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Sousa C, Carton I, Jaillard S, Cospain A, Lavillaureix A, Nyangoh Timoh K, Juricic M, Lavoué V, Dion L. Mayer-Rokitansky-Küster-Hauser syndrome patients' interest, expectations and demands concerning uterus transplantation. J Gynecol Obstet Hum Reprod 2023; 52:102674. [PMID: 37805077 DOI: 10.1016/j.jogoh.2023.102674] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To better understand patients' conditions and expectations before starting a uterus transplantation (UTx) program for women suffering from Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome). METHOD A web-based survey was conducted among MRKH patients via the French national association network from March to August 2020. The questionnaire comprised twenty-eight questions about their desire for parenthood, their condition's characteristics and previous reconstructive procedures, opinions and knowledge about UTx. RESULTS Among the 148 participants, 88 % reported a desire for parenthood, and 61 % opted for UTx as their first choice to reach this aim. The possibility of bearing a child and having the same genetic heritage were the main motivations. Once informed about the usual course of an UTx protocol, only 13 % of the participants changed their mind and 3 out of 4 of them opted for UT. CONCLUSION Uterus transplantation seems to be the first option to reach motherhood in patients suffering from MRKH syndrome. The development of UTx programs could meet the demands of this already well-informed population.
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Affiliation(s)
- C Sousa
- Service de Gynécologie, Centre hospitalo-Universitaire de Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France
| | - I Carton
- Service de Gynécologie, Centre hospitalo-Universitaire de Rennes, Rennes, France
| | - S Jaillard
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France; Service de Cytogénétique et Biologie Cellulaire, Rennes F-35033, France
| | - A Cospain
- Service de Génétique Clinique, CHU Rennes, CLAD Ouest, Rennes, France; ERN ITHACA, Hôpital Sud Rennes France, Université de Rennes, CNRS, IGDR, UMR 6290, Rennes F-35000, France
| | - A Lavillaureix
- Service de Génétique Clinique, CHU Rennes, CLAD Ouest, Rennes, France; ERN ITHACA, Hôpital Sud Rennes France, Université de Rennes, CNRS, IGDR, UMR 6290, Rennes F-35000, France
| | - K Nyangoh Timoh
- Service de Gynécologie, Centre hospitalo-Universitaire de Rennes, Rennes, France
| | - M Juricic
- Service de chirurgie pédiatrique, Centre hospitalo-Universitaire de Rennes, Rennes, France
| | - V Lavoué
- Service de Gynécologie, Centre hospitalo-Universitaire de Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France.
| | - L Dion
- Service de Gynécologie, Centre hospitalo-Universitaire de Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France
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Sousa C, Sánchez-Mansilla A, Broer R, Straatsma TP, de Graaf C. A Nonorthogonal Configuration Interaction Approach to Singlet Fission in Perylenediimide Compounds. J Phys Chem A 2023; 127:9944-9958. [PMID: 37964533 PMCID: PMC10694806 DOI: 10.1021/acs.jpca.3c04975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
Perylenediimide molecules constitute a family of chromophores that undergo singlet fission, a process in which an excited singlet state converts into lower energy triplets on two neighboring molecules, potentially increasing the efficiency of organic solar cells. Here, the nonorthogonal configuration interaction method is applied to study the effect of the different crystal packing of various perylenediimide derivatives on the relative energies of the singlet and triplet states, the intermolecular electronic couplings, and the relative rates for singlet fission. The analysis of the wave functions and electronic couplings reveals that charge transfer states play an important role in the singlet fission mechanism. Dimer conformations where the PDI molecules are at large displacements along the long axis and short on the short axis are posed as the most favorable for singlet fission. The role of the substituent at the imide group has been inspected concluding that, although it has no effect in the energies, for some conformations it significantly influences the electronic couplings, and therefore, replacing this substituent with hydrogen may introduce artifacts in the computational modeling of the PDI molecules.
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Affiliation(s)
- C. Sousa
- Departament
de Ciència de Materials i Química Física and
Institut de Química Teòrica i Computacional, Universitat de Barcelona, 08028 Barcelona, Spain
| | - A. Sánchez-Mansilla
- Departament
de Química Física i Inorgànica, Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - R. Broer
- Zernike
Institute of Advanced Materials, University
of Groningen, 9747 AG Groningen, The Netherlands
| | - T. P. Straatsma
- National
Center for Computational Sciences, Oak Ridge
National Laboratory, Oak Ridge, Tennessee 37831-6373, United States
- Department
of Chemistry and Biochemistry, University
of Alabama, Tuscaloosa, Alabama 35487-0336, United States
| | - C. de Graaf
- Departament
de Química Física i Inorgànica, Universitat Rovira i Virgili, 43007 Tarragona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
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Ferreira AF, Azevedo MJ, Saraiva FA, Trindade F, Barros A, Leite S, Proença T, Sousa C, Machado AP, Leite-Moreira A, Sampaio-Maia B, Ramalho C, Falcão-Pires I. The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling. Rev Port Cardiol 2023:S0870-2551(23)00173-7. [PMID: 36958578 DOI: 10.1016/j.repc.2022.08.015] [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: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid progression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehensive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR. OBJECTIVES To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes. METHODS We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT® and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities. RESULTS Not applicable Conclusion: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily.
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Affiliation(s)
- A F Ferreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - M J Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, The Netherlands
| | - F A Saraiva
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F Trindade
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - A Barros
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - S Leite
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Anta Family Health Unit, Espinho/Gaia Healthcare Center, Espinho, Portugal
| | - T Proença
- Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - C Sousa
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A P Machado
- Center of Prenatal Diagnosis, Obstetrics Department, São João Hospital, Porto, Portugal
| | - A Leite-Moreira
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiothoracic Surgery Department, Centro Hospitalar de São João, Porto, Portugal
| | - B Sampaio-Maia
- Faculdade de Medicina Dentária, Universidade do Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - C Ramalho
- Center of Prenatal Diagnosis, Obstetrics Department, São João Hospital, Porto, Portugal; Obstetrics, Gynecology and Pediatrics Department, Faculty of Medicine of the University of Porto, Portugal
| | - I Falcão-Pires
- Cardiovascular R&D Center - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Kislaya I, Peralta-Santos A, Vieira L, Sousa C, Ferreira B, Pelerito A, Gomes JP, Pinto Leite P, Nunes B. Case-case study on comparative vaccine effectiveness against Delta and Omicron SARS-CoV-2 infections. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.668] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Vaccination is the primary pharmacological measure to reduce SARS-CoV-2 transmission and its complications. Timely information on vaccines effectiveness in a context of novel variants of concern (VOC) emergence is essential for public health policies. This study aimed to provide a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.627.2) VOC according to vaccination exposure (complete primary regimen or booster dose) for Portuguese population aged 12 or more years old using routinely collected data from electronic health records.
Methods
We used a case-case study design linking national electronic vaccination registry and surveillance data on 13,134 SARS-CoV-2 RT-PCR laboratory-confirmed cases notified in Portugal during weeks 49-51 of 2021. Notified cases were classified as Omicron or Delta based on whole-genome sequencing or S-gene Target Failure (SGTF) status using the RT-PCR TaqPath™ Covid 19 CE IVD Kit (Thermo Scientific™) assay. The odds of vaccination was compared between Omicron cases and Delta cases using logistic regression adjusted for age group, sex, region and week of diagnosis and laboratory of origin.
Results
The odds of vaccination were higher in laboratory-confirmed cases infected by Omicron (BA.1) VOC compared to Delta (B.1.627.2) VOC for both complete primary vaccination (Odds ratio (OR)=2.1; 95% Confidence Interval (95%CI): 1.8 - 2.4) and booster dose (OR = 5.2; 95%CI: 3.1 - 8.8), indicating vaccine effectiveness reduction against Omicron.
Conclusions
We found significantly higher odds of vaccination in Omicron cases compared to Delta, suggesting lower effectiveness of the primary vaccination and the booster dose in preventing infections by Omicron. Case-case study design has proven to be feasible approach to rapidly compare vaccine effectiveness between VOC in context of novel VOC emergence to timely inform public health stakeholders.
Key messages
• Reduction of vaccine-induced protection against SARS-COV-2 infection with the Omicron compared to Delta after primary and booster vaccination.
• Continuous monitoring of COVID-19 vaccine effectiveness is essential to support public health policies in context of novel VOC emergence.
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Affiliation(s)
- I Kislaya
- Departamento de Epidemiologia, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - A Peralta-Santos
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Direção de Serviços de Informação e Análise, Direção-Geral da Saúde , Lisbon, Portugal
| | - L Vieira
- Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
| | | | - B Ferreira
- Algarve Biomedical Center Research Institute , Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve , Faro, Portugal
| | - A Pelerito
- Portuguese Red Cross Laboratory , Lisbon, Portugal
| | - JP Gomes
- Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
| | - P Pinto Leite
- Direção de Serviços de Informação e Análise, Direção-Geral da Saúde , Lisbon, Portugal
| | - B Nunes
- Departamento de Epidemiologia, National Institute of Health Doutor Ricardo Jorge , Lisbon, Portugal
- Public Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa , Lisbon, Portugal
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6
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Amador A, Martins Da Costa C, Calvao J, Carvalho JM, Proenca T, Pinto R, Marques C, Cabrita A, Santos L, Oliveira C, Pinho A, Palma P, Rocha M, Sousa C, Macedo F. Aortic valve calcium score: does it correlate with mean transaortic gradient? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1550] [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
Introduction
Aortic valvular calcium score (AVCS) is useful in patients with aortic stenosis for whom echocardiography was not conclusive in grading its severity. Transcatheter aortic valve implantation (TAVI) is an established procedure of treatment in symptomatic severe AS. The burden of aortic valve calcification has been associated with some TAVI related complications (as perivalvular leaks), but at the same time it is well accepted that some degree of calcification is needed to ensure stable anchoring of the prosthesis to the aortic annulus.
Purpose
To assess if there is a correlation between aortic valve calcium score and mean transvalvular gradient 6 months after TAVI – is a higher AVCS correlated with lower mean transaortic gradient after TAVI?
Methods
We performed a single-center, retrospective cohort study including patients who underwent TAVI with a preoperative standardized contrast enhanced MSCT with AVCS available. Clinical and echocardiographic data were collected previously to TAVI (pre-TAVI) and at 6 months follow up (6M-FUP).
Results
A total of 187 patients were included, with 54% female and a mean age of 79.4±9.0 years old. Most patients had tricuspid aortic valve (95.7%); 5 patients had aortic bicuspidy and 3 had aortic valve bioprothesis. Concerning the valve type, 73.3% had new generation prosthesis and the main valve used was the CoreValve Evolut Pro (33.7%). Also, 38,5% needed balloon pre-dilation before TAVI. The mean pre-TAVI aortic transvalvular maximum and mean gradients were 76.5±23.2 mmHg and 48.3±15.5 mmHg, respectively; mean aortic valve area was 0.75±0.16 cm2. The mean AVCS was 2851±1524 AU (Agaston Units); 81.2% of women had AVCS>1300 AU and 74.4% men had AVCS >2000 AU. Comparing transvalvular aortic gradients previously and 6M-FUP after TAVI, there was an average differential of maximum gradient of 61±22 mmHg and of mean gradient of 40±15 mmHg. A negative and weak correlation was found between the AVCS and the maximum gradient (pearson coefficient of −0.181, p=0.02) and between mean gradient at 6M-FUP (pearson coefficient of −0.191, p=0.014).
Discussion and conclusion
AVCS is a significant predictor for death, stroke and perivalvular leaks after TAVI. On the other hand, high AVCS is associated with better seating in the native annulus during deployment. Nevertheless, high AVCS did not strongly correlated with mean transaortic gradient 6 months after TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | | | - J Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J M Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - R Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - L Santos
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Oliveira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Pinho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - P Palma
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - M Rocha
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Sousa
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
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7
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Amador A, Martins Da Costa C, Calvao J, Pinto R, Proenca T, Carvalho JM, Cabrita A, Marques C, Pinho A, Santos L, Oliveira C, Moreira H, Palma P, Sousa C, Macedo F. Reduced 3D-left atrium ejection fraction predicts development of atrial fibrillation in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.097] [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
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, related to left atrial (LA) dilatation and remodeling. HCM patients who develop AF have increased risk of HCM-related death, functional impairment, and stroke. Accurate risk stratification for AF in this population is crucial as contemporary treatments are highly successful.
Purpose
To assess if new echocardiographic parameters can predict the development of AF in HCM patients.
Methods
HCM patients who underwent comprehensive echocardiographic examination during 2011 were followed and checked for “de novo” AF until November 2021. We searched for associations between AF development and novel echocardiographic parameters such as LA Volume index, Left Atrioventricular Coupling Index (LACI, as LAVI/a'), 3D LA volumes and 3D LA ejection fraction (3D-LAEF).
Results
A total of 43 patients were included, with 62.8% male and mean age 56,1±6,2 years old. 55.8% had the septal asymmetric HCM type and mean LV mass was 326±127g. Mean LA diameter and biplane 2D volume was 46±7 mm and 78±37 mL, respectively. 11.6% of patients already had AF. During a median follow-up of 9.4 years, the incidence of “de novo” AF was 31,6%. Within the total 17 patients with AF, 35,2% took warfarin and the remaining direct oral anti-coagulation. No stroke was documented. There were 3 deaths (mortality rate of 7,0%), none from cardiac causes.
No association was found between AF development and LAVI, LACI or 3D LA volumes. We only found a statistically significant difference regarding 3D-LAEF, which was lower in patients who developed AF compared with those without AF (26±12% VS 39±19%, p=0.04).
Binary logistic regression analysis found that reduced 3D-LAEF predicts the development of AF (p=0.019, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0 to 1.1). The area under a receiver operating characteristic curve using 3D-LAEF as a predictive marker for AF development in HCM patients was 0.743 (p=0.004). When the cut-off value of 3D-LAEF was set at 34,5%, the sensitivity and specificity for AF diagnosis were 66% and 86%, respectively.
Conclusion
In our study, 3D LAEF predicted the development of AF in HCM patients – this may be a useful tool to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | | | - J Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - R Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - J M Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - A Pinho
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - L Santos
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Oliveira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - H Moreira
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - P Palma
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - C Sousa
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology , Porto , Portugal
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8
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Martins De Carvalho M, Alves Pinto R, Proenca T, Calvao J, Martins Da Costa C, Amador AF, Amaral Marques C, Cabrita A, Santos L, Oliveira C, Pinho A, Sousa C, Paiva M, Silva JC, Macedo F. Long-term success in percutaneous valve commissurotomy – is Wilkins score over 9 a definitive limit? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1571] [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
Percutaneous valve commissurotomy (PMC) is an established treatment in patients with significative mitral stenosis (MS). Although rheumatic MS incidence has decreased in the last century, it remains a prevalent pathology worldwide. The Wilkins score (WS) is a reference in echocardiographic assessment of MS; a score ≤8 is considered a predictor of treatment success and score between 9 and 11 is a “grey zone” (WGZ) in which doubts persists regarding PMC success.
Purpose
To evaluate the early and long-term results of PMC in patients with rheumatic MS and to compare long-term events between patients with WS ≤8 and patients in WGZ.
Methods
We retrospectively analysed all patients between 1991 and 2008 with significative rheumatic MS undergoing PMC. Data were collected at baseline and during long-term follow-up. M ACE was defined as a composite of all-cause mortality, mitral valve re-intervention or cardiovascular hospitalization.
Results
In our cohort, 124 patients were included. Most were female (87%), mean age at the time of repair was 46±11 year-old and mean follow-up was 20±6 years. Before the procedure, 81% had WS ≤8 and 19% were in WGZ. Both groups had similar baseline characteristics, namely age at first intervention, NYHA class and follow-up time. All patients had preserved biventricular systolic function, 83% presented PH, mean transvalvular gradient (TVG) and mitral valve area (MVA) were 12.8 mmHg and 1.0 cm2, respectively. Most of the procedures were successful (91%) and without complications (94%). Mean MVA improvement was similar in both groups [0.9 cm2 in WS ≤8 and 0.8 cm2 in WGZ, t(102)=0.173, p=0.863]; there was also no significative difference in TVG and PASP reduction after PMC. During long-term follow-up, re-intervention and mortality occurred in 40% and 23% in WS ≤8 and in 50% and 29% in WGZ, respectively, and none of these differences was statistically significant (p=0.389 and p=0.544, respectively). Concerning time-to-event analysis, approximately 80% of patients kept uneventful and >90% alive after 10 years in both groups and no significant difference in M ACE events and all-cause mortality between WS ≤8 and WGZ was observed (Log Rank, p=0,419 and p=0.950, respectively).
Conclusion
PMC was safe and effective in clinically significant rheumatic MS in both WS ≤8 and WS 9–11, with similar MVA improvement. After 10 years, approximately 80% of patients were MACE-free and >90% alive in both groups. There was no difference in all-cause mortality and in a composite of all-cause death, mitral valve re-intervention or cardiovascular hospitalization concerning WS groups.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - J Calvao
- Sao Joao Hospital , Porto , Portugal
| | | | | | | | - A Cabrita
- Sao Joao Hospital , Porto , Portugal
| | - L Santos
- Sao Joao Hospital , Porto , Portugal
| | | | - A Pinho
- Sao Joao Hospital , Porto , Portugal
| | - C Sousa
- Sao Joao Hospital , Porto , Portugal
| | - M Paiva
- Sao Joao Hospital , Porto , Portugal
| | - J C Silva
- Sao Joao Hospital , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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9
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Lima-Fontes M, Leuzinger-Dias M, Falcão-Reis F, Sousa C. Injection of Botulinum Toxin A in the Lacrimal Gland for Treatment of Epiphora in Crocodile Tears Syndrome – A Case Report. Int Med Case Rep J 2022; 15:537-542. [PMID: 36171912 PMCID: PMC9512532 DOI: 10.2147/imcrj.s379024] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Crocodile tears syndrome is a rare autonomic synkinesia, in which patients tear excessively in response to salivary stimuli. It usually occurs after idiopathic or traumatic facial palsy, as a result of aberrant reinnervation of the lacrimal gland by salivary efferent fibers from either the seventh or ninth cranial nerve. Patients and Methods We report the case of a 54-year-old woman, with a history of left Bell’s palsy, who attended our ophthalmology clinic due to epiphora of the left eye while eating or speaking, for 6 months. Results The ophthalmologic evaluation revealed a mild weakening of the frontal and left orbicularis oculi muscles without lagophthalmos. No other abnormalities were found, namely ocular surface swelling, ectropion, or obstruction of the lacrimal outflow system. Schirmer test II in the left eye increased from 12 to 23 mm while the patient was chewing. All these clues led to the diagnosis of crocodile tears syndrome and treatment with botulinum toxin A injection was proposed. One month after the injection of the palpebral lobe of the left lacrimal gland with 6 units of botulinum toxin A, the patient reported an almost complete resolution of the complaints, stated by a decrease in Munk scale and Lac-Q scores. Six months after injection, the patient conveyed recurrence of symptoms and a new treatment session was performed with comparable results. Conclusion Since crocodile tears syndrome is rare, it is crucial to increase awareness and knowledge about it among ophthalmologists and other medical doctors. Botulinum toxin is a safe and effective treatment modality, dramatically improving these patients’ quality of life.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | | | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Cristina Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
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10
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Carvalho dos Santos P, Costa P, Carvalho I, Sousa C. Complicaciones de la rinosinusitis aguda. Una revisión clínica radiológica. Radiología 2022. [DOI: 10.1016/j.rx.2022.03.008] [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: 11/30/2022]
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11
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Straatsma TP, Broer R, Sánchez-Mansilla A, Sousa C, de Graaf C. GronOR: Scalable and Accelerated Nonorthogonal Configuration Interaction for Molecular Fragment Wave Functions. J Chem Theory Comput 2022; 18:3549-3565. [PMID: 35640094 DOI: 10.1021/acs.jctc.2c00266] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
GronOR is a program package for nonorthogonal configuration interaction calculations. Electronic wave functions are constructed in terms of antisymmetrized products of multiconfiguration molecular fragment wave functions. The computational complexity of the nonorthogonal methodologies implemented in GronOR applied to large molecular assemblies requires a design that takes full advantage of massively parallel supercomputer architectures and accelerator technologies. This work describes the implementation strategy and resulting performance characteristics. In addition to parallelization and acceleration, the software development strategy includes aspects of fault resiliency and heterogeneous computing. The program was designed for large-scale supercomputers but also runs effectively on small clusters and workstations for small molecular systems. GronOR is available as open source to the scientific community.
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Affiliation(s)
- T P Straatsma
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-6373, United States.,Department of Chemistry and Biochemistry, University of Alabama, Tuscaloosa, Alabama 35487-0336, United States
| | - R Broer
- Theoretical Chemistry Group, Zernike Institute for Advanced Materials, University of Groningen, 9747 AG Groningen, The Netherlands
| | - A Sánchez-Mansilla
- Department of Physical and Inorganic Chemistry, Universitat Rovira i Virgili, C. Marcel·lí Domingo 1, 43007 Tarragona, Spain
| | - C Sousa
- Department of Physical Chemistry and Institut de Química Teòrica i Computacional, Universitat de Barcelona, 08028 Barcelona, Spain
| | - C de Graaf
- Theoretical Chemistry Group, Zernike Institute for Advanced Materials, University of Groningen, 9747 AG Groningen, The Netherlands.,Department of Physical and Inorganic Chemistry, Universitat Rovira i Virgili, C. Marcel·lí Domingo 1, 43007 Tarragona, Spain.,ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
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12
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Sánchez-Mansilla A, Sousa C, Kathir RK, Broer R, Straatsma TP, de Graaf C. On the role of dynamic electron correlation in non-orthogonal configuration interaction with fragments. Phys Chem Chem Phys 2022; 24:11931-11944. [PMID: 35521680 DOI: 10.1039/d2cp00772j] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Two different approaches have been implemented to include the effect of dynamic electron correlation in the Non-Orthogonal Configuration Interaction for Fragments (NOCI-F) method. The first is based on shifting the diagonal matrix elements of the NOCI matrix, while the second incorporates the dynamic correlation explicitly in the fragment wave functions used to construct the many-electron basis functions of the NOCI. The two approaches are illustrated for the calculation of the electronic coupling relevant in singlet fission and the coupling of spin moments in organic radicals. Comparison of the calculated diabatic couplings, the NOCI energies and wave functions shows that dynamic electron correlation is not only efficiently but also effectively incorporated by the shifting approach and can largely affect the coupling between electronic states. Also, it brings the NOCI coupling of the spin moments in close agreement with benchmark calculations.
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Affiliation(s)
- A Sánchez-Mansilla
- Departament de Química Física i Inorgànica, Universitat Rovira i Virgili, Tarragona, Spain
| | - C Sousa
- Departament de Ciència de Materials i Química Física and Institut de Química Teòrica i Computacional, Universitat de Barcelona, Spain.
| | - R K Kathir
- Zernike Institute of Advanced Materials, University of Groningen, The Netherlands
| | - R Broer
- Zernike Institute of Advanced Materials, University of Groningen, The Netherlands
| | - T P Straatsma
- National Center for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37831-6373, USA.,Department of Chemistry and Biochemistry, University of Alabama, Tuscaloosa, AL 35487-0336, USA
| | - C de Graaf
- Departament de Química Física i Inorgànica, Universitat Rovira i Virgili, Tarragona, Spain.,Zernike Institute of Advanced Materials, University of Groningen, The Netherlands.,ICREA, Pg. Lluís Companys 23, Barcelona, Spain.
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13
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Favareto S, Sousa C, Pinto P, Ramos H, Neto E, Abrahao C, Chen M, Pellizzon A, Silva M, Gondim G, Castro D, Fogaroli R. PO-1294 clinical prognostic factors for esophageal cancer treated with definitive chemo-radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03258-3] [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: 10/18/2022]
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14
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Lopes J, Teixeira D, Sousa C, Abreu G, Baptista A, Rocha N. Presence of Human Papillomavirus in Human Tissues and the Environment. Skinmed 2022; 20:18-21. [PMID: 35435821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Human Papillomavirus is one of the most well-known pathogens having potential to cause both benign and malignant illnesses. The current controversy focuses on its continuity in non-epithelial tissues and the environment, and its ability to cause infection in these settings. This review addresses the virology aspects that contribute to its presence and resistance in humans and the environment.
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Affiliation(s)
- Jorge Lopes
- Department of Dermatology Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal;
| | - Diogo Teixeira
- Department of Dermatology Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Cristina Sousa
- Department of Dermatology Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Gabriela Abreu
- Department of Clinical Pathology, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Armando Baptista
- Department of Dermatology Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Natividade Rocha
- Department of Dermatology Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
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15
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Martins De Carvalho M, Proenca T, Pinto RA, Costa I, Torres S, Resende CX, Grilo PD, Amador AF, Costa C, Calvao J, Cabrita A, Marques C, Sousa C, Paiva M, Macedo F. Breast cancer patients presenting with cardiotoxicity - risk factors and role of cardioprotective drugs. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.020] [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
Recent advances in cancer treatment have led to improved survival, albeit with cardiovascular adverse effects being some of the most frequent and feared consequences. Patient’s risk stratification, prevention and treatment are still to be fully elucidated. Our aim was to evaluate the risk and therapy of cardiotoxicity (CT) secondary to cancer treatment in a subset of patients with breast cancer (BC).
Methods
We collected a retrospective cohort of female with BC treated with conventional chemotherapy (CHT) and/or anti-HER2-targeted therapies (AHT) referred to Cardio-oncology consultation from January 2017 to March 2020. All patients were evaluated before CHT and at least at 3, 6 and 12-months with echocardiogram and cardiac biomarkers, namely high sensitivity troponin I (hs-cTnI) and brain natriuretic peptide (BNP). CT was defined as left ventricle ejection fraction (LVEF) under 50% or decline of at least 10% in LVEF during follow-up. As cardioprotective drugs (CPD) we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.
Results
A total of 203 women were enrolled, with mean age 50.9 ± 10.9 year-old. As for the cardiovascular risk factors, 23.5% had hypertension, 32.4% dyslipidaemia, 9.8% diabetes and 33.0% were smokers or previous smokers. The majority of patients had a high or very-high CT risk score (98.5% with score ≥ 5) and 35.5% were already on CPD before CHT. All patients were submitted to CHT: anthracyclines (AC) and AHT were applied to 83.8% and 41.7% of patients, respectively, with 27.9% of patients on both therapies; 81.4% were submitted to radiotherapy (RT). At presentation, all patients had normal cardiac function with mean LVEF of 62.9% and mean global longitudinal strain (GLS) of -19.4; mean hs-cTnI and BNP were 3.3 ng/L and 33.4 pg/mL, respectively. During a median follow-up of 16 months, 8.5% of patients developed CT, leading to initiation or titration of CPD in 76.9% and treatment interruption in 23.5%; most of them recovered (88.2%). During treatment there was a significantly increase of hs-cTnI (mean 19.7 ng/L at 3 months, p < 0.001) and a decrease of GLS and LVEF at 12 months (decrease of 1.1 and 2.2%, respectively, both p < 0.001). Both AHT and AHT plus AC were significantly associated with CT (p = 0.002 and p < 0.001, respectively), with an extremely high prevalence in the latter group (19.6%). Nor CVRF neither RT raised the risk of CT. Although patients on CPD did not had lower prevalence of CT (5.6% vs 10.2%, p = 0.268), its initiation was associated with a higher rate of cardiac function recovery (100.0% vs 66.7%, p = 0.057).
Conclusion
Patients submitted to AHT or AHT plus AC were at higher risk of developing CT. This and the significant LVEF decline during follow-up highlight the importance of long-term-monitoring of these patients. CPD seemed to be associated with cardiac recovery, although this finding needs further validation.
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Affiliation(s)
| | | | - RA Pinto
- Sao Joao Hospital, Porto, Portugal
| | - I Costa
- Sao Joao Hospital, Porto, Portugal
| | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | | | - PD Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | | | | | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - M Paiva
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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16
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Amador A, Martins Da Costa C, Calvao J, Alves Pinto R, Proenca T, Carvalho JM, Cabrita A, Marques C, Grilo PD, Sousa C, Macedo F. Aortic valve calcium score and peri-prothesis leaks after transcatheter aortic valve implantation: a hint? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.230] [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
The first-line evaluation of aortic stenosis (AS) severity is Doppler echocardiography. Aortic valvular calcium score (AVCS) measured by tomography scans (TS) is useful in patients for whom echocardiography is not conclusive. For high-risk patients with symptomatic severe AS, transcatheter aortic valve implantation (TAVI) is an established procedure of treatment. The burden of aortic valve calcification has been associated with some TAVI related complications. Peri-prothesis leaks (PPL) are an important complication that may compromise TAVI net results and further refinements are required to predict high-risk patients. Purpose: To access if there is an association between aortic valve calcium score and moderate to severe (mod-sev) peri-prothesis leaks immediately and 6 month after TAVI. Methods: We performed a single-center, retrospective cohort study including patients who underwent TAVI with a preoperative standardised TS with AVCS available. Clinical and echocardiographic data were collected previously to TAVI (pre-TAVI) and at 6 months follow up (6M-FUP). Results: A total of 187 patients were included, with 54% female and a mean age of 79.37± 9.029 year-old. Most patients had tricuspid aortic valve (95.7%); 5 patients had aortic bicuspidy and 3 had aortic valve bioprothesis. Considering left ventricular systolic function, the majority had conserved function (73.0%), the remaining had mild (9.7%), moderate (11.4%) or severe (5.9%) dysfunction. Concerning the valve type, 73.3% had new generation prosthesis and the main valve used was the CoreValve Evolut Pro (33.7%). Also, 38.5% patients underwent balloon valve pre-dilation before implantation. In-hospital mortality was 2.7%. At 6M-FUP, 8 of 182 patients had dead. The mean AVCS was 2851 ± 1524 AU (Agaston Units); 81.2% of women had AVCS > 1300 AU and 74.4% men had AVCS >2000 AU. Comparing AVCS with the presence or absence of moderate to severe peri-prothesis leaks, no statistically significant difference was found immediately (no vs mod-sev leak, AS: 2758 ± 2308 vs 3621 ± 1376, p= 0,13) and 6 months after the procedure (no vs mod-sev leak, AS: 2892 ± 2366 vs 3621 ± 1424, p = 0.15). Considering earlier (Portico, CoreValve Evolut R) vs newer valves (CoreValve Evolut Pro; Edward Sapiens 3; Accurate Neo), there was no statistically significant difference relating AVCS and PPL; however, in patients who had newer valves there was a trend to higher AVCS and moderate to severe leaks, both on the immediate (no vs mod-sev leak, AS: 2777 ± 2507 vs 3601 ± 1385, p = 0.07) and at 6 months (no vs mod-sev leak, AS: 2782 ± 2506 vs 3984 ± 1138, p = 0.06). No statistically significant difference was found when comparing pre-ballooning dilatation. Conclusion: Aortic calcium measured by Agatston score did not show an association with new moderate to severe peri-valvular leaks after TAVI. Nevertheless, it seems to be a trend for higher AS and moderate to severe peri-prothesis leaks when newer valves are implanted.
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Affiliation(s)
- A Amador
- Centro Hospitalar Universitario Sao Joao, Porto, Portugal
| | | | - J Calvao
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - R Alves Pinto
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - T Proenca
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - JM Carvalho
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - A Cabrita
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - C Marques
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - PD Grilo
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - C Sousa
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
| | - F Macedo
- Centro Hospitalar Universitario Sao Joao, Cardiology, Porto, Portugal
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17
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Calvao J, Costa C, Amador A, Pinto R, Carvalho M, Proenca T, Marques C, Cabrita A, Grilo P, Resende C, Torres S, Sousa C, Macedo F. Impact of severe mitral annular calcification on mitral regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.215] [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
Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequent in patients with aortic stenosis, and its presence is associated with increased cardiovascular morbidity and mortality. Not infrequently, it is associated with significant morphologic and functional abnormalities of the mitral valve apparatus.
Purpose
The aim of this work is to evaluate the relationship between severe MAC and the presence and development of significant mitral regurgitation after TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019. Clinical, echocardiographic and procedure-related data were collected until a follow-up of 6 months. Statistical analysis was conducted on IBM SPSS® Statistics software. Descriptive statistics were calculated for all variables. Sample T-test, Chi-square and Wilcoxon sign test were used. A p-value < 0.05 was considered significant. The presence and severity of MAC was defined according to echocardiographic data. Severe MAC was defined by the presence of calcification of more than half of the mitral annular circumference.
Results
A total of 343 patients were enrolled in the study. The mean age of the population was 80 ± 8 years, 45% were male. Mean functional area was 0.75 ± 0.18 cm2, mean transvalvular pressure gradient was 48 ± 15 mmHg and the mean left ventricular ejection fraction (LVEF) was 54 ± 14%. MAC was detected in 231 (67%) patients. In 44 (19%) of these patients, MAC was graded as severe. Patients with severe MAC tended to have higher prevalence of moderate (27.3 vs 20.4%, p = 0.30) as well as severe (4.5 vs 1.8%, p = 0.24) mitral regurgitation at baseline. After TAVI, the prevalence of moderate mitral regurgitation at 6 months was similar between both groups (22.5 vs 20.4%, p = 0.76). Although not reaching statistical significance, patients with severe MAC had higher prevalence of severe mitral regurgitation at 6 months post-procedure (12.2 VS 5.0%, p = 0.07) as well as higher incidence of worsening of mitral regurgitation (34.2 vs 23.7%, p = 0.16). The proportion of patients that had improvement (13.2 vs 15.0%, p = 0.76) or no change (52.6 vs 61.3%, p = 0.31) in the degree of mitral regurgitation was similar in both groups.
Conclusion
The presence of severe MAC at baseline echocardiography in patients undergoing TAVI may be associated with worsening of mitral regurgitation after the procedure. These patients tend to have higher prevalence of severe mitral regurgitation post-TAVI. Further studies are needed in order to further elucidate this association.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | | | - P Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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18
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Costa C, Calvao J, Amador A, Proenca T, Carvalho M, Pinto R, Marques C, Cabrita A, Grilo PD, Resende CX, Torres S, Sousa C, Macedo F. Can aortic calcium score predict new conduction disturbances in pos-transcatheter aortic valve implantation? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.217] [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.
Background
Transcatheter aortic valve implantation (TAVI) may be the first line treatment for severe aortic stenosis according to overall patient characteristics. Semi-quantitative Agatston score (AS), which quantifies aortic calcium by cardiac computed tomography (CCT), has knowledgeable practical and clinical implications, and is performed in TAVI diagnostic workup. Since conduction disturbances continue to be the most frequent complication, further refinements are required to predict high-risk patients.
Purpose
To access if aortic AS relates with new conduction disturbances and permanent pacemaker (PPM) implantation in patients undergoing TAVI.
Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019; patients with previous permanent pacemaker (PPM) or had no aortic AS were excluded. Clinical and electrocardiogram (ECG) data were collected at admission and after the procedure. All categorical variables are reported as numbers and percentages. Continuous variables were analyzed using the two-tailed unpaired Student’s t-test and are reported as mean values and the standard deviation. Statistical analysis was performed using the IBM SPSS.
Results
172 patients with a mean age 79 ± 9.1 years old were included (see table 1 for baseline characteristics). AS was on average 3008 ± 2262 (see table 2 for remaining diagnostic workup and procedure characteristics).
Comparing AS with new conduction disturbances, no statistically significant difference was found for new complete left branch block (LBBB) (no vs new LBBB, AS: 3179 ± 2555 vs 2637 ± 1388, p= 0,15) and with new complete atrioventricular block (AVB) (no vs new AVB, AS: 2834 ± 1520 vs 4485 ± 5285, p = 0.2). Considering PPM implantation after TAVI, there was a tendency for higher AS and PPM implantation (no vs PPM implantation, AS: 2756 ± 1451 vs 4242 ± 4310, p = 0.07).
In patients who had pre-ballooning, there was no difference relating to AS; however, in patients who had no pre-ballooning there was a trend to higher AS and PPM implantation (no vs PPM implantation, AS: 2417 ± 1301 vs 4616 ± 4969, p = 0.06). No statistically significant difference was found when comparing earlier (Portico, CoreValve Evolut R) vs newer valves (CoreValve Evolut Pro; Edward Sapiens 3; Accurate Neo).
Conclusion
Aortic calcium measured by Agatston score did not show a correlation with new LBBB or new AVB after TAVI. Nevertheless, it seems to be a trend for higher AS and PPM implantation; this was more noticeable when pre-ballooning was not performed. Further studies are needed in order to further elucidate this association. Abstract Figure. Patients baseline characteristics Abstract Figure. TAVI diagnostic workup and procedure
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Affiliation(s)
- C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - A Amador
- Sao Joao Hospital, Porto, Portugal
| | | | | | - R Pinto
- Sao Joao Hospital, Porto, Portugal
| | | | | | - PD Grilo
- Sao Joao Hospital, Porto, Portugal
| | | | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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19
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BEIRÃO B, Freitas M, Francisco J, Sousa C, Pereira P, Prata C, Castro R, Morgado T. POS-928 EFFICACY OF THE PFIZER/ BNT162b2 COVID-19 VACCINE IN PERITONEAL DIALYSIS PATIENTS. Kidney Int Rep 2022. [PMCID: PMC8854947 DOI: 10.1016/j.ekir.2022.01.968] [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: 11/23/2022] Open
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20
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FRANCISCO J, Beirão B, Freitas M, Sousa C, Pereira P, Castro R, Morgado T. POS-939 EFFICACY OF BNT162b2 VACCINE IN PATIENTS UNDERGOING HEMODIALYSIS IN NORTH OF PORTUGAL. Kidney Int Rep 2022. [PMCID: PMC8854880 DOI: 10.1016/j.ekir.2022.01.979] [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: 11/13/2022] Open
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21
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Marques-Gomes J, Salt MJ, Pereira-Neto R, Barteldes FS, Gouveia-Barros V, Carvalho A, d'Arminio-Monforte A, De-la-Torre-Rosas A, Harris A, Esteves C, Maor C, Mora C, Oliveira C, Sousa C, Richman DD, Martinez E, Cota-Medeiros F, Gramacho F, Behrens GMN, Gonçalves G, Farinha H, Nabais I, Vaz-Pinto I, Sierra-Madero J, Sousa-Gago J, Thornhill J, Vera J, Erceg-Tusek M, Tavares M, Vasconcelos M, Fernandes N, Gianotti N, Langebeek N, Anjos P, Couto R, Fernandes R, Rajasuriar R, Serrão R, Watson S, Branco T, Teixeira T, Soriano V. Development of the HIV360 international core set of outcome measures for adults living with HIV: A consensus process. HIV Med 2021; 23:639-649. [PMID: 34964226 DOI: 10.1111/hiv.13221] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care. METHODS An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice. RESULTS From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years. CONCLUSIONS Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.
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Affiliation(s)
- João Marques-Gomes
- Nova School of Business and Economics, Carcavelos, Portugal.,Nova Medical School, Nova University Lisbon, Lisbon, Portugal
| | | | | | | | | | - Alexandre Carvalho
- Braga Public Hospital, Braga, Portugal.,School of Medicine, Minho University, Braga, Portugal
| | - Antonella d'Arminio-Monforte
- Institute of Infectious and Tropical Diseases - Department of Health Sciences, ASST Santi Paolo e Carlo University Hospital, Milan, Italy
| | | | - Amy Harris
- Aneurin Bevan University Health Board, NHS Wales, Newport, UK.,Pharmacy Department, Royal Gwent Hospital, Newport, UK
| | - Catarina Esteves
- Portuguese Association for the Clinical Study of AIDS (APECS), Lisbon, Portugal.,HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal
| | | | | | - Carla Oliveira
- Santo António Hospital, Porto University Hospital Centre, Porto, Portugal
| | | | - Douglas D Richman
- Center for AIDS Research, University of California San Diego, La Jolla, California, USA
| | | | - Fábio Cota-Medeiros
- Northern Lisbon University Hospital Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Filipa Gramacho
- Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Georg M N Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Graça Gonçalves
- Northern Lisbon University Hospital Centre, Lisbon, Portugal
| | - Helena Farinha
- Pharmacy Department, Egas Moniz Hospital, Western Lisbon Hospital Centre, Lisbon, Portugal.,Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Isabel Nabais
- Northern Lisbon University Hospital Centre, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Cascais Hospital Dr. José de Almeida, Cascais, Portugal.,HIV Disease Study Group, Portuguese Society of Internal Medicine (NEDVIH-SPMI), Lisbon, Portugal
| | - Juan Sierra-Madero
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Joaquim Sousa-Gago
- Nova Medical School, Nova University Lisbon, Lisbon, Portugal.,Oeiras Mental Health Unit, Western Lisbon Hospital Centre, Lisbon, Portugal
| | - John Thornhill
- British HIV Association, London, UK.,Department of Medicine, Imperial College London, London, UK.,Barts Health NHS Trust, London, UK
| | - José Vera
- HIV Disease Study Group, Portuguese Society of Internal Medicine (NEDVIH-SPMI), Lisbon, Portugal.,Barreiro-Montijo Hospital Centre, Barreiro, Portugal
| | - Maja Erceg-Tusek
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | | | - Miguel Vasconcelos
- Division of Intervention in Addictive Behaviours and Dependencies (DICAD), Regional Health Administration of Lisbon and Tagus Valley, Lisbon, Portugal
| | | | - Nicola Gianotti
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Raquel Couto
- Vila Nova de Gaia-Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Reena Rajasuriar
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | | | | | - Teresa Branco
- Portuguese Association for the Clinical Study of AIDS (APECS), Lisbon, Portugal.,Fernando Fonseca Hospital, Amadora, Portugal
| | - Tiago Teixeira
- Infectious Diseases Department, Vila Nova de Gaia-Espinho Hospital Centre, Vila Nova de Gaia, Portugal
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Sousa C, Varela P, Baptista A. Acrodermatitis continua de Hallopeau y el fenómeno de Koebner. Actas Dermo-Sifiliográficas 2021. [DOI: 10.1016/j.ad.2020.01.019] [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: 10/21/2022] Open
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23
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Ferreira AF, Azevedo MJ, Proenca T, Saraiva FA, Machado AP, Sousa C, Sampaio Maia B, Leite-Moreira A, Ramalho C, Fa I. Cardiac remodelling and reverse remodelling in pregnant women: what can be expected? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2904] [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
Hemodynamic overload during pregnancy induces cardiac remodelling which is characterized by left ventricle (LV) eccentric hypertrophy and left-atrium enlargement.After delivery,the woman's heart undergoes reverse remodelling and myocardial performance normalize to their pre-gravid structure and function.
Aim
To characterize cardiac remodelling and reverse remodelling during pregnancy and postpartum, respectively, as well as to investigate the impact of cardiovascular (CV) risk factors in these processes.
Methods
This prospective cohort study included volunteer pregnant women recruited in a tertiary centre between 2019 and 2020.Women were evaluated by transthoracic echocardiography and pulse wave velocity at the 1st trimester [1T, baseline], 3rd trimester [3T, peak of CV remodelling] of pregnancy as well as at the 1st month and 6th month after delivery (reverse remodelling). Mann-whitney,wilcoxon and Ffriedman test were used as appropriate to between and within groups comparisons. Bonferroni correction was applied. Spearman correlation was performed to determine the relationship between pulse wave velocity (PWV) and echocardiographic variables.
Results
We included 32 pregnant women with a median age of 34 [26; 41] years, 50% being hypertensive and/or obese. The pregnant women tended to develop eccentric hypertrophy pattern during pregnancy, characterized by significant increase of cardiac mass index (CMi) from 1T to 3T (table 1, p=0.006) and slight modification of relative wall thickness (RWT, table 1, p=0.339). During postpartum, hypertrophy regression became significant only at 6 months after delivery (CMi: table 1, p<0.001; RWT: table 1, p<0.001). In contrast, a fastest recovery of indexed left atrial (3T to 1 month postpartum:table 1,p=0.033) and ventricular volumes (table 1, p<0.001) was observed after delivery, despite its slight enlargement during pregnancy (atrium-table 1, p=0.55; LV-table 1, p=0.084). RWT correlated positively with PWV at 3T (r=0.447, p=0.012). Compared to the healthy pregnant women,CV risk factors group showed higher RWT in all time points of follow-up period,without any differences in CMi and cardiac volumes indexed. Filling pressures increased during gestation (table 1, p=0.002),normalizing as soon as 1 month after delivery (table 1, p=0.001) and maintained at the 6th month (table 1, p<0.001). Pregnant women with CV risk factors revealed a significant higher value of E/e' in comparison with the healthy group, but only at the 6th month of postpartum (5.6 [5.2; 8.2] vs 5.4 [4.4; 7.7], p=0.036).
Conclusion
In our cohort, complete reverse remodelling occurs as soon as one month after delivery, with the exception of hypertrophy.The positive correlation between relative wall thickness and pulse wave velocity highlighted arterial-ventricular coupling relevance for the cardiac remodelling process during pregnancy. Pregnant women with CV risk factors showed higher relative wall thickness when compared with healthy women at all time points of the follow-up.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Universidade do Porto/FMUP and FSE-Fundo Social Europeu; FCT - Foundation for Science and Technology
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Affiliation(s)
- A F Ferreira
- Faculty of Medicine University of Porto, Surgery and Physiology Department, Porto, Portugal
| | - M J Azevedo
- I3s (Institute for Research and Innovation in Health), Porto, Portugal
| | - T Proenca
- Sao Joao Hospital, Cardiology Department, Porto, Portugal
| | - F A Saraiva
- Faculty of Medicine University of Porto, Surgery and Physiology, Cardiovascular R&D Unit, Porto, Portugal
| | - A P Machado
- Sao Joao Hospital, Obstetrics Department, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Cardiology Department, Porto, Portugal
| | - B Sampaio Maia
- I3s (Institute for Research and Innovation in Health), Porto, Portugal
| | - A Leite-Moreira
- Faculty of Medicine University of Porto, Surgery and Physiology, Cardiovascular R&D Unit, Porto, Portugal
| | - C Ramalho
- Faculty of Medicine University of Porto, Gynecology-Obstetrics and Pediatrics Department, Porto, Portugal
| | - I Fa
- Faculty of Medicine University of Porto, Surgery and Physiology, Cardiovascular R&D Unit, Porto, Portugal
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Almeida I, Santos H, Santos M, Miranda H, Chin J, Sa C, Almeida S, Sousa C, Almeida L. Antithrombotic strategy in patients with atrial fibrillation and acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1485] [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
Atrial fibrillation (AF) is frequent in patients admitted with acute coronary syndromes (ACS). The development of this arrhythmia occurs in 2–21% of patients with non ST-elevation ACS and 21% of ST-elevation ACS. According with the most recent European guidelines, a short period up to 1 week of triple antithrombotic therapy (TAT) is recommended, followed by dual antithrombotic therapy (DAT) using a NOAC and a single antiplatelet agent, preferably clopidogrel.
Objective
To compare the antithrombotic strategy (DAT vs TAT) used and its prognostic value in patients with AF and ACS.
Methods
Retrospective analysis of patients' data admitted with ACS in a multicentric registry between 10/2010–09/2019. TAT was defined as the prescription of dual antiplatelet therapy and one anticoagulant and DAT as one antiplatelet and one anticoagulant. Survival and rehospitalization were evaluated through Kaplan-Meier curve.
Results
1067 patients were included, mean age 67±14 years, 72.3% male. Patients who developed de novo AF during hospitalization due to ACS were older (75±12 vs 66±14 years, p<0.001) and with higher prevalence of cardiovascular risk factors and cardiovascular disease. AF was more often in patients with ST elevation ACS (53.4%). During hospitalization, AF patients were more often medicated with aspirin, glycoprotein inhibitor, heparin, fondaparinux and vitamin K antagonists. No difference was found regarding P2Y12 inhibitors. AF patients presented more often obstructive coronary disease (normal coronaries 5.4 vs 8.5%, p<0.001) so they were more often submitted to PCI (79.5 vs 70.9%, p<0.001). AF patients presented with higher rates of adverse in-hospital events as re-infarction, heart failure, shock, ventricular arrhythmias, cardiac arrest, stroke, major bleeding and death (p<0.001). At discharge, AF patients were less prescribed with aspirin or ticagrelor, but the rate of clopidogrel prescription was higher, such as vitamin K antagonists or any of the new anticoagulants. In the AF group, 21.5% patients were discharged with TAT and 30.3% with DAT. Concerning patients discharged with TAT, 1-year follow-up revealed no significant differences in mortality (p=0.578), re-admission for cardiovascular causes (p=0.301) and total re-admission rates (p=0.291). Patients discharged with DAT had similar mortality (p=0.623) and re-admission for cardiovascular causes rates (p=0.138), but significant differences were identified regarding total re-admissions (p=0.024).
Conclusions
In patients with ACS and de novo AF, a low percentage of patients was discharged with oral anticoagulation (51.8%). In those whose anticoagulation was initiated, DAT was the preferred strategy. 1-year outcomes were not different between the antithrombotic strategy, except for all cause re-admission.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Barreiro, Portugal
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25
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Martins De Carvalho M, Pinto RA, Proenca T, Costa I, Torres S, Resende CX, Grilo PD, Amador AF, Costa C, Calvao J, Sousa C, Paiva M, Macedo F, Marques C, Cabrita A. HER2 positive breast cancer: is there a preventive role of cardioprotective drugs? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2872] [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
Introduction
In patients with breast cancer, anti-HER2-targeted therapies (AHT) are highly associated with cardiotoxicity (CT), being the main reason for treatment interruption in patients receiving adjuvant trastuzumab. Guidelines recommend regular left ventricular ejection fraction (LVEF) assessments and CT's management with cardioprotective drugs (CPD). However, while secondary prevention has already entered clinical practice, primary prevention is still in the research domain. Our aim was to evaluate risk of CT and the role of CPD in a subset of breast cancer patients treated with AHT.
Methods
We retrospectively analyzed a population of breast cancer female patients treated with AHT referred to Cardio-oncology consultation at a tertiary center from January 2017 to March 2020. All patients were evaluated with echocardiogram before treatment initiation and at least at 3, 6, 9 and 12-months. CT was defined as LVEF under 50% or decline of at least 10% in LVEF during follow-up. As CPD we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.
Results
A total of 85 patients were included with mean age of 52.4±10.2 year-old. Concerning cardiovascular risk factors 11.8% had diabetes, 32.9% dyslipidaemia, 29.4% hypertension and 22.4% were smokers or previous smokers; most patients had a high or very-high CT risk score (98.8% with score ≥5). Besides AHT, 68.2% and 80% were also on anthracyclines and radiotherapy, respectively. Patients were followed for a median follow-up of 16 months. At baseline, mean high sensitivity troponin I was 3.9 ng/L, mean LVEF was 63.1% and mean global longitudinal strain was −19.7, with all patients having normal cardiac function. During follow-up, 15.7% developed CT with a higher prevalence in patients concomitantly on anthracyclines (19.6% vs 7.4%, p=0.151). CPD was initiated or titrated in 84.6% of patients and 30.8% needed to suspend AHT; overall 92.3% of CT patients recovered. Unlike AHT suspension, CPD initiation after CT was associated with a higher rate of cardiac function recovery (100.0% vs 50.0%, p=0.020). When comparing patients already medicated with CPD before cancer treatment (41.7%) to those naïve of CPD, the first group presented a significative lower incidence of CT [2.9% vs 25.0%, p=0.006, OR=0.09 (95% CI 0.01 – 0.72)]. When analysed all sample (with or without CT), patients already on CPD also presented a higher LVEF at 6 months follow-up (62.5% vs 59.2%, t(69)=−2.4, p=0.017 at 6 months), despite a non-significative lower LVEF at baseline (62.3% vs 63.6%, p=0.139). Medication with statins before chemotherapy didn't reduce the risk of CT.
Conclusion
Pre-treatment with CPD was significantly associated with a lower prevalence of CT and a higher LVEF at 6-months follow-up. CPD initiation after CT was associated with cardiac function recovery. These results highlights the importance of cardiac evaluation in HER2+ patients and strengthen the primary prevention field in these patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | - I Costa
- Sao Joao Hospital, Porto, Portugal
| | - S Torres
- Sao Joao Hospital, Porto, Portugal
| | | | | | | | - C Costa
- Sao Joao Hospital, Porto, Portugal
| | - J Calvao
- Sao Joao Hospital, Porto, Portugal
| | - C Sousa
- Sao Joao Hospital, Porto, Portugal
| | - M Paiva
- Sao Joao Hospital, Porto, Portugal
| | - F Macedo
- Sao Joao Hospital, Porto, Portugal
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Santos H, Almeida I, Miranda H, Santos M, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Sustained ventricular tachycardia as a predictor of major adverse cardiac events in acute coronary syndrome patients. Europace 2021. [DOI: 10.1093/europace/euab116.330] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Sustained ventricular tachycardia (VT) is a frequent rhythm disturbance during an ischemic event like acute coronary syndrome (ACS). VT was frequently associated with worse prognosis, then is expected, that its presence is related to a higher incidence of major adverse cardiac events (MACE).
Objective
Evaluate if sustained VT was a predictor of MACE in ACS hospitalized patients.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Were excluded patients without a previous cardiovascular history or clinical data. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke and hospitalization death. Univariate logistic regression was performed to assess if VT in ACS patients was a predictor of MACE.
Results
A total of 29851 patients was analyze and 25725 had information regarding VT. From the group of patients that presented VT, 177 (1.1%) had re-infarction, 2415 (14.1%) had congestive heart failure, 816 (5.0%) had atrial fibrillation, 108 (0.7%) had a mechanical complication of myocardial infarction, 442 (2.7%) had completed atrioventricular block, 458 (2.8%) had cardiac arrest, 101 (0.6%) had stroke and 535 (3.3%) died. VT did not predict re-infarction (p = 0.071), mechanical complication of myocardial infarction (p = 0.979) and stroke (p = 0.500) in ACS hospitalized patients. Logistic regression revealed that VT in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 2.304, p < 0.001, confidence interval (CI) 1.742-3.047), atrial fibrillation (OR 2.078, p < 0.001, CI 1.453-2.973), completed atrioventricular block (OR 1.831, p = 0.012, CI 1.145-2.928), cardiac arrest (OR 15.434, p < 0.001, CI 11.429-20.843) and hospitalization death (OR 6.472, p < 0.001, CI 4.484-9.342).
Conclusions
VT in ACS patients predict MACE, namely congestive heart failure, atrial fibrillation, completed atrioventricular block, cardiac rest and hospitalization death.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Almeida I, Miranda H, Sa C, Almeida S, Chin J, Sousa C, Almeida L. Was the atrioventricular block similar in anterior and inferior ST-elevation myocardial infarction? Europace 2021. [DOI: 10.1093/europace/euab116.322] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
The presence of atrioventricular block (AVB) in ST-elevation myocardial infarction (STEMI) is more frequently registered when is identified in the inferior leads. However, AVB maybe occurs in anterior STEMI, yet the AVB and STEMI localization maybe had different implications.
Objective
Evaluate the impact and prognosis of AVB according to the STEMI localization.
Methods
Multicenter retrospective study, based on the Portuguese Registry of Acute Coronary Syndrome between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients with anterior STEMI, and B – patients with inferior STEMI. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess AVB as a prognostic marker in STEMI patients.
Results
From 32157 patients, was identified 462 with AVB, 72 in group A (15.6%) and 390 in group B (84.4%). Both groups were similar regarding gender (p = 0.710), age (p = 0.068), body mass index (p = 0.535), admitly directly to cat lab (p = 0.635), initial symptons until first medical contact (p = 0.561), smoker status (p = 0.483), diabetes mellitus (p = 0.331), coronary artery disease (p = 0.053), previous stroke (p = 0.332), peripheral artery disease (p = 0.348), chronic kidney disease (p = 0.425), systolic blood pressure (p = 0.057), multivessel diasease (p = 0.235), new-onset of atrial fibrillation (p = 0.582), cardiac arrest (p = 0.062) and stroke complication (p = 0.685). Group B had higher left ventricular ejection fraction (LVEF) >50% (16.9 vs 60.7%, p < 0.001). On the other hand, group A had more arterial hypertension (79.7 vs 66.2%, p = 0.027), dislipidaemia (58.2 vs 54.4%, p = 0.038), heart rate at admission (81 ± 20 vs 59 ± 23, p < 0.001), Killip-Kimball class > I (45.7 vs 29.6%, p = 0.008), sinus rhythm at admission (84.5 vs 72.6%, p = 0.035), heart failure complication (65.3 vs 37.1%, p < 0.001), cardiogenic shock complication (42.3 vs 24.7%, p < 0.001), ACS mechanical complication (8.3 vs 3.1%, p = 0.047), sustained ventricular tachycardia during ACS hospitalization (19.4 vs 8.5%, p = 0.005) and hospitalization death (52.9 vs 44.7%, p < 0.001). Logistic regression revealed that AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation (odds ratio (OR) 3.817, p = 0.038, confidence interval (CI) 1.123-12.975), with a R2 Nagelkerke 24.4. Also, revealed that AVB in anterior STEMI was a predictor of death (OR 0.111, p < 0.001, CI 0.034-0.366), with a R2 Nagelkerke 55.2.
Conclusions
AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation and AVB in anterior STEMI was a predictor of death.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Miranda H, Almeida I, Santos M, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Sustained ventricular tachycardia in acute coronary syndromes the Portuguese experience. Europace 2021. [DOI: 10.1093/europace/euab116.372] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Acute coronary syndromes (ACS) are frequent and are associated with high levels of comorbidities and complications. Ventricular tachycardia (VT) is one of the most danger and stressful situations in ACS.
Objective
Evaluate predictors of ventricular tachycardia in ACS.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Logistic regression was performed to assess predictors of VT in ACS patients.
Results
25361 in group A (98.6%) and 364 in group B (1.4%). Both groups were similar regarding gender, cardiovascular risk factors, except for dyslipidemia (61.7 vs 51.9%, p < 0.001) and ST-segment elevation myocardial infarction (STEMI) location. Group B was elderly (67 ± 14 vs 70 ± 14, p < 0.001), was admitted directly to the cat lab (10.6 vs 20.4%, p < 0.001), had less time since the onset of symptoms until the admission (383 ± 157 vs 349 ± 121, p = 0.003), but presented higher previous history of heart failure (5.9 vs 10.6%, p < 0.001), peripheral vascular disease (5.5 vs 8.4%, p = 0.015), chronic obstructive pulmonary disease (COPD) (4.4 vs 7.9%, p = 0.001) and dementia (1.7 vs 3.2%, p = 0.038). At admission presented higher levels of STEMI (42 vs 67%, p < 0.001), dyspnea (29 vs 18.1%, p < 0.001), syncope (1.3 vs 6.6%, p < 0.001), cardiac arrest (0.4 vs 4.4%, p < 0.001), Killip-Kimball classification > I (14.8 vs 40.5%, p < 0.001) and atrial fibrillation at admission (AF) (7.1 vs 15.3%, p < 0.001). Ivabradine (3.7 vs 7.6%, p < 0.001), aldosterone receptor antagonists (10.2 vs 24%, p < 0.001), diuretic (28 vs 57.2%, p < 0.001), amiodarone (5.6 vs 53.5%, p < 0.001), digoxin (1.4 vs 4.7%, p < 0.001) were more prevalent used in the admission. Group B exhibited higher multivessel disease (MVD) (51.5 vs 61.5%, p < 0.001), culprit as common coronary trunk (CT) (1.7 vs 4.2%, p = 0.024), hybrid revascularization (0.8 vs 2%, p = 0.032) and left ventricular ejection fraction (LVEF)<50% (38.7 vs 71%, p < 0.001). On the other hand, the used of beta block (81.4 vs 62.3%, p < 0.001), angiotensin-converting-enzyme inhibitor (85.5 vs 74.4%, p < 0.001) and calcium channel blockers (10.1 vs 24%, p < 0.001) since had a protect effect. Regarding reinfarction (0.9 vs 2.5%, p = 0.007), de novo heart failure (15.1 vs 50.3%, p < 0.001), atrioventricular block (2.2 vs 17%, p < 0.001), stroke (1.4 vs 4.9%, p < 0.001) and death (3.4 vs 26.9%, p < 0.001), all were higher in Group B. Logistic regression revealed COPD (odds ratio (OR) 1.9, p = 0.010, confidence interval (CI) 1.17-3.10), STEMI (OR 2.73, p < 0.001, CI 2.00-3.73), AF (OR 2.30, p < 0.001, CI 1.52-3.49), MVD (OR 1.44, p = 0.012, CI 1.08-1.92), CT (OR 2.87, p = 0.003, CI 1.45-5.69) and LVEF < 50% (OR 3.44, p < 0.001, CI 2.52-4.71) as predictors of VT in ACS.
Conclusions
COPD, STEMI, AF, MVD, CT and LVEF < 50% were predictors of VT in ACS.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Atrial Fibrillation in Acute Coronary Syndrome - early onset impact on MACE. Europace 2021. [DOI: 10.1093/europace/euab116.294] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Atrial Fibrillation (AF) complicates approximately 10% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on ACS patients’ (pts) prognosis.
Objective
To evaluate early onset (≤48h) de novo atrial fibrillation (AF) as predictor of major adverse cardiovascular events (MACE) and in-hospital complications.
Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 8/01/2019. Pts were divided in two groups: A – early onset de novo AF (EOAF), and B – late onset de novo AF (LOAF). Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Univariate logistic regression was performed to assess if LOAF in ACS was a predictor of MACE or complications.
Results
29851 pts had ACS. EOAF occurred in 584 pts (2.0%) and LOAF in 360 pts (1.2%). EOAF were younger (73 ± 13 vs 77 ± 10, p < 0.001) and smokers (21.3% vs 12.1%, p < 0.001). LOAF had higher rates of diabetes mellitus (40.1% vs 30.2%, p < 0.001), angina (30.8% vs 21.4%, p < 0.001), previous ACS (22.5% vs 15.4%, p = 0.006), previous revascularization (percutaneous coronary intervention 14% vs 9.5%, p = 0.032; coronary artery bypass surgery 8.4% vs 3.9%, p = 0.004). ST-segment elevation myocardial infarction (MI) rates were higher in EOAF (56.8% vs 46.9%, p = 0.003) and were admitted directly to the cath lab more often (21.7% vs 13.4%, p = 0.001). Non-ST elevation MI rates were higher in LOAF (44.2% vs 37.7%, p = 0.048). LOAF times from first symptoms to admission were longer (420min vs 183%, p < 0.001), mean brain natriuretic peptide levels were higher (579 vs 447, p = 0.009) and diuretics usage was more frequent (72.8% vs 54.3%, p < 0.001). EOAF had higher rates of heart failure (32.1% vs 17.2%, p < 0.001), atrioventricular block (10.5% vs 7.8%, p = 0.006) and sustained ventricular tachycardia (8.1% vs 3.1%, p = 0.001). LOAF had higher in-hospital mortality (14.2% vs 9.6%, p = 0.031) and longer hospital stay (12 days vs 7 days, p < 0.001). Logistic regression confirmed that EOAF was predictive of in-hospital heart failure (p < 0.001, OR 2.15) and atrioventricular block (p = 0.008, OR 7.46). Regarding 1 year-follow-up, EOAF had poorer prognosis comparing to LOAF (59.3% vs 73.0%, p = 0.018, OR 1.62, CI 1.09-2.42)
Conclusion
EOAF is predictive of MACE, namely heart failure and atrioventricular block, and is associated to poorer prognosis comparing to LOAF.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Almeida I, Paula S, Miranda H, Figueiredo M, Neto M, Sa C, Sousa C, Chin J, Almeida S, Almeida L. Endocardial left ventricular pacing Where are we a systematic review. Europace 2021. [DOI: 10.1093/europace/euab116.433] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits.
Objective
Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.
Methods
A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.
Results
Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p < 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p < 0.00001, I2 = 89%) %) (reported in 5 studies), (all p < 0.00001).
Conclusions
Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Figueiredo
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Neto
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Cardiac arrest in Acute Coronary Syndrome: predictors and prognosis. Europace 2021. [DOI: 10.1093/europace/euab116.336] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Cardiac arrest (CA) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of CA in the setting of ACS.
Objective
To evaluate predictors and prognosis of CA in the setting of ACS.
Methods
Based on a multicenter retrospective study, data collected between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without CA; GB - pts with CA during hospitalization. Logistic regression and survival analysis was performed.
Results
Between 25718 pts with ACS, CA occurred in 651 (2.5%). GB was younger (65 ± 15 vs 67 ± 14, p < 0.001), had higher rates of smoking (35.8% vs 26.4%, p < 0.001), and lower rates of hypertension (62.3% vs 70.9%, p < 0.001), diabetes (25.7% vs 31.7%, p < 0.001), dyslipidaemia (53.8% vs 61.7%, p < 0.001), previous ACS (17.2% vs 20.6%, p = 0.037) and coronary artery bypass grafting (CABG) (1.9% vs 5.1%, p < 0.001). Both groups were similar regarding previous heart failure (p = 0.450) and chronic kidney disease (p = 0.560). GB had shorter times from first symptoms to admission (158min vs 243min, p < 0.001). GA had higher rate of non-ST-elevation myocardial infarction (MI) (78.6% vs 41.4%, p < 0.001), whether GB had higher rates of ST-elevation myocardial infarction (STEMI) (46.7% vs 18.1%, p < 0.001), namely anterior (54.9% vs 46.9%, p < 0.001). GB had lower blood pressure (BP) (122 ± 33 vs 139 ± 28, p < 0.001), higher heart rate (HR) (83 ± 23 vs 77 ± 19, p < 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (37.6% vs 14.6%, p < 0.001), in atrial fibrillation (AF) (13.9% vs 7.0%, p < 0.001) and with right bundle block (10.6% vs 5.3%, p < 0.001). GB had higher rates of common trunk culprit lesion (CL) (3.9% vs 1.6%, p < 0.001), anterior descending coronary CL (49% vs 37%, p < 0.001), 1 vessel lesion (53.4% vs 38.5%, p < 0.001), lower CABG rates (4.3% vs 6.3%, p = 0.042), more left ventricle dysfunction (57.7% vs 38.7%, p < 0.001) and needed more frequently mechanical ventilation (35.3% vs 1.1%, p < 0.001), non-invasive ventilation (6.8% vs 1.6%, p < 0.001) and provisory pacemaker (9.4% vs 1.3%, p < 0.001). Logistic regression confirmed that older age (p < 0.001, OR 1.89, CI 1.35-2.64), higher HR (p < 0.029, OR 1.33, CI 1.03-1.71), lower BP (P < 0.001, OR 2.67, CI 1.94-3.68), KKC ≥2 (p < 0.001, OR 2.35, CI 1.84-3.00), AF at admission (p < 0.001, OR 1.84, CI 1.34-2.51), STEMI (p < 0.001, OR 4.08, CI 3.66-6.77), lower left ventricle function (p = 0.009, OR 1.38, CI 1.08-1.75) were predictors of CA. Event-free survival was higher in GA than GB (92.8% vs 83.3%, OR 1.68, p = 0.008, CI 1.41-2.47).
Conclusion
As expected, CA in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the development of CA during hospitalization, allowing earlier identification and prompt treatment.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Almeida I, Santos M, Paula S, Miranda H, Figueiredo M, Neto M, Sousa C, Sa C, Chin J, Almeida S, Almeida L. Septal vs apical defibrillator electrode placement a systematic review. Europace 2021. [DOI: 10.1093/europace/euab116.405] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The optimal right ventricular defibrillator lead placement is still a debatable matter. We attempt to performed a systemic review to evaluate whether septal and apical placement had significant differences in the follow-up with an indication for implantation of these devices.
Objective
Review the evidence regarding the efficacy and safety of right ventricular apical and septal defibrillator lead placement.
Methods
A systemic research on MEDLINE and PUBMED with the term "septal pacing", "apical pacing" "septal defibrillation" or "apical defibrillation". 309 results were identified, however, after a serious analysis, several articles were excluded. Comparisons between apical and septal placement were performed regarding R wave amplitude, pacing threshold at 0.5 ms, lead impedance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and lead complication that produced lead re-placement. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.
Results
Six studies were selected, including a total of 2180 patients. The studies were performed with different techniques, analyses and goals. The studies presented heterogeneous and diverse results, with a varied follow-up period, that resulted in the exclusion of one of the studies. Mean age 64.51 years old, 76.86% male, a median ejection fraction of 27.84%, NYHA class of 2.65, ischemic etiologic in 51.10% and a follow-up period of 26.49 months. Septal defibrillator lead placement was established in 772 patients, while the apical defibrillator lead placement was performed in 1399 patients. No differences regarding the lead performance on apical and septal placement were detected regarding the R-wave (MD -0.36, CI -0.75 - +0.03, p = 0.68, I2 = 0%) (reported in 3 studies) and lead impedance (MD -23.83, CI -51.36 - +3.69, p = 0.003, I2 = 82%) (reported in 3 studies). Pacing threshold seems to be favor a septal defibrillator lead implantation (MD -0.05, CI -0.09 - -0.02, p = 0.12, I2 = 53%) (reported in 3 studies). Concerning echocardiography parameters during the follow up period, LVEF (MD -0.83, CI -3.05 - +1.38, p = 0.10, I2 = 57%) (reported in 3 studies) and LVEDD (MD -0.51, CI -2.13 - +1.10, p = 0.20, I2 = 38%) (reported in 3 studies) were not significant influenced for the defibrillator lead placement. Lead complications that provoke a lead replacement was not significant between the lead placement (MD 1.25, CI 0.53 – 2.94, p = 0.71, I2 = 0%) (reported in 3 studies).
Conclusions
Just pacing threshold proved to improve the septal defibrillator lead placement. Neither the other lead parameters or the echocardiography results during the follow-up were influenced by the lead placement. For a definitive conclusion is important to further investigation.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Figueiredo
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Neto
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience. Europace 2021. [DOI: 10.1093/europace/euab116.180] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term.
Objective
Evaluate the impact and prognosis of new-onset AF in ACS.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up.
Results
9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p < 0.001) and left ventricular ejection fraction (LVEF) >50% (69.2 vs 45.1%, p < 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p < 0.001), female (26.9 vs 34.0%, p < 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p < 0.001), Killip-Kimball classification > I (12.8 vs 34.8%, p < 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p < 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p < 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p < 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p < 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p < 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515.
Conclusions
New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Atrioventricular block in acute coronary syndrome: Portuguese experience. Europace 2021. [DOI: 10.1093/europace/euab116.317] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
The atrioventricular block (AVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demand a rapid and efficient response regarding reperfusion time and rhythm stabilization.
Objective
Evaluate the impact and prognosis of AVB in ACS patients, as well as predictors of AVB.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess predictors of AVB in ACS patients.
Results
From 32157 patients, 23774 was included, 23148 in group A (97.4%) and 626 in group B (2.6%). Both groups were similar regarding initial symptons until first medical contact (p = 0.410), smoker status (p = 0.222), arterial hypertension (p = 0.776), diabetes mellitus (p = 0.508), peripheral artery disease (p = 0.479), chronic kidney disease (p = 0.467) and re-infarction during the hospitalization for ACS (p = 0.145). Group A had higher body mass index (27.4 ± 4.4 vs 26.9 ± 4.6, p = 0.005), dislipidaemia (59.6 vs 51.4%, p < 0.001), coronary artery disease (18.9 vs 13.0, p < 0.001), heart rate (78 ± 19 vs 65 ± 25, p < 0.001), systolic blood pressure (139 ± 29 vs 119 ± 32, p < 0.001) and left ventricular ejection fraction (LVEF) >50% (60.1 vs 51.7%, p < 0.001). On the other hand, group B was elderly (66 ± 13 vs 71 ± 13, p < 0.001), female (27.4 vs 32.4%, p < 0.001), previous stroke (6.9 vs 10.9%, p < 0.001), neoplasia (4.9 vs 6.8%, p = 0.031), ST-segment elevation myocardial infarction (46.2 vs 75.4%, p < 0.001), syncope as major symptom (1.3 vs 10.0%, p < 0.001), Killip-Kimball class > I (15.4 vs 31.6%, p < 0.001), multivessel diasease (52.1 vs 61.4%, p < 0.001), heart failure complication (15.5 vs 40.6%, p < 0.001), cardiogenic shock complication (3.8 vs 24.6%, p < 0.001), new-onset of atrial fibrillation (4.2 vs 14.1%, p < 0.001), ACS mechanical complication (0.6 vs 3.2%, p < 0.001), sustained ventricular tachycardia during ACS hospitalization (1.3 vs 10.0%, p < 0.001), cardiac arrest (2.7 vs 13.3%, p < 0.001), stroke complication (0.6 vs 1.9%, p < 0.001) and hospitalization death (3.5 vs 19.0%, p < 0.001). Logistic regression revealed that female gender (odds ratio (OR) 1.422, p = 0.015, confidence interval (CI) 1.072-1.885), age ≥75 years old (OR 1.560, p = 0.002, CI 1.174-2.073), heart rate <60 (OR 6.692, p < 0.001, CI 5.180-8.644) and Killip-Kimball class > I (OR 3.264, p < 0.001, CI 2.446-5.356) were predictors of AVB in ACS patients.
Conclusions
Female gender, age ≥75 years old, heart rate <60 and Killip-Kimball class > I were predictors of AVB in ACS patients.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. In-hospital outcomes of sustained ventricular tachycardia in the setting of Acute Coronary Syndrome. Europace 2021. [DOI: 10.1093/europace/euab116.337] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT.
Objective
To evaluate predictors of early onset (<48h) and late onset (≥48h) SVT.
Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS.
Results
Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p < 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p < 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p < 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (<30%) left ventricle dysfunction (32.9% vs 15.4%, p < 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p < 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p < 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p < 0.001) and in-hospital stay (14 days vs 7 days, p < 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70).
Conclusion
LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Vagnoni D, Sousa C, Messman M. Substitution of non-forage fibre sources for cereal grains and molasses in calf starter on performance and development of ruminal function. Journal of Applied Animal Nutrition 2021. [DOI: 10.3920/jaan2020.0016] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One hundred and thirty-six, new-born female Holstein calves (body weight (BW) = 37.6±0.79 kg) were allocated to one of four starter feeds to evaluate the effects of replacing cereal grains and (or) molasses with non-forage fibre sources on intake, weight gain, and indicators of ruminal development. Diets consisted of a typical, low (16%) neutral detergent fibre (NDF) texturised calf starter, texturised calf starter with moderately higher (20%) NDF, texturised calf starter with moderately higher (21%) NDF and no molasses, and a complete pelleted high (25%) NDF calf starter. Average daily gains and starter intakes were unaffected by moderate levels of NDF. Average daily gain and feed intakes were increased in the preweaning phase but decreased in the postweaning phase by the high NDF complete pelleted diet. Total tract apparent NDF digestibility increased linearly with age but did not differ among diets. Blood concentrations of glucose and β-hydroxybutyrate (BHB) decreased and increased, respectively, with age. Further, blood BHB concentrations were largely unaffected by diet and did not change with increasing dry matter (DM) intake until a threshold was reached, and then increased linearly. Calf-side blood BHB testing resulted in an appreciable number of measurements below the limit of detection of the meter, resulting in censored data. Application of appropriate statistical methodology, required for proper parameter estimation from censored data, suggest the potential for successful field application of calf-side BHB measurements for monitoring starter intake and readiness for weaning in commercial settings. Feeding solely a complete pelleted calf starter throughout the starter phase may provide insufficient levels of effective fibre. Integration of the results of this study with previously published literature via a quantitative analysis suggests that maintaining intake may be the key to successful inclusion of non-forage fibre sources in calf starters.
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Affiliation(s)
- D.B. Vagnoni
- Department of Animal Science, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA 93407, USA
| | - C. Sousa
- Department of Animal Science, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA 93407, USA
| | - M.A. Messman
- Cargill Animal Nutrition Center, 10383 165th Ave NW, Elk River, MN 55330, USA
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Santos H, Santos M, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Cardiovascular risk factors as predictors of new onset atrial fibrillation during hospitalization for Acute Coronary Syndromes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.001] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Cardiovascular risk factors (CVRF) are a growing health problem in developed countries, being directly associated with acute coronary syndrome (ACS) occurrence and atrial fibrillation (AF). Nevertheless, new onset of AF in context of ACS is a clinical problem with prognostic and therapeutic implications.
Objective
Evaluate the impact of the CVRF in new onset AF during the hospitalization for ACS.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of AF during the hospitalization for ACS and B – with new onset of AF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset AF in these patients.
Results
14037 patients were included, 637 in group B (4.8%). Both groups were similar regarding diabetes mellitus (p = 0.116), coronary artery disease (p = 0.264) and neoplasia (p = 0.327). Curiously the group A exhibited higher body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p < 0.001), smokers (28.1 vs 18.5%, p < 0.001) and dyslipidemia (62.8 vs 56.7%, p < 0.001). On the other hand, group B presented more females (26.4 vs 35.0%, p < 0.001), arterial hypertension (70.0 vs 74.9%, p = 0.002), peripheral arterial disease (5.4 vs 8.4%, p < 0.001) and chronic kidney disease (6.7 vs 9.5%, p < 0.001). Logistic regression revealed that body mass index, smoker status, diabetes, dyslipidemia, coronary artery disease, neoplasia, chronic kidney disease and peripheral arterial disease were not predictors of AF during the hospitalization for ACS. Nonetheless, female gender (odds ratio (OR) 1.23, p = 0.025, confidence interval (CI) 1.03-1.47), obesity (OR 1.39, p = 0.004, CI 1.11-1.74) and arterial hypertension (OR 1.22, p = 0.049, CI 1.01-1.50) were predictors of new onset of AF during hospitalization for ACS. Conclusions: Female gender, obesity and arterial hypertension were predictors of new onset of AF in during hospitalization for ACS.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Paula S, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Acute heart failure: does etiology matter? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.021] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients (pts) with acute heart failure (AHF) are a heterogeneous population. The etiology of the heart disfunction may play a role in prognosis. Risk stratification at admission may help predict in-hospital complications and needs.
Objective
To explore predictors of in-hospital mortality (IHM), post discharge early mortality [1-month mortality (1mM)] and late mortality [1-year mortality (1yM)] and early and late readmission, respectively 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data.
Methods
Based on a single-center retrospective study, data collected from patients (pts) admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. The pts were divided in 3 groups: ischemic etiology (IE), valvular etiology (VE) and other etiologies (OE), which included hypertensive and idiopathic cardiomyopathies). Statistical analysis used non-parametric tests and Kaplan-Meyer survival analysis.
Results
We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. The heart failure was of IE in 45%, VE in 22.7% and of OE in 32.3% of the cases.
There were no significant differences between groups regarding body mass index, Killip-Kimball class, systolic blood pressure at admission, blood tests aspects at admission (namely, creatinine, sodium or urea), inotropes’ usage or need of non-invasive or invasive ventilation. However, IE group had higher percentage of males comparing to VE e OE (83.0% vs 55.9% vs 70.1%, respectively, p < 0.001), higher rates of prior revascularization procedures (68.9%, vs 19.1%, vs 7.2%, p < 0.001) and higher rates of traditional cardiovascular risk factors, namely hypertension (74.1% vs 55.9% vs 57.7%, p = 0.014), diabetes mellitus (48.1% vs 27.9% vs 27.8%, p = 0.002) and dyslipidaemia (48.9% vs 30.9% vs 40.2%, p = 0.022). OE group was younger compared to IE and VE (63.9 ± 13.5 vs 68.9 ± 11.1 vs 69.5 ± 13.0 years old, respectively, p = 0.003). VE group had less left ventricle disfunction comparing to IE and VE groups (left ventricle ejection fraction 40.8 ± 14.1 vs 32.2 ± 9.8 vs 31.6 ± 12.8%, respectively, p < 0.001).
The groups showed no significant differences regarding IHM (IE 5.2% vs VE 8.8% vs OE 2.1%, p = 0.146), 1mRA (IE 8.1&, VE 7.4%, OE 3.1%, p = 0.276) or 1yRA (IE 55.6%, VE 54.4%, OE 47.4%, p = 0.449). However, VE group had higher rates of 1mM (VE 13.2% vs IE 8.9% vs OE 3.1%, p = 0.05) and 1yM compared to IE and OE (33.8% vs 30.4% vs 17.5%, respectively, p = 0.34). These aspects are represented in Kaplan Meier survival curves.
Conclusion
In our population, the etiology of heart failure was predictor of early and late post-discharge mortality but not readmission.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.082] [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: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation.
Objective
Evaluate the impact of the CVRF in HF during the hospitalization for ACS.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients.
Results
14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p < 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p < 0.001), arterial hypertension (68.7 vs 78.2%, p < 0.001), diabetes mellitus (28.5 vs 43.1%, p < 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p < 0.001), neoplasia (4.4 vs 7.0%, p < 0.001), peripheral arterial disease (5.2 vs 15.8%, p < 0.001) and chronic kidney disease (4.6 vs 10.0%, p < 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p < 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p < 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p < 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p < 0.001, CI 0.59-0.78) in new onset HF in ACS patients.
Conclusions
Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Almeida I, Santos H, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.054] [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.
Introduction
Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial.
Objective
To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data.
Methods
Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA).
Results
268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis <50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%.
KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p < 0.001), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p < 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yRA.
Conclusion
This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Acute Coronary Syndrome - reinfarction predictors and outcomes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.056] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS.
Objective
To evaluate predictors and prognosis of RI in the setting of ACS.
Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed.
Results
Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p < 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p < 0.001) non-invasive ventilation (5.4% vs 1.7%, p < 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p < 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399).
Conclusion
RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Paula S, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Acute heart failure: is ACTION-ICU useful? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.022] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.
Objective
To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data.
Methods
Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis.
Results
We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge.
Older age (p < 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p < 0.001, OR 8.13) and need of inotropes (p < 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage.
ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV.
ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84).
Conclusion
In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Paula S, Almeida I, Santos H, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Acute heart failure: predicting early in-hospital outcomes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.019] [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.
Introduction
Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.
Objective
To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data.
Methods
Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis.
Results
Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge.
Older age (p < 0.001), lower SBP (p = 0,035) and need of inotropes (p < 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage.
Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p < 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p < 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84).
Conclusion
In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Paula
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Miranda H, Santos M, Almeida I, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Acute Coronary Syndrome follow up: Portuguese experience. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.261] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
Acute coronary syndrome is a major health problem, with several acute and chronic complications. So, it is imperative identifying factors that can be associated with better and worse prognosis during the follow up these patients.
Objective
Evaluate predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Logistic regression was performed to assess predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.
Results
1492 patients were included, 141 die during the first year. Age > 75 years old (odds ratio (OR) 2.557, p < 0.001, confidence interval (CI) 1.727-3.785), heart rate < 60 (OR 2.686, p = 0.008, CI 1.296-5.569), cardiogenic shock (OR 6.726, p = 0.012, CI 1.512-29.915), creatinine >2mg/dL (OR 1.956, p = 0.023, CI 1.099-3.480), left ventricular ejection fraction <50% (OR 1.911, p = 0.001, CI 1.284-2.844), nitrate (OR 1.589, p = 0.020, CI 1.074-2.351), ivabradine (OR 1.831, p = 0.011, CI 1.146-2.924), aldosterone antagonists (OR 1.632, p = 0.020, CI 1.079-2.468), diuretic (OR 1.625, p = 0.023, CI 1.069-2.472) and mechanical complication d (OR 55.518, p < 0.001, CI 11.516-267.655) were predictors of mortality of 1 year of follow up. Regarding cardiovascular readmission was registered in 291 patients, of a total 1412. Were predictors of cardiovascular readmission previous history of heart failure (OR 1.467, p = 0.003, CI 1.135-1.895), cardiogenic shock (OR 3.447, p = 0.039, CI 1.068-11.128), acetylsalicylic acid previous to ACS (OR 1.751, p = 0.008, CI 1.285-2.385), multivessel disease (OR 1.667, p = 0.002, CI 1.206-2.306), left ventricular ejection fraction <50% (OR 1.489, p = 0.003, CI 1.145-1.938), nitrate (OR 1.812, p < 0.001, CI 1.403-2.341), aldosterone antagonists (OR 1.572, p = 0.004, CI 1.155-2.140) and sustained ventricular tachycardia (OR 55.518, p < 0.001, CI 11.516-267.655). On the other hand 411 patients was readmitted (all causes), in 1455 patients with follow up. Were predictors of all causes of readmission previous history of heart failure (OR 1.347, p = 0.025, CI 1.039-1.747), previous chronic obstructive pulmonary disease (OR 1.456, p = 0.041, CI 1.016-2.087), atrial fibrillation (OR 1.439, p = 0.027, CI 1.041-1.988), acetylsalicylic acid previous to ACS (OR 1.473, p = 0.001, CI 1.161-1.869), left ventricular ejection fraction <50% (OR 1.456, p = 0.001, CI 1.166-1.819), nitrate (OR 1.478, p < 0.001, CI 1.192-1.831), aldosterone antagonists (OR 1.493, p = 0.003, CI 1.148-1.943) and sustained ventricular tachycardia (OR 3.792, p = 0.004, CI 1.540-9.337). Conclusions: Left ventricular ejection fraction <50%, nitrate as discharge therapeutic and aldosterone antagonists as discharge therapeutic were predictors of mortality, cardiovascular readmission and readmission for all causes at 1 year follow up.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Stroke in acute coronary syndrome: predictors and prognosis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.055] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Stroke is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of stroke in the setting of ACS.
Objective
To evaluate predictors and prognosis of stroke in the setting of ACS.
Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without stroke; GB - pts with stroke during hospitalization. Logistic regression was performed to assess predictors of stroke in ACS. Survival analysis was evaluated through Kaplan Meier curve.
Results
Population – 25711 pts with ACS, CA occurred in 154 (0.6%). Regarding epidemiological factors and past history, GB was older (72 ± 12 vs 67 ± 14, p < 0.001), had higher rates of females (53.2% vs 27.5%, p < 0.001), diabetes (43.9% vs 31.5%, p < 0.001), previous stroke (13.3% vs 7.2%, p = 0.004), peripheric arterial disease (9.2% vs 5.5%, p = 0.044) and dementia (6.8% vs 1.7%, p < 0.001), and had lower rates of smoking (16.6% vs 26.7%, p = 0.005), dyslipidaemia (53.5% vs 61.6%, p = 0.047) and previous ACS (12.7% vs 20.6%, p = 0.017. GB had longer times from first symptoms to admission (340min vs 240min, p = 0.011). The groups were similar regarding diagnosis, namely non-ST-elevation myocardial infarction (MI) (p = 0.345) and ST-elevation MI (p = 0.541). GB had higher heart rate (HR) (84 ± 24 vs 77 ± 19, p = 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (28.0% vs 15.1%, p < 0.001), in atrial fibrillation (AF) (16.4% vs 7.1%, p < 0.001) and with higher brain-natriuretic peptide levels (545 vs 180, p < 0.001). The groups were similar regarding culprit lesion and number of lesions. GB had more left ventricle (<50%) dysfunction (51.4% vs 39.1%, p < 0.001) and needed more frequently mechanical ventilation (10.4% vs 1.9%, p < 0.001) and provisory pacemaker (8.4% vs 1.5%, p < 0.001).
Logistic regression confirmed that older age (p = 0.018, OR 1.69, CI 1.10-2.60), female gender (p < 0.001, OR 2.09, CI 1.38-3.15), diabetes (p = 0.002, OR 1.91, CI 1.27-2.86), dementia (p = 0.047, OR 2.13, CI 1.01-4.50), AF (p = 0.024, OR 1.87, CI 1.09-3.21) and lower left ventricle function (p = 0.002, OR 2.01, CI 1.29-3.15) were predictors of stroke in the setting of ACS. Event-free survival was higher in GA than GB (79.9% vs 70.5%, OR 1.58, p < 0.001, CI 1.36-1.83).
Conclusion
As expected, stroke in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the occurrence of stroke during hospitalizations, therefore allowing an earlier identification and prompt treatment.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos H, Santos M, Miranda H, Almeida I, Sa C, Chin J, Almeida S, Sousa C, Almeida L. Cardiovascular risk factors as predictors of completed atrioventricular block during hospitalization for Acute Coronary Syndromes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.081] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Portuguese Registry of Acute Coronary Syndromes
Background
The presence of cardiovascular risk factors (CVRF) are directly related to acute coronary syndrome (ACS) occurrence. ACS is a major health problem with multiple complications. Completed atrioventricular block (CAVB) in context of ACS can impact the patient’s prognosis, and is not clarified if its presence can be predicted only by CVFR.
Objective
Evaluate the impact of the CVRF in CAVB during the hospitalization for ACS.
Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without CAVB during the hospitalization for ACS and B – with CAVB during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of CAVB in these patients.
Results
14031 patients were included, 401 in group B (2.9%). Both groups were similar regarding smoking status (p = 0.920), arterial hypertension (p = 0.928), diabetes mellitus (p = 0.249), peripheral arterial disease (p = 0.352) and chronic kidney disease (p = 0.783). Interestingly the group A exhibited higher body mass index (27.4 ± 4.3 vs 26.9 ± 4.5, p < 0.001), dyslipidemia (62.8 vs 53.6%, p < 0.001) and coronary artery disease (20.7 vs 15.0%, p = 0.001). On the other hand, group B presented more females (26.7 vs 31.5%, p = 0.012), mean age (66 ± 13 vs 71 ± 13, p < 0.001) and neoplasia (4.8 vs 7.1%, p = 0.012). Logistic regression revealed that any of the CVRF were a predictor of CAVB during the hospitalization for ACS. Just, age (odds ratio 1.48, p < 0.001, confidence interval 1.16-1.88) has been a predictor of CAVB during hospitalization for ACS.
Conclusions
Any CVFR was a predictor of CAVB in context of ACS. Age was a predictor of CAVB during hospitalization for ACS.
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Affiliation(s)
- H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Santos M, Santos H, Almeida I, Miranda H, Sa C, Chin J, Almeida S, Sousa C, Tavares J, Santos L, Almeida ML. Heart failure in Acute Coronary Syndrome: predictors and prognosis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.053] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "
Introduction
Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF.
Objective
To evaluate predictors and prognosis of HF in the setting of ACS.
Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization.
Results
HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56).
Conclusion
As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.
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Affiliation(s)
- M Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - I Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - H Miranda
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Chin
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - S Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - C Sousa
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - J Tavares
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - L Santos
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
| | - ML Almeida
- Hospital N.S. Rosario, Cardiology, Barreiro, Portugal
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Scopel CFV, Sousa C, Machado MRF, Santos WGD. BPA toxicity during development of zebrafish embryo. BRAZ J BIOL 2021; 81:437-447. [DOI: 10.1590/1519-6984.230562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/23/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract Bisphenol A (BPA) is a monomer used in the production of polycarbonate, a polymer commonly found in plastics, epoxy resins and thermal papers. The presence of BPA in food, water, air and dust has been of great concern in recent years not only due to environmental and ecological issues but also because of its supposed risk to public health related to its mutagenic and carcinogenic potential. In this study we evaluated the toxicity of bisphenol A in zebrafish embryos (Danio rerio) and determined the 50% lethal concentration (LC50) of this chemical. BPA was used at concentrations ranging from 1 μM to 100 μM in E3 medium/0.5% dimethylsulfoxide (DMSO) from previously prepared stock solutions in 100% DMSO. Controls included embryos exposed only to E3 medium or supplemented with 0.5% DMSO. Camptothecin (CPT), a known inhibitor of cell proliferation was used as positive control at a concentration of 0.001 μM in E3 medium/0.5% DMSO. Adults zebrafish were placed for breeding a day before the experimental set up, then, viable embryos were collected and selected for use. Experiments were carried out in triplicates, according to specifications from Organization for Economic Cooperation and Development (OECD). One embryo/well (25 embryos per concentration) was distributed in 96 well microplates in presence or absence of the chemicals. The plates were kept in BOD incubators with a controlled temperature of 28.5 ºC and with photoperiod of 14 h light:10 h dark. After 24h, 48h, 72h and 96h exposure, the exposed embryos were evaluated according to the following parameters: mortality, coagulation, rate of heartbeat, hatching and presence of morphological abnormalities. Photography was obtained by photomicroscopy. Apoptosis was evaluated by DNA ladder assay. DNA was extracted by phenol:chloroform method and analyzed by 2% agarose gel electrophoresis. DNA fragments were visualized after ethidium bromide staining in ultraviolet transilluminator. The LC50 determined for BPA was 70 μM after 24 hours, 72 μM after 48 hours, 47 μM after 72 hours and 31 μM after 96 hours exposure. BPA induced morphological and physiological alterations such as yolk sac and pericardial edema, hatching delay or inhibition, spine deformation, decreasing in heartbeat rate and mortality. In conclusion, this study demonstrated that BPA induced marked malformations in zebrafish embryos at concentrations above 25 μM corroborating the current concerns related to the widespread presence of BPA in the air, food and water used by humans as well as in the bodily fluids and tissues.
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Affiliation(s)
| | - C. Sousa
- Universidade Federal de Goiás, Brasil
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Vieira-Baptista P, Silva AR, Costa M, Aguiar T, Saldanha C, Sousa C. Clinical validation of a new molecular test (Seegene Allplex™ Vaginitis) for the diagnosis of vaginitis: a cross-sectional study. BJOG 2021; 128:1344-1352. [PMID: 33540484 DOI: 10.1111/1471-0528.16661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To validate the use of Seegene Allplex™ Vaginitis assay in the diagnosis of candidiasis, bacterial vaginosis (BV) and trichomoniasis. DESIGN Cross-sectional, prospective study conducted in a single centre. SETTING Outpatient clinic of a gynaecology department. POPULATION Consecutive symptomatic and asymptomatic women (18-60 years of age). METHODS Comparison of the assay test with the reference standards for the diagnosis of vaginitis (cultures for yeasts, Nugent for BV and nucleic acid amplification test for trichomoniasis). MAIN OUTCOME MEASURES Performance of the investigational assay, in comparison with the reference standards for the diagnosis of the presence of Candida spp., Trichomonas vaginalis and BV. Secondary objectives are the evaluation of the performance of the test in postmenopausal women and in symptomatic women. RESULTS A diagnosis of vaginitis was established in 14.0%. The global prevalences of BV, Candida spp. and T. vaginalis were 22.3%, 13.2% and 2.4%, respectively. The sensitivity and specificity of the assay test for those three causes of vaginitis were as follows: BV 91.7% and 86.6%; any Candida spp. 91.1% and 95.6%; Candida albicans 88.1% and 98.2%, non-albicans Candida 100% and 97.5%, and T. vaginalis 94.4 and 99.9%. The performance of the test was identical in the subgroup of women that reported vulvovaginal symptoms. The presence of multiple infections did not interfere with the performance of the test. CONCLUSIONS The Seegene Allplex™ Vaginitis assay has an excellent performance in the diagnosis of the BV and presence of Candida; the results were good for trichomoniasis, but the study was underpowered for this outcome. TWEETABLE ABSTRACT Seegene Allplex™ Vaginitis is an excellent option for screening and diagnosis of vaginitis.
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Affiliation(s)
- P Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal.,Lower Genital Tract Unit, Gynaecology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A R Silva
- LAP, a Unilabs Company, Porto, Portugal
| | - M Costa
- LAP, a Unilabs Company, Porto, Portugal
| | - T Aguiar
- Centro Hospitalar de São João, Porto, Portugal
| | | | - C Sousa
- LAP, a Unilabs Company, Porto, Portugal
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