diastolic function evaluated by echo/tissue Doppler imaging; 2) current NYHA functional class, hospitalization due to sHCM and nonsustained ventricular tachycardia (NSVT) on Holter, during the preceding year. Associations were considered statistically significant if p<0.05. Results: Controlling for age and body mass index, TIMP1 levels (a measure of tissue inhibition of collagentype 1 degradation) correlated with LV mass index (LVMI; r=0.49), septal thickness (ST; r=0.43), maximal wall thickness (MWT; r=0.44), LVWT score (r=0.44), lateral E' (r=−0.49), septal E/E' (r=0.55), and lateral E/E' (r=0.64); and CITP (a measure of collagentype I degradation) levels correlated with LVMI (r=0.38), ST (r=0.36), MWT (r=0.38), LVWT score (r=0.37) and lateral E' (r=−0.45). No correlations were found between PICP or other bioColT levels and echodata. Only TIMP1 levels were significantly increased in the presence of symptoms and hospitalizations (p=0.031). None bioColT was associated with the occurrence of NSVT on Holter. Conclusions: In pts with sHCM and LVH, collagen turnover is active, and acts in favor of a predominance of inhibition of collagen degradation over collagen degradation. Both, TIMP1 and CITP levels were associated with the degree and extension of LVH, but only TIMP1 levels were also positively associated with echoindices of diastolic dysfunction, left ventricular filling pressures and morbidity. Therefore, it appears in this series to be the biomarker of choice amongst ColT biomarkers, for future research.
- Transcatheter aortic valve implantation: efficacy, safety and mortality at 30-days to 1- year from a nationwide eight year registryPublication . 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.