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Mira JJ, Torres D, Gil V, Carratalá C. Loneliness impact on healthcare utilization in primary care: A retrospective study. J Healthc Qual Res 2024:S2603-6479(24)00027-7. [PMID: 38670900 DOI: 10.1016/j.jhqr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increased number of patients seek help for loneliness in primary care. OBJECTIVE To analyze whether loneliness was associated with a higher utilization of healthcare facilities. METHODS Observational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. RESULTS A total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6-9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. CONCLUSION Loneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.
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Affiliation(s)
- J J Mira
- Healthcare District Alicante-Sant Joan, Fisabio, Alicante, Spain; Health Psychology Department, Universidad Miguel Hernandez, Elche, Spain; RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain.
| | - D Torres
- Healthcare District Alicante-Sant Joan, Fisabio, Alicante, Spain
| | - V Gil
- RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain; Medicine Department, Universidad Miguel Hernandez, Sant Joan, Spain
| | - C Carratalá
- RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain; Medicine Department, Universidad Miguel Hernandez, Sant Joan, Spain
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Reis Santos R, Abecasis J, Maltês S, Lopes P, Oliveira L, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Sousa Uva M, Neves JP, Gil V, Cardim N. Cardiac magnetic resonance patterns of left ventricular remodeling in patients with severe aortic stenosis referred to surgical aortic valve replacement. Sci Rep 2024; 14:7085. [PMID: 38528043 DOI: 10.1038/s41598-024-56838-0] [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: 03/22/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR). Prospective study of 130 consecutive patients (71y [IQR 68-77y], 48% men) with severe AS, referred for surgical AVR. Patterns of LV remodeling were assessed by CMR. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling. At baseline CMR study: mean LV indexed mass: 81.8 ± 26.7 g/m2; mean end-diastolic LV indexed volume: 85.7 ± 23.1 mL/m2 and median geometric remodeling ratio: 0.96 g/mL [IQR 0.82-1.08 g/mL]. LV hypertrophy occurred in 49% of subjects (concentric 44%; eccentric 5%). Both normal LV structure and concentric remodeling had a prevalence of 25% among the cohort; one patient had an adverse remodeling pattern. Asymmetric LV wall thickening was present in 55% of the patients, with predominant septal involvement. AVR was performed in 119 patients. At 3-6 months after AVR, LV remodeling changed to: normal ventricular geometry in 60%, concentric remodeling in 27%, concentric hypertrophy in 10%, eccentric hypertrophy in 3% and adverse remodeling (one patient). Indexes of AS severity, LV systolic and diastolic function and NT-proBNP were significantly different among the distinct patterns of remodeling. Several distinct patterns of LV remodelling beyond concentric hypertrophy occur in patients with classical severe AS. Asymmetric hypertrophy is a common finding and LV response after AVR is diverse.
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Affiliation(s)
- Rita Reis Santos
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sérgio Maltês
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Luís Oliveira
- Cardiology Department, Hospital Divino Espírito Santo, Açores, Portugal
| | - Pedro Freitas
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - António Ferreira
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Miguel Sousa Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Neves
- Cardiac Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Victor Gil
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
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Abecasis J, Maltês S, Santos RR, Lopes P, Manso RT, Gil V, Cardim N, Ramos S, Félix A. Subendocardial "ischemic-like" state in patients with severe aortic stenosis: Insights from myocardial histopathology and ultrastructure. Cardiovasc Pathol 2024; 69:107589. [PMID: 38029890 DOI: 10.1016/j.carpath.2023.107589] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Myocardial adaptation to severe aortic stenosis (AS) is a complex process that involves myocardial fibrosis (MF) beyond cardiomyocyte hypertrophy. Perfusion impairment is believed to be involved in myocardial remodeling in chronic pressure overload. AIM To describe morphological and ultrastructural myocardial changes at endomyocardial tissue sampling, possibly reflecting subendocardial ischemia, in a group of patients with severe AS referred to surgical aortic valve replacement (AVR), with no previous history of ischemic cardiomyopathy. METHODS One-hundred-fifty-eight patients (73 [68-77] years, 50% women) referred for surgical AVR because of severe symptomatic AS with preoperative clinical and imaging study and no previous history of ischemic cardiomyopathy. Intra-operative septal endomyocardial sampling was obtained in 129 patients. Tissue sections were stained with Masson´s Trichrome for MF quantification and periodic acid-Schiff (PAS) staining was performed to assess the presence of intracellular glycogen. Ultrastructure was analyzed through Transmission electron microscopy (TEM). RESULTS MF totalized a median fraction of 11.90% (6.54-19.97%) of EMB, with highly prevalent perivascular involvement (95.3%). None of the samples had histological evidence of myocardial infarction. In 58 patients (45%) we found subendocardial groups of cardiomyocytes with cytoplasmatic enlargement, vacuolization and myofiber derangement, surrounded by extensive interstitial fibrosis. These cardiomyocytes were PAS positive, PAS-diastase resistant and Alcian Blue/PAS indicative of the presence of neutral intracellular glyco-saccharides. At TEM there were signs of cardiomyocyte degeneration with sarcomere disorganization and reduction, organelle rarefaction but no signs of intracellular specific accumulation. CONCLUSION Almost half of the patients with severe AS referred for surgical AVR have histological and ultrastructural signs of subendocardial cardiomyocyte ischemic insult. It might be inferred that local perfusion imbalance contributes to myocardial remodeling and fibrosis in chronic pressure overload.
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Affiliation(s)
- João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - Sergio Maltês
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | | | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | | | - Victor Gil
- Hospital da Luz, Lisboa, Portugal; Faculdade de Medicina, Universidade Católica, Lisboa, Portugal
| | | | - Sancia Ramos
- Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | - Ana Félix
- Nova Medical School, Lisboa, Portugal; Pathology Department, IPOFG, Lisboa, Portugal
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4
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Abecasis J, Lopes P, Maltes S, Santos RR, Ferreira A, Ribeiras R, Andrade MJ, Uva MS, Gil V, Félix A, Ramos S, Cardim N. Histopathological Myocardial Changes in Patients with Severe Aortic Stenosis Referred for Surgical Valve Replacement: A CMR Correlation Study. Eur Heart J Cardiovasc Imaging 2024:jeae023. [PMID: 38246861 DOI: 10.1093/ehjci/jeae023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Myocardial fibrosis (MF) takes part in left ventricular (LV) remodeling in patients with aortic stenosis (AS), driving the transition from hypertrophy to heart failure. The structural changes that occur in this transition are not fully enlightened. AIM to describe histopathology changes at endomyocardial biopsy (EMB) in patients with severe AS referred to surgical aortic valve replacement (AVR); to correlate them with LV tissue characterization from pre-operative cardiac magnetic resonance (CMR). METHODS one-hundred-fifty-eight patients (73[68-77]years, 50%women) referred for surgical AVR because of severe symptomatic AS, with pre-operative CMR (n = 143) with late gadolinium enhancement (LGE), T1, T2 mapping and extracellular volume fraction (ECV) quantification. Intra-operative septal EMB was obtained in 129 patients. MF was assessed through Masson´s Trichrome histochemistry. Immunohistochemistry was performed for both inflammatory cells and extracellular matrix (ECM) characterization (Type I Collagen, Fibronectin, Tenascin C). RESULTS non-ischemic LGE was present in 106 patients (67.1%) (median fraction:5.0% [2.0-9.7]). Native T1 was above normal: 1053 ms[1024-1071] and T2 within normal range (39.3 ms[37.3-42.0]). Median MF was 11.9%[6.54-19.97], with predominant type I collagen perivascular distribution (95.3%). Subendocardial cardiomyocyte ischemic-like changes were identified in 45% of EMB. There was no inflammation, despite ECM remodeling expression. MF quantification at EMB was correlated with LGE mass (p = 0.008) but not with global ECV (p = 0.125). CONCLUSION patients with severe symptomatic AS referred for surgical AVR have unspecific histological myocardial changes, including signs of cardiomyocyte ischemic insult. ECM remodeling is ongoing, with MF heterogeneity. These features may be recognized by comprehensive CMR protocols. However, no single CMR parameter captures the burden of MF and histological myocardial changes in this setting.
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Affiliation(s)
- João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
- Nova Medical School, Lisboa, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | - Sergio Maltes
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | | | | | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | | | - Miguel Sousa Uva
- Cardiac Surgery Department, Hospital de Santa Cruz, Lisboa, Portugal
| | - Victor Gil
- Hospital da Luz, Lisboa, Portugal
- Faculdade de Medicina, Universidade Católica, Lisboa
| | - Ana Félix
- Nova Medical School, Lisboa, Portugal
- Pathology Department, IPOFG, Lisboa, Portugal
| | - Sancia Ramos
- Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal
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Baptista R, Silva Cardoso J, Canhão H, Maria Rodrigues A, Kislaya I, Franco F, Bernardo F, Pimenta J, Mendes L, Gonçalves S, Teresa Timóteo A, Andrade A, Moura B, Fonseca C, Aguiar C, Brito D, Ferreira J, Filipe Azevedo L, Peres M, Santos P, Moraes Sarmento P, Cernadas R, Santos M, Fontes-Carvalho R, Campos Fernandes A, Martinho H, González-Juanatey JR, Filipe Pereira L, Gil V, Raquel Marques C, Almeida M, Pardal M, Barbosa V, Gavina C. Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study. Rev Port Cardiol 2023; 42:985-995. [PMID: 37918783 DOI: 10.1016/j.repc.2023.10.004] [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: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. METHODS The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. CONCLUSIONS Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.
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Affiliation(s)
- Rui Baptista
- Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
| | - José Silva Cardoso
- Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Rheumatology Unit, Centro Hospitalar Universitário de Lisboa Central, Santo António Capuchos Hospital, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Irina Kislaya
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal; Public Health Research Center, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Unidade de Tratamento de Insuficiência Cardiaca Avançada (UTICA), Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Joana Pimenta
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lígia Mendes
- Department of Cardiology, Hospital da Luz Setúbal, Setúbal, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Sara Gonçalves
- Unidade Integrada de Insuficiência Cardíaca (UNIICA), Department of Cardiology, Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | - Ana Teresa Timóteo
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Aurora Andrade
- Clínica de Insuficiência Cardíaca, Department of Cardiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | | | - Cândida Fonseca
- Department of Medicine, Clínica de Insuficiência Cardiaca, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carlos Aguiar
- Unidade de Insuficiência Cardíaca Avançada, Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde & Laboratório Associado - Rede de Investigação em Saúde (CINTESIS@RISE), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal
| | - Marisa Peres
- Department of Cardiology, Hospital de Santarém, Santarém, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Pedro Moraes Sarmento
- Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal; Centro de Investigação Clinica, Hospital da Luz Learning Health, Lisbon, Portugal
| | - Rui Cernadas
- Serviços de Saúde Ocupacional, Continental Mabor, Lousado, Portugal
| | - Mário Santos
- Department of Cardiology, Pulmonary Vascular Disease Unit, Centro Hospitalar Universitário de Santo António, Oporto, Portugal; CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Oporto, Portugal; Department of Immuno-Physiology and Pharmacology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Oporto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Oporto, Portugal
| | - Ricardo Fontes-Carvalho
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Oporto, Portugal
| | | | | | - José Ramon González-Juanatey
- Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luís Filipe Pereira
- Associação de Apoio aos Doentes com Insuficiência Cardiaca (AADIC), Lisbon, Portugal
| | - Victor Gil
- Cardiovascular Department, Hospital da Luz-Lisboa, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Cláudia Raquel Marques
- National Center for Data Collection in Cardiology, Portuguese Society of Cardiology, Coimbra, Portugal
| | | | | | | | - Cristina Gavina
- Pedro Hispano Hospital - ULS Matosinhos, Matosinhos, Portugal; Cardiology Department, Faculty of Medicine, University of Porto, Oporto, Portugal; RISE- Health Research Network, Faculty of Medicine, University of Porto, Oporto, Portugal
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Domínguez-Rodríguez A, Hernandez-Vaquero D, Suero-Mendez C, Burillo-PutzE G, Gil V, Calvo-Rodriguez R, Piñera-Salmeron P, Llorens P, Martín-Sánchez FJ, Abreu-Gonzalez P, Miró Ò. Effects of MIdazolam versus MOrphine in acute cardiogenic pulmonary edema and chronic obstructive pulmonary disease: An analysis of MIMO trial. Am J Emerg Med 2023; 73:176-181. [PMID: 37703629 DOI: 10.1016/j.ajem.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure. The MIMO trial showed that patients with acute cardiogenic pulmonary edema (ACPE) treated with midazolam had fewer serious adverse events than those treated with morphine. In this post hoc analysis, we examined whether the presence/ absence of COPD modifies the reduced risk of midazolam over morphine. METHODS Patients >18 years old clinically diagnosed with ACPE and with dyspnea and anxiety were randomized (1:1) at emergency department arrival to receive either intravenous midazolam or morphine. In this post hoc analysis, we calculated the relative risk (RR) of serious adverse events in patients with and without COPD. Calculating the CochranMantel-Haenszel interaction test, we evaluated if COPD modified the reduced risk of serious adverse events in the midazolam arm compared to morphine. RESULTS Overall, 25 (22.5%) of the 111 patients randomized had a history of COPD. Patients with COPD were more commonly men with a history of previous episodes of heart failure, than participants without COPD. In the COPD group, the RR for the incidence of serious adverse events in the midazolam versus morphine arm was 0.36 (95%CI, 0.1-1.46). In the group without COPD, the RR was 0.44 (95%CI, 0.22-0.91). The presence of COPD did not modify the reduced risk of serious adverse events in the midazolam arm compared to morphine (p for interaction =0.79). CONCLUSIONS The reduced risk of serious adverse events in the midazolam group compared with morphine is similar in patients with and without COPD.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | | | - Victor Gil
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS); University of Barcelona. Barcelona, Catalonia, Spain
| | | | | | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | | | - Pedro Abreu-Gonzalez
- Department of Physiology, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS); University of Barcelona. Barcelona, Catalonia, Spain
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7
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Martín-Mojarro E, Gil V, Llorens P, Flores-Quesada S, Troiano-Ungerer OJ, Alquézar-Arbé A, Jacob J, Herrero P, Sánchez C, Miró Ò. Factors associated with unjustified chronic treatment with digoxin in patients with acute heart failure and relationship with short-term prognosis. Rev Clin Esp 2023; 223:532-541. [PMID: 37716426 DOI: 10.1016/j.rceng.2023.09.003] [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: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome. METHOD Patients diagnosed with AHF who were in chronic treatment with digoxin, were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge. RESULTS We analyzed 2,366 patients on chronic digoxin treatment (median age = 83 years, women = 61%), which was considered adequate in 1,373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin-angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% versus 7.6%, p = 0.05; and 12.6% versus 9.1%, p < 0.001, respectively). No differences were recorded in prolonged stay (35.7% versus 33.8%) or post-discharge adverse events (32.9% versus 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95%CI = 0.85-2.03) for in-hospital mortality; 1.29 (0.74-2.25) for 30-day mortality; 1.07 (0.82-1.40) for prolonged stay; and 0.88 (0.65-1.19) for post-discharge adverse event. CONCLUSION There is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.
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Affiliation(s)
- E Martín-Mojarro
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - S Flores-Quesada
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - O J Troiano-Ungerer
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - C Sánchez
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain.
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Lima MR, Abecasis J, Santos RR, Maltês S, Lopes P, Ferreira A, Ribeiras R, Andrade MJ, Abecasis M, Gil V, Ramos S, Cardim N. Is myocardial fibrosis appropriately assessed by calibrated and 2D strain derived integrated backscatter? Cardiovasc Ultrasound 2023; 21:14. [PMID: 37568167 PMCID: PMC10422833 DOI: 10.1186/s12947-023-00311-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
AIMS Increased collagen content of the myocardium modifies tissue reflectivity and integrated backscatter (IBS) indexes are suggested as markers of myocardial fibrosis (MF). We sought to assess the correlation between calibrated (c) IBS and bidimensional (2D) strain derived IBS with left ventricular (LV) MF in patients with severe aortic stenosis (AS). METHODS AND RESULTS We made a prospective observational cohort study including 157 patients with severe AS referred for surgical aortic valve replacement (AVR), with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of surgery. Two groups of 30 patients were specifically evaluated, with and without late gadolinium enhancement (LGE) at CMR. IBS was obtained at QRS peak from both parasternal long axis (PLAX) and apical-three-chamber (AP3C) views and measured in decibels (dB). Whole-cardiac cycle IBS at basal anterior septum was obtained from 2D longitudinal strain. Correlation analysis of reflectivity indexes was performed with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) (Masson´s Trichrome). IBS values were compared in both group of patients (LGE + vs. LGE -). 60 patients (74 [36-74] years, 45% male) with high gradient (mean gradient: 63 ± 20mmHg), normal flow (45 ± 10mL/m2) AS and preserved left ventricular ejection fraction (60 ± 9%) were included. Basal septum cIBS was - 17.45 (-31.2-10.95) and - 9.17 ± 9.45dB from PLAX and A3C views, respectively. No significant correlations were found between IBS and both non-invasive CMR tissue characterization and CVF: median MF of 9.7(2.1-79.9)%. Acoustic indexes were not significantly different according to the presence of pre-operative LGE. CONCLUSION In this group of patients with classical severe AS, IBS reflectivity indexes are of no added value to discriminate the presence of MF.
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Affiliation(s)
- Maria Rita Lima
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Rita Reis Santos
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Sérgio Maltês
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - António Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Abecasis
- Cardiac Surgery Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Sância Ramos
- Pathology Anatomy Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Semedo CS, Diniz AM, Aguiar JE, Almeida SS, Timóteo AT, Gil V. What do Portuguese cardiologists think and feel about their work? Rev Port Cardiol 2023:S0870-2551(23)00280-9. [PMID: 37271307 DOI: 10.1016/j.repc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/27/2022] [Accepted: 11/14/2022] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES This study reports the results of an online survey carried out by the Portuguese Society of Cardiology about its medical members' work characteristics before and during the COVID-19 pandemic, their job satisfaction, work motivation, and burnout. METHODS A sample of 157 participants answered a questionnaire with demographic, professional, and health-related information, followed by questionnaires on job satisfaction and motivation designed and validated for this study and a Portuguese version of the Maslach Burnout Inventory. Data were analyzed through descriptive statistics, ANOVA, and MANOVA, considering gender, professional level, and sector of activity, respectively. Multiple regression was used to assess the impact of job satisfaction and motivation on burnout. RESULTS The only variable that distinguished participants was sector of activity. Cardiologists working in the private sector worked fewer weekly hours during COVID-19, while those in the public sector worked more. The latter expressed more desire to reduce their working hours than those who worked in private medicine and in both sectors. There were no differences between sectors in work motivation, while job satisfaction was higher in the private sector. Moreover, job satisfaction negatively predicted burnout. CONCLUSIONS Our findings point to a deterioration in working conditions during the COVID-19 pandemic, with its consequences being felt especially in the public sector, which may have contributed to the lower levels of satisfaction among cardiologists who worked exclusively in this sector, but also for those working in both public and private sectors.
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Affiliation(s)
- Carla Santarém Semedo
- Research Centre in Education and Psychology (CIEP-UÉ), Department of Psychology, School of Social Sciences, Universidade de Évora, Évora, Portugal.
| | - António Moreira Diniz
- Research Centre in Education and Psychology (CIEP-UÉ), Department of Psychology, School of Social Sciences, Universidade de Évora, Évora, Portugal
| | | | - Susana Sousa Almeida
- Faculdade de Medicina da Universidade do Porto, Instituto Português de Oncologia - Porto, Hospital Cuf Porto, Porto, Portugal
| | - Ana Teresa Timóteo
- NOVA Medical School - Faculdade de Ciências Médicas, Serviço de Cardiologia Hospital de Santa Marta, CHULC, Lisboa, Portugal
| | - Victor Gil
- Universidade de Lisboa, Faculdade de Medicina, Centro de Risco Cardiovascular e Trombose - Hospital da Luz, Lisboa, Portugal
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Maltês S, Abecasis J, Santos RR, Lopes P, Oliveira L, Guerreiro S, Freitas P, Ferreira A, Nolasco T, Gil V, Cardim N. LGE prevalence and patterns in severe aortic stenosis: When "junctional" means the same. Int J Cardiol 2023; 378:159-163. [PMID: 36828032 DOI: 10.1016/j.ijcard.2023.02.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Left ventricular (LV) remodeling in severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response. Reparative/replacement fibrosis is considered irreversible and has recognized value in both risk stratification and prognosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for fibrosis identification through late gadolinium enhancement (LGE) assessment. However, its prevalence and distribution are quite variable among series. Our goal was to assess LGE prevalence and patterns in severe AS. METHODOLOGY Single-center prospective cohort of 140 patients with severe symptomatic high-gradient AS (mean age 72 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean LV ejection fraction by echocardiogram 58 ± 9%) undergoing surgical aortic valve replacement. Those with previous myocardial infarction and/or non-ischemic cardiomyopathy were excluded. All patients performed 1.5 T LGE-CMR prior to surgery. RESULTS Overall, 103 patients (74%) had non-ischemic LGE (median LGE mass 2.8 g [IQR 0.0-7.8] g), many of them with combined mid-wall and junctional enhancement pattern (36%). LGE was most frequently observed in the mid-basal segments of the interventricular septum. Seventy-four patients (53%) had non-exclusively junctional LGE. Contrary to those with junctional enhancement, patients with non-exclusively junctional LGE had higher LV volumes/mass, worse LV ejection fraction and worse global longitudinal strain. CONCLUSION Among patients with severe, symptomatic, high-gradient AS, LGE is frequent, primarily affecting the mid-basal interventricular septum. Contrary to junctional LGE, the presence of non-junctional LGE seems to correlate with adverse markers of LV remodeling.
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Affiliation(s)
- Sérgio Maltês
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rita Reis Santos
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luis Oliveira
- Cardiology Department, Hospital Divino Espírito Santo, Azores, Portugal
| | - Sara Guerreiro
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Freitas
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - António Ferreira
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Tiago Nolasco
- Cardiac Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Victor Gil
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
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Abecasis J, Cortez-Dias N, Pinto DG, Lopes P, Madeira M, Ramos S, Gil V, Cardim N, Félix A. QUANTITATIVE ASSESSMENT OF MYOCARDIAL FIBROSIS BY DIGITAL IMAGE ANALYSIS: an adjunctive tool for pathologist "ground truth": original article. Cardiovasc Pathol 2023; 65:107541. [PMID: 37127060 DOI: 10.1016/j.carpath.2023.107541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023] Open
Abstract
AIMS Myocardial fibrosis (MF) is a common pathological process in a wide range of cardiovascular diseases. Its quantity has diagnostic and prognostic relevance. We aimed to assess if the complementary use of an automated artificial intelligence software might improve the precision of the pathologist´s quantification of MF on endomyocardial biopsies (EMB). METHODS AND RESULTS Intraoperative EMB samples from 30 patients with severe aortic stenosis submitted to surgical aortic valve replacement were analysed. Tissue sections were stained with Masson´s trichrome for collagen/fibrosis and whole slide images (WSI) from the experimental glass slides were obtained at a resolution of 0.5μm using a digital microscopic scanner. Three experienced pathologists made a first quantification of MF excluding the subendocardium. After two weeks, an algorithm for Masson´s trichrome brightfield WSI (at QuPath software) was applied and the automatic quantification was revealed to the pathologists, who were asked to reassess MF, blinded to their first evaluation. The impact of the automatic algorithm on the inter-observer agreement was evaluated using Bland-Altman type methodology. Median values of MF on EMB were 8.33% [IQR 5.00-12.08%] and 13.60% [IQR 7.32-21.2%], respectively for the first pathologist´s and automatic algorithm quantification, being highly correlated (R2: 0.79; p<0.001). Inter-observer discordance was relevant, particularly for higher percentages of MF. The knowledge of the automatic quantification significantly improved the overall pathologist´s agreement, which became unaffected by the degree of MF severity. CONCLUSIONS The use of an automated artificial intelligence software for MF quantification on EMB samples improves the reproducibility of measurements by experienced pathologists. By improving the reliability of the quantification of myocardial tissue components, this adjunctive tool may facilitate the implementation of imaging-pathology correlation studies.
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Affiliation(s)
- João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - Nuno Cortez-Dias
- Cardiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina de Lisboa, Portugal.
| | - Daniel Gomes Pinto
- Nova Medical School, Lisboa, Portugal; Pathology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal.
| | - Márcio Madeira
- Cardiac Surgery Department, Hospital de Santa Cruz, Lisboa, Portugal.
| | - Sancia Ramos
- Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal.
| | - Victor Gil
- Hospital da Luz, Lisboa, Portugal; Faculdade de Medicina, Universidade Católica, Lisboa.
| | | | - Ana Félix
- Nova Medical School, Lisboa, Portugal; Pathology Department, IPOFG, Lisboa, Portugal.
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Espinosa B, Gil V, Herrero P. Considerations for clinical ultrasound in patients with heart failure treated in home hospitalization. Med Clin (Barc) 2023:S0025-7753(23)00111-2. [PMID: 37076362 DOI: 10.1016/j.medcli.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Begoña Espinosa
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | - Victor Gil
- Área de Urgencias, Hospital Clínic, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, España
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Domínguez-Rodríguez A, Hernandez-Vaquero D, Suero-Mendez C, Burillo-Putze G, Gil V, Calvo-Rodriguez R, Piñera-Salmeron P, Llorens P, Martín-Sánchez FJ, Abreu-Gonzalez P, Miró Ò. Midazolam versus morphine in acute cardiogenic pulmonary edema patients with and without atrial fibrillation: findings from the MIMO trial. Eur J Emerg Med 2023; 30:78-84. [PMID: 36727880 DOI: 10.1097/mej.0000000000001005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND IMPORTANCE The MIMO clinical trial showed that patients with acute cardiogenic pulmonary edema (ACPE) treated with midazolam had fewer serious adverse events than those treated with morphine. Atrial fibrillation (AF) is a common comorbidity in heart failure and affects patient's outcome. OBJECTIVE The primary endpoint of this substudy is to know if AF modified the reduced risk of serious adverse events in the midazolam arm compared to morphine. The first secondary endpoint is to know if AF modified the reduced risk of serious adverse events or death at 30 days in the midazolam arm. The second secondary objective of this substudy is to analyze whether AF modified the reduced risk of midazolam against morphine on the total number of serious adverse events per patient. DESIGN We conducted a secondary analysis of the MIMO trial. Patients more than 18 years old clinically diagnosed with ACPE and with dyspnea and anxiety were randomized (1:1) at emergency department arrival to receive either intravenous midazolam or morphine. OUTCOME MEASURES AND ANALYSIS In this post hoc analysis, we calculated the relative risk (RR) of serious adverse events in patients with and without AF. Calculating the Cochran-Mantel-Haenszel interaction test, we evaluated if AF modified the reduced risk of serious adverse events in the midazolam arm compared to morphine. MAIN RESULTS One hundred eleven patients (median = 78.9 years; IQR, 72.3-83.7; women, 52.2%) were randomized in the MIMO trial, 55 to receive midazolam and 56 to morphine. All randomized patients received the assigned drug and there were no losses to follow-up. Forty-four patients (39.6%) had AF. In the AF group, the RR for the incidence of serious adverse events in the midazolam versus morphine arm was 0.42 (95% CI, 0.14-1.3). In the group without AF, the RR was 0.46 (95% CI, 0.21-1). The presence of AF did not modify the reduced risk of serious adverse events in the midazolam arm compared with morphine ( P for interaction = 0.88). CONCLUSION This post hoc analysis of the MIMO trial suggests that the reduced risk of serious adverse events in the midazolam group compared to morphine is similar in patients with and without AF.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid
| | - Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Central University Hospital of Asturias
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo
| | | | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife
| | - Victor Gil
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS), University of Barcelona. Barcelona, Catalonia
| | | | | | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante
| | | | - Pedro Abreu-Gonzalez
- Department of Physiology, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Institutd' Investigación Biomèdica August Pi iSunyer (IDIBAPS), University of Barcelona. Barcelona, Catalonia
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Abecasis J, Lopes P, Santos RR, Maltês S, Guerreiro S, Ferreira A, Freitas P, Ribeiras R, Andrade MJ, Manso RT, Ramos S, Gil V, Masci PG, Cardim N. Prevalence and significance of relative apical sparing in aortic stenosis: insights from an echo and cardiovascular magnetic resonance study of patients referred for surgical aortic valve replacement. Eur Heart J Cardiovasc Imaging 2023:7058252. [PMID: 36841934 DOI: 10.1093/ehjci/jead032] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 02/27/2023] Open
Abstract
AIMS This study aims to assess the prevalence of relative apical sparing pattern (RASP) in patients with severe symptomatic aortic stenosis (AS), referred for surgical aortic valve replacement (AVR), to evaluate its significance, possible relation to amyloid deposition, and persistence after surgery. METHODS AND RESULTS Prospective study of 150 consecutive patients [age 73 (interquartile range: 68-77), 51% women], with severe symptomatic AS referred to surgical AVR. All patients underwent cardiac magnetic resonance (CMR) before surgery. RASP was defined by [average apical longitudinal strain (LS)/(average basal LS + average mid LS)] > 1 by echocardiography. AVR was performed in 119 (79.3%) patients. Both Congo red and sodium sulphate-Alcian blue (SAB) stain were used to exclude amyloid on septal myocardial biopsy. LV remodelling and tissue characterization parameters were compared in patients with and without RASP. Deformation pattern was re-assessed at 3-6 months after AVR.RASP was present in 23 patients (15.3%). There was no suspicion of amyloid at pre-operative CMR [native T1 value 1053 ms (1025-1076 ms); extracellular volume (ECV) 28% (25-30%)]. None of the patients had amyloid deposition at histopathology. Patients with RASP had significantly higher pre-operative LV mass and increased septal wall thickness. They also had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels [1564 (766-3318) vs. 548 (221-1440) pg/mL, P = 0.010], lower LV ejection fraction (53.7 ± 10.5 vs. 60.5 ± 10.2%, P = 0.005), and higher absolute late gadolinium enhancement (LGE) mass [9.7 (5.4-14.1) vs. 4.8 (1.9-8.6) g, P = 0.016] at CMR. Follow-up evaluation after AVR revealed RASP disappearance in all except two of the patients. CONCLUSION RASP is not specific of cardiac amyloidosis. It may also be found in severe symptomatic AS without amyloidosis, reflecting advanced LV disease, being mostly reversible after surgery.
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Affiliation(s)
- João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal.,Nova Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Rita Reis Santos
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Sérgio Maltês
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Sara Guerreiro
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - António Ferreira
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Pedro Freitas
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz, Calçada da Palma de Baixo, 8, 4° B, 1600-175 Lisboa, Portugal
| | | | - Sancia Ramos
- Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal
| | - Victor Gil
- Cardiology Department, Hospital da Luz, Lisboa, Av. Lusíada 100, 1500-650 Lisboa, Portugal
| | - Pier Giorgio Masci
- Imaging and Biomedical Engineering, King´s College, London, UK.,St Thomas' Campus, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Nuno Cardim
- Nova Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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Domínguez-Rodríguez A, Hernández-Vaquero D, Suero-Méndez C, Burillo-Putze G, Gil V, Calvo-Rodríguez R, Piñera-Salmerón P, Llorens P, Martín-Sánchez FJ, Abreu-González P, Formica F, Miró Ò. Effects of midazolam vs morphine in patients with acute pulmonary edema with left ventricular systolic dysfunction: a secondary analysis of data from the MIMO trial. Emergencias 2023; 35:25-30. [PMID: 36756913] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The midazolam vs morphine (MIMO) trial showed that patients treated with midazolam had fewer serious adverse events than those treated with morphine. In many patients with acute pulmonary edema, the left ventricular ejection fraction (LVEF) is preserved, at 50% or higher. We aimed to determine whether left ventricular (LV) systolic dysfunction (D), defined by an LVEF of less than 50%, modifies the protective effect of midazolam vs morphine. MATERIAL AND METHODS The MIMO trial randomized 111 patients with acute pulmonary edema to receive intravenous midazolam in 1-mg doses to a maximum of 3 mg (n = 55) or morphine in 2- to 4-mg doses to a maximum of 8 mg (n= 56). We calculated the relative risk (RR) for a serious adverse event in patients with and without systolic LVD. RESULTS LVEF was preserved in 84 (75.7%) of the patients with acute pulmonary edema. In patients with systolic LVD, 4 patients (26.9%) in the midazolam arm vs 6 (50%) in the morphine arm developed serious adverse events (RR, 0.53; 95% CI, 0.2-1.4). In patients without systolic LVD, 6 patients (15%) in the midazolam arm vs 18 (40.9%) in the morphine arm experienced such events (RR, 0.37; 95% CI, 0.16-0.83). The presence of systolic LVD did not modify the protective effect of midazolam on serious adverse effects (P=.57). CONCLUSION The effect of midazolam vs morphine in protecting against the development of serious adverse events or death is similar in patients with and without systolic LVD.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Servicio de Cardiología, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, España. CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España. Universidad de Oviedo, Oviedo, España
| | | | - Guillermo Burillo-Putze
- Servicio de Urgencias, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Victor Gil
- Servicio de Urgencias, Hospital Clinic, Barcelona, Institut d' Investigació Biomèdica August Pi iSunyer (IDIBAPS); Universidad de Barcelona, Cataluña, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Hospital General de Alicante, España
| | | | - Pedro Abreu-González
- Departmento de Fisiología, Facultad de Medicina, Universidad de La Laguna, Tenerife, España
| | - Francesco Formica
- Universidad de Parma, Departamento de Medicina y Cirugía, Parma, Italia
| | - Òscar Miró
- Servicio de Urgencias, Hospital Clinic, Barcelona, Institut d' Investigació Biomèdica August Pi iSunyer (IDIBAPS); Universidad de Barcelona, Cataluña, España
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16
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Febra C, Spinu V, Ferreira F, Gil V, Maio R, Penque D, Macedo A. Predictive Value for Increased Red Blood Cell Distribution Width in Unprovoked Acute Venous Thromboembolism at the Emergency Department. Clin Appl Thromb Hemost 2023; 29:10760296231193397. [PMID: 37691287 PMCID: PMC10494517 DOI: 10.1177/10760296231193397] [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: 05/28/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Acute venous thromboembolism (VTE) is a common worldwide disease admitted to emergency departments (ED), usually presenting as pulmonary embolism or lower limb deep vein thrombosis (DVT). Due to the lack of typical clinical and biomarker diagnostic features of unprovoked VTE, early identification is challenging and has direct consequences on correct treatment delay. Longitudinal, prospective, observational study. Patients admitted to ED with a suspicion of unprovoked acute VTE between October 2020 and January 2021 were included. Clinical and laboratorial variables were compared between VTE positive and negative diagnoses. Red cell distribution width (RDW) cut point was determinate through a receiver operating characteristic analysis. RDW accuracy, sensitivity, and specificity were calculated. Fifty-eight patients were analyzed. And 82.8% of suspected patients with VTE were diagnosed with an acute thrombotic event confirmed by imaging examination. In patients with VTE, RDW at admission in ED was higher than with other diagnosis, respectively, 14.3% (13.2-15.1) and 13.5% (13.0-13.8). Platelet count was the only additional characteristic that revealed difference between the 2 groups (264×109/L for VTE and 209×109/L for non-VTE). Logistic regression models showed good discriminatory values for RDW≥14%, with an area under the curve (AUC) = 0.685 (95% confidence interval, 0.535-0.834). These findings were more pronounced in isolated DVT, with a sensitivity of 76.9%, specificity 100%, and accuracy 85.7%. Our study demonstrated a significant association between an early high RDW and the diagnosis of acute unprovoked DVT. RDW ≥ 14% has an independent predictor of unprovoked VTE in adult patients.
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Affiliation(s)
- Cláudia Febra
- Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Verónica Spinu
- Department of Emergency Medicine, Hospital Beatriz Angelo, Loures, Portugal
| | - Filipa Ferreira
- Department of Emergency Medicine, Hospital Beatriz Angelo, Loures, Portugal
| | - Victor Gil
- Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Cardiovascular Risk and Thrombosis, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Rui Maio
- Department of General Surgery, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Deborah Penque
- Laboratory of Proteomics, Department of Human Genetics, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - Ana Macedo
- Algarve Biomedical Center (ABC), Faro, Portugal
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal
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17
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Carratalá-Perales JM, Gil V, Andueza JA. Comments on "Characteristics of prolonged non-invasive ventilation in hospital emergency departments and their impact on efficacy. Analysis of the VNICat registry". Med Intensiva 2022; 46:658-659. [PMID: 36257881 DOI: 10.1016/j.medine.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 06/16/2023]
Affiliation(s)
- J M Carratalá-Perales
- Urgencias y Unidad Corta Estancia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - V Gil
- Àrea d'Urgències, Hospital Clínic Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - J A Andueza
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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18
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R Santos R, Abecasis J, Maltes S, Mendes GS, Guerreiro S, Padrao C, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Neves JP, Ramos S, Mendes M. Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.137] [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
Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS).
Aim
To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery.
Methods
We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio >1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR.
Results
RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%).
Conclusions
RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | - C Padrao
- Hospital Santa Cruz , Lisbon , Portugal
| | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
| | - S Ramos
- Hospital Santa Cruz , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
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19
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Left ventricular remodeling in aortic stenosis patients referred for surgical aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.237] [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
Left ventricular (LV) hypertrophy is a common expected finding in aortic stenosis (AS) patients. Cardiac magnetic resonance (CMR) plays an important role as a non-invasive method for determining LV mass and volume, and to characterize the LV remodeling response in AS.
Aim
To assess the prevalence, to describe the patterns and evolution of LV remodeling (by CMR) in AS patients referred for surgical aortic valve replacement (AVR).
Methods
Single-center prospective cohort of 132 consecutive patients (73 years [68–77 years], 49% men] with severe AS: mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; aortic valve area (AVA): 0.7±0.1 cm2, referred for surgical AVR, with no previous history of ischemic cardiomyopathy. Before surgery, all patients underwent electrocardiogram, complete transthoracic echocardiogram (TTE) and CMR for LV assessment and tissue characterization (mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]). Patterns of LV remodeling were investigated before and after AVR by CMR measurements of LVMi, LVEDVi and M/V. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling (Figure 1).
Results
Overall, 43% (n=58) of the patients had concentric hypertrophy, 30% (n=40) concentric remodeling, 22% (n=29) normal ventricular geometry, 4% (n=5) eccentric hypertrophy and in two patients we observed an adverse remodeling pattern. AVR was performed in 80 patients. At the 3rd to 6th month post-AVR assessment, LV remodeling changed to: normal ventricular geometry in 46%, concentric remodeling in 31%, concentric hypertrophy in 19%, eccentric hypertrophy in 3% and adverse remodeling in only one patient (Figure 1).
Conclusions
In this group of patients with severe aortic stenosis, concentric hypertrophy was not the sole pattern of LV remodeling and two out of every five still presented a normal ventricular geometry and mass as assessed by CMR. LV response was dynamic after AVR which stands for complex and multifactorial interaction in these group of patients despite similar valvular pathophysiology and therapeutic intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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20
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Cardiac magnetic resonance patterns of left ventricular hypertrophy in aortic stenosis patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1544] [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
Left ventricular (LV) hypertrophy is a known compensatory mechanism to pressure overload in aortic stenosis (AS) patients. However, by cardiac magnetic resonance (CMR) different patterns of LV adaptation are seen in this group of patients.
Aim
To describe the patterns of LV adaptation (by CMR) and to analyze its structure and function indexes in AS patients referred for surgical aortic valve replacement (AVR).
Methods
We prospectively studied 134 consecutive patients (age: 73y [IQR 68–77y], 49% men) with severe symptomatic AS - mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; mean aortic valve area: AVA): 0.7±0.1 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. All patients underwent electrocardiogram, 2D transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) before surgery for LV assessment and tissue characterization. Five patterns of LV structure were considered: normal ventricular structure (normal LV mass/volume ratio [M/V], normal LVMi and normal indexed LV end-diastolic volume (LVEDVi); concentric remodeling: increased M/V, normal LVMi; concentric hypertrophy: increased M/V and LVMi; eccentric hypertrophy: increased LVMi and LVEDVi, normal M/V and ejection fraction; and adverse remodeling: dilated left ventricle, increased LVMi and normal M/V in the context of an impaired ejection fraction. Echocardiogram and CMR structural and functional indexes were compared between these groups.
Results
At baseline study, at CMR: mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]. Overall, 22% patients had normal LV structure, 30% concentric remodeling ventricular geometry, and two patients had an adverse remodeling pattern. LV hypertrophy was the most prevalent pattern and occurred in 48% of subjects (concentric 43%; eccentric 4%). In our cohort, the severity of AS (AVmean (p<0.001), LV function (LV ejection fraction [p<0.001] and Global longitudinal strain [p<0.001]), LV loading conditions (indexed left atrial volume [p<0.001] and E/e' ratio [p<0.001]) and NT-proBNP (p<0.001) were related to the pattern of LV structure (Table 1).
Conclusions
In our cohort, AS patients presented several distinct patterns of LV remodeling. Disease severity, functional repercussion and loading conditions are distinct between them.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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21
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Left ventricular reverse remodeling in post operative aortic stenosis patients: prevalence and predictor(s). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with severe aortic stenosis (AS), left ventricular (LV) remodeling is believed to be a compensatory adaptive process which should reverse after aortic valve intervention. However, this is not always the rule and remodeling persistence may negatively impact post-procedural outcomes and survival.
Aim
To assess the prevalence and predictors of morphological LV reverse remodeling in severe symptomatic AS patients after surgical aortic valve replacement (AVR).
Methods
We prospectively studied 75 patients (72y [68–77y], 45% male) with severe symptomatic AS - mean gradient (AVM): 61±17mmHg; mean indexed aortic valve area (AVAi) 0.41±0.10 cm2/m2 with no previous history of ischemic cardiomyopathy, all with high gradient, 4 with low-flow, 81% with hypertension, 27% with type 2 diabetes mellitus and 35% patients with stage 3 chronic kidney disease: median MDR creat clearance: 70.4mL/min [40–102]. All patients performed pre-operative cardiac magnetic resonance (CMR) at a mean period of 3.4 months (0–17 months) before AVR and at the 3–6th months after AVR, for LV reverse remodeling assessment. It was defined as at least the occurrence of one of the following: >15% reduction in LVEDVi; >15% reduction in LVMi by CMR; >10% reduction in geometric remodeling ratio. Clinical, AV severity data, preoperative functional LV and tissue characterization data were analyzed at multivariate regression to predict the occurrence of LV reverse remodeling.
Results
Overall, at pre-operative CMR: mean LV indexed mass (LVMi): 82±28.9 g/m2; mean end-diastolic LV indexed volume (LVEDVi): 87.4±26.6 mL/m2; mean geometric remodeling (LV mass/end-diastolic volume): 0.92±0.2 g/mL. After AVR, at echocardiographic evaluation, no patient had prosthetic obstruction or prosthetic patient mismatch: median LV-Ao gradient 12mmHg [9.1–14 mmHg]; 5 of them had mild paravalvular regurgitation. LV reverse remodeling occurred in 65 patients (88%) (Figure 1A) and these were younger, had significantly smaller preoperative AVAi and higher valvular gradients (Figure 1B). At multivariate analysis, only preoperative AVAi remained an independent predictor (odds ratio 0.85, 95% CI 0.735–0.984, p=0.029).
Conclusions
In this prospective cohort of patients LV reverse remodeling after surgical AVR was highly frequent, occurring in almost nine out of every ten patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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22
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Sánchez-Marcos C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez F, Herrera S, Castillero-Díaz L, Herrero P, Gil V, Miró Ò. Análisis de la efectividad y seguridad de las unidades de estancia corta en la hospitalización de pacientes con insuficiencia cardíaca aguda. Propensity Score UCE-EAHFE. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Domínguez-Rodríguez A, Suero-Mendez C, Burillo-Putze G, Gil V, Calvo-Rodriguez R, Piñera-Salmeron P, Llorens P, Martín-Sánchez FJ, Abreu-Gonzalez P, Miró Ò. Midazolam versus morphine in acute cardiogenic pulmonary oedema: results of a multicentre, open-label, randomized controlled trial. Eur J Heart Fail 2022; 24:1953-1962. [PMID: 35780488 DOI: 10.1002/ejhf.2602] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema (ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE. METHODS AND RESULTS A randomized, multicentre, open-label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in-hospital all-cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30-day mortality and SAE. Analyses were made on an intention-to-treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in-hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratio[RR] 0.71, 95% confidence interval [CI] 0.29-1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22-0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30-0.92; p = 0.03). CONCLUSION Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.
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Affiliation(s)
- Alberto Domínguez-Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Universidad Europea de Canarias, Tenerife, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Victor Gil
- Emergency Department, Hospital Clinic, Barcelona, Institut d'Investigació Biomèdica August Pi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante, Spain
| | | | - Pedro Abreu-Gonzalez
- Department of Physiology, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, Barcelona, Institut d'Investigació Biomèdica August Pi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
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Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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25
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Ascenção R, Alarcão J, Araújo F, Costa J, Fiorentino F, Gil V, Gouveia M, Lourenço F, Mello e Silva A, Vaz Carneiro A, Borges M. Atherosclerosis in the primary health care setting: A real-word data study. Rev Port Cardiol 2022; 41:475-484. [DOI: 10.1016/j.repc.2021.03.018] [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: 11/26/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022] Open
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Baptista R, Maricoto T, Monteiro S, Dias J, Gonçalves S, Febra H, Gil V. Practical approach to referral from primary health care to a cardiology hospital consultation in 2021. Rev Port Cardiol 2022. [DOI: 10.1016/j.repc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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27
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Carratalá-Perales J, Gil V, Andueza J. Puntualizaciones sobre «Características de la ventilación no invasiva prolongada en los servicios de urgencias hospitalarios y su impacto en la eficacia. Análisis del registro VNICat». Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Monza E, Gil V, Lucas MF. Computational Enzyme Design at Zymvol. Methods Mol Biol 2022; 2397:249-259. [PMID: 34813068 DOI: 10.1007/978-1-0716-1826-4_13] [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] [Indexed: 06/13/2023]
Abstract
Directed evolution is the most recognized methodology for enzyme engineering. The main drawback resides in its random nature and in the limited sequence exploration; both require screening of thousands (if not millions) of variants to achieve a target function. Computer-driven approaches can limit laboratorial screening to a few hundred candidates, enabling and accelerating the development of industrial enzymes. In this book chapter, the technology adopted at Zymvol is described. An overview of the current development and future directions in the company is also provided.
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Affiliation(s)
- Emanuele Monza
- Zymvol Biomodeling SL, Carrer Roc Boronat 117, Barcelona, Spain.
| | - Victor Gil
- Zymvol Biomodeling SL, Carrer Roc Boronat 117, Barcelona, Spain
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Fialho I, Beringuilho M, Madeira D, Ferreira JB, Faria D, Ferreira H, Roque D, Santos MB, Morais C, Gil V, Augusto JB. Acute myocardial infarction on YouTube - is it all fake news? Rev Port Cardiol 2021; 40:815-825. [PMID: 34857152 DOI: 10.1016/j.repce.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. METHODS We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): "cardiac + arrest"; "heart + attack"; "heart + thrombosis"; "coronary + thrombosis"; "infarction - brain", "myocardial + infarction" and "acute + myocardial + infarction". Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non-Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores - the higher the score, the better the quality. RESULTS 242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). CONCLUSIONS One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.
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Affiliation(s)
- Inês Fialho
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Marco Beringuilho
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Daniela Madeira
- Serviço de Medicina III, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | | | - Daniel Faria
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Hilaryano Ferreira
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - David Roque
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Miguel B Santos
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Carlos Morais
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal
| | - João B Augusto
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal; Institute of Cardiovascular Science, University College London, London, England, United Kingdom; Cardiac Imaging Department, Barts Heart Centre, St Bartholomew's Hospital, London, England, United Kingdom.
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Sa Mendes G, Abecasis J, Maltez S, Guerreiro S, Freitas P, Horta E, Lima T, Ribeiras R, Andrade M, Cardim N, Gil V. Left ventricular myocardial work in patients with high gradient severe symptomatic aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1553] [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
Left ventricular myocardial work (LVMW) is a novel method to evaluated left ventricular (LV) function using pressure-strain loops. It might correct global longitudinal strain (GLS) for afterload, being eventually useful to assess whether GLS reduction is due to reduced contractility (reflected as reduced myocardial work) or increased afterload (reflected as increased myocardial work).
Aim
To describe indices of LVMW in a group of patients with severe symptomatic aortic stenosis (AS).
Methods
We prospectively studied 104 consecutive patients (age: 71 years [IQR 66.5–75.5] years, 51% men) with severe symptomatic high gradient AS: mean transaortic pressure gradient: 56.5mmHg [IQR 46.8–67.8]; aortic valve area: 0.73cm2 [IQR 0.61–0.88]; indexed stroke volume: 47.7±1.3 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance for LV myocardium tissue characterization. As proposed for AS, LV systolic pressure was corrected adding the mean transaortic pressure gradient to non-invasive systolic blood pressure cuff measurement in the echocardiographic algorithm. Four LVMW indices were collected in 83 patients (patients excluded for atrial fibrillation, left bundle branch block or absence of non-invasive blood pressure registration) and correlated to LV function indexes, LV hypertrophy and remodeling, myocardial tissue characterization, BNP and troponin levels (Pearson or Spearman correlation). These same indexes were compared in patients with LV ejection fraction (EF) below and above 50%, normal and reduced flow and presence of replacement fibrosis.
Results
Global constructive work (GCW) (2658.6±76.4mmHg%), global myocardial work (GMW) (2218.7±74.9mmHg%) and global wasted work (GWE) (262.0mmHg% [198.8–339.5]) were high above normal with concomitant lower work efficiency (WE) (88.0% [83.2–91.8]. Weak correlations were found between LVMW indexes and parameters describing aortic valve severity, flow and LV function (table). Except for significant differences of LVMI in patients with reduced LV ejection fraction (GCW 2770.3±687.4 vs 2056.0±380.7mmHg%, p=0,014 and GMW 2362.5±657.9 vs 1621.3±319.9, p=0,021 in patients with LV EF>50% vs. LV EF<50%, respectively) work indexes were neither significantly different in low-flow patients nor in those with myocardial late gadolinium enhancement.
Conclusions
Global constructive and myocardial work are increased in these patients with severe aortic stenosis. This might reflect an increased afterload predominance rather than a LV functional impairment, particularly relevant in this group of patients with exclusive high gradient disease and preserved LVEF.
Funding Acknowledgement
Type of funding sources: None. Correlations between LVMI – LV function
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Affiliation(s)
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Maltez
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - P Freitas
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - T Lima
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Andrade
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - N Cardim
- Hospital da Luz, SA, Lisbon, Portugal
| | - V Gil
- Hospital dos Lusiadas, Lisbon, Portugal
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Maltes S, Abecasis J, Mendes GSM, Padrao C, Reis C, Guerreiro S, Freitas P, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M. Prevalence and determinants of right ventricular dysfunction in patients with severe symptomatic high gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development.
Aim
To describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload.
Methods
We prospectively studied 93 consecutive patients (age: 73 years [IQR 68–77] years, 55% women) with pure severe symptomatic high gradient aortic stenosis: mean transaortic pressure gradient: 57.0mmHg [IQR 46.9–71.1]; aortic valve area: 0.72cm2 [IQR 0.61–0.88]; indexed stroke volume: 48.8±1.5 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume). Normal RV function was defined according to TAPSE ≥17mm, tricuspid annular systolic velocity ≥12cm/s, mean free wall longitudinal strain ≤−20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) – 1 normal parameter (12.9%), (2) – 2 normal parameters (44.1%), (3) – 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0, 1, 2 vs. group 3) at multivariate regression analysis.
Results
Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction.
Conclusion
RV dysfunction is common in this group of patients with severe high gradient aortic stenosis and preserved ejection fraction. RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - C Padrao
- Hospital Santa Cruz, Lisbon, Portugal
| | - C Reis
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - N Cardim
- Hospital da Luz, SA, Lisbon, Portugal
| | - V Gil
- Hospital da Luz, SA, Lisbon, Portugal
| | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
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Fialho I, Beringuilho M, Madeira D, Ferreira JB, Faria D, Ferreira H, Roque D, Santos MB, Morais C, Gil V, Augusto JB. Acute myocardial infarction on YouTube - Is it all fake news? Rev Port Cardiol 2021; 40:S0870-2551(21)00154-2. [PMID: 34183216 DOI: 10.1016/j.repc.2020.11.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The Internet is a fundamental aspect of health information. However, the absence of quality control encourages misinformation. We aim to assess the relevance and quality of acute myocardial infarction videos shared on YouTube (www.youtube.com) in Portuguese. METHODS We analyzed 1,000 videos corresponding to the first 100 search results on YouTube using the following terms (in Portuguese): "cardiac + arrest"; "heart + attack"; "heart + thrombosis"; "coronary + thrombosis"; "infarction - brain", "myocardial + infarction" and "acute + myocardial + infarction". Irrelevant (n=316), duplicated (n=345), without audio (n=24) or non-Portuguese (n=106) videos were excluded. Included videos were assessed according to source, topic, target audience and scientific inaccuracies. Quality of information was assessed using The Health on the Net Code (HONCode from 0 to 8) and DISCERN (from 0 to 5) scores - the higher the score, the better the quality. RESULTS 242 videos were included. The majority were from independent instructors (n=95, 39.0%) and were addressed to the general population (n=202, 83.5%). One third of the videos (n=79) contained inaccuracies while scientific society and governmental/health institution videos had no inaccuracies. The mean video quality was poor or moderate; only one video was good quality without any inaccuracies. Governmental/health institutions were the source with the best quality videos (HONCode 4±1, DISCERN 2±1). CONCLUSIONS One third of the videos had irrelevant information and one third of the relevant ones contained inaccuracies. The average video quality was poor; therefore it is important to define strategies to improve the quality of online health information.
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Affiliation(s)
- Inês Fialho
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Marco Beringuilho
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Daniela Madeira
- Serviço de Medicina III, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | | | - Daniel Faria
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Hilaryano Ferreira
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - David Roque
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Miguel B Santos
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Carlos Morais
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal
| | - João B Augusto
- Serviço de Cardiologia, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal; Institute of Cardiovascular Science, University College London, London, England; Cardiac Imaging Department, Barts Heart Centre, St Bartholomew's Hospital, London, England.
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Costa J, Alarcão J, Amaral‐Silva A, Araújo F, Ascenção R, Caldeira D, Cardoso MF, Correia M, Fiorentino F, Gavina C, Gil V, Gouveia M, Lourenço F, Mello e Silva A, Mendes Pedro L, Morais J, Vaz‐Carneiro A, Teixeira Veríssimo M, Borges M. Os custos da aterosclerose em Portugal. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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Costa J, Alarcão J, Amaral-Silva A, Araújo F, Ascenção R, Caldeira D, Cardoso MF, Correia M, Fiorentino F, Gavina C, Gil V, Gouveia M, Lourenço F, Mello E Silva A, Mendes Pedro L, Morais J, Vaz-Carneiro A, Veríssimo MT, Borges M. Atherosclerosis: The cost of illness in Portugal. Rev Port Cardiol 2021; 40:409-419. [PMID: 34274081 DOI: 10.1016/j.repce.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. METHODS Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. RESULTS The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). CONCLUSIONS Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
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Affiliation(s)
- João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Alarcão
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alexandre Amaral-Silva
- Unidade de AVC, Unidade de Neurologia, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal; Serviço de Neurologia, Hospitais CUF Descobertas, CUF Santarém e CUF Torres Vedras, Portugal
| | | | - Raquel Ascenção
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Preventiva, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Marta Ferreira Cardoso
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Manuel Correia
- Serviço de Neurologia, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Francesca Fiorentino
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Gavina
- Serviço de Cardiologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal; Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal; Departamento de Medicina, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Miguel Gouveia
- Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Francisco Lourenço
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Luís Mendes Pedro
- Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Serviço de Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cirurgia Vascular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Morais
- Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - António Vaz-Carneiro
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Manuel Teixeira Veríssimo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Margarida Borges
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Unidade de Farmacologia Clínica, Centro Hospitalar Lisboa Central EPE, Lisboa, Portugal
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Abecasis J, Gomes Pinto D, Ramos S, Masci PG, Cardim N, Gil V, Félix A. Left Ventricular Remodeling in Degenerative Aortic Valve Stenosis. Curr Probl Cardiol 2021; 46:100801. [PMID: 33588124 DOI: 10.1016/j.cpcardiol.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 01/15/2023]
Abstract
Aortic stenosis was once considered a pure isolated valve obstacle challenging left ventricle driving force of contraction and flow generation. Left ventricular (LV) adaptation was merely interpreted as a uniform hypertrophic response to increased afterload. However, in these last 2 decades cardiac imaging research and some histopathology correlation studies brought insight towards the complex interaction between the vasculature, the valve and the myocardium. Verily, LV remodeling in this setting is a complex multidetermined process that goes further beyond myocardial hypertrophy. Ultrastructural changes involving both diffuse and replacement fibrosis of the myocardium take part and might explain the transition of clinical phenotypes with distinct prognosis, from compensated hypertrophy to LV maladaptive dysfunction and heart failure. Presently, the combined appropriate use of echocardiography and cardiac magnetic resonance may better assess the global LV afterload, hypertrophy and geometric remodeling, global and regional LV function, beyond ejection fraction, and structural changes that include the fibrotic burden of the myocardium. As a whole these may not only better stratify individual risk of disease progression but also identify patients benefiting from earlier valve intervention. In this paper, we review the maladaptive response of the LV to chronic pressure overload, describing the different signaling pathways and mechanisms that underly both hypertrophy and remodeling. Histomorphology changes in this setting are described and we try to make sense of the use of new imaging tools for LV characterization.
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Affiliation(s)
- João Abecasis
- Nova Medical School, Lisboa, Portugal; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal.
| | - Daniel Gomes Pinto
- Nova Medical School, Lisboa, Portugal; Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sância Ramos
- Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Faculdade Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | | | - Nuno Cardim
- Nova Medical School, Lisboa, Portugal; Hospital da Luz, Lisboa, Portugal
| | - Victor Gil
- Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal; Faculdade de Medicina de Lisboa, Portugal
| | - Ana Félix
- Nova Medical School, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Miró Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile and results of patients with acute heart failure transferred directly to home hospitalisation from emergency departments. Rev Clin Esp 2021; 221:1-8. [PMID: 32560917 DOI: 10.1016/j.rce.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU: 68/979/384). The HH rate was 4.7% (95% CI, 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p=.106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p<.001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI, 0.73-1.14) or SSU (HR, 0.77; 95% CI, 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI, 0.25-0.97) and SSU (HR, 0.37; 95% CI, 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Universitat Miguel Hernández, Elx, Alicante, España
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, España
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
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Mirò Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile, and outcomes of patients with acute heart failure transferred directly to home hospitalization from emergency departments. Rev Clin Esp 2020; 221:1-8. [PMID: 33998472 DOI: 10.1016/j.rceng.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU:68/979/384). The HH rate was 4.7% (95% CI 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p = .106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p < .001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI 0.73-1.14) or SSU (HR, 0.77; 95% CI 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI 0.25-0.97) and SSU (HR, 0.37; 95% CI 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Mirò
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universitat Miguel Hernández, Elx, Alicante, Spain
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, Spain
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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Abecasis J, Mendes G, Ferreira A, Andrade M, Ribeiras R, Ramos S, Masci P, Gil V. Relative apical sparing in patients with severe aortic stenosis: prevalence and significance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Relative apical sparing (RAS) of LV longitudinal strain (LS) is a red flag for diagnostic suspicion of amyloid cardiomyopathy (AC). However, it may present in pts with aortic stenosis (AS), where the prevalence of transthyretin AC is being increasingly reported.
Aim
To describe the prevalence of RAS deformation pattern in patients with AS and its clinical significance.
Methods
We prospectively studied 53 pts (71±8y, 54.7% men) with severe symptomatic AS - mean gradient (AVM): 54.6 mmHg; aortic valve area 0.74cm2, referred for surgical replacement with no previous history of ischemic cardiomyopathy. Beyond ECG and transthoracic echo (TTE), all pts underwent CMR, with tissue characterization before surgery. RAS was defined as average apical LS / average basal LS + average mid LS >1 at 2D LV LS analysis. Aortic valve replacement and septal myocardial biopsy were already performed in 26 pts. AS severity indexes, LV remodelling and tissue characterization were compared in both groups, with and without RAS.
Results
RAS was present in 16 pts (30.8%). There were neither pseudoinfarct pattern or low voltage at ECG, nor infiltration suspicion from CMR study (native T1 value 1047ms [IQR 1028–1084]; ECV 22% [IQR 18–25]). Furthermore, none of the pts had suspicion of amyloid deposition at histopathology. Median CMR LVEF was 64.5% [IQR 51.3–70.8%] and 36 pts (67.9%) had non-ischemic DE, with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Comparing both groups, RAS cohort showed a significantly higher AVM, relative wall thickness, maximum septal thickness, peak systolic dispersion and higher LV indexed mass, DE and lower LVEF at CMR. RAS group has also higher NT pro BNP (Table).
Conclusions
RAS is common in this group of pts despite the absence of clinical and histological signs of myocardial infiltration. RAS occurs with worse indexes of LV remodeling and fibrosis consistent with a more advanced stage of the disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - G Mendes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | | | - S Ramos
- Hospital Santa Cruz, Lisbon, Portugal
| | - P.G Masci
- King's College London, London, United Kingdom
| | - V Gil
- Hospital dos Lusiadas, Lisbon, Portugal
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Sa Mendes G, Abecasis J, Ferreira A, Ribeiras R, Saraiva C, Ferreira S, Gil V, Andrade M, Mendes M, Neves J, Campante Teles R, Goncalves P. LV replacement fibrosis in aortic stenosis: prevalence and relation to LV remodelling and function. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1867] [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
Background
Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Aim
To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis.
Methods
We prospectively studied 53 consecutive patients (age: 71±8 years [min. 51–max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6–63.2] and aortic valve area 0.74cm2 [IQR 0.61–0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification – using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE.
Results
Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028–1084]; 22% [IQR 18–25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3–70.8%] (11 patients with reduced EF) and 76.5g/m2 [IQR 57.4–94.8g/m2], respectively. Median GLS was −13.9% [IQR −11.4 to −17.0%] and torsion was 24.2° [IQR 19.8–32.5°]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m2, p=0.001), worse GLS (−14.4% vs −16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure).
Conclusions
Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Saraiva
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - V Gil
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - M Mendes
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J.P Neves
- Hospital de Santa Cruz, Carnaxide, Portugal
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Costa J, Alarcão J, Araujo F, Ascenção R, Caldeira D, Fiorentino F, Gil V, Gouveia M, Lourenço F, Mello E Silva A, Sampaio F, Vaz Carneiro A, Borges M. The burden of atherosclerosis in Portugal. Eur Heart J Qual Care Clin Outcomes 2020; 7:154-162. [PMID: 32946553 PMCID: PMC7962771 DOI: 10.1093/ehjqcco/qcaa060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/30/2022]
Abstract
Aims This article sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. Methods and results The burden of atherosclerosis was measured in disability-adjusted life years following the latest 2010 Global Burden of Disease (GBD) methodology. Disability-adjusted life years were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischaemic heart disease (IHD) (including acute myocardial infarction, stable angina, and ischaemic heart failure), ischaemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Years of life lost were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD, and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. Years lived with disability corresponded to the product of the number of prevalent cases by an average disability weight for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. Disability weights were sourced from the published literature. In 2016, 15 123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. Disability-adjusted life years totalled 260 943, 75% due to premature death (196 438 YLL) and 25% due to disability (64 505 YLD). Conclusion Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.
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Affiliation(s)
- João Costa
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Joana Alarcão
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Francisco Araujo
- Serviço de Medicina, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Raquel Ascenção
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Preventiva, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Centro Cardiovascular da Universidade de Lisboa e Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Francesca Fiorentino
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas, R. Abílio Mendes 12, 1500-458 Lisboa, Portugal.,Departamento de Medicina, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Miguel Gouveia
- Centro de Estudos Aplicados, Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Palma de Cima, 1649-023 Lisboa, Portugal
| | - Francisco Lourenço
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Alberto Mello E Silva
- Sociedade Portuguesa de Aterosclerose, Av. José Malhoa, n.º 2, 1070-158 Lisboa, Portugal
| | - Filipa Sampaio
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Department of Public Health and Caring Sciences, Uppsala Biomedical Centre, Uppsala University, Husargatan 3, 751 22 Uppsala, Sweden
| | - António Vaz Carneiro
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Margarida Borges
- Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.,Unidade de Farmacologia Clínica, Centro Hospitalar Lisboa Central EPE, Alameda Santo António dos Capuchos, 1169-050 Lisboa, Portugal
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Affiliation(s)
- Rogério Teixeira
- Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | - Mário Santos
- Serviço de Cardiologia, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Victor Gil
- Centro Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Teixeira R, Santos M, Gil V. COVID-19 and cardiovascular comorbidities: An update. Rev Port Cardiol 2020; 39:417-419. [PMID: 38620731 PMCID: PMC7832377 DOI: 10.1016/j.repce.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Rogério Teixeira
- Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Mário Santos
- Serviço de Cardiologia, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Victor Gil
- Centro Cardiovascular, Hospital dos Lusíadas, Lisboa, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Monteiro S, Timóteo AT, Caeiro D, Silva M, Tralhão A, Guerreiro C, Silva D, Aguiar C, Santos J, Monteiro P, Gil V, Morais J. Cardiac intensive care in Portugal: The time for change. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Gil V, Cabello I, Richard F, Garrido JM, Gil C, Llauger L, Wussler D, Mueller C, Miró Ò. High-sensitivity cardiac troponin T 30 days all-come mortality in patients with acute heart failure. A Propensity Score-Matching Analysis Based on the EAHFE Registry. TROPICA4 Study. Eur J Clin Invest 2020; 50:e13248. [PMID: 32306389 DOI: 10.1111/eci.13248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/05/2020] [Accepted: 04/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable. OBJECTIVES The main objective of this study was to determine the best hs-TnT cut-off for prediction of 30-day all-cause mortality. METHODS The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis. RESULTS Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 30-day all-cause mortality was 0.70 (CI95% 0.68 to 0.71; P < .001), establishing an optimal cut-off of hs-TnT of 35 ng/L. The sensitivity and specificity of this cut-off were 76.2 and 55.5%, respectively, with a negative predictive value (NPV) of 95.3%. A propensity score was made with 34 variables showing differences based on the cut-off of 35 ng/L for hs-TnT. In the analysis of the population obtained with the propensity score, patients with hs-TnT > 35 ng/L showed a greater 30-day all-cause mortality, with a HR of 2.95 (CI95% 1.83-4.75; P < .001). External validation reported similar results. CONCLUSIONS An hs-TnT value of 35 ng/L is an adequate cut-off to evaluate the prediction of 30-day all-cause mortality with a NPV of 95.3%.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital at-home, Hospital General Universitario de Alicante, Alicante, Spain
| | - Victor Gil
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
| | - Irene Cabello
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fernando Richard
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lluis Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, Barcelona, Spain
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- Emergency Department, Hospital Clín, Research Group Emergencies: Processes and Diseases, IDIBAPS, Barcelona, Spain
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Roque D, Ferreira J, Monteiro S, Costa M, Gil V. Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. Rev Port Cardiol 2020; 39:57-72. [PMID: 32205012 DOI: 10.1016/j.repc.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality. OBJECTIVE The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods. METHODS We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology. RESULTS A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy. CONCLUSION In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.
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Affiliation(s)
- David Roque
- Cardiology Department, Hospital Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Victor Gil
- Cardiovascular Unit, Hospital dos Lusíadas, Lisbon University, Lisbon, Portugal
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47
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Augusto JB, Antunes S, Ferreira JB, Faria D, Roque D, Beringuilho M, Ferreira H, Fialho I, Faustino M, Cabanelas N, Ferreira AR, Vasconcelos H, Santos MB, Freitas A, Madeira F, Gil V, Morais C. Utility of Pacemaker With Sleep Apnea Monitor to Predict Left Ventricular Overload and Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1720-1724. [PMID: 31606190 DOI: 10.1016/j.amjcard.2019.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022]
Abstract
Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.
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Affiliation(s)
- João B Augusto
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
| | - Susana Antunes
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Daniel Faria
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - David Roque
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Marco Beringuilho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Hilaryano Ferreira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Fialho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Mariana Faustino
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Cabanelas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Rita Ferreira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Hugo Vasconcelos
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Miguel Borges Santos
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Francisco Madeira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Victor Gil
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Carlos Morais
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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García Sarasola A, Alquézar Arbé A, Gil V, Martín-Sánchez F, Jacob J, Llorens P, Rizzi M, Fuenzalida C, Calderón S, Miró Ò. NOVICA: Characteristics and outcomes of patients who have a first episode of heart failure (de novo). Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.04.007] [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: 10/26/2022]
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Jacob J, Llauger L, Herrero-Puente P, Martín-Sánchez FJ, Llorens P, Roset A, Gil V, Fuentes M, Lucas-Imbernón FJ, Miró Ò. Acute heart failure and adverse events associated with the presence of renal dysfunction and hyperkalaemia. EAHFE- renal dysfunction and hyperkalaemia. Eur J Intern Med 2019; 67:89-96. [PMID: 31331793 DOI: 10.1016/j.ejim.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination. METHOD We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality. RESULTS A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67-3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04-1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04-1.70); (p = 0.021) for the RD-Hk group. CONCLUSIONS The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Lluis Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Spain.
| | | | - Francisco Javier Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Pere Llorens
- Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Spain
| | - Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Victor Gil
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
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50
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Roset A, Jacob J, Herrero-Puente P, Alquézar A, Martín-Sanchez FJ, Llorens P, Llauger L, Gil V, Miró Ò. Characteristics and prognosis of patients with acute heart failure without troponin determination: The EAHFE-TROPICA3 study. Arch Cardiovasc Dis 2019; 112:390-399. [PMID: 31014989 DOI: 10.1016/j.acvd.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The absence of cardiac troponin (cTn) determination in an episode of acute heart failure (AHF) is frequent. The characteristics of these patients are not well known; nor is it known whether they have a better prognosis than patients in whom cTn is determined. AIM The objective of the EAHFE-TROPICA3 study was to analyse the characteristics of patients consulting for AHF in whom cTn was not determined (nocTn), and to evaluate the relationship of cTn determination (wcTn) with patient outcomes. METHODS This was an analysis of the multipurpose prospective EAHFE registry of patients with AHF consulting at the emergency departments of 34 Spanish hospitals. RESULTS Data from 8850 patients with AHF were analysed; cTn was not determined in 4216 of these patients (47.6%), who had a lower prevalence of ischaemic heart disease, more frequent use of loop diuretics at baseline, a greater rate of oedema in the acute episode, more frequent history of heart failure, and less use of angiotensin-converting enzyme inhibitors or aldosterone receptor antagonists and beta-blockers at baseline. Compared with the wcTn group, the nocTn group had the same in-hospital mortality (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 0.98-1.50), mortality at 30 days (adjusted OR 1.07, 95% CI 0.90-1.28) and reconsultation at 30 days (adjusted OR 0.90, 95% CI 0.80-1.02). CONCLUSIONS Patients presenting with AHF with and without cTn determination have different characteristics. These differences are not related to a better prognosis.
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Affiliation(s)
- Alex Roset
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Catalonia, Spain.
| | - Pablo Herrero-Puente
- Emergency Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Aitor Alquézar
- Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Catalonia, Spain
| | - Francisco Javier Martín-Sanchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Pere Llorens
- Department of Emergency Medicine, Short-Stay Unit and Hospital At-Home, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Lluís Llauger
- Department of Emergency Medicine, Hospital Universitari de Vic, 08500 Barcelona, Catalonia, Spain
| | - Victor Gil
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Research Group "Emergencies: Processes and Pathologies", IDIBAPS, 08036 Barcelona, Catalonia, Spain
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