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1. Levosimendan in outpatients with advanced heart failure: Single-center experience of 200 intermittent perfusions

Author

Ferreira Reis, J, Gonçalves, A, Ilhão Moreira, R, Pereira-da-Silva, T, Timóteo, AT, Pombo, D, Carvalho, T, Correia, C, Santos, C, and Cruz Ferreira, R

Subjects
Male, Heart Failure* / therapy, Cardiotonic Agents / therapeutic use, Hydrazones / therapeutic use, Stroke Volume, HSM CAR, Simendan / therapeutic use, Ventricular Function, Left, Simendan / pharmacology, Outpatients, Humans, Pyridazines* / therapeutic use, Female, Cardiology and Cardiovascular Medicine
Abstract

Introduction: Patients with advanced heart failure (HF) have high morbidity and mortality, with only a small proportion being eligible for advanced therapies. Intermittent outpatient levosimendan infusion has been shown to provide symptomatic relief and reduce the rate of HF events. Our aim was to assess the safety and efficacy of outpatient levosimendan administration in an advanced HF population. Methods: This is a report of a single-center experience of consecutive advanced HF patients referred for intermittent intravenous outpatient administration of levosimendan, between January 2018 and March 2021. Baseline and follow-up evaluation included clinical assessment, laboratory tests, transthoracic echocardiography and cardiopulmonary exercise testing. Baseline and clinical follow-up data were compared using the Wilcoxon signed-rank test. Results: A total of 24 patients (60.8 years, 83% male, mean left ventricular ejection fraction [LVEF] 24%), with a median of 1.5 HF hospitalizations in the previous six months, were referred for outpatient levosimendan pulses, the majority as a bridge to transplantation or due to clinical deterioration. At six-month follow-up there was a significant reduction in HF hospitalizations to 0.4±0.7 (p

Published
2023
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2. Associações Entre Defeitos de Perfusão, Características Tecidulares e Deformação Miocárdica na Miocardiopatia Hipertrófica, uma Análise Segmentar por Ressonância Magnética Cardíaca

Author

Brás, P, Aguiar Rosa, S, Thomas, B, Fiarresga, A, Cardoso, I, Pereira, R, Branco, G, Cruz, I, Baquero, L, Cruz Ferreira, R, Mota Carmo, M, and Rocha Lopes, L

Subjects
Strain Imaging, Myocardial Deformation, Coronary Microvascular Dysfunction, Hypertrophic Cardiomyopathy, Cardiac Magnetic Resonance, HSM CAR, Cardiology and Cardiovascular Medicine, Tissue Characteristics
Abstract

Background: Microvascular dysfunction is an often overlooked feature of hypertrophic cardiomyopathy (HCM). Our aim was to assess the association between microvascular dysfunction, wall thickness, tissue characteristics and myocardial deformation in HCM patients, by analyzing individual myocardial segments. Methods: Prospective assessment including cardiac magnetic resonance to assess wall thickness, T1 and T2 mapping, extracellular volume, late gadolinium enhancement (LGE) and stress perfusion. Results were stratified according to the 16 American Heart Association segments. Results: Seventy-five patients were recruited (1200 segments), 63% male, mean age 54.6±14.8 years, maximal wall thickness of 20.22±4.6 mm. Among the 424 segments (35%) with perfusion defects, 24% had defects only in the endocardial layer and 12% in both endocardial and epicardial layers. Perfusion defects were more often detected in hypertrophied segments (64%). Among the 660 segments with normal wall thickness, 19% presented perfusion defects. Independently of wall thickness, segments with perfusion defects had a higher T1 (β-estimate 30.28, p

Published
2022
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3. Impacto da Coartação da Aorta Reparada no Trabalho Miocárdico Ventricular Esquerdo

Author

Timóteo, AT, Branco, L, Galrinho, A, Rio, P, Sousa, L, and Cruz Ferreira, R

Subjects
Repaired Aortic Coarctation, Myocardial Work, HSM CAR, Cardiology and Cardiovascular Medicine, Strain
Abstract

Aims: Myocardial strain analysis enables more precise assessment of cardiac performance but is relatively load dependent. New tools have been developed with afterload adjustment. Our objective was to assess myocardial work (MW) in patients with repaired aortic coarctation (rACo). Methods: Prospective study of consecutive patients with rACo who underwent a routine transthoracic echocardiogram in 2018 and 2019 at our center. Patients with significant aortic valve disease, pacemaker, or other congenital heart diseases (except for mild bicuspid aortic valve disease) were excluded. Global longitudinal strain with two dimensional speckle tracking analysis and MW were obtained (GWI:Global Work Index; GCW: Global Constructive Work; GWW: Global Wasted Work; GWE: Global Work Efficiency). Blood pressure was measured in the patient's right arm. Results: We included 42 patients in the analysis, mean age of 37±10 years, 38% males. In this group, 52% had hypertension and 64% had a concomitant bicuspid aortic valve. In comparison to previously published reference values, patients with rACo had significantly lower GWI (1807 vs. 1896 mmHg%) and GCW (2173 vs. 2232 mmHg%) (p0.594). Neither age nor gender were independent predictors. Conclusions: In patients with rACo, there are some signs of left ventricular dysfunction with a reduction in GCW and GWI and with preserved GWE, despite normal ejection fraction and strain. info:eu-repo/semantics/publishedVersion

Published
2020

14. Safety and effectiveness of the genous endothelial progenitor cell-capture stent: Follow-up to 5 years

Author

Pereira-da-Silva, T, Bernardes, T, Cacela, D, Fiarresga, A, Sousa, L, Patrício, L, and Cruz Ferreira, R

Subjects
Percutaneous Coronary Intervention/methods, Endothelial Progenitor Cells/pathology, HSM CAR, Coronary Restenosis/epidemiology, Acute Coronary Syndrome/pathology, Risk Factors, Coronary Thrombosis/epidemiology, Myocardial Infarction/epidemiology, Stents*/adverse effects, cardiovascular diseases, Longitudinal Studies, Percutaneous Coronary Intervention/instrumentation, Acute Coronary Syndrome/therapy, Follow-Up Studies, Proportional Hazards Models, Retrospective Studies
Abstract

AIMS: To evaluate the long-term clinical outcomes following percutaneous coronary intervention (PCI) with the Genous stent in an unselected population. METHODS: All patients admitted to a single center who underwent PCI using the GS exclusively, between May 2006 and May 2012, were enrolled, and a clinical follow-up of up to 60 months was carried out. The primary endpoint of major adverse cardiac event (MACE) rate was defined as the composite of cardiac death, acute myocardial infarction (AMI), and target lesion revascularization (TLR). RESULTS: Of the 450 patients included (75.1% male; 65.5 ± 11.7 years), 28.4% were diabetic and acute coronary syndrome was the reason for PCI in 76.4%. Angioplasty was performed in 524 lesions using 597 Genous stents, with angiographic success in 97.1%. At a median of 36 months of follow-up (range, 1-75 months), MACE, AMI, TLR, stent restenosis (SR), and stent thrombosis (ST) rates were 15.6%, 8.4%, 4.4%, 3.8%, and 2.2%, respectively. Between 12 and 24 months, the TLR, SR, and ST rates practically stabilized, up to 60 months. Bifurcation lesions were independently associated with MACE, TLR, and SR. CONCLUSION: This is the first study reporting clinical results with the Genous stent up to 60 months. The Genous stent was safe and effective in the long-term, in an unselected population.

17. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial

Author

Pascal Vranckx, Marco Valgimigli, Peter Jüni, Christian Hamm, Philippe Gabriel Steg, Dik Heg, Gerrit Anne van Es, Eugene P McFadden, Yoshinobu Onuma, Cokky van Meijeren, Ply Chichareon, Edouard Benit, Helge Möllmann, Luc Janssens, Maurizio Ferrario, Aris Moschovitis, Aleksander Zurakowski, Marcello Dominici, Robert Jan Van Geuns, Kurt Huber, Ton Slagboom, Patrick W Serruys, Stephan Windecker, Mohamed Abdellaoui, David Adlam, Ibrahim Akin, Agustin Albarran Gonzalez-Trevilla, Manuel Almeida, Pedro Alves Lemos Neto, Adel Aminian, Richard Anderson, Rick Andreae, Michael Angioi, Taku Asano, Emanuele Barbato, Peter Barlis, Pascal Barraud, Olivier Bertrand, Farzin Beygui, Leonardo Bolognese, Roberto Botelho, Coby Bouwman, Marco Bressers, Philippe Brunel, Pawel Buszman, Ian Buysschaert, Pedro Canas da Silva, Didier Carrie, Angel Cequier, Chun Chin Chang, Saqib Chowdhary, Carlos Collet, Antonio Colombo, James Cotton, Rui Cruz Ferreira, Salvatore Curello, Nick Curzen, Judith de Bot, Tone de Vreede, Georg Delle Karth, Lynn Dijksma, István Édes, Eric Eeckhout, Ingo Eitel, József Faluközy, Farzin Fath-Ordoubadi, Geza Fontos, Jose Francisco Diaz, Edgard Freitas Quintella, Bernhard Frey, Guy Friedrich, Gavin Galasko, Grzegorz Galuszka, Vasco Gama Ribeiro, Scot Garg, Giuseppe Gargiulo, Tobias Geisler, Valeri Gelev, Art Ghandilyan, Javier Goicolea, Tommaso Gori, Felice Gragnano, Ana Guimarães, Michael Haude, Pieter Heijke, Rosa Ana Hernández Antolin, David Hildick-Smith, Dorien Hillen, Ina Hoekman, Sjoerd Hofma, Lene Holmvang, Stephen Hoole, Iván Horváth, Annemarie Hugense, Karim Ibrahim, Andres Iñiguez, Karl Isaaz, Zoltán Jambrik, Pawel Jasionowicz, Judith Jonk, Werner Jung, Yuki Katagiri, Norihiro Kogame, Tian Hai Koh, René Koning, Mariana Konteva, Zsolt Kőszegi, Florian Krackhardt, Yvonne Kreuger, Neville Kukreja, Boudijn Ladan, Pierre Lantelme, Sergio Leandro, Gregor Leibundgut, Christoph Liebetrau, Wietze Lindeboom, Carlos Macaya Miguel, François Mach, Michael Magro, Luc Maillard, Negar Manavifar, Laura Mauri, Eugene McFadden, Bela Merkely, Yosuke Miyazaki, Adam Młodziankowski, Tiziano Moccetti, Rodrigo Modolo, Helge Möllman, Jean-François Morelle, Michael Munndt Ottesen, Martin Muurling, Christoph Kurt Naber, Franz-Josef Neumann, Keith Oldroyd, Paul Ong, Sanne Palsrok, Ivo Petrov, Sylvain Plante, Janusz Prokopczuk, Tessa Rademaker-Havinga, Christopher Raffel, Benno Rensing, Marco Roffi, Kees-Jan Royaards, Manel Sabate, Volker Schächinger, Tim Seidler, Antonio Serra Peñaranda, Patrick Serruys, Lali Sikarulidze, Osama I Soliman, Amanda Sousa, Ernest Spitzer, Rod Stables, Gabriel Steg, Clemens Steinwender, Eduardas Subkovas, Harry Suryapranata, Kuniaki Takahashi, Suneel Talwar, Emmanuel Teiger, Addy ter Weele, Eva Teurlings, Attila Thury, Jan Tijssen, Gincho Tonev, Diana Trendafilova-Lazarova, Carlo Tumscitz, Victor Umans, Imre Ungi, Veselin Valkov, Pim van der Harst, Robert Jan van Geuns, Dobrin Vassilev, Vasil Velchev, Esther Velthuizen, Freek Verheugt, Natalia Vlcek, Jürgen vom Dahl, Mathias Vrolix, Simon Walsh, Nikos Werner, Maarten Witsenburg, Azfar Zaman, Krzysztof Żmudka, Bernhard Zrenner, Robert Zweiker, University of Zurich, Serruys, Patrick W, Cardiology, Vranckx, P., Valgimigli, M., Juni, P., Hamm, C., Steg, P. G., Heg, D., van Es, G. A., Mcfadden, E. P., Onuma, Y., van Meijeren, C., Chichareon, P., Benit, E., Mollmann, H., Janssens, L., Ferrario, M., Moschovitis, A., Zurakowski, A., Dominici, M., Van Geuns, R. J., Huber, K., Slagboom, T., Serruys, P. W., Windecker, S., Abdellaoui, M., Adlam, D., Akin, I., Albarran Gonzalez-Trevilla, A., Almeida, M., Alves Lemos Neto, P., Aminian, A., Anderson, R., Andreae, R., Angioi, M., Asano, T., Barbato, E., Barlis, P., Barraud, P., Bertrand, O., Beygui, F., Bolognese, L., Botelho, R., Bouwman, C., Bressers, M., Brunel, P., Buszman, P., Buysschaert, I., Canas da Silva, P., Carrie, D., Cequier, A., Chin Chang, C., Chowdhary, S., Collet, C., Colombo, A., Cotton, J., Cruz Ferreira, R., Curello, S., Curzen, N., de Bot, J., de Vreede, T., Delle Karth, G., Dijksma, L., Edes, I., Eeckhout, E., Eitel, I., Falukozy, J., Fath-Ordoubadi, F., Fontos, G., Francisco Diaz, J., Freitas Quintella, E., Frey, B., Friedrich, G., Galasko, G., Galuszka, G., Gama Ribeiro, V., Garg, S., Gargiulo, G., Geisler, T., Gelev, V., Ghandilyan, A., Goicolea, J., Gori, T., Gragnano, F., Guimaraes, A., Haude, M., Heijke, P., Hernandez Antolin, R. A., Hildick-Smith, D., Hillen, D., Hoekman, I., Hofma, S., Holmvang, L., Hoole, S., Horvath, I., Hugense, A., Ibrahim, K., Iniguez, A., Isaaz, K., Jambrik, Z., Jasionowicz, P., Jonk, J., Jung, W., Katagiri, Y., Kogame, N., Koh, T. H., Koning, R., Konteva, M., Koszegi, Z., Krackhardt, F., Kreuger, Y., Kukreja, N., Ladan, B., Lantelme, P., Leandro, S., Leibundgut, G., Liebetrau, C., Lindeboom, W., Macaya Miguel, C., Mach, F., Magro, M., Maillard, L., Manavifar, N., Mauri, L., Mcfadden, E., Merkely, B., Miyazaki, Y., Mlodziankowski, A., Moccetti, T., Modolo, R., Mollman, H., Morelle, J. -F., Munndt Ottesen, M., Muurling, M., Naber, C. K., Neumann, F. -J., Oldroyd, K., Ong, P., Palsrok, S., Petrov, I., Plante, S., Prokopczuk, J., Rademaker-Havinga, T., Raffel, C., Rensing, B., Roffi, M., Royaards, K. -J., Sabate, M., Schachinger, V., Seidler, T., Serra Penaranda, A., Serruys, P., Sikarulidze, L., Soliman, O. I., Sousa, A., Spitzer, E., Stables, R., Steg, G., Steinwender, C., Subkovas, E., Suryapranata, H., Takahashi, K., Talwar, S., Teiger, E., ter Weele, A., Teurlings, E., Thury, A., Tijssen, J., Tonev, G., Trendafilova-Lazarova, D., Tumscitz, C., Umans, V., Ungi, I., Valkov, V., van der Harst, P., van Geuns, R. J., Vassilev, D., Velchev, V., Velthuizen, E., Verheugt, F., Vlcek, N., vom Dahl, J., Vrolix, M., Walsh, S., Werner, N., Witsenburg, M., Zaman, A., Zmudka, K., Zrenner, B., Zweiker, R., ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Graduate School, ACS - Heart failure & arrhythmias, and ACS - Amsterdam Cardiovascular Sciences

Subjects
medicine.medical_specialty, Aspirin, Acute coronary syndrome, business.industry, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Percutaneous coronary intervention, 610 Medicine & health, General Medicine, 2700 General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Clopidogrel, 11171 Cardiocentro Ticino, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Drug-eluting stent, Internal medicine, medicine, 030212 general & internal medicine, Myocardial infarction, business, Ticagrelor, medicine.drug
Abstract

Background We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. Methods GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed by a core lab in a blinded manner. The key secondary safety endpoint was site-reported bleeding assessed according to the Bleeding Academic Research Consortium criteria (grade 3 or 5). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01813435, and is closed to new participants, with followup completed. Findings Between July 1, 2013, and Nov 9, 2015, 15 968 participants were randomly assigned, 7980 to the experimental group and 7988 to the control group. At 2 years, 304 (3.81%) participants in the experimental group had died or had a non-fatal centrally adjudicated new Q-wave myocardial infarction, compared with 349 (4.37%) participants in the control group (rate ratio 0.87 [95% CI 0. 75-1. 01]; p=0.073]). There was no evidence for a difference in treatment effects for the primary endpoint across prespecified subgroups of acute coronary syndromes and stable coronary artery disease (p=0.93). Grade 3 or 5 bleeding occurred in 163 participants in the experimental group and 169 in the control group (2.04% vs 2.12%; rate ratio 0.97 [95% CI 0. 78-1. 20]; p=0.77). Interpretation Ticagrelor in combination with aspirin for 1 month followed by ticagrelor alone for 23 months was not superior to 12 months of standard dual antiplatelet therapy followed by 12 months of aspirin alone in the prevention of all-cause mortality or new Q-wave myocardial infarction 2 years after percutaneous coronary intervention. Copright (C) 2018 Elsevier Ltd. All rights reserved. European Clinical Research Institute; Biosensors International; AstraZeneca; Medicines Company; Canada Research Chairs Programme

Published
2018

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