Publications by authors named "Carla de Sousa"

16 Publications

  • Page 1 of 1

Left ventricular pacing with a temporary pacemaker: Case report.

Rev Port Cardiol (Engl Ed) 2021 Feb 26;40(2):141.e1-141.e4. Epub 2020 Dec 26.

Department of Cardiology, Centro Hospitalar São João, EPE, Porto, Portugal.

We report a case of temporary pacemaker lead malposition in the left ventricle crossing the interventricular septum (IVS). The majority of described cases occur due to a patent foramen ovale and are frequently incidental findings. A course across the IVS is rarely found and this complication with temporary leads is not even reported in the literature. This very rare location entails a risk of dangerous complications associated with left-to-right flow after lead removal. Echocardiography was an essential tool to diagnose the lead's course inside the heart and enabled secure removal of the lead with cardiac surgery backup.
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http://dx.doi.org/10.1016/j.repc.2020.12.006DOI Listing
February 2021

[Thoughts about the Impact Factor].

Acta Med Port 2020 Oct 1;33(10):633-634. Epub 2020 Oct 1.

Acta Médica Portuguesa. Ordem dos Médicos. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.14773DOI Listing
October 2020

In-depth characterization of a novel live-attenuated Mayaro virus vaccine candidate using an immunocompetent mouse model of Mayaro disease.

Sci Rep 2020 03 24;10(1):5306. Epub 2020 Mar 24.

Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.

Mayaro virus (MAYV) is endemic in South American countries where it is responsible for sporadic outbreaks of acute febrile illness. The hallmark of MAYV infection is a highly debilitating and chronic arthralgia. Although MAYV emergence is a potential threat, there are no specific therapies or licensed vaccine. In this study, we developed a murine model of MAYV infection that emulates many of the most relevant clinical features of the infection in humans and tested a live-attenuated MAYV vaccine candidate (MAYV/IRES). Intraplantar inoculation of a WT strain of MAYV into immunocompetent mice induced persistent hypernociception, transient viral replication in target organs, systemic production of inflammatory cytokines, chemokines and specific humoral IgM and IgG responses. Inoculation of MAYV/IRES in BALB/c mice induced strong specific cellular and humoral responses. Moreover, MAYV/IRES vaccination of immunocompetent and interferon receptor-defective mice resulted in protection from disease induced by the virulent wt MAYV strain. Thus, this study describes a novel model of MAYV infection in immunocompetent mice and highlights the potential role of a live-attenuated MAYV vaccine candidate in host's protection from disease induced by a virulent MAYV strain.
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http://dx.doi.org/10.1038/s41598-020-62084-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093544PMC
March 2020

[I Submitted a Paper to Acta Médica Portugal. What Happens Now?]

Acta Med Port 2020 Feb 3;33(2):88-89. Epub 2020 Feb 3.

Acta Médica Portuguesa. Ordem dos Médicos. Lisboa. Portugal.

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http://dx.doi.org/10.20344/amp.13373DOI Listing
February 2020

Prediction of new onset of resting pulmonary arterial hypertension in systemic sclerosis.

Arch Cardiovasc Dis 2016 Apr 15;109(4):268-77. Epub 2016 Feb 15.

Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy. Electronic address:

Background: Early detection of pulmonary arterial hypertension (PH) is crucial in systemic scleroderma. However, predictors of new onset of resting PH during follow-up (FUPH) have been poorly explored.

Aim: To determine whether nailfold videocapillaroscopy (NVC) grade and exercise echocardiographic variables are predictors of FUPH.

Methods: We prospectively enrolled 40 patients with systemic sclerosis (age 54±13 years; 68% women). All patients underwent graded semisupine exercise echocardiography and NVC. Baseline resting PH and FUPH were defined as systolic pulmonary arterial pressure (sPAP)>35 mmHg, and exercise-induced PH (EIPH) as exercise sPAP>50 mmHg.

Results: Seventeen patients developed EIPH (43%). During follow-up (FU) (25±15 months), 11 patients without baseline PH developed FUPH (28%), all from the EIPH group. Patients with FUPH were significantly older (60±14 vs 50±12 years; P=0.04), had higher resting and exercise sPAP (30±4 vs 22±5 and 60±12 vs 40±11 mmHg, respectively; P<0.0001) and a higher exercise E/e' ratio (9.4±0.7 vs 5.8±0.4; P=0.0003) and presented more frequently NVC grade>2 (90% vs 35%; P=0.0009). After adjustment for age, resting sPAP, exercise sPAP and NVC grade>2 were associated with maximal resting sPAP during follow-up and FUPH (P<0.05). Patients with both EIPH and NVC grade>2 had a very high incidence of FUPH (82%), and both variables remained strongly associated with FUPH after adjustment for age (hazard ratio 11.6, 95% confidence interval 2.4-55.3; P=0.002).

Conclusion: Exercise echocardiography and NVC can identify a subgroup of patients with systemic sclerosis who are at risk of developing FUPH.
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http://dx.doi.org/10.1016/j.acvd.2015.11.014DOI Listing
April 2016

Cardiovascular outcome in systemic sclerosis.

Acta Cardiol 2015 Oct;70(5):554-63

Objectives: Cardiovascular involvement is recognized as a poor prognostic factor in systemic sclerosis (SSc). The aim of this study was to evaluate the usefulness of nailfold video-capillaroscopy (NVC), brain natriuretic peptide (BNP) blood level and exercise echocardiography to predict the occurrence of cardiovascular events in SSc.

Methods: We prospectively enrolled 65 patients with SSc (age 54±14 years, 30% female) followed in CHU Sart-Tilman, Liège, Belgium. All patients underwent graded semi-supine exercise echocardiography. Both baseline resting pulmonary hypertension (PH) and PH during follow-up (FUPH) were defined as systolic pulmonary arterial pressure (sPAP)>35 mmHg, and exercise-induced PH (EIPH) as sPAP>50 mmHg during exercise.

Results: EIPH was present in 21 patients. During FU (27±18 months), 13 patients developed FUPH and 9 presented cardiovascular complications. Patients with cardiovascular events were significantly older (63±14 vs 52±13 years; P=0.03), presented more frequently NVC grade>2 (89 vs 43%; P=0.009), had higher resting and exercise sPAP (30±6 vs 24±6; P=0.007 and 57±13 vs 44±13 vs mmHg; P=0.01, respectively), and higher BNP blood level (112±106 vs 26±19 pg/ml; P=0.0001). After adjustment for age and gender, NVC grade>2 (ß=2.4±1.1; P=0.03), EIPH (ß=2.30±1.13; P=0.04), FUPH (ß=0.24±0.09; P=0.01 and ß=3.52±1.16; P=0.002, respectively;) and BNP (ß=0.08±0.04; P=0.02) were independent predictors of CV events. Beyond age, an incremental value of EIPH, BNP and NVC grade>2 was predictive of cardiovascular events (P<0.001).

Conclusion: Cardiovascular complications are not rare in SSc (18%). NVC, BNP blood level assessment and exercise echocardiography could be useful tools to identify patients at risk of SSc.
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http://dx.doi.org/10.2143/AC.70.5.3110516DOI Listing
October 2015

[Let's go publishing!].

Acta Med Port 2014 Nov-Dec;27(6):673-4. Epub 2014 Dec 30.

Editor Associado. Acta Médica Portuguesa. Lisboa. Portugal.

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December 2016

Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic dysfunction.

Rev Port Cardiol 2014 Jul-Aug;33(7-8):403-9. Epub 2014 Aug 23.

Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.

Introduction And Objective: The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction.

Methods: Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy.

Results: We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003).

Conclusions: GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
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http://dx.doi.org/10.1016/j.repc.2014.01.023DOI Listing
July 2016

Iron deficiency status irrespective of anemia: a predictor of unfavorable outcome in chronic heart failure patients.

Cardiology 2014 7;128(4):320-6. Epub 2014 Jun 7.

Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.

Objective: To assess the prognostic significance of iron deficiency (ID) in a chronic heart failure (CHF) outpatient population.

Methods And Results: We prospectively evaluated 127 patients with stable CHF and left ventricular ejection fraction ≤45%. Clinical and analytical data as well as information regarding the occurrence of the composite endpoint of overall mortality and nonfatal cardiovascular events were assessed. Among the 127 patients enrolled [81% men, median age: 62 years (25th-75th percentile: 53-68)], 46 (36%) patients had ID. Women, patients with higher plasma brain natriuretic peptide levels (>400 pg/ml) and with right ventricular systolic dysfunction presented ID more frequently (p < 0.05 for all). At 225 ± 139 days of follow-up, the composite endpoint occurred in 15 (12%) patients. It was more frequent in ID (24 vs. 5%, p = 0.001) and anemic patients (25 vs. 8%, p = 0.014). In a Cox regression analysis, ID was associated with a higher likelihood of composite endpoint occurrence (HR 5.00, 95% CI 1.59-15.78, p = 0.006). In a multivariable analysis adjusted for clinical variables, including the presence of anemia, ID remained a significant predictor of the composite endpoint (HR 5.38, 95% CI 1.54-18.87, p = 0.009).

Conclusion: In a CHF outpatient population, ID carried a higher risk of unfavorable outcome, irrespectively of the presence of anemia.
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http://dx.doi.org/10.1159/000358377DOI Listing
February 2015

The usefulness of the head-up tilt test in patients with suspected epilepsy.

Seizure 2014 May 17;23(5):367-70. Epub 2014 Feb 17.

Neurology Department, São João Hospital Center, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.

Purpose: It is estimated that approximately 20-30% of patients diagnosed with epilepsy have been misdiagnosed, and neurocardiogenic syncope (NCS) might frequently be the real cause of transient loss of consciousness (TLOC) episodes. We assessed the role of the head-up tilt test (HUTT) in patients previously diagnosed with refractory epilepsy to evaluate the ability of this test to correctly diagnose patients with NCS.

Method: We retrospectively analysed the clinical records of 107 consecutive patients with a previous diagnosis of refractory epilepsy that were taking antiepileptic drugs and who were referred for HUTT between January 2000 and December 2010. During the subsequent follow-up, we recorded the treatments performed and the recurrence of symptoms.

Results: Complete follow-up data were available for 94 (88%) patients, and the mean follow-up period was 80±36 months. The HUTT was positive in 54% of patients. Thirty-one (33%) patients were misdiagnosed with epilepsy, and 20 (21%) patients had a dual diagnosis of NCS and epilepsy. The recurrence of TLOC was reported in 55% of the patients, but it was significantly lower in the misdiagnosed group (42% versus 64%; P=0.039).

Conclusion: NCS is an important cause of epilepsy misdiagnosis. The HUTT is often critical for making an accurate diagnosis and subsequently selecting the appropriate treatment for patients presenting with TLOC. The diagnostic overlap between epilepsy and NCS is not uncommon, suggesting that electroencephalographic monitoring during a HUTT may play an important role in diagnosing patients with recurrent, undiagnosed TLOC episodes.
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http://dx.doi.org/10.1016/j.seizure.2014.02.004DOI Listing
May 2014

Acute coronary syndrome in a patient with multifocal coronary vasospasm.

J Cardiol Cases 2014 Jun 28;9(6):217-220. Epub 2014 Feb 28.

Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.

Vasospastic angina results from temporary spasm of one or more coronary segments. Although prognosis of patients presenting with coronary vasospasm appears to be generally good, multivessel coronary vasospasm may increase the risk of life-threatening cardiac events. We present a case of a 51-year-old man admitted to the emergency room due to severe retrosternal pain, who was documented with multifocal coronary vasospasm. < The case described illustrates the importance of recognizing coronary vasospasm as a cause of reversible ischemia. Although vasospastic angina is associated with a favorable prognosis, multivessel involvement may increase the risk of life-threatening cardiac events.>.
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http://dx.doi.org/10.1016/j.jccase.2014.01.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278680PMC
June 2014

Spirito-Maron echocardiographic score: a marker for morphological and physiological assessment of patients with hypertrophic cardiomyopathy.

Echocardiography 2014 Jul 24;31(6):708-15. Epub 2014 Jan 24.

Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.

Aims: The heterogeneous distribution of hypertrophy in hypertrophic cardiomyopathy (HCM) limits the echocardiographic conventional measurements accuracy in the evaluation of left ventricular hypertrophy (LVH). The aim of this study was to assess the correlation of the echocardiographic Spirito-Maron score (SMS) with left ventricle (LV) mass quantification by cardiac magnetic resonance (CMR) and with LV diastolic function.

Methods And Results: Left ventricle diastolic function parameters, SMS, LV mass (American Society of Echocardiography formula), and maximal wall thickness (MWT) were evaluated by two-dimensional (2D) transthoracic echocardiography. The SMS was obtained by adding the MWT of 4 LV segments, at the mitral valve or papillary muscles short-axis views. Echocardiographic parameters of LVH, including SMS, were correlated with LV mass obtained by CMR and with E/e' ratio. We included 45 patients (60% male, mean age 48 ± 18 years), who underwent 2D echocardiography. Twenty-two of them performed a CMR study. A positive correlation was found between SMS and CMR LV mass (r = 0.80; P < 0.001), whereas MWT (r = 0.62; P = 0.002) and the 2D LV mass (r = 0.60; P = 0.011) presented a lower correlation with CMR LV mass. The SMS was significantly correlated with E/e' ratio (r = 0.60; P = 0.007), whereas a nonsignificant correlation was found with MWT (r = 0.41; P = 0.081) and 2D LV mass (r = 0.22; P = 0.400).

Conclusion: Spirito-Maron score presents a highly positive correlation with CMR LV mass and with diastolic dysfunction severity in HCM patients. SMS is a reliable quantitative LVH measurement method and seems to provide more comprehensive morphological and physiological information than 2D echocardiographic conventional parameters used to estimate LVH.
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http://dx.doi.org/10.1111/echo.12471DOI Listing
July 2014

Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study.

Eur Heart J Cardiovasc Imaging 2014 Jun 21;15(6):680-90. Epub 2014 Jan 21.

Department of Cardiac, Thoracic and Vascular Sciences University of Padova, School of Medicine, Padova, Italy.

Aims: Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges for cardiac chambers size obtained in a large group of healthy volunteers accounting for gender and age. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following chamber quantitation protocols approved by the European Association of Cardiovascular Imaging.

Methods: A total of 734 (mean age: 45.8 ± 13.3 years) healthy volunteers (320 men and 414 women) were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was performed on all subjects following pre-defined protocols. There were no gender differences in age or cholesterol levels. Compared with men, women had significantly smaller body surface areas, and lower blood pressure. Quality of echocardiographic data sets was good to excellent in the majority of patients. Upper and lower reference limits were higher in men than in women. The reference values varied with age. These age-related changes persisted for most parameters after normalization for the body surface area.

Conclusion: The NORRE study provides useful two-dimensional echocardiographic reference ranges for cardiac chamber quantification. These data highlight the need for body size normalization that should be performed together with age-and gender-specific assessment for the most echocardiographic parameters.
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http://dx.doi.org/10.1093/ehjci/jet284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402333PMC
June 2014

Short-time variation in serum uric acid concentrations in post-myocardial infarction patients.

Clin Lab 2013 ;59(3-4):263-70

Institute of Public Health, University of Porto, Portugal.

Background: Studies on SUA temporal profile in relation to acute myocardial infarction (AMI) are controversial. The aim of this study was to evaluate the SUA level variations following myocardial infarction.

Methods: We studied 222 patients more than 18 years old diagnosed with AMI. SUA was measured at baseline and on day 2 to 4 and day 5 to 8 after AMI. Within and between person variability of SUA following an AMI was estimated using intraclass correlation coefficients (ICC). The change in SUA between each assessment point was analyzed by repeated measures one-way analysis of variance. To evaluated.SUA variation post-myocardial infarction and its predictors we used generalized linear mixed-effects models.

Results: The mean plasma concentration of SUA was lower at baseline (58.5 +/- 18.9 mg/L). The ICC across the three time points was 0.75 (95% CI 0.70 - 0.80). SUA levels increased 1.33 mg/L per day after AMI (2.3 mg/L/day in women and 1.0 mg/L/day in men). Normouricemic patients had a 1.6 fold increase risk to change to hyperuricemic status per day after AMI (OR = 1.60, 95% CI: 1.27 - 2.00).

Conclusions: Serum uric acid concentration is relatively stable over an eight-day post-myocardial infarction period. However, even a small increase of SUA per day after AMI is associated with a high probability of changing the classification of hyperuricemic status.
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http://dx.doi.org/10.7754/clin.lab.2012.120628DOI Listing
June 2013

[Metastatic tumor of the right ventricle: an unusual location of tumor involvement in laryngeal carcinoma].

Rev Port Cardiol 2012 Dec 6;31(12):809-13. Epub 2012 Nov 6.

Serviço de Cardiologia, Hospital de S. João, Porto, Portugal.

Secondary tumors are much more frequent than primary tumors, but cardiac metastasis of laryngeal carcinoma is uncommon. The authors report the case of a 71-year-old man, with a history of laryngeal carcinoma, admitted to the emergency room with symptoms of two weeks' evolution suggestive of respiratory infection. Due to lack of therapeutic response and progressive clinical deterioration, a transthoracic echocardiogram was performed which revealed a large infiltrating mass within the right ventricle, involving the apex, interventricular septum and free wall, not causing significant right ventricular outflow tract obstruction. Evaluation by computed tomography showed signs of widespread metastasis from the previously diagnosed laryngeal cancer.
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http://dx.doi.org/10.1016/j.repc.2012.02.021DOI Listing
December 2012

[Hypocalcemia as a reversible cause of heart failure].

Rev Port Cardiol 2012 Jan 7;31(1):39-41. Epub 2011 Dec 7.

Serviço de Cardiologia, Hospital de S. João, Porto, Portugal.

Calcium plays a key role in heart muscle contraction and relaxation. Hypocalcemic heart failure is a rare and potentially reversible disturbance, which reflects this intrinsic relationship. The authors present the case of a 35-year-old woman who developed acute heart failure during the early postoperative period following total thyroidectomy. The echocardiogram showed severe global left ventricular dysfunction. Laboratory tests showed severe hypocalcemia and new-onset hypoparathyroidism. Cardiac catheterization showed angiographically normal coronary arteries. After clinical, hemodynamic and metabolic stabilization, a repeat echocardiogram revealed recovery of left ventricular function. Subsequently, cardiac magnetic resonance imaging was performed, which also showed no alterations. The patient was discharged asymptomatic, medicated with calcium carbonate, calcitriol and levothyroxine. This case highlights the importance of considering hypocalcemia as a cause of reversible myocardial dysfunction.
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http://dx.doi.org/10.1016/j.repc.2011.09.016DOI Listing
January 2012