Publications by authors named "Filipe Macedo"

58 Publications

Left ventricle implantable cardioverter defibrillator: a dextro-transposition of the great arteries case.

Cardiol Young 2021 Jun 14:1-2. Epub 2021 Jun 14.

Department of Cardiology, São João Universitary Hospital, Porto, Portugal.

We present a case of a patient with dextro-transposition of the great arteries palliated with a Senning procedure and a long-term arrhythmic complication that required an intervention, with an Implantable Cardioverter Defibrillator (ICD) implantation in the sub-pulmonary ventricle (morphologically left). This case highlights the need to perform off-label procedures to deal with the long-term complications of these complex patients.
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http://dx.doi.org/10.1017/S1047951121002249DOI Listing
June 2021

Secondary prevention after acute coronary syndrome: are dyslipidaemia guideline targets achieved?

Eur J Prev Cardiol 2021 Jun 7. Epub 2021 Jun 7.

Centro Hospitalar Universitário de São João, Alameda Prof. Hernani Monteiro 4200-319 Porto, Portugal, Portugal; and Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro 4200-319 Porto, Portugal, Portugal.

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http://dx.doi.org/10.1093/eurjpc/zwab070DOI Listing
June 2021

Nosocomial Outbreak of SARS-CoV-2 in a "Non-COVID-19" Hospital Ward: Virus Genome Sequencing as a Key Tool to Understand Cryptic Transmission.

Viruses 2021 04 1;13(4). Epub 2021 Apr 1.

Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal.

Dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare institutions affects both patients and health-care workers (HCW), as well as the institutional capacity to provide essential health services. Here, we investigated an outbreak of SARS-CoV-2 in a "non-COVID-19" hospital ward unveiled by massive testing, which challenged the reconstruction of transmission chains. The contacts network during the 15-day period before the screening was investigated, and positive SARS-CoV-2 RNA samples were subjected to virus genome sequencing. Of the 245 tested individuals, 48 (21 patients and 27 HCWs) tested positive for SARS-CoV-2. HCWs were mostly asymptomatic, but the mortality among patients reached 57.1% (12/21). Phylogenetic reconstruction revealed that all cases were part of the same transmission chain. By combining contact tracing and genomic data, including analysis of emerging minor variants, we unveiled a scenario of silent SARS-CoV-2 dissemination, mostly driven by the close contact within the HCWs group and between HCWs and patients. This investigation triggered enhanced prevention and control measures, leading to more timely detection and containment of novel outbreaks. This study shows the benefit of combining genomic and epidemiological data for disclosing complex nosocomial outbreaks, and provides valuable data to prevent transmission of COVID-19 in healthcare facilities.
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http://dx.doi.org/10.3390/v13040604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065743PMC
April 2021

The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal.

Rev Port Cardiol (Engl Ed) 2021 Mar 20. Epub 2021 Mar 20.

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

Introduction And Objectives: The coronavirus SARS-CoV-2 (COVID-19) pandemic has been an unmatched challenge to global healthcare. Although the majority of patients admitted with acute coronary syndrome (ACS) may not be infected with COVID-19, the quarantine and public health emergency measures may have affected this particular high risk group. The objective of this study is to assess the impact of the early period of the COVID-19 pandemic on ACS admissions and clinical course in a tertiary care hospital in Portugal's most affected region.

Methods: This retrospective, case-control study included patients admitted with a diagnosis of ACS during March and April 2020 (pandemic group) and in the same period in 2019 (control group). Clinical course and complications were also assessed.

Results: During the pandemic, there were fewer ACS admissions but presentation was more severe, with a larger proportion of acute ST-elevation myocardial infarctions (54.9% vs. 38.8%, p=0.047), higher maximum troponin levels and greater prevalence of left ventricular systolic dysfunction at discharge (58.0% vs. 35.0%, p=0.01). In this population, although not statistically significant, it was observed a delay between the onset of symptoms and percutaneous coronary intervention, which may traduce a deferred search for urgent medical care during the pandemic.

Conclusion: The lockdown phase of COVID-19 pandemic was associated with fewer and more severe ACS in a Tertiary Care Hospital in Portugal's most affected region by the pandemic.
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http://dx.doi.org/10.1016/j.repc.2021.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980138PMC
March 2021

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

ST-elevation acute coronary syndrome without obstructive coronary disease in a COVID-19 patient.

Rev Port Cardiol (Engl Ed) 2021 Jan 9;40(1):69-70. Epub 2020 Nov 9.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2020.06.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7651238PMC
January 2021

Pacman heart: An unexpected finding.

Rev Port Cardiol (Engl Ed) 2020 Nov 2;39(11):674-675. Epub 2020 Nov 2.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.10.010DOI Listing
November 2020

Evaluation of Usability, Perception of Usefulness, and Efficiency of an Application in Interpreting Imaging Examinations and Supporting Decision-Making in Orthopedics.

Telemed J E Health 2021 05 30;27(5):561-567. Epub 2020 Jun 30.

Department of Medicine Master's Program, Christus University Center (Unichristus), Fortaleza, Brazil.

Medical smartphone applications have rendered positive results in daily practice and also serve as potentially valuable educational tools. In orthopedics, radiograph analysis and angle measurements comprise an essential mechanism in the diagnosis, treatment, planning, and evaluation of the results in orthopedic surgery. Thus, the present study aimed to evaluate an application for mobile devices for orthopedic doctors and orthopedic residents. The application proposes the analysis and interpretation of radiographic imaging examinations through assessments and angle measurements. In this survey, we analyzed the parameter usability and usefulness of a mobile application for the iOS system, in addition to conducting its validation. The application was tested by 26 volunteers: 13 orthopedists and 13 orthopedic residents. After applying the System Utility Score (SUS) questionnaire, which assesses the usability of an application, a score of 84.5 was obtained, a value that represents an A+ rating on the Sauro and Lewis scale. There was no statistically significant difference when comparing the SUS between the orthopedic residents and orthopedists. According to the usefulness perception analysis, 90% of the residents responded positively to the questions, while among orthopedists, the percentage was 75%, denoting a statistically significant difference (p = 0.002). Subsequently, the application underwent validation to assess whether the calculated angle measurements were reliable when compared with those obtained using the goniometer. No significant differences were observed when comparing the angles measured by the two evaluated methods. In conclusion, the developed application can reliably contribute to the measurement of angles in radiographs, assisting in therapeutic decision-making, and may be used as an instrument to promote the teaching and learning processes in orthopedics.
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http://dx.doi.org/10.1089/tmj.2020.0108DOI Listing
May 2021

Echocardiographic appearance of a rare condition - tracheobronchomegaly.

Rev Port Cardiol (Engl Ed) 2020 Apr 20;39(4):229-230. Epub 2020 May 20.

Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.03.010DOI Listing
April 2020

Infective endocarditis: When an image surprises the echocardiographer.

Rev Port Cardiol (Engl Ed) 2019 Nov 6;38(11):831-832. Epub 2020 Feb 6.

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

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http://dx.doi.org/10.1016/j.repc.2019.01.009DOI Listing
November 2019

Two hearts: A complex case of heart failure.

Rev Port Cardiol (Engl Ed) 2019 Jul 11;38(7):515-517. Epub 2019 Sep 11.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2018.09.012DOI Listing
July 2019

Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?

Rev Port Cardiol (Engl Ed) 2019 Apr 16;38(4):261-266. Epub 2019 May 16.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI.

Methods: Clinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these.

Results: Both TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006).

Conclusions: While both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes.
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http://dx.doi.org/10.1016/j.repc.2018.07.008DOI Listing
April 2019

Traumatic aortic valve tear - role of echocardiography.

Acta Cardiol 2020 Aug 25;75(4):373-374. Epub 2019 Apr 25.

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

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http://dx.doi.org/10.1080/00015385.2019.1584695DOI Listing
August 2020

TAVI in TAVI: new paradigm.

Acta Cardiol 2020 Apr 29;75(2):172-174. Epub 2019 Mar 29.

Centro Hospitalar de São João, Serviço de Cardiologia, Porto, Portugal.

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http://dx.doi.org/10.1080/00015385.2019.1569311DOI Listing
April 2020

Real-life data on heart failure before and after implantation of resynchronization and/or defibrillation devices - the Síncrone study.

Rev Port Cardiol (Engl Ed) 2019 Jan 23;38(1):33-41. Epub 2019 Jan 23.

Serviço de Cardiologia, Hospital da Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.

Introduction: The aim of this study was to document clinical practice in Portugal regarding the use of electronic cardiac devices in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).

Methods: The Síncrone study was an observational prospective multicenter registry conducted in 16 centers in Portugal between 2006 and 2014. It included adult patients with a diagnosis of HF, LVEF <35% and indication for implantable cardioverter-defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) devices, according to the recommendations of the European Society of Cardiology at the beginning of the study. Patients were followed for one year according to the practice of each center.

Results: A total of 486 patients were included in the registry, half of whom received an ICD and the other half a CRT pacemaker (CRT-P) or CRT defibrillator (CRT-D). Mean age was 65±12 years and the most frequent causes of HF were ischemic (47%) and idiopathic dilated cardiomyopathy (28%). Overall mortality at one year was 3.6% and the hospitalization rate was 11%, significantly higher in patients with CRT-P/CRT-D than with ICD (17% vs. 5.6%, p<0.001). Patients who received CRT-P/CRT-D experienced significant reductions in QRS duration (160±21 vs. 141±24 ms, p<0.001) as well as improvement in New York Heart Association functional class.

Conclusion: The Síncrone study shows that the use of implantable devices in HF with reduced LVEF in Portugal is in accordance with international recommendations and that patients presented functional improvement and reduced one-year mortality.
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http://dx.doi.org/10.1016/j.repc.2018.04.011DOI Listing
January 2019

Mini-sternotomy versus full sternotomy aortic valve replacement: a single-centre experience.

Rev Port Cir Cardiotorac Vasc 2018 Jul-Dec;25(3-4):119-126

Faculdade de Medicina da Universidade do Porto, Departamento de Medicina, Portugal; Centro Hospitalar São João - Serviço de Cardiologia, Portugal.

Background: full sternotomy (FS) is the gold standard approach to perform surgical aortic valve replacement (AVR). However, potential advantages of a less traumatic approach fomented the development of so-called minimally invasive procedures, which include upper mini-sternotomy (MS).

Objective: to compare immediate postoperative clinical results and mid-term mortality after AVR through MS and FS.

Methods: single-centre retrospective study including all patients who underwent isolated AVR through MS between January 1, 2011 and July 31, 2017. These were then matched with patients who underwent the same procedure through FS and by the same surgeons who performed MS, using coarsened exact matching for the variables age, gender, body mass index and diabetes mellitus. Groups were later characterized and compared regarding postoperative results using Qui- -squared and Mann-Whitney tests and regarding mid-term mortality through Kaplan-Meier curves.

Results: we included 82 patients (n=41 in each group). Aortic cross clamp [78 vs. 63 minutes, p=0.001] and cardiopulmonary bypass times [107 vs. 90 minutes, p=0.002] were significantly longer in the MS group vs. FS group, respectively. Although without reaching statistical significant difference, a smaller percentage of patients from the MS group required red blood cells transfusions during surgery (39.0% vs. 53.7%, p=0.184). Similar results were found regarding mechanical ventilation, inotropic support, morphine infusion, intensive care unit length of stay and incidence of de novo atrial fibrillation. Cumulative survival at 6 years was 86.7% after MS and 88.5% after FS (p=0.650).

Conclusions: Aortic valve replacement through MS seems to be a safe alternative to the gold standard FS.
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July 2019

Thrombogenic Porcelain Atrium.

Heart Lung Circ 2018 Nov 8;27(11):e111-e112. Epub 2018 Jun 8.

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

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http://dx.doi.org/10.1016/j.hlc.2018.04.305DOI Listing
November 2018

Patent foramen ovale may not always be benign in the elderly.

Rev Port Cardiol (Engl Ed) 2019 May 9;38(5):387-388. Epub 2018 Jul 9.

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

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http://dx.doi.org/10.1016/j.repc.2018.05.012DOI Listing
May 2019

Percutaneous Closure of a Fistulous Giant Coronary Aneurysm.

Can J Cardiol 2018 06 3;34(6):812.e13-812.e15. Epub 2018 Feb 3.

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

Giant coronary artery aneurysms larger than 50 mm are rare and associated with important complications: namely, rupture. Its workup requires comprehensive imaging and standard treatment is surgical exclusion. We present a 60-year-old patient with previous ostium secundum atrial septal defect surgical closure diagnosed with a giant proximal right coronary artery aneurysm (70 x 62 mm) fistulizing into the right atrium. Percutaneous closure of its aortic origin with an atrial septal occluder was successfully performed, and thrombosis of the aneurysm confirmed on angiography and echocardiogram. This case depicts an innovative, minimally invasive approach to this worrisome entity.
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http://dx.doi.org/10.1016/j.cjca.2018.01.088DOI Listing
June 2018

The role of biomarkers in dilated cardiomyopathy: Assessment of clinical severity and reverse remodeling.

Rev Port Cardiol 2017 Oct 6;36(10):709-716. Epub 2017 Oct 6.

Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal.

Introduction: Biomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR).

Methods: In this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy.

Results: Baseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e' (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e' velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05).

Conclusions: No correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.
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http://dx.doi.org/10.1016/j.repc.2017.02.015DOI Listing
October 2017

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report.

Cardiology 2017;138(2):80-86. Epub 2017 Jun 15.

Cardiology Department, Centro Hospitalar São João, Faculty of Medicine, Universidade do Porto, Porto, Portugal.

Patients with severely depressed left ventricular ejection fractions (LVEFs) receive implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death. However, in some patients, LVEFs may improve or even normalize over time, and these patients would no longer be qualified for ICD implantation based on the original criteria for which they have initially received an ICD. We report a patient with idiopathic dilated cardiomyopathy whose LVEF recovered to normal values after pharmacological therapy. Meanwhile, the patient had life-threatening ventricular fibrillation, aborted by the ICD. We reflect on the pathological features of left ventricular reverse remodelling and ventricular arrhythmogenesis, where the myocardial substrate appears to play an important role. Also, after LVEF improvement in a patient with a cardiac device, there is still a debate on whether we should perform a battery replacement.
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http://dx.doi.org/10.1159/000475523DOI Listing
August 2018

Left ventricular reverse remodeling in dilated cardiomyopathy- maintained subclinical myocardial systolic and diastolic dysfunction.

Int J Cardiovasc Imaging 2017 May 24;33(5):605-613. Epub 2016 Dec 24.

Cardiology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.

In idiopathic dilated cardiomyopathy (DCM), myocardial deformational parameters and their relationships remain incompletely characterized. We measured those parameters in patients with DCM, during left ventricular reverse remodeling (LVRR). Prospective study of 50 DCM patients (in sinus rhythm), with left ventricular ejection fraction (EF) <40%. LVRR was defined as an increase of ten units of EF and decrease of diastolic left ventricular diameter (LVDD) in the absence of resynchronization therapy. Performed morphological analysis, myocardial performance quantification (LV and RV Tei indexes) and LV averaged peak systolic longitudinal strain (SSR long) and circumferential strain (SSR circ). At baseline, mean EF was 25.4 ± 9.8%, LVDD was 62.4 ± 7.4 mm, LVDD/BSA of 34.2 ± 4.5 mm/m and 34% had MR grade >II/IV. LVRR occurred in 34% of patients within 17.6 ± 15.6 months and was associated with a reduced rate of death or heart failure hospitalization (5.9% vs. 33.3; p = 0.03). Patients with LVRR had a final EF of 48.9 ± 7.9% (Δ LV EF of 22.4%) and there was a significant decrease (p < 0.05) in: LVDD/BSA, LV systolic diameter/BSA, LV diastolic volume, LV systolic volume, LV mass; an increase (p < 0.05) in sphericity index. However, measures of diastolic function (LA volume/BSA, e'velocity and' E/e'ratio), final LV and RV Tei indexes were not significantly different from baseline. Additionally, final SSR circ and SSR long values were not different from basal. Patients who recovered EF >50% (n = 10), SSR circ and SSR long were inferior to normal. Improvement in EF occurred in one-third of DCM pts and was associated with a decrease of major cardiac events. There was an improvement of diastolic and systolic volumes and in sphericity index, confirming truly LV reverse reshaping. However, myocardial performance indexes, SSR long and SSR circ in reverse-remodeled DCM were still abnormal, suggesting a maintained myocardial systolic and diastolic dysfunction.
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http://dx.doi.org/10.1007/s10554-016-1042-6DOI Listing
May 2017

Aortic valve replacement with the Carpentier-Edwards Perimount bioprosthesis: Clinical and hemodynamic evaluation.

Rev Port Cir Cardiotorac Vasc 2016 Jul-Dec;23(3-4):111-117

Departamento de Medicina, Faculdade de Medicina, Universidade do Porto; Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal.

Introduction: The number of aortic valve replacement (AVR) surgeries has increased recently, along with the number of bioprosthetic valves implantations. Several studies reported excellent durability and low incidence of valve-related complications with the Carpentier-Edwards Perimount (CEP) pericardial bioprosthesis. The aim of this study is to evaluate the hemodynamic performance and clinical outcomes of the CEP in the aortic position.

Methods: This retrospective study included all patients who underwent AVR using the CEP valve from January 2010 to December 2010 at our institution. Clinical, surgical and early echocardiographic data were retrospectively collected. Survival was the primary endpoint. Median follow-up was 6.5 years. Hemodynamic profile was evaluated by echocardiography 3±1 months after AVR.

Results: Out of 175 patients, 50% were male and the mean age was 70.8+8.8 years. We registered a relatively low rate of complications: 2.2% permanent pacemaker implantation; 32.2% post-operative atrial fibrillation episodes; 1.1% stroke. The 30-day mortality rate was 5.1%. One patient underwent reoperation to replace the CEP bioprosthesis due to endocarditis (0.6%). Overall survival rates at 1, 3, 5 and 7 years were 93.4, 82.5, 75.3, and 62.3%, respectively. No significant differences were found between 7-year survival rates for isolated AVR and multiple procedures (67.8% vs. 61.8%, Log-Rank test, p=0.286). Post-operative mean transvalvular gradient was 15.5±4.8 mmHg and EOA 1.6±0.3 cm2.

Conclusion: The CEP bioprosthesis in the aortic position shows acceptable mid-term clinical results and hemodynamic profile that support its clinical use.
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December 2016

[Comment on "Haemodynamic and anatomic progression of aortic stenosis"].

Authors:
Filipe Macedo

Rev Port Cardiol 2016 Feb;35(2):131-2

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February 2016

[Surgical treatment of type A acute aortic syndrome: a single-center 10-year experience].

Rev Port Cir Cardiotorac Vasc 2016 Jan-Jun;23(1-2):29-36

Faculdade de Medicina da Universidade do Porto, Departamento de Medicina, Porto, Portugal; Centro Hospitalar São João - Serviço de Cardiologia, Porto, Portugal.

Introduction: Acute Aortic Syndrome (AAS) affecting the ascending aorta still represents a challenge to cardiologists and cardiothoracic surgeons, being associated with high mortality even with early surgery.

Aims: To describe the immediate post-operative results and long-term survival after the surgical treatment of type A AAS. Secondary outcomes include hospital mortality, length of hospital stay and long-term mortality.

Methods: Retrospective longitudinal study, including all patients who underwent ascending aorta replacement for surgical treatment of type A AAS, in a tertiary center, between January 2005 and December 2015. Preoperative, surgical and postoperative characteristics were evaluated. In addition to the descriptive analysis, the impact of some variables on long-term mortality, hospital mortality and length of hospital stay was evaluated.

Results: We included 78 patients, the most common type of AAS was aortic dissection (92,3%). 6 patients died at operation room and 12 in the immediate post-operative period, completing 23,1% of in-hospital mortality. Considering 60 survivors who were followed by a mean time of 5 years, maximum of 12, we registered a cumulative survival at 1, 3, 5, 10-years of 93,5%, 84,3%, 77% and 69,5%, respectively. Marfan Syndrome was found to be a risk factor of higher long term mortality (HR: 3,85, p=0,045).

Conclusion: Our study confirms previous observations associating AAS type A with high rates of morbidity and mortality, despite significant advances in diagnostic and therapeutic techniques.
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June 2016

Relationship between body mass index and mean arterial pressure in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study.

BMC Pregnancy Childbirth 2015 Oct 30;15:281. Epub 2015 Oct 30.

Department of Mathematics, Faculty of Sciences, University of Porto, 4169-007, Porto, Portugal.

Background: Being overweight is associated with both higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) during pregnancy and increased risk of gestational hypertensive disorders. The objective of this study was to determine and quantify the effect of body mass index (BMI) on mean arterial pressure (MAP) at several time points throughout pregnancy in normotensive (NT) and chronic hypertensive pregnant (HT) women.

Methods: A prospective longitudinal study was carried out in 461 singleton pregnancies (429 low-risk and 32 with chronic arterial hypertension), with measurements taken at the 1(st), 2(nd), and 3(rd) trimesters and at delivery. Linear mixed-effects regression models were used to evaluate the time-progression of BMI, SBP, DBP and MAP during pregnancy (NT vs. HT). The longitudinal effect of BMI on MAP, adjusted for the hypertensive status, was investigated by the same methodology.

Results: BMI consistently increased with time in both NT and HT women. In contrast, MAP decreased during the first half of pregnancy, after which it increased until the moment of delivery in both groups. A 5-unit increase in BMI was predicted to produce an increase of approximately 1 mmHg in population MAP values. This effect is independent from the time period and from hypertensive status.

Conclusions: In both NT and HT pregnant women, MAP is strongly (and significantly) influenced by increases in BMI.
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http://dx.doi.org/10.1186/s12884-015-0711-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628392PMC
October 2015

Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol.

Pediatr Radiol 2015 Dec 14;45(13):1916-29. Epub 2015 Aug 14.

SMIC, Porto, Portugal.

Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.
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http://dx.doi.org/10.1007/s00247-015-3403-zDOI Listing
December 2015

Construction of a competence-based curriculum for internship in obstetrics and gynecology within the medical course at the Federal University of Ceará (Sobral campus).

Sao Paulo Med J 2015 May-Jun;133(3):264-70. Epub 2015 Apr 14.

Faculdade de Medicina, Universidade Federal do Ceará, Sobral, Ceará, Brazil.

Context And Objective: This research project arose from a proposal made to the teachers by the students of a medical course at a federal university in Brazil, from their personal experiences regarding the skills and competencies that should be developed during the obstetrics and gynecology (OBG) stage of the internship. The objective here was to develop the matrix of skills necessary for training good general physicians in the medical course.

Design And Setting: Exploratory qualitative study conducted in a federal university in Brazil.

Methods: The basis for developing these competencies among OBG interns was "The Competency Matrix for Medical Internship" developed by Bollela and Machado. The instrument was presented to, analyzed by and modified by a set of OBG specialists, at two sessions.

Results: The specific competencies expected from students over the internship in OBG were framed within overall topics that had previously been determined and listed: healthcare, decision-making, communication and interpersonal relationships, management and organization of the Brazilian National Health System (Sistema Único de Saúde, SUS) and professionalism.

Conclusions: A competency matrix that standardizes the minimum requirements that interns should be capable of putting into practice after concluding the OBG stage is a valuable tool for ensuring student performance and a fair and rigorous assessment for them, thereby seeking to train good general physicians who meet the community's needs.
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http://dx.doi.org/10.1590/1516-3180.2014.0804872DOI Listing
January 2016

Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study.

BMC Pregnancy Childbirth 2015 Feb 13;15:28. Epub 2015 Feb 13.

Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.

Background: The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.

Methods: A cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up.

Results: The cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI95%: 61.5%-76.5% and 75.0%, CI95%: 57.9%-86.8%, respectively) and specificity (75.0%, CI95%: 57.9%-86.8% and 65.6%, CI95%: 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively.

Conclusions: The potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.
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http://dx.doi.org/10.1186/s12884-015-0464-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332726PMC
February 2015

Reference ranges for uterine artery pulsatility index during the menstrual cycle: a cross-sectional study.

PLoS One 2015 5;10(3):e0119103. Epub 2015 Mar 5.

Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Obstetrics-Gynecology, Hospital-CUF Porto, 4100-180 Porto, Portugal.

Background: Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity.

Methods: From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression.

Results: The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1-34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes.

Conclusions: The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119103PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351196PMC
January 2016