Abstract Aims Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL. Methods Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement. Results Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups. Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003). There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table). Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577 Conclusions In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.

EuroSCORE

10.1093/eurheartj/ehz746.1098

Cite

Citations (0)

Chest pain, elevated troponin and moderate coronary stenosis — a clinical puzzle solved by cardiac magnetic resonance

Revista Portuguesa de Cardiologia (English Edition) (2011)

Sérgio Madeira A Ferreira Maria Salomé Carvalho M Trabulo Pedro Jerónimo Sousa

Cardiac magnetic resonance

10.1016/s2174-2049(11)70031-9

Cite

Citations (0)

Relato de Caso de Doença Coronariana e Vascular Não Aterosclerótica: Em Busca de uma Entidade Clínica Rara

Arquivos Brasileiros de Cardiologia (2022)

G Sa Mendes António Mesquita B Rocha João Abecasis Sáncia Ramos

Introdução Aqui relatamos um caso desafiador de uma condição sistêmica rara – doença relacionada à imunoglobulina G4 (IgG4-RD) –que se apresentou com uma rara manifestação cardiovascular. A aortite por IgG4-RD está bem documentada na literatura, mas raramente tem sido relacionada ao envolvimento da árvore arterial coronariana. Documentamos IgG4-RD com periarterite coronariana difusa, apresentando-se como insuficiência cardíaca aguda neste caso particular. Apesar da gravidade inicial, o trabalho em equipe multidisciplinar foi a chave para o diagnóstico rápido e o início do [...]

10.36660/abc.20210722

Cite

Citations (0)

Secondary mitral regurgitation: Maintaining coherence with the American Society of Echocardiography grading guidelines, which proportionality concept best predicts prognosis in the real world?

Revista Portuguesa de Cardiologia (2022)

J Presume P Lopes P Freitas Francisco Albuquerque Carla Reis

Proportionality of secondary mitral regurgitation (sMR) may be a key factor in deciding whether a patient may benefit from mitral intervention. The aim of this study was to evaluate the prognostic value of two different concepts of proportionality and assess their ability to improve MR stratification proposed by the American Society of Echocardiography (ASE) guidelines.We conducted a retrospective analysis in patients with reduced left ventricular ejection fraction (LVEF) (<50%) and at least mild sMR. Proportionality status was calculated using formulas proposed by a) Grayburn et al. - disproportionate sMR defined as EROALVEDV >0.14; b) Lopes et al. - disproportionate sMR whenever measured EROA>theoretical EROA (determined as 50%×LVEF×LVEDVMitralVTI). Primary endpoint was all-cause mortality.A total of 572 patients (69±12 years; 76% male) were included. Mean LVEF was 33±9%, with a median left ventricular end-diastolic volume of 174 mL [136;220] and a median effective regurgitant orifice area of 14 mm2 [8;22]. During mean follow-up of 4.1±2.7 years, there were 254 deaths. There was considerable disagreement (p<0.001) between both formulas: of 96 patients with disproportionate sMR according to Lopes' criteria, 46 (48%) were considered proportionate according to Grayburn's; and of 62 patients with disproportionate sMR according to Grayburn's, 12 (19%) were considered proportionate according to Lopes' formula. In multivariate analysis, only Lopes' definition of disproportionate sMR maintained independent prognostic value (hazard ratio 1.5; 95% confidence interval 1.07-2.1, p=0.018) and improved the risk stratification of ASE sMR classification.Of the two formulas available to define disproportionate sMR, Lopes' model emerged as the only one with independent prognostic value while improving the risk stratification proposed by the ASE guidelines.

10.1016/j.repc.2022.03.005

Cite

Citations (3)

External validation of the unifying concept for the quantitative assessment of functional mitral regurgitation

The International Journal of Cardiovascular Imaging (2023)

P Lopes Francisco Albuquerque P Freitas Carla Reis S Guerreiro

Clinical endpoint

Risk Stratification

10.1007/s10554-023-02920-z

Cite

Citations (0)

[Maximal oxygen consumption measured in the cardiopulmonary stress test versus the predicted maximal consumption: an evaluation of 3 protocols].

PubMed (1995)

M Trabulo Luís Bronze L Brízida A Barbaça Maria José Mendes

Consumption

Stress test

Stress testing (software)

Source

Cite

Citations (0)

Unveiling Mitochondrial Cardiomyopathy: The Crucial Role of Multiparametric Cardiac Magnetic Resonance

CJC Open (2024)

Rita Reis Santos Joana Certo Pereira P Lopes Pedro Freitas M Trabulo

Cardiac magnetic resonance

10.1016/j.cjco.2024.11.008

Cite

Citations (0)

Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Revista Portuguesa de Cardiologia (2015)

António Tralhão A Ferreira Sérgio Madeira Miguel Borges Santos Mariana Castro

The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population. We studied 276 consecutive patients (mean age 62±14 years, 75% male, 20% Killip class >1) admitted over a two-year period for STEMI and treated with PPCI. ZRS, length of stay, 30-day mortality and readmission were obtained for all patients. Low risk was defined as ZRS ≤3. The median ZRS was 3 (interquartile range [IQR] 1–4), with 171 patients (62%) being classified as low risk. Thirty-day mortality was 4.7% (13 patients). Compared to other patients, low-risk patients had shorter length of stay (median 5.0 [IQR 4–7] vs. 7.0 [5–13] days, p<0.001), and lower 30-day mortality (0 vs. 12.4%, p<0.001), yielding a negative predictive value of 100% (95% CI 97.0–100%) for the proposed cutoff. The ZRS showed excellent discriminative power (C-statistic: 0.937, 95% CI 0.906–0.968, p<0.001), and good calibration against the original cohort. The ZRS appears to perform well in identifying low-risk STEMI patients who could be safely discharged within 72 hours of admission. Using the ZRS in our population could result in a more rational use of in-patient resources. A duração ótima de internamento após enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST) não complicado, submetido a intervenção coronária percutânea primária (ICPP), permanece por determinar. O Score de Zwolle (SZ) é um instrumento simples, desenhado para identificar os doentes candidatos a alta precoce (<72h) segura. Este estudo pretendeu avaliar a aplicabilidade do SZ na nossa população. Analisámos 276 doentes consecutivos (idade média 62±14 anos, 75% homens, 20% em classe de Killip>1) com EAMCST submetidos a ICPP durante um período de dois anos. Foram obtidos os SZ, duração de internamento, mortalidade e readmissão aos 30 dias. Foi definido baixo risco como SZ ≤3. A mediana do SZ foi de 3 [distância interquartil (IQR) 1-4] e 171 doentes (62%) foram classificados como de baixo risco. A mortalidade aos 30 dias foi de 4,7% (13 doentes). Em comparação com os restantes, os doentes de baixo risco tiveram menor duração de internamento [mediana 5,0 (IQR 4-7) versus 7,0 (IQR 5-13) dias, p<0,001] e menor mortalidade (0 versus 12,4%, p<0,001), resultando num valor preditivo negativo de 100% (IC95% 97,0-100%) para o cut-off proposto. O ZS mostrou excelente poder descriminativo (estatística-C: 0,937, IC95% 0,906-0,968, p<0,001) e boa calibração quando comparado com o coorte original. O SZ parece capaz de identificar com precisão os doentes com EAMCST de baixo risco que podem ter alta segura 72h após a admissão. O uso do SZ na nossa população poderá resultar numa utilização mais racional dos recursos hospitalares.

Interquartile range

Killip class

10.1016/j.repc.2015.04.006

Cite

Citations (22)

Are intraventricular gradients a cause of false positive treadmill exercise tests?

Revista Portuguesa de Cardiologia (English Edition) (2012)

Nuno Cardim Pedro Campos Daniel Ferreira Vanda Carmelo Júlia Toste

Treadmill exercise testing has low specificity for the detection of significant epicardial coronary artery disease (CAD). A possible mechanism to explain some of the false positives is transient subendocardial ischemia induced by intraventricular gradients (IVG) during stress. The development of IVG during dobutamine stress echocardiography (DSE) occurs in 8-38% of non-selected populations. To determine: the prevalence of IVG in a selected population of false positives on treadmill stress testing; whether this prevalence is different from that described for non-selected populations; whether patient characteristics are related to the presence of IVG; the relation between the presence of IVG and the occurrence of ECG abnormalities, symptoms and blood pressure. We evaluated 50 consecutive patients with false positive treadmill stress tests (normal CT coronary angiography, nuclear perfusion tests or angiography) with DSE (2D and Doppler evaluation). All DSE exams were negative for ischemia. Stress-induced IVG was seen in 34 of the 50 patients (68%) and 16 patients (32%) did not develop IVG (p < 0.05). The prevalence of IVG in our selected population (68%) was significantly higher than that described for non-selected populations (8-38%) (p < 0.001). Most patient characteristics (gender, age, risk factors for CAD, treatment with beta-blockers/calcium antagonists, significant valvular disease/left ventricular hypertrophy [LVH], symptoms, and blood pressure during stress) were not statistically associated with the prevalence of IVG (p > 0.05). However, the presence of IVG was associated with the occurrence of ischemic ST depression during dobutamine stress echo (p < 0.05). The prevalence of IVG during dobutamine stress echocardiography in a selected population of false positives on treadmill stress testing is very high, occurring in more than two-thirds of patients. This prevalence is significantly higher than that described for non-selected populations. Age, gender, risk factors for CAD, treatment with beta-blockers/calcium channel antagonists, significant valvular disease/LVH, symptoms and blood pressure during stress were not associated with the presence or absence of IVG. The presence of IVG is associated with the occurrence of ischemic ST changes during dobutamine stress echocardiography. A prova de esforço é um exame com baixa especificidade na detecção de doença coronária epicárdica significativa (DAC). Um mecanismo possível para explicar alguns dos seus falsos positivos (FP) é a isquémia subendocárdica transitória induzida pelos gradientes intraventriculares (GIV) durante o stress. O desenvolvimento de GIV durante o ecocardiograma de sobrecarga com dobutamina (ESD) ocorre, em populações não seleccionadas, em 8-38% dos doentes. Determinar: A prevalência de GIV numa população seleccionada de FP de prova de esforço. Se esta prevalência é diferente da descrita para populações não seleccionadas. Se as características dos doentes estão relacionadas com a presença de GIV. A relação entre a presença de GIV e a ocorrência de alterações electrocardiográficas, o aparecimento de sintomas e a pressão arterial. O nosso estudo analisou 50 doentes consecutivos considerados falsos positivos de prova de esforço (Angio-TC coronária, Cintigrafia de Perfusão Miocárdica ou Angiografia normais) com avaliação por ESD. Todos os ESD foram negativos para isquémia. 34 dos 50 doentes (68%) apresentaram GIV induzido pelo stress e 16 doentes (32%) não desenvolveram GIV (p < 0,05). A prevalência de GIV na população seleccionada (68%) foi significativamente mais elevada que a descrita para populações não seleccionadas (8-38%) (p < 0,001). A maioria das características dos doentes (género, idade, factores de risco para DAC, tratamento com beta-bloqueantes/antagonistas dos canais de cálcio, doença valvular significativa/hipertrofia ventricular esquerda (HVE), sintomas, pressão arterial durante o stress) não foram estatisticamente relevantes para explicar a presença de GIV (p > 0,05). No entanto, a presença de GIV relacionou-se com a ocorrência de depressão do segmento ST durante o ecocardiograma de sobrecarga com dobutamina (p < 0,05). A prevalência de GIV durante o ecocardiograma de stress com dobutamina em populações seleccionadas de falsos positivos de prova de esforço é muito elevada, ocorrendo em 2/3 dos doentes. Esta prevalência é significativamente mais alta que a descrita para populações não seleccionadas. Idade, género, factores de risco para DAC, terapêutica com beta-bloqueantes/antagonistas dos canais de cálcio, doença arterial significativa/HVE, sintomas e a pressão arterial durante a sobrecarga não se relacionam com a presença ou ausência de GIV. A presença de GIV está relacionada com a ocorrência de alterações isquémicas do segmento ST durante a ecocardiografia de sobrecarga com dobutamina.

Dobutamine

Treadmill

Stress testing (software)

10.1016/j.repce.2012.01.017

Cite

Citations (0)