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1. Desfecho a Curto e Longo Prazo Após Ablação Septal Alcoólica na Miocardiopatia Hipertrófica Obstrutiva: Experiência num Centro de Referência

Author

Rui Cruz Ferreira, Ana Galrinho, António Fiarresga, Bernardes L, António Valentim Gonçalves, Ruben Ramos, Lídia de Sousa, Lino Patrício, Sílvia Aguiar Rosa, Luísa Moura Branco, and Duarte Cacela

Subjects
Ablation Techniques, Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Alcohol septal ablation, medicine.medical_specialty, Time Factors, Ventricular Outflow Obstruction, Ventricular Septum, HSM CAR, Nyha class, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Clinical endpoint, medicine, Ventricular outflow tract, Humans, 030212 general & internal medicine, Cardiac Surgical Procedures, Lead (electronics), General Environmental Science, Retrospective Studies, Ethanol, business.industry, Retrospective cohort study, Cardiomyopathy, Hypertrophic, Middle Aged, Treatment Outcome, 030228 respiratory system, lcsh:RC666-701, Echocardiography, Cardiology, General Earth and Planetary Sciences, Female, Obstructive hypertrophic cardiomyopathy, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Introduction: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. Methods: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. Results: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker.The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. Conclusion: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause. Resumo: Introdução: Na miocardiopatia hipertrófica obstrutiva (MCHO), ablação septal alcoólica (ASA) pode levar a redução do gradiente e melhoria sintomática. O objetivo foi avaliar a eficácia e segurança da ASA no desfecho a longo prazo. Métodos: Análise de doentes submetidos a ASA, durante sete anos, num centro terciário. Endpoint primário ecocardiográfico: redução >50% do gradiente na câmara de saída do ventrículo esquerdo (CSVE) durante o primeiro ano após o procedimento. Endpoints primários clínicos: a) melhoria da capacidade funcional; b) endpoint combinado: morte de causa cardíaca+hospitalização de causa cardíaca. Tempo de seguimento 4,17±2,13 anos. Resultados: Oitenta doentes, idade média de 63,9±12,3 anos, 30,0% homens. De base, o gradiente na CSVE era 96,3±34,6 mmHg, espessura do septo interventricular 21,6±3,1 mm. Complicações minor foram verificadas em 6,3%, complicações major em 2,5% e 8,8% receberam um pacemaker definitivo. O endpoint primário ecocardiográfico foi atingido em 85,7%. Aos três meses, o gradiente na CSVE foi de 25,8±26,0 mmHg no grupo com sucesso no procedimento contrastando com 69,2±35,6 mmHg nos restantes doentes (p=0,001). Aos seis meses, os gradientes na CSVE foram 27,1±27,4 versus 58,2±16,6 mmHg (p=0,024).De entre os 74 doentes em classe NYHA III/IV antes do procedimento, 57 (77%) melhoraram para classe NYHA I/II. O endpoint primário combinado (morte de causa cardíaca+hospitalização de causa cardíaca) verificou-se em 27,5% (n=22). No grupo sem sucesso, o endpoint primário composto verificou-se em 54,5%, contrastando com apenas 22,7% no grupo com sucesso. Apenas dois doentes apresentaram morte de causa cardíaca. Conclusão: A ASA é um procedimento seguro com elevada taxa de sucesso. Doentes que atingiram redução significativa do gradiente na CSVE apresentam menor morte de causa cardíaca e hospitalização de causa cardíaca. Keywords: Obstructive hypertrophic cardiomyopathy, Alcohol septal ablation, Left ventricular outflow tract gradient, Palavras chave: Miocardiopatia hipertrófica obstrutiva, Ablação septal alcoólica, Gradiente na câmara de saída do ventrículo esquerdo

Published
2019

2. Interventional treatment in diabetics in the era of drug-eluting stents and compliance to the ESC guidelines: lessons learned from the Euro Heart Survey Programme

Author

Onuma Y., Kukreja N., Ramcharitar S., Hochadel M., Gitt A., Serruys P., Marco J., Vahanian A., Weidinger F., Wijns W., Zeymer U., Silber S., Seabra-Gomez R., Eberli F., Manini M., Bramley C., Laforest V., Taylor C., Huber K., Backer G. D., Sirakova V., Cerbak R., Thayssen P., Aziz O. A., Tammam K., Lehto S., Delahaye F., Kobulia B., Cokkinos D., Kremastinos D., Karlocai K., Shelley E., Behar S., Maggioni A., Grabauskiene V., Deckers J., Asmussen I., Stepinska J., Goncalves L., Fonseca C., Mareev V., Vasilijevic Z., Riecansky M. I., Kenda M. F., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Schofield P., Gitt A. K., Tavazzi L., Gomes R. S., de la Iglesia J. M., Wallentin L., Kearney P., McGregor K., Simoons M. L., Squibb B. -M., Lilly E., Margaryan K., Khachatryan S., Doerler J., Stocker E. -M., Altenberger I. J., Heigert M., Pichler M., Christ S. G., Glogar H., Lang I., Ingerle S., De Wilde P., de Marneffe M., Vrolix B. M., Dens J., Lierde J. V., De Wagter G. X., Carlier G. M., Weyne G. A., Legrand K. V., Doneux P., Gach O., Davin L., Mievis L. E., Massart P. -E., Holvoet N. G., Giunio L., Glavas D., Vukovic I., Markovic B., Duplancic D., Runjic F., Galic S. E., Mirat J., Kala P., Semenka J., Hlinomaz O., Petrikovits E., Widimsky B. P., Tousek P., Varvarovsky P. I., Cappelen H., Helqvist O. S., Kelbaek H., Jorgensen E., Engstrom T., Saunamaki K., Kastrup J., Clemmensen P., Hansen H., Al Abbadi M., Razek H. A., Aboul el Nasr G., Ragi H., Ibrihim B., Zarif B., el Banhawy N., Sorour K., Meguid M. A., Mahrous A., Al Khashab K. A., Ahmed Abd Elmoniem F., El Emry M., El Naggar A., Saad B. A., Laanmets P., Voitk J., Lutter P., Jarvekulg S., Jalakas M., Reinmets J., Marandi T., Peeba M., Serka T., Syvannne M., Kaihovirta E., Korpilahti H. K., Vaittinen M. -A., Bassand J. -P., Espinosa D. P., Cottin B. Y., Lhuillier I., Buffet P., Lorgis L., Machecourt D. J., Bertrand B., Serrano D., Bonnet G. J. -L., Steg M. P. G., Juliard J. -M., Farnoud R., Delarche P. N., Marco P. J., Petit F., Farah B., Carrie D., Galinier M., Puel J., Cahuzac J., Roncalli J., Tauzin S., Elbaz M., Schachinger V., Gitt F. A., am Rhein Ralf Zahn L., Fraiture B., Haetinger S., Klepzig N. H., Girth E., Hauber A., Firschke O. C., Widmaier J., Hofbauer F., Huttl S., Sechtem P. U., Parade U., Linnartz S. G., Andrianidis S., Tsiavou N., Papaioannou G., Deliargyris E., Attikis M., Alexopoulos D., Davlouros P., Tsikaderis D., Dardas P., Mezilis N., Istvan E., Zoltan B., Turgeman Y., Khaled S., Feldman A., Jafari J., Manevich I., Cafri C., Ilia R., Abu-Ful A., Yaroslavslev S., Wainstain J. M., Rosenchtein G., Sheva B., Krakover R., Yakov B., Halon D., Gruberg L., Markiewicz W., Grenadier E., Boulos M., Roguin A., Kerner A., Amikam S., Ben-Tzvi M., Rezmovitz J., Mosseri H. M., Lotan H., Varshizky B., Nassar H., Daninberg H., Rot D., Vais T., Benhorin J., Keren A., Medina A., Huri Z., Brandis J. S., Schoenmann G., Kornowski N. R., Assali A., Fuch S., Hasdai D., Brosh D., Sela O., Teplitski I., Tikva P., Eisenberg O., Banai S., Finkelstein A., Hasin Y., Aboud M., Nahir M., Qarwani D., Diab G., Meloni L., Lai G., Cadeddu M., Pirisi R., Bonechi F., Nassi F., Nieri M., Taiti A., Naldoni A., Calabro F., Achilli F., Maggiolini S., Piatti L., Tiberti G., Addamiano P., Berti S., Ravani M., Palmieri C., Trianni G., Cardullo S., Cioppa A., Rubino P., Ambrosini V., Salemme L., Sorropago G., Tesorio T., Geraci G., Scalise F., Mazzeti S., Auguadro C., Esposito G., Canali G., Caccia M. E., Ruggieri C., Benedetta B., de Cesare N., De Benedictis M., Coco T., Manzotti S., Fraz O. S., Marraccini P., Danesi A., Ricci R., Ferraironi A., Olivieri E., Chiera A., Garducci S., Grasseli D., McFadden E., Cahill N., Quinn M., Crean P., Caroll E., Foley D., O'Connor S., O'Hanlon R., Lynch B., O'Donnell S., Roy J., O'Brien D., Krastina A., Erglis A., Lawand S., Dorniak W., Klaudel J., Pawlowski K., Trenkner W., Janion M., Sadowski M., Janion-Sadowska A., Skorupa I., Bystryk L., Kern A., Janiak B., Szelemej R., Ruzyllo W., Witkowski A., Deptuch T., Maczynska-Mazuruk R., Budaj A., Cegieska K. L., Opolski G., Wilczyska J., Roik M., Kochman J., Martins D., Goncalves I. M. F. J., Pereira H., Faria H., Calisto J., Matos V., Leitao-Marques A., Costa M., Oliveira H., Mota P., Santos W., Brandao V., Caires F. G., Silva B., Teles F. R. C., Almeida M., Goncalves P., Raposo L., Mourao L., Bernardes L., Pedro P. G., Ferreira R., Conduto R., Quininha J., Patricio L., Cacela D., Goncalves J. M., de Sousa L., Adao M., Carvalho L. H. C., Romeira H., Sousa J. P., Garcia J. M. M., Silva J. C., Magalhaes D., Santos P. R., Mendes S. P. G., Pipa J., Nunes L., Ferreira P., Vinereanu D., Udroiu C., Florescu N., Parvu O., Stoicescu C., Dorobantu M., Balanescu S. M., Niculescu R., Calmac L., Marinescu M., Olinic B. D., Ober M., Homorodean C., Budurea C., Hij A., Anton F., Cluj-Napoca, Ortan F., Suciu C., Ursu M., Baba C., Targu-Mures, Dragulescu S. I., Petrescu L., Slovenski M., Gavrilescu D., Dina C., Mut B., Babic R., Colic M., Topic D., Vilarrasa J. B., Pont M. P., Martorell R. M., Rohlfs I., Moreno R. M., Irurita M., Irurita J., de Gran Canaria L. P., Cervantes C. E., Galvan T., Navarro J., Franco D., Rodriguez I. S., Ramirez V. H., Fernandes-Aviles F., Revilla A., Masson N., Dupertuis V., Kachboura S., Iyisoy A., Erol M. K., Ongen Z., Babalik E., Oskan M., Ozdemir N., Oto A., Aytemir K., Yavuz B., Sahin M., Durna K., Aytekin V., Demiroglu C., Gulbaran M., Aytekin S., Catakoglu A. B., Ozme B., Gemici G., Feray H., Schofield P. M., Kahn S., Clarke S., Millington H., Di Mario C., Dempster D., Henderson R. A., Burton J., Falcon-Lang D., Cardiology, Onuma, Y., Kukreja, N., Ramcharitar, S., Hochadel, M., Gitt, A., Serruys, P., Marco, J., Vahanian, A., Weidinger, F., Wijns, W., Zeymer, U., Silber, S., Seabra-Gomez, R., Eberli, F., Manini, M., Bramley, C., Laforest, V., Taylor, C., Huber, K., Backer, G. D., Sirakova, V., Cerbak, R., Thayssen, P., Aziz, O. A., Tammam, K., Lehto, S., Delahaye, F., Kobulia, B., Cokkinos, D., Kremastinos, D., Karlocai, K., Shelley, E., Behar, S., Maggioni, A., Grabauskiene, V., Deckers, J., Asmussen, I., Stepinska, J., Goncalves, L., Fonseca, C., Mareev, V., Vasilijevic, Z., Riecansky, M. I., Kenda, M. F., Lopez-Sendon, J. L., Rosengren, A., Buser, P., Okay, T., Sychov, O., Schofield, P., Gitt, A. K., Tavazzi, L., Gomes, R. S., de la Iglesia, J. M., Wallentin, L., Kearney, P., Mcgregor, K., Simoons, M. L., Squibb, B. -M., Lilly, E., Margaryan, K., Khachatryan, S., Doerler, J., Stocker, E. -M., Altenberger, I. J., Heigert, M., Pichler, M., Christ, S. G., Glogar, H., Lang, I., Ingerle, S., De Wilde, P., de Marneffe, M., Vrolix, B. M., Dens, J., Lierde, J. V., De Wagter, G. X., Carlier, G. M., Weyne, G. A., Legrand, K. V., Doneux, P., Gach, O., Davin, L., Mievis, L. E., Massart, P. -E., Holvoet, N. G., Giunio, L., Glavas, D., Vukovic, I., Markovic, B., Duplancic, D., Runjic, F., Galic, S. E., Mirat, J., Kala, P., Semenka, J., Hlinomaz, O., Petrikovits, E., Widimsky, B. P., Tousek, P., Varvarovsky, P. I., Cappelen, H., Helqvist, O. S., Kelbaek, H., Jorgensen, E., Engstrom, T., Saunamaki, K., Kastrup, J., Clemmensen, P., Hansen, H., Al Abbadi, M., Razek, H. A., Aboul el Nasr, G., Ragi, H., Ibrihim, B., Zarif, B., el Banhawy, N., Sorour, K., Meguid, M. A., Mahrous, A., Al Khashab, K. A., Ahmed Abd Elmoniem, F., El Emry, M., El Naggar, A., Saad, B. A., Laanmets, P., Voitk, J., Lutter, P., Jarvekulg, S., Jalakas, M., Reinmets, J., Marandi, T., Peeba, M., Serka, T., Syvannne, M., Kaihovirta, E., Korpilahti, H. K., Vaittinen, M. -A., Bassand, J. -P., Espinosa, D. P., Cottin, B. Y., Lhuillier, I., Buffet, P., Lorgis, L., Machecourt, D. J., Bertrand, B., Serrano, D., Bonnet, G. J. -L., Steg, M. P. G., Juliard, J. -M., Farnoud, R., Delarche, P. N., Marco, P. J., Petit, F., Farah, B., Carrie, D., Galinier, M., Puel, J., Cahuzac, J., Roncalli, J., Tauzin, S., Elbaz, M., Schachinger, V., Gitt, F. A., am Rhein Ralf Zahn, L., Fraiture, B., Haetinger, S., Klepzig, N. H., Girth, E., Hauber, A., Firschke, O. C., Widmaier, J., Hofbauer, F., Huttl, S., Sechtem, P. U., Parade, U., Linnartz, S. G., Andrianidis, S., Tsiavou, N., Papaioannou, G., Deliargyris, E., Attikis, M., Alexopoulos, D., Davlouros, P., Tsikaderis, D., Dardas, P., Mezilis, N., Istvan, E., Zoltan, B., Turgeman, Y., Khaled, S., Feldman, A., Jafari, J., Manevich, I., Cafri, C., Ilia, R., Abu-Ful, A., Yaroslavslev, S., Wainstain, J. M., Rosenchtein, G., Sheva, B., Krakover, R., Yakov, B., Halon, D., Gruberg, L., Markiewicz, W., Grenadier, E., Boulos, M., Roguin, A., Kerner, A., Amikam, S., Ben-Tzvi, M., Rezmovitz, J., Mosseri, H. M., Lotan, H., Varshizky, B., Nassar, H., Daninberg, H., Rot, D., Vais, T., Benhorin, J., Keren, A., Medina, A., Huri, Z., Brandis, J. S., Schoenmann, G., Kornowski, N. R., Assali, A., Fuch, S., Hasdai, D., Brosh, D., Sela, O., Teplitski, I., Tikva, P., Eisenberg, O., Banai, S., Finkelstein, A., Hasin, Y., Aboud, M., Nahir, M., Qarwani, D., Diab, G., Meloni, L., Lai, G., Cadeddu, M., Pirisi, R., Bonechi, F., Nassi, F., Nieri, M., Taiti, A., Naldoni, A., Calabro, F., Achilli, F., Maggiolini, S., Piatti, L., Tiberti, G., Addamiano, P., Berti, S., Ravani, M., Palmieri, C., Trianni, G., Cardullo, S., Cioppa, A., Rubino, P., Ambrosini, V., Salemme, L., Sorropago, G., Tesorio, T., Geraci, G., Scalise, F., Mazzeti, S., Auguadro, C., Esposito, G., Canali, G., Caccia, M. E., Ruggieri, C., Benedetta, B., de Cesare, N., De Benedictis, M., Coco, T., Manzotti, S., Fraz, O. S., Marraccini, P., Danesi, A., Ricci, R., Ferraironi, A., Olivieri, E., Chiera, A., Garducci, S., Grasseli, D., Mcfadden, E., Cahill, N., Quinn, M., Crean, P., Caroll, E., Foley, D., O'Connor, S., O'Hanlon, R., Lynch, B., O'Donnell, S., Roy, J., O'Brien, D., Krastina, A., Erglis, A., Lawand, S., Dorniak, W., Klaudel, J., Pawlowski, K., Trenkner, W., Janion, M., Sadowski, M., Janion-Sadowska, A., Skorupa, I., Bystryk, L., Kern, A., Janiak, B., Szelemej, R., Ruzyllo, W., Witkowski, A., Deptuch, T., Maczynska-Mazuruk, R., Budaj, A., Cegieska, K. L., Opolski, G., Wilczyska, J., Roik, M., Kochman, J., Martins, D., Goncalves, I. M. F. J., Pereira, H., Faria, H., Calisto, J., Matos, V., Leitao-Marques, A., Costa, M., Oliveira, H., Mota, P., Santos, W., Brandao, V., Caires, F. G., Silva, B., Teles, F. R. C., Almeida, M., Goncalves, P., Raposo, L., Mourao, L., Bernardes, L., Pedro, P. G., Ferreira, R., Conduto, R., Quininha, J., Patricio, L., Cacela, D., Goncalves, J. M., de Sousa, L., Adao, M., Carvalho, L. H. C., Romeira, H., Sousa, J. P., Garcia, J. M. M., Silva, J. C., Magalhaes, D., Santos, P. R., Mendes, S. P. G., Pipa, J., Nunes, L., Ferreira, P., Vinereanu, D., Udroiu, C., Florescu, N., Parvu, O., Stoicescu, C., Dorobantu, M., Balanescu, S. M., Niculescu, R., Calmac, L., Marinescu, M., Olinic, B. D., Ober, M., Homorodean, C., Budurea, C., Hij, A., Anton, F., Cluj-Napoca, Ortan, F., Suciu, C., Ursu, M., Baba, C., Targu-Mures, Dragulescu, S. I., Petrescu, L., Slovenski, M., Gavrilescu, D., Dina, C., Mut, B., Babic, R., Colic, M., Topic, D., Vilarrasa, J. B., Pont, M. P., Martorell, R. M., Rohlfs, I., Moreno, R. M., Irurita, M., Irurita, J., de Gran Canaria, L. P., Cervantes, C. E., Galvan, T., Navarro, J., Franco, D., Rodriguez, I. S., Ramirez, V. H., Fernandes-Aviles, F., Revilla, A., Masson, N., Dupertuis, V., Kachboura, S., Iyisoy, A., Erol, M. K., Ongen, Z., Babalik, E., Oskan, M., Ozdemir, N., Oto, A., Aytemir, K., Yavuz, B., Sahin, M., Durna, K., Aytekin, V., Demiroglu, C., Gulbaran, M., Aytekin, S., Catakoglu, A. B., Ozme, B., Gemici, G., Feray, H., Schofield, P. M., Kahn, S., Clarke, S., Millington, H., Di Mario, C., Dempster, D., Henderson, R. A., Burton, J., and Falcon-Lang, D.

Subjects
Registrie, Male, medicine.medical_treatment, Angiotensin-Converting Enzyme Inhibitors, Comorbidity, Coronary Artery Disease, Severity of Illness Index, Cardiovascular Disease, Hospital Mortality, Registries, Angioplasty, Balloon, Coronary, Drug-Eluting Stents, Middle Aged, Clopidogrel, Europe, Treatment Outcome, Drug-eluting stent, Cardiovascular Diseases, Practice Guidelines as Topic, Female, Guideline Adherence, Inpatient, Cardiology and Cardiovascular Medicine, Human, medicine.drug, medicine.medical_specialty, Diabetic Angiopathie, Adrenergic beta-Antagonists, Diabetic, SDG 3 - Good Health and Well-being, Internal medicine, Diabetes mellitus, Angioplasty, medicine, Humans, Drug eluting stent, cardiovascular diseases, Risk factor, Aged, European Heart Survey, Inpatients, Clinical Audit, business.industry, Platelet Aggregation Inhibitor, Adrenergic beta-Antagonist, Angiotensin-Converting Enzyme Inhibitor, Guideline, medicine.disease, Surgery, Health Care Survey, Health Care Surveys, Conventional PCI, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, Diabetic Angiopathies, Platelet Aggregation Inhibitors
Abstract

Aims: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. Methods and results: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3,603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). Inhospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs 3.0%, p=0.09). Conclusions: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication. © Europa Edition. All rights reserved.

Published
2009
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3. Timing and long-term prognosis of recurrent MI after primary angioplasty : Stent thrombosis vs. non-stent-related reinfarction

Author

L. De Sousa, R Ramos, R Cruz Ferreira, Duarte Cacela, Lino Patrício, Bernardes L, C Soares, António Fiarresga, and A Viveiros Monteiro

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Comorbidity, 030204 cardiovascular system & hematology, HSM CAR, 03 medical and health sciences, Primary Percutaneous Coronary Intervention, 0302 clinical medicine, Age Distribution, Percutaneous Coronary Intervention, Recurrence, Risk Factors, Internal medicine, medicine, Prevalence, Humans, Stent Thrombosis, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Longitudinal Studies, Sex Distribution, Survival rate, Retrospective Studies, Portugal, business.industry, Mortality rate, Incidence, Percutaneous coronary intervention, Electrocardiography in myocardial infarction, Stent, Thrombosis, Middle Aged, medicine.disease, Prognosis, Combined Modality Therapy, ST Segment Elevation, Causality, Survival Rate, Treatment Outcome, Conventional PCI, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business
Abstract

BACKGROUND: In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI. PATIENTS AND METHODS: From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS: Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods. CONCLUSION: Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.

Published
2016

4. Ablação Septal Alcoólica no Tratamento da Cardiomiopatia Hipertrófica Obstrutiva - Experiência de Quatro Anos de um Centro

Author

Duarte Cacela, Rui Cruz Ferreira, Ruben Ramos, Bernardes L, Lino Patrício, Lídia de Sousa, Ana Galrinho, and António Fiarresga

Subjects
Ablation Techniques, Male, medicine.medical_specialty, Alcohol septal ablation, lcsh:Diseases of the circulatory (Cardiovascular) system, Percutaneous, Time Factors, HSM CAR, Refractory, Heart Septum, Medicine, Humans, General Environmental Science, Aged, Retrospective Studies, Medical treatment, Ethanol, business.industry, Retrospective cohort study, Cardiomyopathy, Hypertrophic/therapy, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, Heart septum, Hospitals, Surgery, lcsh:RC666-701, General Earth and Planetary Sciences, Female, Obstructive hypertrophic cardiomyopathy, business, Atrioventricular block
Abstract

Introduction: We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. Objective: To assess the results of ASA in all patients treated in the first four years of activity at our center. Methods: We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. Results: In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in‐hospital deaths; during clinical follow‐up (22±14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. Discussion and Conclusion: The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure‐related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment. Resumo: Introdução: A ablação septal alcoólica (ASA) é a forma percutânea de tratamento invasivo da cardiomiopatia hipertrófica obstrutiva (CMHO). A propósito da descrição da experiência no nosso centro, procurar‐se‐á rever as indicações, os aspetos técnicos e práticos e os resultados da ASA, assim como a sua posição atual em comparação com a miectomia cirúrgica. Objetivo: Avaliar os resultados da ASA numa série de doentes consecutivos tratados nos primeiros quatro anos de atividade. Métodos: Estudo retrospetivo de todos os doentes, consecutivos e não selecionados, com CMHO, tratados por ASA, entre janeiro de 2009 e fevereiro de 2013. Resultados: Durante o período de quatro anos foram tratados com ASA 40 doentes. Em três doentes (7,5%) repetiu‐se o procedimento. A taxa de sucesso foi de 84%. A taxa de complicações minor foi de 7,5%. Foi necessário implantar pacemaker definitivo por bloqueio‐auriculoventricular em dois doentes (6%, do subgrupo sem pacemaker prévio). A taxa de complicações major foi de 5%. Não houve mortalidade intra‐hospitalar nesta população. Durante o seguimento clínico (22 ± 14 meses) a mortalidade cardiovascular foi de 2,5%. A mortalidade total foi de 5%. Discussão e conclusão: Os resultados apresentados refletem a experiência inicial do tratamento com ASA no nosso centro. O procedimento foi bem‐sucedido na maioria dos doentes, sendo a taxa de sucesso semelhante à descrita em outras séries, mas ainda com possibilidade de beneficiar de uma melhor seleção dos doentes. A intervenção também se revelou segura, com uma baixa ocorrência de complicações e sem mortalidade associada. A ASA é uma alternativa percutânea no tratamento invasivo dos doentes com CMHO refratária à terapêutica médica. Keywords: Obstructive hypertrophic cardiomyopathy, Percutaneous treatment, Alcohol septal ablation, Palavras‐chave: Cardiomiopatia hipertrófica obstrutiva, Tratamento percutâneo, Ablação septal alcoólica

Published
2013

5. Safety and Effectiveness of the Genous™ Endothelial Progenitor Cell-Capture Stent in the First Year Following ST-Elevation Acute Myocardial Infarction: A Single Center Experience and Review of the Literature

Author

Bernardes L, Tiago Pereira-da-Silva, Duarte Cacela, Lino Patrício, Rui Cruz Ferreira, Lídia de Sousa, and António Fiarresga

Subjects
Male, medicine.medical_specialty, Angioplastia, medicine.medical_treatment, Enfarte do Miocárdio, Myocardial Infarction, Coronary Angiography, HSM CAR, Efeitos Adversos, Electrocardiography, Electrocardiografia, Internal medicine, Angiografia Coronária, Trombose, Resultado de Tratamento, medicine, Genous, Stent, Humans, Myocardial infarction, cardiovascular diseases, Angioplasty, Balloon, Coronary, Aged, Aged, 80 and over, Células-Tronco, business.industry, ST elevation, Stem Cells, Percutaneous coronary intervention, Endothelial Cells, Thrombosis, General Medicine, Angioplastia Coronária de Balão, Middle Aged, medicine.disease, Literatura de Revisão como Assunto, Surgery, Review Literature as Topic, Treatment Outcome, Células Endoteliais, Conventional PCI, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, TIMI, Mace
Abstract

Purpose The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. Methods and Materials All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12 months. Results In the cohort of 109 patients (73.4% male, 59 ± 12 years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00 mm (2.50–4.00) and median length of 15 mm (9–33). Cumulative MACEs were 2.8% at one month and 6.4% at 12 months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12 months, 33.9% of patients were not on dual antiplatelet therapy. Conclusions GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. Summary We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction.

Published
2013

6. [The QTc interval and its dispersion in hypertrophic myocardiopathy--its relation to complex ventricular arrhythmias and the effect of anti-arrhythmia agents]

Author

Mj, Sousa, Aranha J, Carlos Cotrim, Sousa L, Sequeira A, Rm, Soares, Abreu J, Bernardes L, Gracias R, and Salomão S

Subjects
Adult, Male, Chi-Square Distribution, Heart Ventricles, Adrenergic beta-Antagonists, Arrhythmias, Cardiac, Cardiomyopathy, Hypertrophic, Middle Aged, Calcium Channel Blockers, Electrocardiography, Humans, Female, Anti-Arrhythmia Agents, Aged, Retrospective Studies
Abstract

The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HCM): 1. The relation of rate corrected QT interval (QTc) and of QTc interlead variability (QTc dispersion) to complex ventricular arrhythmias (CVA); 2. The effects of amiodarone (Am), beta-blockers (beta B) and calcium antagonists (CA) on QTc and on QTc dispersion. Surface 12 leads ECG was analysed in 55 patients with HCM (39 +/- 12 years, 32 males). All patients were in sinus rhythm, without bundle branch block. Maximum (max), minimum (min) and mean QTc values were considered. QTc dispersion was calculated as: a) max QTc - min QTc (max-min); b) dispersion index (DI) = standard deviation of QTc/mean QTcx100. Patients groups were defined accordingly to: 1--the absence (group A1-35 patients) or the presence (group A2-20 patients) of CVA on 24 hours Holter monitoring; II--absence of cardioactive medication (group B1-20 patients) versus monotherapy with Am (group B3-10 patients), or beta B (group B4-15 patients), or CA (group B5-10 patients). Age, gender, type of HCM (asymmetric versus concentric) and echocardiographic fractional shortening were not different in the studied groups.[table: see text]1. Maximum QTc interlead QTc dispersion are increased in patients with HCM that show CVA on Holter monitoring; 2. Amiodarone prolongs QTc but reduces QTc dispersion, while beta-blockers and calcium antagonists do not significantly change neither the duration nor the dispersion of ventricular repolarization.

Published
1995

7. [Non-invasive evaluation of ventricular ejection force by Doppler echocardiography]

Author

Mj, Sousa, Carlos Cotrim, Nunes H, Valério L, Rm, Soares, Abreu J, Bernardes L, Salomão S, and Ja, Rato

Subjects
Adult, Male, Predictive Value of Tests, Humans, Female, Stroke Volume, Prospective Studies, Middle Aged, Sensitivity and Specificity, Echocardiography, Doppler, Aged
Abstract

Left ventricular ejection force as been purpose as a new Doppler ejection phase index, to assess left ventricular performance. In order to evaluate its usefulness, 33 patients undergoing cardiac catheterization were prospectively study. We considered three groups based on angiographic ejection fraction: group A--or = 55% (11 patients), group B--35 to 55% (10 patients), and group C--or = 35% (10 patients). All patients were in sinus rhythm and mitral regurgitationI/IV or aortic valve disease were exclusion criterion. The following parameters, derived from Pulsed Doppler aortic velocities curves, were analyzed: peak velocity (cm/s), acceleration time (s), velocity time integral over the acceleration time (VTI Ac-cm), mean acceleration (cm/s2) and ejection force (g.cm/s2). Ejection force as calculated using the mass-acceleration concept, ad: ejection force = mean acceleration x VTI Ac x CsA x 1.06 (CsA - 2D cross sectional area of the aortic annulus; 1.06 - mass density of blood, g/cm3). [table: see text]The present study confirms that Doppler echocardiography can be used for the assessment of left ventricular performance based on noninvasive measurements and that Doppler derived ejection force is an accurate index for this purpose. However, ejection force evaluation, taking in account the results obtained for mean acceleration, a much less time consuming Doppler derived parameter, appears not to show any clinical advantage.

8. Noninvasive monitoring of pulmonary capillary wedge pressure in heart failure

Author

Martins, S., Rosário, L., Soares, R. M., Bico, P., Rasteiro, R., Bernardes, L., Branco, L., Ramos, S., Quininha, J., Salomão, S., and Alexandre Antunes

Subjects
Adult, Cardiomyopathy, Dilated, Heart Failure, Male, Cardiac Catheterization, Humans, Pulmonary Wedge Pressure, Middle Aged, Echocardiography, Doppler, Aged

9. [Cardiovascular syphilis. Report of 2 cases]

Author

Carlos Cotrim, Bernardes L, Nunes H, Abreu J, Mj, Sousa, Ramos S, Figueiredo L, and Ja, Rato

Subjects
Adult, Male, Cardiovascular Diseases, Humans, Female, Syphilis, Middle Aged
Abstract

We present two cases of cardiovascular syphilis being one of them a curious case of chronic pericardial effusion associated with cardiovascular complications of lues. In this article we will make as well a review of cardiovascular syphilis.

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