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Lynch C, Braver J, Issaka A, De Moel-Mandel C, Zisis G, Carrington M, Oldenburg B. Implementation evaluation of mhealth interventions in the secondary prevention of coronary artery disease: a supplementary review. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.127] [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: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): La Trobe University
Introduction
mHealth technologies have evolved rapidly in recent years and are now widely implemented for the secondary prevention of coronary artery disease (CAD). While there is increasing evidence of their effectiveness, there are significant knowledge gaps concerning their reach, adoption, implementation, and maintenance.
Purpose
This study evaluates internal and external validity dimensions of mHealth-enabled cardiac disease management programs (DMPs) using elements of Glasgow’s RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) Framework. It is a supplementary review to a systematic review and meta-analysis which evaluated effectiveness.
Methods
From the 27 studies reviewed for the previous systematic review on effectiveness, a citation search was performed to identify additional publications reporting on elements of reach, adoption, implementation, and maintenance. All eligible publications were independently coded by two team members using the 23-item RE-AIM extraction tool and analysed using mixed-methods to ascertain the reporting of these elements.
Results
In total, 35 publications were included in the analysis, 27 from the previous systematic review and 8 supplementary publications. The items for the Reach dimension indicated participant participation rates ranging between 18% to 67%, and used a wide range of exclusion criteria, relating to mental and cognitive impairment (37%), physical impairments (41%) and language issues (26%). Most (44%) interventions were solely home-based with nurses being the main health professionals delivering the intervention (adoption items). The implementation and maintenance items showed intervention duration of between 4-52 weeks (median 24 weeks) with intervention follow-up of between 1-48 months (median 6 months).
Conclusions
This review found great heterogeneity in the duration and follow-up of mHealth-enabled DMPs for patients with CAD, with low participation rates suggesting access barriers. Addressing RE-AIM dimensions in the evaluation of mHealth-enabled cardiac DMPs for patients with CAD is critically important for identifying factors affecting the reach, adoption, implementation, and maintenance of interventions in order to improve translation of research evidence into practice for patients, clinicians and health service organisations.
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Affiliation(s)
- C Lynch
- La Trobe University , Melbourne , Australia
| | - J Braver
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Issaka
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | | | - G Zisis
- La Trobe University , Melbourne , Australia
| | - M Carrington
- Baker Heart and Diabetes Institute , Melbourne , Australia
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S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Carrington M, Henriques De Gouveia R, Corte-Real F, Goncalves L, Providencia R. Characterization of sudden death etiologies in a Portuguese population younger than 40 years-old. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.676] [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
The incidence and pathogenesis of sudden death (SD) in the young adult population in Portugal remains to be clarified. Some of the causes are known to be hereditary and a better understanding of these can have implications on the development of a national screening program for relatives of SD victims.
Purpose
To describe the leading causes of sudden cardiac and non-cardiac death in a young adult Portuguese population (≤40 years-old).
Methods
The authors retrospectively reviewed cases from a national database regarding individuals who underwent an autopsy, between 2012 and 2016, at 6 districts of mainland Portugal plus the islands. All young adults (1–40 years-old) who had a sudden unexpected death were included and violent deaths were excluded. This study was approved by the Institute Ethics Committee. We reviewed the autopsy files and collected demographic, clinical, necropsic, anatomopathological and toxicological data from each case. We performed statistical analysis using Stata 13.0 software.
Results
During a 5-year period, out of an estimated total of 2101 deaths in ages 1 to 40, 175 SD were identified. SD victims had a mean age of 32±9 years-old, the majority being of male gender (69%,n=120). There were 115 (66%) cases of SD of confirmed cardiac origin (see Table 1). The remaining causes were respiratory (18%), cerebral (7%), digestive (6%), endocrinologic (2%), urinary (1%), infectious (1%). The most frequent cardiac cause being coronary atherosclerosis (n=40,35%), which included lesions with estimated luminal narrowing >75% and/or documented type 1 acute myocardial infarction. These patients were older (31±8 vs 35±4, p<0.020), had a minimum age of 26 years, and more frequently male (85% vs 61%, p=0.011). There were 17 (15%) victims who had cardiopathy with histopathological hypertrophy (5 of them with associated fibrosis), and the diagnosis of hypertrophic cardiomyopathy (HCM) was possible in only 3 (3%) victims. In addition, there were 15 (13%) who died from pulmonary embolism who were predominantly women (23% vs 80%, p<0.001). There were 8 (7%) victims with a final diagnosis of cardiopathy with histopathological dilation, 2 possibly corresponding to post-partum cardiomyopathy (CMP), 1 to ethanolic CMP and 1 to ventricular dilation and fibrosis due to previous myocarditis, who had associated hepatitis with signs of activity. Six cases of acute myocarditis were identified, who were significantly younger, comparing to patients dying from other cardiac causes (23±13 vs 33±7, p=0,011). There were 2 cases of HCM with genetic data, one of which was complemented during molecular autopsy.
Conclusions
During a 5-year period, the cumulative incidence of SD in a region of Portugal is very low (n=175), cardiac causes being present in 66% of the cases. The most frequent cardiac cause is coronary atherosclerosis (35%).
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology , Evora , Portugal
| | - R Henriques De Gouveia
- Delegação do Centro, Instituto Nacional de Medicina Legal e Ciências Forenses, Forensic Pathology Department , Coimbra , Portugal
| | - F Corte-Real
- Delegação do Centro, Instituto Nacional de Medicina Legal e Ciências Forenses, Forensic Pathology Department , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar Universitário de Coimbra, Cardiology department , Coimbra , Portugal
| | - R Providencia
- Barts Heart Centre, Cardiology , London , United Kingdom
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Zisis G, Huynh Q, Whitmore K, Lay M, Yang Y, Carrington M, Marwick T. Pre-discharge B-lines at bedside predicts 30-day and multiple 90-day hospital re-admission in patients admitted for acute decompensated heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1091] [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
Inadequate decongestion at index admission for Acute Decompensation of Heart Failure (ADHF) is a common cause of adverse outcomes. A bedside 9-zone Lung and IVC ultrasound assessment (LUICA) may help to guide decongestion and reduce hospital readmission or mortality.
Purpose
To identify predictors of multiple 90-day hospital representations or mortality based on a bedside handheld 9-zone LUICA volume assessment obtained by HF nurses.
Methods
Patients admitted for ADHF, enrolled in the RISK-HF registry and undergoing pre-discharge LUICA, were assessed for 90-day readmission and/or mortality. The primary outcome of this observational report was prediction of multiple hospital representations based on pre-discharge volume status. The LUICA was performed with a hand-held ultrasound (HHU) device (Lumify, Philips) by trained HF-nurses. Functional capacity was measured with Duke Activity Status Index (DASI). Paired t-tests were used to compare mean differences. Logistic and linear regression were used to study relationships of outcomes with clinical characteristics. Cox regression was used to analyse time to repeated readmission or death. Analysis conducted with SPSS statistics V27 and STATA SE16.
Results
Of 302 ADHF patients, 67 readmitted within 30-days (age 76±8.5; men, 60%; HFrEF; 44%) and 235 did not readmit within 30-days (age 72±14; 57% men; 52% HFrEF). Readmission occurred in older patients (p=0.05), with pre-discharge signs of residual congestion that was based on the number of b-lines (p<0.01) (Table 1). Pre-discharge B-lines were predictive of DAOOH (β −0.41, −0.6, −0.22, p<0.01) and of multiple 90-day hospital readmissions (β 0.03, 0.018, 0.05, p<0.01), independently of 30-day event risk score, number of readmissions the preceding 12 months and age at index admission (Table 2). Number of B-lines at discharge was also associated with repeated readmission or death (HR=1.02 [1.01, 1.04]) in time-to-event analysis, independent of any other factors.
Conclusion
Pre-discharge residual congestion defined by the number B-lines increases the likelihood of multiple 90-day adverse outcomes.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart & Diabetes Institute
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Affiliation(s)
- G Zisis
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - Q Huynh
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - K Whitmore
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - M Lay
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - Y Yang
- Western Health , Melbourne , Australia
| | - M Carrington
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - T Marwick
- Baker Heart and Diabetes Institute , Melbourne , Australia
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Azcui Aparicio R, Huynh Q, Ball J, Marwick T, Carrington M. Imaging-Guided and Nurse-Coordinated Disease Management Program for Primary Prevention of Cardiovascular Disease: Findings From the IMPRESS Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.254] [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: 11/15/2022]
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Dias Claudio F, Rocha R, Carrington M, Pais J, Guerreiro R, Hyde-Congo K, Neves D, Santos AR, Picarra B. Characterization and quality of care indicators in patients with acute myocardial infarction without ST segment elevation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The definition of the quality of care in healthcare services is paramount to implement the resources necessary to grant the best quality of care according to the current guidelines. Recently, the European Society of Cardiology's guidelines for the management of acute coronary syndromes without ST segment elevation (NSTEMI) were published, and defined the quality indicators to be evaluated in such patients.
Purpose
To characterize the level of care given to the population of patients with NSTEMI included in the a national registry since 2011, according to the new guidelines directives.
Population and methods
We evaluated 12193 patients with NSTEMI. For each year the following variables were analyzed: age, gender, cardiovascular and non-cardiovascular comorbidities, clinical presentation (rhythm, blood pressure, Killip-Kimball Class), left ventricular ejection fraction (LVEF), treatment during admission and discharge, and time to invasive coronary angiography (ICA). Besides this, a comparing between years was made to analyze differences according to the quality indicators established in the guidelines.
Results
In 2019, 83.9% of patient with LVEF <40% were treated with IECA/ARA II and 80.6% were prescribed a betablocker at discharge. No statistically significant differences were found across the year with respect to IECA/ARA II at discharge (p=0.495), and beta-blocker at discharge (p=0.812). In terms of P2Y12 inhibitors during the hospital admission, there was a statistically significant increase in its use when comparing 2019 to 2014, 2015, 2016 and 2017 (p=0.019 for 2014 and p<0,001 the following years), with prescription in 90.4% of the patients in 2019. At discharge 88.3% of the patients were prescribed a P2Y12 inhibitor in 2019 and there was also a statistically significant increase in its prescription when compared to the previous years (from 2011 to 2017 with a p<0.001). When it comes to the prescription of statins at discharge there was a statistically significant difference between groups, driven mostly by an increase compared to the year 2012 (95.6% vs 90.8%, p=0.005). Only 16% of patients were subjected to ICA within 24h of admission during the year 2019. No statistically significant difference was found between other years (p>0.100 when comparing between years).
Discussion
The most striking feature that can be improved is the amount of patients subject to ICA within the first 24h after diagnosis. When it comes to the P2Y12 inhibitors it is also clear that there has been an increase in its prescription during the admission and at discharge. To sum up, it is clear that there is still some margin to improve care, of at least 10–20% in most parameters. This data portrays a picture of the measures and steps to take in order to provide the adequate care according to the latest guidelines.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - R Rocha
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - R Guerreiro
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - K Hyde-Congo
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Evora, Portugal
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Carrington M, Silverio Antonio P, Nunes-Ferreira A, Rodrigues T, Cunha N, Couto Pereira S, Brito J, Alves Da Silva P, Valente Silva B, Lima Da Silva G, Carpinteiro L, Cortez-Dias N, J Pinto F, De Sousa J. Cryoablation: safety of same day discharge. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0537] [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
Discharge after overnight hospital stay is standard procedure in patients submitted to elective atrial fibrillation (AF) ablation. Taking into consideration the low rate of cryoablation procedure complications could the same day discharge be an option?
Purpose
To assess the safety of same day discharge of patients submitted to AF cryoablation.
Methods
Single-center retrospective study of consecutive patients admitted to elective AF cryoablation in a tertiary center between February 2017 and November 2020. Patients were divided into two groups: same day discharge and next day discharge. Only patients submitted to ablation until 4 p.m. were included. Complication rates were obtained up to six months after the procedure. Complications were defined as death, pericardial tamponade, hematoma requiring evaluation and/or intervention, major bleeding requiring transfusion, hospital admission related to the procedure.
Results
One hundred fifty-four patients were included, with a mean age of 61±10.9 years, 66.2% were males, 18.2% with diabetes, 65.6% with dyslipidemia, 77.9% with hypertension, 10.4% with chronic kidney disease KDIGO stage 3 or more. Median follow-up of 436 [178 – 729] days. Most of the patients had paroxysmal (73.4%) and persistent short duration AF (23.4%). Sixty-two patients (40.3%) were early discharged and there were no differences between the two groups regarding epidemiological and clinical characteristics (p=NS).
A very low rate of complications in both groups was observed, occurring in 6.5% of patients with early discharge and in 8.7% of patients in overnight stay, without statistical significance between the two groups (p=0.61). The most frequent complications were local hematoma (5 patients, 2 in early discharged group), pericardial effusion (3 patients, all in overnight stay), femoral pseudo-aneurism (2 patients, 1 in each group) and arteriovenous fistula (1 patient in overnight stay group). The type of complications did not differ between the two groups (p=0.51). Two patients died during follow up, and this was unrelated to the procedure. In addition, no difference in success rate and arrhythmic recurrence was observed between the two groups (p=NS).
Conclusion
Our study suggests that it is safe to early discharge patients submitted to AF ablation, reducing the hospital stay length in selected patients. Larger studies are needed to confirm this data before routine implementation of this strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | | | - T Rodrigues
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - N Cunha
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | | | - J Brito
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | | | | | | | - L Carpinteiro
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - N Cortez-Dias
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - F J Pinto
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - J De Sousa
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
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8
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Zisis G, Yang Y, Whitmore K, Lay M, Huynh Q, Neil C, Carrington M, Marwick TH. Association of heart failure readmission with results of lung ultrasound at discharge and follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1047] [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
Attainment of euvolemia at discharge and maintaining it after discharge are fundamental to avoiding readmission in heart failure (HF). Lung ultrasound (LUS) is potentially of value to detect congestion but the role of sequential LUS is undefined.
Purpose
To determine the predictive value of discharge and follow-up LUS.
Methods
98 pts (mean age 72.8±12.3, mean ejection fraction 41.4%±18.4, gender male 56%) admitted with HF or fluid overload, underwent pre-discharge LUS to evaluate pulmonary (presence of ≥10 B lines) and peripheral (IVC diameter) congestion. LUS was repeated at home follow-up visits at 2 weeks post-discharge. Associations were sought between pre-discharge and follow-up LUS and 90 day outcomes (readmission or mortality).
Results
Overall, there was an increase in the total number of B-lines from baseline to week 2 [mean change in B-lines 3.82 [95% confidence intervals (CI), 0.30, 7.33) p=0.036] followed by a small decrease between scan 2 and scan 3 [mean change in B-lines −0.25 (95% CI, −0.17, 7.68), p=0.94]. Of 73 with <10 B-lines pre-discharge, 26 (36%) had events by 90 days, compared with 14 of the 25 with ≥10 pre-discharge B-lines (56%, p=0.07). However, all of those with ≥10 B lines at 2 weeks had events, compared with 25% of those with <10 B lines (p=0.04).
Conclusions
Attainment and preservation of euvolemia after index hospitalization for HF is challenging and requires appropriate patient support. Detection of residual congestion, as well as detection of early re-congestion after hospital discharge.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart & Diabetes Institute Readmission risk ratio
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Affiliation(s)
- G Zisis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Y Yang
- Western Health, Melbourne, Australia
| | - K Whitmore
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - M Lay
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Q Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Health, Melbourne, Australia
| | - M Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - T H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
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9
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Zisis G, Yang Y, Whitmore K, Lay M, Huynh Q, Neil C, Carrington M, Marwick TH. Efficacy and feasibility of heart failure nurses to deliver a lungs and inferior vena cava ultrasound assessment (LUICA) protocol and prediction of outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1046] [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/Introduction
Congestion is the main cause for hospital admission and readmission in heart failure (HF), with almost half being discharged with symptoms that suggest residual congestion. Novel non-invasive assessments (eg. lung ultrasound; [LUS], and Inferior Vena Cava [IVC]) may be used to assess congestion. A LUs and IvC Assessment (LUICA) delivered by HF nurses before discharge, could detect residual congestion, optimise diuresis and guide post discharge treatment.
Purpose
To determine the ability of HF nurses to successfully learn a LUICA protocol, obtain interpretable images, provide diagnostic reports and predict outcomes.
Methods
A teaching program focused on quantification of congestion by counting B-lines and reporting estimated right atrial pressure (e-RAP) from IVC congestion. LUICA readings were dichotomised based on lung congestion (≥10 vs <10 B-lines), the presence of lung pathology (consolidation, atelectasis, effusion) and IVC congestion (e-RAP >3mmHg vs 3mmHg). LUICA (8 lung zones + 2 IVC zones) was added to pre-discharge review (4 days post-admission) by HF nurses in 108 hospitalised pts (72±13 years; 58% male) with acute HF, fluid overload, and a variety of lung pathology. Images were assessed for quality (good, usable, measurable or not measurable) and interpreted by a LUICA expert and HF nurses, blinded to admission diagnosis. The predictive value of LUICA readings for patient outcomes (readmission or mortality) was expressed as risk ratio.
Results
The quality at the majority of the images was assessed as good or usable (expert: 82/107, nurses: 66/107, p=0.02). Readmission was predicted by both experts and nurses (picture 1).
Conclusions
HF nurses can be adequately trained in a 10 Zone LUICA and successfully obtain interpretable images. The predictive power of their interpretation is similar to experts.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart & Diabetes Institute Readmission risk ratio based on LUICA
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Affiliation(s)
- G Zisis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Y Yang
- Western Health, Melbourne, Australia
| | - K Whitmore
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - M Lay
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Q Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Health, Melbourne, Australia
| | - M Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - T H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
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10
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Carrington M, Silverio Antonio P, Nunes-Ferreira A, Rodrigues T, Couto Pereira S, Bernardes A, Lima Da Silva G, Magalhaes A, J Pinto F, De Sousa J, Marques P. It is possible to predict mortality after ICD implantation? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Implantable Cardioverter Defibrillators (ICD) therapy is not recommended in patients who do not have a reasonable expectation of survival for at least 1 year, although specific recommendations regarding clinical or functional status evaluation are lacking.
Purpose
To identify predictors of all-cause mortality in patients who implanted an ICD.
Methods
Prospective single-center study of patients who implanted ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry of citizens. We performed uni and multivariate analysis to compare clinical characteristics of patients who died and who survived using Cox regression and Kaplan-Meier methods. For the predictor creatinine, we assessed the discrimination power and the best cut-off using the area under the ROC curve (AUC) method.
Results
From 2015–2019, 414 ICDs were implanted (81% male, 62±12 years-old), and 50 (13%) of the patients died after a median follow-up of 23 [11–41] months. Patients who died during the follow-up were older (67±9 vs 61±12, p=0.002), had more diabetes (48% vs 33%, p=0.033) and a higher creatinine (1.23 [0.84–1.86] vs 1.00 [0.84–1.22], p<0.001). The remaining comorbidities were similar between groups (Fig. 1). Patients who died had more frequently an ICD implanted after complication associated with a previous device or as a pacemaker upgrade (6% vs 2%, p=0.030). They also had a higher frequency of ischaemic cardiomyopathy (i-CMP) (82% vs 56%, p=0.002) and of ejection fraction (EF) ≤50% (96% vs 82%, p=0.040). The best cut-off value of creatinine to predict mortality with a sensitivity of 65% and a specificity of 72% was 1.2mg/dl (AUC 0.650; CI95% 0.53–0.77). After adjusting for diabetes, i-CMP, EF ≤50% and upgrade/re-implantation after complication, we found that age (HR 1.033; 95% CI 1.00–1.06, p=0.041) and creatinine ≥1.2mg/dl (HR 2.134; 95% CI 1.09–4.19, p=0.028) were independent predictors of all-cause mortality.
Conclusion
In our cohort of patients who underwent ICD implantation for primary or secondary sudden cardiac death prevention, the all-cause mortality over a median follow-up period of 23 [11–41] months was 13%. We found that in addition to age, a baseline creatinine level ≥1.2mg/dl increases by 2-fold mortality in patients who undergo ICD implantation. Decisions regarding ICD candidacy should not be based on age alone but should also consider creatinine that predisposes to mortality despite ICD implantation.
Funding Acknowledgement
Type of funding sources: None. All cause mortality
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | | | - T Rodrigues
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | | | - A Bernardes
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | | | - A Magalhaes
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - F J Pinto
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - J De Sousa
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
| | - P Marques
- Hospital De Santa Maria, Cardiology, Lisbon, Portugal
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11
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Caldeira Da Rocha R, Picarra B, Santos AR, Carias M, Claudio F, Pais J, Carrington M, Fernandes R, Trinca M. Cardiac magnetic resonance evaluation of takotsubo cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.112] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Takotsubo Cardiomyopathy(TCM)is a reversible pathology with clinical features practically indistinguishable from AMI.Cardiac magnetic resonance(CMR)is uniquely suited in differentiating TCM from other forms of acute ventricular dysfunction.CMR can also identify potential complications.
Purpose
The aim of this study was to characterize TCM features,as well as to evaluate diagnostic and prognostic impact of CMR in these patients.
Methods
A 7-years prospective study,which included patients of our center proposed to CMR with presumptive diagnosis of MINOCA based on acute chest pain,troponin raise and absence of angiographically significant coronary disease (luminal stenosis <50%).We analysed clinical characteristics, electrocardiograms, echo and coronariography.A presumptive diagnosis was elaborated and comparison was made with the TCM definitive one after CMR.We applied a protocol to evaluate TCM patients’ left and right ventricles(LV;RV)both anatomically and functionally, and search for late gadolinium enhancement(LGE).
Results
A total of 93 patients were evaluated,of which 16 had the final diagnosis of TCM.Takotsubo-cardiomyopathy patients were all female,with a mean age of 69 ± 14years old.At admission,75% had ST segment elevation, so emergent coronariography was performed. The median highest troponin I was 2,235[1,30-4,27]ng/mL.CMR confirmed 25%(n = 4) of presumptive diagnosis of TCM. On the other 75%initial diagnosis was changed to TCM after CMR:50%(n = 6) and 17%(n = 2)of patients had an initial presumptive diagnoses of reperfunded STEMI and NSTEMI,respectively. In 33% the initial diagnosis was myocarditis.From CMR evaluation of TCM patients, left atrial dilation was found in 31%(mean indexed area 18 ± 1,5cm2/m2).A majority (81%) presented with preserved ejection fraction(EF)(mean LV EF 59 ± 10%).Regional contractility abnormalities were described in 19%,being hypokinesia in all mid and apical segments in 2 cases, and diffuse in one.LV dysfunction was present in 13%(mean LV EF 32 ± 2%) and RV"s in 2cases (mean RV EF 42%),with only one with biventricular EF depression.Mean LV end diastolic indexed volume(EDIV)was 72 ± 23mL/m2,with only 2 with LV dilation(LV EDIV 120 ± 7mL/m2),non had dilated RV.Mild pericardial effusion was found in 38%,mild mitral regurgitation in 8patients and moderate in 1.A complication was registered:LV outflow tract protomesossystolic acceleration with mild anterior leaflet prolapse,without SAM.No LV thrombus was identified.LGE was observed in 2(13%)of patients:in one it was found on the apex,on the other one the pattern was linear intramyocardial on mid segment of inferior septum.
Conclusion
CMR provides a noninvasive and multidimensional assessment for evaluation of Takotsubo cardiomyopathy.In our population,performing CMR allowed an initial diagnosis modification in 3/4 of the cases and identification of one complication,both with therapeutic and prognostic implications.
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - AR Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carias
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - F Claudio
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Trinca
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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12
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Caldeira Da Rocha R, Picarra B, Pais J, Santos AR, Carrington M, Dias Claudio F, Fernandes R, Trinca M. Cardiac Magnetic Resonance as a diagnostic tool in arrhythmias. Europace 2021. [DOI: 10.1093/europace/euab116.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Etiology of cardiac arrhythmias is often difficult to determine.As the gold standard to anatomical and functional cardiac evaluation,Cardiac Magnetic Resonance(CMR)can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.
Purpose
The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.
Methods
We performed a six-years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis.These patients underwent CMR for diagnostic and risk stratification assessment.We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.
Results
A total of 93 patients were included,of which 66% were male, with a mean age of 45 ± 17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n = 31) of the patients had very frequent premature ventricular complexes, 23% (n = 21) had sustained ventricular tachycardia (VT), 5%(n = 5) non-sustained VT, 17%(n = 16) suspected structural heart disease with high arrhythmic potential,10%(n = 9) unexplained recurrent syncope,9 %(n = 8) supraventricular tachycardia and 3% (n = 3) aborted sudden cardiac death. Depressed ejection fraction (EF)(<50%) was present in 10% (n = 9) for LV(mean EF 38 ± 9%) and 15%(n = 14) for RV (mean EF 42 ± 7%). Dilation of LV was found in 25% of patients (n = 23, mean LV volume: 115 ± 7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15 ± 4mm/m2).We found slight anterior leaflet prolapse of mitral valve in 10% (n = 9) of the cases and mild mitral regurgitation in 15% (n = 14). Left atrium dilation was observed in 17% (n = 16) of patients (mean area of 18 ± 2cm2/m2), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n = 5) have hypertrophic cardiomyopathy,4%(n = 4)a myocarditis sequelae and 2%(n = 2)had RVAD. LV non-compaction,a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3%of the cases each. In 15%(n = 14)we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.
Conclusion
As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - AR Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - F Dias Claudio
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Trinca
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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13
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Tipton TRW, Hall Y, Bore JA, White A, Sibley LS, Sarfas C, Yuki Y, Martin M, Longet S, Mellors J, Ewer K, Günther S, Carrington M, Kondé MK, Carroll MW. Characterisation of the T-cell response to Ebola virus glycoprotein amongst survivors of the 2013-16 West Africa epidemic. Nat Commun 2021; 12:1153. [PMID: 33608536 PMCID: PMC7895930 DOI: 10.1038/s41467-021-21411-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/26/2021] [Indexed: 11/09/2022] Open
Abstract
Zaire ebolavirus (EBOV) is a highly pathogenic filovirus which can result in Ebola virus disease (EVD); a serious medical condition that presents as flu like symptoms but then often leads to more serious or fatal outcomes. The 2013-16 West Africa epidemic saw an unparalleled number of cases. Here we show characterisation and identification of T cell epitopes in surviving patients from Guinea to the EBOV glycoprotein. We perform interferon gamma (IFNγ) ELISpot using a glycoprotein peptide library to identify T cell epitopes and determine the CD4+ or CD8+ T cell component response. Additionally, we generate data on the T cell phenotype and measure polyfunctional cytokine secretion by these antigen specific cells. We show candidate peptides able to elicit a T cell response in EBOV survivors and provide inferred human leukocyte antigen (HLA) allele restriction. This data informs on the long-term T cell response to Ebola virus disease and highlights potentially important immunodominant peptides.
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Affiliation(s)
- T R W Tipton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - Y Hall
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J A Bore
- Center for Training and Research on Priority Diseases including Malaria in Guinea (CEFORPAG), Nongo, Conakry, Guinea
| | - A White
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L S Sibley
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Sarfas
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Y Yuki
- Basic Science Program, Frederick National Laboratory for Cancer Research in the Laboratory of Integrative Cancer Immunology, National Cancer Institute, Frederick, MD, USA
| | - M Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research in the Laboratory of Integrative Cancer Immunology, National Cancer Institute, Frederick, MD, USA
| | - S Longet
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Mellors
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Ewer
- The Jenner Institute, Oxford, UK
| | - S Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, DE, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Börstel-Riems, Hamburg, DE, Germany
| | - M Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research in the Laboratory of Integrative Cancer Immunology, National Cancer Institute, Frederick, MD, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - M K Kondé
- Center for Training and Research on Priority Diseases including Malaria in Guinea (CEFORPAG), Nongo, Conakry, Guinea
| | - M W Carroll
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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14
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Beale A, O'Donnell J, Nakai M, Nanayakkara S, Vizi D, Carter K, Dean E, Ribiero R, Yiallourou S, Carrington M, Marques F, Kaye D. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.108] [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: 10/20/2022]
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15
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Zisis G, Halabi A, Huynh Q, Neil C, Carrington M, Marwick T. Use of Intra-Vascular Volume to Guide Outpatient Management of Fluid Overload and Reduce Hospital Readmission: Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.118] [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: 10/20/2022]
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16
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Wright L, Yiallourou S, Carrington M, Maguire G, Marwick T. Association of Poor Sleep in Indigenous Australians With Abnormal Cardiac Structure and Function. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Caldeira Da Rocha R, Picarra B, Santos A, Pais J, Carrington M, Bras D, Guerreiro R, Fernandes R, Aguiar J. Searching for the final diagnosis using cardiac magnetic resonance in MINOCA patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with clinical evidence of acute myocardial infarction (AMI), absence of obstructive coronary disease does not imply absence of acute thrombotic process. Thereafter, it can be designated as Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). In these cases, performing Cardiac Magnetic Resonance (CMR) can be essential for establishing a final diagnosis, due to evaluation of the presence and pattern of late enhancement.
Purpose
The aim of this study is to evaluate the diagnostic and prognostic impact of cardiac magnetic resonance in patients with a possible diagnosis of MINOCA.
Methods
A 7-years prospective study in our centre, which included all patients proposed to CMR with a presumptive diagnosis of MINOCA due to acute chest pain, troponin raise and absence of angiographically significant coronary disease (luminal stenosis of <50%). All patients performed functional, anatomical evaluation, as so late gadolinium enhancement search. We analysed clinical characteristics, electrocardiographic presentation, echocardiographic and coronariography results. A presumptive diagnosis was elaborated after coronariography and comparison was made with the definitive one after CMR.
Results
A total of 85 patients were included, 53% were male, with a mean age of 49±20 years old. Clinical history of hypertension was observed in 52% patients, 34% had dyslipidaemia, 8% with diabetes, obesity was present in 21% of patients and smoking habits in 33%. At admission, 47% had ST segment elevation, so emergent coronariography was performed. The mean highest troponin I was 7,54±9,39ng/mL. Late gadolinium enhancement was observed in 50 (59%) of patients. After CMR realization a final diagnosis of MINOCA was made in only 13 patients (15%) and in 51 patients (60%) CMR evaluation allowed a diagnosis modification, with impact on patients' management and prognosis. Of these 51 patients, a definitive diagnosis of myocarditis was seen in 65% of cases, of Takotsubo's myocardiopathy in 27%, and hypertrophic cardiomyopathy in 8%. In 21 (25%) of patients, late gadolinium enhancement was not found. However its absence could exclude type 1 AMI as definitive diagnosis.
Conclusion
CMR is a fundamental technique on MINOCA patients' management. In our population, performing CMR allowed initial diagnosis modification in about two thirds of the cases, with important therapeutic and prognostic implications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A.R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R.A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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Picarra B, Santos A, Pais J, Carrington M, Bras D, Congo K, Rocha A, Neves D, Guerreiro R, Aguiar J. Cardiogenic shock without severe left ventricular dysfunction after acute myocardial infarction: population characterization and impact in prognosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1792] [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
Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS afte acute myocardial infarction (AMI), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction.
Purpose
To characterize the population of patients (Pts) with CS after AMI but without severe left ventricular dysfunction (defined as ejection fraction >30%) and assess their impact in mortality.
Methods
From a national multicenter registry, we evaluated 16332 Pts with AMI and ejection fraction (EF) >30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 – Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation and coronary anatomy. We also evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality.
Results
The presence of CS without severe left ventricular dysfunction was observed in 3,2% pts (n=518) with AMI, being CS present at admission in 46,8% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 53±11%, p<0,001). Patients in group 1 were older (71±13 vs 65±13 years, p<0,001), more females (38,8% vs 26,6%, p<0,001), had a higher prevalence of previous valvular heart disease (6,1% vs 3,0%, p<0,001), heart failure (10,1% vs 4,8%, p<0,001, peripheral artery disease (7,5% vs 5,3%, p=0,03), chronic kidney disease (9,8% vs 5,4%, p<0,001), chronic pulmonary obstructive disease (9,1% vs 4,9%, p<0,001) and previous stroke (11,0% vs 7,2%, p<0,001). At admission, Group 1 pts had more ST-elevation AMI (72,6% vs 43,0%, p<0,001), more AF (11,4% vs 6,6%, p<0,001) and more right bundle block (9,9%% vs 5,8%, p<0,001). Group 1 patients received less coronary angiography (80,9% vs 88,2%, p<0,00. The presence of multivessel disease (64,3% vs 51,4%, p<0,001), left main disease (12,2% vs 7,2%, p<0,001), left anterior descending disease (72,4% vs 64,3%, p<0,001) and right coronary disease (64,8% vs 55,5%, p<0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (4,4% vs 0,9%, p<0,001), AF (23,0% vs 4,3%, p<0,001), mechanical complications (8,9% vs 0,3%, p<0,001), high atrial ventricular block (21,9% vs 2,3%, p<0,001), VT (10,8% vs 1,2%, p<0,001) and major bleeding (8,9% vs 1,3%, p<0,001). In-hospital mortality was also much higher in Group 1 pts (29,5% vs 1,2%, p<0,001).
Conclusions
Cardiogenic shock is present in 3,2% of AMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with a much higher in-hospital mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A.R Santos
- Hospital do Espírito Santo, Έvora, Portugal
| | - J.A Pais
- Hospital do Espírito Santo, Έvora, Portugal
| | | | - D Bras
- Hospital do Espírito Santo, Έvora, Portugal
| | - K Congo
- Hospital do Espírito Santo, Έvora, Portugal
| | - A.R Rocha
- Hospital do Espírito Santo, Έvora, Portugal
| | - D Neves
- Hospital do Espírito Santo, Έvora, Portugal
| | | | - J Aguiar
- Hospital do Espírito Santo, Έvora, Portugal
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Bras D, Pais J, Carrington M, Rocha A, Picarra B, Neves D, Semedo P, Aguiar J. Modified zwolle score with delta-creatinine: enhancing the safety of early discharge after STEMI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The Zwolle score (ZS) is recommended to identify low-risk patients eligible for early discharge after acute ST-segment elevation myocardial infarction (STEMI), but as only one-third of STEMIs have a low ZS, the discharge is often postponed. Creatinine variation (Δ-Cr) also provide prognostic information after STEMI.
Purpose
The authors intend to study the “modified Zwolle Score” (MZS) model, which encompasses Δ-Cr as a variable that may enhance the discriminative power of the standard ZS. The outcome is 30-day mortality, time range that starts right after the ACS.
Methods
This is a retrospective study with data from a national multicentre registry. We have included 3.296 patients with STEMI. Zwolle score was calculated for each patient. It is defined as shown in figure 1.
Δ-Cr was defined as maximum serum creatinine minus admission serum creatinine. A Δ-Cr≥0.3 was assigned 2 points in the Modified Zwolle Score, after interpretation of odds ratio via multivariate analysis.
For prediction quality assessment, we have performed ROC curve analysis with both scoring systems versus 30-day mortality. Regarding survival analysis, we have performed Kaplan-Meier curves with Log-rank analysis. We have also registered complications during hospital stay.
Results
The sample mean age is 63±14, and it is composed by 76.8% of males. The majority of patients presented Killip Class I (87.3%). The STEMI was anterior in 49.7% of patients and inferior in 49.8% of patients. The mean admission time was 5 days. Intrahospital mortality was 3% and 30-day mortality was 4%.
The mean ZS was 3.1±2.8 points, the mean MZS was 3±2.1 points and the mean Δ-Cr was 0.2±0.6mg/dL.
The ROC curve analysis between ZS and early mortality revealed a c-statistic of 0.810 (CI 0.796–0.823), whereas the ROC curve between MZS and early mortality revealed a c-statistic of 0.853 (95% CI: 0.841–0.865). The ROC curves comparison showed superiority of the MZS c-statistic, with a difference between AUC of 0.043 (p<0.001, 95% CI: 0.024–0.063).
Regarding low-risk patients, 30-day mortality was 3.3% using ZS (0–2 points) and 2.4% using modified ZS (0–2 points). Fifty patients (1.5%) died between 3rd and 10th day after ACS: original ZS low-risk criteria registered 0.09% and modified ZS low-risk criteria 0.06% fatalities. Kappa coefficient for intergroup concordance was good (0.73).
Conclusion
We conclude that by adding Δ-Cr to the standard ZS, a renal function parameter that was lacking in the ZS, its predicting capacity regarding early mortality in patients admitted with STEMI was increased. Comparing both scores, low-risk patients defined by MZS registered less complications, 3–10 day mortality and 30-day mortality than low-risk patients defined by the original ZS. This fact may lead to better distinction of patients who will benefit from early discharge.
Zwolle Score, ROC curves and survival
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A.R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - P Semedo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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Carrington M, Creta A, Young W, Pais J, Rocha A, Santos A, Melo J, Henriques J, Teixeira R, Goncalves L, Lambiase P, Providencia R. Non Type-1 Brugada pattern, diagnostic yield of 5 ECG criteria in a young adult cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0373] [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
Distinguishing between non-Type 1 Brugada pattern (non-T1BrP) and an athlete's ECG remains challenging and may have important prognostic implications. We aimed to study prevalence and the diagnostic yield of experts and non-experts for the electrocardiographic non-T1BrP criteria in the young adults from the Sudden Cardiac Death-Screening Of risk factorS (SCD-SOS) cohort.
Methods
We performed a cross-sectional study in which we reviewed 14662 ECGs of SCD-SOS survey participants and selected 2494 that presented a rSr'-pattern in V1-V2. Among these, 98 were classified by experts in hereditary arrhythmic syndromes for the presence of non-T1BrP and by non-experts who performed manual measurements of the diagnostic criteria based on triangle formed by r'-wave. We estimated intra and interobserver concordance for each criterion, and used logistic regression and receiver operating characteristics (ROC) analysis and C-statistics for diagnostic accuracy and definition of the most appropriate cut-off values.
Results
We detected a rSr'-pattern in V1-V2 in 17% of the individuals and found that it was associated with higher PQ and QTc intervals, male gender and lower BMI. The manual measurements of non-T1BrP criteria were reproducible: we had high intraobserver concordance coefficients (CC) ranging from 0.90 to 0.94 (except for d(B) that had 0.66), but interobserver CC were lower (0.45–0.68). The measurements performed were highly correlated with non-T1BrP diagnosis and the criteria with higher discriminatory capacity were the distance d(B) (AUC 0.77; 95% CI0.69–0.84) and the degree of ST-ascent (AUC 0.79; 95% CI 0.72–0.86). The cut-offs defined by other authors had very low sensitivity (8–12%), despite high specificity (98%), so we defined new cut-offs: d(A) ≥2mm, d(B) ≥1.25mm, d(B)/h ≥0.38, β-angle ≥19° and ST-ascent ≥1mm. The addition of the degree of ST-ascent to a model with these 4 parameters presented an increase in C-statistics from 0.77 (95% CI: 0.68–0.86) to 0.83 (95% CI: 0.75–0.91) for the diagnosis of non-T1BrP by an expert in Sudden Arrhythmic Death and Channelopathies.
Conclusion
A rSr'-pattern in precordial leads V1-V2 is a frequent finding and the detection of non-T1BrP by using the aforementioned 5 measurements is reproducible and accurate. In this study, we describe new cut-off values that may help untrained clinicians to identify young individuals who should be referred for provocative drug testing for Brugada Syndrome.
Accuracy of non-T1 BrP criteria
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A Creta
- Barts Heart Centre, Cardiology, London, United Kingdom
| | - W Young
- Barts Heart Centre, Cardiology, London, United Kingdom
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A.R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A.R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Melo
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Henriques
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - P Lambiase
- Barts Heart Centre, Cardiology, London, United Kingdom
| | - R Providencia
- Barts Heart Centre, Cardiology, London, United Kingdom
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Haregu TN, Nanayakkara S, Carrington M, Kaye D. Prevalence and correlates of normal body mass index central obesity among people with cardiovascular diseases in Australia. Public Health 2020; 183:126-131. [PMID: 32497780 DOI: 10.1016/j.puhe.2020.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obesity is one of the most common risk factors for cardiometabolic diseases in Australia and worldwide. Recent studies show that people with normal body mass index (BMI) but with central obesity are at increased risk of morbidity and mortality from cardiometabolic diseases. This risk has not been explained well. The aim of this study was to examine the magnitude, correlates and effects of normal BMI central obesity in the Australian adult population. STUDY DESIGN Longitudinal study with data linkage. METHODS We used the Baker Biobank, which contains sociodemographic, behavioural, clinical and mortality data. Data were collected between 2000 and 2011 from 6530 adults who were between 18 and 69 years of age. Biobank data were linked to the National Death Index. A matrix of BMI and waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) were used to create adiposity categories. For analysis, we used descriptive statistics, logistic regression and cox regression models. RESULTS The overall prevalence of normal BMI central obesity was 13.4% by WHtR and 14.4% by WHR. Gender, age, BMI and physical activity were associated with normal BMI central obesity. Higher odds of multimorbidity and increased hazards of all-cause and cardiovascular mortality were associated with WHR. CONCLUSION WHtR and WHR, when each used with BMI, provided similar estimates of prevalence of normal BMI central obesity. However, WHR is a better predictor of all-cause and cardiovascular mortality.
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Affiliation(s)
- T N Haregu
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - S Nanayakkara
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
| | - M Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - D Kaye
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
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Carrington M, Cao T, Haregu T, Gao L, Moodie M, Yiallourou S, Marwick T. 721 Cholesterol Management and Attainment of LDL Targets in Secondary Prevention of Cardiovascular Disease in Primary Care in Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.728] [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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Briosa A, Almeida AR, Gomes AC, Pereira AR, Marques A, Alegria S, Sebaiti D, Santos J, Carrington M, Miranda R, Joao I, Sousa S, Pereira H. 475 A rare cause of right ventricular mass. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Intracardiac masses are always a challenging diagnosis, especially when it involves the right side of the heart. There are multiples etiologies that can be responsible for these masses, namely thrombosis, neoplasm or vegetations. Occasionally, these may be related to an autoimmune process not yet discovered.
Case Report
17-year-old male, with a previous history of genital ulcers, medicated with penicillin with complete resolution of symptoms.
In January 2019, he started an history of recurrent fever, associated with right anterior thoracalgia, weight loss and oral afthosis. He went to the emergency department several times, where he was medicated with antibiotic, with partial symptom relief.
Three months later, he returned to medical attention due to an episode of abundant hemoptysis, followed by hematemesis and cough. At hospital admission, he was hemodynamically stable, tachycardic (100/min) and with occasional episodes of cough. Cardiac and pulmonary auscultation were unremarkable. Thoracic CT revealed the presence of pulmonary thromboembolism (PTE) and a large mass in the right ventricle (RV). It was performed an echocardiogram (echo) that confirmed the presence of a large mass in the RV (50x53mm) from which a projecting hypermobile mass appeared to prolapse into the right atrium.
Taking into account the diagnosis of PTE and the presence of a right ventricular mass, the patient was hospitalized and started anticoagulation. The case was immediately discussed with cardiac surgery, that confirmed that there was no surgical indication. During hospitalization, there were no more episodes of hemoptysis or hematemesis.Consecutive echos were performed, that did not reveal a significant decrease in mass dimensions despite anticoagulation. Viral serologies and autoimmunity panel were all negative. Cardiac RMI was performed raising the suspicion of a possible mass covered with thrombus.
After discussion with rheumatology, and according to clinical signs, the hypothesis of vasculitis was placed, and the patient started treatment with steroids. This treatment had to be suspended after a few days due to an infectious intercurrence. After a course of antibiotic therapy, the patient started therapy with cyclophosphamide with good clinical and echocardiographic response (reduced mass dimensions).
It was admitted Behçet’s disease with cardiac complications, and the patient was referred to the rheumatology consultation.
Conclusion
Behçet’s disease is a multi-system, chronic disorder that behaves like vasculitis.There are some typical clinical manifestations associated with this disease, such as oral and genital afthosis, uveitis, arthritis, skin lesions and nervous system involvement.Presentations with cardiac symptoms are one of the extremely rare manifestations of this disease, posing a challenge for the treating physician.
Abstract 475 Figure. Right ventricular mass
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Affiliation(s)
- A Briosa
- Hospital Garcia de Orta, Lisbon, Portugal
| | | | - A C Gomes
- Hospital Garcia de Orta, Lisbon, Portugal
| | | | - A Marques
- Hospital Garcia de Orta, Lisbon, Portugal
| | - S Alegria
- Hospital Garcia de Orta, Lisbon, Portugal
| | - D Sebaiti
- Hospital Garcia de Orta, Lisbon, Portugal
| | - J Santos
- Hospital Garcia de Orta, Lisbon, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Evora, Portugal
| | - R Miranda
- Hospital Garcia de Orta, Lisbon, Portugal
| | - I Joao
- Hospital Garcia de Orta, Lisbon, Portugal
| | - S Sousa
- Hospital Garcia de Orta, Lisbon, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Lisbon, Portugal
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Carrington M, Briosa A, Quadrado M, Manuel A, Marques G, Ferreira MJ, Joao I, Pereira H. P1461 Concomitant potential cardioembolic sources in a patient with an acute ischemia of the limb. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transesophageal echocardiography (TEE) is the gold standard exam to look for a cardioembolic source in a patient with an otherwise unexplained suspected systemic ischemic event. Purpose: This clinical case aims to illustrate the importance of a thorough TEE evaluation in the presence of a suspected systemic emboli, and to not neglect thoracic aorta evaluation when a potential intracardiac cause has been detected. Case presentation: We present the case of a 55-year-old man, obese (BMI 30kg/m2), active smoker, with no past medical history or medication, and whose father died from an unspecified cardiovascular cause at 45 years-old. He was admitted to the hospital because of an acute ischemia of the right lower limb, for which he underwent urgent percutaneous femoral embolectomy of the limb, with success. During hospitalization, he was referred for a TEE, which showed valves and cavities with no evidence of potential embolic sources. However, he had a thin and hypermobile atrial septum, with no obvious defect after color flow mapping, but with a patent foramen oval (PFO) that was detected after agitated saline injection associated with a Valsalva maneuver, with the passage of 5-25 microbubbles (grade 2/4 shunt) and an atrial septum aneurysm (ASA), with an excursion of the fossa ovalis towards the left atrium of 10.1mm (Figure 1). The ascending aorta was normal, but the descending aorta depicted 2 hypermobile masses, 1 starting at 35cm from the dental arch (transversal area: 0,52cm2), the longest (7cm) starting at 32cm and ending at the aortic arch (transversal area: 1,76cm2). An angio-CT was immediately performed, which depicted an atheromatous calcified plaque in the terminal portion of the aortic arch, giving rise to the image suggestive of thrombus, and extending for about 6cm to the medium third of the descending thoracic aorta. The remaining portions of the aorta and iliac arteries depicted diffuse atheromatous and partially calcified plaques (Figure 2). The patient was submitted to an urgent thoracic endovascular aortic repair with a 26x10cm prosthesis implantation with occlusion of the left subclavian artery and an adequate final clinical result. Syphilis and auto-immune disease were excluded and a diffuse atheromatous disease of the aorta was assumed as the cause of the thrombus and the embolic event. After 16 days, he was discharged asymptomatic and with no signs of chronic ischemia, treated with oral anticoagulation with rivaroxabano, high-dose statin and strict smoking cessation. Conclusion: Cardioembolic source is a heterogeneous entity. In this patient, 2 potential cardioembolic sources were detected: while the PFO and ASA are minor or unclear risk sources of emboli, TEE also allowed for the detection of a large thrombus arising from an atherosclerotic calcified plaque in the thoracic aorta, which was considered a major risk source, thus implying urgent surgery to obviate the risk of further embolic events.
Abstract P1461 Figure. Fig.1.POF and ASA;Fig.2.Aortic Thrombus
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A Briosa
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - M Quadrado
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - A Manuel
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - G Marques
- Hospital Garcia de Orta, Vascular Surgery, Almada, Portugal
| | - M J Ferreira
- Hospital Garcia de Orta, Vascular Surgery, Almada, Portugal
| | - I Joao
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
| | - H Pereira
- Hospital Garcia de Orta, Cardiology, Almada, Portugal
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Da Conceicao Pedro Pais JA, Picarra B, Congo K, Carrington M, Santos AR, Guerreiro R, Bras D, Rocha AR, Aguiar J. P260 Left ventricular pseudoaneurysm manifesting as syncope. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.121] [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
Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI.
Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery.
Description of the clinical case
74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall)
Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure.
This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise.
A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis.
Abstract P260 Figure. Fig 1 - LV pseudoaneurysm
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - R Guerreiro
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - A R Rocha
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
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Picarra B, Pais JA, Santos AR, Carrington M, Bras D, Carvalho J, Aguiar J. P1722A new predictive score for mortality and cardiogenic shock in patients with ST-elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0477] [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
Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality.
Objective
To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI.
Population and methods
Evaluated 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg/dL (1 point) and creatinine at admission >1.5mg/dL (2 points). The population was divided into three subgroups: group A low score (0–2 points), group B intermediate score (3–5 points) and group C score (6–8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC).
Results
After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775–0,830, p=0,001), of CS (ASC 0,763, 95% CI 0,731–0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756–0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p<0,001) and 18-fold higher CS (OR 18,0; p<0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p<0.001) for MIH and 82% (OR 1,82, p<0,001) for CS.
Conclusion
This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.
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Affiliation(s)
- B Picarra
- Hospital do Espírito Santo, Έvora, Portugal
| | - J A Pais
- Hospital do Espírito Santo, Έvora, Portugal
| | - A R Santos
- Hospital do Espírito Santo, Έvora, Portugal
| | | | - D Bras
- Hospital do Espírito Santo, Έvora, Portugal
| | - J Carvalho
- Hospital do Espírito Santo, Έvora, Portugal
| | - J Aguiar
- Hospital do Espírito Santo, Έvora, Portugal
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Picarra B, Pais JA, Santos AR, Carrington M, Bras D, Congo K, Aguiar J. P2265Cardiogenic shock without severe left ventricular dysfunction after ST-elevation acute myocardial infarction: population characterization and impact in prognosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The presence of cardiogenic shock (CS) after ST-elevation acute myocardial infarction (STEMI) is associated with a high mortality. Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS, however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction.
Purpose
To characterize the population of patients (Pts) with CS after STEMI but without severe left ventricular dysfunction and assess their impact in mortality.
Methods
From a national multicenter registry, we evaluated 7181 Pts with STEMI and ejection fraction (EF) >30%, and excluded all pts with STEMI and an EF<30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 - Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategies, reperfusion times and coronary anatomy. We evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality.
Results
The presence of CS without severe left ventricular dysfunction was observed in 5,2% pts (n=376), being CS present at admission in 51,2% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 51±11%, p<0,001). Patients in group 1 were older (70±14 vs 63±13 years, p<0,001), more females (39,4% vs 23,3%, p<0,001), had a higher prevalence of previous valvular heart disease (2,7% vs 1,0%, p=0,005), heart failure (4,8% vs 1,4%, p<0,001, peripheral artery disease (5,5% vs 2,9%, p=0,004), chronic kidney disease (6,4% vs 2,7%, p<0,001) and chronic pulmonary obstructive disease (8,2% vs 3,1%, p<0,001). At admission, Group 1 pts had more atrial fibrillation (10,4% vs 4,4%, p<0,001) and received less reperfusion (77,7% vs 83,0%, p=0,008), without differences in the type of reperfusion or times to reperfusion. The presence of multivessel disease (60,0% vs 45,7%, p<0,001) and left main disease (6,6% vs 2,4%, p<0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (3,5% vs 0,7%, p<0,001), AF (22,1% vs 5,0%, p<0,001), mechanical complications (9,6% vs 0,5%, p<0,001), high atrial ventricular block (26,7% vs 3,7%, p<0,001), VT (10,6% vs 1,9%, p<0,001), stroke (1,9% vs 0,6%, p=0,01) and major bleeding (10,4% vs 1,5%, p<0,001). In-hospital mortality was much higher in Group 1 pts (26,6% vs 1,4%, p<0,001).
Conclusions
Cardiogenic shock is present in 5,2% of STEMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with much higher in-hospital mortality.
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Affiliation(s)
- B Picarra
- Hospital do Espírito Santo, Έvora, Portugal
| | - J A Pais
- Hospital do Espírito Santo, Έvora, Portugal
| | - A R Santos
- Hospital do Espírito Santo, Έvora, Portugal
| | | | - D Bras
- Hospital do Espírito Santo, Έvora, Portugal
| | - K Congo
- Hospital do Espírito Santo, Έvora, Portugal
| | - J Aguiar
- Hospital do Espírito Santo, Έvora, Portugal
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Nobre De Matos Pereira Vieira MJ, Campos D, Carrington M, Goncalves L, Teixeira R. P621Variation of global longitudinal strain (2D STE) with passive leg lifting maneuver: a marker of myocardial functional reserve? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In a normal heart, the passive leg lifting maneuver (LLM) will result in an increase in myocardial contractility, according to the mechanistic concept of the Frank-Starling law. With the progression of myocardial disease this ability is impaired and the myocardial functional reserve (mFR) is reduced (Figure1 – Panel A). The variation of left ventricular global longitudinal strain (as an index of contractile function) with LLM may thus represent a marker of left ventricular mFR.
Purpose
To assess the variation of left ventricular global longitudinal strain (LV GLS) with LLM as a marker of mFR in a healthy population and in patients with myocardial disease (hypertrophic myocardiopathy - HCM and systolic dysfunction patients – SystDysf.
Methods and results
We evaluated the variation of LV GLS by 2-dimensional Speckle Tracking Echocardiography (2D-STE), in response to passive LLM, in a population of 103 individuals (54 healthy individuals, 28 HCM patients and 21 left ventricular SystDysf patients). Clinical, demographic and echocardiographic parameters (including LV longitudinal mechanics obtained with 2D-STE before and after LLM) were described. The population had a mean age of 46±18 years and 55% were women. Increased venous return to the heart during LLM was confirmed by an increase in the maximal diameter of the inferior vena cava (15,1±3,6 vs 20,6±3,8 mm, p<0.001).
There was a significant variation of LV GLS in healthy individuals submitted to LLM (−20,58±3,0 vs −21,5±2,6%, p=0,02, Δ 0,6%, 95% CI 0,1–1,1%). Regarding the HCM and SystDysf groups, no significant change in LV GLS was observed with LLM (−13,2±2,8 vs −12,3±2,9%, p=0,12, Δ +0,6%, 95% CI −1,4 to 0,18% and −10,2±2,5 vs 10,2±2,7%, p=0,79, Δ 0,08%, 95% CI −0,7 to 0,5%, respectively). Figure 1 (Panel B)
Conclusion
To our knowledge, this is the first report describing the use of LV GLS and LLM to assess mFR in this clinical setting. The absolute increase of LV GLS in the healthy population suggests that this may be a reliable method and a sensitive marker to assess the mFR. Conversely, patients with HCM and with SystDysf show poor or no response to the LLM, suggesting, as expected, a low myocardial functional reserve. Given the non-invasiveness and cost-effectiveness nature of this technique, we suggest that this maneuver could pose a feasible way to assess mFR. Further studies are needed to validate this technique and to assess the role of mFR by 2D-STE as a prognostic marker.
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Affiliation(s)
| | - D Campos
- University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Hospital Geral, Cardiology, Coimbra, Portugal
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Da Conceicao Pedro Pais JA, Picarra BC, Carrington M, Santos AR, Guerreiro RA, Carvalho J, Bras D, Congo K, Neves D, Aguiar J. P1764Quality criteria for STEMI care - a national perspective. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0517] [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
The definition of quality criteria in health care is essential to implement structural organization strategies that ensure that patients (P) receive the best care according to the most updated recommendations available at the time they are treated. Quality indicators have recently been defined with regard to the approach and treatment of STEMI in the European Guidelines published in 2017.
Objective
The authors intend to characterize the level of care provided to P with STEMI inserted into a national multicenter registry since 2011 in order to establish a relationship with international recommendations.
Population and methods
Descriptive study based on a national multicenter registry. A total of 2051 P admitted to the hospital with the diagnosis of STEMI were included, 1266 P for the year 2011 and 785 P for the year 2016.
Results
The P of the year 2011 and 2016 presented similar age (64±14 vs 63±13). There was a higher percentage of P admitted by STEMI fast track managed care system in 2016 (36.9% vs 22.2%, p<0,001) and less from the Emergency Department (31.6% vs 56.8%; p<0,001). Regarding the transport to the Hospital, there was an increase in patients transported by prehospital medical teams (28% vs 21%; p<0,001) and less by own means (35.7% vs 45.6%; p<0,001). Regarding in-hospital therapy, it was found that in 2016 more patients received loading doses of P2Y12 inhibitors – Clopidogrel (78.1% vs 70.3% P<0,001) and Ticagrelor (54.7% vs 0.7% P<0,001). In post-discharge therapy, there was also a slight improvement in care in 2016, with more P being treated with P2Y12 inhibitor (96.2% vs 92.4%; p=0.03) and beta-blocker (84.4% vs 78.7%; p<0,001). Regarding the type of reperfusion, there was an increase in angioplasty (95.5% vs 92.2%; p<0,001) and a decrease in fibrinolysis (4.5% vs 7.8%; p=0.03) in 2016. There was a slight worsening of the prehospital delay in 2016 (median 163min vs 120min) and an improvement in door to reperfusion time (median 60min vs 70min). There was also an increase in angioplasties performed in 2016 (87.1% vs 85.1%; p<0,001) as well as an increase in the percentage of left ventricular function evaluation before discharge (98.2% vs 93.9%; p<0,001).
Conclusion
The results presented demonstrate a slight improvement in the quality of the care provided to STEMI P. However, there are areas for improvement, in accordance with international recommendations, in particular with regard to reperfusion times.
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Affiliation(s)
| | - B C Picarra
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
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30
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Carrington M, Creta A, Santos R, Teixeira R, Goncalves L, Providencia R. P309R' wave in precordial leads V1-V2 in patients from the young SCD-SOS cohort. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sudden Cardiac Death – Screening Of risk factorS (SCD-SOS) survey aimed to screen for warning signs of potential channelopathies and cardiomyopathies that may course with sudden cardiac death in the young (≤40 years old) and consisted in an ECG and a digital-based previously validated questionnaire.
Purpose
We aimed to study clinical and electrocardiographic characteristics of young patients from the SCD-SOS cohort who presented with an r'-wave in precordial leads V1 and V2.
Methods
All the ECG were screened for the detection of an r'-wave in precordial leads V1 and V2. The ECGs selected were reviewed by a second investigator (agreed in 97.7% of the cases). We performed classical descriptive statistics and multivariate logistic regression to compare patients with and without r'-wave in these leads.
Results
From a total of 14669 patients who had an ECG performed as part of the SCD-SOS survey, 17% displayed an r'-wave in precordial leads V1 and V2 and 0.4% had complete right bundle branch block (RBBB). Patients with rSr' pattern had a mean age of 20±5 years old, 54% of them were male, they had a mean body mass index (BMI) of 22±3kg/m2, and 54% practiced sports regularly, with a mean of 5±4 hours of physical activity per week. Regarding previous symptoms reported by these individuals, 24% (n=487) reported a transient loss of consciousness, 15% (n=310) a reflex syncope, 3% (n=58) had unexplained syncope and 21% (n=425) palpitations. Sudden death in relatives before 50 years-old was present in 11% (n=172) of the patients with an r'-wave in V1-V2. After adjusting for heart rate and physical activity, PQ interval (OR 1.007 - CI95% 1.004–1.010, p<0.001), QTc interval (OR 1.009 - CI95% 1.005–1.012, p<0.001), male gender (OR 2.438 - CI95% 2.144–2.772, p<0.001) and BMI (OR 0.881 - CI95% 0.864–0.900, p<0.001) were independently associated with the presence of r'wave in precordial leads V1-V2. Unexplained syncope, palpitations and family history of sudden death were not associated with r'-wave in the young SCD-SOS population.
Conclusions
We conclude that r'-wave in V1-V2 is a frequent finding in the young population and that it is associated with higher PQ and QTc intervals. The prognostic implications of this pattern are unknown, but thorough differential diagnosis is warranted since this pattern may correspond to incomplete RBBB/athlete's ECG, and may also be suggestive of other potentially serious conditions such as Type 2 Brugada pattern and multiple causes of right ventricular enlargement. Finally, this pattern is also associated with male gender and lower BMI, suggesting a dependence on anatomical factors.
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A Creta
- St Bartholomew's Hospital, London, United Kingdom
| | - R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Da Conceicao Pedro Pais JA, Picarra B, Carrington M, Santos AR, Guerreiro RA, Bras D, Congo KISA, Carvalho J, Neves D, Aguiar J. P1720Survival analysis in a population of patients with cardiogenic shock after acute myocardial infarction: characterization of the population and identification of mortality predictors. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0475] [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
The presence of cardiogenic shock (CC) after acute myocardial infarction (AMI) is associated with high mortality.
Purpose
To compare the clinical characteristics, cardiac and non-cardiac complications among survivors and non-survivors of CC after AMI in order to identify predictors of in-hospital mortality.
Population and methods
An observational study involving 467 patients (P) with CC after AMI included in a national multicenter registry. Considered 2 groups: Group 1 - P with CC who died (n=190) and Group 2 - P with CC who survived (n=277). We recorded age, gender, personal history, coronary angiography and angioplasty performed, in-hospital therapy and ejection fraction, cardiac complications (Re-infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia) and non-cardiac complications [acute renal injury (ARI), major bleeding and stroke]. Multivariate analysis was performed to identify predictors of in-hospital mortality.
Results
Mortality in patients with CC after AMI was 40.6%. Group 1 P were older (77±10 vs 68±13 years, p<0.001), presented higher prevalence of diabetes mellitus (41.8% vs 28.2%, p=0.003), previous AMI (23.8% vs. 12%, p<0.001) 7%, p=0.002), previous angor (31.9% vs 14.1%, p=0.001), heart failure (18.6% vs 8.7%, p=0.002) and peripheral arterial disease (11.8% vs 6.2%, p=0.03). There were fewer coronary angiographies (64.2% vs 87.7%, p<0.001), with no difference in the number or type of vessels with lesions in both groups, as well as inotropic therapy. With the exception of mechanical complications, more prevalent in group 1 (12.6% vs 5.4%, p=0.006), there were no differences in the prevalence of the remaining cardiac complications. Among the non-cardiac complications considered, only the presence of ARI was more prevalent in Group 1 (72.1% vs 37.5%, p<0.001). After multivariate analysis the presence of age>75 years [OR: 2.21 (CI: 1.39–3.51)], previous angor [OR: 1.91 (CI: 1.09–2.92)], LRA [OR: 3.14 (CI: 4.0–7.04)] and mechanical complications [OR: 3.82 (CI: 2.39–6.10] were independent predictors of in-hospital mortality of P with CC post-AMI.
Conclusions
Mortality in patients with CC after AMI remains high. Age>75 years, prior angor, ARI and mechanical complications are independent predictors of in-hospital mortality in P with CC post-AMI.
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Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - K I S A Congo
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal
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Carrington M, Santos R, Pais J, Picarra B, Rocha R, Bras D, Azevedo-Guerreiro R, Hyde-Congo K, Aguiar J. P603Cardiac Magnetic Resonance evaluation and risk stratification of patients with unexplained or suspected arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The etiological diagnosis of cardiac arrhythmias is often difficult. Cardiac Magnetic Resonance (CMR) is the gold standard exam for anatomical and functional cardiac evaluation and it may be indicated in patients with ventricular arrhythmias when echocardiography does not provide an accurate assessment of left and right ventricles (LV, RV).
Purpose
The aim of this study was to determine the impact of CMR in the diagnosis and stratification of arrhythmic risk in patients with confirmed or suspected arrhythmias, as well as to describe the changes observed.
Methods
We performed a prospective registry over a 5-year period of all the patients with arrhythmias who underwent CMR for diagnostic and risk stratification purposes. We followed a protocol to evaluate both anatomically and functionally the ventricles and to look for the presence of late gadolinium enhancement (LGE).
Results
A total of 78 patients were included, of which 65% were male and a mean age of 46±17 years-old was observed. The indications for CMR evaluation of patients with confirmed or suspected arrhythmias were as follows: 33% (n=26) of the patients had very frequent premature ventricular complexes (PVC), 23% (n=18) had sustained ventricular tachycardia (VT), 17% (n=13) suspected structural heart disease with high arrhythmic potential, 12% (n=9) unexplained recurrent syncope, 6% (n=5) supraventricular tachycardia, 5% (n=4) non-sustained VT and 4% (n=3) aborted sudden cardiac death. Depressed ventricular ejection fraction (<50%) was present in 9% (n=7) for the LV and in 14% (n=11)for the RV. Dilation of the LV was found in 24% of the patients (n=19, mean LV volume: 115±4ml/m2) and RV dilation was present in only 1 patient who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m2). Cardiac synchronization artifacts due to the presence of very frequent PVC compromised the calculation of v volumes in only 4% (n=3) of the patients. In total, 6% (n=5) had interventricular septum hypertrophy (mean 15±6g/m2), 10% (n=8) had a slight prolapse of the anterior leaflet of the mitral valve and 19% (n=15) had a dilated left auricle. LGE was present in 13% (n=10) and slight pericardium effusion was detected in 12% (n=9). CMR was considered normal in 65% (n=51), in 15% (n=12) we found nonspecific changes deserving follow-up and in 20% (n=15) it was possible to establish a diagnosis which was previously unknown: 5% (n=4) had hypertrophic cardiomyopathy, 4% (n=3) LV non-compaction, 4% (n=3) a myocarditis sequelae, 3% (n=2) RVAD, 3% (n=2) a myocardial infarction scar and 1 had non-ischemic dilated cardiomyopathy.
Conclusions
CMR is a technique with high spatial resolution, feasible and safe, which allowed an increase in diagnosis in 20% of the patients, thus contributing to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.
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Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Rocha
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | - K Hyde-Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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Haji K, Marwick T, Neil C, Stewart S, Carrington M, Wright L, Chan Y, Simons K, Wong C. P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0782] [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
The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF.
Method
Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage.
Results
63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure.
HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04
Conclusion
GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.
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Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - S Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - M Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - L Wright
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Y Chan
- Australian Catholic University, Melbourne, Australia
| | - K Simons
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
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Bras D, Guerreiro RA, Pais J, Congo K, Carrington M, Semedo P, Picarra B, Fernandes R, Aguiar J. P130Impact of pre-test probability of CAD in post-test probability by Myocardial Perfusion Scintigraphy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.017] [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: 11/13/2022] Open
Affiliation(s)
- D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - P Semedo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R Fernandes
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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35
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Ball J, Marwick T, Zisis G, Carrington M. Heart Failure Digital Coach: Pilot Findings of an Avatar Style Application to Improve Symptoms, Self-care and Knowledge. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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Haregu T, Carrington M, Yiallourou S, Nanayakkara S, Kaye D. The Overlap between Cancer and Cardiovascular Diseases Mortality. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.137] [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]
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37
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Haji K, Marwick T, Neil C, Carrington M, Stewart S, Chan Y, Wong C. Use of Left Ventricular Strain imaging to Predict Long Term Heart Failure Risk in High Risk Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.329] [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]
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38
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Carrington M, Santos AR, Pais J, Picarra B, Bras D, Azevedo-Guerreiro R, Hyde-Congo K, Carvalho J, Neves D, Aguiar J. P4613A quick New Score to predict in-hospital mortality, cardiac arrest and cardiogenic shock in Acute Myocardial Infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | - K Hyde-Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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Haji K, Marwick T, Neil C, Carrington M, Stewart S, Chan Y, Simons K, Wright L, Wong C. P2745Use of left ventricular deformation imaging to predict heart failure risk in cardiac inpatients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2745] [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: 11/13/2022] Open
Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - M Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - S Stewart
- Australian Catholic University, Melbourne, Australia
| | - Y Chan
- Australian Catholic University, Melbourne, Australia
| | - K Simons
- Western Hospital, Cardiology, Melbourne, Australia
| | - L Wright
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
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40
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Da Conceicao Pedro Pais JA, Picarra B, Santos AR, Congo K, Carvalho J, Aguiar J, Carrington M, Guerreiro AR, Bras D, Neves D. P1583Previous neoplasia in patients with STEMI: characterization of population and impact on prognosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1583] [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: 11/13/2022] Open
Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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41
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Bras D, Guerreiro RA, Pais J, Congo K, Carrington M, Carvalho J, Picarra B, Santos AR, Aguiar J. P6426Predicting haemorrhagic complications and intra-hospital mortality in Acute Coronary Syndromes: a comparison study between two risk scores. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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42
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Da Conceicao Pedro Pais JA, Picarra B, Guerreiro RA, Carrington M, Santos AR, Congo K, Bras D, Carvalho J, Neves D, Aguiar J. P5565Role of the right branch block in the prognosis of STEMI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5565] [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: 11/13/2022] Open
Affiliation(s)
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - R A Guerreiro
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - K Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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43
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Carrington M, Santos AR, Pais J, Picarra B, Bras D, Azevedo-Guerreiro R, Hyde-Congo K, Carvalho J, Neves D, Aguiar J. P1732Comparision of a quick New Score with GRACE and TIMI for the prediction of in-hospital mortality, cardiogenic shock and cardiac arrest in NSTEMI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | - K Hyde-Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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44
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Carrington M, Santos AR, Pais J, Picarra B, Bras D, Azevedo-Guerreiro R, Hyde-Congo K, Carvalho J, Neves D, Aguiar J. 4176Impact of prior stroke on acute myocardial infarction: population characterization and influence on in-hospital mortality and complications. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4176] [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: 11/15/2022] Open
Affiliation(s)
- M Carrington
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - A R Santos
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Pais
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - B Picarra
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Bras
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | | | - K Hyde-Congo
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Carvalho
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - D Neves
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
| | - J Aguiar
- Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal
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45
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Picarra B, Pais J, Carrington M, Santos A, Guerreiro R, Carvalho J, Congo K, Bras D, Aguiar J. P3018Nosocomial infections in a cardiac care intensive unit: epidemiology, prognosis and predictors. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Rodrigues A, Carrington M. Relationship Between Cardio-Metabolic Disease Risk and Health Beliefs, Perceptions and Behaviours: a Regional Perspective. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.432] [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: 11/28/2022]
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47
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Townsley E, O'Connor G, Cosgrove C, Woda M, Co M, Thomas SJ, Kalayanarooj S, Yoon IK, Nisalak A, Srikiatkhachorn A, Green S, Stephens HAF, Gostick E, Price DA, Carrington M, Alter G, McVicar DW, Rothman AL, Mathew A. Interaction of a dengue virus NS1-derived peptide with the inhibitory receptor KIR3DL1 on natural killer cells. Clin Exp Immunol 2015; 183:419-30. [PMID: 26439909 PMCID: PMC4750593 DOI: 10.1111/cei.12722] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Accepted: 10/04/2015] [Indexed: 12/26/2022] Open
Abstract
Killer immunoglobulin-like receptors (KIRs) interact with human leucocyte antigen (HLA) class I ligands and play a key role in the regulation and activation of NK cells. The functional importance of KIR-HLA interactions has been demonstrated for a number of chronic viral infections, but to date only a few studies have been performed in the context of acute self-limited viral infections. During our investigation of CD8(+) T cell responses to a conserved HLA-B57-restricted epitope derived from dengue virus (DENV) non-structural protein-1 (NS1), we observed substantial binding of the tetrameric complex to non-T/non-B lymphocytes in peripheral blood mononuclear cells (PBMC) from a long-standing clinical cohort in Thailand. We confirmed binding of the NS1 tetramer to CD56(dim) NK cells, which are known to express KIRs. Using depletion studies and KIR-transfected cell lines, we demonstrated further that the NS1 tetramer bound the inhibitory receptor KIR3DL1. Phenotypical analysis of PBMC from HLA-B57(+) subjects with acute DENV infection revealed marked activation of NS1 tetramer-binding natural killer (NK) cells around the time of defervescence in subjects with severe dengue disease. Collectively, our findings indicate that subsets of NK cells are activated relatively late in the course of acute DENV illness and reveal a possible role for specific KIR-HLA interactions in the modulation of disease outcomes.
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Affiliation(s)
- E Townsley
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - G O'Connor
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - C Cosgrove
- Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Woda
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - M Co
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - S J Thomas
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - S Kalayanarooj
- Queen Sirikit National Institute for Child Health, Bangkok, Thailand
| | - I-K Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - A Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - A Srikiatkhachorn
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - S Green
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - H A F Stephens
- Centre for Nephrology and the Anthony Nolan Trust, Royal Free Campus, University College, London, UK
| | - E Gostick
- Cardiff University School of Medicine, Institute of Infection and Immunity, Cardiff, UK
| | - D A Price
- Cardiff University School of Medicine, Institute of Infection and Immunity, Cardiff, UK.,Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.,Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - G Alter
- Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D W McVicar
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - A L Rothman
- Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA
| | - A Mathew
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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48
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Ahn RS, Moslehi H, Martin MP, Abad-Santos M, Bowcock AM, Carrington M, Liao W. Inhibitory KIR3DL1 alleles are associated with psoriasis. Br J Dermatol 2015; 174:449-51. [PMID: 26286807 DOI: 10.1111/bjd.14081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- R S Ahn
- Department of Dermatology, University of California San Francisco, 2340 Sutter Street, Box 0808, San Francisco, CA, 94143-0808, U.S.A..
| | - H Moslehi
- Department of Dermatology, University of California San Francisco, 2340 Sutter Street, Box 0808, San Francisco, CA, 94143-0808, U.S.A
| | - M P Martin
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, U.S.A.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA, U.S.A
| | - M Abad-Santos
- Department of Dermatology, University of California San Francisco, 2340 Sutter Street, Box 0808, San Francisco, CA, 94143-0808, U.S.A
| | - A M Bowcock
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - M Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, U.S.A.,Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA, U.S.A
| | - W Liao
- Department of Dermatology, University of California San Francisco, 2340 Sutter Street, Box 0808, San Francisco, CA, 94143-0808, U.S.A
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49
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Carrington M, Santos-Sousa H, Barbosa E, Costa-Maia J. 2078 Prognosis and predictive factors of early-recurrence in colorectal cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Chan Y, Ball J, Teng T, Tuttle C, Ahamed Y, Carrington M, Scuffham P, Stewart S. Increasing clinical and economic burden of heart failure among older Australians. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.773] [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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