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R Sousa B, Rodrigues TB, Ribeiro J. When the Stomach Takes a Vacation: The Unseen Battles of Gastroparesis. Cureus 2024; 16:e56263. [PMID: 38623117 PMCID: PMC11017365 DOI: 10.7759/cureus.56263] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
Gastroparesis is a syndrome characterised by delayed gastric emptying that is usually idiopathic, diabetic, or iatrogenic. This underdiagnosed disease has a substantial influence on the quality of life of its patients. We present the case of an 86-year-old man with dementia, benign prostatic hyperplasia, and gastroesophageal reflux disease who developed symptoms of gastroparesis during a lengthy hospital stay. Computed tomography (CT) and upper digestive endoscopy demonstrated gastric distention and pyloric stenosis. Despite cautious treatment and eventual pyloric dilation, the patient died from aspiration due to refractory respiratory failure. This example emphasises the need for early detection and thorough examination of gastroparesis to optimise patient outcomes and reduce morbidity and mortality.
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Affiliation(s)
- Beatriz R Sousa
- Internal Medicine, Hospital de São José, Unidade Local de Saúde São José, Lisbon, PRT
| | | | - José Ribeiro
- Internal Medicine, Hospital de São José, Unidade Local de Saúde São José, Lisbon, PRT
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2
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Santos-Ferreira D, Fernandes I, Diaz SO, Guerreiro C, Saraiva F, Barros AS, Leite-Moreira A, Pereira E, Sampaio F, Ribeiro J, Braga P, Fontes-Carvalho R. Prognostic value of flow-status in severe aortic stenosis patients undergoing percutaneous intervention. Int J Cardiovasc Imaging 2024; 40:341-350. [PMID: 37981631 PMCID: PMC10884040 DOI: 10.1007/s10554-023-02992-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Low-flow status is a mortality predictor in severe aortic stenosis (SAS) patients, including after transcatheter aortic valve implantation (TAVI) treatment. However, the best parameter to assess flow is unknown. Recent studies suggest that transaortic flow rate (FR) is superior to currently used stroke volume index (SVi) in defining low-flow states. Therefore, we aimed to evaluate the prognostic value of FR and SVi in patients undergoing TAVI. METHODS A single-centre retrospective analysis of all consecutive patients treated with TAVI for SAS between 2011 and 2019 was conducted. Low-FR was defined as < 200 mL/s and low-SVi as < 35 mL/m2. Primary endpoint was all-cause five-year mortality, analyzed using Kaplan-Meier curves and Cox regression models. Secondary endpoint was variation of NYHA functional class six months after procedure. Patients were further stratified according to ejection fraction (EF < 50%). RESULTS Of 489 cases, 59.5% were low-FR, and 43.1% low-SVi. Low-flow patients had superior surgical risk, worse renal function, and had a higher prevalence of coronary artery disease. Low-FR was associated with mortality (hazard ratio 1.36, p = 0.041), but not after adjustment to EuroSCORE II. Normal-SVi was not associated with survival, despite a significative p-trend for its continuous value. No associations were found for flow-status and NYHA recovery. When stratifying according to preserved and reduced EF, both FR and SVi did not predict all-cause mortality. CONCLUSION In patients with SAS undergoing TAVI, a low-FR state was associated with higher mortality, as well as SVi, but not at a 35 mL/m2 cut off.
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Affiliation(s)
- Diogo Santos-Ferreira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Isabel Fernandes
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Sílvia O Diaz
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Francisca Saraiva
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - António S Barros
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Eulália Pereira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - José Ribeiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Pedro Braga
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, 4434-502, Portugal.
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
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Leukes VN, Hella J, Sabi I, Cossa M, Khosa C, Erkosar B, Mangu C, Siyame E, Mtafya B, Lwilla A, Viegas S, Madeira C, Machiana A, Ribeiro J, Garcia-Basteiro AL, Riess F, Elísio D, Sasamalo M, Mhalu G, Denkinger CM, Castro MDM, Bashir S, Schumacher SG, Tagliani E, Malhotra A, Dowdy D, Schacht C, Buech J, Nguenha D, Ntinginya N, Ruhwald M, Penn-Nicholson A, Kranzer K. Study protocol: a pragmatic, cluster-randomized controlled trial to evaluate the effect of implementation of the Truenat platform/MTB assays at primary health care clinics in Mozambique and Tanzania (TB-CAPT CORE). BMC Infect Dis 2024; 24:107. [PMID: 38243223 PMCID: PMC10797907 DOI: 10.1186/s12879-023-08876-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In 2020, the WHO-approved Molbio Truenat platform and MTB assays to detect Mycobacterium tuberculosis complex (MTB) and resistance to rifampicin directly on sputum specimens. This primary health care center-based trial in Mozambique and Tanzania investigates the effect of Truenat platform/MTB assays (intervention arm) combined with rapid communication of results compared to standard of care on TB diagnosis and treatment initiation for microbiologically confirmed TB at 7 days from enrolment. METHODS The Tuberculosis Close the Gap, Increase Access, and Provide Adequate Therapy (TB-CAPT) CORE trial employs a pragmatic cluster randomized controlled design to evaluate the impact of a streamlined strategy for delivery of Truenat platform/MTB assays testing at primary health centers. Twenty-nine centers equipped with TB microscopy units were selected to participate in the trial. Among them, fifteen health centers were randomized to the intervention arm (which involves onsite molecular testing using Truenat platform/MTB assays, process process optimization to enable same-day TB diagnosis and treatment initiation, and feedback on Molbio platform performance) or the control arm (which follows routine care, including on-site sputum smear microscopy and the referral of sputum samples to off-site Xpert testing sites). The primary outcome of the study is the absolute number and proportion of participants with TB microbiological confirmation starting TB treatment within 7 days of their first visit. Secondary outcomes include time to bacteriological confirmation, health outcomes up to 60 days from first visit, as well as user preferences, direct cost, and productivity analyses. ETHICS AND DISSEMINATION TB-CAPT CORE trial has been approved by regulatory and ethical committees in Mozambique and Tanzania, as well as by each partner organization. Consent is informed and voluntary, and confidentiality of participants is maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals. TRIAL REGISTRATION US National Institutes of Health's ClinicalTrials.gov, NCT04568954. Registered 23 September 2020.
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Affiliation(s)
| | - J Hella
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - I Sabi
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - M Cossa
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - C Khosa
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | | | - C Mangu
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - E Siyame
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - A Lwilla
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | - S Viegas
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - C Madeira
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A Machiana
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - J Ribeiro
- Instituto Nacional de Saúde (INS), Marracuene, Mozambique
| | - A L Garcia-Basteiro
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - F Riess
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany
| | - D Elísio
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - M Sasamalo
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - G Mhalu
- Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - C M Denkinger
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - M D M Castro
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | - S Bashir
- Division of Infectious Disease and Tropical Medicine and German Centre for Infection Research, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Malhotra
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | - D Dowdy
- Johns Hopkins University (JHU), Baltimore, MD, USA
| | | | - J Buech
- LINQ Management, Berlin, Germany
| | - D Nguenha
- Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique
| | - N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research (NIMR), Mbeya, Tanzania
| | | | | | - K Kranzer
- Division of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University Hospital, Munich, Germany.
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
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Vilela EM, Oliveira C, Oliveira C, Torres S, Sampaio F, Primo J, Ribeiro J, Teixeira M, Oliveira M, Bettencourt N, Viamonte S, Fontes-Carvalho R. Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring. Porto Biomed J 2023; 8:e235. [PMID: 37846299 PMCID: PMC10575366 DOI: 10.1097/j.pbj.0000000000000235] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
The cardiovascular response to exercise has long been a focus of interest. Over a century ago, the first descriptions of electrocardiographic changes occurring during exercise highlighted the possible relevance of this dynamic assessment. In this background, the inception of the Bruce protocol circa 60 years ago allowed for a major leap in this field by providing a standardized framework with which to address this issue, by means of an integrated and structured methodology. Since then, exercise stress testing with electrocardiographic monitoring (ExECG) has become one of the most widely appraised tests in cardiovascular medicine. Notably, past few decades have been profoundly marked by substantial advances in the approach to cardiovascular disease, challenging prior notions concerning both its physiopathology and overall management. Among these, the ever-evolving presentations of cardiovascular disease coupled with the development and implementation of several novel diagnostic modalities (both invasive and noninvasive) has led to a shifting paradigm in the application of ExECG. This technique, however, has continuously shown to be of added value across various momentums of the cardiovascular continuum, as depicted in several contemporary guidelines. This review provides a pragmatical reflexion on the development of ExECG, presenting a comprehensive overview concerning the current role of this modality, its challenges, and its future perspectives.
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Affiliation(s)
- Eduardo M. Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cátia Oliveira
- Cardiology Department, Hospital de Braga, Braga, Portugal
- Faculty of Medicine, Minho University, Braga, Portugal
| | - Cláudia Oliveira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Susana Torres
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Cardiovascular Research Center (UniC@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Primo
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Bettencourt
- Cardiovascular Research Center (UniC@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sofia Viamonte
- North Rehabilitation Centre, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Cardiovascular Research Center (UniC@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
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Castelo-Branco L, Lee R, Brandão M, Cortellini A, Freitas A, Garassino M, Geukens T, Grivas P, Halabi S, Oliveira J, Pinato DJ, Ribeiro J, Peters S, Pentheroudakis G, Warner JL, Romano E. Learning lessons from the COVID-19 pandemic for real-world evidence research in oncology-shared perspectives from international consortia. ESMO Open 2023; 8:101596. [PMID: 37418836 PMCID: PMC10277850 DOI: 10.1016/j.esmoop.2023.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- L Castelo-Branco
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal.
| | - R Lee
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| | - M Brandão
- Medical Oncology Department, Institut Jules Bordet, Brussels, Belgium
| | - A Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; Department of Surgery and Cancer, Hammersmight Hospital Campus, Imperial College London, London
| | - A Freitas
- Department of Computer Science/CRUK Manchester Institute, The University of Manchester, Manchester, UK; IDIAP Research Institute, Martigny, Switzerland
| | - M Garassino
- Department of medicine, Hematology Oncology section, The University of Chicago, Chicago, USA
| | - T Geukens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Grivas
- Department of Medicine, Division of Oncology, University of Washington, Seattle; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle
| | - S Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - J Oliveira
- Department of Medicine, Instituto Português de Oncologia, Porto, Portugal
| | - D J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - J Ribeiro
- Gustave Roussy, Department of Cancer Medicine, Villejuif, France
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - G Pentheroudakis
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - J L Warner
- Center for Clinical Cancer Informatics and Data Science, Division of Hematology/Oncology, Department of Medicine, Brown University, Providence, USA
| | - E Romano
- Emanuela Romano Center of Cancer Immunotherapy, Department of Oncology, Institut Curie, Paris, France
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Martin P, Tsourti Z, Ribeiro J, Castelo-Branco L, de Azambuja E, Gennatas S, Rogado J, Sekacheva M, Šušnjar S, Viñal D, Lee R, Khallaf S, Dimopoulou G, Pradervand S, Whisenant J, Choueiri TK, Arnold D, Harrington K, Punie K, Oliveira J, Michielin O, Dafni U, Peters S, Pentheroudakis G, Romano E. COVID-19 in cancer patients: update from the joint analysis of the ESMO-CoCARE, BSMO, and PSMO international databases. ESMO Open 2023; 8:101566. [PMID: 37285719 DOI: 10.1016/j.esmoop.2023.101566] [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: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND COVID-19 has significantly affected patients with cancer and revealed unanticipated challenges in securing optimal cancer care across different disciplines. The European Society for Medical Oncology COVID-19 and CAncer REgistry (ESMO-CoCARE) is an international, real-world database, collecting data on the natural history, management, and outcomes of patients with cancer and SARS-CoV-2 infection. METHODS This is the 2nd CoCARE analysis, jointly with Belgian (Belgian Society of Medical Oncology, BSMO) and Portuguese (Portuguese Society of Medical Oncology, PSMO) registries, with data from January 2020 to December 2021. The aim is to identify significant prognostic factors for COVID-19 hospitalization and mortality (primary outcomes), as well as intensive care unit admission and overall survival (OS) (secondary outcomes). Subgroup analyses by pandemic phase and vaccination status were carried out. RESULTS The cohort includes 3294 patients (CoCARE: 2049; BSMO: 928, all hospitalized by eligibility criteria; PSMO: 317), diagnosed in four distinct pandemic phases (January to May 2020: 36%; June to September 2020: 9%; October 2020 to February 2021: 41%; March to December 2021: 12%). COVID-19 hospitalization rate was 54% (CoCARE/PSMO), ICU admission 14%, and COVID-19 mortality 22% (all data). At a 6-month median follow-up, 1013 deaths were recorded with 73% 3-month OS rate. No significant change was observed in COVID-19 mortality among hospitalized patients across the four pandemic phases (30%-33%). Hospitalizations and ICU admission decreased significantly (from 78% to 34% and 16% to 10%, respectively). Among 1522 patients with known vaccination status at COVID-19 diagnosis, 70% were non-vaccinated, 24% had incomplete vaccination, and 7% complete vaccination. Complete vaccination had a protective effect on hospitalization (odds ratio = 0.24; 95% confidence interval [0.14-0.38]), ICU admission (odds ratio = 0.29 [0.09-0.94]), and OS (hazard ratio = 0.39 [0.20-0.76]). In multivariable analyses, COVID-19 hospitalization was associated with patient/cancer characteristics, the first pandemic phase, the presence of COVID-19-related symptoms or inflammatory biomarkers, whereas COVID-19 mortality was significantly higher in symptomatic patients, males, older age, ethnicity other than Asian/Caucasian, Eastern Cooperative Oncology Group performance status ≥2, body mass index <25, hematological malignancy, progressive disease versus no evident disease, and advanced cancer stage. CONCLUSIONS The updated CoCARE analysis, jointly with BSMO and PSMO, highlights factors that significantly affect COVID-19 outcomes, providing actionable clues for further reducing mortality.
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Affiliation(s)
- P Martin
- Department of Oncology, Institut Curie, Paris, France
| | - Z Tsourti
- Frontier Science Foundation-Hellas, Athens, Greece
| | - J Ribeiro
- Gustave Roussy, Department of Cancer Medicine, Villejuif, France
| | - L Castelo-Branco
- NOVA National School of Public Health, NOVA University, Lisbon, Portugal; Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - E de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - S Gennatas
- Medical Oncology Department, The Royal Marsden Hospital - NHS Foundation Trust, London, UK
| | - J Rogado
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M Sekacheva
- World-Class Research Center 'Digital Biodesign and Personalized Healthcare', Sechenov First Moscow State Medical University, Moscow, Russia
| | - S Šušnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - D Viñal
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - R Lee
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| | - S Khallaf
- Medical Oncology Department, South Egypt Cancer Institute (SECI), Assiut University, Assiut, Egypt
| | - G Dimopoulou
- Frontier Science Foundation-Hellas, Athens, Greece
| | - S Pradervand
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - J Whisenant
- Vanderbilt University Medical Center, Nashville
| | - T K Choueiri
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Department of Oncology, Haematology and Palliative Care, Hamburg, Germany
| | - K Harrington
- Division of Radiotherapy and Imaging, The Royal Marsden/The Institute of Cancer Research NIHR Biomedical Research Centre, London, UK
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - J Oliveira
- Department of Medicine, Instituto Português de Oncologia, Porto, Portugal
| | - O Michielin
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens Frontier Science Foundation-Hellas, Athens, Greece
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - G Pentheroudakis
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - E Romano
- Department of Oncology, Institut Curie, Paris, France.
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Ribeiro J, Pires-Morais G. IVUS versus OCT: Calibrating the use of intracoronary imaging. Rev Port Cardiol 2023:S0870-2551(23)00193-2. [PMID: 37023981 DOI: 10.1016/j.repc.2023.04.004] [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: 04/07/2023] Open
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Paulino D, Guimarães D, Correia A, Ribeiro J, Barroso J, Paredes H. A Model for Cognitive Personalization of Microtask Design. Sensors (Basel) 2023; 23:3571. [PMID: 37050630 PMCID: PMC10098703 DOI: 10.3390/s23073571] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
The study of data quality in crowdsourcing campaigns is currently a prominent research topic, given the diverse range of participants involved. A potential solution to enhancing data quality processes in crowdsourcing is cognitive personalization, which involves appropriately adapting or assigning tasks based on a crowd worker's cognitive profile. There are two common methods for assessing a crowd worker's cognitive profile: administering online cognitive tests, and inferring behavior from task fingerprinting based on user interaction log events. This article presents the findings of a study that investigated the complementarity of both approaches in a microtask scenario, focusing on personalizing task design. The study involved 134 unique crowd workers recruited from a crowdsourcing marketplace. The main objective was to examine how the administration of cognitive ability tests can be used to allocate crowd workers to microtasks with varying levels of difficulty, including the development of a deep learning model. Another goal was to investigate if task fingerprinting can be used to allocate crowd workers to different microtasks in a personalized manner. The results indicated that both objectives were accomplished, validating the usage of cognitive tests and task fingerprinting as effective mechanisms for microtask personalization, including the development of a deep learning model with 95% accuracy in predicting the accuracy of the microtasks. While we achieved an accuracy of 95%, it is important to note that the small dataset size may have limited the model's performance.
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Affiliation(s)
- Dennis Paulino
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
- INESC TEC, 4200-465 Porto, Portugal
| | - Diogo Guimarães
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
- INESC TEC, 4200-465 Porto, Portugal
| | - António Correia
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
- INESC TEC, 4200-465 Porto, Portugal
| | - José Ribeiro
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
| | - João Barroso
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
- INESC TEC, 4200-465 Porto, Portugal
| | - Hugo Paredes
- School of Science and Technology, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal; (D.P.)
- INESC TEC, 4200-465 Porto, Portugal
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9
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Ribeiro J. Three-dimensional transesophageal echocardiography - An added value tool for the assessment of aortic plaques in ischemic stroke. Rev Port Cardiol 2023; 42:157-159. [PMID: 36526132 DOI: 10.1016/j.repc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- José Ribeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Serviço de Cardiologia, Vila Nova de Gaia, Portugal.
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10
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Brandão M, Temtem M, Costa SS, Ribeiro J, Fontes-Carvalho R. Concomitant left atrial and left ventricular masses: lessons to clinical practice. Eur Heart J Cardiovasc Imaging 2023; 24:e31. [PMID: 36423228 DOI: 10.1093/ehjci/jeac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mariana Brandão
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Margarida Temtem
- Department of Cardiology, Hospital Central do Funchal-Madeira, Funchal, Portugal
| | - Sara Simões Costa
- Department of Cardiothoracic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal.,Cardiovascular R&D Centre-UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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11
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Gonçalves-Teixeira P, Costa T, Fragoso I, Ferreira D, Brandão M, Leite-Moreira A, Sampaio F, Ribeiro J, Fontes-Carvalho R. Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives. Arq Bras Cardiol 2022; 119:328-341. [PMID: 35946695 PMCID: PMC9363048 DOI: 10.36660/abc.20201362] [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: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.
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Affiliation(s)
- Pedro Gonçalves-Teixeira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Telma Costa
- Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal.,Departamento de Oncologia, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Isabel Fragoso
- Unidade de Atenção Primária à Saúde Aracetti, Arazede - Portugal
| | - Diogo Ferreira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Mariana Brandão
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Departamento de Cirurgia Cardiotorácica, Hospital Universitário São João, Porto - Portugal.,Unidade de Pesquisa Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Francisco Sampaio
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - José Ribeiro
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
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12
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Silva MR, Azevedo AI, Sampaio F, Ribeiro J, Fontes-Carvalho R. "Lightning The Heart" with 3D Echo: Transillumination of a Prosthetic Mitral Valve Dehiscence. Arq Bras Cardiol 2022; 119:358-360. [PMID: 35946700 PMCID: PMC9363061 DOI: 10.36660/abc.20210655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Francisco Sampaio
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto - Portugal.,University of Oporto, Oporto - Portugal
| | - José Ribeiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto - Portugal
| | - Ricardo Fontes-Carvalho
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto - Portugal.,University of Oporto, Oporto - Portugal
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13
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Pais JA, Sampaio F, Ribeiro J, Fontes-Carvalho R. Cardiac papillary fibroelastoma – different locations, the same suspect. Rev Port Cardiol 2022; 41:433-434. [DOI: 10.1016/j.repc.2021.08.004] [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] [Received: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 10/18/2022] Open
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14
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Brito J, Silva P, Valente Silva B, Pereira S, Silverio Antonio P, Morais P, Rigueira J, Placido R, David C, Silva D, Fernandes S, Ribeiro J, Pinto FJ, Almeida A. Long term left ventricular impairment after SARS-COV2 infection. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.105] [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
The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown.
Purpose
To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization.
Methods
This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis.
Results
A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS.
Conclusion
In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Long-term monitoring of these patients should be undertaken in order to timely detect late complications. Abstract Figure.
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Affiliation(s)
- J Brito
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Pereira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Silverio Antonio
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - P Morais
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Rigueira
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - R Placido
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - C David
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - D Silva
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - S Fernandes
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - J Ribeiro
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
| | - A Almeida
- Santa Maria University Hospital CHLN Lisbon Academic Medical Centre, Lisbon, Portugal
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15
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Guerreiro C, Melica B, Barbosa AR, Dias A, Ribeiro J, Caeiro D, Braga P. Rescue percutaneous repair of ischemic acute severe mitral regurgitation. Rev Port Cardiol 2022; 41:349.e1-349.e6. [DOI: 10.1016/j.repc.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/03/2019] [Accepted: 02/22/2020] [Indexed: 11/24/2022] Open
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16
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Vilela EM, Ladeiras-Lopes R, Joao A, Braga J, Torres S, Viamonte S, Ribeiro J, Teixeira M, Nunes JP, Fontes-Carvalho R. Current role and future perspectives of cardiac rehabilitation in coronary heart disease. World J Cardiol 2021; 13:695-709. [PMID: 35070112 PMCID: PMC8716974 DOI: 10.4330/wjc.v13.i12.695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/08/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
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Affiliation(s)
- Eduardo M Vilela
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ana Joao
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Joana Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Susana Torres
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Sofia Viamonte
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4405-565, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
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17
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Melica B, Braga P, Ribeiro J, Pires-Morais G, Fonte Boa A, Guerreiro C, Caeiro D, Pereira R, Meerkin D, Fontes-Carvalho R. Transeptal Mitral Annuloplasty With the AMEND System: First-in-Human Experience. JACC Cardiovasc Interv 2021; 15:e3-e5. [PMID: 34922891 DOI: 10.1016/j.jcin.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Bruno Melica
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Pedro Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Gustavo Pires-Morais
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ana Fonte Boa
- Department of Anesthesiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Rodolfo Pereira
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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18
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Ribeiro J. Diastolic dysfunction and type 1 diabetes: A sweet link? Rev Port Cardiol 2021; 40:767-769. [PMID: 34857115 DOI: 10.1016/j.repce.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- José Ribeiro
- Cardiology Department, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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19
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Gonçalves-Teixeira P, Costa S, Martins D, Neves P, Ribeiro J. Transapical off-pump mitral valve repair with NeoChord™ implantation: An early single-center Portuguese experience. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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20
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Flora S, Hipólito N, Brooks D, Marques A, Morais N, Silva CG, Silva F, Ribeiro J, Caceiro R, Carreira BP, Burtin C, Pimenta S, Cruz J, Oliveira A. Phenotyping Adopters of Mobile Applications Among Patients With COPD: A Cross-Sectional Study. Front Rehabilit Sci 2021; 2:729237. [PMID: 36188799 PMCID: PMC9397739 DOI: 10.3389/fresc.2021.729237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
Effectiveness of technology-based interventions to improve physical activity (PA) in people with COPD is controversial. Mixed results may be due to participants' characteristics influencing their use of and engagement with mobile health apps. This study compared demographic, clinical, physical and PA characteristics of patients with COPD using and not using mobile apps in daily life. Patients with COPD who used smartphones were asked about their sociodemographic and clinic characteristics, PA habits and use of mobile apps (general and PA-related). Participants performed a six-minute walk test (6MWT), gait speed test and wore an accelerometer for 7 days. Data were compared between participants using (App Users) and not using (Non-App Users) mobile apps. A sub-analysis was conducted comparing characteristics of PA–App Users and Non-Users. 59 participants were enrolled (73% Male; 66.3 ± 8.3 yrs; FEV1 48.7 ± 18.4% predicted): 59% were App Users and 25% were PA-App Users. Significant differences between App Users and Non-App Users were found for age (64.2 ± 8.9 vs. 69.2 ± 6.3yrs), 6MWT (462.9 ± 91.7 vs. 414.9 ± 82.3 m), Gait Speed (Median 1.5 [Q1–Q3: 1.4–1.8] vs. 2.0 [1.0–1.5]m/s), Time in Vigorous PA (0.6 [0.2–2.8] vs. 0.14 [0.1–0.7]min) and Self-Reported PA (4.0 [1.0–4.0] vs. 1.0 [0.0–4.0] Points). Differences between PA–App Users and Non-Users were found in time in sedentary behavior (764.1 [641.8–819.8] vs. 672.2 [581.2–749.4] min) and self-reported PA (4.0 [2.0–6.0] vs. 2.0 [0.0–4.0] points). People with COPD using mobile apps were younger and had higher physical capacity than their peers not using mobile apps. PA-App Users spent more time in sedentary behaviors than Non-Users although self-reporting more time in PA.
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Affiliation(s)
- Sofia Flora
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Nádia Hipólito
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Nuno Morais
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Cândida G. Silva
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Department of Chemistry, Coimbra Chemistry Centre, University of Coimbra, Coimbra, Portugal
| | - Fernando Silva
- School of Technology and Management, Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, Leiria, Portugal
| | - José Ribeiro
- School of Technology and Management, Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Rúben Caceiro
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Technology and Management, Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Bruno P. Carreira
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- Unidade de Saúde Familiar Pedro e Inês, ACeS Oeste Norte, Alcobaça, Portugal
| | - Chris Burtin
- Faculty of Rehabilitation Sciences, REVAL—Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- BIOMED—Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sara Pimenta
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
- *Correspondence: Joana Cruz
| | - Ana Oliveira
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
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21
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Bastos D, Ribeiro J, Silva F, Rodrigues M, Rabadão C, Fernández-Caballero A, Barraca JP, Rocha NP, Pereira A. Security Mechanisms of a Mobile Health Application for Promoting Physical Activity among Older Adults. Sensors (Basel) 2021; 21:7323. [PMID: 34770631 PMCID: PMC8588378 DOI: 10.3390/s21217323] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Physical activity contributes to the maintenance of health conditions and functioning. However, the percentage of older adults who comply with the recommendations for physical activity levels is low when compared to the same percentages on younger groups. The SmartWalk system aims to encourage older adults to perform physical activity (i.e., walking in the city), which is monitored and adjusted by healthcare providers for best results. The study reported in this article focused on the implementation of SmartWalk security services to keep personal data safe during communications and while at rest, which were validated considering a comprehensive use case. The security framework offers various mechanisms, including an authentication system that was designed to complement the pairs of usernames and passwords with trusted execution environments and token-based features, authorization with different access levels, symmetric and asymmetric key cryptography, critical transactions review, and logging supported by blockchain technology. The resulting implementation contributes for a common understanding of the security features of trustful smart cities' applications, which conforms with existing legislation and regulations.
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Affiliation(s)
- David Bastos
- Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, School of Technology and Management, 2411-901 Leiria, Portugal; (D.B.); (J.R.); (F.S.); (C.R.); (A.P.)
| | - José Ribeiro
- Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, School of Technology and Management, 2411-901 Leiria, Portugal; (D.B.); (J.R.); (F.S.); (C.R.); (A.P.)
| | - Fernando Silva
- Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, School of Technology and Management, 2411-901 Leiria, Portugal; (D.B.); (J.R.); (F.S.); (C.R.); (A.P.)
| | - Mário Rodrigues
- Institute of Electronics and Telematics Engineering of Aveiro, Higher School of Technology and Management of Águeda, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Carlos Rabadão
- Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, School of Technology and Management, 2411-901 Leiria, Portugal; (D.B.); (J.R.); (F.S.); (C.R.); (A.P.)
| | - Antonio Fernández-Caballero
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, 02071 Albacete, Spain;
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - João Paulo Barraca
- Department of Electronics, Telecommunications and Informatics, Institute of Telecommunications, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Nelson Pacheco Rocha
- Department of Medical Sciences, Institute of Electronics and Telematics Engineering of Aveiro, University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Pereira
- Computer Science and Communications Research Centre, Polytechnic Institute of Leiria, School of Technology and Management, 2411-901 Leiria, Portugal; (D.B.); (J.R.); (F.S.); (C.R.); (A.P.)
- INOV INESC INOVAÇÃO, Institute of New Technologies—Leiria Office, Apartado 4163, 2411-901 Leiria, Portugal
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22
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Carvalho R, Rodrigues T, Rocha R, Ribeiro J, Silva G, Carpinteiro L, Cortez-Dias N, Sousa J. Real-world comparison of different periprocedural antithrombotic strategies for atrial fibrillation catheter ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0535] [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
Atrial Fibrillation (AF) catheter ablation carries high bleeding and thromboembolic risks, requiring a detailed assessment of overall risk-benefit profile regarding antithrombotic strategy. Vitamin K Anticoagulant (VKA) and Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) have been used in the latest years in this setting, and with different interruption protocols periprocedural. Our goal was to evaluate the rate of acute adverse events (AAE) and compare them according to antithrombotic strategy used periprocedural, in a real-world basis.
Methods
A single-center retrospective study, including adult patients admitted to first AF catheter ablation, from 2004 to 2020. Different antithrombotic strategies (anticoagulation with VKA uninterrupted, anticoagulation with NOAC uninterrupted, no therapy or antiaggregation/interrupted ACO) were compared concerning the rate of any clinically relevant AAE; the composite of major AAE (hemopericardium and stroke/transient ischemic attack [TIA]) and minor AAE associated with vascular access. Descriptive statistics and logistic regression were used to compare groups according to the antithrombotic strategy with an alpha level of 0.05.
Results
Among the 868 patients included (mean age 59±12 yo, 67,5% [n=586] men), pulmonary vein isolation was performed under uninterrupted anticoagulation in 640 (73,7%), of which 595 patients with NOAC (68,5%) and 45 with VKA (5,2%). AF was paroxysmal, persistent and long-standing persistent in 63,4% (n=550), 21,4% (n=185) and 15,4% (n=133) patients, respectively. Mean CHADS-VASc score was 1,86±1,48. Over time there was a shift in the distribution of the type of antithrombotic therapy used, consistent with changes in recommendations (Graph 1).
The composite outcome occurred in 6,8% (n=62), including hemopericardium in 1,8% (n=16), stroke/TIA in 0,7% (n=6) and events related to vascular access in 1,4% (n=13) [Table 1]. No anticoagulation therapy or antiaggregation/interrupted ACO was more associated to the outcome, driven by major AAE, although the difference did not meet statistical significance (p=0,06) [Table 1]. No difference was found between VKA and NOAC group. Additionally, there was no diference in the incidence of hemorrhagic AAE since the implementation of an uninterrupted anticoagulation strategy periprocedural.
Conclusion
In our population of patients submitted to AF catheter ablation, an uninterrupted anticoagulation strategy is associated with lower rate of AAE, either with VKA or NOAC. Our real-world results are reassuring of the benefit of an uninterrupted strategy, and consistent with recent controlled trials.
Funding Acknowledgement
Type of funding sources: None. Antithrombotic therapies over timeClinically relevant acute adverse events
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Affiliation(s)
- R Carvalho
- Hospital Santo Andre, Cardiology, Leiria, Portugal
| | - T Rodrigues
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Ribeiro
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - G.L Silva
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - L Carpinteiro
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - N Cortez-Dias
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
| | - J Sousa
- Centro Hospitalar Universitário Lisboa Norte, Cardiology, Lisbon, Portugal
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23
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Vilela EM, Ladeiras-Lopes R, João A, Torres S, Ribeiro J, Campos L, Miranda F, Nunes JP, Teixeira M, Fontes-Carvalho R. Cardiac rehabilitation in elderly myocardial infarction survivors: focus on circulatory power. Rev Cardiovasc Med 2021; 22:903-910. [PMID: 34565089 DOI: 10.31083/j.rcm2203097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022] Open
Abstract
Exercise-based cardiac rehabilitation (EBCR) is paramount after an acute myocardial infarction (AMI). Older individuals have been reported as having a worse prognosis after an AMI, and some series have reported differences in the functional response to EBCR. The peak circulatory power (CP), a non-invasive parameter, has been described as a surrogate for the cardiac power, showing promising results as a comprehensive measure of the cardiovascular response. Whilst this, data concerning the impact of EBCR on CP, particularly among elderly individuals, remains elusive. To address this issue, an observational, retrospective study including all patients admitted due to an AMI who completed a phase II EBCR programme between 11/2012 and 4/2017, was conducted, with CP being analysed by a symptom-limited cardiopulmonary exercise test. A total of 379 patients, 30% aged ≥65 years-old, were included. CP significantly improved after the EBCR programme (in all patients, as well as in both subgroups). Older patients presented lower CP than their younger counterparts at the beginning and the end of the programme, while presenting smaller improvements (122 ± 540 vs 293 ± 638 mmHg mL/kg/min, p = 0.013). This was maintained after adjusting for several potential confounding factors. A contemporary ECBR programme was associated with significant improvements in CP among AMI patients. Though those aged ≥65 years-old presented smaller improvements in CP than younger individuals, these still presented significant increases in this parameter. These results highlight the importance of EBCR in this challenging higher risk group of patients.
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Affiliation(s)
- Eduardo Matos Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Ladeiras-Lopes
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal.,Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ana João
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Susana Torres
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Lilibeth Campos
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Fátima Miranda
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - José Pedro Nunes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal.,Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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24
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Fuentes D, Correia L, Costa N, Reis A, Ribeiro J, Rabadão C, Barroso J, Pereira A. IndoorCare: Low-Cost Elderly Activity Monitoring System through Image Processing. Sensors (Basel) 2021; 21:s21186051. [PMID: 34577256 PMCID: PMC8472621 DOI: 10.3390/s21186051] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
The Portuguese population is aging at an increasing rate, which introduces new problems, particularly in rural areas, where the population is small and widely spread throughout the territory. These people, mostly elderly, have low income and are often isolated and socially excluded. This work researches and proposes an affordable Ambient Assisted Living (AAL)-based solution to monitor the activities of elderly individuals, inside their homes, in a pervasive and non-intrusive way, while preserving their privacy. The solution uses a set of low-cost IoT sensor devices, computer vision algorithms and reasoning rules, to acquire data and recognize the activities performed by a subject inside a home. A conceptual architecture and a functional prototype were developed, the prototype being successfully tested in an environment similar to a real case scenario. The system and the underlying concept can be used as a building block for remote and distributed elderly care services, in which the elderly live autonomously in their homes, but have the attention of a caregiver when needed.
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Affiliation(s)
- Daniel Fuentes
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
| | - Luís Correia
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
| | - Nuno Costa
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
| | - Arsénio Reis
- INESC TEC, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal; (A.R.); (J.B.)
| | - José Ribeiro
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
| | - Carlos Rabadão
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
| | - João Barroso
- INESC TEC, University of Trás-os-Montes e Alto Douro, Quinta de Prados, 5001-801 Vila Real, Portugal; (A.R.); (J.B.)
| | - António Pereira
- Computer Science and Communication Research Centre, School of Technology and Management, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (D.F.); (L.C.); (N.C.); (J.R.); (C.R.)
- INOV INESC Inovação, Institute of New Technologies, Leiria Office, Campus 2, Morro do Lena-Alto do Vieiro, Apartado 4163, 2411-901 Leiria, Portugal
- Correspondence:
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25
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Ribeiro J. Diastolic dysfunction and type 1 diabetes: A sweet link? Rev Port Cardiol 2021; 40:S0870-2551(21)00350-4. [PMID: 34462171 DOI: 10.1016/j.repc.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- José Ribeiro
- Cardiology Department, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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26
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Manuel AM, Ladeiras-Lopes R, Ribeiro J, Ferreira ND, Faria R, Carvalho M, Ferreira W, Ferraz R, Gonçalves F, Batista A, Gonçalves C, Pires-Morais G, Rodrigues A, Sampaio F, Teixeira M, Braga P, Fontes-Carvalho R. Prevalence, multimodality imaging characterization, and mid-term prognosis of quadricuspid aortic valves: an analysis of eight cases, based on 160 004 exams performed during 12 years in a tertiary care hospital. Eur Heart J Cardiovasc Imaging 2021; 22:765-776. [PMID: 33400773 DOI: 10.1093/ehjci/jeaa355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis. METHODS AND RESULTS Retrospective search in imaging exams database of one tertiary centre, for patients diagnosed with QAV between January 2007 and September 2019. QAV was characterized by cardiac computed tomography, transthoracic/transoesophageal echocardiography, and cardiac magnetic resonance. A total of 160 004 exams were reviewed and eight patients with QAV were identified (50% men, mean age 53.5 ± 10.7 years). The prevalence of QAV was 0.005%. During a median follow-up of 52 months (interquartile range 16-88), there were no deaths. Seven patients (88%) had pure AR (three severe, one moderate, and three mild) and one patient (12%) had moderate AR and moderate aortic stenosis. Three patients (38%) with severe AR underwent valve surgery (two replacements and one repair). Analysis of predictors of severe AR was not statistically significant. CONCLUSION QAV is a rare congenital cardiac defect, with a prevalence of 0.005% in our study. Its predominant functional abnormality was regurgitation and about one-third of the patients required aortic valve surgery. Multimodality imaging may play a pivotal role in assessing patients with QAV with significant valve dysfunction or associated congenital heart disease and improve their treatment strategy.
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Affiliation(s)
- Ana Mosalina Manuel
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | | | - José Ribeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Nuno Dias Ferreira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Rita Faria
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Mónica Carvalho
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Wilson Ferreira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Ricardo Ferraz
- Cardiothoracic Surgery Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Fernando Gonçalves
- Cardiology Department, Trás-os-Montes e Alto Douro Hospital Centre, Vila Real, Portugal
| | - Ana Batista
- Cardiology Department, Trás-os-Montes e Alto Douro Hospital Centre, Vila Real, Portugal
| | - Carlos Gonçalves
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Gustavo Pires-Morais
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Alberto Rodrigues
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Francisco Sampaio
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.,Cardiovascular Research & Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Madalena Teixeira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.,Cardiovascular Research & Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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27
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Graca Rodrigues TE, Brito J, Silverio-Antonio P, Couto Pereira P, Valente Silva B, Alves Da Silva P, Cunha N, Nunes-Ferreira A, Ribeiro J, Lima Da Silva G, Carpinteiro L, Cortez-Dias N, Pinto FJ, Sousa J. Long-term risk of major cardiovascular events after cavotricuspid isthmus ablation: when and in whom to discontinue oral anticoagulation? Europace 2021. [DOI: 10.1093/europace/euab116.305] [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.
Introduction
Cavotricuspid isthmus ablation (CTA) is the 1st line therapy to accomplish rhythm control in typical atrial flutter (AFL). Several studies have shown that AFL is frequently associated with AF, which may be silent, posing the patient at risk of systemic embolism. Nowadays, there are no formal recommendations for OAC after CTA in patients with isolated AFL.
Aim
To determine the risk of MACE after CTA and compare: 1) the presence of concomitant AF, 2) concomitantly performing PVI and 3) persistence on OAC.
Methods
Single-center retrospective study of pts submitted to CTA between 2015 and 2019, comprising 3 groups: I – pts with lone AFL; II – patients with AFL and prior AF submitted to CTA only; and III – patients with AFL and prior AF submitted to PVI and CTA. Clinical records were analyzed to determine the occurrence of MACE - death (of CV or unknown cause), stroke, clinically relevant bleed or hospitalization due to HF or arrhythmic events. Long-term OAC was defined as its persistence over 18 months after CTA. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses.
Results
A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 109 pts (23%) and III – 83 pts (17%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 67 ± 11, 61 ± 11, p < 0.03). The mean baseline CHA2DS2VASc was 2.3 ± 1.5 and the median post-CTA follow-up was 2.8 year. The 1-, 3- and 5-years MACE risk was 7%, 21% and 32%, respectively and did not differ significantly between groups. OAC was suspended on the long-term in 105 pts (23%), at a mean of 241 days post-CTA. Suspension of OAC was significantly associated with lower MACE risk (HR: 0.26, 95%CI 0.12-0.56, p = 0.001). This effect was independent of the age and CHA2DS2VASc. The prognostic benefit of OAC suspension was driven by the group I and was not verified in patients with concomitant AF. In group I, withdraw of OAC (56 pts - 27%) was associated with a 70% relative risk reduction in the 5-year MACE risk (16% vs 43%, HR: 0.30, 95%CI 0.13-0.69, p = 0.005). In group I, OAC was suspended in patient who were younger (65 ± 11 vs. 69 ± 12, p = 0.002), had lower CHA2DS2VASc (1.9 ± 1.6 vs. 2.7 ± 1.4, p < 0.001) and less often had cerebral vascular disease (1% vs. 8%, p = 0.036), HF (14% vs. 38%, p = 0.001), ischemic cardiomyopathy (9% vs. 19%, p = 0.04) and HTN(61% vs. 75%, p = 0.019).
Conclusions
In pts with AFL submitted to CTA, the long-term risk of MACE is frighteningly high, even in the ones without prior documentation of concomitant AF. Pts with prior AF presenting at the electrophysiological procedure in typical AFL and submitted just to CTA were not significantly harmed, from a prognostic perspective. In pts with lone AFL submitted to successful CTA, it may be reasonable to suspend OAC within 18 months provided that the concomitant AF is carefully excluded. Abstract Figure.
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Affiliation(s)
- TE Graca Rodrigues
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Brito
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Silverio-Antonio
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Couto Pereira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - B Valente Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - P Alves Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cunha
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - A Nunes-Ferreira
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Ribeiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - G Lima Da Silva
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - L Carpinteiro
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - N Cortez-Dias
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - FJ Pinto
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
| | - J Sousa
- Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal
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28
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Brandao M, Goncalves Almeida J, Fonseca P, Rosas F, Santos E, Ribeiro J, Oliveira M, Goncalves H, Fontes-Carvalho R, Primo J. Outcomes and predictors of clinical response after upgrade to resynchronization therapy. Europace 2021. [DOI: 10.1093/europace/euab116.446] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Upgrade to resynchronization therapy (CRT) is common practice in Europe. However, patient selection remains a challenge. Data regarding predictors of response to upgrade is currently lacking.
AIM
To identify predictors of clinical response after upgrade to CRT.
METHODS
Single-center retrospective study of consecutive patients submitted to upgrade to CRT (2007-2018). Patients underwent clinical and echocardiographic (echo) evaluation at baseline, 6-months and 1-year. Major adverse cardiac events (MACE) included hospitalization for heart failure (HF) or all-cause mortality. Clinical response was defined as New York Heart Association (NYHA) class improvement without MACE in the 1st year of follow-up (FU). Left ventricle end-systolic volume reduction of >15% designated echo response. Multivariate logistic regression was performed to identify predictors of clinical response to CRT.
RESULTS
Fifty-six patients submitted to upgrade to CRT (80.4% male, mean age 70.0 ± 9.6 years) were included; 43 patients (78.2%) previously had a pacemaker and 12 (21.8%) had a defibrillator device. Most patients had non-ischemic HF (67.9%), with a mean baseline left ventricle (LV) ejection fraction of 27.9 ± 6.4%. Indications for upgrade were mainly pacemaker dependency or pacing-induced LV dysfunction (76.6%) and de novo left bundle branch block (23.4%).
Thirty-one (59.3%) patients were clinical responders. MACE occurred in 37.5% of patients; 28.6% were hospitalized for HF and 13% died during the 1st year of FU. Clinical responders had a lower rate of atrial fibrillation (AF) (46.9% vs. 53.1%, p=.025) and a higher rate of pacemaker rythm prior to upgrade (80.6% vs 47.6%, p=.013). Among responders, the previous device was more frequently a pacemaker (87.5% vs 61.9%, p=.029), and the new device a CRT-P (81.2% vs 54.5%, p=.035). HF etiology did not differ between responders and non-responders.
Multivariate analysis identified absence of AF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-17.6, p=.037), CRT-P (OR 5.7, 95% CI 1.3-25.8, p=.022) and quadripolar lead implant (OR 3.8, 95% CI 1.3-25.8, p=.024) as predictors of clinical response in upgraded patients.
CONCLUSIONS
In this cohort, absence of AF, implantation of CRT-P and use of a quadripolar lead predicted clinical response to upgrade to CRT. Larger studies are warranted to tailor selection of patients for upgrade procedures.
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Affiliation(s)
- M Brandao
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Rosas
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - E Santos
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Oliveira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - H Goncalves
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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29
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Brandao M, Goncalves Almeida J, Fonseca P, Rosas F, Santos E, Ribeiro J, Oliveira M, Goncalves H, Fontes-Carvalho R, Primo J. Superresponse to cardiac resynchronization therapy: clinical outcomes and predictors. Europace 2021. [DOI: 10.1093/europace/euab116.447] [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
Resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure with reduced ejection fraction (HFrEF). Patients that experience significant reverse remodelling and left ventricular (LV) ejection fraction (LVEF) improvement have been called "superresponders".
AIM
To describe a cohort of superresponders and identify predictors of superresponse to CRT.
METHODS
Single-center retrospective study of consecutive patients submitted to CRT implantation (2007-2018). Patients underwent echocardiographic (echo) assessment at baseline, 6-months and 1-year. Superresponse was defined as LVEF≥50% during the 1st year of follow-up (FU). Major adverse cardiac events (MACE) included heart failure hospitalization or all-cause mortality. Multivariate logistic regression was performed to identify predictors of superresponse. Survival analysis with Kaplan-Meier method and Log-rank test was performed to compare outcomes between superresponders and non-superresponders.
RESULTS
295 CRT patients (70.5% male, mean age 67 ± 11 years) were included. Fifty-nine (21.4%) patients were superresponders. Superresponders were more often female (42.4% vs 25.8%, p=.021), tended to be older (69.6 vs 66.7 years, p=.054) and had lower rates of coronary disease (17.2% vs 32.9%, p=.032), atrial fibrillation (20.3% vs 38.0%, p=.018), valve disease (13.6% vs 30.0%, p=.018) and chronic kidney disease (6.9% vs 26.0%, p=.003). Superresponders had higher rates of non-ischemic HF (88.1% vs 69.1%, p=.006) and were more often implanted with CRT-P (69.5% vs 37.8%, p<.001). HFrEF medication did not differ between groups.
Superresponders had lower baseline LV end-systolic volumes (115.5 vs 166.2 ml, p<.001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) values (1232.6 vs 5252 pg/ml, p<.001). Baseline QRS duration did not differ (171.7 vs 171.3 ms, p=.883). During a median FU of 3 ± 5 years, there were no differences in terms of ventricular arrythmias (5.3% vs 6.8%, p=.913) or appropriate defibrillator therapies (1.8% vs 6.8%, p=.147) between groups. In addition to LVEF improvement (53.7% vs 35.3%, p<.001), superresponders also showed higher tricuspid annular plane systolic excursion values (22.1 vs 19.8 mm, p=.004) during FU. MACE occurred less frequently (Log-rank test, p=.003) and all-cause mortality (Log-rank test, p < 0.001) was lower in superresponders.
Multivariate analysis identified female gender (odds ratio [OR] 5.7, 95% confidence interval [CI] 1.03-31.73, p=.045), older age (OR 1.1, 95% CI 1.02-1.24, p=.017) and lower baseline NT-proBNP (OR 0.9, 95% CI 0.99-1.00, p=.011) as independent predictors of superresponse to CRT.
CONCLUSION
In superresponders, in addition to a significant improvement in LVEF, we observed an improvement in right ventricular function. As expected, MACE and all-cause mortality were lower. Female gender, older age and lower baseline NT-proBNP predicted super-response to CRT.
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Affiliation(s)
- M Brandao
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Rosas
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - E Santos
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Oliveira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - H Goncalves
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Agricola E, Ancona F, Brochet E, Donal E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Ribeiro J, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Edvardsen T, Bertrand P, Delgado V, Gerber B, Stankovic I. The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2021; 22:471-479. [DOI: 10.1093/ehjci/jeab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 01/05/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of ‘Interventional Imaging’ for SHD interventions and a new dedicated professional figure, the ‘Interventional Imager’ with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Hospital, IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Italy
| | - Eric Brochet
- Cardiology Department, Hôpital BICHAT Paris, France
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, Rennes, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Francesco Faletra
- Director of cardiac imaging service, . Cardiocentro Ticino Switzerland
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Hani Mahmoud-Elsayed
- Consultant Cardiologist, Director of Echocardiography Lab, Al-Nas Hospital, Cairo, Egypt
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | | | - Mark Monaghan
- Director of Non-Invasive Cardiology, King’s College Hospital, London, UK
| | - José Ribeiro
- Thorax and Circulation Unit Director, Gaia Hospital Center, Oporto, Portugal
| | - Leyla Elif Sade
- University of Baskent, Department of Cardiology, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy ‘Carol Davila’ - Euroecolab, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’, Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Thor Edvardsen
- Dept of Cardiology, Oslo University Hospital, Pb 4950 Nydalen, 0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Manuel AM, Almeida J, Fonseca P, Monteiro J, Guerreiro C, Barbosa AR, Teixeira P, Ribeiro J, Santos E, Rosas F, Ribeiro J, Dias A, Caeiro D, Sousa O, Teixeira M, Oliveira M, Gonçalves H, Primo J, Braga P. Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: The experience of a Portuguese tertiary center. Rev Port Cardiol 2021; 40:95-103. [PMID: 33422375 DOI: 10.1016/j.repc.2020.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/24/2019] [Revised: 04/08/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed. OBJECTIVES To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events. METHODS We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center. RESULTS A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF) functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002). CONCLUSIONS Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia.
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Affiliation(s)
- Ana Mosalina Manuel
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.
| | - João Almeida
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Paulo Fonseca
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Joel Monteiro
- Cardiology Department, Funchal Central Hospital, Madeira, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Ana Raquel Barbosa
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Pedro Teixeira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - José Ribeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Elisabeth Santos
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Filipa Rosas
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - José Ribeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Adelaide Dias
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Daniel Caeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Olga Sousa
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Madalena Teixeira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Marco Oliveira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Helena Gonçalves
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
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Sakai R, Assumpção M, Ribeiro J, Sakano E. Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review. J Clin Exp Dent 2021; 13:e1258-e1270. [PMID: 34987719 PMCID: PMC8715551 DOI: 10.4317/jced.58932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/11/2021] [Indexed: 11/05/2022] Open
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Statins for venous thromboembolism prevention: old dog, new tricks. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2267] [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
Statins are highly effective in preventing major acute cardiovascular events in the setting of atherosclerotic arterial disease. On the other hand, given their antithrombotic and anti-inflammatory properties, statins may also attenuate patients' odds of developing venous thromboembolism (VTE). However, clinical studies have yielded variable estimates of this effect.
Purpose
To perform a meta-analysis designed to evaluate the extent to which statin use influences the rate of subsequent VTE events.
Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar for both randomized controlled trials (RCTs) and observational studies addressing the association between statins and VTE risk, published up until December 1, 2019. Manually reviewed references and key investigators interaction via e-mail correspondence were also data sources. RCTs comparing the effects of statin therapy with those of a placebo or no treatment were included, while interventional studies appraising different lipid-lowering pharmacological strategies were not. Observational studies encompassed both cohort and case-control designs. The primary endpoints were general VTE, deep vein thrombosis or pulmonary embolism. Patients with cancer, heart failure and chronic kidney disease (CKD) were further investigated separately. Study-specific relative risks (RRs) were pooled using generic inverse variance outcome meta-analytic technique with a random-effects model.
Results
23 RCTs comprising 118.464 participants, 12 cohort studies encompassing 2.881.184 patients and 9 case-control studies including 354.367 patients were regarded as eligible for quantitative evaluation. Specifically, 5 observational studies comprising 9.656 cancer patients, 3 studies encompassing 9.693 heart failure patients and 4 studies including 4.353 CKD patients were gathered. In RCTs, statin therapy was proven slightly superior to placebo or no treatment in lowering VTE incidence (RR 0.85, 95% CI 0.73–0.99, p=0.04, i2=14%). Observational studies were found to corroborate this effect, with statin treatment resulting in VTE risk reduction overall (RR 0.72, 95% CI 0.64–0.81, p<0.001, i2=84%) and in both cohort (RR 0.86, 95% CI 0.83–0.90, p<0.001, i2=85%) and case-control (RR 0.68, 95% CI 0.57–0.82, p<0.001, i2=80%) designs. This positive effect held true in cancer patients (RR 0.56, 95% CI 0.33–0.95, p=0.03, i2=78%), but not in those with heart failure (RR 0.7, 95% CI 0.42–1.16, p=0.17, i2=2%) and CKD (RR 1.04, 95% CI 0.67–1.60, p=0.87, i2=0%).
Conclusion
Currently available evidence suggests that statins significantly reduce patients' odds of developing VTE. Given their favorable safety profile and low cost, statin treatment should now be considered in high-risk individuals, particularly in those with cancer.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Brandao M, Goncalves Almeida J, Monteiro J, Montenegro Sa F, Fonseca P, Rosas F, Santos E, Ribeiro J, Oliveira M, Goncalves H, Primo J, Braga P. Comparison of de novo and upgrade to resynchronization therapy: a propensity-score matched analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0795] [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
Upgrade to resynchronization therapy (CRT) from conventional pacemaker (P) or defibrillator (D) is common practice in Europe. However, guidelines (GL) are discordant: Pacing GL give a class I recommendation, while Heart Failure (HF) GL provide a class IIb indication. Previous studies suggested worse outcomes in upgraded patients (pts).
Aim
To compare response rate and clinical outcomes in a cohort of pts receiving de novo or upgrade to CRT.
Methods
Single-center retrospective study of consecutive pts submitted to CRT implantation (2007–2017). Major adverse cardiac events (MACE) included HF hospitalization (HHF) or all-cause mortality. Clinical response was defined as New York Heart Association class improvement without MACE in the first year of follow-up (FU). Left ventricle end-systolic volume reduction of >15% denoted echocardiographic (echo) response. Survival analysis with Kaplan-Meier method and Log-rank test was performed. Propensity-score matching (PSM) analysis was made to adjust for possible confounder variables.
Results
230 CRT recipients (70.9% male, mean age 67±11 years, 71.5% non-ischemic cardiomyopathy, 39.6% CRT-P) were included, of whom 46 (20%) underwent an upgrade. Upgraded pts were older (69.8 vs 65.9 years, p=0.015), with higher rates of permanent atrial fibrillation (37.0% vs 12.7%, p=0.001), moderate to severe valve disease (45.7% vs 22.3%, p=0.002), chronic kidney disease (37.0% vs 17.2%, p=0.005) and treatment with mineralocorticoid receptor antagonists (79.1% vs 52.0%, p=0.002). They were more likely to receive CRT-P (65.2% vs 33.2%, p<0.001) and CRT-D were more often implanted for secondary prevention (60.0% vs 17.9%, p=0.001). No differences emerged in procedural complications, clinical (74.4% vs 71.4%, p=0.712) or echo (66.7% vs 69.7%, p=0.822) response rates.
During a median FU of 3±4 years, all-cause mortality was similar among groups (Log Rank test, p=0.522, unadjusted hazard ratio [HR] 1.25, confidence interval [CI] 95% 0.62–2.49, p=0.534). There was a statistical tendency for higher MACE rate in the upgrade group (Log Rank test, p=0.064, HR 1.66, CI 95% 0.95–2,91, p=0.076). No differences were found in lead dislodgement (10.9% vs 7.1%, p=0.368) or endocarditis (2.2% vs 4.3%, p=0.692) rates.
PSM analysis identified 88 matched pairs (46 upgrade/42 de novo pts). In this cohort, all-cause mortality (Log Rank test, p=0.77, HR 0.89, CI 95% 0.39–2.03, p=0.78) and MACE (Log Rank test, p=0.36, HR 1.38, CI 95% 0.68–2.81, p=0.37) were comparable between groups [graph no. 1].
Conclusion
Upgrade to CRT was similar to de novo implantation in terms of complications and clinical and echo response, in this cohort. The risk for MACE and mortality was also comparable.
Graph 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Brandao
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - J Monteiro
- Hospital Central do Funchal, Funchal, Portugal
| | | | - P Fonseca
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Rosas
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - E Santos
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Oliveira
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - H Goncalves
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Primo
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - P Braga
- Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Provisional versus 2-stent strategies for coronary bifurcations: is a bird in the hand worth two in the bush? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Among all subsets of coronary artery lesions, bifurcations stand out due to high incidence, demanding percutaneous interventions (PCIs) and poor outcomes. Amid the different PCI strategies, the provisional (PS) approach is generally recommended over 2-stent (TS) techniques, but this paradigm has been challenged.
Purpose
To compare PS with TS for PCI of coronary bifurcation lesions, concerning procedural aspects and both immediate and long-term patient outcomes.
Methods
Retrospective study encompassing patients consecutively referred to a tertiary interventional cardiology unit for coronary angiography, who were found to have at least 1 native bifurcation lesion. According to operator experience and angiographic features, patients were managed with PS or/(and) TS. Procedural aspects regarding radiological variables, angiographic success and immediate complications were reviewed, as were in-hospital outcomes. Besides, clinical follow-up, by clinic appointment or telephone calling, was performed targeting stent failure, target vessel revascularization (TVR), acute coronary syndromes (ACS), heart failure and mortality.
Results
From January 2010 to June 2017, 404 patients with 433 bifurcation lesions were included. Median age was 70 (62–77) years and 25.3% were female. Median follow-up was 2 (1–3) years. Chronic angina was the dominant PCI context (61.3%) with 9.7% presenting with ST-segment elevation myocardial infarction (MI). Medina class 1,1,1 was documented in 54.1% and 64.9% of lesions were hailed as true bifurcations. 303 patients underwent PS, whereas 67 were managed with TS, with TAP (43.3%) and mini-crush (34.3%) as the leading techniques. True bifurcations were more frequently approached with TS (p<0.001), whereas PCI context did not influence procedure selection. Fluoroscopy time (p<0.001), radiation dose (p=0.003) and contrast volume (p=0.009) were higher in the TS subgroup. OCT guidance (p=0.039) was also more common with TS. Angiographic success was uniformly high (95.1% for PS and 97% for TS), while procedural complications, including iatrogenic coronary dissections (7.4%, mostly minor) and slow-reflow (3.5%), were homogenously low. Acute kidney injury and type 4a MI occurred in 14.5% and 32.3%, respectively, also with no difference between groups. As for long-term outcomes, stent failure, encompassing both stent thrombosis (1 event) and restenosis (4.2%), occurred more often with TS (p=0.046), with ACS events (9.5%) following the same trend (p=0.08). In turn, rates of TVR (12.5%), heart failure hospitalization (6.2%) and mortality, regardless of its cardiovascular nature, were similar.
Conclusion
PS outperforms TS during follow-up, particularly due to lower stent failure odds. Thus, this study further supports the concept of PS as the standard approach for coronary bifurcation lesions.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Lopes J, Saleiro C, Campos D, Sousa J, Puga L, Gomes A, Ribeiro J, Lourenco C, Silva J, Goncalves L. Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1760] [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
Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).
Purpose
Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients.
Methods
A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P.
A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year.
Results
A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001).
In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047).
Conclusion
In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Lourenco
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Ranolazine as you have never seen it before: an antiarrhythmic for atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0555] [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
Currently available pharmacological options for rhythm control in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and both frequent and potentially severe adverse events. Recent studies have added evidence to the hypothesis that ranolazine might exert antiarrhythmic effects, particularly in atrial tachyarrhythmias.
Purpose
To perform a systematic review with meta-analysis in order to ascertain the potential role of ranolazine in the management of AF.
Methods
We systematically searched MEDLINE, Embase and Scopus for randomized controlled trials (RCTs) and cohort studies addressing the association between ranolazine and AF outcomes, published up until December 1, 2019. The primary endpoint was incidence of AF, which was evaluated under a ranolazine versus placebo design. In this regard, patients in the setting of postcardiac surgery were further investigated separately. Secondary endpoints included AF cardioversion outcomes, which were addressed through comparison between ranolazine plus amiodarone and amiodarone alone for proportional efficacy and temporal requirements (time-to-cardioversion). The latter analysis was also undertaken in a dose-sensitive fashion (≤1000mg vs. 1500mg of ranolazine). Tertiary endpoints covered AF burden and episodes, in paroxysmal AF patients, and safety outcomes, namely death, QTc interval prolongation and hypotension. Study-specific odds ratios (ORs) were pooled using meta-analytic techniques with a random-effects model.
Results
A total of 10 RCTs comprising 8.109 participants and 3 cohort studies encompassing 37.112 patients were regarded as eligible for evaluation. Ranolazine was found to attenuate patients' odds of developing AF (OR 0.53, 95% CI: 0.41–0.69, p<0.001, i2=58%). This effect held true, with an even larger effect size, in the context of post-cardiac surgery (OR 0.34, 95% CI: 0.16–0.72, p=0.005, i2=64%). Ranolazine increased the chances of successful AF cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95% CI: 1.49–29.89, p=0.01, i2=76%), while significantly reducing time-to-cardioversion [SMD 9.54h, 95% CI: −13.3–5.75, p<0.001, i2=99%]. Interestingly, cardioversion was faster with ≤1000mg of ranolazine (SMD −13.16h, 95% CI: −15.07–11.25, p<0.001, i2=95%) than with 1500mg (SMD −3.57h, 95% CI: −5.06–2.08, p<0.001, i2=23%). In paroxysmal AF, ranolazine was also proved to significantly reduce both AF burden and episodes. There were no safety signals regarding mortality odds, QTc interval prolongation (mostly clinically insignificant) and hypotension (mostly transitory).
Conclusion
Current evidence suggests that ranolazine provides an effective and safe option for a chemical rhythm control strategy in AF management, a field in which medical breakthroughs are desperately needed.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Miller K, James N, Oliver M, Ou J, Emerson J, Borgstadt A, DiSilvestro P, Ribeiro J. Immune modeling analysis identifies ICOS and CTLA-4 as predictive biomarkers in serous epithelial ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.071] [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: 10/23/2022]
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Pinto D, Batista E, Gouveia P, Mavioso C, Correia-Anacleto J, Abreu N, Vasconcelos M, Correia M, Ribeiro J, Sousa B, Gouveia H, Ferreira A, Chumbo M, Alves C, Cardoso M, Cardoso F. Feasibility trial of lymph node marking using both clip and carbon dye in cN1 patients submitted to neo-adjuvant chemotherapy to improve accuracy of axillary surgical staging in ycN0 patients after treatment. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30845-5] [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: 10/23/2022]
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Konsoulova-Kirova A, Ribeiro J, Gouveia H, Volovat S, Sousa B, Marques R, Brito M, Pinto D, Gouveia P, Vasconcelos M, Batista E, Cardoso M, Alves C, Cardoso F. Optimal duration and effectiveness of neoadjuvant endocrine therapy in breast cancer – Retrospective series. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. Rev Port Cardiol 2020; 39:431-440. [DOI: 10.1016/j.repc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2020.02.012] [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: 11/16/2022] Open
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Soares RF, Monteiro A, Macedo F, Pereira TC, Paulo J, Marques M, Bonito N, Jacinto P, Ribeiro J, Sousa G. P-208 Is there a role for adjuvant chemotherapy in ypN0 disease rectal cancer patients? Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Monteiro A, Pereira TC, Soares RF, Macedo F, Paulo J, Marques M, Bonito N, Jacinto P, Ribeiro J, Sousa G. P-36 Prognostic value of tumor laterality and recurrence risk in patients with stage III colon cancer treated with adjuvant chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pereira TC, Salgueiro F, Monteiro A, Soares RF, Macedo F, Jacinto P, Paulo J, Bonito N, Marques M, Ribeiro J, Sousa G. P-225 KRAS codon 12 and 13 mutations in metastatic colorectal cancer: Predictive marker in first-line bevacizumab-based chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.307] [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: 11/25/2022] Open
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Peixoto M, Macedo F, Sousa M, Paulo J, Marques M, Jacinto P, Bonito N, Ribeiro J, Sousa G. P-263 The role of biologic targets in metastatic colorectal cancer in non-elderly patients: A single institutional analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.345] [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: 10/23/2022] Open
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Soares RF, Pereira TC, Monteiro A, Macedo F, Paulo J, Marques M, Bonito N, Jacinto P, Ribeiro J, Sousa G. P-203 Restaging rectal cancer after neoadjuvant chemoradiation therapy: Is magnetic resonance imaging accurate enough? Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.285] [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: 10/23/2022] Open
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Lopes J, Saleiro C, Campos D, Sousa J, Puga L, Gomes R, Ribeiro J, Silva J, Goncalves L. P1092Syncope in the emergency department: can 24-hour holter monitoring be of any help? Europace 2020. [DOI: 10.1093/europace/euaa162.157] [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
Background
Syncope is a very common reason for presenting to the emergency department (ED). The existence of a telemetry unit is crucial but it is not the reality in some hospitals. In order to avoid unnecessary ward admission, 24-hour Holter (24HH) monitoring could be useful to help with the diagnosis (when the arrhythmic etiology is suspected and the symptoms are frequent enough) and also be important to safely discharge a patient.
Purpose
The purpose of this study is to evaluate the diagnostic performance of 24HH monitoring, during a syncope episode in the ER, and to compare the readmission rates between patients with normal and abnormal not diagnostic 24HH monitoring.
Methods
A cohort study of consecutive patients (P) who were monitored with 24HH in one hospital in the ED, between January 2015 and December 2017, were included. All the 24HH results were seen by a senior cardiologist and divided in three groups: A - normal, B - abnormal Holter study unlikely to explain syncope and C- Holter study considered to be diagnostic.
Groups A and B were compared using chi-square independence test to evaluate association between the result of the 24HH and readmission rates at 30 days and 1 year, as well as mortality and device implantation at 1 year. Multivariate logistic regression was used to look for other confounders.
Results
A total of 111 P were included in this study. Mean age was 75 ± 14 years old, with 55.6% male patients.
A previous emergency episode with syncope was present in 56.9% of P. The mortality at one-year follow-up was 11.9%. The 24HH was considered diagnostic in 25.2% of P (28 P), with 18.9% of all the P with necessity of pacemaker (PM) implantation. In the patients with a non-diagnostic 24HH, 6,4% implanted a loop recorder before discharge.
Group B patients had a higher 30-day readmission rate to the ED when compared with group A (OR = 4.050 CI 95 [1.13 – 14.497], p = 0.033), but no difference in one-year readmission rate (p= 0.065). There was no difference in one-year mortality between the two groups (p= 0.731) or in one-year implantation of pacemaker (p= 0.431).
Conclusion
The use of 24HH in the ED could be a valuable tool in the diagnosis of rhythm disorders that cause syncope. An abnormal non diagnostic result can still be a predictor of 30-day readmission to the ED with similar complaints.
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Brito J, Cortez-Dias N, Nunes-Ferreira N, Aguiar-Ricardo I, Silva G, Rigueira J, Silverio Antonio P, Rodrigues T, Cunha N, Santos R, Sobral S, Ribeiro J, Carpinteiro L, Pinto FJ, Sousa JDE. P945What is the role of late-potentials determined by signal-averaged ECG in predicting flecainide provocative test in brugada pattern? Europace 2020. [DOI: 10.1093/europace/euaa162.284] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
The sudden cardiac death risk in Brugada Syndrome (BrS) is higher in patients with spontaneous type 1 pattern. Brugada diagnosis is also established in patients with induced type 1 morphology after provocative test with intravenous administration with a sodium blocker channel. Nevertheless, this group of patients is known to be at a lower risk of SCD, and their risk stratification is still a matter of discussion. Late potentials (LP) detected on signal-averaged ECG (SAECG) on the RVOT have been previously proposed as a predictor factor for BrS, even though data is lacking on its value.
Purpose
To evaluate the association between positive LP (LMS40> 38ms) on SAECG with modified Brugada leads and a positive flecainide test in patients with non-type 1 BrS.
Methods
Retrospective single-center study of non-type 1 BrS patients referred for the performance of a flecainide provocative test. Patients presenting with spontaneous type 1 morphology were excluded from the study. Study of LP on SAECG with modified leads for Brugada were evaluated before administration of flecainide [2mg/kg (maximum150mg), for 10minutes] with determination of filtered QRS duration (fQRS), root mean square voltage of the last 40ms of the QRS complex (RMS40) and duration of low amplitude signals <40μV of the terminal QRS complex (LMS40).
Results
126 patients (47.3 ± 14.1 years, 61.9% males) underwent study with LP SAECG and flecainide test. Among these patients, 7.9% were symptomatic and 16.7% had familiar history of BrS. Flecainide test was positive in 46.8% of patients.
In patients with a positive flecainide test, 64.4% presented LMS40 > 38ms whereas LMS40 > 38ms was present in only 46% of those with a negative flecainide test (p = 0.031). The presence of positive LMS40 was a positive predictor for a positive flecainide test, associated with a two-fold increase likelihood in the induction of a Brugada pattern (OR: 2,12; IC95% 1,025-4,392; P = 0,043).
There was no association between fQRS or RMS40 and a positive flecainide test (p = NS). fQRS > 114ms and RMS40 <20uV was present in 22% and 61% of patients with a positive flecainide test, respectively.
Conclusion
In patient with non-type 1 Brugada syndrome, LMS40 > 38ms in SAECG was a predictor for a positive flecainide test, suggesting that this finding could be helpful on the risk stratification of patients undergoing diagnostic study for Brugada syndrome.
Abstract Figure. Effect of LMS 40 in flecainide test
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Affiliation(s)
- J Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Nunes-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - I Aguiar-Ricardo
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - G Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Rigueira
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - P Silverio Antonio
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - T Rodrigues
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - N Cunha
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - R Santos
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - S Sobral
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J Ribeiro
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - L Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - F J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - J DE Sousa
- Cardiology Department, Santa Maria University Hospital (CHULN), CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Braga S, Ribeiro J, Oliveira M, Silva J, Reis M, Ferreira L. EOSINOPHILIC PNEUMONIA WHEN STEROIDS ARE NOT THE ANSWER: CASE REPORT. Chest 2020. [DOI: 10.1016/j.chest.2020.05.195] [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: 10/24/2022] Open
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