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Cazeiro DI, Plácido R, Raposo MA, Brito J, Borba A, Guimarães T, Pinto E, Freitas P, Pinto FJ. Pulmonary Arterial Hypertension with Features of Venous Involvement: A Detective's Task. Arq Bras Cardiol 2024; 121:e20230565. [PMID: 38695472 PMCID: PMC11081196 DOI: 10.36660/abc.20230565] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/30/2023] [Accepted: 01/18/2024] [Indexed: 05/12/2024] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome.
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Affiliation(s)
- Daniel Inácio Cazeiro
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Rui Plácido
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Miguel Azeredo Raposo
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Joana Brito
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Alexandra Borba
- Centro Hospitalar Universitário Lisboa CentralServiço de PneumologiaLisboaPortugalServiço de Pneumologia – Centro Hospitalar Universitário Lisboa Central, Lisboa – Portugal
| | - Tatiana Guimarães
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
| | - Eugénia Pinto
- Centro Hospitalar Universitário Lisboa CentralServiço de PatologiaLisboaPortugalServiço de Patologia – Centro Hospitalar Universitário Lisboa Central, Lisboa – Portugal
| | - Pedro Freitas
- Centro Hospitalar Universitário Lisboa OcidentalServiço de CardiologiaCarnaxidePortugalServiço de Cardiologia – Centro Hospitalar Universitário Lisboa Ocidental, Carnaxide – Portugal
| | - Fausto J. Pinto
- Universidade de LisboaFaculdade de Medicina de LisboaCentro Hospitalar Universitário Lisboa NorteLisboaPortugalDepartamento de Coração e Vasos – Centro Hospitalar Universitário Lisboa Norte – Faculdade de Medicina de Lisboa – Universidade de Lisboa, Lisboa – Portugal
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Brito J, Pinto FJ, Plácido R. Chronic fibrothrombotic deposits: a cause or consequence of pulmonary hypertension? Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00015-X. [PMID: 38191053 DOI: 10.1016/j.rec.2023.12.005] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Joana Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Brito J, Plácido R, Matos P. Right atrium crossover. Eur Heart J Case Rep 2024; 8:ytad642. [PMID: 38213870 PMCID: PMC10783639 DOI: 10.1093/ehjcr/ytad642] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/27/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Joana Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz 1649-028, Lisboa, Portugal
| | - Rui Plácido
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz 1649-028, Lisboa, Portugal
- Department of Cardiology, Hospital CUF Tejo, Lisboa, Portugal
| | - Pedro Matos
- Department of Cardiology, Hospital CUF Tejo, Lisboa, Portugal
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Silva BV, Menezes MN, Plácido R, Jorge C, Rigueira J, Garcia AB, Martins AM, Oliveira C, Abrantes A, Pinto FJ, Almeida AG. Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care. Heart Lung Circ 2023; 32:1312-1320. [PMID: 37867042 DOI: 10.1016/j.hlc.2023.09.016] [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: 05/10/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. METHODS Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. RESULTS A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. CONCLUSION Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Miguel Nobre Menezes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Beatriz Garcia
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Margarida Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Oliveira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Abrantes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana G Almeida
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Fontes T, Dourado E, Barreira S, Gregório C, Plácido R, Fonseca JE, Romeu JC. Oral antiviral treatments for COVID-19 during severe connective tissue disease flares: report of two cases. ARP Rheumatol 2022; 1:332-333. [PMID: 36617316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Antiviral therapies targeting SARS-CoV-2 replication change the course of COVID-19. The European Medicines Agency (EMA) has approved a nirmatrelvir/ritonavir combination that inhibits the main protease of the virus. Molnupiravir, an RNA polymerase misdirector, is proposed by EMA in selected cases, despite still without marketing authorisation. Both are for use in mild disease with a high risk of progression to severe COVID. Patients with inflammatory rheumatic diseases under immunosuppression, mainly high-dose glucocorticoids, are at higher risk of developing severe COVID. We report two clinical cases in which nirmatrelvir/ritonavir and molnupiravir were successfully used to treat COVID-19 in immunosuppressed patients during severe flares of connective tissue diseases, namely systemic lupus erythematosus and dermatomyositis. No significant adverse events attributable to these drugs were noted.
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Affiliation(s)
| | - Eduardo Dourado
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
| | - Sofia Barreira
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
| | | | - Rui Plácido
- Centro Hospitalar Universitário Lisboa Norte
| | - João Eurico Fonseca
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
| | - José Carlos Romeu
- Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
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Plácido R. Catheter-directed therapy for acute pulmonary embolism: Time for “debulking and extracting” the gaps. Rev Port Cardiol 2022; 41:547-549. [DOI: 10.1016/j.repc.2022.04.003] [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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Rodrigues T, Silva BV, Plácido R, Mendonça C, Urbano ML, Rigueira J, Almeida AG, Pinto FJ. Comparison of 5 acute pulmonary embolism mortality risk scores in patients with COVID-19. IJC Heart & Vasculature 2022; 39:100984. [PMID: 35252539 PMCID: PMC8882432 DOI: 10.1016/j.ijcha.2022.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
Abstract
Objective Methods Results Conclusion
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Cabral DR, Guimarães T, Almeida AG, Campos P, Martins SR, da Silva PC, Pinto FJ, Plácido R. Chest pain in a patient with pulmonary arterial hypertension. Rev Port Cardiol 2022; 41:73-80. [DOI: 10.1016/j.repc.2020.05.021] [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: 11/09/2019] [Revised: 03/18/2020] [Accepted: 05/05/2020] [Indexed: 10/20/2022] Open
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Plácido R, Guimarães T, Jenkins D, Cortez-Dias N, Pereira SC, Campos P, Mineiro A, Lousada N, Martins SR, Moreira S, Dias AR, Resende CL, Vieira R, Pinto FJ. Chronic thromboembolic pulmonary hypertension: Initial experience of patients undergoing pulmonary thromboendarterectomy. Rev Port Cardiol 2021; 40:741-752. [PMID: 34857112 DOI: 10.1016/j.repce.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/13/2020] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary endarterectomy (PEA) is a potentially curative procedure in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study reports the initial experience of a Portuguese PH center with patients undergoing PEA at an international surgical reference center. METHODS Prospective observational study of consecutive CTEPH patients followed at a national PH center, who underwent PEA at an international surgical reference center between October 2015 and March 2019. Clinical, functional, laboratory, imaging and hemodynamic parameters were obtained in the 12 months preceding the surgery and repeated between four and six months after PEA. RESULTS 27 consecutive patients (59% female) with a median age of 60 (49-71) years underwent PEA. During a median follow-up of 34 (21-48) months, there was an improvement in functional class in all patients, with only one cardiac death. From a hemodynamic perspective, there was a reduction in mean pulmonary artery pressure from 48 (42-59) mmHg to 26 (22-38) mmHg, an increase in cardiac output from 3.3 (2.9-4.0) L/min to 4.9 (4.2-5.5) L/min and a reduction in pulmonary vascular resistance from 12.1 (7.2-15.5) uW to 3.5 (2.6-5,2) uW. During the follow-up, 44% (n=12) of patients had no PH criteria, 44% (n=12) had residual PH and 11% (n=3) had PH recurrence. There was a reduction of N-terminal pro-B-type natriureticpeptide from 868 (212-1730) pg/mL to 171 (98-382) pg/mL. Rright ventricular systolic function parameters revealed an improvement in longitudinal systolic excursion and peak velocity of the plane of the tricuspid ring from 14 (13-14) mm and 9 (8-10) cm/s to 17 (16-18) mm and 13 (11-15) cm/s, respectively. Of the 26 patients with preoperative right ventricular dysfunction, 85% (n=22) recovered. The proportion of patients on specific vasodilator therapy decreased from 93% to 44% (p<0.001) and the proportion of those requiring oxygen therapy decreased from 52% to 26% (p=0.003). The six-minute walk test distance increased by about 25% compared to the baseline and only eight patients had significant desaturation during the test. CONCLUSION Pulmonary endarterectomy performed at an experienced high-volume center is a safe procedure with a very favorable medium-term impact on functional, hemodynamic and right ventricular function parameters in CTEPH patients with operable disease. It is possible for PH centers without PEA differentiation to refer patients safely and effectively to an international surgical center in which air transport is necessary.
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Affiliation(s)
- Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal.
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - David Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Inglaterra, United Kingdom
| | - Nuno Cortez-Dias
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sara Couto Pereira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Paula Campos
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Lisboa, Portugal
| | - Ana Mineiro
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Nuno Lousada
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Susana R Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Susana Moreira
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Rocha Dias
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | | | - Rita Vieira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
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Valente Silva B, Plácido R, Jorge C, Mendonça C, Urbano ML, Rodrigues T, Brito J, Alves da Silva P, Rigueira J, Pinto FJ. Prognostic Accuracy of the Modified CHA2DS2-VASc Score in COVID-19 Patients Admitted to the Emergency Department Due to Clinical Worsening. ACTA MEDICA PORT 2021; 35:433-442. [PMID: 34837357 DOI: 10.20344/amp.17016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Risk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department. MATERIAL AND METHODS Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (≥ 4 points). RESULTS We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p < 0.001). The M-CHA2DS2-VASc score was identified as an independent predictor of mortality in a multivariable logistic regression model (OR 1.406, p = 0.007). The Kaplan-Meier survival curves showed that the M-CHA2DS2-VASc score was associated with short-term mortality (log-rank test < 0.001), regardless of hospitalization (log-rank test p < 0.001 and p = 0.007, respectively). The survival proportion was 92%, 80% and 63% in the lower, intermediate, and higher risk-groups. As for the risk-categories, no difference was found in pulmonary embolism, Intensive Care Unit admission, and invasive mechanical ventilation. DISCUSSION This is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department. CONCLUSION The M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Rui Plácido
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Cláudia Jorge
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Carlos Mendonça
- Radiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Maria Luísa Urbano
- Radiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Tiago Rodrigues
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Joana Brito
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Pedro Alves da Silva
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Joana Rigueira
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Fausto J Pinto
- Cardiology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Centro Académico de Medicina de Lisboa. Centro Cardiovascular da Universidade de Lisboa. Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
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Dias A, Mineiro A, Pinto L, Lança F, Plácido R, Lousada N. Pregnancy and Pulmonary Arterial Hypertension: A Case Report. Open Respiratory Archives 2021. [PMID: 37496839 PMCID: PMC10369517 DOI: 10.1016/j.opresp.2021.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Silva BV, Jorge C, Plácido R, Mendonça C, Urbano ML, Rodrigues T, Brito J, da Silva PA, Rigueira J, Pinto FJ. Pulmonary embolism and COVID-19: A comparative analysis of different diagnostic models performance. Am J Emerg Med 2021; 50:526-531. [PMID: 34547695 PMCID: PMC8423667 DOI: 10.1016/j.ajem.2021.09.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. METHODS This retrospective study included all COVID-19 patients admitted to the Emergency Department (ED) who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. The diagnostic prediction rules for PE were compared between patients with and without PE. RESULTS We included 300 patients and PE was confirmed in 15%. No differences were found regarding comorbidities, traditional risk factors for PE and signs and symptoms between patients with and without PE. Wells and Geneva scores showed no predictive value for PE occurrence, whether a standard or an age-adjusted cut-off was considered. YEARS and PEGeD algorithms were associated with increased specificity (19% CTPA reduction) but raising non-diagnosed PE. Despite elevated in all patients, those with PE had higher D-dimer levels. However, incrementing thresholds to select patients for CTPA was also associated with a substantial decrease in sensitivity. CONCLUSION None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.
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Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Mendonça
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Maria Luísa Urbano
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Alves da Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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13
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Koval N, Alves M, Plácido R, Almeida AG, Fonseca JE, Ferreira JJ, Pinto FJ, Caldeira D. Direct oral anticoagulants versus vitamin K antagonists in patients with antiphospholipid syndrome: systematic review and meta-analysis. RMD Open 2021; 7:rmdopen-2021-001678. [PMID: 34253684 PMCID: PMC8276293 DOI: 10.1136/rmdopen-2021-001678] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Background Despite vitamin K antagonists (VKA) being the gold standard in the prevention of thromboembolic events in antiphospholipid syndrome (APS), non-vitamin K antagonists oral anticoagulants/direct oral anticoagulants (DOACs) have been used off-label. Objective We aimed to perform a systematic review comparing DOACs to VKA regarding prevention of thromboembolic events, occurrence of bleeding events and mortality in patients with APS. Methods An electronic database search was performed through MEDLINE, CENTRAL and Web of Science. After data extraction, we pooled the results using risk ratio (RR) and 95% CI. Heterogeneity was assessed using the I². The outcomes considered were all thromboembolic events as primary, and major bleeding, all bleeding events and mortality as secondary. Evidence confidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Results We included 7 studies and a total of 835 patients for analyses. Thromboembolic events were significantly increased in DOACs arm, compared with VKA—RR 1.69, 95% CI 1.09 to 2.62, I²—24%, n=719, 6 studies. In studies using exclusively rivaroxaban, which was the most representative drug in all included studies, the thromboembolic risk was increased threefold (RR 3.36, 95% CI 1.53 to 7.37). The risks of major bleeding, all bleeding events and mortality were not significantly different from control arm. The grade of certainty of our results is very low. Conclusions Current evidence suggests DOACs use, particularly rivaroxaban, among patients with APS, is less effective than VKA since it is associated with 69% increased risk of thromboembolic events. Trial registration number CRD42020216178.
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Affiliation(s)
- Nazariy Koval
- Universidade de Lisboa Faculdade de Medicina, Lisbon, Portugal
| | - Mariana Alves
- Laboratório de Farmacologia Clinica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Rui Plácido
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal
| | - João Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Reumatologia, Centro Hospitalar Universitario Lisboa Norte (CHULN), Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratório de Farmacologia Clinica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clinica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal .,Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal
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14
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Plácido R, Guimarães T, Jenkins D, Cortez-Dias N, Pereira SC, Campos P, Mineiro A, Lousada N, Martins SR, Moreira S, Dias AR, Resende CL, Vieira R, Pinto FJ. Chronic thromboembolic pulmonary hypertension: initial experience of patients undergoing pulmonary thromboendarterectomy. Rev Port Cardiol 2021; 40:S0870-2551(21)00248-1. [PMID: 34474956 DOI: 10.1016/j.repc.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary endarterectomy (PEA) is a potentially curative procedure in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study reports the initial experience of a Portuguese PH center with patients undergoing PEA at an international surgical reference center. METHODS Prospective observational study of consecutive CTEPH patients followed at a national PH center, who underwent PEA at an international surgical reference center between October 2015 and March 2019. Clinical, functional, laboratory, imaging and hemodynamic parameters were obtained in the 12 months preceding the surgery and repeated between four and six months after PEA. RESULTS 27 consecutive patients (59% female) with a median age of 60 (49-71) years underwent PEA. During a median follow-up of 34 (21-48) months, there was an improvement in functional class in all patients, with only one cardiac death. From a hemodynamic perspective, there was a reduction in mean pulmonary artery pressure from 48 (42-59) mmHg to 26 (22-38) mmHg, an increase in cardiac output from 3.3 (2.9-4.0) L/min to 4.9 (4.2-5.5) L/min and a reduction in pulmonary vascular resistance from 12.1 (7.2-15.5) uW to 3.5 (2.6-5, 2) uW. During the follow-up, 44% (n=12) of patients had no PH criteria, 44% (n=12) had residual PH and 11% (n = 3) had PH recurrence. There was a reduction of N-terminal pro-B-type natriureticpeptide from 868 (212-1730) pg/mL to 171 (98-382) pg/mL. Rright ventricular systolic function parameters revealed an improvement in longitudinal systolic excursion and peak velocity of the plane of the tricuspid ring from 14 (13-14) mm and 9 (8-10) cm/s to 17 (16-18) mm and 13 (11-15) cm/s, respectively. Of the 26 patients with preoperative right ventricular dysfunction, 85% (n=22) recovered. The proportion of patients on specific vasodilator therapy decreased from 93% to 44% (p<0.001) and the proportion of those requiring oxygen therapy decreased from 52% to 26% (p=0.003). The six-minute walk test distance increased by about 25% compared to the baseline and only eight patients had significant desaturation during the test. CONCLUSION Pulmonary endarterectomy performed at an experienced high-volume center is a safe procedure with a very favorable medium-term impact on functional, hemodynamic and right ventricular function parameters in CTEPH patients with operable disease. It is possible for PH centers without PEA differentiation to refer patients safely and effectively to an international surgical center in which air transport is necessary.
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Affiliation(s)
- Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal.
| | - Tatiana Guimarães
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - David Jenkins
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Inglaterra
| | - Nuno Cortez-Dias
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Sara Couto Pereira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Paula Campos
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Lisboa, Portugal
| | - Ana Mineiro
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Nuno Lousada
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Susana R Martins
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Susana Moreira
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Rocha Dias
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | | | - Rita Vieira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Cardiovascular Centre, University of Lisbon, Lisboa, Portugal
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15
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Plácido R, Almeida AG, Pinto FJ. Multisite embolic events secondary to pulmonary valve endocarditis. Eur Heart J Cardiovasc Imaging 2020; 21:1432. [PMID: 32464647 DOI: 10.1093/ehjci/jeaa132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre and Cardiovascular Centre, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria. Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Ana G Almeida
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre and Cardiovascular Centre, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria. Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre and Cardiovascular Centre, Faculty of Medicine, University of Lisbon, Hospital de Santa Maria. Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
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Plácido R, Abecasis J, Almeida AG, Pinto FJ. Clearly defined interventricular septum chemical shift: an extensive lipidic interposition. Eur Heart J 2020; 41:3091. [DOI: 10.1093/eurheartj/ehaa367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rui Plácido
- Cardiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, CCUL, Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental (CHLO), NOVA Medical School, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, CCUL, Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, CCUL, Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal
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17
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Anker MS, Bouleti C, Christodoulides T, Durante A, Gara E, Hadzibegovic S, Keramida K, Lena A, Massouh A, Milinkovic I, Nägele MP, Nossikoff A, Plácido R, Radovits T, Tolppanen H, Vergaro G, Wallner M, Welch S, Lopatin Y, Lainscak M, Mebazaa A, Coats AJS, Seferović PM, Jankowska EA. The heart failure specialists of tomorrow: a network for young cardiovascular scientists and clinicians. ESC Heart Fail 2020; 7:873-877. [PMID: 32352242 PMCID: PMC7261537 DOI: 10.1002/ehf2.12674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 12/29/2022] Open
Abstract
The “Heart failure specialists of Tomorrow” (HoT) group gathers young researchers, physicians, basic scientists, nurses and many other professions under the auspices of the Heart Failure Association of the European Society of Cardiology. After its foundation in 2014, it has quickly grown to a large group of currently 925 members. Membership in this growing community offers many advantages during, before, and after the ‘Heart Failure and World Congress on Acute Heart Failure’. These include: eligibility to receive travel grants, participation in moderated poster sessions and young researcher and clinical case sessions, the HoT walk, the career café, access to the networking opportunities, and interaction with a large and cohesive international community that constantly seeks multinational collaborations.
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Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Department of Cardiology (CBF), Charité, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Claire Bouleti
- University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402, Cardiology Department, Poitiers University Hospital, Poitiers, France
| | | | - Angela Durante
- Biomedicine and Prevention Department, University of Rome "Tor Vergata", Rome, Italy
| | - Edit Gara
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Department of Cardiology (CBF), Charité, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Kalliopi Keramida
- Medical School, University of Cyprus, Nicosia, Cyprus.,Cardio-oncology clinic, Heart Failure Unit, Department of Cardiology, University Hospital Attikon, Athens, Greece
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Department of Cardiology (CBF), Charité, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Angela Massouh
- School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Ivan Milinkovic
- Clinical Center of Serbia, Belgrade University Faculty of Medicine, Belgrade, Serbia
| | | | | | - Rui Plácido
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, and Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Lisbon, Portugal
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Heli Tolppanen
- Heart and Lung Center, Division of Cardiology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Giuseppe Vergaro
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy & Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Markus Wallner
- Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, PA, USA.,Division of Cardiology, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Sophie Welch
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Yuri Lopatin
- Volgograd Regional Cardiology Centre, Volgograd State Medical University, Volgograd, Russia
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana and Department of Internal Medicine, General Hospital Murska Sobota, Slovenia
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Saint Louis Lariboisière University Hospitals, Université de Paris, Paris, France
| | | | - Petar M Seferović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, and Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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Plácido R, Sousa I, Antunes D, Guimarães T, Pinto FJ. More than a rare cause of pulmonary hypertension in the elderly. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Rigueira J, Plácido R, Silva ACE, Almeida AG, Pinto FJ. Papillary fibroelastoma with an atypical location. Rev Port Cardiol 2020; 38:739-740. [PMID: 31911014 DOI: 10.1016/j.repc.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/13/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Joana Rigueira
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Portugal.
| | - Rui Plácido
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Portugal
| | | | - Ana G Almeida
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), CAML, CCUL, Faculdade de Medicina da Universidade de Lisboa, Portugal
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20
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Agostinho JR, Plácido R, Almeida AG, Pinto FJ. Aortic valve endocarditis by a rare infectious agent in a patient with a rare congenital mitral valve abnormality. Eur Heart J Case Rep 2019; 3:1-2. [PMID: 32099955 PMCID: PMC7026585 DOI: 10.1093/ehjcr/ytz175] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/20/2019] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
- João R Agostinho
- Cardiology Department, Hospital de Santa Maria/CHULN, CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Rui Plácido
- Cardiology Department, Hospital de Santa Maria/CHULN, CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Ana G Almeida
- Cardiology Department, Hospital de Santa Maria/CHULN, CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
| | - Fausto J Pinto
- Cardiology Department, Hospital de Santa Maria/CHULN, CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Portugal, Av. Prof. Egas Moniz, Lisbon 1649-035, Portugal
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Abstract
Phosphodiesterases (PDEs) comprise a superfamily with 11 subfamilies. Within these families, more than 40 isoforms are expressed. Phosphodiesterase-3 inhibitors (PDE3i) are used as inotrope/vasodilators for acute heart failure (HF), and PDE5i for pulmonary hypertension and erectile dysfunction. Despite being studied for chronic HF, none of the PDEis have been presently approved for such an indication itself. The PDE3is milrinone (the PROMISE trial and OPTIME-CHF), raised safety concerns. Although low-dose intravenous milrinone with a beta-blocker is till proposed by some. Enoximone failed to show significant benefits in patients with severe chronic HF in a series of phase 3 clinical trials (ESSENTIAL 1, ESSENTIAL II, EMOTE, EMPOWER). Of the PDE5is, Sildenafil is the most extensively investigated, with proven efficacy in treating erectile dysfunction and pulmonary arterial hypertension, but it has only been tested in relatively small trials in the field of HFrEF, but shows some promise in HFpEF and in pulmonary hypertension complicating HF. Elucidation of the potential clinical role of PDEis on across the spectrum of HF phenotypes will require more definitive evidence from large-scale clinical trials.
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Rigueira J, Plácido R, Silva ACE, Almeida AG, Pinto FJ. Papillary fibroelastoma with an atypical location. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2020.01.011] [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: 10/25/2022] Open
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23
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Guimarães T, Plácido R, Almeida AG. Divertículo submitral congénito. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.04.024] [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: 10/14/2022]
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Guimarães T, Plácido R, Almeida AG. Congenital Submitral Diverticulum. Rev Esp Cardiol (Engl Ed) 2019; 72:417. [PMID: 29778499 DOI: 10.1016/j.rec.2018.04.014] [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] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal.
| | - Rui Plácido
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
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Guimarães T, Plácido R, Quadros AC, Costa JMD, Pinto FJ. Unexpected Mass in the Left Atrium. Arq Bras Cardiol 2018; 111:226-227. [PMID: 30183992 PMCID: PMC6122916 DOI: 10.5935/abc.20180110] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/26/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Rui Plácido
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Ana Catarina Quadros
- Anatomopathology Department, Santa Maria University Hospital, CHLN, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - José Marques da Costa
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisboa - Portugal
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Almeida AG, Silva GL, Plácido R, Francisco AR, Guimaraes T, David C, Pinto F. LEFT ATRIAL ABNORMAL MECHANICS BY CARDIAC MAGNTIC RESONANCE FEATURE TRACKING AS AN EARLY SUBCLINICAL MANIFESTATION IN PATIENTS WITH SYSTEMIC SCLEROSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Plácido R, Cortez‐Dias N, Robalo Martins S, Gomes Almeida A, Calisto C, Gonçalves S, Sadoune M, Nunes Diogo A, Mebazaa A, Pinto FJ. Estratificação prognóstica na hipertensão pulmonar: valor acrescido da abordagem multibiomarcadores. Rev Port Cardiol 2017; 36:111-125. [DOI: 10.1016/j.repc.2016.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 02/05/2023] Open
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Plácido R, Cortez-Dias N, Robalo Martins S, Almeida AG, Calisto C, Gonçalves S, Sadoune M, Nunes Diogo A, Mebazaa A, Pinto FJ. Prognostic stratification in pulmonary hypertension: A multi-biomarker approach. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Plácido R, Cunha Lopes B, Almeida AG, Rochitte CE. The role of cardiovascular magnetic resonance in takotsubo syndrome. J Cardiovasc Magn Reson 2016; 18:68. [PMID: 27729054 PMCID: PMC5059937 DOI: 10.1186/s12968-016-0279-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/01/2016] [Indexed: 12/11/2022] Open
Abstract
Takotsubo syndrome (TS) is a transient form of left ventricular dysfunction associated with a distinctive contraction pattern in the absence of significant coronary artery disease triggered by stressful events. Several aspects of its clinical profile have been described but it still remains difficult to quickly establish the diagnosis at admission.Cardiovascular magnetic resonance (CMR) has achieved great improvements in the last years, which in turn has made this imaging technology more attractive in the diagnosis and evaluation of TS. With its superior tissue resolution and dynamic imaging capabilities, CMR is currently the most useful imaging technique in this setting.In this review, we propose to comprehensively define the role of CMR in the evaluation of patients with TS and to summarize a set of criteria suitable for diagnostic decision making in this clinical setting.
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Affiliation(s)
- Rui Plácido
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
- Cardiology Department, Lisbon Academic Medical Centre, CCUL, Santa Maria University Hospital, Lisbon, Portugal
| | - Bernardo Cunha Lopes
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Ana G. Almeida
- Cardiology Department, Lisbon Academic Medical Centre, CCUL, Santa Maria University Hospital, Lisbon, Portugal
| | - Carlos E. Rochitte
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
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Plácido R, Abecasis J, Gonçalves S, Pinto FJ, G. Almeida A. Right ventricular hematoma. Rev Port Cardiol 2016; 35:449-50. [DOI: 10.1016/j.repc.2015.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022] Open
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Plácido R, Martins SR, Canas da Silva P, Infante de Oliveira E, Campos P, Almeida AG, Pinto FJ. ST-Segment-Elevation Myocardial Infarction Attributable to Left Main Coronary Artery Compression. Circulation 2016; 133:1828-9. [PMID: 27143552 DOI: 10.1161/circulationaha.115.021102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rui Plácido
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.).
| | - Susana Robalo Martins
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
| | - Pedro Canas da Silva
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
| | - Eduardo Infante de Oliveira
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
| | - Paula Campos
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
| | - Ana G Almeida
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
| | - Fausto J Pinto
- From Santa Maria Hospital, Cardiology Department, Lisbon Academic Medical Centre, CCUL, Portugal and University of Lisbon, Portugal (R.P., S.R.M., P.C.d.S., E.I.d.O., A.G.A., F.J.P.); and Santa Maria Hospital, Radiology Department, Lisbon, Portugal (P.C.)
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Plácido R, Almeida AG, Canas da Silva P, Pinto F. Left main ostial agenesis and right coronary artery occlusion: the importance of the ‘Vieussens' arterial ring’. Eur Heart J 2016; 37:1170. [DOI: 10.1093/eurheartj/ehv762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Plácido R, Cortez-Dias N, Veiga A, Jorge C, Miltenberger-Miltény G, Pinto F. Coronary Fistulas in a Patient with a Novel Long QT Syndrome Mutation. Arq Bras Cardiol 2015; 105:536-9. [PMID: 26577721 PMCID: PMC4651413 DOI: 10.5935/abc.20150047] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rui Plácido
- Departamento de Cardiologia, Hospital Santa Maria University, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Nuno Cortez-Dias
- Departamento de Cardiologia, Hospital Santa Maria University, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Arminda Veiga
- Departamento de Cardiologia, Hospital Santa Maria University, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Cláudia Jorge
- Departamento de Cardiologia, Hospital Santa Maria University, Lisbon Academic Medical Centre, Lisbon, Portugal
| | | | - Fausto Pinto
- Departamento de Cardiologia, Hospital Santa Maria University, Lisbon Academic Medical Centre, Lisbon, Portugal
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Plácido R, Cholley B, Almeida AG. An unexpected cause of myocardial infarction. Rev Esp Cardiol (Engl Ed) 2015; 68:528. [PMID: 25481616 DOI: 10.1016/j.rec.2014.07.034] [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] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/28/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Rui Plácido
- Serviço de Cardiologia I, Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal.
| | - Bernard Cholley
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Ana G Almeida
- Serviço de Cardiologia I, Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal
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Plácido R, Silva Marques J, Amaro MJ, Brito D, Pinto FJ, G. Almeida A. Massive calcification involving a left ventricular false tendon. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada syndrome. Rev Port Cardiol 2014; 33:305.e1-7. [PMID: 24931179 DOI: 10.1016/j.repc.2014.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 60-year-old woman with Brugada syndrome, permanent type 1 electrocardiographic pattern, who had previously received an implantable cardioverter-defibrillator. She suffered frequent syncopal episodes and multiple appropriate shocks (around five per month) due to polymorphic ventricular tachycardia/ventricular fibrillation, refractory to quinidine therapy. Combined epicardial and endocardial electroanatomical mapping was performed with a view to substrate ablation. An area of abnormal fractionated electrograms, lasting up to 370 ms and up to 216 ms after the end of the surface QRS, was identified in the epicardium in the lower anterior part of the right ventricular outflow tract. Extensive epicardial ablation of this area, which eliminated the fractionated electrograms, led to the disappearance of the Brugada electrocardiographic pattern six weeks after ablation. Despite discontinuation of quinidine, no further ventricular arrhythmias occurred during follow-up, which is still of short duration.
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Affiliation(s)
- Nuno Cortez-Dias
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Rui Plácido
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Liliana Marta
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Serviço de Cardiologia, Hospital Distrital de Santarém, Santarém, Portugal
| | - Ana Bernardes
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Sílvia Sobral
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Luís Carpinteiro
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada Syndrome. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.01.005] [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: 10/25/2022] Open
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Soto EF, Pasquini JM, Plácido R, La Torre JL. Fractionation of lipids and proteolipids from cat grey white matter by chromatography on an organophilic dextran gel. J Chromatogr A 1969; 41:400-9. [PMID: 5796332 DOI: 10.1016/0021-9673(64)80154-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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