Teles, R; Pereira, H; Carvalho, H; Patrício, L; Santos, R; Baptista, J; Pipa, J; Abreu, PF; Faria, H; Ramos, S; Ribeiro, V; Martins, D; Almeida, M
Introdução: Os suportes vasculares restaurativos transitórios (sVRT) foram recentemente
aprovados para intervenção coronária percutânea (ICP) na Europa e possuem propriedades
muito inovadoras. O objetivo desta declaração de posição é rever criticamente a informação
e os estudos com os sVRT disponíveis e contribuir para uma reflexão científica que promova o
seu uso racional com orientações estruturadas para a sua aplicação inicial em Portugal.
Métodos e resultados: Foi constituído um grupo de trabalho para alcançar um consenso com
base na evidência científica conhecida, na discussão de casos clínicos modelo e na experiência
individual. A evidência reunida sugere que os sVRT disponíveis podem produzir uma melhoria
fisiológica e clínica em doentes...
Saldanha, C; Loureiro, J; Moreira, C; Silva, J
The aim of this work was to evaluate in vitro the effect of autologous plasma lipoprotein subfractions on erythrocyte tendency to aggregate. Aliquots of human blood samples were enriched or not (control) with their own HDL-C, LDL-C, or VLDL-C fractions obtained from the same batch by density gradient ultracentrifugation. Plasma osmolality and erythrocyte aggregation index (EAI) were determined. Blood aliquots enriched with LDL-C and HDL-C showed significant higher EAI than untreated aliquots, whereas enrichment with VLDL-C does not induce significant EAI changes. For the same range of lipoprotein concentrations expressed as percentage of osmolality variation, the EAI variation was positive...
Carneiro, G; Nascimento, J; Freitas, A
We present a new supervised learning model designed for the automatic segmentation of the left ventricle (LV) of the heart in ultrasound images. We address the following problems inherent to supervised learning models: 1) the need of a large set of training images; 2) robustness to imaging conditions not present in the training data; and 3) complex search process. The innovations of our approach reside in a formulation that decouples the rigid and nonrigid detections, deep learning methods that model the appearance of the LV, and efficient derivative-based search algorithms. The functionality of our approach is evaluated using a data...
Santos, MJ; Vinagre, F; Silva, J; Gil, V; Fonseca, J
OBJECTIVES: The amount and distribution of fat and lean mass have important implications for health and systemic inflammation may represent a risk for altered body composition. The aim of this study was to analyse whether changes in body composition are similarly associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), two inflammatory conditions of different pathogenesis.
METHODS: Body mass index (BMI), waist circumference, fat mass (FM) and fat-free mass (FFM) were measured in 92 women with SLE, 89 with RA and 107 controls. Results were compared among the 3 groups and correlations of FM percentage were explored within SLE and...
Alves-Rodrigues, A; Thomas, B
Buller, C; Rankin, J; Carere, R; Buszman, P; Pfisterer, M; Dzavik, V; Thomas, B; Forman, S; Ruzyllo, W; Mancini, G; Michalis, L; Abreu, G; Lamas, G; Hochman, J
BACKGROUND: The Occluded Artery Trial (OAT) was a 2,201-patient randomized clinical trial comparing routine stent-based percutaneous coronary intervention (PCI) versus optimal medical therapy alone in stable myocardial infarction (MI) survivors with persistent infarct-related artery occlusion identified day 3 to 28 post MI. Intent-to-treat analysis showed no difference between strategies with respect to the incidence of new class IV congestive heart failure, MI, or death. The influence of PCI failure, procedural hazard, and crossover on trial results has not been reported.
METHODS: Study angiograms were analyzed and adjudicated centrally. Factors associated with PCI failure were examined. Time-to-event analysis using the OAT primary...
Dzavík, V; Buller, C; Lamas, G; Rankin, J; Mancini, G; Cantor, W; Carere, R; Ross, J; Atchison, D; Forman, S; Thomas, B; Buszman, P; Vozzi, C; Glanz, A; Cohen, E; Mecia, P; Devlin, G; Mascette, A; Sopko, G; Knatterud, G; Hochman, J
BACKGROUND: In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function.
METHODS AND RESULTS: Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change...
Steigen, T; Christopher, E; Buller, C; Mancini, G; Jorapur, V; Cantor, W; Rankin, J; Thomas, B; Webb, J; Kronsberg, S; Atchison, D; Lamas, G; Hochman, J; Dzavík, V
BACKGROUND: Whether myocardial perfusion grade (MPG) following late recanalization of infarct-related arteries (IRAs) predicts left ventricular (LV) function recovery beyond the acute phase of myocardial infarction (MI) is unknown.
METHODS AND RESULTS: The Total Occlusion Study of Canada-2 enrolled stable patients with a persistently occluded IRA beyond 24 hours and up to 28 days post-MI. We studied the relationship between the initial MPG and changes in LV function and volume as well as the change in MPG from immediate post-percutaneous coronary intervention (PCI) to 1 year in 139 PCI patients with thrombolysis in myocardial infarction grade 3 epicardial flow post-PCI and...
Santos, MJ; Carmona-Fernandes, D; Canhão, H; Silva, J; Fonseca, J; Gil, V
Accelerated atherosclerosis represents a major problem in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients, and endothelial damage is a key feature of atherogenesis. We aimed to assess early endothelial changes in SLE and RA female patients (127 SLE and 107 RA) without previous CV events. Biomarkers of endothelial cell activation (intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (TM), and tissue factor (TF)) were measured and endothelial function was assessed using peripheral artery tonometry. Reactive hyperemia index (RHI), an indicator of microvascular reactivity, and augmentation index (AIx), a measure of arterial stiffness, were obtained. In...
Thomas, B; Batista, R
When medical therapy is unsuccessful in improving the functional class in patients with heart failure, surgical options must be considered. Although transplantation may be considered the gold standard, numerous factors limit the number of patients who can benefit from it. Therefore, other surgical methods have been devised as alternatives to transplantation. Left ventricular reduction by surgical resection of a piece of myocardium was introduced in Brazil a few years ago, and enthusiasm for the procedure is increasing because encouraging results have been published by various groups. It is hoped that this procedure will form part of the treatment for congestive...
Abreu, A; Galrinho, A; Sá, E; Ramos, S; Martins, A; Fragata, J; Ferreira, R
A 16-year-old boy was submitted to a cardiac examination after an episode of faintness. A transthoracic echocardiogram was performed, which revealed a very mobile multicystic tumor attached to the mitral valve. A small solid mass adherent to the cysts was better defined by transesophageal echocardiography. The patient was submitted to cardiac surgery consisting of tumor resection and a mitral prosthesis implant. The surgery was successful. The tumor consisted of three bright red tense cysts with hematic content, each 1 to 2 cm in diameter. The cysts were coalescent and adherent to a solid mass attached to the posterior papillary muscle...
Santomauro, M; Ottaviano, L; Borrelli, A; de Lucia, V; Riganti, C; Ferreira, D; Chiarello, M
In Italian hospitals, 85% of patients hospitalized in general medical wards who experience cardiac arrest die, while the incidence is much lower in patients in intensive care units. Defibrillation, in Italian hospitals, often occurs very late, either due to a lack of defibrillators, or due to architectural and structural barriers. The object of an in-hospital emergency service is to prevent and treat cardiac arrest without subsequent complications, such as brain damage, renal failure etc. The Naples Heart Project was based on a feasibility study of the in-hospital emergency service to evaluate and analyze problems associated with type of structure, departmental...
Silva-Cardoso, J; Ferreira, J; Oliveira-Soares, A; Martins-de-Campos, J; Fonseca, C; Lousada, N; Ilídio-Moreira, J; Rabaçal, C; Damasceno, A; Amorim, S; Seabra-Gomes, R; Ferreira, R; Abreu-Lima, C
BACKGROUND: In previous randomized studies levosimendan improved hemodynamics and clinical course, with a still unclear effect on prognosis. There are, however, few data regarding its effects when used in daily practice.
AIMS: We evaluated the clinical effectiveness and safety of levosimendan in the treatment of acute systolic heart failure (SHF) in daily practice conditions.
METHODS: In this prospective, multicenter, nonrandomized trial, a continuous infusion of levosimendan (0.05 microg/kg/min-0.2 microg/kg/min) was administered for 24 hours. An optional loading dose of 12 microg/kg over 10 minutes was used. The primary combined endpoint of clinical effectiveness (as defined by a eight-variable clinical score) and safety...
Cardim, N; Freitas, A; Brito, D
The prevalence, complexity, clinical importance, heterogeneity and unpredictability of inherited cardiovascular diseases make the development of inherited cardiovascular disease centers an inevitability, with the ultimate goal of reducing the morbidity and mortality associated with these conditions. An inherited cardiovascular disease center may be seen as a subunit of a cardiology department, with health professionals specializing in these types of disorders, organized to provide excellence in all related areas, including diagnosis, treatment, followup, prevention, risk stratification and prognosis. Among its objectives are the development of action protocols and the creation of databases that enable patients to be included in national and...
Loureiro, J; Gonçalves-Pereira, M; Trancas, B; Caldas-de-Almeida, J; Castro-Caldas, A
Introdução e Objectivos: A empatia é um elemento fundamental da relação médico-doente, havendo evidência da sua associação a melhores resultados clínicos. Contudo, alguns estudos têm sugerido uma diminuição dos níveis de empatia, no decurso da formação pré-graduada em Medicina ou da prática clínica continuada. Neste estudo pretendemos analisar, em alunos do
primeiro ano de um curso de Medicina, a evolução das atitudes face à empatia ao longo de um semestre lectivo (correspondendo à frequência de Psicologia Médica, cujo programa aborda a empatia em Medicina mediante ensino de conteúdos e treino elementar de competências).
Pretendemos, igualmente, explorar as relações entre atitudes face à...
Ricardo, J; Anaya, MJ; Barbosa, M; André, N; Magno, P; Morais, J; Proença, G; Rabaçal, C; Gil, V
Apresentamos o caso de um homem de 21 anos, que foi submetido a apendicectomia
sob anestesia geral e que imediatamente após a extubação desencadeou quadro de edema
putmonar agudo. A propósito, faremos uma breve revisão da literatura, enfatizando os
mecanismos fisiopatotógicos subjacentes e os aspectos mais importantes do diagnóstico e
Santos, MJ; Vinagre, F; Silva, J; Gil, V; Fonseca, J
OBJECTIVE: Premature atherosclerosis is well-documented both in Systemic Lupus Erythematosus (SLE) and in Rheumatoid Arthritis (RA) patients, but cardiovascular (CV) risk is particularly high in lupus women. Although conventional CV risk factors do not fully explain the excessive risk in inflammatory diseases, they remain major contributors to atherosclerosis. The aim of the present study was to investigate whether CV risk factors are differentially associated with SLE and RA.
METHODS: One hundred women with SLE, 98 with RA and 102 controls matched on age and without overt CV or renal disease were assessed for the presence of Framingham (hypertension, hypercholesterolemia, low HDL,...
Cantor, W; Baptista, S; Srinivas, V; Pearte, C; Menon, V; Sadowski, Z; Ross, J; Meciar, P; Nikolsky, E; Forman, S; Lamas, G; Hochman, J
Background—In the Occluded Artery Trial (OAT), 2201 stable patients with an occluded infarctrelated artery (IRA) were randomized to percutaneous coronary intervention (PCI) or optimal medical treatment alone (MED). There was no difference in the primary endpoint of death, re-MI or heart failure (CHF). We examined the prognostic impact of pre-randomization stress testing.
Methods—Stress testing was required by protocol except for patients with single vessel disease and akinesis/dyskinesis of the infarct zone. The presence of severe inducible ischemia was an exclusion criterion for OAT. We compared outcomes based on performance and results of stress
Results—598 (27%) patients (297 PCI, 301 MED) underwent stress...