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1. Determinantes cardíacas do tempo de ventilação mecânica e mortalidade de doentes com insuficiência respiratória crónica exacerbada: A importância dos parâmetros ecocardiográficos Cardiac influence on mechanical ventilation time and mortality in exacerbated chronic respiratory failure patients: The role of echocardiographic parameters

Author

Paulo Marcelino, Nuno Germano, Ana Paiva Nunes, Lígia Flora, Ana Moleiro, Susan Marum, and Ana Paula Fernandes

Subjects
Insuficiência respiratória crónica, ventilação mecânica, ecocardiografia, Mechanical ventilation, chronic respiratory failure, echocardiography, Diseases of the respiratory system, RC705-779
Abstract

Objectivo: estudar determinantes cardiovasculares condicionantes do tempo de ventilação, mortalidade e gravidade de doença em doentes admitidos numa unidade de cuidados intensivos para ventilação mecânica por exacerbação de insuficiência respiratória crónica. Desenho e local: Estudo prospectivo, com duração de 30 meses numa unidade de cuidados intensivos médico-cirúrgica com 14 camas. Material e métodos: Estudados 59 doentes com idade média de 74,7 +/- 9,7 anos, tempo médio de ventilação de 10,8 +/- 12,6 dias, APACHE II médio de 23 +/- 8,3. Avaliaram-se parâmetros ecocardiográficos (dimensões das cavidades, débito cardíaco, estudo Doppler do fluxo transvalvular mitral, estudo da veia cava inferior) e electrocardiográficos (presença de ritmo sinusal ou fibrilhação auricular) nas primeiras 24 horas de internamento na Unidade e parâmetros gasimétricos à saída. Resultados: Um tempo de ventilação mais prolongado associou-se à presença de fibrilhação auricular (p=0,027), à presença conjunta de fibrilhação auricular e uma veia cava inferior dilatada (> 20mm p=0,004) e com níveis séricos de bicarbonato> 35mEq/l na gasimetria obtida à saída (p=0,04). Verificaram-se 12 óbitos. A mortalidade associou-se à presença de dilatação do ventrículo direito (p=0,03) e a uma relação entre o ventrículo direito e o esquerdo> 0,6 (p=0,04). Conclusão: Nos doentes submetidos a ventilação mecânica por exacerbação de insuficiência respiratória crónica, a presença de fibrilhação auricular indica a possibilidade de um período de ventilação mais prolongado, em especial se houver concomitantemente uma veia cava inferior com diâmetro> 20mm. Nestes doentes, a presença de dilatação das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade.Objective: To study the influence of cardiac status on the length of mechanical ventilation, outcome and disease severity in patients admitted to an Intensive Care Unit (ICU) with exacerbation of chronic respiratory failure. Design and setting: A 30-month prospective study in a 14 bed ICU Patients and methods: Fifty nine patients were enrolled, with a mean age 74.7 +/- 9.7 years, mean length of ventilator support 10.8 +/- 12.6 days, and mean APACHE II score 23 +/- 8.3. Within the first 24 hours of admittance, cardiac chamber dimensions, inferior vena cava (IVC), and mitral transvalvular Doppler were evaluated using transthoracic echocardiography; the cardiac rhythm was recorded (presence of sinus rhythm or atrial fibrillation). Blood gases were evaluated at dis charge. Results: Greater length of ventilation was observed in patients presenting atrial fibrillation (p=0.027), particularly when a dilated IVC was also present (>20mm, p=0.004). A high level of serum bicarbonate (>35mEq/l), was also related with longer ventilation (p=0. 04). Twelve patients died. Mortality was related to the presence of a dilated right ventricle (p=0. 03) and a ratio between right and left ventricle> 0. 6 (p=0.04). Conclusion: Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period, particularly if a dilated IVC is also present. Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome.

Published
2006

2. Determinantes cardíacas do tempo de ventilação mecânica e mortalidade de doentes com insuficiência respiratória crónica exacerbada. A importância dos parâmetros ecocardiográficos

Author

Paulo Marcelino, Nuno Germano, Ana Paiva Nunes, Lígia Flora, Ana Moleiro, Susan Marum, and Ana Paula Fernandes

Subjects
Diseases of the respiratory system, RC705-779
Abstract

Resumo: Objectivo: estudar determinantes cardiovasculares condicionantes do tempo de ventilação, mortalidade e gravidade de doença em doentes admitidos numa unidade de cuidados intensivos para ventilação mecânica por exacerbação de insuficiência respiratória crónica.Desenho e local: Estudo prospectivo, com duração de 30 meses numa unidade de cuidados intensivos médico-cirúrgica com 14 camas.Material e métodos: Estudados 59 doentes com idade média de 74,7 +/- 9,7 anos, tempo médio de ventilação de 10,8 +/- 12,6 dias, APACHE II médio de 23 +/- 8,3. Avaliaram-se parâmetros ecocardiográficos (dimensões das cavidades, débito cardíaco, estudo Doppler do fluxo transvalvular mitral, estudo da veia cava inferior) e electrocardiográficos (presença de ritmo sinusal ou fibrilhação auricular) nas primeiras 24 horas de internamento na Unidade e parâmetros gasimétricos à saída.Resultados: Um tempo de ventilação mais prolongado associou-se à presença de fibrilhação auricular (p=0,027), à presença conjunta de fibrilhação auricular e uma veia cava inferior dilatada (> 20 mm p=0,004) e com níveis séricos de bicarbonato> 35 mEq/l na gasimetria obtida à saída (p=0,04). Verificaram-se 12 óbitos. A mortalidade associou-se à presença de dilatação do ventrículo direito (p=0,03) e a uma relação entre o ventrículo direito e o esquerdo> 0,6 (p=0,04). Conclusão: Nos doentes submetidos a ventilação mecânica por exacerbação de insuficiência respiratória crónica, a presença de fibrilhação auricular indica a possibilidade de um período de ventilação mais prolongado, em especial se houver concomitantemente uma veia cava inferior com diâmetro> 20 mm. Nestes doentes, a presença de dilatação das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade.Rev Port Pneumol 2006; XII (2): 131-146 Abstract: Objective: To study the influence of cardiac status on the length of mechanical ventilation, outcome and disease severity in patients admitted to an Intensive Care Unit (ICU) with exacerbation of chronic respiratory failure.Design and setting: A 30-month prospective study in a 14 bed ICUPatients and methods: Fifty nine patients were enrolled, with a mean age 74.7 +/â9.7 years, mean length of ventilator support 10.8 +/â12.6 days, and mean APACHE II score 23 +/- 8.3. Within the first 24 hours of admittance, cardiac chamber dimensions, inferior vena cava (IVC), and mitral transvalvular Doppler were evaluated using transthoracic echocardiography; the cardiac rhythm was recorded (presence of sinus rhythm or atrial fibrillation). Blood gases were evaluated at discharge.Results: Greater length of ventilation was observed in patients presenting atrial fibrillation (p=0.027), particularly when a dilated IVC was also present (>20 mm, p=0.004). A high level of serum bicarbonate (>35 mEq/l), was also related with longer ventilation (p=0. 04). Twelve patients died. Mortality was related to the presence of a dilated right ventricle (p=0. 03) and a ratio between right and left ventricle> 0. 6 (p=0.04). Conclusion: Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period, particularly if a dilated IVC is also present. Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome.Rev Port Pneumol 2006; XII (2): 131-146 Palavras-chave: Insuficiência respiratória crónica, ventilação mecânica, ecocardiografia, Key-words: Mechanical ventilation, chronic respiratory failure, echocardiography

Published
2006
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3. Functional Outcome after Mechanical Thrombectomy with or without Previous Thrombolysis

Author

Alberto Fior, Ana Luísa Papoila, Marta Alves, João Gilberto Mendes dos Reis, Ana Paiva Nunes, Manuel Machado, and Isabel Fragata

Subjects
Male, Time Factors, Databases, Factual, Ischemic Stroke / physiopathology, medicine.medical_treatment, HSJ UCV, Stroke onset, Thrombectomy* / adverse effects, Disability Evaluation, 0302 clinical medicine, Risk Factors, Thrombolytic Therapy, Infusions, Intravenous, Stroke, Thrombectomy, Aged, 80 and over, Ischemic Stroke / therapy, Standard treatment, Rehabilitation, Thrombolysis, Middle Aged, Combined Modality Therapy, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Thrombolytic Therapy* / adverse effects, Female, Cardiology and Cardiovascular Medicine, Fibrinolytic Agents / administration & dosage, CHLC CINV, Time-to-Treatment, 03 medical and health sciences, Fibrinolytic Agents, medicine, Ischemic Stroke / diagnosis, Humans, Ischemic Stroke, Aged, Retrospective Studies, Groin, business.industry, Recovery of Function, medicine.disease, Mechanical thrombectomy, Functional Status, Intravenous therapy, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, Large vessel occlusion, Fibrinolytic Agents / adverse effects
Abstract

Introduction: Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. Objectives: To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. Methods: Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. Results: A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age

Published
2021

4. Mechanical Thrombectomy in Stroke in Nonagenarians: Useful or Futile?

Author

João Gilberto Mendes dos Reis, Mariana Baptista, Isabel Fragata, Mafalda Mendes Pinto, Jaime Pamplona, Rui A. Carvalho, Ana Paiva Nunes, Ana Luísa Papoila, and Marta Alves

Subjects
Male, Time Factors, HSJ NEU, medicine.medical_treatment, Brain Ischemia, Thrombectomy* / adverse effects, Disability Evaluation, 0302 clinical medicine, Modified Rankin Scale, Risk Factors, Brain Ischemia / diagnosis, Hospital Mortality, Stroke, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Standard treatment, Rehabilitation, Age Factors, Stroke / mortality, humanities, Patient Discharge, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Thrombectomy* / mortality, Clinical Decision-Making, HSJ NRAD, CHLC CINV, Revascularization, Risk Assessment, Cerebral edema, Stroke / physiopathology, 03 medical and health sciences, medicine, Humans, Brain Ischemia / mortality, Retrospective Studies, business.industry, Patient Selection, Recovery of Function, medicine.disease, Brain Ischemia / therapy, Brain Ischemia / physiopathology, Surgery, Mechanical thrombectomy, Stroke / diagnosis, Angiography, Stroke / therapy, Neurology (clinical), business, Complication, 030217 neurology & neurosurgery
Abstract

Background: Mechanical thrombectomy is the standard treatment in acute ischemic stroke due to large vessel occlusion, but there is limited evidence about its efficacy in very old patients. We sought to analyse safety and effectiveness of mechanical thrombectomy in nonagenarian versus octagenarian patients. Methods: We included consecutive patients with acute ischemic stroke due to large vessel occlusion subjected to mechanical thrombectomy, during 29 months in a tertiary center. Patients were divided into two sub-groups, according to age: 80-89 and >90 years old. Recanalization, complications, functional outcome and mortality at discharge and at 3 months were compared. Multivariable analysis was performed to identify independent predictors of functional outcome at 3 months of follow-up, assessed by the modified Rankin Scale. Results: A total of 128 octogenarians (88.9%) and 16 nonagenarians (11.1%) met the inclusion criteria. Successful revascularization was achieved in 87.5% of octagenarians and in 81.3% of nonagenarians (p = 0.486). Symptomatic hemorrhage occurred in 3.1% and 6.3% of younger and older patients, respectively (p = 0.520). Cerebral edema occured in 35.2% of octagenarians versus 25.0% of nonagenarians (p = 0.419). Functional independence (mRS ≤ 2) at 3 months was achieved in 28 (22.6%) and 5 (31.3%) of octagenarians and nonagenarians, respectively (p = 0.445). Mortality at 3 months was not significantly higher in nonagenarians (37.5%) versus octagenarians (33.9%, p = 0.773). Conclusions: No significant diferences were found in functional outcome, mortality, recanalization and complication rates between octagenarians and nonagenarians submitted to mechanical thrombectomy, underlining that patients should not be excluded from mechanical thrombectomy based on age alone. info:eu-repo/semantics/publishedVersion

Published
2020

5. Left ventricular systolic dysfunction detected by speckle tracking in hypertensive patients with preserved ejection fraction

Author

Adriana Belo, Nuno Cortez-Dias, Ana Paiva Nunes, Fausto J. Pinto, Susana Gonçalves, Inês Zimbarra Cabrita, Catarina Sousa, and Repositório da Universidade de Lisboa

Subjects
Male, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Ventricular Dysfunction, Left, Systolic strain, Internal medicine, medicine, Humans, Statistical analysis, General Environmental Science, Subclinical infection, Ultrasonography, Speckle tracking, Ejection fraction, Sub-clinical left ventricular dysfunction, Ventricular function, business.industry, Stroke Volume, Middle Aged, Myocardial strain, medicine.disease, Hypertensive heart disease, Blood pressure, Cross-Sectional Studies, Echocardiography, lcsh:RC666-701, Hypertension, Cardiology, General Earth and Planetary Sciences, Female, business
Abstract

Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved., Introduction: The spectrum of hypertensive heart disease is wide, and can include left ventricular dysfunction. The development of echocardiographic parameters to improve patient stratification and to identify early adverse changes could be clinically useful. Aim: To identify subclinical left ventricular dysfunction in hypertensive subjects with preserved ejection fraction (>55%), identified by global parameters of myocardial strain on speckle tracking imaging. Methods: This was a comparative observational study of two groups of individuals: normotensive (n=20, age 59±7 years, 55% male) and hypertensive (n=229, age 62±12 years, 57% male). Left ventricular function was assessed by various conventional clinical and echocardiographic parameters and global longitudinal and circumferential myocardial strain. Cut-off values to detect subclinical left ventricular dysfunction were established and applied in the hypertensive group. The Student's t test, Mann-Whitney test and chi-square test were used for the comparative statistical analysis. Results: Most hypertensive subjects (53.7%) had grade I hypertension; blood pressure was controlled in 64.9%, and 54.8% showed left ventricular structural changes. Comparison between the normotensive and hypertensive groups showed no significant differences in parameters of global longitudinal or circumferential systolic strain. Application of the cut-offs to the hypertensive group identified 35 individuals (15.3%) as having subclinical left ventricular systolic dysfunction as assessed by global longitudinal myocardial strain parameters. Conclusions: In this group of hypertensive patients, global myocardial strain parameters identified a group of individuals with subclinical left ventricular systolic dysfunction despite preserved ejection fraction. The clinical relevance of these findings needs to be assessed in long-term follow-up studies., Introdução: O espectro da cardiopatia hipertensiva é diverso podendo ir até à disfunção ventricular esquerda. O desenvolvimento de metodologias ecocardiográficas que permitam melhorar o estadiamento da cardiopatia hipertensiva e identificar precocemente hipertensos em risco de evolução desfavorável poderá ser clinicamente relevante. Objetivos: Identificar o compromisso subclínico da função ventricular esquerda em indivíduos hipertensos com fração de ejeção preservada (> 55%), utilizando parâmetros globais da deformação miocárdica (Speckle Tracking). Metodologia: Foram estudados dois grupos de indivíduos: normotensos (N = 20; 59 ± 7 anos; 55% homens) e hipertensos (N = 229; 62 ± 12 anos; 57% homens), tendo sido avaliados vários parâmetros clínicos e ecocardiográficos de função ventricular esquerda (convencionais e parâmetros globais da deformação miocárdica longitudinal e circunferencial). Foram determinados os cut-offs da normalidade a partir do grupo de normotensos e aplicados ao grupo de hipertensos, para se detetar disfunção ventricular esquerda subclínica. Foram utilizados os testes t de Student, Mann-Whitney e do Qui-Quadrado. Resultados: O grupo de hipertensos apresentou na sua maioria hipertensão arterial do tipo I (53,7%), pressão arterial controlada (64,9%) e alteração estrutural do ventrículo esquerdo em 54,8% dos indivíduos. Não se detetaram diferenças significativas entre os grupos nos parâmetros globais de deformação longitudinal ou circunferencial. Após aplicação dos cut-offs da normalidade nos hipertensos, foram identificados 35 indivíduos (15,3%) com disfunção ventricular esquerda subclínica. Conclusões: A avaliação da deformação miocárdica permitiu identificar o compromisso sistólico subclínico da função ventricular esquerda num grupo de hipertensos com fração de ejeção preservada. A relevância clínica destes achados deverá ser confirmada por estudos de follow up prolongado.

Published
2014

6. Disfunção sistólica ventricular esquerda detetada por speckle tracking em hipertensos com fração de ejeção preservada

Author

Inês Zimbarra Cabrita, Adriana Belo, Catarina Sousa, Ana Paiva Nunes, Susana Gonçalves, Nuno Cortez-Dias, and Fausto J. Pinto

Subjects
Gynecology, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, business.industry, lcsh:RC666-701, Hipertensao arterial, Myocardial strain, medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Resumo: Introdução: O espectro da cardiopatia hipertensiva é diverso podendo ir até à disfunção ventricular esquerda. O desenvolvimento de metodologias ecocardiográficas que permitam melhorar o estadiamento da cardiopatia hipertensiva e identificar precocemente hipertensos em risco de evolução desfavorável poderá ser clinicamente relevante. Objetivos: Identificar o compromisso subclínico da função ventricular esquerda em indivíduos hipertensos com fração de ejeção preservada (> 55%), utilizando parâmetros globais da deformação miocárdica (speckle tracking). Metodologia: Foram estudados dois grupos de indivíduos: normotensos (N = 20; 59 + 7 anos; 55% homens) e hipertensos (N = 229; 62 + 12 anos; 57% homens), tendo sido avaliados vários parâmetros clínicos e ecocardiográficos de função ventricular esquerda (convencionais e parâmetros globais da deformação miocárdica longitudinal e circunferencial). Foram determinados os cut-offs da normalidade a partir do grupo de normotensos e aplicados ao grupo de hipertensos, para se detetar disfunção ventricular esquerda subclínica. Foram utilizados os testes t de Student, Mann-Whitney e do Qui-Quadrado. Resultados: O grupo de hipertensos apresentou na sua maioria hipertensão arterial do tipo I (53,7%), pressão arterial controlada (64,9%) e alteração estrutural do ventrículo esquerdo em 54,8% dos indivíduos. Não se detetaram diferenças significativas entre os grupos nos parâmetros globais de deformação longitudinal ou circunferencial. Após aplicação dos cut-offs da normalidade nos hipertensos, foram identificados 35 indivíduos (15,3%) com disfunção ventricular esquerda subclínica. Conclusões: A avaliação da deformação miocárdica permitiu identificar o compromisso sistólico subclínico da função ventricular esquerda num grupo de hipertensos com fração de ejeção preservada. A relevância clínica destes achados deverá ser confirmada por estudos de follow–up prolongado. Abstract: Introduction The spectrum of hypertensive heart disease is wide, and can include left ventricular dysfunction. The development of echocardiographic parameters to improve patient stratification and to identify early adverse changes could be clinically useful.Aim To identify subclinical left ventricular dysfunction in hypertensive subjects with preserved ejection fraction (>55%), identified by global parameters of myocardial strain on speckle tracking imaging.Methods This was a comparative observational study of two groups of individuals: normotensive (n=20, age 59±7 years, 55% male) and hypertensive (n=229, age 62±12 years, 57% male). Left ventricular function was assessed by various conventional clinical and echocardiographic parameters and global longitudinal and circumferential myocardial strain. Cut-off values to detect subclinical left ventricular dysfunction were established and applied in the hypertensive group. The Student's t test, Mann-Whitney test and chi-square test were used for the comparative statistical analysis.Results Most hypertensive subjects (53.7%) had grade I hypertension; blood pressure was controlled in 64.9%, and 54.8% showed left ventricular structural changes. Comparison between the normotensive and hypertensive groups showed no significant differences in parameters of global longitudinal or circumferential systolic strain. Application of the cut-offs to the hypertensive group identified 35 individuals (15.3%) as having subclinical left ventricular systolic dysfunction as assessed by global longitudinal myocardial strain parameters.Conclusions In this group of hypertensive patients, global myocardial strain parameters identified a group of individuals with subclinical left ventricular systolic dysfunction despite preserved ejection fraction. The clinical relevance of these findings needs to be assessed in long-term follow-up studies. Palavras-chave: Hipertensão arterial, Deformação miocárdica, Disfunção ventricular esquerda subclínica, Ecocardiografia, Speckle tracking, Keywords: Hypertension, Myocardial strain, Subclinical left ventricular dysfunction, Echocardiography, Speckle tracking

Published
2014

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