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- Percutaneous treatment for refractory angina with the coronary sinus Reducer: A multicenter initial experiencePublication . da Silveira, João Brum
- Acute total occlusion of the unprotected left main coronary artery: Patient characteristics and outcomesPublication . Calvão, João; Braga, Marta; Brandão, Mariana; Campinas, Andreia; Alexandre, André; Amador, Ana; Costa, Catarina; Silva, João C.; Silva, Marisa; Brochado, Bruno; Freitas, João; Macedo, FilipeIntroduction and objectives: Acute total occlusion of the unprotected left main coronary artery (LMCA) is a dramatic event. There are limited data regarding this population. We aimed to describe the clinical presentation and outcomes of patients and to determine predictors of in-hospital mortality. Methods: This retrospective study included patients presenting with acute (<12 h) myocardial infarction due to total occlusion of the LMCA (TIMI flow 0) between January 2008 and December 2020 in three tertiary hospitals. Results: During this period, 11036 emergent coronary angiographies were performed, 59 (0.5%) of which revealed acute total occlusion of the LMCA. Patients' mean age was 61.2 (SD±12.2) years and 73% were male. No patients had left dominance. At presentation, 73% were in cardiogenic shock, aborted cardiac arrest occurred in 27% and 97% underwent myocardial revascularization. Primary percutaneous coronary intervention was performed in 90% of cases and angiographic success was achieved in 56% of procedures, while 7% of patients underwent surgical revascularization. In-hospital mortality was 58%. Among survivors, 92% and 67% were alive after one and five years, respectively. After multivariate analysis, only cardiogenic shock and angiographic success were independent predictors of in-hospital mortality. Use of mechanical circulatory support and presence of well-developed collateral circulation were not predictive of short-term prognosis. Conclusion: Acute total occlusion of the LMCA is associated with a dismal prognosis. Cardiogenic shock and angiographic success play a major role in predicting the prognosis of these patients. The effect of mechanical circulatory support on patient prognosis remains to be determined.
- Global warming and heat wave risks for cardiovascular diseases: A position paper from the Portuguese Society of CardiologyPublication . Caldeira, Daniel; Dores, Hélder; Franco, Fátima; Bravo Baptista, Sérgio; Cabral, Sofia; Cachulo, Maria do Carmo; Peixeiro, António; Rodrigues, Rui; Santos, Mario; Timóteo, Ana Teresa; Campos, Luís; Vasconcelos, João; Nogueira, Paulo Jorge; Gonçalves, LinoGlobal warming is a result of the increased emission of greenhouse gases. The consequences of this climate change threaten society, biodiversity, food and resource availability. The consequences include an increased risk of cardiovascular (CV) disease and cardiovascular mortality. In this position paper, we summarize the data from the main studies that assess the risks of a temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently support global warming/heat waves (extreme temperatures) as cardiovascular threats. Achieving neutrality in emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent steps are required to adapt the society and individuals to this new climatic context that is potentially harmful for cardiovascular health. Multidisciplinary teams should plan and intervene healthcare related to temperature changes and heat waves and advocate for a change in environmental health policy.
- Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design – A population-based studyPublication . Baptista, Rui; Silva Cardoso, José; Canhão, Helena; Maria Rodrigues, Ana; Kislaya, Irina; Franco, Fátima; Bernardo, Filipa; Pimenta, Joana; Mendes, Lígia; Gonçalves, Sara; Teresa Timóteo, Ana; Andrade, Aurora; Moura, Brenda; Fonseca, Cândida; Aguiar, Carlos; Brito, Dulce; Ferreira, Jorge; Filipe Azevedo, Luís; Peres, Marisa; Santos, Paulo; Moraes Sarmento, Pedro; Cernadas, Rui; Santos, Mario; Fontes-Carvalho, Ricardo; Campos Fernandes, Adalberto; Martinho, Hugo; González-Juanatey, José Ramon; Filipe Pereira, Luís; Gil, Victor; Raquel Marques, Cláudia; Almeida, Mário; Pardal, Marisa; Barbosa, Veneranda; Gavina, CristinaIntroduction and objectives: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. Methods: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. Conclusions: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.
- Panorama das Intervenções Coronárias Percutâneas em Oclusões Totais Crônicas em Centros Participantes do LATAM CTO Registry no BrasilPublication . Silva, Antonio Carlos Botelho da; Paula, João Eduardo Tinoco de; Campos, Carlos M.; Ribeiro, Marcelo Harada; Martins, Evandro; Oliveira, Marcos Danillo Peixoto; Côrtes, Leandro Assumpção; Abelin, Aníbal Pereira; Zukowski, Cleverson Neves; Martinelli, Gustavo Cervino; Brito, Fábio Sândoli de; Muniz, Antônio José; Cantarelli, Marcelo José de Carvalho; Andrade, Pedro Beraldo de; Medeiros, César Rocha; Falcão, Breno de Alencar Araripe; Fuchs, Felipe Costa; Silva, Leonardo Sinnott; Fattah, Tammuz; Degrazia, Ramiro Caldas; Mangione, José Armando; Bezerra, Cristiano Guedes; Baradel, Sandra; Silveira, João Brum; Ybarra, Luiz Fernando; Weillenmann, Daniel; Gottschall, Carlos; Lemke, Viviana; Silva, Franciele Rosa da; Schmidt, Marcia Moura; Belli, Karlyse Claudino; Oliveira, Pedro Piccaro de; Quadros, Alexandre Schaan deBackground: Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. Objectives: To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. Methods: Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. Results: Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. Conclusions: CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers
- Uma Apresentação Atípica e Não-Cardíaca de Cardiomiopatia HipertróficaPublication . Alexandre, André; Roque, Carla; Sá, Isabel; Silveira, João; Torres, Severo
- Temporary atrial septal defect balloon occlusion test as a must in the elderlyPublication . Alexandre, André; Luz, André; de Frias, André Dias; Santos, Raquel Baggen; Brochado, Bruno; Oliveira, Filomena; Silveira, João; Torres, SeveroBackground: Atrial septal defect (ASD) can often remain asymptomatic until adulthood. It still remains unclear whether large ASD closure in senior people should be performed or not. Temporary ASD balloon occlusion test has been suggested as a tool to assess the risk of acute left ventricular heart failure post-ASD closure, and it allows to better distinguish responders from non-responders. Case presentation: An 83-year-old man with a long-standing uncorrected secundum ASD was admitted for recently decompensated right-sided heart failure. During hospitalization, this patient was studied with trans-esophageal echocardiography, cardiac magnetic resonance imaging, and right heart catheterization, showing high Qp:Qs ratio and favorable anatomical conditions for percutaneous closure. Because of patient's increasing need for intravenous diuretics and worsening renal function, it was considered that transcatheter ASD closure could improve symptoms, hence it was performed an attempt of percutaneous closure of the ASD with a fenestrated device. Unfortunately, irrespective of ASD being hemodynamically significant, it was found a very significant increase in pulmonary capillary wedge pressure during the temporary balloon occlusion test, supporting the existence of concealed left ventricular diastolic dysfunction. As a result, it was decided to abandon the procedure and not to close the ASD. Conclusion: This clinical case illustrates the value of temporary balloon occlusion test before permanent percutaneous closure of ASD in elderly patients, regardless of left ventricular (systolic or diastolic) dysfunction.
- Transitioning intravenous epoprostenol to oral selexipag in idiopathic pulmonary arterial hypertension: a case reportPublication . Alexandre, André; Furtado, Inês; Gonçalves, Fabienne; Gonçalves, Fabienne; Melo, Alzira; Alves, Joana; Santos, Mario; Reis, AbilioIntravenous (i.v.) prostacyclin is the cornerstone treatment in high-risk pulmonary arterial hypertension (PAH) patients. Selexipag is an orally available prostacyclin receptor agonist. Limited data are available regarding the feasibility of transitioning from i.v. epoprostenol to selexipag. A 50-year-old woman with idiopathic PAH was diagnosed in a World Health Organization (WHO) Functional Class (FC) IV. She improved with upfront triple combination therapy, including i.v. epoprostenol. Over 2 years of follow-up, the patient remained at low risk and expressed strong preference towards oral therapies. After careful risk-benefit clinical consideration, she was transitioned from i.v. epoprostenol to selexipag. Selexipag was started at dosage of 200 μg twice daily (b.i.d.) and titrated up to 1600 μg b.i.d. over 8 weeks (up-titration of 200 μg b.i.d. every week). Simultaneously, i.v. epoprostenol was down-titrated 3.0 ng/kg/min every week from a dosage of 27.5 ng/kg/min. The transition occurred under strict medical surveillance and was well tolerated. One year after discontinuation of epoprostenol, the patient remains in WHO FC I and has no signs of clinical deterioration. Although not generalizable to most PAH patients, this case highlights that a carefully planned transition from epoprostenol to selexipag is feasible in selected low-risk patients within a shared medical decision-making framework.
- Amiodarone-Induced Electrical Storm: A Nightmare in the Emergency RoomPublication . Campinas, Andreia; Pereira Santos, Mariana; Sousa, Maria João; Gomes, Catarina; Torres, SeveroDrug-induced long QT syndrome (LQTS) is defined as prolonged corrected QT interval (QTc ≥460 ms) plus polymorphic ventricular arrhythmia fitting the description of torsades de pointes temporally associated with the administration of a drug or combination of drugs. Amiodarone therapy is a known uncommon cause of acquired QT interval prolongation that should not be underestimated. We present a case of an iatrogenic electrical storm with atrial fibrillation (AF) in which amiodarone was administered to attempt chemical cardioversion, resulting in an unnoticed prolongation of the QT interval, with subsequent repeated polymorphic ventricular tachycardia, managed with isoproterenol. Concomitant drugs and slight electrolyte disturbances potentiated this phenomenon. Given the widespread use of this drug in the emergency department, our case highlights a pertinent matter for all medical emergency practitioners. Additionally, it stresses the significance of potential precipitating factors, such as electrolyte imbalances, which are clinical conditions very frequent in the emergency context, along with the importance of recognizing drug interactions. Finally, this case also emphasizes the vital importance of closely monitoring the patient's receiving amiodarone.