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Kitt J, Krasner S, Barr L, Frost A, Tucker K, Bateman PA, Suriano K, Kenworthy Y, Lapidaire W, Lacharie M, Mills R, Roman C, Mackillop L, Cairns A, Aye C, Ferreira V, Piechnik S, Lukaschuk E, Thilaganathan B, Chappell LC, Lewandowski AJ, McManus RJ, Leeson P. Cardiac Remodeling After Hypertensive Pregnancy Following Physician-Optimized Blood Pressure Self-Management: The POP-HT Randomized Clinical Trial Imaging Substudy. Circulation 2024; 149:529-541. [PMID: 37950907 DOI: 10.1161/circulationaha.123.067597] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Hypertensive pregnancy disorders are associated with adverse cardiac remodeling, which can fail to reverse in the postpartum period in some women. The Physician-Optimized Postpartum Hypertension Treatment trial demonstrated that improved blood pressure control while the cardiovascular system recovers postpartum associates with persistently reduced blood pressure. We now report the effect on cardiac remodeling. METHODS In this prospective, randomized, open-label, blinded end point trial, in a single UK hospital, 220 women were randomly assigned 1:1 to self-monitoring with research physician-optimized antihypertensive titration or usual postnatal care from a primary care physician and midwife. Participants were 18 years of age or older, with preeclampsia or gestational hypertension, requiring antihypertensives on hospital discharge postnatally. Prespecified secondary cardiac imaging outcomes were recorded by echocardiography around delivery, and again at blood pressure primary outcome assessment, around 9 months postpartum, when cardiovascular magnetic resonance was also performed. RESULTS A total of 187 women (101 intervention; 86 usual care) underwent echocardiography at baseline and follow-up, at a mean 258±14.6 days postpartum, of which 174 (93 intervention; 81 usual care) also had cardiovascular magnetic resonance at follow-up. Relative wall thickness by echocardiography was 0.06 (95% CI, 0.07-0.05; P<0.001) lower in the intervention group between baseline and follow-up, and cardiovascular magnetic resonance at follow-up demonstrated a lower left ventricular mass (-6.37 g/m2; 95% CI, -7.99 to -4.74; P<0.001), end-diastolic volume (-3.87 mL/m2; 95% CI, -6.77 to -0.98; P=0.009), and end-systolic volume (-3.25 mL/m2; 95% CI, 4.87 to -1.63; P<0.001) and higher left and right ventricular ejection fraction by 2.6% (95% CI, 1.3-3.9; P<0.001) and 2.8% (95% CI, 1.4-4.1; P<0.001), respectively. Echocardiography-assessed left ventricular diastolic function demonstrated a mean difference in average E/E' of 0.52 (95% CI, -0.97 to -0.07; P=0.024) and a reduction in left atrial volumes of -4.33 mL/m2 (95% CI, -5.52 to -3.21; P<0.001) between baseline and follow-up when adjusted for baseline differences in measures. CONCLUSIONS Short-term postnatal optimization of blood pressure control after hypertensive pregnancy, through self-monitoring and physician-guided antihypertensive titration, associates with long-term changes in cardiovascular structure and function, in a pattern associated with more favorable cardiovascular outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854.
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Affiliation(s)
- Jamie Kitt
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Samuel Krasner
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Logan Barr
- Queen's University School of Medicine, Kingston, Canada (L.B.)
| | - Annabelle Frost
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul A Bateman
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Katie Suriano
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Yvonne Kenworthy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Winok Lapidaire
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Miriam Lacharie
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Cristian Roman
- Institute of Biomedical Engineering, Department of Engineering Science (C.R.), University of Oxford, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Alexandra Cairns
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
| | - Christina Aye
- Nuffield Department of Women's and Reproductive Health (A.F., L.M., A.C., C.A.), University of Oxford, United Kingdom
- Fetal Medicine Unit, Oxford University Hospitals National Health Service Foundation Trust, United Kingdom (C.A.)
| | - Vanessa Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Stefan Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.L., R.M., S.P.), University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (V.F., E.L.), University of Oxford, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom (B.T.)
- Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (B.T.)
| | - Lucy C Chappell
- King's College London and Guy's and St Thomas' National Health Service Foundation Trust, United Kingdom (L.C.C.)
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences (J.K., K.T., P.A.B., R.J.M.), University of Oxford, United Kingdom
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine (J.K., S.K., A.F., K.S., Y.K., W.L., A.J.L., P.L.), University of Oxford, United Kingdom
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Kotronias RA, Raman B, Ferreira V, Neubauer S, Antoniades C. Photon-Counting Computed Tomography: "One-Stop Shop" For Coronary Stenosis, Inflammation And Myocardial Assessment in STEACS. Eur Heart J Cardiovasc Imaging 2024:jeae003. [PMID: 38193731 DOI: 10.1093/ehjci/jeae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Rafail A Kotronias
- Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Betty Raman
- Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Vanessa Ferreira
- Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Neubauer
- Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
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Ng MY, Tam CH, Lee YP, Fong HTA, Wong CK, Ng WKC, Yeung MHY, Ling WHI, Tsao S, Wan EYF, Ferreira V, Yan AT, Siu CW, Yiu KH, Hung IFN. Post-COVID-19 vaccination myocarditis: a prospective cohort study pre and post vaccination using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:74. [PMID: 38057820 DOI: 10.1186/s12968-023-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Concerns about COVID-19 vaccination induced myocarditis or subclinical myocarditis persists in some populations. Cardiac magnetic resonance imaging (CMR) has been used to detect signs of COVID-19 vaccination induced myocarditis. This study aims to: (i) characterise myocardial tissue, function, size before and after COVID-19 vaccination, (ii) determine if there is imaging evidence of subclinical myocardial inflammation or injury after vaccination using CMR. METHODS Subjects aged ≥ 12yrs old without prior COVID-19 or COVID-19 vaccination underwent two CMR examinations: first, ≤ 14 days before the first COVID-19 vaccination and a second time ≤ 14 days after the second COVID-19 vaccination. Biventricular indices, ejection fraction (EF), global longitudinal strain (GLS), late gadolinium enhancement (LGE), left ventricular (LV) myocardial native T1, T2, extracellular volume (ECV) quantification, lactate dehydrogenase (LDH), white cell count (WCC), C-reactive protein (CRP), NT-proBNP, troponin-T, electrocardiogram (ECG), and 6-min walk test were assessed in a blinded fashion. RESULTS 67 subjects were included. First and second CMR examinations were performed a median of 4 days before the first vaccination (interquartile range 1-8 days) and 5 days (interquartile range 3-6 days) after the second vaccination respectively. No significant change in global native T1, T2, ECV, LV EF, right ventricular EF, LV GLS, LGE, ECG, LDH, troponin-T and 6-min walk test was demonstrated after COVID-19 vaccination. There was a significant WCC decrease (6.51 ± 1.49 vs 5.98 ± 1.65, p = 0.003) and CRP increase (0.40 ± 0.22 vs 0.50 ± 0.29, p = 0.004). CONCLUSION This study found no imaging, biochemical or ECG evidence of myocardial injury or inflammation post COVID-19 vaccination, thus providing some reassurance that COVID-19 vaccinations do not typically cause subclinical myocarditis.
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Affiliation(s)
- Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China.
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen, China.
| | - Cheuk Hang Tam
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Yung Pok Lee
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Ho Tung Ambrose Fong
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun-Ka Wong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Kei Carol Ng
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 406, Block K, Queen Mary Hospital, Hong Kong SAR, China
| | - Wood-Hay Ian Ling
- Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong SAR, China
| | - Sabrina Tsao
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford BHF Centre of Research Excellence, Oxford Centre for Clinical Magnetic Resonance Research, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew T Yan
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Chung Wah Siu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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Guiné RPF, Florença SG, Costa CA, Correia PMR, Cruz-Lopes L, Esteves B, Ferreira M, Fragata A, Cardoso AP, Campos S, Anjos O, Bartkiene E, Djekic I, Matran IM, Čulin J, Klava D, Chuck-Hernández C, Korzeniowska M, Boustani NM, Papageorgiou M, Gutiérrez BP, Černelič-Bizjak M, Damarli E, Ferreira V. Edible Insects: Perceptions of Marketing, Economic, and Social Aspects among Citizens of Different Countries. Foods 2023; 12:4229. [PMID: 38231666 DOI: 10.3390/foods12234229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Because edible insects (EI) have been, in recent years, recommended as a nutritious animal protein food with enormous environmental advantages over other sources of animal protein for human consumption, studies aimed at investigating the consumer perspective have become more prominent. Hence, this study intended to examine the perceptions of participants from different countries about the commercialization and economic and social impacts of edible insects. The study was made using a questionnaire survey, and data were collected in Brazil, Croatia, Greece, Latvia, Lebanon, Lithuania, Mexico, Poland, Portugal, Romania, Serbia, Slovenia, Spain, and Turkey. The final number of received answers was 7222 participants. For the treatment of the results, different statistical techniques were used: factor analysis, internal reliability by Cronbach's alpha, cluster analysis, ANOVA to test differences between groups, and Chi-square tests. The results obtained confirmed the validity of the scale, constituted by 12 out of the 14 items initially considered, distributed by 4 factors: the first related to the economic impact of EIs, the second related to the motivation for consumption of EIs, the third related to the places of purchase of EIs, and the fourth corresponding to a question presented to the participants as a false statement. A cluster analysis allowed identifying three clusters, with significant differences between them according to all the sociodemographic variables tested. Also, it was found that the participants expressed an exceptionally high level of agreement with aspects such as the difficulty in finding EIs on sale, knowledge acting as a strong motivator for EI consumption, and the role of personalities and influencers in increasing the will to consume EIs. Finally, practically all sociodemographic variables were found to be significantly associated with perceptions (country, sex, education, living environment, and income), but not age. In conclusion, the perceptions about EI commercialization were investigated and revealed differences among samples originating from different countries. Moreover, the sociodemographic characteristics of the participants were found to be strongly associated with their perceptions.
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Affiliation(s)
- Raquel P F Guiné
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Sofia G Florença
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Cristina A Costa
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Paula M R Correia
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Luísa Cruz-Lopes
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Bruno Esteves
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Manuela Ferreira
- Health Sciences Research Unit: Nursing (UICISA: E), Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Anabela Fragata
- CIDEI-IPV Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Ana P Cardoso
- CIDEI-IPV Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Sofia Campos
- CIDEI-IPV Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - Ofélia Anjos
- CERNAS Research Centre, Polytechnic University of Castelo Branco, 6001-909 Castelo Branco, Portugal
| | - Elena Bartkiene
- Department of Food Safety and Quality, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
| | - Ilija Djekic
- Department of Food Safety and Quality Management, Faculty of Agriculture, University of Belgrade, 11000 Belgrade, Serbia
| | - Irina M Matran
- Department of Community Nutrition and Food Safety, GEP University MPhScTch of Targu Mures, 540139 Targu Mures, Romania
| | - Jelena Čulin
- Maritime Department, University of Zadar, 23000 Zadar, Croatia
| | - Dace Klava
- Faculty of Food Technology, Latvia University of Life Sciences and Technologies, LV 3001 Jelgava, Latvia
| | | | - Malgorzata Korzeniowska
- Faculty of Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wrocław, Poland
| | - Nada M Boustani
- Faculty of Business and Administration, Saint Joseph University, Beirut 1104 2020, Lebanon
| | - Maria Papageorgiou
- Department of Food Science and Technology, International Hellenic University, 57001 Thessaloniki, Greece
| | | | - Maša Černelič-Bizjak
- Department of Nutritional Counseling-Dietetics, Faculty of Health Science, University of Primorska, 6320 Izola, Slovenia
| | - Emel Damarli
- Research and Development Center, Altıparmak Food Coop., Çekmeköy, 34782 İstanbul, Turkey
| | - Vanessa Ferreira
- Department of Nutrition, School of Nursing, UFMG-Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
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Balligand JL, Brito D, Brosteanu O, Casadei B, Depoix C, Edelmann F, Ferreira V, Filippatos G, Gerber B, Gruson D, Hasenclever D, Hellenkamp K, Ikonomidis I, Krakowiak B, Lhommel R, Mahmod M, Neubauer S, Persu A, Piechnik S, Pieske B, Pieske-Kraigher E, Pinto F, Ponikowski P, Senni M, Trochu JN, Van Overstraeten N, Wachter R, Pouleur AC. Repurposing the β3-Adrenergic Receptor Agonist Mirabegron in Patients With Structural Cardiac Disease: The Beta3-LVH Phase 2b Randomized Clinical Trial. JAMA Cardiol 2023; 8:1031-1040. [PMID: 37728907 PMCID: PMC10512168 DOI: 10.1001/jamacardio.2023.3003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/23/2023] [Indexed: 09/22/2023]
Abstract
Importance Left ventricular (LV) hypertrophy contributes to the onset and progression of heart failure (HF), particularly for patients with pre-HF (stage B) for whom no treatment has yet proven effective to prevent transition to overt HF (stage C). The β3-adrenergic receptors (β3ARs) may represent a new target, as their activation attenuates LV remodeling. Objective To determine whether activation of β3ARs by repurposing a β3AR agonist, mirabegron, is safe and effective in preventing progression of LV hypertrophy and diastolic dysfunction among patients with pre- or mild HF. Design, Setting, and Participants The Beta3-LVH prospective, triple-blind, placebo-controlled phase 2b randomized clinical trial enrolled patients between September 12, 2016, and February 26, 2021, with a follow-up of 12 months. The trial was conducted at 10 academic hospitals in 8 countries across Europe (Germany, Poland, France, Belgium, Italy, Portugal, Greece, and the UK). Patients aged 18 years or older with or without HF symptoms (maximum New York Heart Association class II) were screened for the presence of LV hypertrophy (increased LV mass index [LVMI] of ≥95 g/m2 for women or ≥115 g/m2 for men) or maximum wall thickness of 13 mm or greater using echocardiography. Data analysis was performed in August 2022. Intervention Participants were randomly assigned (1:1) to mirabegron (50 mg/d) or placebo, stratified by the presence of atrial fibrillation and/or type 2 diabetes, for 12 months. Main Outcomes and Measures The primary end points were LVMI determined using cardiac magnetic resonance imaging and LV diastolic function (early diastolic tissue Doppler velocity [E/e'] ratio assessed using Doppler echocardiography) at 12 months. Patients with at least 1 valid measurement of either primary end point were included in the primary analysis. Safety was assessed for all patients who received at least 1 dose of study medication. Results Of the 380 patients screened, 296 were enrolled in the trial. There were 147 patients randomized to mirabegron (116 men [79%]; mean [SD] age, 64.0 [10.2] years) and 149 to placebo (112 men [75%]; mean [SD] age, 62.2 [10.9] years). All patients were included in the primary intention-to-treat analysis. At 12 months, the baseline and covariate-adjusted differences between groups included a 1.3-g/m2 increase in LVMI (95% CI, -0.15 to 2.74; P = .08) and a -0.15 decrease in E/e' (95% CI, -0.69 to 0.4; P = .60). A total of 213 adverse events (AEs) occurred in 82 mirabegron-treated patients (including 31 serious AEs in 19 patients) and 215 AEs occurred in 88 placebo-treated patients (including 30 serious AEs in 22 patients). No deaths occurred during the trial. Conclusions In this study, mirabegron therapy had a neutral effect on LV mass or diastolic function over 12 months among patients who had structural heart disease with no or mild HF symptoms. Trial Registration ClinicalTrials.gov Identifier: NCT02599480.
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Affiliation(s)
- Jean-Luc Balligand
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal
| | - Oana Brosteanu
- Clinical Trial Centre Leipzig, Universität Leipzig, Leipzig, Germany
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
- National Institute of Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Christophe Depoix
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frank Edelmann
- Department of Cardiology, German Centre for Cardiovascular Research, Charité University Campus Virchow, Berlin, Germany
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Bernhard Gerber
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics, and Epidemiology, Universität Leipzig, Leipzig, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pneumology, German Centre for Cardiovascular Research, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ignatios Ikonomidis
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Bartosz Krakowiak
- Department of Cardiology, Centre for Heart Diseases, Clinical Military Hospital, Wrocław Medical University, Wrocław, Poland
| | - Renaud Lhommel
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Masliza Mahmod
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
| | - Alexandre Persu
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Stefan Piechnik
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
| | - Burkert Pieske
- Department of Cardiology, German Centre for Cardiovascular Research, Charité University Campus Virchow, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Cardiology, German Centre for Cardiovascular Research, Charité University Campus Virchow, Berlin, Germany
| | - Fausto Pinto
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Centro Cardiovascular, Universidade de Lisboa, Lisboa, Portugal
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Diseases, Clinical Military Hospital, Wrocław Medical University, Wrocław, Poland
| | - Michele Senni
- Department of Cardiology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, University of Milano-Bicocca, Bergamo, Italy
| | - Jean-Noël Trochu
- Institut du Thorax, Centre National de la Recherche Scientifique, Nantes Université, Nantes, France
- L’Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Nancy Van Overstraeten
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Rolf Wachter
- Department of Cardiology and Pneumology, German Centre for Cardiovascular Research, Universitätsmedizin Göttingen, Göttingen, Germany
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Anne-Catherine Pouleur
- Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Duque BR, Bruno SF, Ferreira V, Guedes TB, Machado C, Hamdan B. Venomous snakes of medical importance in the Brazilian state of Rio de Janeiro: habitat and taxonomy against ophidism. BRAZ J BIOL 2023; 83:e272811. [PMID: 37909585 DOI: 10.1590/1519-6984.272811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023] Open
Abstract
Snakebite envenoming is a major global health problem that kills or disables half a million people in the world's poorest countries. Identifying the biting snake and its habitat use is key to understanding snakebite eco-epidemiology and optimizing its clinical management. To prevent and combat the neglected snakebite disease, we characterize the morphology, geographic distribution, habitat use, and snakebites of medically important venomous snakes in the state of Rio de Janeiro (Brazil). Despite Philodryas spp. not being considered of medical importance by the Brazilian Ministry of Health, we also explore their data once the bites may require medical intervention, may cause death, and their consequences are underestimated. Methods: We assessed taxonomy and geographic data from specimens housed in scientific collections, the literature, and the Notifiable Diseases Information System. Our data revealed fragility in the morphological characters recommended to distinguish Bothrops jararaca from B. jararacussu, identify the subspecies of Crotalus durissus and distinguish the species of Philodryas. To help identify these species, we present an identification key to the venomous snake species from Rio de Janeiro based on the morphological data collected. We record the genera Bothrops and Micrurus in all mesoregions of the state. Here, we provide the first record of C. durissus in the Serrana region, supporting the hypothesis of geographic expansion of the species in the state. The crotalic antivenom must not be missing in Médio Paraíba, Centro-Sul Fluminense, and Serrana, where the rattlesnake C. durissus occurs. Bothrops bilineatus and Lachesis muta have historical records presented for the first time herein. However, these species are likely endangered or extinct in the state. There were 7,483 snakebites reported between 2001 and 2019, with an annual average of 393.8 cases. The Bothrops genus is responsible for the majority of accidents. The highest number of cases occurred in the Serrana region, the largest pole of family agriculture in Rio de Janeiro. We improve the identification of venomous snake species, better delimit their distribution, and update the number of cases of snakebites, thus providing greater precision in the attention to this problem in Rio de Janeiro. We emphasize the importance of clinical studies to test using bothropic-crotalic antivenom and heparin in all mesoregions to treat B. jararacussu envenomation; and mechanical ventilation, atropine, and anticholinesterases in the emergency health centers in the Metropolitana and Norte Fluminense regions due to the occurrence of the coral M. lemniscatus in these areas.
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Affiliation(s)
- B R Duque
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Programa de Pós-graduação em Ecoturismo e Conservação, Rio de Janeiro, RJ, Brasil
| | - S F Bruno
- Universidade Federal Fluminense - UFF, Faculdade de Veterinária, Niterói, RJ, Brasil
| | - V Ferreira
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - T B Guedes
- Universidade Estadual de Campinas - UNICAMP, Instituto de Biologia, Departamento de Biologia Animal, Campinas, SP, Brasil
- University of Gothenburg, Gothenburg Global Biodiversity Center - GGBC, Department of Biological and Environmental Sciences, Göteborg, Sweden
| | - C Machado
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - B Hamdan
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Rio de Janeiro - UFRJ, Instituto de Bioquímica Médica Leopoldo de Meis, Laboratório de Hemostase e Venenos, Rio de Janeiro, RJ, Brasil
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7
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Mesquita FV, Ferreira V, Mesquita D, Andrade LEC. CD4 T lymphocyte subsets display heterogeneous susceptibility to apoptosis induced by serum from patients with systemic lupus erythematosus. Adv Rheumatol 2023; 63:40. [PMID: 37587510 DOI: 10.1186/s42358-023-00321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Serum from systemic lupus erythematosus (SLE) patients has been shown to induce T-lymphocyte (TL) apoptosis. Given that different cells of the immune system display different sensitivity to apoptosis, we set to evaluate the in vitro effect of SLE serum on regulatory T-cells (Treg), Th17, Th1 and Th2 from SLE patients and healthy controls. METHODS Peripheral blood mononuclear cells from SLE patients or normal controls were exposed to a pool of sera from SLE patients or normal controls. Annexin V was used to label cells in apoptosis or necrosis. Annexin V-labeled Treg, Th17, Th1 and Th2 cells were determined using flow cytometry. RESULTS Total CD3 + and CD4 + cells from SLE patients showed higher frequency of spontaneous apoptosis/necrosis, whereas Th1 cells from SLE patients presented reduced spontaneous apoptosis/necrosis rate as compared with cells from controls. Incubation with SLE serum induced increased frequency of apoptotic/necrotic CD3 + , CD4 + and Th2 cells from normal controls or from SLE patients as compared with cultures incubated with normal human serum (NHS) or without human serum at all. Incubation with SLE serum did not increase the apoptosis/necrosis rate in Th1 or Th17 cells. Treg cells from SLE patients were more prone to apoptosis/necrosis induced by SLE serum than Treg cells from normal individuals. Th1, Th2, and Th17 cells presented increased apoptosis rates in cultures without human serum. CONCLUSION Our findings indicate that the serum of patients with active SLE stimulates apoptosis of CD4 + T cells in general and exhibit differentiated effects on CD4 + T-cell subsets.
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Affiliation(s)
- Fernanda Vieira Mesquita
- Division of Rheumatology - Escola Paulista de Medicina, UNIFESP, Universidade Federal de São Paulo, Rua Botucatu 740, SP, 04023-062, São Paulo, Brazil
| | - Vanessa Ferreira
- Division of Rheumatology - Escola Paulista de Medicina, UNIFESP, Universidade Federal de São Paulo, Rua Botucatu 740, SP, 04023-062, São Paulo, Brazil
| | - Danilo Mesquita
- Division of Rheumatology - Escola Paulista de Medicina, UNIFESP, Universidade Federal de São Paulo, Rua Botucatu 740, SP, 04023-062, São Paulo, Brazil
| | - Luís Eduardo Coelho Andrade
- Division of Rheumatology - Escola Paulista de Medicina, UNIFESP, Universidade Federal de São Paulo, Rua Botucatu 740, SP, 04023-062, São Paulo, Brazil.
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8
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Pedrosa AG, Reglinski K, Lismont C, Kors S, Costello J, Rodrigues TA, Marques M, Linka N, Argyriou C, Weinhofer I, Kocherlakota S, Riccio V, Ferreira V, Di Cara F, Ferreira AR, Francisco T, Azevedo JE, Ribeiro D. Peroxisomes : novel findings and future directions. Histochem Cell Biol 2023; 159:379-387. [PMID: 37160800 PMCID: PMC10170047 DOI: 10.1007/s00418-023-02201-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Ana G Pedrosa
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Katharina Reglinski
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Headley Way, Oxford, OX3 9DS, UK
- Leibniz-Institute of Photonic Technologies, Albert-Einstein Strasse 9, 07745, Jena, Germany
- Institute of Applied Optic and Biophysics, Friedrich-Schiller University Jena, Max-Wien-Platz 1, 07743, Jena, Germany
- University Hospital Jena, Bachstraße 18, Jena, Germany
| | - Celien Lismont
- Laboratory of Peroxisome Biology and Intracellular Communication, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Suzan Kors
- College of Life and Environmental Sciences, Biosciences, University of Exeter, Exeter, UK
| | - Joseph Costello
- College of Life and Environmental Sciences, Biosciences, University of Exeter, Exeter, UK
| | - Tony A Rodrigues
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Mariana Marques
- Institute of Biomedicine - iBiMED & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Nicole Linka
- Institute of Plant Biochemistry, Heinrich Heine University, Düsseldorf, Germany
| | | | - Isabelle Weinhofer
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | | | - Victoria Riccio
- Cell Biology Department, Hospital for Sick Children, Toronto, Canada
- Department of Biochemistry, University of Toronto, Toronto, Canada
| | - Vanessa Ferreira
- Institute of Biomedicine - iBiMED & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Francesca Di Cara
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, Nova Scotia Health Authority IWK, Halifax, NS, Canada
| | - Ana Rita Ferreira
- Institute of Biomedicine - iBiMED & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Tânia Francisco
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Jorge E Azevedo
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal.
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Daniela Ribeiro
- Institute of Biomedicine - iBiMED & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
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Ferreira V, Sánchez-Gimeno D, Ontañón I. A method for the quantitative and reversible trapping of sulfidic gases from headspaces and its application to the study of wine reductive off-odors. Food Chem 2023; 421:136092. [PMID: 37087988 DOI: 10.1016/j.foodchem.2023.136092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Some relevant food systems release tiny amounts of sulfidic gases, whose measurement is difficult because of their inherent instability. The present paper demonstrates that Cu(I) solutions trap quantitatively and stabilize sulfidic gases. Once trapped, the gases remain stable for weeks at 4 °C and at least 8 days at 75 °C. Trapped gases can be quantitatively released with tris(2-carboxyethyl) phosphine (TCEP) and brine dilution and then determined by GC. Trapping solutions, placed in 20-mL opened vials housed in 100 mL hermetically-sealed flasks containing wine in anoxia, have been used to monitor the release of sulfidic gases by wines, revealing that at 50 °C, up to 400 μg/L of H2S and 58 μg/L of MeSH can be released in 68 days, and 3-5 times more at 75 °C in 28 days. The possibility to differentiate between released and accumulated amounts provides key clues to understanding the fate of sulfidic gases in wine and other food systems.
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Ferreira V, Ferreira AR, Ribeiro D. Peroxisomes and Viruses: Overview on Current Knowledge and Experimental Approaches. Methods Mol Biol 2023; 2643:271-294. [PMID: 36952192 DOI: 10.1007/978-1-0716-3048-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The general interest in the study of the interplay between peroxisomes and viruses has increased in recent years, with different reports demonstrating that distinct viruses modulate peroxisome-related mechanisms to either counteract the cellular antiviral response or support viral propagation. Nevertheless, mechanistical details are still scarce, and information is often incomplete. In this chapter, we present an overview of the current knowledge concerning the interplay between peroxisomes and different viruses. We furthermore present, compare, and discuss the most relevant experimental approaches and tools used in the different studies. Finally, we stress the importance of further, more detailed, and spatial-temporal analyses that encompass all the different phases of the viruses' infection cycles. These studies may lead to the discovery of novel peroxisome-related cellular mechanisms that can further be explored as targets for the development of novel antiviral therapies.
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Affiliation(s)
- Vanessa Ferreira
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Ana Rita Ferreira
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Daniela Ribeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
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11
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Lacerda Teixeira B, Grazina A, Castelo A, Ferreira V, Bras P, Branco Mano T, Gil R, Moura Branco L, Galrinho A, Timoteo AT, Rio P, Pinto E, Coelho P, Fragata J, Cruz Ferreira R. Cardiac myxoma embolic events: characterization and predictors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.165] [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
Myxomas are the most common heart tumors. Although, myxomas are often diagnosed incidentally in asymptomatic patients, they are frequently associated with embolic events, becoming an important cause of morbidity and mortality. Whether some myxomas' characteristics predict more embolic risk is not well established.
Objectives
This analysis aims to describe the clinical and echocardiographic data in a long cohort of patients with cardiac myxomas and to establish potential predictors of embolic events int these patients.
Methods
Between 1990 and 2021, 88 patients were diagnosed with cardiac myxoma. 84 were included in this analysis. Baseline characteristics, echocardiographic findings and embolic events were noted retrospectively. A binary logistic regression analysis using SPSS statistics software, version 25.0 was performed to establish possible embolic predictors.
Results
84 patients (mean age 63.1±12.9 years old, 75% female) with cardiac myxoma (sporadic type in 100%) were analyzed (table 1). The majority were located in the left atrium (88.1%, n=74), followed by right atrium (10.7%, n=9) and right ventricle (1.2%, n=1). The average dimension (longer axis) was 36.8±17.4mm. 9.6% of the patients (n=8) had Atrial Fibrillation (AF) rhythm. 22.6% of the patients (n=19) experienced embolic events, the majority to the central nervous system (19.0%, n=6), followed by peripheric/limbs (2.4%, n=2), renal (1.2%, n=1) and coronary (1.2%, n=1). The presence of irregular borders (papillary, bosselated) was the only parameter independently associated with increased risk of embolic events, by 6 times (OR 6.78, 95% confidence interval of 2.14–21.51, p-value 0.001). Neither the presence of AF, myxoma dimensions, presence of calcifications, pediculated insertion, myxoma mobility or heterogeneous aspect predicted embolic events with statistical significance (table 2).
Conclusions
Cardiac myxomas are frequently associated with embolic events (22.6% in our population), posing an important cause of morbidity and mortality in these patients. Besides the presence of irregular borders, the other myxoma's characteristics did not consistently predict the occurrence of embolic events. This data supports the well-recognized fact that all cardiac myxomas have the potential to embolic events, and therefore, should be excised, although those with very irregular borders are at much higher risk of embolization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Grazina
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | - V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | - P Bras
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - R Gil
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A Galrinho
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - P Rio
- Hospital de Santa Marta , Lisbon , Portugal
| | - E Pinto
- Hospital de Santa Marta , Lisbon , Portugal
| | - P Coelho
- Hospital de Santa Marta , Lisbon , Portugal
| | - J Fragata
- Hospital de Santa Marta , Lisbon , Portugal
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12
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Spartera M, Stracquadanio A, Von Ende A, Pessoa-Amorim G, Hess A, Young V, Mazzucco S, Kennedy J, Ferreira V, Neubauer S, Casadei B, Wijesurendra R. Left atrial vorticity is independently associated with embolic brain infarcts and represents a promising imaging biomarker of cardioembolism in sinus rhythm and atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.274] [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
Atrial fibrillation (AF) is associated with embolic stroke, but risk scores such as CHA2DS2-VASc perform only modestly (C statistics 0.6–0.7). Meanwhile, up to 25% of embolic strokes in patients without AF have no identifiable cause, and occult left atrial (LA) thromboembolism may be a relevant mechanism in such cases.
Purpose
We hypothesised that imaging of left atrial blood flow could improve embolic risk prediction in patients with and without AF. We used 4D flow magnetic resonance imaging (MRI) to identify a biomarker that is: (a) independently associated with embolic brain infarction by brain MRI, (b) able to stratify blood flow characteristics both during AF and in sinus rhythm (SR), and (c) reproducible.
Methods
We recruited 3 patient cohorts to respectively address each aim. Firstly, to assess the association between LA flow parameters and embolic brain infarcts, we recruited cohort A, consisting of 134 patients (41% female; age 70±9 years) with a history of ischaemic stroke (N=44) or no history of stroke but with CHA2DS2VASc score ≥1 (N=90). Next, the sensitivity of 4D flow parameters to rhythm change was assessed in cohort B: 37 patients with persistent AF studied before and after cardioversion, whose results were compared with those of 23 healthy controls in SR [CHA2DS2-VASc = 0.0 (0.0–0.0)]. Finally, scan-rescan coefficients of variation (CV) and interval-scan CV at 30 days were determined in Cohort C (86 subjects; 64 in SR, 22 in AF). Brain MRI was used to identify large non-cortical or cortical brain infarcts (LNCCI) – i.e. infarcts likely to be embolic in origin.
Results
At least one LNCCI was present in 39 of 134 patients in cohort A. Lower LA vorticity was significantly associated with higher risk of prevalent LNCCIs (Figure 1), after adjustment for AF, age, and CHA2DS2VASc score [OR=2.10 (95% CI 1.12–3.92) per SD, P=0.02]. This association remained significant after further adjustment for other cardiac parameters (all P<0.05, Figure 1). By contrast, there was no significant association between peak velocity and LNCCIs (P=0.21).
LA vorticity was sensitive to rhythm change, improving significantly in patients in cohort B in SR at ≥4 weeks after cardioversion (CV) of persistent AF (Figure 2A, paired P<0.001 vs pre-CV), but remained impaired compared to healthy controls (Figure 2B, P<0.01).
Finally, reproducibility studies in cohort C showed that LA vorticity had a same-day scan-rescan CV of 7% without significant differences between SR and AF subjects (P>0.05), and also showed no significant temporal variability on interval scanning (P>0.05).
Conclusions
LA vorticity is reproducible, sensitive to changes in heart rhythm, and independently associated with embolic brain infarcts, suggesting a promising imaging biomarker of cardioembolism in SR and AF. LA blood flow imaging could improve stroke prediction and the personalisation of decisions about anticoagulation, regardless of heart rhythm.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Oxford BRC, BHF
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Affiliation(s)
- M Spartera
- University of Oxford , Oxford , United Kingdom
| | | | - A Von Ende
- University of Oxford , Oxford , United Kingdom
| | | | - A Hess
- University of Oxford , Oxford , United Kingdom
| | - V Young
- University of Oxford , Oxford , United Kingdom
| | - S Mazzucco
- University of Oxford , Oxford , United Kingdom
| | - J Kennedy
- University of Oxford , Oxford , United Kingdom
| | - V Ferreira
- University of Oxford , Oxford , United Kingdom
| | - S Neubauer
- University of Oxford , Oxford , United Kingdom
| | - B Casadei
- University of Oxford , Oxford , United Kingdom
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Ferreira V, Garcia Bras P, Castelo A, Santos A, Viveiros A, Ilhao Moreira R, Machado AI, Alves M, Cruz Ferreira R. Outcomes in pregnant women with valvular heart disease from sub Saharan Africa transferred to a developed nation. A distinct care model. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2604] [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
Pregnant women with valvular heart disease (VHD) in African countries still bear a disproportionate burden of maternal morbidity and mortality, due to the reduced accessibility to health care and the scarcity of skilled professionals. It is unclear if outcomes would be improved by care-delivery model changes.
Purpose
We performed a clinical audit of African pregnant women with VHD who were transferred for their care from five countries to our cardio-obstetrics unit, during a twenty-year period, through a memorandum of agreement of international cooperation.
Methods
A retrospective analysis of 81 pregnancies (P) in 45 African women with VHD (median age 24, IQR 22–29 years) from 2001 to 2020. The main outcome measures were major maternal complications and perinatal outcome.
Results
History of rheumatic heart disease was determined in 74.1% of the P. Most women were in NHYA I or II before P (79.0%), 43.2% had previous cardiac medication and 60.5% were anticoagulated (33.3% with acenocoumarol and 27.2% with warfarin). 59.3% of P had at least one valvular prosthesis, including 38 mechanical prosthetic valve (MPV) and 10 biological valves. 22.2% had prior surgical or percutaneous VHD correction, excluding prosthesis implantation. At baseline, impaired left ventricular ejection fraction was found in 12.3%. Previous arrhythmic event, stroke or infectious endocarditis were found in 12.3%, 8.6% and 6.2% of P, respectively.
During P, deterioration in NYHA functional class occurred in 42.0% and 9.9% required initiation or intensified cardiac medication. For MPV, 51% maintained a vitamin K antagonist, 15.7% used LMWH from 6 to 12th weeks and 9.8% used LMWH throughout P. Valve thrombosis occurred in 4 women (4.9% of P), with one maternal death in a patient with double MPV.
Hemorrhagic complications happened in 8.6% of P, all anticoagulated, in immediate postpartum or puerperal period. The 81 P resulted in 56 live births (69.1%), with a medium birth weight of 3026±471g. Delivery by caesarean section was performed in 28.3% of newborns. The incidence of miscarriage was 23.5% and fetal malformations occurred in 14.8%, with warfarin embryopathy in 4 cases. In univariate analysis, the presence of valvular protheses (p=0.001), and anticoagulation (p=0.001) were related to unsuccessful P. In multivariate analysis, VKA therapy was the unique independent predictor of unsuccessful P (p=0.048).
Conclusion
With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful for women transferred from sub–Saharan Africa. However, the presence of a valvular prothesis is associated with unsuccessful pregnancy even in a developed nation. Efforts other than the implantation of a MPV should be pursued vigorously in sub Saharan Africa.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Santos
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Viveiros
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A I Machado
- Maternidade Alfredo da Costa , Lisbon , Portugal
| | - M Alves
- Maternidade Alfredo da Costa , Lisbon , Portugal
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14
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Grazina A, Teixeira B, Ferreira V, Castelo A, Garcia Bras P, Viegas JM, Cardoso I, Moura Branco L, Galrinho A, Timoteo AT, Rio P, Coelho P, Fragata J, Cruz Ferreira R. Cardiac myxomas: characteristics and outcomes in a tertiary center. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.163] [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
Cardiac myxoma (CM) is the most common primary cardiac tumour. It can manifest in a variety of clinical presentations or it can be asymptomatic and, ultimately, be detected with image techniques. The only successful treatment of these tumours is surgical excision, with low complications and recurrence rate.
Objectives
This analysis aims to describe the clinical forms of presentation and echocardiographic characteristics of cardiac myxomas, establish myxoma features associated with obstructive symptons, as well as describe the postoperative outcome and long-term recurrence in a tertiary center.
Methods
Between 1990 and 2021, 88 patients were diagnosed with cardiac myxoma. 84 were included in this analysis. Baseline characteristics, clinical presentation, echocardiographic findings and outcomes were noted retrospectively. A binary logistic regression analysis using SPSS statistics software, version 25.0 was performed to establish myxoma features associated with atrioventricular valves obstruction.
Results
Mean age was 63±12 years old, 75% female. All CM were sporadic. The majority of the patients (52.4%, n=44) were asymptomatic, embolic events were present in 22.9% of the patients (n=19), with the most common site being central nervous system (19.0%, n=16) and constitutional symptoms in 16.7% (n=14), the most frequent fatigue (11.9%, n=10). Atrial fibrilation was present in 9.6% of the patients (n=8). The majority of the myxomas were located in the left atrium (88.1%), followed by right atrium (10.7%) and right ventricle (1.2%). Mean myxoma dimension was 36.8±17.4mm (longer axis), with heterogeneous aspect in 63.1%, presence of calcification in 11.9%, pediculated insertion in 40.5%, mobility in 70.2% and irregular borders in 52.4%. Moderate or severe ventricular inflow obstruction was present in 13.1% (n=11), 13.6% with mitral obstruction in the left atrial myxomas and 11.1% with tricuspid obstruction in the right atrial myxomas. CM longer axis 40–59mm and superior to 60mm were independently associated with obstruction (OR 5.1, 95% CI 1.4–18.4, p0.014 and OR 11.5, 95% CI 2.9–45.4, p0.001, respectively). No other morphologic features were associated with mitral or tricuspid obstruction. All but 3 patients had the myxoma surgically removed because of advanced age and comorbidities (96.4% surgical rate). There was no in-hospital or 1 year mortality in these patients. During the follow-up period, 3.6% patients had recurrence of the myxoma, with a men period of 5 years after the first surgery (one, two and twelve years), all of them re-submitted to surgical excision.
Conclusion
Despite being asymptomatic in the majority of the patients and often diagnosed incidentally, cardiac myxomas are frequent source of morbidity and mortality due to embolic events, obstructive and constitutional symptoms. Surgery is the treatment of choice for cardiac myxomas and in most cases it is curative, with low complications and low recurrence rate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Grazina
- Hospital de Santa Marta , Lisbon , Portugal
| | - B Teixeira
- Hospital de Santa Marta , Lisbon , Portugal
| | - V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - J M Viegas
- Hospital de Santa Marta , Lisbon , Portugal
| | - I Cardoso
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - A Galrinho
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - P Rio
- Hospital de Santa Marta , Lisbon , Portugal
| | - P Coelho
- Hospital de Santa Marta , Lisbon , Portugal
| | - J Fragata
- Hospital de Santa Marta , Lisbon , Portugal
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15
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Grazina A, Ferreira V, Cardoso I, Garcia Bras P, Viegas JM, Aguiar Rosa S, Fiarresga A, Ramos R, Castelo A, Teixeira AR, Teixeira B, Jacinto S, Martins Oliveira M, Cacela D, Cruz Ferreira R. 3 year outcomes of permanent pacemaker implantation after alcoholic septal ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1729] [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
Patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimized medical therapy are often submitted to alcohol septal ablation (ASA). One of the most frequent complications is the complete hear block (CHB), requiring permanent pacemaker (PPM) in variable rates, up to 20% of the patients. The long-term impact of PPM implantation in these patients remains unclear.
Objectives
This study aims to evaluate the long-term clinical outcomes in patients who implant PPM after ASA.
Methods
In a tertiary center, patients who underwent ASA were consecutively enrolled prospectively. Patients with previous PPM or implantable cardio-defibrillator were from this analysis. The groups with and without PPM implantation after ASA were compared regarding baseline characteristics, procedure data and 3-year primary and secondary endpoints.
Results
Between 2009 and 2020, 109 patients underwent ASA. 97 patients were included in this analysis (68% female, mean age 65.2 years-old). 16 patients (16.5%) required PPM implantation for CHB. In those, no vascular access, pacemaker pocket or pulmonary parenchyma complications were noted. The baseline characteristics regarding comorbidities, symptoms, echocardiographic and electrocardiographic findings were identical in the two groups, with statistically significant differences in the mean age (70.6y/o in the PPM group versus 64.1y/o) and in the beta-blocker therapy rates previously to the intervention (56% in the PPM group versus 84%). Procedure-related data showed higher creatine kinase (CK) peaks in the PPM group (1692U/L versus 1243U/L, p0.05), without significant differences in the alcohol dose (2.1ml in both groups, p0.33). At 3 years after ASA procedure, the primary endpoint (composite of all-cause mortality and all-cause re-hospitalization) showed a statistical tendency to a lower event rate in the group who implanted PPM (p-value 0.097, Graphic 1). The secondary endpoint (composite of all-cause mortality and cardiac cause re-hospitalization) did not show any significant statistical difference between the two groups (p-value 0.216, Graphic 2).
Conclusions
The long-term endpoint analysis suggests that the outcomes in patients who implant PPM after ASA are non-inferior to those who do not, with a tendency to a lower rate of the endpoint composite of all-cause mortality and all cause re-hospitalizations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Grazina
- Hospital de Santa Marta , Lisbon , Portugal
| | - V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | - I Cardoso
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - J M Viegas
- Hospital de Santa Marta , Lisbon , Portugal
| | | | | | - R Ramos
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - B Teixeira
- Hospital de Santa Marta , Lisbon , Portugal
| | - S Jacinto
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - D Cacela
- Hospital de Santa Marta , Lisbon , Portugal
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16
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Castelo A, Grazina A, Mendonca T, Rodrigues I, Bras P, Ferreira V, Viegas J, Ramos R, Fiarresga A, Cacela D, Ferreira R. Transcatheter aortic valve implantation outcomes in patients with low flow low gradient aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2077] [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
There are limited data about the outcomes of transcatheter aortic valve implantation (TAVI) in patients with low flow – low gradient (LF-LG) aortic stenosis (AS), but some studies suggest that these patients may have worse results.
Purpose
To compare outcomes between LF-LG AS and high gradient AS patients submitted to TAVI.
Methods
Retrospective analysis of consecutive patients (P) submitted to TAVI between 2009 and 2020 in a tertiary center. Baseline characteriscs and outcomes after the procedure were collected. LF-LG AS was considered in patients with mean gradient <40mmHg, valve area <1mm2, stroke volume index <35mL/m2 and at least one other criteria of contractile reserve confirmed by stress echocardiography, with elevation of mean gradient to >40mmHg, or high aortic calcium score in angio-CT.
Results
A total of 480P (56.9% female) were included, with a mean age of 82±7 years. Patients with LF-LG AS (81P, 16.9%) had worse baseline characteriscs, with higher new euroscore (10.4% vs 6.3%, p<0.0001), and natriurec peptide B (11252 vs 3095 pg/mL, p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (33.3% vs 8.8%, p<0.0001), more coronary artery disease (58% vs 37.1%, p<0.0001), including previous myocardial infarction (28.4% vs 14.1%, p=0.002) and coronary artery bypass graft (29.6% vs 12.3%, p<0.0001). In univariable analysis, LF-LG AS was associated with worse 1 year and long-term functional class (NYHA 3–4 – 17.8% vs 3.8% p<0.0001 and 20.5% vs 6.0%, p<0.0001, respectively), 1 year mortality (21.3% vs 10.8%, p=0.012) and 1 year and long-term heart failure hospitalizations (16.6% vs 3.3%, p<0.0001 and 24.3% vs 6.3%, p<0.0001). When adjusted to the differences in baseline characteristics, in a mulvariable analysis, LF-LG AS was still associated with worse functional class at 1 year (p=0.023) and long-term (p=0.004) and with heart failure hospitalizations at 1 year and long-term (p=0.001 and p<0.0001, respectively). In a sub-analysis considering only the patients with LF-LG AS, those with LVEF <40% have the worst outcomes, with more global, intra-hospital and 30 days mortality (48.1% vs 18.5%, p=0.005; 14.8% vs 1.9%, p=0.040; 18.5% vs 1.9%, p=0.014), global cardiovascular mortality (25.9% vs 7.4%, p=0.036), worse 1 year functional class (31.8% vs 11.8%, p=0.040) and more long-term heart failure hospitalizations (40.9% vs 17.3%, p=0.031).
Conclusion
Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteriscs differences. The sub-group of patients with LVEF <40% have the worst global outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Castelo
- Hospital de Santa Marta , Lisbon , Portugal
| | - A Grazina
- Hospital de Santa Marta , Lisbon , Portugal
| | - T Mendonca
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - P Bras
- Hospital de Santa Marta , Lisbon , Portugal
| | - V Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
| | - J Viegas
- Hospital de Santa Marta , Lisbon , Portugal
| | - R Ramos
- Hospital de Santa Marta , Lisbon , Portugal
| | | | - D Cacela
- Hospital de Santa Marta , Lisbon , Portugal
| | - R Ferreira
- Hospital de Santa Marta , Lisbon , Portugal
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Lima-Bernardes F, Soares D, Costa T, Ferreira V, Vasconcelos J, Vidoedo J, Almeida-Pinto J. Lemierre's syndrome: case report of "the forgotten disease" in current COVID-19 pandemic. Port J Card Thorac Vasc Surg 2022; 29:71-74. [PMID: 35780408 DOI: 10.48729/pjctvs.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
Lemierre's syndrome refers to infectious thrombophlebitis of the internal jugular vein developed as complication of an oropharyngeal infection. It is a rare syndrome, affecting otherwise healthy young adults, which may lead to sepsis complicated by septic embolization. Although there is a characteristic clinical picture, many modern physicians are unaware of this syndrome, leading it to be termed 'the forgotten disease'. The authors report a case of late diagnosis due to initial suspicion of COVID-19 and highlight the pitfalls on its diagnosis.
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Affiliation(s)
- F Lima-Bernardes
- Orthopaedic and Traumatology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - D Soares
- Orthopaedic and Traumatology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - T Costa
- Orthopaedic and Traumatology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - V Ferreira
- Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - J Vasconcelos
- Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - J Vidoedo
- Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - J Almeida-Pinto
- Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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18
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Marsol-Vall A, Ainsa S, Lopez R, Ferreira V. Development and validation of a method for the analysis of halophenols and haloanisoles in cork bark macerates by stir bar sorptive extraction heart-cutting two-dimensional gas chromatography negative chemical ionization mass spectrometry. J Chromatogr A 2022; 1673:463186. [DOI: 10.1016/j.chroma.2022.463186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
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19
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Grazina A, Aguiar Rosa S, Fiarresga A, Garcia Bras P, Ferreira V, Cardoso I, Viegas JM, Ramos R, De Sousa L, Oliveira M, Cacela D, Cruz Ferreira R. Permanent pacemaker implantation after Alcoholic Septal Ablation: long-term outcomes. Europace 2022. [DOI: 10.1093/europace/euac053.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimized medical therapy are often submitted to alcohol septal ablation (ASA). One of the most frequent complications is the complete heart block (CHB), requiring permanent pacemaker (PPM) in variable rates, up to 20% of the patients. The long-term impact of PPM implantation in these patients remains unclear.
Objectives
This study aims to evaluate the long-term pacemaker dependency in patients with PPM after ASA and to assess the long-term impact of PPM in these patients.
Methods
In a tertiary center, patients who underwent ASA were retrospectively analyzed. Patients with previous PPM or implantable cardio-defibrillator were excluded. The groups with and without PPM implantation after ASA were compared regarding baseline characteristics, procedure data and outcomes. In the group who implanted PPM, the long-term pacing rates were evaluated.
Results
Between 2009 and 2020, 109 patients underwent ASA. 97 patients were included in this analysis (68% female, mean age 65.2 years-old). 16 patients (16.5%) required PPM implantation for CHB. In those, no vascular access, pacemaker pocket or pulmonary parenchyma complications were noted. The baseline characteristics regarding co-morbidities, symptoms, echocardiographic and electrocardiographic findings were identical in the two groups, with statistically significant differences in the mean age (70.6y/o in the PPM group versus 64.1y/o) and in the beta-blocker therapy rates previously to the intervention (56% in the PPM group versus 84%). Procedure-related data showed higher creatine kinase (CK) peaks in the PPM group (1692U/L versus 1243U/L, p0.05), without significant differences in the alcohol dose (2.1ml in both groups, p0.33). In the PPM group, the mean pacing rates at 1 month, 1 year and 2 years were 66.6±38.0, 50.4±44.1 and 50.8±42.5, respectively, with 2 patients (12.5%) having 1-5% pacing and none having pacing <1% at 2 years. In the group without PPM, 5 patients (6.2%) required posteriorly PPM implantation during the follow-up. There were no statistically significant differences in the two groups regarding in-hospital mortality, 1 year mortality or 1 year re-hospitalization. Despite a lower mean follow-up period in the PPM group (2.3±1.5 years versus 3.5±2.2 years, p0.05), there were no differences in the groups regarding all-cause mortality, cardiac cause mortality and cardiac cause re-hospitalization, with a statistical tendency to a lower all cause re-hospitalization in the PPM group (19% versus 43%, p0.07).
Conclusions
The registered pacing rates shows that all devices were adequately implanted. The long-term impact analysis suggests that the outcomes in patients who implant PPM after ASA are non-inferior to those who do not, with a tendency to reduce all cause re-hospitalizations.
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Affiliation(s)
- A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | - JM Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
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20
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Denat M, Ontañón I, Querol A, Ferreira V. The diverse effects of yeast on the aroma of non-sulfite added white wines throughout aging. Lebensm Wiss Technol 2022. [DOI: 10.1016/j.lwt.2022.113111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Ferreira V, Teixeira P. Insufficient heat treatment of eggs due to following cooking instructions in the labels. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Ferreira V, Garcia Bras P, Aguiar Rosa S, Fiarresga A, Galrinho A, Moura Branco L, Cardoso I, Ramos R, Castelo A, Almeida Morais L, Cruz Ferreira R. Ecocardiographic comprehensive evaluation of OHCM patients treated with percutaneous ASA. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Alcohol septal ablation (ASA) has been widely accepted as an alternative to surgical myectomy in patients with symptomatic obstructive hypertrophic cardiomyopathy (OHCM) despite optimal medical treatment.
The aim of this study was to analyse the effect of ASA on anatomical and functional features analysed by echocardiography, as well as its clinical impact. We further evaluated the safety of procedure.
Methods and results
Retrospective analysis of consecutive patients submitted to ASA (2009 – 2019) in a single tertiary centre. A dedicated echocardiogram was performed at 3 and 6 months after procedure. Echocardiographic primary endpoint was a > 50% reduction in left ventricular outflow tract (LVOT) gradient (the definition used for successful procedure). Echocardiographic secondary endpoint was improvement in mitral regurgitation. Clinical primary endpoint was defined as a combined endpoint of cardiac death or hospitalization during follow-up (FU).
110 patients were included, 66.4% women, mean age 65.1 ± 12.2 years. Functional class NHYA class III/IV, angina CCS class II/III and syncope were present in 87.3%, 52.7% and 10.0%, respectively.
Baseline LVOT gradients at rest and at Valsalva manoeuvre were 93.6 ± 39.8 mmHg and 118.9 ± 44.2 mmHg. Maximum septal thickness was 21.0 ± 3.3 mm, 24.5% had moderate mitral regurgitation and 52.7% showed systolic anterior motion of mitral valve.
During hospitalization for ASA, peak creatine kinase after procedure was 1306 ± 816 U/l. 17 (17.1%) patients required permanent PM due to induction of permanent complete heart block. There was one case of inferior myocardial infarction and one case of cardiac tamponade.
Echocardiographic primary endpoint was achieved by 83.6% of patients. At 3 and 6-months follow up, LVOT gradients was significantly decreased in successful comparing with unsuccessful procedure group (24.6 ± 23.9 vs 82.0 ± 28.7 mmHg, p = 0.003 and 31.8 ± 34.5 vs 68.6 ± 27.8 mmHg, p = 0.027, respectively). There was no difference in baseline clinical or echocardiographic parameters between both groups. Regarding the echocardiographic secondary endpoint, among patients with moderate mitral regurgitation, 80% improved to mild regurgitation. A significant reduction in basal septal thickness was achieved in most patients, from 21.0 ± 3.3mm to 16.4 ± 2.7 mm after ASA (p = 0.001).
During mean FU of 3.4 ± 2.1 years, clinical primary endpoint occurred in 25.5%, mainly in unsuccessful procedure group (50.0% vs 20.7%, p = 0.013). Reintervention was performed for recurrence of symptoms in 14 (12.7%) patients, surgical myectomy in 3 (3.6%) and repeated ASA in 10 (9.1%).
Conclusion
ASA allows a significant reduction in LVOT gradient and improvement of mitral regurgitation in the majority of patients with OHCM. Systematic and comprehensive echocardiographic evaluation assumes a paramount importance for the evaluation of procedural success. Abstract Figure.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
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23
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Dias Ferreira Reis JP, Bras P, Ferreira V, Goncalves A, Pereira Da Silva T, Soares R, Timoteo AT, Galrinho A, Branco L, Ferreira R. Evaluation of RV-arterial coupling in advanced heart failure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) - TAPSE/PASP ratio - is a noninvasive measure of RV-arterial coupling. TAPSE/PASP ratio is a potent independent predictor of prognosis in heart failure and pulmonary arterial hypertension, with a prognostic cutoff value of 0.36 mm/mmHg.
Objective
To assess the prognostic impact of TAPSE/PASP ratio in a population of advanced HF patients.
Methods
Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 2 years for the primary endpoint of cardiac death and HT. Echocardiographically determined TAPSE/PASP ratio was used to assess RV-arterial coupling and a survival analysis was performed to evaluate the prognostic impact of the suggested cutoff of 0.36 mm/mmHg.
Results
A total of 450 Heart Failure with Reduced Ejection Fraction (HFrEF) patients with a mean age of 56 ± 12 years, of which 80% are male, and with a mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and PASP of 38 ± 11mmHg. The mean TAPSE/PASP was 0.80 ± 0.28. Fifty-four patients (12%) met the primary endpoint. Patients with RV-arterial uncoupling (TAPSE/PASP < 0.36 mm/mmHg) were more likely to have a non-ischaemic etiology for HF (66.7% vs 40%, p = 0.047), had a lower prevalence of diabetes (53.3% vs 77.9%, p = 0.041), a higher prevalence of moderate-to-severe mitral regurgitation (33.3% vs 13.0%, p = 0.035), a lower LVEF (26.2 ± 6.1 vs 29.9 ± 5.9, p = 0.038), a higher prevalence of RV dysfunction (73.3% vs 26.7%, p < 0.001) and worse cardiopulmonary fitness (pVO2: 12.7 ± 5.1 vs 15.8 ± 6.0 ml/kg/min, p = 0.047; VE/VCO2 slope: 49.5 ± 17.2 vs 37.6 ± 9.7, p < 0.001; cardiorespiratory optimal point: 36.9 ± 11.3 vs 29.0 ± 6.4, p < 0.001). More patients in the group of TAPSE/PASP < 0.36 mm/mmHg met the primary endpoint (33.3% vs 9.6%, p = 0.034) and more patients underwent urgent HT (13.3% vs 1.4%, p = 0.44). RV-arterial coupling was associated with a lower survival free of events during follow-up (log-rank p = 0.010).
Conclusion
RV-arterial coupling predicts a worse prognosis in advanced HF patients, with those below a cutoff of 0.36 mm/mmHg having lower survival. This variable may improve risk stratification in this setting. Abstract Figure.
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Affiliation(s)
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - R Soares
- Hospital de Santa Marta, Lisbon, Portugal
| | - AT Timoteo
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Branco
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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24
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Garcia Bras P, Aguiar Rosa S, Moura Branco L, Galrinho A, Cardoso I, Valentim Goncalves A, Selas M, Silva F, Castelo A, Ferreira V, Ferreira R. Assessment of myocardial work: a promising tool in obstructive and nonobstructive hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Myocardial work is a novel dynamic non-invasive method for assessing myocardial deformation providing incremental information to left ventricular ejection fraction (LVEF) and strain imaging. The aim of this study was to assess left ventricular myocardial work in hypertrophic cardiomyopathy (HCM) and compare patients with obstructive HCM (oHCM) and nonobstructive HCM (nHCM).
Methods
Prospective assessment of HCM patients’ myocardial strain parameters with 2D speckle-tracking echocardiography, stratified according to LV segments (basal, midcavity and apical regions). Results were compared between oHCM and nHCM patients.
Results
83 patients with HCM, 60% male, 33% oHCM (with a LVOT gradient of 89 ± 60 mmHg). There was no significant difference between groups in mean age (56 ± 13 years vs. 55 ± 15 years, p = 0.719), LV mass index (186 ± 75 g/m2 vs. 158 ± 65 g/m2, p = 0.103), maximum wall thickness (21 ± 4 mm vs. 19 ± 5 mm, p = 0.425) or left ventricular ejection fraction (LVEF) (68 ± 8% vs. 67 ± 11%, p = 0.584).
Regarding global work index (GWI) there was no significant difference between oHCM and nHCM (1206 ± 431 mmHg% vs. 1384 ± 437 mmHg%, p = 0.090), although oHCM patients had a significantly inferior GWI in the basal (921 ± 383 mmHg% vs. 1364 ± 419 mmHg%, p < 0.001) and midcavity (1049 ± 456 mmHg% vs. 1288 ± 492 mmHg%, p = 0.038) segments (Figure 1). No significant difference was noted in the apical segments (1680 ± 653 mmHg% vs. 1519 ± 770 mmHg%, p = 0.335). Myocardial work index in the basal segments showed inverse correlation with resting LVOT gradient (r=-0.242, p = 0.032) and maximum provoked LVOT gradient (r=-0.291, p = 0.010). Furthermore, patients with septal hypertrophy pattern showed significantly impaired basal myocardial work index compared with apical hypertrophy patients (1090 ± 428 mmHg% vs 1537 ± 389 mmHg%, p < 0.001).
Global constructive work (GCW) (1443 ± 449 mmHg% vs. 1604 ± 426 mmHg%, p = 0.123) and global wasted work (GWW) (197 ± 140 mmHg% vs. 154 ± 107 mmHg%, p = 0.137) were not significantly different between groups.
Global work efficiency (GWE) was significantly reduced in oHCM patients vs. nHCM (84.1 ± 7% vs. 88.3 ± 7.3%, p = 0.017), particularly in the basal (80.2 ± 11.2% vs. 88.3±.7.2%, p = 0.033) and midcavity segments (85.4 ± 9.2% vs. 90.0 ± 8.5%, p = 0.044) (Figure 2). No significant difference was noted in the apical segments (88.2 ± 9.9% vs. 87.0 ± 12%, p = 0.679). Myocardial work efficiency in the basal segments showed inverse correlation with resting LVOT gradient (r=-0.389, p = 0.002) and maximum provoked LVOT gradient (r=-0.446, p < 0.001). Moreover, patients with septal hypertrophy pattern showed significantly reduced basal myocardial work efficiency versus apical hypertrophy patients (83 ± 9% vs 92 ± 3%, p < 0.001).
Conclusion
Myocardial work is a promising tool to evaluate myocardial function in patients with oHCM and nHCM. oHCM patients had a significantly inferior GWI and GWE particularly in the basal and midcavity segments versus nHCM patients. Abstract Figure 1: Myocardial Work Index Abstract Figure 2: Myocardial Work Efficiency
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Affiliation(s)
| | | | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Selas
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Silva
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Rodrigues I, Almeida Morais L, Cacela D, Bernardes L, Patricio L, Moura Branco L, Galrinho A, Leal A, Castelo A, Garcia Bras P, Viegas J, Cruz Ferreira R. Long-term follow-up of percutaneous balloon mitral valvuloplasty for mitral stenosis: an old but needed player. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.368] [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.
Background
In the era of innovative transcatheter valve interventions, percutaneous balloon mitral valvuloplasty (PBMV) remains the primary treatment option in anatomic suitable patients.
Purpose
This study aimed to evaluate longterm follow-up (FU) of PBMV and to determine predictors of MACE.
Methods
Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention and hospitalization for heart failure) were analysed. Predictors of MACE were determined by Cox regression analysis.
Results
Mean age was 47.3 ± 13.6 years, 89.6% female, 47.3% patients presenting atrial fibrillation. Mean Wilkins score was 7.6 ± 1.4, 51.5% had mild or moderate mitral regurgitation and mean pulmonary artery systolic pressure (PASP) of 46.7 ± 17.1 mmHg. Mean pre MVA and mean mitral valve (MV) gradient were 1.1 ± 0.2 cm2 and 10.8 ± 5.6 mmHg, respectively. Successful PMBV was achieved in 89.1%.
During a mean FU of 12.0 ± 8.8 years, there were 25 deaths (12.4%) and 33.3% needed MV reintervention (6.5% underwent PBMV and 29.7% needed MV surgery). At univariate analysis, previous MV intervention [HR = 1.95 (1.02–3.72), p < 0.05], Wilkins score [HR = 1.22 (1.01–1.47), p < 0.05], pre mean MV gradient≥8 [HR = 0.62 (0.38–1.00), p < 0.05], mean MV gradient after procedure [HR = 1.37 (1.19–1.58), p < 0.05] and PASP >45 mmHg [HR = 3.29 (1.13–9.55), p < 0.05] were predictors of MV reintervention. At multivariate analysis, pre mean MV gradient≥8 [HR = 0.17 (0.037–0.81), p < 0.05] and mean MV gradient after procedure were independent predictors of MV reintervention [HR = 1.74 (1.21–2.49), p < 0.05]. Wilkins score [HR = 1.29 (1.06–1.57), p < 0.05] and mean MV gradient after procedure [HR = 1.41 (1-21–1.63), p < 0.05] were independent predictors of MACE. Cumulative event-free survival at 10 and 20 years were 72.0 and 46.0%, respectively.
Conclusions
PBMV remains a reliable and efficient therapeutic option of mitral stenosis, warranting event-free survival at 10 years in most patients selected for the procedure. Mean MV gradient after procedure was independent predictor of MV reintervention and MACE during follow-up. Abstract Figure. Abstract Figure.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L Patricio
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Leal
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Viegas
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Rodrigues I, Almeida Morais L, Bernardes L, Cacela D, Patricio L, Galrinho A, Reis JP, Grazina A, Castelo A, Cruz Ferreira R. Pulmonary hypertension in mitral stenosis patients submitted to percutaneous balloon mitral valvuloplasty: an innocent bystander? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.299] [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.
Background
Percutaneous balloon mitral valvuloplasty (PBMV) is the cornerstone of the treatment of rheumatic mitral stenosis (MS) in suitable patients. Pulmonary hypertension (PH) is a common coexisting finding and an indication for intervention. We sought to assess the influence of PH in PBMV immediate results and in very longterm outcome.
Methods
Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention) were analysed.
Results
Mean age was 47.3 ± 13.6 years and 89.6% were women. A previous commissurotomy or PBMV was found in 10.4% and mean Wilkins score was 7.6 ± 1.4. PH, defined as pulmonary artery systolic pressure (PASP) ≥45mmHg, was present in 32.7% of patients. A successful procedure was achieved in 89.1% of total population. Mean mitral valve (MV) gradient decreased from 13.1 to 5.0 mmHg (p < 0.001) and MV area increased from 1.1 to 1.8 cm2 (p < 0.001). A significant reduction also occurred in left atrium diameter (48.8 to 46.8 mm, p < 0.001) and PASP (50.5 to 38.5 mmHg, p < 0.001). During a mean follow-up of 12.0 ± 8.8 years, 7 cardiovascular deaths occurred (3.5%) and 33.2% of patients needed MV reintervention. Baseline PH did not impact immediate success and was not related with MACE in the follow-up. However, PH persistence after PBMV was correlated with unsuccessful procedure (p = 0.023) and with the occurrence of MACE during FU (HR 3.3, CI 95% 1.1-9.6, p = 0.028 and Kaplan-Meier analysis, log-rank 0.020).
Conclusions
PBMV in patients with MS and PH is a safe and effective intervention, achieving a significant decrease in PASP after procedure. Baseline PH was not associated with success or MACE. However, PH persistence after PBMV, correlated with worse prognosis in longterm follow up. Special attention and further investigation for this subgroup is needed. Abstract Figure.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Patricio
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - JP Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
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27
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Sobral AF, Chan FY, Norman MJ, Osório DS, Dias AB, Ferreira V, Barbosa DJ, Cheerambathur D, Gassmann R, Belmonte JM, Carvalho AX. Plastin and spectrin cooperate to stabilize the actomyosin cortex during cytokinesis. Curr Biol 2021; 31:5415-5428.e10. [PMID: 34666005 PMCID: PMC8699742 DOI: 10.1016/j.cub.2021.09.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
Cytokinesis, the process that partitions the mother cell into two daughter cells, requires the assembly and constriction of an equatorial actomyosin network. Different types of non-motor F-actin crosslinkers localize to the network, but their functional contribution remains poorly understood. Here, we describe a synergy between the small rigid crosslinker plastin and the large flexible crosslinker spectrin in the C. elegans one-cell embryo. In contrast to single inhibitions, co-inhibition of plastin and the βH-spectrin (SMA-1) results in cytokinesis failure due to progressive disorganization and eventual collapse of the equatorial actomyosin network. Cortical localization dynamics of non-muscle myosin II in co-inhibited embryos mimic those observed after drug-induced F-actin depolymerization, suggesting that the combined action of plastin and spectrin stabilizes F-actin in the contractile ring. An in silico model predicts that spectrin is more efficient than plastin at stabilizing the ring and that ring formation is relatively insensitive to βH-spectrin length, which is confirmed in vivo with a sma-1 mutant that lacks 11 of its 29 spectrin repeats. Our findings provide the first evidence that spectrin contributes to cytokinesis and highlight the importance of crosslinker interplay for actomyosin network integrity.
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Affiliation(s)
- Ana Filipa Sobral
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Fung-Yi Chan
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Michael J Norman
- Department of Physics, North Carolina State University, Raleigh, NC 27695, USA; Quantitative and Computational Developmental Biology Cluster, North Carolina State University, Raleigh, NC 27695, USA
| | - Daniel S Osório
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Ana Beatriz Dias
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Vanessa Ferreira
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Daniel J Barbosa
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Dhanya Cheerambathur
- Wellcome Centre for Cell Biology, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - Reto Gassmann
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Julio Monti Belmonte
- Department of Physics, North Carolina State University, Raleigh, NC 27695, USA; Quantitative and Computational Developmental Biology Cluster, North Carolina State University, Raleigh, NC 27695, USA
| | - Ana Xavier Carvalho
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal.
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28
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Djekic I, Bartkiene E, Szűcs V, Tarcea M, Klarin I, Černelić-Bizjak M, Isoldi K, EL-Kenawy A, Ferreira V, Klava D, Korzeniowska M, Vittadini E, Leal M, Frez-Muñoz L, Papageorgiou M, Guiné RP. Cultural dimensions associated with food choice: A survey based multi-country study. Int J Gastron Food Sci 2021. [DOI: 10.1016/j.ijgfs.2021.100414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Santa Mina D, Adams SC, Brahmbhatt P, Ferreira V, St-Pierre J, Scheede-Bergdahl C. Introduction to Pre-operative Exercise Prescription and Physical Activity Promotion for Clinicians and Exercise Professionals. Curr Anesthesiol Rep 2021. [DOI: 10.1007/s40140-021-00491-0] [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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30
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Ferreira V, Guerreiro J, Correia J, Gonçalves J, Farinha C, Mendes F. 556: Development of molecular imaging tools to monitor drug efficacy through assessment of CFTR localization in vivo. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01979-2] [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: 11/28/2022]
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31
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Garcia Bras P, Mano T, Rito T, Castelo A, Ferreira V, Teixeira B, Teixeira R, Jacinto S, Agapito A, Ferreira R, Sousa L. Non-vitamin K antagonist oral anticoagulants in adult congenital heart disease: a single-center study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1867] [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
Adults with congenital heart disease (ACHD) are at an increased risk for thromboembolic events and atrial arrhythmias are common in this population. Non-vitamin K anatagonist oral anticoagulants (NOACs) prescription is increasing, however data on efficacy and safety in ACHD is unclear, particularly in patients (P) with complex CHD. The aim of the study was to review the use of NOACs in various types of ACHD and assess its safety and efficacy.
Methods
Evaluation of consecutive ACHD P started on NOAC therapy from 2014 to 2020. P were followed-up for bleeding or thromboembolic events and mortality. CHA2DS2-VASc and HASBLED scores were calculated and risk factors for bleeding were identified.
Results
93 ACHD P were included, mean age 52±15 years, 58% female, 44% with complex CHD (3.2% with Fontan circulation), with diagnosis of: 22.2% atrial septal defect, 20% tetralogy of Fallot, 11.1% transposition of the great arteries, 10% Ebstein's anomaly, 8.9% ventricular septal defect, 7.8% pulmonary stenosis, 5.6% ductus arteriosus, 4.4% AV septal defect, 3.4% univentricular heart, 3.4% coarctation of aorta, 2.2% supra-aortic stenosis and 1% with Uhl disease.
Most P were anticoagulated with rivaroxaban (43%), followed by edoxaban (24%), apixaban (20%), and dabigatran (13%). The indications for anticoagulation were: atrial arrhythmias (81%), pulmonary embolism (PE) (6.3%), atrial thrombi (4.3%), thromboprophylaxis in Fontan circulation (3.2%), deep vein thrombosis (3.2%) and stroke (2%). 66% of P had a CHA2DS2-VASc score ≥2 and 82% HASBLED score ≤2.
In a mean follow-up of 41±21 months (400.4 patient-years), there were embolic events in 2P (1 splenic infarction and 1 PE) albeit both were in the context of oral anticoagulation interruption. The cardiovascular mortality was 2% and allcause mortality 5%, however with no relation to thrombosis or bleeding events.
6 P (6.5%) suffered a minor and 3 P (3.2%) suffered a major bleeding, a median time of 12 (IQR 15) months after starting NOAC therapy. The annual risk for bleeding was 2.2%/patient/year. P with bleeding events showed no significant difference regarding age (55±16 vs 52±15 years, p=0.587), gender (13% female vs 5.1% male, p=0.295) or CHD type (p=0.582). 8.6% of P required dose reduction, mostly for bleeding (3.2%) or renal impairment (2.2%).
Renal disease was a strong risk factor for major bleeding (HR 14.6 [95% CI 1.23–73.6], p=0.033 and multivariate analysis showed that an increased HASBLED score was an independent predictor of minor (adjusted HR 3.44 [95% CI 1.13–10.52], p=0.030) and major (adjusted HR 5.29 [95% CI 1.14–24.45], p=0.033) bleeding complications.
Conclusion
Anticoagulation with NOACs is a safe and effective option for selected ACHD P, although bleeding complications were not negligible, particularly in P with renal disease. Larger scale research studies are required, especially regarding complex CHD such as P with Fontan circulation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Jacinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Ferreira V, Ramos R, Bras P, Reis J, Grazina A, Jacinto S, Teixeira R, Oliveira E, Santana A, Melo J, Cacela D, Cruz Ferreira R. Virtual fractional flow reserve derived from coronary angiography – artery and lesion specific correlations. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1197] [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
Virtual Fractional flow reserve (vFFR) from standard non-hyperaemic invasive coronary angiography (ICA) has emerged as a promising non-invasive test to assess hemodynamic severity of coronary artery disease (CAD).
Purpose
To investigate the difference in vFFR analysis between vessels and specific lesions.
Methods
Retrospective analysis of consecutive patients (pts) who underwent invasive functional assessment (iFA) in a tertiary center between 2019 and 2020. vFFR was calculated using dedicated software (CAAS Workstation 8.4) based on coronary angiograms of the acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance of vFFR was evaluated and correlated with iFA, according to coronary vessel, vessel diameter at stenosis, diameter stenosis and area stenosis at lesion. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards.
Results
106 coronary arteries of 95 pts (78% male, mean age 67.8±9.7 years) underwent vFFR evaluation. ICA indications were chronic coronary syndrome in 63% or acute coronary syndrome (non-culprit lesion) in the remaining pts. VFFR accuracy was good (AUC 0.839 (p<0.001) and Pearson's correlation coefficient 0.533 (p<0.001) when vFFR was measured in the distal vessel segment. The correlation improved when vFFR were assessed at lesion site (r=0.631, p<0.001) or up to 1cm below the stenosis (0.610, p<0.001). Binary concordance of 89% were observed in RCA and LAD (Sensibility -S 68%, Specificity-Sp 96%, False positive -FP 3.8%, False negative - FN 31%, predictive positive value-PPV 87%, predictive negative value- PNV 89%), while in the circumflex coronary artery binary concordance were of 77% (S 50%; Sp 82%; FP 18%; FN 50%; PPV 33% and PNV 90%). Correlation between vFFR and iFA was higher in vessels ≥2mm (r=0.730, p<0.001). and in lesions in the extremes of the severity spectrum (Table 1).
Conclusion
vFFR has a moderate to high linear correlation to iFA, depending on the artery and type of lesion studied. The higher correlation was found when vFFR were measured at lesion site, in non-circumflex artery stenosis, in vessels ≥2mm and in vessels with mild or severe stenosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Jacinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Santana
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Melo
- Hospital de Santa Marta, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Viegas J, Reis J, Castelo A, Bras P, Ferreira V, Cardoso I, Grazina A, Figueiredo L, Ruano C, Marques H, Ramos R, Cruz Ferreira R. Quantification of epicardial fat with cardiac CT and association with cardiovascular risk factors and obstructive coronary disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0181] [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
Recent studies advocate epicardial fat (EF) as a biologically active organ that influence coronary atherosclerosis development through endocrine and paracrine pathways. We aim to study the relations between EF, thoracic adipose tissue (TAT), cardiovascular risk factors (CRF) and obstructive coronary disease (OCD).
Methods
Retrospective analysis of patients (pts) referred to 64-multislice cardiac computed tomography (CT) in one center. The authors underwent a standardized protocol for quantification of EAT, TAT (subcutaneous and visceral), abdominal visceral fat, coronary calcium score and angiography.
Results
Total of 178 pts: male 99 (56%), mean age 65.9±12.9 years. Indications for performing CT were coronary disease (76%), valvular heart disease (15%), atrial fibrillation (6%) and congenital heart disease (2%). Regarding CRF, EF was only significant higher in patients with diabetes (115±60 vs 95±47, p=0.018), in male gender (114±60 vs 91±42, p=0.04) and was linear correlated with age (p=0.004). The authors also found that EF volume is significant higher in patients with typical angina (p=0.02) and with coronary atherosclerosis: non-obstructive (p=0.0049) and OCD (p=0.001) – Graphic 1. ROC analysis of EF (AUC 0.659, p=0.0039) and EF/TAT relation (AUC 0.704, p=0.003) allowed to estimate that EF>100 ml and EF/TAT >0.06 had a sensibility to predict OCD of 53% and 58%, respectively, and specificity of 66% and 60%. We did not find a correlation between EF, EF/TAT or TAT and coronary calcium score.
Conclusion
EF is higher in patients with diabetes and coronary atherosclerosis. EF and EF/TAT relation had moderate sensibility and specificity to predict OCD, irrespective of calcium score. EF and EF/TAT are promising atherosclerotic markers that could be routinely use in the near future.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - C Ruano
- Hospital de Santa Marta, Lisbon, Portugal
| | - H Marques
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
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Garcia Bras P, Moura Branco L, Galrinho A, Castelo A, Ferreira V, Mano T, Reis J, Grazina A, Timoteo AT, Abreu J, Pinto E, Coelho P, Bravio I, Ferreira R. Malignant cardiac tumors: a single-centre 25-year review. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1837] [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
Primary cardiac tumors are extremely rare and are usually diagnosed late due to the nonspecific symptoms. Surgery is the main treatment option, and despite chemotherapy, the prognosis remains poor. Cardiac invasion by metastatic tumors, while more common, also entails an unsatisfactory outcome. The aim of this study was to review patients (P) with malignant cardiac tumors that were diagnosed by transthoracic echocardiogram (TTE) or transoesophageal echocardiogram (TOE) in a tertiary center between 1995 and 2020.
Methods
Retrospective analysis of clinical data, echocardiographic assessment of tumor location and morphology, histology results and survival outcomes.
Results
A total of 44 malignant cardiac tumors were diagnosed: 12 primary tumors (A) and 32 metastatic tumors (B). A: Regarding primary cardiac tumors, the most common types were angiosarcomas (6), undifferentiated pleomorphic sarcomas (2), fibrosarcomas (2), myxofibrosarcoma (1) and primary cardiac lymphoma (1). The mean age of P at time of diagnosis was 43±15 years, 50% male. The most frequent presentation was heart failure symptoms (50%) followed by arrhythmias (20%). 1 P presented with pruritus and polyarthralgias. On TTE, the most prevalent tumor location was in the right-heart chambers (70%) – mostly the right atrium (50%), with mean dimensions of 40±18x27±11 mm. 85% of P had preserved biventricular systolic function and there was severe pericardial effusion in 38%. The most frequent metastatic involvement at diagnosis was pulmonary (33%) and hepatic (33%). 50% of P were submitted to tumor resection and 40% to chemotherapy. Regarding angiosarcomas, the most common immunohistochemical markers were vimentin, CD31 and CD34. The authors found a mortality rate of 10P (83%) in P with primary cardiac tumors, with a median time to mortality of 5.5 (IQR 2–10) months (Figure 1), in a median follow-up of 6.2 (IQR 2.5–15) months (minimum of 20 days and maximum of 19 years). In the latter case, the P was submitted to heart transplantation after diagnosis of a fibrosarcoma and is still alive and well.
B: Regarding secondary cardiac invasion, there was a diagnosis of the following primary tumor sites: 12 lung carcinomas, 7 thymomas, 4 lymphomas, 3 hepatocellular carcinomas, 2 bladder carcinomas, 1 parathyroid carcinoma, 1 soft tissue sarcoma, 1 uterine sarcoma and 1 melanoma. The mean age of P was 57±19 years, 57% male. On TTE/TOE the authors found a right-sided chambers predominance (12 P, 38%) vs left-sided chambers in (8 P, 25%), with pericardial metastasis also present in 13 P (41%). Cardiac tamponade occurred in 6P (19%). The mortality rate was 75% (24P), with a median time to mortality of 1.1 (IQR 0.6–3.8) months (minimum of 7 days, maximum of 44 months), in a median follow-up of 2.3 (IQR 0.8–14) months.
Conclusion
Cardiac malignant tumors generally present in a late stage with a dismal prognosis. When possible, heart transplantation can be an option with a favourable outcome.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier analysis
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Affiliation(s)
| | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Coelho
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Bravio
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Ferreira V, Cruz Coutinho M, Almeida Morais L, Aguiar Rosa S, Moura Branco L, Galrinho A, Timoteo AT, Branco Mano T, Cardoso I, Castelo A, Garcia Bras P, Oliveira S, Cruz Ferreira R. A 3D-TTE left atrial function study in cardio-oncology patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Transthoracic Doppler echocardiography (TTE) remains the standard imaging method to evaluate cancer therapeutics-related cardiac dysfunction (CTRCD). 3D-TTE with strain analysis is a novel technique, proved useful for earlier detection of left ventricular (LV) function impairment. However, diastolic and left atrial (LA) function impact is less studied.
Purpose
To assess LA volumetric and LA strain (LAS) features by 3D-TTE in cardio-oncology patients.
Methods
A prospective study of female breast cancer patients (P) submitted to therapy (TH) who underwent serial monitoring by 2D and 3D-TTE. Standard 2D, 3D-TTE and LAS parameters were evaluated, including longitudinal (LALS) and circumferential strain (LACS) during conduit (cd), contraction (ct) and reservoir (r) phases. P were evaluated at T0, T1 and T2 (before, ≥6 and ≥12 months after starting TH). CTRCD was defined as an absolute decrease in 2D LVEF >10% to a value <54% or a relative decrease in 2D GLS >15%, according to literature. P with previous cancer treatment, coronary artery disease, significant valvular disease, and atrial arrhythmias were excluded.
Results
98 P (mean age 54.6±12.0 years-old), mostly treated with anthracyclines (78.6%, cumulative dose 268.2±77.6mg/m2), anti-HER (70.4%) and radiotherapy (80.6%) were included. 2D LV and LA volumes had a significantly raise from baseline to T1 (2D LVEDV 82.2±18.8 vs 91.9±18.8 mL, p=0.019 and LA 43.3±12.9 vs 49.8±13.3 mL, p=0.005). 2D and 3D LVEF were significantly reduced during TH, however remaining within the limits of normality. 2D GLS was also impaired at T1 (−19.9±2.6% vs −18.6±3.1%, p=0.009). During a mean follow-up of 14.1±8.1months, 31 P (31.6%) developed CTRCD. 3D LV and LA volumes also globally increased at T1 comparing to baseline with partially recovery at T2. Maximum LA volume was significantly higher at T1 (39.1±9.3 vs 43.6±10.6 ml, p=0.024). 3D LA ejection fraction (T0 53.7±9.7%, T1 53.4±8.6%, T2 49.9±8.6%, pT0-T2=0.039) and LAS values tended to progressively worse during TH. LA dilation (vol>34ml/m2) at baseline was correlated to dysfunction in contraction phase at T1 (LACSct −19.6±8.6 vs −17.3±4.6%, p=0.024). LACSr has substantially decreased from baseline to T2 (31.4±11.6 vs 27.0±10.4%, p=0.05). In univariate analysis, delta LALSr (T1-T0) was a predictor of CTRCD (mean −5.2% vs 1.9%, p=0.05).
Conclusion
CTRCD was frequent during the earlier phase of breast cancer treatment. LA function was also affected, mirroring LV volumetric and functional changes. Diastolic dysfunction, assessed through LA reservoir strain, was impaired in association with CTRCD. 3D-TTE usefulness in the surveillance and monitoring of CTRCD goes beyond systolic LV function assessment, allowing a detailed LA function analysis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - S Oliveira
- Hospital dos Capuchos, Oncology department, Lisbon, Portugal
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Garcia Bras P, Portugal G, Castelo A, Ferreira V, Teixeira R, Jacinto S, Teixeira B, Viegas J, Cardoso I, Timoteo AT, Ferreira R. Familial hypercholesterolemia in acute coronary syndrome patients: underdiagnosis in female and in young patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Familial hypercholesterolemia (FH) is often underdiagnosed, particularly in female patients (P), even during hospital admission for acute coronary syndromes (ACS). The aim of this study was to apply the Dutch Lipid Clinic Network (DLCN) Criteria in P admitted for ACS and evaluate gender and age differences.
Methods
Prospective evaluation of P with ACS admitted to a tertiary center from 2005 to 2019. Data including family history and laboratory tests was analysed for the application of the DLCN criteria and results were stratified according to ACS subtype, gender and age groups (20–39, 40–59, 60–79 and ≥80 years [y]). P were followed up for 30 days for hospitalization, recurring ACS and mortality.
Results
3811 P were evaluated, mean age 63±13 years, 28% female and mean LDL cholesterol of 125±43 mg/dL. The admission diagnosis was unstable angina (UA) in 5%, non-ST-segment elevation myocardial infarction (NSTEMI) in 27% and ST-segment elevation MI (STEMI) in 68%.
Applying the DLCN criteria, 3089 P (81%) had a score of <3 (unlikely FH), 675P (17.7%) a score of 3 to 5 (possible FH), 41P (1.1%) a score of 6 to 8 (probable FH) and 1P (0.03%) a score of >8 (definite FH). Stratifying according to ACS type: among UA, 31P (16%) had possible FH and 4P (2.1%) had probable FH. Among NSTEMI, 145P (14.2%) had possible FH, 9P (0.9%) probable FH and 1P (0.03%) definite FH. Finally, among STEMI P, 497P (19.1%) had possible FH and 28P (1.1%) probable FH. Regarding female P, 158P (14.7%) had possible FH and 16 P (1.5%) probable FH. Among male P, 517P (18.9%) had possible FH and 25P (0.9%) probable FH (p=0.016 for interaction).
According to age groups, among P aged 20–39 y (136P), 61P (44.9%) had possible FH and 6P (4.4%) had probable FH. Concerning P aged 40–59 y (1766P), 575P (32.6%) had possible FH, 31 P (1.8%) probable FH and 1P (0.1%) definite FH. With regard to P aged 60–80 y (2122P), 80P (3.8%) had possible FH and 4P (0.2%) probable FH. Among P aged ≥80 y (1837P), only 9P (0.5%) had possible FH and no P had probable FH.
In a 30-day follow-up, there was an hospitalization rate of 3.5% (134P) and recurring ACS in 1.7% (65P), while the all-cause mortality was 2% (78P) and cardiovascular (CV) death was 1.3% (49P). Female P had a significantly lower hospitalization rate (1.8% vs 3.2%, p=0.003) as well as fewer recurring ACS (0.6% vs 1.7%, p=0.001). There was no significant gender difference regarding all-cause mortality (female 1.7% vs 1.5%, p=0.552) or CV death (0.8% vs 1.1%, p=0.323). The DLCN criteria score was significantly correlated with admission for recurring ACS (OR 1.19 [95% CI 1.04–1.36], p=0.04).
Conclusion
Application of the DLCN criteria in female P admitted for ACS revealed 158P (14.7%) with possible FH and 16P (1.5%) with probable FH. Regarding younger ACS P (20–39y), 44.9% had criteria for possible FH and 4.4% for probable FH, prompting us to do not overlook these P subgroups in daily practice and routinely assess the likelihood of FH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Jacinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Ferreira V, Moreira RI, Teixeira B, Agapito A, Rito T, Pinto F, Cruz Ferreira R, De Sousa L. Fetal and maternal outcomes in patients with tetralogy of Fallot. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2899] [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
Women with tetralogy of Fallot (TOF) have an increased risk of adverse cardiac and neonatal events during pregnancy. The aim was to assess fetal and maternal outcomes in patients (pts) with uncorrected and corrected TOF.
Methods
Retrospective analysis of cardiological and obstetric data in women with TOF followed at our institution. Pregnancy and neonatal outcomes were compared in patients (pts) submitted to corrective surgery vs pts with no previous intervention and in pts with or without cyanosis.
Results
51 women (median age 27 years; median number of previous interventions of 2), 22% with cyanosis, who experienced 126 pregnancies resulting in 73 live births A previous corrective surgery was found in 78% (40 pts), while 4% (2 pts) had previous palliative surgery and 18% (9 pts) no previous procedure. We found that women that were not submitted to previous intervention had a significant higher incidence of preterm birth (56% vs 17.5%, p=0.029), spontaneous abortion (56% vs 10%, p=0.006) and stillbirth (22% vs 0%). No difference was found for obstetric complications between groups. Cyanotic pts also demonstrated higher incidence of low birth weight (LBW) (36% vs 7.5%, p=0.031), preterm birth (54% vs 17.5%, p=0.021), spontaneous abortion (55% vs 10%, p=0.004) and stillbirth (18% vs 0%). There were no cardiac complications during pregnancy nor evident deterioration on cardiac status. Congenital heart disease was reported in 2 infants (3% of live births).
Conclusions
Pregnancy is well tolerated in pts with TOF. In our population, even in uncorrected TOF and in pts with cyanosis, there were no cardiac complications during pregnancy, although those pts had worse fetal outcomes. An explanation for the low incidence of cardiac events may be less severe forms of the disease, allowing survival into adulthood without intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - L De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Viegas JM, Rosa SA, Bras P, Castelo A, Ferreira V, Gameiro F, Rio P, Abreu J, Timoteo AT, Galrinho A, Branco LM, Ferreira RC. Left ventricular noncompaction: the importance of identifying high-risk patients within the scope of left ventricular hypertrabeculation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1743] [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
Prominent left ventricular (LV) trabeculation is frequently encountered, however LV noncompaction (LVNC) criteria are not always fulfilled. The clinical and prognostic significance of these findings remains unclear.
Objectives
To characterize the patients (P) with echocardiographic suspicion of LVNC and to assess clinical outcomes.
Methods
Retrospective single-centre study that included all echocardiograms between January 2018 and June 2020 perceiving LV hypertrabeculation. The cohort underwent diagnostic assessment for LVNC by Chin and Jenni criteria. Baseline characteristics were evaluated. Composite endpoint of cardiovascular death, heart failure (HF) hospitalization, ventricular arrythmias (VA) and nonfatal stroke was considered.
Results
51P, 75% male, mean age 50±18 years. 35P (69%) had associated heart conditions, of which 57% had other known cardiomyopathy (mainly dilated cardiomyopathy), 14% congenital, 26% ischemic and 3% valvular heart disease. 2P were in postpartum period and 1P was an athlete. Family history of cardiomyopathy was present in 8P (16%). 12P underwent genetic testing, with TTN and MYH7 mutations being the most frequently detected. Prior clinical HF was reported in 53%, previous stroke in 14%, and non-sustained and sustained VA in 24% and 4%, respectively. Mean NYHA classification was 1.8±0.7, with 31% being asymptomatic.
The prevalence of LVNC by Chin criteria was 31% and by Jenni criteria was 55%. 32P (63%) met at least one LVNC criteria. This group was younger (45±18 vs 59±15, p=0.004), had higher NT-proBNP levels (3644±2819 vs 389±640, p=0.048) and QRS fragmentation (59% vs 21%, p=0.027). Significantly higher LV end-diastolic volume (84 (41) vs 64 (28)ml/m2, p=0.008) and end-systolic volume (51 (37) vs 35 (20)ml/m2, p=0.004), along with lower LV ejection fraction (39±12 vs 49±13%, p=0.009) and global longitudinal strain (−11±5 vs −17±4%, p=0.003) were noticed. P who met LVNC criteria also had higher number of affected LV segments (6.4±1.8 vs 4.2±1.6, p<0.001).
Over a mean follow-up of 18±9 months, the incidence of composite endpoint was 35%. Univariate Cox analysis showed a significant association between the presence of LVNC criteria and adverse outcomes (HR: 5.108, 95% CI: 1.682–11.236, p=0.030) (Fig. 1).
Conclusion
LV hypertrabeculation can be encountered in a variety of clinical scenarios and often overlaps with other heart diseases. P satisfying criteria for LVNC had more impairment in LV performance and worse clinical outcomes.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- J M Viegas
- Hospital de Santa Marta, Lisbon, Portugal
| | - S A Rosa
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Gameiro
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Abreu
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Galrinho
- Hospital de Santa Marta, Lisbon, Portugal
| | - L M Branco
- Hospital de Santa Marta, Lisbon, Portugal
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Mano T, Ferreira V, Ramos R, Oliveira E, Santana A, Melo J, Reis J, Bras P, Teixeira B, Cardoso I, Castelo A, Cacela D, Cruz Ferreira R. Feasibility of virtual fractional flow reserve derived from coronary angiography and its correlation with invasive functional assessment. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1196] [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
Invasive functional assessment (iFA) of coronary artery disease (CAD) needs expensive devices, has potential procedure-related complications and is still underutilized. Virtual Fractional Flow Reserve (vFFR) derived from invasive coronary angiography (ICA) has the potential to overcome these limitations.
Purpose
To investigate the feasibility of vFFR analysis and its correlation with iFA (iFR, RFR or FFR).
Methods
Retrospective analysis of consecutive patients (pts) who underwent iFA in a tertiary center between 2019 and 2020. vFFR was calculated using a dedicated software (CAAS Workstation 8.4) based on standard non-hyperaemic coronary angiograms acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance and accuracy of vFFR were evaluated. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards.
Results
Out of 113 coronary arteries of 102 pts, vFFR was successfully analysed in 106 (94%). Reasons for vFFR analysis failure were: vessel projection overlap (48%), <2 angiographic projections (28%) and table movement while acquisition (24%). From 106 coronary arteries of 95 pts with analysable vFFR (78% male, mean age 67.8±9.7 years), 90 (85%) showed agreement with the respective iFA result. The vFFR predicted which lesions were physiologically significant and which were not with accuracy, sensitivity, specificity, positive and negative predictive values of 73%, 73%, 83%, 53%, and 92% respectively. The mean difference between vFFR and iFA were −0.0484±0.096 and Pearson's correlation coefficient was 0.533 (p<0.001). The ROC area under the curve was 0.839 (0.751–0.928, p<0.001).
Conclusion
FFR were feasible in 94% of cases analysed retrospectively. As compared to gold-standard iFA, vFFR had an overall moderate accuracy in detecting ischemia-producing lesions and a negative predictive value >90%. vFFR has the potential to substantially simplify physiological coronary lesion assessment and thus improve its current uptake.
Funding Acknowledgement
Type of funding sources: None. Bland-Altman plot between vFFR and IFA
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Affiliation(s)
- T Mano
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ramos
- Hospital de Santa Marta, Lisbon, Portugal
| | - E Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Santana
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Melo
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Reis
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - B Teixeira
- Hospital de Santa Marta, Lisbon, Portugal
| | - I Cardoso
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - D Cacela
- Hospital de Santa Marta, Lisbon, Portugal
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40
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Ferreira V, Branco Mano T, Rito T, Ilhao Moreira R, Agapito A, Pinto F, Sousa L. Pregnancy outcomes in women with severe congenital heart disease – a specialized centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2898] [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
Progress in pediatric cardiology and cardiac surgery has dramatically raised the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy (P) in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding P and neonatal outcomes in women with SC-CHD.
Methods
Retrospective analysis of obstetric data in women with CHD followed at our institution. P and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity CHD (MMC-CHD), according to ESC guidelines CHD complexity classification.
Results
The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD pts was cyanotic tetralogy of Fallot (19.0%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedure (13.8%) – Figure 1.
Pts with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p<0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p<0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD P (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1st trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis.
Conclusion
Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Severe CHD
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - T Rito
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Agapito
- Hospital de Santa Marta, Lisbon, Portugal
| | - F Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Sousa
- Hospital de Santa Marta, Lisbon, Portugal
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Burrage M, Hundertmark M, Valkovic L, Watson W, Rayner J, Sabharwal N, Ferreira V, Neubauer S, Miller J, Lewis A, Rider O. Impaired myocardial energetics limits cardiac functional reserve and leads to exercise-induced pulmonary congestion in heart failure with preserved ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0734] [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
Abnormal cardiac mitochondrial function and energetics may be a unifying feature in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Transient pulmonary congestion during exercise is emerging as an important determinant of reduced exercise capacity and symptoms in patients with HFpEF.
Purpose
We sought to determine if impaired myocardial energetics limits cardiac exercise reserve and leads to exercise-induced pulmonary congestion in HFpEF.
Methods
42 patients across the spectrum of diastolic dysfunction and HFpEF (controls n=10; type 2 diabetes (T2DM) n=9; HFpEF n=14; severe diastolic dysfunction due to cardiac amyloid n=9) (Fig. 1a) underwent assessment of cardiac energetics (myocardial phosphocreatine to adenosine triphosphate ratio, PCr/ATP) and function using cardiovascular magnetic resonance (CMR) imaging and echocardiography, and lung-water using a novel pulmonary proton-density MR sequence. Studies were performed at rest and during exercise (20W for 6 minutes) using a CMR-ergometer.
Results
Paralleling the stepwise decline in diastolic function across the groups (E/e' ratio, p<0.0001) was an increase in NT-pro BNP (p<0.0001, Fig. 1b) and reduction in PCr/ATP (control 2.00 [1.86,2.15], T2DM 1.71 [1.61,1.91], HFpEF 1.66 [1.44,1.89], amyloid 1.30 [1.16,1.53], p<0.0001, Fig. 1c). During exercise, there was progressive blunting of left ventricular (LV) diastolic filling (p<0.0001) (Fig. 2a-b), left atrial (LA) dilatation (p<0.0001), failure of RVEF augmentation (p=0.003), RV-PA uncoupling (RV stroke volume to end-systolic volume (SV/ESV) ratio, p=0.0002), and right atrial (RA) dilatation (p<0.0001) across the groups (Fig. 2b). LV diastolic filling (r 0.41, p=0.008), LA dilatation (r −0.35, p=0.03), RVEF augmentation (r 0.46, p=0.003), RV-PA uncoupling (r 0.36, p=0.02), and RA dilatation (r −0.68, p<0.001) during exercise were strongly linked with impaired myocardial energetics (Fig. 2b).
The novel pulmonary proton-density sequence provided images that scaled linearly with water content (validated using a water-doped sponge phantom; r 0.98, p<0.0001), and revealed a progressive increase in lung water signal/pulmonary congestion (Fig. 2c) post-exercise (p<0.0001) across the groups (controls: +0.25% [−1.8, 3.1], p=0.82; T2DM: +0.8% [−1.7, 1.9], p=0.82; HFpEF: +4.4% [0.5, 6.4], p=0.002; amyloid: +6.4% [3.3, 10.0], p=0.004). Pulmonary congestion was associated with impaired LV diastolic filling (r −0.32, p=0.04), RV-PA uncoupling (r −0.39, p=0.01) and RA dilatation (r 0.4, p=0.01) during exercise, and impaired myocardial energetics (r −0.36, p=0.02).
Conclusion
A gradient of myocardial energetic deficit exists across the spectrum of HFpEF. This energetic deficit is related to markedly abnormal cardiac exercise responses, which leads to transient pulmonary congestion. The findings support an energetic basis for impaired cardiac reserve and exercise-induced pulmonary congestion in HFpEF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Baseline clinical and CMR parametersExercise cardiopulmonary parameters
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Affiliation(s)
- M Burrage
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Hundertmark
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - L Valkovic
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - W Watson
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - J Rayner
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - N Sabharwal
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - V Ferreira
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - J Miller
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Lewis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - O Rider
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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Ferreira V, Lawson C, Carli F, Scheede-Bergdahl C, Chevalier S. Feasibility of a novel mixed-nutrient supplement in a multimodal prehabilitation intervention for lung cancer patients awaiting surgery: A randomized controlled pilot trial. Int J Surg 2021; 93:106079. [PMID: 34464752 DOI: 10.1016/j.ijsu.2021.106079] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/20/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate, in lung cancer patients awaiting elective surgery, the feasibility of delivering a novel four-week multimodal prehabilitation intervention and its effects on preoperative functional capacity and health-related quality of life (HRQoL), compared to standard hospital care. METHODS Adult patients awaiting elective thoracotomy for lung cancer stages I, II or IIIa, were approached to participate in an open-label, randomized controlled trial of two parallel arms: multimodal prehabilitation combining a mixed-nutrient supplement with structured supervised and home-based exercise training, and relaxation-strategies (Prehab) or standard hospital care (Control). Feasibility was assessed based on recruitment and adherence rates to the intervention and study outcome assessment. Functional capacity, measured by the 6-min walk test (6MWT), and HRQoL were measured at baseline and after four weeks (preoperative). RESULTS Within 5 months, 34 patients were enrolled and randomized (2:1) to Prehab (n = 24; median age = 67 years) or Control (n = 10; median age = 69 years); recruitment rate of 58.6%. The study was interrupted by the COVID-19 pandemic. Adherence to the prescribed intensity of the supervised exercise program was 84.1% (SD 23.1). Self-reported adherence to the home-based exercise program was 88.2% (SD 21) and to the nutritional supplement, 93.2% (SD 14.2). Adherence to patients' preoperative assessment was 82% and 88% in Prehab and Control, respectively. The mean adjusted difference in 4-week preoperative 6MWT between groups was 37.7 m (95% CI, -6.1 to 81.4), p = 0.089. There were no differences in HRQoL between groups. CONCLUSION Within a preoperative timeframe, it was feasible to deliver this novel multimodal prehabilitation intervention in lung cancer patients awaiting surgery.
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Affiliation(s)
- Vanessa Ferreira
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Claire Lawson
- School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Chabot K, Gillis C, Minnella EM, Ferreira V, Awasthi R, Baldini G, Carli F. Functional capacity of prediabetic patients: effect of multimodal prehabilitation in patients undergoing colorectal cancer resection. Acta Oncol 2021; 60:1025-1031. [PMID: 34102947 DOI: 10.1080/0284186x.2021.1937307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prehabilitation is the process of increasing functional capacity (FC) before surgery. Poor glycemic control is associated with worse outcomes in patients undergoing surgery. Therefore, prediabetic patients could particularly benefit from prehabilitation. METHODS This is a pooled analysis of individual patient data from three multimodal prehabilitation trials in colorectal cancer surgery. Following a baseline assessment using the 6-minute walking test (6MWT), subjects were randomized to multimodal prehabilitation or to a control group. Participants were reassessed 24 h before surgery and 4 weeks after surgery. Prediabetes (PreDM) was defined as HbA1c 5.7%-6.4%. Multivariable logistic regression was used to adjust for potentially confounding variables. RESULTS Participation in a prehabilitation program was the most important predictive factor of clinical improvement in FC prior to surgery (Adjusted OR 2.42, 95% CI 1.18, 4.94); prediabetes was not a statistically significant predictor of improvement in FC after adjustments for covariates. Prehabilitation attenuated the loss of FC in unadjusted analyses after surgery in prediabetic patients (PreDM Control: median change -6 m [IQR -50-20] vs PreDM Prehab: median change +25 m [IQR -20-53], p = 0.045). Adjusted analyses also suggested the protective effect against loss of FC after surgery was stronger in prediabetic patients (PreDM Prehab vs PreDM Control: OR 5.5, 95% CI: 1.2-25.8; Normo Prehab vs Normo Control: OR 1.5, 95% CI: 0.53-4.52). CONCLUSIONS Multimodal prehabilitation favored clinical recovery of FC after surgery in CRC patients, especially prediabetic patients.
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Affiliation(s)
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, Canada
| | - Enrico Maria Minnella
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Vanessa Ferreira
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University, Montreal, Canada
| | | | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Canada
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Rodrigues HR, Ferreira V, Alves L, Sousa D, Pinto J, Pinto A, Rio P, Ferreira R. The impact of the cardiac rehabilitation program in patients with mid-range heart failure (40-50%) in improving cardio respiratory predictors. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central
Methods
We studied 30 patients (P) with ejection fraction (EF) 40-50%, in a number of 198 P that participated in cardiac rehabilitation program (CRP). Of these P, 24 (80%) male and 6 (20%) female, 20 P were diagnosed myocardial infarction with ST-segment elevation, 2 P myocardial infarction non ST and 8 P with myocardial hypertrophy non ischemic. Of these P 30% were diabetics, 56% hypertension, 70% dyslipidemia, 36% smokers previous to CRP and body mass index 26,3 medium.
All P were submitted to previous echocardiogram, cardiopulmonary exercise testing (CET) and a rehabilitation program minimum 4 sessions and maximum 52 sessions. At the end of the total sessions the echocardiogram and CET were repeated.
Results
Of the 30 P that participated in CRP only 20 completed the program, while the other 10 P dropped out because of social and economic problems. Of the P that completed the CRP, 70% got better on EF, 80% improved VE/VCO2 slope < 33 therefore are classified VC-II in ventilatory classification (VC), 5% VE/VCO2 slope > 40 VC-III classification, and 15% maintained the initial classification. 50% of the P increased at least one level metabolic equivalent of task (MET) from the first CET. Only 3 of the 20 patients came, once, to the hospital after the CRP with heart failure, and one died but did not fulfill the program.
Conclusion
Patients with mid-range heart failure submitted to a CRP can improve cardiorespiratory predictors, leading to a better quality of life. However, it is important to find solutions to minimize the causes that make patients to give up CRP.
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Affiliation(s)
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - L Alves
- Hospital de Santa Marta, Lisbon, Portugal
| | - D Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - J Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Pinto
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Rio
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Lawson C, Ferreira V, Carli F, Chevalier S. Effects of multimodal prehabilitation on muscle size, myosteatosis, and dietary intake of surgical patients with lung cancer - a randomized feasibility study. Appl Physiol Nutr Metab 2021; 46:1407-1416. [PMID: 34265218 DOI: 10.1139/apnm-2021-0249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Many patients with lung cancer undergo surgery, which can increase the risk for muscle loss, leading to worsened outcomes. A multimodal prehabilitation intervention integrating dietary and muscle assessment may help clinicians better understand changes in these outcomes. This pilot assessed feasibility of multimodal prehabilitation in early-stage surgical lung cancer patients and explored relationships between body composition, muscle characteristics and dietary intake, as well as muscle changes due to prehabilitation. Patients were randomized to one of two groups: multimodal prehabilitation including nutritional supplements (fish oil with vitamin D3 + whey protein with leucine), exercise and relaxation, or standard of care. Physical function, dietary intake and muscle were evaluated at 0 and 4 weeks pre-operatively. Of 87 patients assessed for eligibility, 34 (39%) were randomized and 3 (9%) were lost to follow-up. Median age was 69 years and baseline protein intake was 1.0 g/kg/d. Adherence to exercise (86%) and supplements was high (93%); 3 patients (16%) reported side effects. Supplements significantly increased protein, omega-3 fatty acid, leucine and vitamin D intake. There were no significant changes in muscle characteristics. Multimodal prehabilitation with dietary and muscle analyses proved to be feasible. An adequately powered randomized controlled trial is warranted. ClinicalTrials.gov registration no: NCT04610606. Novelty: • Multimodal prehabilitation incorporating dietary assessment and muscle analysis is feasible for early-stage surgical lung cancer patients. • An adequately powered randomized controlled trial is warranted to further explore functional and post-operative outcomes.
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Affiliation(s)
- Claire Lawson
- McGill University, 5620, School of Human Nutrition, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
| | - Vanessa Ferreira
- McGill University, 5620, Department of Kinesiology and Physical Education, Montreal, Quebec, Canada;
| | - Francesco Carli
- McGill University, 5620, Department of Anesthesia, Montreal, Quebec, Canada;
| | - Stéphanie Chevalier
- McGill University, School of Human Nutrition, Ste-Anne-de-Bellevue, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
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Martinho VJPD, Bartkiene E, Djekic I, Tarcea M, Barić IC, Černelič-Bizjak M, Szűcs V, Sarcona A, El-Kenawy A, Ferreira V, Klava D, Korzeniowska M, Vittadini E, Leal M, Bolhuis D, Papageorgiou M, Guiné RPF. Determinants of economic motivations for food choice: insights for the understanding of consumer behaviour. Int J Food Sci Nutr 2021; 73:127-139. [PMID: 34148490 DOI: 10.1080/09637486.2021.1939659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Food consumption involves several dimensions, being some of them directly associated with the consumers' characteristics. The interrelationships between these domains impact consumer behaviour for food choice and the consequent decisions for food consumption. In these frameworks, economic motivations are determinant. On the other hand, the scientific literature highlights that the economic-based stimuli to choose food is still underexplored. In this perspective, the objective of this study was to assess the main sociodemographic and anthropometric determinants of the economic motivations for food choice. For that, a questionnaire survey was carried out involving 11,919 respondents from 16 countries. A validated questionnaire was used, translated into the native languages in all participating countries, using a back-translation process. First, the information obtained was assessed through factor analysis to reduce the number of variables associated with the economic motivations and to identify indexes. After, and considering the indexes obtained as dependent variables, a classification and regression tree analysis was performed. As main insights, it is highlighted that the main determinants of the economic motivations are country of residence, age, gender, civil state, professional activity, educational level, living environment, responsibility for buying food, weight, height, body mass index, healthy diets and physical exercise practices. Additionally, the results also reveal that economic motivations may be associated with two indexes, one related to convenience attitudes and the other to quality concerns. Finally, the younger persons and the women are the social groups more concerned with healthy diets and food quality. In conclusion, this work confirmed that food choice is to a high extent influenced by several sociodemographic and behavioural factors.
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Affiliation(s)
- Vítor J P D Martinho
- Agricultural School and CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Elena Bartkiene
- Department of Food Safety and Quality, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ilija Djekic
- Faculty of Agriculture, University of Belgrade, Belgrade, Serbia
| | - Monica Tarcea
- Department of Community Nutrition and Food Safety, University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
| | - Irena Colić Barić
- Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | | | - Viktória Szűcs
- Directorate of Food Industry, Hungarian Chamber of Agriculture, Budapest, Hungary
| | - Alessandra Sarcona
- Department of Nutrition, West Chester University of Pennsylvania, West Chester, PA, USA
| | - Ayman El-Kenawy
- Molecular Biology Department, Genetic Engineering and Biotechnology Institute, University of Sadat City, Sadat, Egypt
| | - Vanessa Ferreira
- Department of Nutrition, Faculty of Biological and Health Sciences, UFVJM University, Diamantina, Brazil
| | - Dace Klava
- Faculty of Food Technology, Latvian University of Agriculture, Jelgava, Latvia
| | - Małgorzata Korzeniowska
- Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Wroclaw, Poland
| | - Elena Vittadini
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Marcela Leal
- Red IESVIDAS (Investigación en Estilos de Vida Saludable)/CONINUT (Consorcio de Investigadores en Nutriología), Buenos Aires, Argentina
| | - Dieuwerke Bolhuis
- Food Quality and Design Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Maria Papageorgiou
- Department of Food Science and Technology, International Hellenic University, Thessaloniki, Greece
| | - Raquel P F Guiné
- Agricultural School and CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Viseu, Portugal
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Kraus SM, Shaboodien G, Francis V, Laing N, Cirota J, Chin A, Pandie S, Lawrenson J, Comitis GAM, Fourie B, Zühlke L, Wonkam A, Wainwright H, Damasceno A, Mocumbi AO, Pepeta L, Moeketsi K, Thomas BM, Thomas K, Makotoko M, Brown S, Ntsekhe M, Sliwa K, Badri M, Gumedze F, Cordell HJ, Keavney B, Ferreira V, Mahmod M, Cooper LT, Yacoub M, Neubauer S, Watkins H, Mayosi BM, Ntusi NAB. Rationale and design of the African Cardiomyopathy and Myocarditis Registry Program: The IMHOTEP study. Int J Cardiol 2021; 333:119-126. [PMID: 33607192 DOI: 10.1016/j.ijcard.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF), the dominant form of cardiovascular disease in Africans, is mainly due to hypertension, rheumatic heart disease and cardiomyopathy. Cardiomyopathies pose a great challenge because of poor prognosis and high prevalence in low- and middle-income countries (LMICs). Little is known about the etiology and outcome of cardiomyopathy in Africa. Specifically, the role of myocarditis and the genetic causes of cardiomyopathy are largely unidentified in Africans. METHOD The African Cardiomyopathy and Myocarditis Registry Program (the IMHOTEP study) is a pan-African multi-centre, hospital-based cohort study, designed with the primary aim of describing the clinical characteristics, genetic causes, prevalence, management and outcome of cardiomyopathy and myocarditis in children and adults. The secondary aim is to identify barriers to the implementation of evidence-based care and provide a platform for trials and other intervention studies to reduce morbidity and mortality in cardiomyopathy. The registry consists of a prospective cohort of newly diagnosed (i.e., incident) cases and a retrospective (i.e., prevalent) cohort of existing cases from participating centres. Patients with cardiomyopathy and myocarditis will be subjected to a standardized 3-stage diagnostic process. To date, 750 patients have been recruited into the multi-centre pilot phase of the study. CONCLUSION The IMHOTEP study will provide comprehensive and novel data on clinical features, genetic causes, prevalence and outcome of African children and adults with all forms of cardiomyopathy and myocarditis in Africa. Based on these findings, appropriate strategies for management and prevention of the cardiomyopathies in LMICs are likely to emerge.
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Affiliation(s)
- Sarah M Kraus
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Gasnat Shaboodien
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Veronica Francis
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Jacqui Cirota
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ashley Chin
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Shahiemah Pandie
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - George A M Comitis
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Barend Fourie
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Liesl Zühlke
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Ambroise Wonkam
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Helen Wainwright
- Department of Pathology, National Health Laboratory Service and UCT, Cape Town, South Africa
| | | | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique
| | - Lungile Pepeta
- Department of Paediatrics, Port Elizabeth Hospital Complex and Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Khulile Moeketsi
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Baby M Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Kandathil Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Makoali Makotoko
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Stephen Brown
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Mpiko Ntsekhe
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; College of Medicine, King Saudi Bin Abdulaziz University for Medical Sciences, Riyadh, Saudi Arabia
| | | | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Masliza Mahmod
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bongani M Mayosi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa.
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Ferreira V, Portugal G, Cruz Coutinho M, Silva Cunha P, Valente B, Lousinha A, Castelo A, Garcia Bras P, Grazina A, Guerra C, Delgado A, Paulo M, Cruz Ferreira R, Oliveira M. Low-fluoro workflows and impact in radiation exposure in the electrophysiology lab. Europace 2021. [DOI: 10.1093/europace/euab116.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
During electrophysiology (EP) procedures, fluoroscopy imaging is employed to visualise catheters position in real-time. However, ionizing radiation is a health hazard to both the patient and operator. In recent years, the use of electroanatomical mapping systems and operator adoption of low-fluoro workflows has allowed a reduction of radiation exposure. The aim of this study was to assess the evolution of fluoroscopy time (FT) in EP procedures, using conventional technique or an electroanatomical mapping system (EMS).
Methods
A retrospective analysis of consecutive EP procedures performed at a tertiary centre between September 2018 and October 2020 was conducted. The procedures were divided in 3 tertiles according to date (T1, T2 and T3), with T3 corresponding to the most recent interventions. Procedural duration, FT, use of EMS, radiofrequency time (RT), acute ablation success and procedural complications were examined.
Results
A total of 615 procedures were analysed: atrioventricular node reentry tachycardia (AVNRT) – n = 144, accessory pathways (AP) – n = 83, typical atrial flutter – n = 106, atrial fibrillation (AF) ablation with radiofrequency (RF) – n = 61, AF ablation with cryoballoon – n = 92, ablation of ventricular arrhythmias – n = 53, and 75 miscellaneous procedures (including atrioventricular node ablation, left atrial flutter ablation and cardioneuroablation). Mean age was 54.6 ± 18.2 years with 59.4% male sex patients. An EMS was used in 75% of the procedures, without significant differences between tertiles. A progressive reduction in median FT was observed over the tertiles (T1 6.3 min, interquartile range [IQR] 2.9-13.6; T2 5.4 min, IQR 2.1-12.0, and T3 3.1 min, IQR 1.2-7.2, Figure 1), and a statistical significant difference was found when comparing T1 to T3 (p < 0.001) and T2 to T3 (p < 0.001). The decrease in FT was observed throughout the study period for all different EP procedures (Figure 2). The number of procedures with zero fluoroscopy had gradually increased (T1 6.1%, T2 8.5% and T3 14.1%; T1 vs. T3 p <0.01). Younger patients (<20 years) were submitted to low fluoroscopy doses with a significant decrease over tertiles (T1 1.2 min, IQR 0.0-4.3; T2 0.9 min, IQR 0.0-2.5; T3 0.0, IQR 0.0-2.2, T1 vs.T3 p < 0.001). No significant difference in procedural duration, RT, acute procedural success or complication rate were noted between tertiles.
Conclusion
Reduction in radiation exposure can be achieved without compromising duration, safety and effectiveness of the procedure. The commitment of operators to reduce radiation exposure using 3D mapping technology can lead to a significant decrease in the use of fluoroscopy. Abstract Figure. Fluoroscopic time analysis
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Affiliation(s)
- V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - B Valente
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Lousinha
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - A Grazina
- Hospital de Santa Marta, Lisbon, Portugal
| | - C Guerra
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Delgado
- Hospital de Santa Marta, Lisbon, Portugal
| | - M Paulo
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
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Castelo A, Rosa S, Fiarresga A, Marques M, Portugal G, Cunha P, Bras P, Ferreira V, Mendonca T, Oliveira M, Ferreira R. Late gadolinium enhancement as a predictor of arrhythmias in patients with hypertrophic cardiomyopathy. Europace 2021. [DOI: 10.1093/europace/euab116.032] [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
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of arrhythmias and sudden cardiac death (SCD). The Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) has been associated with the occurrence of arrhythmic events.
Purpose
The aim was to analyze the association between LGE burden and location and arrhythmic events in HCM patients (P).
Methods
Retrospective analysis of P with HCM in a single tertiary center. Baseline clinical, echocardiographic and CMR characteristics were collected. On follow up arrhythmias (ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF) and atrial flutter (AFL)) were identified. LGE on CMR was compared between patients with and without arrhythmias.
Results
61P (59% male) were included, with a mean age of 58 ± 2 years. The HCM risk-SCD score was 3.35 ± 0.28%. On echocardiography mean left ventricle ejection fraction was 62.16 ± 1.36% and maximum wall thickness 20.59 ± 0.596mm. 31.1% had systolic anterior movement of mitral valve and 26.7% had left ventricle outflow tract obstruction. LGE was present in 88.5% P with a median number of 5 ± 7 segments involved. Interventricular septum (IVS) was involved in 78.7% P, anterior wall
in 57.4%, inferior wall in 54.1%, lateral wall in 52.5%, posterior wall in 9.8%, basal segments in 62.3%, median segments in 68.9% and apical segments in 63.9%. On follow up 3.3%P died, 45.8% had hospitalizations (22,2% because of an arrhythmia) and 75% had arrhythmias (1.6% VF, 6.6% SVT, 50% NSVT, 9.8% PSVT, 37.7% AF and 6.6% AFL). The number of segments with LGE correlated with arrhythmias (p = 0.05 for arrhythmias, p = 0.03 for SVT, p = 0.008 for NSVT and p = 0.042 for PSVT). A cut off of 5 segments involved was a good predictor of arrhythmias (p = 0.002), NSVT (p= 0.006), PSVT (p = 0.024) and AF (p = 0.0029). For SVT the best cut off was 9 (p = 0.003). Considering the LGE location, we found an association between the segments involved and the occurrence of different arrhythmias (table 1).
Conclusion
Supraventricular and ventricular Arrhythmias are frequent in patients with HCM, with the most frequents being NSVT and AF. The LGE burden (>5 segments) and location (median inferior IVS, median anterior IVS, median anterior wall, basal anterior IVS, apical anterior wall, median inferior wall, apical anterior wall and basal inferior IVS) were correlated with arrhythmic events. Abstract Figure.
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Affiliation(s)
- A Castelo
- Hospital de Santa Marta, Lisbon, Portugal
| | - S Rosa
- Hospital de Santa Marta, Lisbon, Portugal
| | | | - M Marques
- Hospital de Santa Marta, Lisbon, Portugal
| | - G Portugal
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Lisbon, Portugal
| | - P Bras
- Hospital de Santa Marta, Lisbon, Portugal
| | - V Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
| | - T Mendonca
- Hospital de Santa Marta, Lisbon, Portugal
| | - M Oliveira
- Hospital de Santa Marta, Lisbon, Portugal
| | - R Ferreira
- Hospital de Santa Marta, Lisbon, Portugal
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Arias-Pérez I, Sáenz-Navajas MP, de-la-Fuente-Blanco A, Ferreira V, Escudero A. Insights on the role of acetaldehyde and other aldehydes in the odour and tactile nasal perception of red wine. Food Chem 2021; 361:130081. [PMID: 34022483 DOI: 10.1016/j.foodchem.2021.130081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/27/2022]
Abstract
Wine models with or without a dearomatised and lyophilized red wine extract containing a young red aroma base (control) plus one vector with one or several aroma compounds (unsaturated-aldehydes, saturated-aldehydes, benzaldehyde, isoamyl-alcohol, methoxypyrazines and (Z)-1,5-octadien-3-one) were prepared. Models were spiked with increasing amounts of acetaldehyde whose headspace concentrations were controlled. Odour and nasal chemesthesic properties were assessed by a trained sensory panel. Results confirm the contribution of the different players, notably isoamyl-alcohol, (Z)-1,5-octadien-3-one, benzaldehyde and methoxypyrazines, to wine aroma and tactile nasal characteristics and demonstrate that acetaldehyde levels play an outstanding role in their modulation. At low levels, it can play positive roles in some specific aromatic contexts, while at higher levels, enhance the negative effects associated to the generic presence of other aldehydes (saturated, unsaturated and Strecker aldehydes) by enhancing "green vegetable" notes and "itching" character and the "burning" effects linked to high levels of isoamyl alcohol.
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Affiliation(s)
- I Arias-Pérez
- Laboratorio de análisis del aroma y enología (LAAE), Department of Analytical Chemistry, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2) (UNIZAR-CITA), Associate unit to Instituto de Ciencias de la Vid y del Vino (ICVV) (UR-CSIC-GR), c/ Pedro Cerbuna 12, 50009 Zaragoza, Spain
| | - M P Sáenz-Navajas
- Instituto de Ciencias de la Vid y del Vino (ICVV) (Universidad de La Rioja-CSIC-Gobierno de La Rioja), Carretera de Burgos Km. 6, Finca La Grajera, 26007 Logroño, La Rioja, Spain
| | - A de-la-Fuente-Blanco
- Laboratorio de análisis del aroma y enología (LAAE), Department of Analytical Chemistry, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2) (UNIZAR-CITA), Associate unit to Instituto de Ciencias de la Vid y del Vino (ICVV) (UR-CSIC-GR), c/ Pedro Cerbuna 12, 50009 Zaragoza, Spain
| | - V Ferreira
- Laboratorio de análisis del aroma y enología (LAAE), Department of Analytical Chemistry, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2) (UNIZAR-CITA), Associate unit to Instituto de Ciencias de la Vid y del Vino (ICVV) (UR-CSIC-GR), c/ Pedro Cerbuna 12, 50009 Zaragoza, Spain
| | - A Escudero
- Laboratorio de análisis del aroma y enología (LAAE), Department of Analytical Chemistry, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2) (UNIZAR-CITA), Associate unit to Instituto de Ciencias de la Vid y del Vino (ICVV) (UR-CSIC-GR), c/ Pedro Cerbuna 12, 50009 Zaragoza, Spain.
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