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Monteiro J, Caetano A, Costa C, Pires M, Tavares A, Mariano M, Madeira P, Bonito N, Sousa G. Systemic inflammatory index as a predictor of BCG-refractory non-muscle invasive bladder cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02585-x] [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: 11/11/2022] Open
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2
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Barradas M, Duarte F, Coutinho Dos Santos I, Resendes De Oliveira L, Serena C, Xavier Fontes A, Viveiros Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Physical activity and heart failure: a forgotten indicator. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2437] [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
Low physical activity may be associated with comorbidities, sedentary lifestyle or clinical worsening in heart failure (HF) patients. Cardiovascular implantable electronic devices (CIEDs) detect and analyse physical activity data that is often integrated in multifactorial algorithms for predicting HF decompensations, but its potential is probably underestimated.
Purpose
We hypothesized that low physical-activity levels, obtained from remote monitoring of CIEDs, help predict clinical outcomes in HF patients, independently from multifactorial algorithms.
Methods
We retrospectively evaluated consecutive patients with HF and CIEDs through clinical assessments and remote monitoring (two monitoring systems were used). Low activity was defined as <1 hour/day of physical activity and two groups of patients were defined: patients with low activity alerts (group 1) and patients without low activity alerts (group 2). Primary outcome was defined as death by all causes and secondary outcome as HF hospitalizations and sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes.
Results
From 121 patients with RPM, physical activity data was obtained in 104 (85,9%). Mean age was 63,98±12,44 years, 70,2% were males and follow-up was 59,19±38,491 months. Fifty-four (51,9%) had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 46 (44,2%) transvenous implantable cardioverter defibrillator (ICD), and 4 (3,8%) CRT pacemaker (CRT-P). The aetiology was idiopathic in 42,5% and ischemic in 40,2%. Mean left ventricular ejection fraction was 34,08±11,40% and mean physical activity duration was 2,25±1,84 hours/day. Forty-eight (53,7%) had low activity alerts (group 1) and 56 (46,3%) had no low activity alerts (group 2). In group 1 mean period of low activity was 52,978±15,75 days/year. Patients from group 1 were older (p=0,001), had more oncological disease (p=0,041) and peripheral artery disease (p=0,028). Three deaths occurred in total, all in group 1 (p=0,039) and HF hospitalizations were more frequent in group 1 (1,68±2,59 vs 0,69±1,32, p=0,005). Low activity burden was also associated with atrial fibrillation burden (r=0,473, p<0,05) and number of episodes of VT or VF (r=0,267, p=0,007). A decrease of 50% or more in mean duration of physical activity, but above 1 hour/day, was associated with increase HF hospitalizations (1,83±2,13 vs 1,05±1,95, p=0,006).
Conclusion
Low physical activity data obtained from CIEDs was associated with HF hospitalizations, arrhythmic events and death by all causes, independently of multifactorial algorithms. A decrease in basal activity even above alert threshold, was associated with HF hospitalizations and may be an even earlier sign of HF decompensations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Barradas
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - F Duarte
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Serena
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Machado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - R Dourado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Santos
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Tavares
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - D Martins
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
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Barradas M, Duarte F, Coutinho Dos Santos I, Resendes De Oliveira L, Serena C, Xavier Fontes A, Viveiros Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Lower rate limit in cardiac resynchronization therapy defibrillators. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1002] [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] Open
Abstract
Abstract
Background
There is few data about programmed lower rate limit (LRL) in real world heart failure (HF) patients with cardiac resynchronization therapy–defibrillators (CRT-Ds) and its influence in clinical outcomes. Heart rate score (HRS) is the percentage of all atrial-paced and sensed events in the single tallest 10 beats/min device histogram bin and may indicate impaired heart rate variability.
Purpose
We hypothesized that higher LRL programming is associated with worse clinical outcomes as arrhythmic events and HF decompensations in chronic HF patients with CRT-Ds.
Methods
LRL was evaluated and HRS was calculated from remote monitoring in 126 HF patients with CRT-D. Primary outcome was defined as HF hospitalizations and related admissions to the emergency department and secondary outcome as number of device therapies, sustained ventricular tachycardia (VT) and ventricular fibrillation (VF).
Results
Mean age was 69,03±10,39 years, 81 (64,3%) were males and mean follow-up was 53,72±46,13 months. Mean left ventricular ejection fraction was 30,31±8,33% and 29 (23,0%) were in NYHA III–IV. HF aetiology was idiopathic in 39 (43,3%), ischemic in 32 (25,4%) and alcoholic cardiomyopathy in 8 (6,3%). Thirty-seven (29,4%) patients had atrial fibrillation and 33 (26,2%) coronary disease. LRL ranged from to 40 to 80 bpm and mean LRL was 52,64±9,64 and mean HRS 49,60±23,17%. Programmed LRL was higher in women (p=0,014), patients with atrial fibrillation (AF) (p=0,012) and coronary disease (p=0,015). Higher LRL correlated with HF hospitalizations and related admissions to the emergency department (ED) (r=0,541, p=0,001), VT or VF episodes (r=0,337, p=0,005) and CRT-D number of therapies (r=0,342, p=0,004) and higher HRS (r=0,547, p<0,05).
Conclusion
Higher LRL programming was associated with higher HRS, HF decompensations with hospitalization or admission to the emergency department, VT or VF episodes and CRT-D therapies in a real world population. More studies are required but lower LRL may be preferred in HF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Barradas
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - F Duarte
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Serena
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Machado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - R Dourado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Santos
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Tavares
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - D Martins
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
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Barradas M, Duarte F, Coutinho Dos Santos I, Resendes De Oliveira L, Serena C, Xavier Fontes A, Viveiros Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Biventricular or left univentricular pacing in heart failure patients: is there a better strategy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1003] [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] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a cornerstone in treatment of heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and ventricular dyssynchrony. Biventricular (BiV) pacing is often the preferred method and corrects electrical and mechanical dyssynchrony but Left ventricular (LV) preferential pacing is may preserve conduction via the right bundle branch, preventing deleterious effects from right ventricular. The evidence is sparse and there is doubts whether which programming strategy is better.
Purpose
We hypothesized that BiV is non-inferior to preferential LV pacing in HF patients with reduced LVEF and CRT devices in cardiovascular death and HF hospitalizations.
Methods
We retrospectively evaluated 147 patients with HF patients with reduced LVEF and CRT devices. Two groups were defined: LV pacing (group 1) and BiV pacing (group 2). Primary outcome was defined as cardiovascular death and secondary outcome as HF hospitalizations and NYHA class after CRT.
Results
Mean age was 70,26±10,6 years, 68,1% were males and follow-up was 52,22±44,51 months. One hundred and twenty six (85,7%) patients had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D) and 21 (14,3%) CRT pacemaker (CRT-P). Mean LVEF was 31,1±8,5% and mean QRS duration before CRT implantation was 149,5±48,6 ms. Thirty-nine (36,4%) patients were in NYHA III–IV. HF aetiology was idiopathic in 51 (47,2%), ischemic in 36 (33,3%) and alcoholic cardiomyopathy in 9 (8,3%). Forty-five (40,5%) patients had atrial fibrillation and 37 (35,6%) coronary disease. Patients in group 2 were more frequently males than group 1 patients (46 (78,0%) vs 32 (56,1%) respectively, p=0,012). There were no differences in regard to age, LVEF, HF aetiology or other comorbidities between groups. In 57 (49,1%) CRT was programming in preferential LV pacing and 50 (50,9%) in BiV pacing. There were 2 deaths in group 1 and 3 in group 2 (OR 0.80, 95% CI 0.27–2.40). There were 0,98±3,17 hospitalizations per patient and there were no differences in HF hospitalizations between groups (OR 1.01, 95% CI 0.92–1.18) or NYHA after 6 months of CRT (p=0,364).
Conclusion
BiV pacing was not inferior to LV-only pacing in regard to cardiovascular death, HF hospitalizations and NYHA class improvement. There was no clear advantage for one pacing strategy over the other but more studies are still required.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Barradas
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - F Duarte
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Serena
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Machado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - R Dourado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Santos
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Tavares
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - D Martins
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
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Barradas M, Duarte F, Coutinho Dos Santos I, Resendes De Oliveira L, Serena C, Xavier Fontes A, Viveiros Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Suboptimal coronary flow after PCI in STEMI patients: clinical implications and predictors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1253] [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
Even in experienced angioplasty centers, percutaneous coronary intervention (PCI) in the acute setting of ST-elevation myocardial infarctions (STEMI) is associated with a low, but still significant rate of suboptimal coronary flow. Identification of its clinical impact and potential modifiable risk factors is important.
Purpose
To evaluate the clinical impact of suboptimal coronary flow after PCI in STEMI patients and to access potential predictors of suboptimal coronary flow.
Methods
We retrospectively evaluated 103 hospitalized patients with acute STEMI who were admitted to our center between 2018 and 2019 and underwent PCI. Coronary flow was accessed using the Thrombolysis in myocardial infarction (TIMI) Flow Grading System. Patients were divided into suboptimal patency of the culprit-vessel, defined as TIMI flow ≤2 (group 1, n=8 (7,8%)) and optimal patency of the culprit-vessel defined as TIMI flow 3 (group 2, n=95 (92,2%)). Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula.
Results
Mean age 58,15±12,6 years and 85,4% were males. Seventy-eight patients (75,7%) had history of smoking, 45 (43,7%) dyslipidemia, 20 (19,4%) previous acute coronary syndrome, 18 (17,5%) diabetes, 17 (15,5%) were obese and 4 (3,9%) had chronic kidney disease. The revascularization strategy was primary PCI in 55 (54,4%) patients and fibrinolytic therapy with facilitated PCI in 48 (46,6%) patients. Infarct-related artery was the left anterior descending artery in 45 (45,5%) and multivessel disease was present in 38 (38,0%). Angiographic no-reflow after PCI was 3,0%. Intrahospital cardiovascular death occurred in 4 (3,9%) patients and was significantly associated with suboptimal flow (p=0,036) and there was no association with stent thrombosis. Predictors of suboptimal flow were higher blood urea nitrogen, creatinine and GFR at hospital admission (p=0,017 and p=0,012), peak creatinine (p=0,012) and stent length (p=0,038). Suboptimal flow was associated with higher Zwolle score (p=0,010) and ischemic Paris score (p=0,036).
Conclusion
Failure to achieve optimal culprit-vessel patency after PCI in STEMI patients, although infrequent, is associated with increased hospital cardiovascular death. Longer stents could be and important modified risk factor. Renal dysfunction is an important comorbidity that should be promptly identified and could be partially improved with medical treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Barradas
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - F Duarte
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Serena
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | | | | | - C Machado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - R Dourado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Santos
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Tavares
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - D Martins
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
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Duarte F, Coutinho I, Barradas MI, Oliveira L, Serena C, Fontes A, Monteiro A, Machado C, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Acute ST-elevation myocardial infarction: are men and women particular cases of STEMI ? Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.021] [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
ST-segment elevation myocardial infarction (STEMI) has high levels of morbidity and mortality. Multiple risk factors may contribute to clinical outcomes and some studies demonstrate gender-related differences in baseline characteristics and in-hospital management.
Purpose
To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis.
Methods
We retrospectively analyzed 121 non-consecutive patients with STEMI during a mean follow-up period 135 ± 31 weeks.
We accessed baseline characteristics and time course of events (symptom onset-to-door admission; time to first EKG; time to fibrinolytic therapy; door-to-cath lab time and time from fibrinolytic therapy to PCI (for patients transferred from another centers).
Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV.
Secondary endpoint (SE) was in-hospital major bleeding events, considered intracerebral hemorrhage, cases of hemodynamic compromise or requiring a blood transfusion.
Tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality.
Results
Of the 121 patients, 102 were male (84.3%) and 19 (15.7%) female. The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years) vs. Men mean age 56 ± 11.6 years.
Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes (vs 10.8% of men) and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021).
According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014).
Conversely, less women smoke (31.6% vs. 82.2%; p <0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04).
Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes).
Regarding to in-hospital hemorrhagic events (secondary endpoint), female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r=0.249; ANOVA p-value < 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes or survival function were observed.
Conclusion
Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.
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Affiliation(s)
- F Duarte
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - I Coutinho
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M I Barradas
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - C Serena
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Fontes
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - C Machado
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Santos
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - A Tavares
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - D Martins
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
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7
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Duarte F, Barradas MI, Barradas MI, Oliveira L, Oliveira L, Serena C, Serena C, Fontes A, Fontes A, Monteiro A, Monteiro A, Machado C, Machado C, Dourado R, Dourado R, Santos E, Santos E, Pelicano N, Pelicano N, Pacheco M, Pacheco M, Tavares A, Tavares A, Martins D, Martins D. Risk scores in predicting adverse events after an acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.081] [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
ST-segment elevation myocardial infarction (STEMI) is a serious event that usually occur in patients with cardiovascular risk factors and is associated with great morbidity and mortality.
PARIS ischemic risk score and TIMI score were validated to evaluate ischemic risk in STEMI patients who underwent percutaneous coronary intervention (PCI) and to estimate mortality, respectively.
Despite these specific purposes, the usefulness of these scores in predicting adverse cardiovascular events (ACE) is unknown.
Objectives
To assess the prognostic value of PARIS and TIMI scores for cardiovascular events, coronary ischemic events and mortality in patients after STEMI.
Methods
Retrospective single center cohort study enrolled 103 patients with STEMI diagnosis between 2018 and 2019, during a mean follow-up period 30.30 ± 6.46 months and patients were included regardless of the reperfusion strategy.
Primary endpoint (PE) was a composite of acute coronary events (ACE), admissions to the emergency department by heart failure (HF) decompensation or chronic coronary syndrome and HF hospitalization. Secondary endpoint (SE) was ACE. Cardiovascular and non-cardiovascular death was determined.
PARIS ischemic risk score was calculated and patients were stratified into low (0-2), intermediate (3-4) or high (≥ 5) ischemic risk categories. TIMI score was also assessed.
Results
Out of 103 patients with STEMI diagnosis, the median age was 58.15 ± 12.6 years and 85,4% were male. Fifty-seven patients (55.3%) had hypertension, 45 (43.7%) dyslipidemia, 18 (17.5%) diabetes, 17 (15.5%) were obese and seventy-eight patients (75.7%) had history of smoking. Twenty (19.4%) patients had a previous acute coronary syndrome and 15 underwent PCI.
Twenty-five (24.3%) patients were included in low PARIS ischemic risk category, 53 (51.5%) in intermediate risk and 20 (19.4%) in high risk category.
PE occurred in 16 patient (15.5%) and SE in 7 patients (6.8%).
Eight patients died during the follow-up period (7.8%), 4 of cardiovascular causes (50%), 3 of non-cardiovascular causes (37.5%) and 1 of unknown cause.
PARIS ischemic risk score showed prognostic value for PE, with an area under the curve (AUC) of 0.65, 95% confidence interval (CI) 0.506-0.806 and p-value 0.039.
PARIS score also had predictive value for SE (AUC 0.816, 95% CI 0.604-1.000; p 0.004) as well as TIMI score (AUC 0.738, 95% CI 0.560 – 0.917; p 0.032).
Both scores showed a good prognostic value in evaluating all-cause mortality, with a slightly better predictive value for TIMI score (AUC 0.91, 95% CI 0.802 – 1.00) when compared to PARIS score (AUC 0.84, 95% CI 0.685 – 0.987).
Conclusion
This study revealed that PARIS and TIMI scores have a good discriminatory power to predict prognosis in STEMI patients. According to our study results, these scores could be an interesting tool to determine the likelihood of fatal and non-fatal outcomes, including ACS.
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Affiliation(s)
- F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M I Barradas
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M I Barradas
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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8
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Duarte F, Barradas MI, Oliveira L, Serena C, Fontes A, Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Hemorrhagic risk scores in hospitalized patients with acute coronary syndrome: can they (only) predict bleeding events? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.082] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Acute coronary syndrome (ACS) is a life-threatening condition and its therapeutic approach increases the risk of important bleeding events which are associated with a worse prognosis. Along with hemorrhagic events, a drop on hemoglobin level not related to bleeding or the development of anemia could have a negative impact on prognosis.
Both CRUSADE and PARIS bleeding risk scores are used to evaluate and to stratify the risk of major bleeding in ACS. However their actual predictive value has been questioned and validity of these scores in predicting in-hospital mortality (IHM) is not established.
Objectives
To evaluate the actual prognostic value of CRUSADE and PARIS bleeding scores in ACS patients during their hospitalization stay.
Methods
Retrospective single center cohort study including 103 hospitalized patients after an acute ST-segment elevation myocardial infarction (STEMI) regardless of its reperfusion strategy.
In-hospital major hemorrhagic events (IHMHE), considered intracerebral hemorrhage, those resulting in hemodynamic compromise or requiring a blood transfusion, were assessed. Data on hemoglobin levels (HL) at hospital admission and at the time of hospital discharge were also collected and a composite endpoint (CE) of IHMHE and a drop in HL ≥ 3g/dL were elaborated.
Both scores were calculated for each patient, its predictive value and their impact on IHM were determined.
Results
Out of 103 patients enrolled, the median age was 58.15 ± 12.6 years and 85.4% were male.
Two IHMHE occurred, twenty patients (19.4%) had anemia at the time of hospital discharge and 16 of these patients (15.5%) were not anemic at the time of hospital admission. Nine (8.7%) patients had a drop in their HL of at least 3g/dL.
The five bleeding risk categories defined by CRUSADE investigators were used, with 48 (46.6%) patients in the very low risk category, 9 (8.7%) and 6 (5.8%) in the high and very high risk category, respectively.
Hospitalization length stay was 5.6 ± 4.1 days with an overall in-hospital mortality (IHM) of 5.8%.
Receiver operating characteristic curve (ROC) analysis showed that CRUSADE score had an excellent discriminatory power for the CE (AUC 0.927, 95% CI 0.854-1.000) and the PARIS score had an acceptable discriminatory value (AUC 0.775, 95% CI 0.616-0.935).
Both CRUSADE and PARIS bleeding scores also had prognostic value in evaluating IHM (AUC 0.929, 95% CI 0.856-1.000 and AUC 0.788, 95% CI 0.634-0.942, respectively).
No specific and independent predictors of IHMHE were found, neither related to individual characteristics nor to therapeutic approach.
Conclusion
The presenting study showed that CRUSADE and PARIS scores still have discriminatory power to assess CE and to assess IHM in ACS patients. Their addition to stratification tools could be of interest.
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Affiliation(s)
- F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M I Barradas
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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Amado A, Castro B, Torre AP, Graça S, Tavares A, Póvoa A, Soares C, Gonçalves G. Serum TSH as a predictor of malignancy in indeterminate thyroid nodules. Ann R Coll Surg Engl 2021; 104:380-384. [PMID: 34939834 DOI: 10.1308/rcsann.2021.0196] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thyroid nodules are lesions that are radiologically distinct from the thyroid parenchyma. Cervical ultrasound diagnoses 19-67% of nodules and is crucial in identifying those that lack cytological characterisation. Approximately 25% of biopsies reveal an indeterminate cytological result (Bethesda III), in which the risk of malignancy is variable (5-15%). The clinical importance of the diagnostic strategy used for thyroid nodules results from the need to exclude malignancy. The aim of this study was to evaluate the usefulness of serum thyroid-stimulating hormone (TSH) levels as a predictor of malignancy in cytologically indeterminate thyroid nodules. METHODS Our retrospective study included 40 patients with cytologically indeterminate thyroid nodules seen in our hospital between January 2013 and December 2017. Clinical parameters were reviewed, including age, gender, serum TSH levels, family history of thyroid carcinoma, radiation exposure and some sonographic features of the nodules. Statistical analysis was performed using SPSS. Statistical significance was defined as p<0.05. RESULTS Female gender was predominant (85%) and the mean (SD) age was 53.3 (15) years. Thyroid carcinoma was confirmed in 28% of patients. Median TSH levels were higher in patients with malignant (2.73µIU/ml) compared with benign (1.56µIU/ml) nodules (p<0.05). We demonstrated an increased risk of malignancy in patients with TSH levels of 2.68µIU/ml or above (p<0.05). CONCLUSION Higher serum TSH levels are associated with an increased risk of thyroid carcinoma in cytologically indeterminate nodules. TSH can become a fundamental diagnostic tool in stratifying the risk of malignancy and assist in diagnostic and therapeutic approaches to these nodules.
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Affiliation(s)
- A Amado
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - B Castro
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A P Torre
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - S Graça
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A Tavares
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - A Póvoa
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - C Soares
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
| | - G Gonçalves
- Vila Nova de Gaia/Espinho Hospital Center (CHVNG/E), Vila Nova de Gaia, Portugal
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10
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Tzolos E, Bing R, Andrews J, Macaskill M, Tavares A, MacNaught G, Clarke T, Williams MC, Van Beek EJR, Koglin N, Stephens A, Dweck MR, Newby DE. In vivo coronary artery thrombus imaging with 18F-GP1 PET-CT. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Coronary artery thrombus is typically present in type 1 myocardial infarction, but small volumes in the setting of an uncertain culprit lesion may be beyond the detection limit of current imaging modalities.
Purpose
Using a novel glycoprotein IIb/IIIa-receptor radiotracer, 18F-GP1, we investigated whether positron emission tomography-computed tomography (PET-CT) could detect thrombus formation in coronary arteries.
Methods
In a single centre cross-sectional study, patients over 40 years of age with myocardial infarction were recruited after myocardial infarction and underwent underwent CT angiography and 18F-GP1 PET-CT. Stable patients with and without coronary artery disease formed a control cohort. Coronary artery 18F-GP1 uptake was visually assessed and quantified using maximum target-to-background ratios (TBRmax).
Results
Ninety-four (44 post-myocardial infarction and 50 control patients) were included in the cross-sectional analysis. The mean age of the post-myocardial infarction group was 61±9 years, three-quarters were male and two thirds had presented with ST elevation on electrocardiography. 34 (80%) patients post-myocardial infarction, but none of the control patients, demonstrated focal 18F-GP1 uptake in the coronary arteries.
Of 42 vessels with an angiographic culprit lesion, 35 (83%) had 18F-GP1 uptake which was significantly higher than non-culprit vessels (p<0.0001) as well as control vessels (p<0.0001), while non-culprit vessel uptake was similar to control vessel uptake (p=0.567): culprit vessel median TBRmax 1.2 [interquartile range 0.96–1.44], non-culprit vessel TBRmax 0.96 [0.84–1.03] and control vessel TBRmax 0.9 [0.76 to 0.94]. Linear regression models demonstrated univariable associations between coronary 18F-GP1 TBRmax and time from myocardial infarction, male sex and presence of culprit vessel. On multivariable analysis, only culprit vessel status was associated with TBRmax (adjusted R2= 0.22, P<0.001). Based on the Youden's index of the ROC curves, the optimal cut-off of predicting the presence of a culprit vessel was 1.20 with a specificity of 97%, accuracy of 83%, sensitivity (60%) and c-statictic of 0.74.
A patient with ectatic vessel and visual thrombus demonstrated the most intense 18F-GP1 uptake (TBRmax 2.0, highest in the cohort) in the region of heaviest thrombus burden (Figure 2). Extra-coronary uptake was seen in regions of left ventricular thrombus, left atrial appendage thrombus, pulmonary thromboembolism and intramyocardial microvascular obstruction.
Conclusions
18F-GP1 PET-CT is able to detect coronary artery thrombus in culprit lesions following myocardial infarction, as well as extra-coronary thrombotic pathologies that may be important in guiding patient management. 18F-GP1 is highly specific in recognising a culprit lesion from a non-culprit lesion both visually as well as quantitatively.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Figure 1Figure 2
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Affiliation(s)
- E Tzolos
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Bing
- University of Edinburgh, Edinburgh, United Kingdom
| | - J Andrews
- University of Edinburgh, Edinburgh, United Kingdom
| | - M Macaskill
- University of Edinburgh, Edinburgh, United Kingdom
| | - A Tavares
- University of Edinburgh, Edinburgh, United Kingdom
| | - G MacNaught
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Clarke
- University of Edinburgh, Edinburgh, United Kingdom
| | - M C Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - N Koglin
- Life Molecular Imaging, Berlin, Germany
| | | | - M R Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
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11
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Barradas Da Silva M, Duarte F, Oliveira L, Serena C, Fontes A, Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. STEMI treatment in remote areas – challenges of the only interventional angioplasty center located in an archipelago. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1443] [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] Open
Abstract
Abstract
Background
In remote islands lack of specialized medical facilities, long distance transfer and emergency medical system organization remains a challenge and fibrinolysis is necessary to achieve revascularization in optimal timing in ST-elevation myocardial infarction (STEMI) patients. Our angioplasty center is the only one located in an archipelago composed of nine islands, six of which do not have hospital facilities and only have small family health care units.
Purpose
To evaluate the reality and outcomes of our interventional angioplasty center and compare cardiovascular outcomes between STEMI patients from the main island and remote islands.
Methods
We retrospectively evaluated 103 patients with STEMI admitted to our center between 2018 and 2019. Patients from the main island where the center is located underwent primary percutaneous coronary intervention (PCI) (group 1, n=55) and patients from remote islands underwent fibrinolytic therapy followed by transference to our center with facilitated or rescue PCI (group 2, n=48). A subanalysis of the far remote islands without hospital facilities was also performed. Primary outcome was defined as cardiovascular death or re-infarction at two years and secondary outcome as intrahospital haemorrhagic complications.
Results
Mean age was 58,15±12,6 years, 85,4% were males and follow up period was 30,30±6,46 months. Seventy-eight patients (75,7%) had history of smoking, 45 (43,7%) dyslipidemia, 20 (19,4%) previous acute coronary syndrome, 18 (17,5%) diabetes and 17 (15,5%) were obese. Troponin I peak was 117,42±129,06 ug/L and 14 (13,6%) were in Killip Class III/IV. Infarct-related artery was the left anterior descending artery in 45 (45,5%) and multivessel disease was present in 38 (38,0%). In group 1 reperfusion after PCI was obtained in 91,5%. In group 2, 73,5% met criteria for reperfusion after fibrinolysis and 23,6% after rescue PCI. Mean time from fibrinolysis to PCI was 558±349 minutes. Rates of successful revascularization did not differ between groups, as well as complete patency of the culprit-vessel defined as thrombolysis in myocardial infarction (TIMI) flow 3 (91,5% vs. 97,2% and 90,0% vs. 93,0% respectively for group 1 and 2). Cardiovascular death at two years occurred in 4 (3,9%) patients and re-infarction in 11 (10,7%) and were similar between groups (3 (5,5%) vs. 1 (2,1%) and 8 (14,5%) vs. 3 (6,3%) respectively) as well as haemorrhagic complications (1 (1,8%) vs. 5 (10,4%) respectively). Nineteen (18,4%) patients were from far remote islands without hospital facilities and when comparing these patients with the others there was also no difference in primary outcome.
Conclusion
Even in remote islands, an organized STEMI network with attempted fibrinolytic treatment and coordinated transference of patients for facilitated or rescue PCI can provide successful revascularization with cardiovascular outcomes similar to those submitted to primary PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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12
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Ribeiro Da Silva M, Vilela E, Mosalina Manuel A, Barbosa A, Almeida J, Guerreiro C, Ribeiro Queiros P, Tavares A, Dias A, Caeiro D, Sousa O, Braga P, Rodrigues A, Teixeira M, Fontes-Carvalho R. The impact of mitral regurgitation grade on exercise capacity following cardiac rehabilitation program after transcatheter aortic valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2689] [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
Severe aortic stenosis (AS) and mitral regurgitation (MR) often coexist. Transcatheter aortic valve implantation (TAVI) is becoming widely used for the treatment of patients (pts) with symptomatic severe AS. However, conflicting data reside concerning the impact of MR on outcomes after TAVI. Also, very few data exist regarding the benefits of a cardiac rehabilitation program (CRP) following TAVI in pts with MR.
Purpose
To evaluate the effect of a CRP in functional parameters after TAVI, particularly in pts with MR grade ≥ II.
Methods
Retrospective study which included all pts submitted to TAVI between 2014 and 2020 that completed a CRP following the procedure. Cardiopulmonary exercise tests (CPET) were performed after TAVI at baseline (pre-CRP) and post-CRP. We evaluated pre- and post-CRP peak oxygen consumption (pVO2), pVO2 at the anaerobic threshold (AT), respiratory exchange ratio (RER), VE/VCO2 and CPET duration. The exercise protocol included low/medium intensity exercises and consisted of sessions 3 times per week carried over 3 months. MR grading severity was assessed with transthoracic echocardiography performed after TAVI and was divided into 2 groups (grade < II vs grade ≥ II).
Results
Fifty-two pts were included, 59,6% were male, mean age of 78,6±8,6 years-old. Mean Society of Thoracic Surgery (STS) risk score was 4,9. Mean pre-TAVI aortic valve area was 0,68 cm2, with a mean gradient of 45,5 mmHg and a mean ejection fraction (EF) of 51%. The majority of pts implanted a self-expandable prosthesis (55,8%).
Twenty-seven (51,9%) pts had MR grade ≥ II. Baseline characteristics were similar between pts with MR grade < II vs MR grade ≥ II, with the exception of the prevalence of coronary artery disease which was higher in MR grade ≥ II (p=0,036). Patients with MR grade < II had higher maximum and median aortic gradients before TAVI (p<0,05 for all). The mean number of cardiac rehabilitation sessions was 21±7, without differences between both groups. In pts with MR grade ≥ II, there was an improvement in CPET duration after CRP (HF protocol from 03:57 min to 05:02 min; p=0,017 and modified Bruce protocol from 06:03 min to 06:41 min; p=0,049) but without significant changes in pVO2 (14,7 mL/kg/min to 14,9 mL/kg/min; p=0,990), RER or VEVCO2/VO2 ratio. Patients with MR grade < II significantly improved pVO2 (13,8 mL/kg/min to 14,7 mL/kg/min; p=0,015), and CPET duration with HF protocol from 05:04 min to 06:23 min; p=0,006 after CRP. There was also an improvement in VEVCO2/VO2 ratio, although not statically significant.
Conclusions
Patients with MR grade < II after TAVI who underwent a CRP significantly improved pVO2 and CPET duration. Although pts with MR grade ≥ II did not improved pVO2 after a CRP, an improvement in CPET duration may translate into a clinical benefit in these pts. These results highlight the importance of further research and personalization among this potentially higher risk subset of pts.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ribeiro Da Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - E Vilela
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Mosalina Manuel
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Barbosa
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - C Guerreiro
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Ribeiro Queiros
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Tavares
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Dias
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - D Caeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - O Sousa
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Braga
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - A Rodrigues
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Teixeira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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13
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Oliveira L, Duarte F, Barradas MI, Serena C, Fontes A, Almeida C, Machado C, Dourado R, Monteiro A, Santos E, Pelicano N, Pacheco A, Tavares A, Martins D. Early and long term prognostic accuracy of 4 acute pulmonary embolism mortality risk scores. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1893] [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
Acute pulmonary embolism (PE) is a frequent condition associated with significant morbidity and mortality. Multiple scores have been developed and validated to predict 30-day mortality risk, however accurate prognostic assessment remains a challenge in clinical practice.
Purpose
To compare the performance of PESI, simplified PESI, Hestia and Bova scores in predicting in-hospital, 30-day and 1-year mortality risk for acute PE.
Methods
We retrospectively assessed consecutive patients from a single center registry who were hospitalized with acute PE between January 2017 and October 2020. Discriminative power of each score was assessed by receiver operating characteristic curve analysis. Charlson comorbidity index (CCI) was also assessed for comparison.
Results
A total of 131 patients with a mean age of 67.6±15.3 years were included with a mean follow-up of 46.3±17.7 months. Thirty-six patients (27.5%) had a recent hospitalization or major surgery and 26 (19.8%) a medical history of cancer. Besides anticoagulation, 7 patients (5.3%) underwent fibrinolysis. Overall in-hospital mortality was 8.4%, 30-day mortality 12.2% and 1-year mortality 19.8%. All acute PE scores, except Bova score, were significantly higher in those patients who died during hospitalization and on 30-day and 1-year follow-up. CCI was also higher in those patients. Discriminative power for in-hospital mortality was higher for PESI (c-statistic 0.84, 95% CI 0.74–0.93, p=0.002), followed by sPESI (c-statistic 0.77, 95% CI 0.65–0.90, p=0.010) and Hestia (c-statistic 0.77, 95% CI 0.61–0.92, p=0.011). The Bova score showed a poor discriminative power for prediction of in-hospital mortality (c-statistic 0.61, 95% CI 0.43–0.78, p=0.325). For 30-day and 1-year mortality PESI score still maintained the best performance with acceptable discriminative power (c-statistic 0.73, 95% CI 0.61–0.85, p=0.007 for 30-day mortality; c-statistic 0.80, 95% CI 0.71–0.89, p<0.0001 for 1-year mortality). However at longer follow-up CCI had a better performance to predict worse outcomes (c-statistic 0.79, 95% CI 0.65–0.92, p=0.001 for 30-day mortality; c-statistic 0.83, 95% CI 0.74–0.92, p<0.0001 for 1-year mortality).
Conclusions
All scores, except Bova score, showed overall good performance in stratifying mortality for acute PE, however PESI score performed better in this population particularly at shorter follow-up. At longer follow-up, although PESI score maintained an acceptable performance, comorbidities seem to play a bigger role. The different performance of multiple scores highlights the complexity of this condition.
Funding Acknowledgement
Type of funding sources: None. ROC curves for mortality risk scores
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Affiliation(s)
- L Oliveira
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - F Duarte
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - M I Barradas
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Almeida
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A Pacheco
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
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14
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Duarte F, Barradas M, Oliveira L, Serena C, Dourado R, Fontes A, Monteiro A, Machado C, Santos E, Pelicano N, Tavares A, Pacheco M, Martins D. New York Heart Association class change on heart failure patients with implantable devices: does it matters? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0697] [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
Chronic heart failure (CHF) is a pathology with high prevalence and an important cause of morbidity and mortality. Benefits of implantable devices have been demonstrated in selected groups of patients with benefits on symptoms and heart failure hospitalization.
Purpose
To determine the clinical impact of New York Heart Association class change (NYHA) in patients with CHF and Cardiac Implantable Electric Devices (CIEDs).
Methods
We retrospectively enrolled 178 consecutive patients with CHF and CIEDs between November 2003 and January 2021, during a follow-up period of 51±43,9 months. Patients demographic characteristic and NYHA class change impact on occurrence of arrhythmic events, heart failure hospitalization (HFH) or long-term admission in an emergency department were assessed. Patients with NYHA class change were considered responders to therapy.
Results
Out of 178 patients enrolled in this study, sixty-seven (37,6%) had a reduction ≥1 in NYHA functional class and in this group, 61 patients (91,0%) had a cardiac resynchronization therapy (CRT) and 9% had an implantable cardioverter defibrillator. Mean age 68±11,3 years, 44 (65,7%) patients were male, 33 (49,2%) were in NYHA class II, 30 (44,8%) NYHA class III and 4 (6%) NYHA class IV. Mean QRS width 129,9±63,1 ms before CIEDs. Fifty-eight patients (86,6%) had an improvement in one NYHA functional class and 9 patients (13,4%) in two NYHA functional class.
Fourty NYHA responders patients (59,7%) had paroxistic or permanent atrial fibrillation and 31,9% had an epicardial coronary artery disease, that was a negative predictor of NYHA response (p=0,012).
A total of 35 (19,7%) enrolled patients experience non-sustained ventricular tachycardia (NSVT) and 74,3% were non-responders (p=0,019).
There was fifteen and twenty HFH at 2 and 5 years of follow-up, respectively, and we observed that an improvement in NYHA class was associated with a reduction in HFH at 2 years of follow-up (p=0,043; OR 0,029, 95% CI 0,050–1,06) and 5 years of follow-up (p 0,027, OR 0,252; 95% CI 0,069 – 0,915). Emergency department (ED) admission related to HF decompensations was significantly reduced at 2 years of follow-up (p=0,035, OR 0,22, 95% CI 0,048 – 1,0) and at 5 years of follow-up (p=0,001, OR 0,15, 95% CI 0,044 – 0,55).
There was no difference on cardiovascular or all-cause mortality.
Conclusion
CHF patients with CIEDs and improving on NYHA class have less NSVT episodes, HFH and HF decompensations with ED admission, both at 2 and 5 years of follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M.I Barradas
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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15
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Barradas Da Silva M, Duarte F, Oliveira L, Serena C, Fontes A, Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Non-sustained ventricular tachycardia on remote patient monitoring in heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0974] [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
Non-sustained ventricular tachycardia (NSVT) is commonly found in patients with structural heart disease and was historically obtained from registers of external ambulatory monitoring. The advent of remote patient monitoring (RPM) in Cardiac implantable electronic devices (CIEDs) has made it possible to detect asymptomatic NSVT in Heart Failure (HF) patients more frequently, but its impact in real world is uncertain.
Purpose
To determine the clinical impact of NSVT detection in RPM in ischemic and non-ischemic chronic heart failure patients with reduced ejection fraction (HFrEF) and CIEDs.
Methods
We retrospectively enrolled 121 consecutive patients with HFrEF, CIEDs and RPM. Patients were evaluated through routine episodic CIEDs interrogation, routine clinical evaluations and continuous monitoring data obtained from CIEDs and transmitted remotely to the care team and divided into NSVT positive (Group 1) and negative groups (Group 2). Primary endpoint was admissions to the emergency department by HF decompensation and secondary endpoint was the occurrence of arrhythmic events. A sub-analysis of non-ischemic HF was also performed.
Results
NSVT was detected in 78 (72,2%) patients. The mean number of episodes of NSVT was 611,68±3271,25 during the follow-up period or 2,445±16,688 in 24 hours. Mean age was 62,40±13,218 years, 71,9% were males and mean follow-up period was 56,30±39,37 months. Fifty-eight patients (47,9%) had transvenous implantable cardioverter defibrillator (ICD), 48 (39,7%) implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 14 (11,6%) subcutaneous ICD (S-ICD) and 1 (0,8%) CRT pacemaker (CRT-P). Medium left ventricular ejection fraction (LVEF) was 34,70±12,53%, 25 (23,14%) were in NYHA III-IV and 46 (39,0%) were ischemic (29 (37,7%) in Group 1 and 11 (37,9%) in Group 2). NSVT was associated with the occurrence of sustained ventricular tachycardia (VT) (1,88±0,186episodes of VT in group 1 and 0,03±0,186 in group 2, p=0,012), ventricular fibrillation (VF) (1,44±5,325 episodes of VT in group 1 and 0,03±0,186 in group 2, p=0,011) and admissions to the emergency department by HF decompensation at 5 years (r=0,310, p=0,011). A sub-analysis in non-ischemic HF patients also showed correlation between NSVT and VT (r=0,602, p<0,05) and admissions to the emergency department by HF decompensation at 5 years (r=0,382, p=0,014).
Conclusions
On remote patient monitoring with CIEDs, NSVT in HF patients was associated with arrhythmic events and may serve as a predictor for HF decompensations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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Barradas Da Silva M, Duarte F, Oliveira L, Serena C, Fontes A, Monteiro A, Machado C, Dourado R, Santos E, Pelicano N, Pacheco M, Tavares A, Martins D. Prognostic significance of non-sustained ventricular tachycardia on stored electrograms of heart failure patients with cardiovascular implantable electronic devices. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0975] [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] Open
Abstract
Abstract
Background
Non-sustained ventricular tachycardia (NSVT) is commonly found in patients with structural heart disease and was historically obtained from registers of external ambulatory monitoring. The advent of Cardiac implantable electronic devices (CIEDs) has made it possible to detect asymptomatic NSVT in Heart Failure (HF) patients more frequently, but its true impact in real world is uncertain, and often does not lead to a change in clinical intervention.
Purpose
To determine the prognostic significance of NSVT detection on stored electrograms of CIEDs in HF patients with systolic left ventricle dysfunction.
Methods
We retrospectively enrolled 132 consecutive HF patients (mean age 67,5±11,1 years, males 72,0%) with systolic left ventricle dysfunction and CIEDs (biventricular pacemakers with or without cardiac defibrillators). Patients were evaluated through CIEDs interrogation and clinical evaluations and divided into NSVT positive (Group 1) and negative groups (Group 2). Mean follow-up period was 62,8±7,1 months.
Results
NSVT was detected in 51 (38,6%) patients. 70 (53,0%) had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 37 (28,0%) transvenous implantable cardioverter defibrillator (ICD), 13 (9,8%) CRT pacemaker (CRT-P) and 12 (9,1%) subcutaneous ICD (S-ICD). Medium left ventricular ejection fraction (LVEF) was 31,1±7,9%, 20,6% were in NYHA III-IV and 47,0% were ischemic (49% Group 1 and 45,7% Group 2, p=0,708). Dyslipidemia was more prevalent in Group 2 (p=0,042). In total 11 (8,3%) patients died, 2 (1,5%) from sudden cardiac death and 5 (3,8%) from cardiovascular death. NSVT was associated with CIEDs treatments (hazard ratio [HR]2,52; 95% confidence interval [CI]1,2–5,1; p=0,001), ventricular fibrillation (VF) (HR: 3,71, 95% CI: 1,19–11,58; p=0,018), sustained ventricular tachycardia (VT) (HR: 9,06, 95% CI: 2,82–29,12; p<0,05) and composite outcome of VT, VF, HF re-admissions and related admissions to emergency department (ED) and death by all causes (HR: 2,52; 95% CI: 1,20–5,10; p=0,011). NSVT at 1 year was associated with HF readmissions at 1 year (p=0,004).
Conclusions
On extended monitoring possible with CIEDs, NSVT in HF patients was associated with a worse prognosis and may serve as a predictor of significant arrhythmic events, HF hospitalizations and mortality. These findings enhances the importance of remote monitoring and optimization of therapeutic modalities in these patients along with a close supervision.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - F Duarte
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Monteiro
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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Tavares A, Mesquita A, Magalhães D, Salgado M, Braga F. 193P Adjuvant endocrine therapy in patients with breast cancer: Relationship between side effects, quality of life and treatment adherence. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.474] [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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18
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Magalhães D, Vilaça M, Cipriano É, Tavares A, Silva D, Cirnes L, Magalhães H, Estevinho F. 9P Lung cancer mutational state assessed by NGS in a Portuguese center. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01851-7] [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]
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19
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Garcia S, Tavares A, Peixoto P, Costa F, Saraiva D, Varzim P, Monteiro A, Fontes M, Pinto G. PO-1073: Dosimetric Predictors of Survival in Esophageal Cancers Treated with Preoperative Chemoradiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01090-2] [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: 10/22/2022]
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20
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Bing R, Andrews J, Williams M, Clark T, Semple S, Van Beek E, Lucatelli C, Sellers S, Leipsic J, Tavares A, Stephens A, Koglin N, Dweck M, Newby D. Thrombus formation on bioprosthetic aortic valves. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0290] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
18F-GP1 is a novel radiotracer with a high affinity for the platelet glycoprotein IIb/IIIa receptor. Subclinical bioprosthetic valve thrombus has been postulated as a trigger for accelerated valve degeneration.
Purpose
To determine the feasibility of 18F-GP1 positron-emission tomography-computed tomography (PET-CT) for the detection of subclinical bioprosthetic aortic valve thrombus.
Methods
(i) Explanted degenerated aortic valve prostheses underwent histology and imaging. (ii) In a prospective observational study, patients with bioprosthetic aortic valve replacement (AVR) underwent echocardiography and 18F-GP1 PET-CT. Valves were assessed for hypoattenuating leaflet thickening (HALT), hypo-attenuation affection leaflet motion (HAM) and GP1 uptake.
Results
(i) GP1 correlated with thrombus on explanted valves (Figure). (ii) The first 6 patients (Table) were asymptomatic and had normally functioning surgical bioprostheses on echocardiography. At a median of 166 (range 122–189) days post-AVR, no patients had HALT or HAM on CT. There was avid focal GP1 uptake on the leaflets of all 6 patients which appeared most prominent along the leaflet edges (Figure). Only one patient had focal uptake in the valve frame, remote from the leaflets. In a separate cohort undergoing 18F-GP1 PET-CT for other conditions, there was no uptake on normal, native aortic valves (n=8).
Conclusion
For the first time, we demonstrate that 18F-GP1 PET-CT is a highly sensitive method of assessing platelet activation on bioprosthetic aortic valves. Despite the absence of CT evidence, early thrombus appeared to be a universal finding on recently implanted valve prostheses. The biological and clinical implications of subclinical bioprosthetic aortic valve thrombus have yet to be established.
GP1 uptake in AVR
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- R Bing
- University of Edinburgh, Edinburgh, United Kingdom
| | - J Andrews
- University of Edinburgh, Edinburgh, United Kingdom
| | - M Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Clark
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Semple
- University of Edinburgh, Edinburgh, United Kingdom
| | - E Van Beek
- University of Edinburgh, Edinburgh, United Kingdom
| | - C Lucatelli
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Sellers
- University of British Columbia, Vancouver, Canada
| | - J Leipsic
- University of British Columbia, Vancouver, Canada
| | - A Tavares
- University of Edinburgh, Edinburgh, United Kingdom
| | | | - N Koglin
- Life Molecular Imaging, Berlin, Germany
| | - M Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Newby
- University of Edinburgh, Edinburgh, United Kingdom
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21
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Tavares A, Magalhães D, Soares A, Laranjinha J, Mesquita A, Duarte F, Abreu R, Magalhães H, Braga F, Sottomayor C, Salgado M. 1772P Impact assessment of SARS-CoV-2 testing on cancer patients undergoing immunosuppressive treatment. Ann Oncol 2020. [PMCID: PMC7506417 DOI: 10.1016/j.annonc.2020.08.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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22
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Vilaca M, Silva D, Magalhães D, Cipriano E, Tavares A, Estevinho F, Magalhães H. P-108 Perioperative chemotherapy in locally advanced, resectable gastric cancer: A single-center experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.190] [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: 11/17/2022] Open
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23
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Vilaca M, Silva D, Magalhães D, Cipriano E, Tavares A, Peixoto R, Salgado M, Mesquita A, Sottomayor C. P-106 Liver metastasis in colorectal cancer: Management and survival outcomes of liver metastasectomy in a single-center analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.188] [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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24
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Santos R, Tavares A. Ultrasound analyses of hamstrings muscle morphology changes whit sport. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa040.063] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction Physical activities and sports can change muscle morphology. Changes caused by regular physical exercise can be assessed by ultrasound parameters such as the pennation angle, cross-sectional area, echo-intensity and muscle thickness.
Objectives This study aims to characterise and evaluate the morphological changes of the hamstring muscles through ultrasound parameters such as the pennation angle, fascicle length, cross-sectional area, echo-intensity and muscle thickness, and verify the existence of morphological changes between the dominant and non-dominant limb.
Methodology Twenty-two young female divided in two groups (control group=11; athletes group=11) were submitted to an ultrasound examination at 50% of the posterior region of the thigh, for the semimembranosus and long portion of the femoral biceps muscles in the longitudinal and in a panoramic view.
Results 22 athletes with a mean age of 22.25 years were evaluated. There were significant differences between the two groups in muscle morphology. The athletes group showed a higher value for muscle thickness, cross-sectional area, pennation angle and fascicle length and a lower value for muscle echo-intensity. This group also showed higher values for these parameters when dominant limb is compared with non-dominant.
Conclusion Physical exercise causes changes in muscle morphology and ultrasound is a good method for the musculoskeletal assessment of athlete’s performance, since it is an imaging modality that allows to carry out comparative bilateral studies for athletes performance follow up and for preventive strategies against the sedentarism.
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Affiliation(s)
- R Santos
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Portugal
| | - A Tavares
- Instituto Politécnico de Coimbra, ESTeSC – Coimbra Health School, Portugal
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25
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Tavares A, Wen X, Maciel J, Carneiro F, Dinis-Ribeiro M. Occult Tumour Cells in Lymph Nodes from Gastric Cancer Patients: Should Isolated Tumour Cells Also Be Considered? Ann Surg Oncol 2020; 27:4204-4215. [PMID: 32367500 DOI: 10.1245/s10434-020-08524-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Regional lymph node metastasis is an important prognostic factor for patients with gastric cancer. Occult tumour cells (OTCs), including either micrometastases (MMs) or isolated tumour cells (ITCs), may be a key factor in the development of cancer recurrence in pN0 patients. AIMS We aimed to determine the frequency and prognostic significance for disease recurrence of OTCs. MATERIALS AND METHODS This retrospective cohort study included all consecutive patients with pN0 gastric adenocarcinoma between January 2000 and December 2011 (n = 73). Immunohistochemistry using the pan-cytokeratin antibody AE1/AE3 was used to detect OTCs in 1257 isolated lymph nodes. RESULTS OTCs were identified in 30 patients (41%), including 20 cases with MMs (27%) and 10 cases with ITCs (14%). Disease recurrence and cancer-related death were observed in 24 (33%) and 20 patients (27%), respectively, and both were significantly associated with the detection of OTCs. A significant difference was also observed for the mean survival time between patients with OTCs and those without OTCs [100 vs 158 months (p = 0.015)]. The presence of OTCs was statistically significantly associated with the Lauren classification, tumour size and lymphatic permeation. Multivariate analyses revealed that only age, T stage and the presence of ITCs in lymph nodes were independent factors for recurrence. The presence of ITCs increased the risk for recurrence by 11.1-fold. CONCLUSIONS In a significant proportion of patients diagnosed as stage pN0, OTCs may be identified in lymph nodes if carefully searched for, which can negatively affect their prognosis. The presence of ITCs was found to be an independent factor for recurrence and after proper validation should be considered during lymph node assessment for prognosis definition.
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Affiliation(s)
- A Tavares
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - X Wen
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal.,Institute for Research Innovation in Health (i3S), University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - J Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal.,Faculty of Health Sciences, Universidade Fernando Pessoa, Porto, Portugal
| | - F Carneiro
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal.,Institute for Research Innovation in Health (i3S), University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal.,Department of Pathology, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - M Dinis-Ribeiro
- Department of Gastroenterology, Oncology Portuguese Institute of Porto, Porto, Portugal.,MEDCIDS/CINTESIS Faculty of Medicine, University of Porto, Porto, Portugal
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Fonseca TG, Carriço T, Fernandes E, Abessa DMS, Tavares A, Bebianno MJ. Impacts of in vivo and in vitro exposures to tamoxifen: Comparative effects on human cells and marine organisms. Environ Int 2019; 129:256-272. [PMID: 31146160 DOI: 10.1016/j.envint.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/22/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Tamoxifen (TAM) is a first generation-SERM administered for hormone receptor-positive (HER+) breast cancer in both pre- and post-menopausal patients and may undergo metabolic activation in organisms that share similar receptors and thus face comparable mechanisms of response. The present study aimed to assess whether environmental trace concentrations of TAM are bioavailable to the filter feeder M. galloprovincialis (100 ng L-1) and to the deposit feeder N. diversicolor (0.5, 10, 25 and 100 ng L-1) after 14 days of exposure. Behavioural impairment (burrowing kinetic), neurotoxicity (AChE activity), endocrine disruption by alkali-labile phosphate (ALP) content, oxidative stress (SOD, CAT, GPXs activities), biotransformation (GST activity), oxidative damage (LPO) and genotoxicity (DNA damage) were assessed. Moreover, this study also pertained to compare TAM cytotoxicity effects to mussels and targeted human (i.e. immortalized retinal pigment epithelium - RPE; and human transformed endothelial cells - HeLa) cell lines, in a range of concentrations from 0.5 ng L-1 to 50 μg L-1. In polychaetes N. diversicolor, TAM exerted remarkable oxidative stress and damage at the lowest concentration (0.5 ng L-1), whereas significant genotoxicity was reported at the highest exposure level (100 ng L-1). In mussels M. galloprovincialis, 100 ng L-1 TAM caused endocrine disruption in males, neurotoxicity, and an induction in GST activity and LPO byproducts in gills, corroborating in genotoxicity over the exposure days. Although cytotoxicity assays conducted with mussel haemocytes following in vivo exposure was not effective, in vitro exposure showed to be a feasible alternative, with comparable sensitivity to human cell line (HeLa).
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Affiliation(s)
- T G Fonseca
- CIMA, Centro de Investigação Marinha e Ambiental, Universidade do Algarve, Campus Gambelas, 8005-135 Faro, Portugal; NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia, Aquática, Universidade Estadual Paulista (UNESP), Campus do Litoral Paulista, São Vicente, SP 11330-900, Brazil
| | - T Carriço
- CIMA, Centro de Investigação Marinha e Ambiental, Universidade do Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - E Fernandes
- CIMA, Centro de Investigação Marinha e Ambiental, Universidade do Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - D M S Abessa
- NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia, Aquática, Universidade Estadual Paulista (UNESP), Campus do Litoral Paulista, São Vicente, SP 11330-900, Brazil
| | - A Tavares
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - M J Bebianno
- CIMA, Centro de Investigação Marinha e Ambiental, Universidade do Algarve, Campus Gambelas, 8005-135 Faro, Portugal.
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Cipriano À, Soares A, Tavares A, Mesquita A, Sottomayor C. Locally advanced unresectable and metastatic pancreatic cancer – predictors of survival. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.255] [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: 11/13/2022] Open
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28
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Cipriano À, Tavares A, Soares A, Mesquita A, Salgado M, Sottomayor C. The importance of laterality in colorectal cancer predicting response to therapeutics – retrospective study evaluating differences between right and left colon in stage IV colon cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.245] [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: 11/13/2022] Open
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29
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Dourado R, Goncalves G, Tavares A, Fontes A, Pacheco M, Melo F, Machado C, Santos E, Ferreira S, Pelicano N, Almeida C, Serena C, Oliveira L, Martins D. P270Cardiac computed tomography after invasive coronary angiography without revascularization. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez148.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Dourado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - G Goncalves
- Hospital Divino Espirito Santo, USISM, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Fontes
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - M Pacheco
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - F Melo
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - S Ferreira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Almeida
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Ponta Delgada, Portugal
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Cipriano É, Tavares A, Soares A, Estevinho F, Sottomayor C. Non-small cell lung cancer in the elderly: A retrospective study comparing first-line treatment with single-agent vs combination chemotherapy vs tyrosine kinase inhibitor. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz065.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Raposo V, Ferreira P, Tavares A. Differences in Portuguese primary care quality: an analysis using geographical and patient satisfaction data. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Raposo
- Centre of Health Studies and Research, University of Coimbra, Portugal
- Centre for Business and Economics Research, University of Coimbra, Portugal
- Faculty of Economics, University of Coimbra, Portugal
| | - P Ferreira
- Centre of Health Studies and Research, University of Coimbra, Portugal
- Faculty of Economics, University of Coimbra, Portugal
| | - A Tavares
- Centre of Health Studies and Research, University of Coimbra, Portugal
- Faculty of Economics, University of Coimbra, Portugal
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Teixeira-Lopes F, Alfarroba S, Dinis A, Gomes M, Tavares A. Ocular tuberculosis – A closer look to an increasing reality. Pulmonology 2018; 24:289-293. [DOI: 10.1016/j.pulmoe.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/24/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022] Open
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Xavier Fontes A, Oliveira L, Serena C, Moura-Ferreira S, Almeida C, Machado C, Dourado R, Santos E, Pelicano N, Pacheco AM, Tavares A, Melo F, Martins D. P6526Impact of atrial fibrillation on the risk of death in patients with mid-range and preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6526] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Xavier Fontes
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - L Oliveira
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Serena
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - S Moura-Ferreira
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Almeida
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - C Machado
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - R Dourado
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - E Santos
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - N Pelicano
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A M Pacheco
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - F Melo
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - D Martins
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
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Xavier Fontes A, Montenegro Sa F, Passos Silva M, Caeiro D, Dias A, Santos L, Rodrigues JA, Tavares A, Braga P. P4659Evolution in the use of intra-aortic balloon pump in patients with cardiogenic shock. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4659] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Xavier Fontes
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | | | - M Passos Silva
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - D Caeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - A Dias
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - L Santos
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - J A Rodrigues
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - A Tavares
- Hospital Divino Espirito Santo, Cardiology, Ponta Delgada, Portugal
| | - P Braga
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
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Fontes A, Serena C, Santos E, Ferin R, Oliveira L, Almeida C, Machado C, Dourado R, Pelicano N, Tavares A, Pavão M, Martins D. Clinical implications of cigarette smoking in stable coronary artery disease: Angiographic and laboratory findings. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.452] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fontes, Serena C, Santos E, Ferin R, Oliveira L, Almeida C, Machado C, Dourado R, Pelicano N, Tavares A, Pavâo M, Martins D. Impact of obesity in patients with coronary artery disease. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.508] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Peixoto MF, Cesaretti M, Hood SD, Tavares A. Effects of SSRI medication on heart rate and blood pressure in individuals with hypertension and depression. Clin Exp Hypertens 2018; 41:428-433. [PMID: 30047786 DOI: 10.1080/10641963.2018.1501058] [Citation(s) in RCA: 6] [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] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To test the role of escitalopram on blood pressure and heart rate of individuals with hypertension and depression. METHODS A total of 30 individuals participated in this study who were being treated for hypertension and were diagnosed with major depression. Escitalopram (10-20 mg) was administered to 15 individuals, while the other 15 received placebo. These individuals were followed for 8 weeks with regular monitoring of blood pressure and heart rate. Scores on the Hamilton Depression Rating Scale were evaluated within the first, second, fourth, and eighth weeks of the study onset. RESULTS Comparing with placebo, heart rate was lower in the escitalopram group (66.79 ± 9.85 vs. 74.10 ± 9.52 bpm, p = 0.044). There was not a significant decrease of systolic blood pressure (140.80 ± 16.48 vs 139.61 ± 18.92 mmHg, p = 0.85) and diastolic blood pressure (80.55 ± 12.64 vs 80.18 ± 16.36 mmHg, p = 0.94). CONCLUSION Escitalopram decreases HR, but not BP, in individuals with hypertension and depression. Abbreviation: SH: systemic hypertension; BP: blood pressure; DSM: Diagnostic and Statistical Manual of Mental Disorders; SRQ 20: Self-Report Questionnaire; SCID: Structured Clinical Interview for DSM-IV; HR: heart rate; SNS: Sympathetic nervous system; HPA: hypothalamus-pituitary-adrenal axis; RAA: renin, angiotensin, aldosterone system; NE: norepinephrine; CSF: cerebrospinal fluid; HAM-D: Hamilton Depression Rating Scale; CRF: corticotropin releasing factor; ACTH: adrenocorticotropic hormone; BMI: Body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; t: time.
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Affiliation(s)
- M F Peixoto
- a Internal Medicine Department, Division of Nephrology , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Mlr Cesaretti
- a Internal Medicine Department, Division of Nephrology , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - S D Hood
- b Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences , The University of Western Australia , Perth , Australia
| | - A Tavares
- a Internal Medicine Department, Division of Nephrology , Federal University of Sao Paulo , Sao Paulo , Brazil
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Tavares A, Garcia A, Abecasis A, Viveiros M, Dias S. 4.10-P12Perspectives of health care providers in Portugal on the provision of care to migrant patients with TB or HIV-TB co-infection. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tavares
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - A Garcia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
- Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), Portugal
| | - A Abecasis
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - M Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
| | - S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Portugal
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Alves M, Tavares A. Cancer Survivor – What Comes Next? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionThe number of long term cancer survivors (more than 5 years after diagnosis) are nowadays increasing because of advances in cancer screening, early detection, treatment strategies and management of acute treatment toxicities.ObjectivesWe aim to highlight the long-term psychological responses or late effect of cancer diagnosis and treatment.MethodsNon systematic literature review through the Medline and clinical key databases, with time constraints.ResultsThere are physical and functional difficulties that may not be solved with the conclusion of treatment or can become problematic in survivors of cancer.Long-term refers to psychological or emotional responses that emerge after cancer diagnosis and treatment and persist for at least 5 years. Late effects of cancer refer to psychological or emotional responses that emerge after treatment completion. Risk factors to its development depends on the diagnosis, type of treatment, age at treatment, time since treatment, genetic vulnerability, psychological, social and environmental factors.Specific deficits are more prevalent in survivors than in healthy adults of the same age. Fatigue, sexual dysfunction, cognitive impairment and musculoskeletal symptoms are common. Functional limitations that induce restricted physical and social activities may happen in survivors. Physical function and late complications can be influenced by lifestyle, socio-economic and biologic factors.ConclusionsCancer survivors face short-term and long-term challenges to physical and mental health and they need to be addressed in the active treatment and throughout the continuum of survivorship care. Screening for mental health morbidity should be better integrated into active cancer treatment and survivorship and it should be provided mental health later interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Thompson A, Dickinson R, Murphy F, Thomson JP, Marriott H, Tavares A, Willson J, Williams L, Lewis A, Mirchandani A, Dos Santos Coelho P, Doherty C, Ryan E, Watts E, Morton NM, Forbes S, Stimson RH, Hameed AG, Arnold N, Preston J, Lawrie A, Finisguerra V, Mazzone M, Sadiku P, Goveia J, Taverna F, Carmeliet P, Foster S, Chilvers E, Cowburn A, Dockrell D, Johnson R, Meehan RR, Whyte M, Walmsley S. Hypoxia determines survival outcomes of bacterial infection through HIF-1alpha dependent re-programming of leukocyte metabolism. Sci Immunol 2017; 2:eaal2861. [PMID: 28386604 PMCID: PMC5380213 DOI: 10.1126/sciimmunol.aal2861] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hypoxia and bacterial infection frequently co-exist, in both acute and chronic clinical settings, and typically result in adverse clinical outcomes. To ameliorate this morbidity, we investigated the interaction between hypoxia and the host response. In the context of acute hypoxia, both S. aureus and S. pneumoniae infections rapidly induced progressive neutrophil mediated morbidity and mortality, with associated hypothermia and cardiovascular compromise. Preconditioning animals through longer exposures to hypoxia, prior to infection, prevented these pathophysiological responses and profoundly dampened the transcriptome of circulating leukocytes. Specifically, perturbation of HIF pathway and glycolysis genes by hypoxic preconditioning was associated with reduced leukocyte glucose utilisation, resulting in systemic rescue from a global negative energy state and myocardial protection. Thus we demonstrate that hypoxia preconditions the innate immune response and determines survival outcomes following bacterial infection through suppression of HIF-1α and neutrophil metabolism. The therapeutic implications of this work are that in the context of systemic or tissue hypoxia therapies that target the host response could improve infection associated morbidity and mortality.
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Affiliation(s)
- A.A.R. Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - R.S. Dickinson
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - F. Murphy
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. P. Thomson
- MRC Human Genetics Unit at the Institute of Genetics and Molecular Medicine at the University of Edinburgh, Edinburgh, UK
| | - H.M. Marriott
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Tavares
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. Willson
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - L. Williams
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Lewis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Mirchandani
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - P. Dos Santos Coelho
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - C. Doherty
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - E. Ryan
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - E. Watts
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - N. M. Morton
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S. Forbes
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R. H. Stimson
- University of Edinburgh/BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A. G. Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - N. Arnold
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - J.A. Preston
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A. Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - V. Finisguerra
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, Department of Oncology, KU Leuven, Leuven, B3000, Belgium
| | - M. Mazzone
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory of Molecular Oncology and Angiogenesis, Vesalius Research Center, Department of Oncology, KU Leuven, Leuven, B3000, Belgium
| | - P. Sadiku
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J. Goveia
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - F. Taverna
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - P. Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, VIB, Leuven, B3000, Belgium
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Centre, K.U. Leuven, B3000, Belgium
| | - S.J. Foster
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - E.R. Chilvers
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - A.S. Cowburn
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - D.H. Dockrell
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - R.S. Johnson
- Department of Physiology, Development and Neuroscience, University of Cambridge, UK
| | - R. R. Meehan
- MRC Human Genetics Unit at the Institute of Genetics and Molecular Medicine at the University of Edinburgh, Edinburgh, UK
| | - M.K.B. Whyte
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S.R. Walmsley
- MRC/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Dickinson RS, Thompson AAR, Thomson JP, Murphy F, Marriott HM, Tavares A, Willson J, Williams L, Lewis A, Forbes S, Stimson RH, Hameed AG, Preston JA, Lawrie A, Finisguerra V, Mazzone M, Foster SJ, Chilvers ER, Cowburn AS, Dockrell DH, Johnson RS, Meehan RR, Whyte MKB, Walmsley SR. S104 Hypoxia preconditions the innate immune response to acute bacterial pulmonary infections. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.110] [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: 11/04/2022]
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Alvito P, Assunção R, Borges T, Leal S, Loureiro S, Louro H, Martins C, Nunes B, Silva M, Vasco E, Tavares A, Calhau M. Risk assessment of multiple mycotoxins in infant food consumed by Portuguese children – The contribute of the MYCOMIX project. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gomes R, Luís F, Tavares A, Sousa N, Correia S, Reis M. Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study. Rev Port Pneumol (2006) 2015; 21:126-31. [PMID: 25926248 DOI: 10.1016/j.rppnen.2014.07.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 07/14/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the respiratory function and lung hyperinflation in asymptomatic smokers without previous pulmonary pathology and with normal chest radiography. To identify tobacco-related diseases and to correlate tobacco consumption, duration of exposure to tobacco smoke and urinary cotinine with the existence of tobacco-related disease. MATERIAL AND METHODS Case-controlled study with pairing by sex, age, and body mass index. CASE DEFINITION smokers who presented to the first appointment of smoking cessation at the Hospital Sousa Martins (HSM) without respiratory symptoms and with normal chest radiography. Definition of control: users without current and/or past tobacco exposition and with plethysmography and chest radiography at HSM within normal parameters. RESULTS Reductions in FEV1/FVC, FEF 75%, FEF 25-75% and the cardiothoracic index were detected in smokers and showed a moderated inverse correlation of TLC (with statistical meaning) compared with the control group. Approximately 31.2% of the smokers showed extrapulmonary disease related to tobacco, and 9.38% of the smokers exhibited subclinical chronic obstructive pulmonary disease (COPD). Smokers with tobacco-related diseases presented a mean age and RV/TLC ratio superior to smokers without pathology. DISCUSSION The reduction of the mean values of FEV1/FVC, FEF 75%, FEF 25-75% and the cardiothoracic index seems to indicate precocious pulmonary dysfunction. This work aims to reveal the importance of detecting premonitory anomalies of pulmonary disease during the subclinical phase in patients at risk. Smoking must be considered a factor of multisystemic repercussion; thus, intervention opportunities in this particular group must not be wasted. This preliminary study identifies potentially promising variables with the aim of testing the hypothesis that there can be premonitory alterations in COPD, according to its evolution versus reversibility after smoking cessation. This work will be concluded in a future study.
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Affiliation(s)
- R Gomes
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal.
| | - F Luís
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - A Tavares
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - N Sousa
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - S Correia
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - M Reis
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal
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Gomes R, Luís F, Tavares A, Sousa N, Correia S, Reis M. WITHDRAWN: Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study. Rev Port Pneumol 2014:S0873-2159(14)00126-3. [PMID: 25445254 DOI: 10.1016/j.rppneu.2014.07.005] [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: 03/15/2014] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.07.007. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- R Gomes
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal.
| | - F Luís
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - A Tavares
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - N Sousa
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - S Correia
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal; Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - M Reis
- Pulmonology Service, Sousa Martins Hospital, Local Health Unit, Guarda, Portugal
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Lima L, Severino PF, Silva M, Miranda A, Tavares A, Pereira S, Fernandes E, Cruz R, Amaro T, Reis CA, Dall'Olio F, Amado F, Videira PA, Santos L, Ferreira JA. Response of high-risk of recurrence/progression bladder tumours expressing sialyl-Tn and sialyl-6-T to BCG immunotherapy. Br J Cancer 2013; 109:2106-14. [PMID: 24064971 PMCID: PMC3798967 DOI: 10.1038/bjc.2013.571] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 12/29/2022] Open
Abstract
Background: High risk of recurrence/progression bladder tumours is treated with Bacillus Calmette-Guérin (BCG) immunotherapy after complete resection of the tumour. Approximately 75% of these tumours express the uncommon carbohydrate antigen sialyl-Tn (Tn), a surrogate biomarker of tumour aggressiveness. Such changes in the glycosylation of cell-surface proteins influence tumour microenvironment and immune responses that may modulate treatment outcome and the course of disease. The aim of this work is to determine the efficiency of BCG immunotherapy against tumours expressing sTn and sTn-related antigen sialyl-6-T (s6T). Methods: In a retrospective design, 94 tumours from patients treated with BCG were screened for sTn and s6T expression. In vitro studies were conducted to determine the interaction of BCG with high-grade bladder cancer cell line overexpressing sTn. Results: From the 94 cases evaluated, 36 had recurrence after BCG treatment (38.3%). Treatment outcome was influenced by age over 65 years (HR=2.668; (1.344–5.254); P=0.005), maintenance schedule (HR=0.480; (0.246–0.936); P=0.031) and multifocallity (HR=2.065; (1.033–4.126); P=0.040). sTn or s6T expression was associated with BCG response (P=0.024; P<0.0001) and with increased recurrence-free survival (P=0.001). Multivariate analyses showed that sTn and/or s6T were independent predictive markers of recurrence after BCG immunotherapy (HR=0.296; (0.148–0.594); P=0.001). In vitro studies demonstrated higher adhesion and internalisation of the bacillus to cells expressing sTn, promoting cell death. Conclusion: s6T is described for the first time in bladder tumours. Our data strongly suggest that BCG immunotherapy is efficient against sTn- and s6T-positive tumours. Furthermore, sTn and s6T expression are independent predictive markers of BCG treatment response and may be useful in the identification of patients who could benefit more from this immunotherapy.
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Affiliation(s)
- L Lima
- 1] Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal [2] Institute of Biomedical Sciences of Abel Salazar, University of Porto, Porto, Portugal [3] Nucleo de Investigação em Farmácia-Centro de Investigação em Saúde e Ambiente (CISA), Health School of the Polytechnic Institute of Porto, Porto, Portugal [4] LPCC, Research Department-Portuguese League Against Cancer (NRNorte), Porto, Portugal
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Hajjar L, Galas F, Goto D, Tavares A, Santos M, Freitas A, Oliveira T, Tonini P, Cavichio L, Bazan M, Almeida J, Cavalcante M, Fukushima J, Vieira S, Osawa E. Outcome of intensive care treatment for lung cancer patients. Crit Care 2013. [PMCID: PMC3643146 DOI: 10.1186/cc12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hajjar L, Cavalcante MF, Galas F, Fukushima JT, Sundin MR, Bergamin F, Park C, Palomba H, Goto DM, Tavares A, Santos M, Freitas A, Tonini P, Cavichio L, Almeida JP, Bazan M. Outcome of older patients with cancer requiring ICU admission. Crit Care 2013. [PMCID: PMC3642861 DOI: 10.1186/cc12408] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- L Hajjar
- Heart Institute, São Paulo, Brazil
| | | | - F Galas
- Cancer Institute of University of São Paulo, Brazil
| | - JT Fukushima
- Cancer Institute of University of São Paulo, Brazil
| | - MR Sundin
- Cancer Institute of University of São Paulo, Brazil
| | - F Bergamin
- Cancer Institute of University of São Paulo, Brazil
| | - C Park
- Cancer Institute of University of São Paulo, Brazil
| | - H Palomba
- Cancer Institute of University of São Paulo, Brazil
| | - DM Goto
- Cancer Institute of University of São Paulo, Brazil
| | - A Tavares
- Cancer Institute of University of São Paulo, Brazil
| | - M Santos
- Cancer Institute of University of São Paulo, Brazil
| | - A Freitas
- Cancer Institute of University of São Paulo, Brazil
| | - P Tonini
- Cancer Institute of University of São Paulo, Brazil
| | - L Cavichio
- Cancer Institute of University of São Paulo, Brazil
| | - JP Almeida
- Cancer Institute of University of São Paulo, Brazil
| | - M Bazan
- Cancer Institute of University of São Paulo, Brazil
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Tavares A, Dewar D, Sutherland A, Pimlott S. (R,S)-2-Iodo-reboxetine: Development as a novel SPECT radiotracer for imaging the noradrenaline transporter in brain. Neuroimage 2010. [DOI: 10.1016/j.neuroimage.2010.04.094] [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: 11/24/2022] Open
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Tavares A, Caldas JG, Castro CC, Puglia P, Frudit ME, Barbosa LA. Changes in perfusion-weighted magnetic resonance imaging after carotid angioplasty with stent. Interv Neuroradiol 2010; 16:161-9. [PMID: 20642890 DOI: 10.1177/159101991001600207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/28/2010] [Indexed: 11/16/2022] Open
Abstract
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
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Affiliation(s)
- A Tavares
- Universidade de São Paulo, São Paulo, Brazil.
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Costa S, Silva S, Costa C, Coelho P, Pina C, Gaspar J, Tavares A, Teixeira J. Formaldehyde occupational exposure: Genotoxic evaluation. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.283] [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: 12/01/2022]
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