SC - Artigos publicados em revistas indexadas na Medline
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- Assessment of left ventricular diastolic function with cardiovascular MRI: what radiologists should knowPublication . Duarte, R.; Fernadez-Perez, G.; Bettencourt, N.; Sampaio, F.; Miranda, D.; França, M.; Portugal, P.Abstract Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and is associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascular magnetic resonance imaging in the assessment of diastolic function.
- Associação de Arco Aórtico Cervical a Delecção 22q11 – Papel da RMN no DiagnósticoPublication . Almeida, R.; Álvares, S.; Fortuma, A.; Moreira, J.; Vieira, A.As anomalias do arco aórtico são relativamente comuns, ocorrendo em 0,5-3% da população, tendo recentemente sido reconhecidas como fazendo parte do espectro de anomalias cardiovasculares associadas à delecção do cromossoma 22q11. Actualmente a RMN surge como mais um método disponível para o seu diagnóstico, pois permite definir com precisão a anatomia vascular (nomeadamente da aorta) e as suas relações com a traqueia e esófago, obviando as limitações da ecocardiografia convencional de superfície e evitando algumas das desvantagens da angiografia convencional, nomeadamente o uso de radiação ionizante e de contraste iodado. Apresentam-se dois casos de arco aórtico cervical e CIV associados ao síndrome de DiGeorge (CATCH22 +), em cujos diagnósticos foram utilizadas a angiografia convencional e a angioressonância, respectivamente.Aortic arch anomalies are relatively common, occurring in 0.5-3% of the population. In recent years, they have been recognized as being among the cardiovascular malformations found in chromosome 22q11 deletion. MRI is now an alternative method of diagnosing aortic arch anomalies since it accurately defines aortic anatomy and its relation with the trachea and esophagus, with some advantages in comparison with echocardiography and conventional angiography. The authors present two cases of cervical aortic arch and VSD associated with DiGeorge syndrome (CATCH22 +), diagnosed by conventional angiography and magnetic resonance imaging, respectively.
- Coronary artery fistula presenting as unstable anginaPublication . Silva-Vieira, M.; Antunes, M.; Anjo, D.; Palma, P.; Cyrne-Carvalho, H.; Torres, S.
- Criss-cross heart: Twisted anatomy by cardiovascular magnetic resonancePublication . Silva-Vieira, M.; Alpendurada, F.; Babu-Narayan, S.; Kilner, P.
- Heart failure and atrial fibrillation: from basic science to clinical practicePublication . Ferreira, J.; Santos, M.Heart failure (HF) and atrial fibrillation (AF) are two growing epidemics associated with significant morbidity and mortality. They often coexist due to common risk factors and shared pathophysiological mechanisms. Patients presenting with both HF and AF have a worse prognosis and present a particular therapeutic challenge to clinicians. This review aims to appraise the common pathophysiological background, as well as the prognostic and therapeutic implications of coexistent HF and AF.
- High-Sensitivity Troponin T: A Biomarker for Diuretic Response in Decompensated Heart Failure PatientsPublication . Ferreira, J.; Santos, M.; Almeida, S.; Marques, I; Bettencourt, P.; Cyrne-Carvalho, H.Background. Patients presenting with acutely decompensated heart failure (ADHF) and positive circulating cardiac troponins were found to be a high-risk cohort. The advent of high-sensitive troponins resulted in a detection of positive troponins in a great proportion of heart failure patients. However, the pathophysiological significance of this phenomenon is not completely clear. Objectives. The aim of this study is to determine the early evolution and clinical significance of high-sensitivity troponin T (hsTnT) in ADHF. Methods. Retrospective, secondary analysis of a prospective study including 100 patients with ADHF. Results. Globally, high-sensitivity troponin T decreased from day 1 to day 3 (P = 0,039). However, in the subgroup of patients who remained decompensated no significant differences in hsTnT from day 1 to day 3 were observed (P = 0,955), whereas in successfully compensated patients a significant reduction in hsTnT levels was observed (P = 0,025). High-sensitivity troponin T decrease was correlated with NTproBNP reduction (P = 0,007). Patients with hsTnT increase had longer length of stay (P = 0,033). Conclusions. Episodes of ADHF are associated with transient increases in the blood levels of hsTnT that are reduced with effective acute episode treatment. The decrease in hsTnT can translate less myocardial damage along with favourable ADHF treatment.
- Influence of spironolactone on matrix metalloproteinase-2 in acute decompensated heart failurePublication . Ferreira, J.; Santos, M.; Oliveira, J.; Marques, I.; Bettencourt, P.; Cyrne-Carvalho, H.Matrix metalloproteinases (MMPs) are a family of enzymes important for the resorption of extracellular matrices, control of vascular remodeling and repair. Increased activity of MMP2 has been demonstrated in heart failure, and in acutely decompensated heart failure (ADHF) a decrease in circulating MMPs has been demonstrated along with successful treatment.
- Long-term effects of a cardiac rehabilitation program in the control of cardiovascular risk factorsPublication . Magalhães, S.; Ribeiro, M.; Barreira, A.; Fernandes, P.; Torres, S.; Lopes-Gomes, J; Viamonte, S.Os programas de reabilitação cardíaca visam melhorar a capacidade funcional do doente com patologia cardíaca, assim como educar e acompanhar no controlo dos seus fatores de risco cardiovasculares. Objetivo Avaliar os efeitos de um programa de reabilitação cardíaca em doentes com doença cardíaca isquémica ao longo de 12 meses de follow-up no que se refere ao controlo dos fatores de risco cardiovascular. Métodos Estudo prospetivo que inclui doentes com diagnóstico de doença cardíaca isquémica que completaram programa de reabilitação cardíaca baseado no exercício entre janeiro de 2008 a dezembro de 2009, sem perda de dados no follow-up. Foram avaliados num momento inicial (primeira consulta da fase ii) aos 3, 6 e 12 meses depois, com registo dos seguintes parâmetros: índice de massa corporal, circometria abdominal, perfil lipídico, HbA1c nos doentes diabéticos, tensão arterial, tabagismo e nível de atividade física (através do International Physical Activity Questionnaire). Resultados Amostra de 256 doentes (76,2%; idade média: 67 anos); a dislipidemia revelou-se o fator de risco mais prevalente (74,2%) seguido de excesso ponderal (71,5%). No final da fase ii ocorreu uma melhoria estatisticamente significativa (p < 0,05) em todos os fatores de risco estudados, que se manteve aos 6 e 12 meses de follow-up, com a exceção do IMC (perda do significado estatístico na avaliação dos 6 meses; p=0,92). Conclusão Este estudo salienta a necessidade de programas de reabilitação cardíaca no contexto da prevenção secundária da doença cardiovascular e a importância de implementar estratégias que potenciem a manutenção dos benefícios a longo prazo.
- Position statement on bioresorbable vascular scaffolds in PortugalPublication . Teles, R.; Pereira, H.; Cyrne-Carvalho, H.; Patrício, L.; Santos, R.; Baptista, J.; Pipa, J.; Farto-Abreu, P.; Faria, H.; Ramos, S.; Gama-Ribeiro, V.; Martins, D.; Almeida, M.BACKGROUND: Bioresorbable vascular scaffolds (BVS) were recently approved for percutaneous coronary intervention in Europe. The aim of this position statement is to review the information and studies on available BVS, to stimulate discussion on their use and to propose guidelines for this treatment option in Portugal. METHODS AND RESULTS: A working group was set up to reach a consensus based on current evidence, discussion of clinical case models and individual experience. The evidence suggests that currently available BVS can produce physiological and clinical improvements in selected patients. There are encouraging data on their durability and long-term safety. Initial indications were grouped into three categories: (a) consensual and appropriate - young patients, diabetic patients, left anterior descending artery, long lesions, diffuse disease, and hybrid strategy; (b) less consensual but possible - small collateral branches, stabilized acute coronary syndromes; and (c) inappropriate - left main disease, tortuosity, severe calcification. CONCLUSION: BVS are a viable treatment option based on the encouraging evidence of their applicability and physiological and clinical results. They should be used in appropriate indications and will require technical adaptations. Outcome monitoring and evaluation is essential to avoid inappropriate use. It is recommended that medical societies produce clinical guidelines based on high-quality registries as soon as possible.
- Potential cardiovascular risk protection of bilirubin in end-stage renal disease patients under hemodialysisPublication . Sameiro-Faria, M.; Kohlova, M.; Ribeiro, S.; Rocha-Pereira, P.; Teixeira, L.; Nascimento, H.; Reis, F.; Miranda, V.; Bronze-da-Rocha, E.; Quintanilha, A.; Belo, L.; Costa, E.; Santos-Silva, A.We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 genotypes, respectively. Although no difference was found in UGT1A1 genotype distribution between the three tertiles of bilirubin, significant differences were found with increasing bilirubin levels, namely, a decrease in platelet, leukocyte, and lymphocyte counts, transferrin, oxidized low-density lipoprotein (ox-LDL), ox-LDL/low-density lipoprotein cholesterol ratio, apolipoprotein (Apo) A, Apo B, and interleukin-6 serum levels and a significant increased concentration of hemoglobin, hematocrit, erythrocyte count, iron, transferrin saturation, Apo A/Apo B ratio, adiponectin, and paraoxonase 1 serum levels. After adjustment for age these results remained significant. Our data suggest that higher bilirubin levels are associated with beneficial effects in HD patients, by improving lipid profile and reducing the inflammatory grade, which might contribute to increase in iron availability. These results suggest a potential cardiovascular risk protection of bilirubin in HD patients