Publications by authors named "Manuel Oliveira-Santos"

24 Publications

  • Page 1 of 1

Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[F]F PET-CT.

J Nucl Cardiol 2021 Apr 6. Epub 2021 Apr 6.

Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.

Background: Fluorine-18 sodium fluoride (Na[F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients.

Methods And Results: Thirty-four high CV risk individuals without previous CV events were scanned with Na[F]F PET-CT. Cardiac Na[F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (r = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (r = 0.61), body mass index (r = 0.66), abdominal perimeter (r = 0.74), thoracic fat volume (r = 0.47), and epicardial adipose tissue (r = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[F]F uptake.

Conclusions: In a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.
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http://dx.doi.org/10.1007/s12350-021-02600-2DOI Listing
April 2021

Late challenges after full plastic jacket in spontaneous coronary dissection.

Rev Port Cardiol 2021 Feb 25;40(2):143-144. Epub 2020 Dec 25.

Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.08.011DOI Listing
February 2021

Fusion imaging in interventional cardiology.

Rev Port Cardiol 2020 08 28;39(8):463-473. Epub 2020 Jul 28.

Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

The number and complexity of percutaneous interventions for the treatment of structural heart disease has increased in clinical practice in parallel with the development of new imaging technologies, in order to render these interventions safer and more accurate. Complementary imaging modalities are commonly used, but they require additional mental reconstruction and effort by the interventional team. The concept of fusion imaging, where two different modalities are fused in real time and on a single monitor, aims to solve these limitations. This is an important tool to guide percutaneous interventions, enabling a good visualization of catheters, guidewires and devices employed, with enhanced spatial resolution and anatomical definition. It also allows the marking of anatomical reference points of interest for the procedure. Some studies show decreased procedural time and total radiation dose with fusion imaging; however, there is a need to obtain data with more robust scientific methodology to assess the impact of this technology in clinical practice. The aim of this review is to describe the concept and basic principles of fusion imaging, its main clinical applications and some considerations about the promising future of this imaging technology.
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http://dx.doi.org/10.1016/j.repc.2020.03.014DOI Listing
August 2020

A 10- and 15-year performance analysis of ESC/EAS and ACC/AHA cardiovascular risk scores in a Southern European cohort.

BMC Cardiovasc Disord 2020 06 19;20(1):301. Epub 2020 Jun 19.

Cardiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Background: A key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms. We aimed to investigate the predictive ability of SCORE (Systematic COronary Risk Estimation) and PCE (Pooled Cohort Equations) systems for atherosclerotic CVD (ASCVD) risk in Portugal, a low CVD risk country, at the 10-year landmark and at a longer, 15-year follow-up.

Methods: The SCORE and PCE 10-year risk estimates were calculated for 455 and 448 patients, respectively. Discrimination was assessed by Harrell's C-statistic. Calibration was analyzed by standardized incidence ratios (SIR).

Results: During the 10-year follow-up, 7 fatal ASCVD events (the SCORE outcome) and 32 any ASCVD events (the PCE outcome) occurred. The SCORE system showed good discrimination (C-statistic 0.83), while the PCE showed poor discrimination (C-statistic 0.62). Calibration was similar for both systems, according to SIR: SCORE, 0.3 (95% CI 0.1-0.7); PCE, 0.5 (95% CI 0.4-0.7). Globally, both 10-year fatal ASCVD risk and any ASCVD risk were overestimated in the overall population and men. However, the risk was underestimated by both systems in women. Despite an overestimation of 15-year fatal ASCVD by SCORE, the 15-year any ASCVD observed incidence was 1.8 times the 10-year incidence among men and 1.4 times among women. This acceleration of CVD risk was more relevant in the lowest classes of ASCVD risk.

Conclusion: In this prospective, contemporary, Portuguese cohort, the SCORE had better discriminatory power and similar calibration compared to PCE. However, both risk scores underestimated 10-year ASCVD risk in women.
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http://dx.doi.org/10.1186/s12872-020-01574-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304198PMC
June 2020

Cardiac allograft vasculopathy: Incidence and predictors in a single-center cohort.

Rev Port Cardiol 2020 Apr 26;39(4):205-212. Epub 2020 May 26.

Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal.

Introduction And Aims: Cardiac allograft vasculopathy (CAV) is one of the most significant complications after orthotopic heart transplantation. We aimed to investigate the incidence and predictors of CAV in a large cohort of orthotopic heart transplantation patients.

Methods: We conducted a retrospective analysis on a prospective cohort of 233 patients who underwent transplantation between November 2003 and May 2014. Baseline clinical data and invasive coronary angiograms (n=712) performed as part of the follow-up program were analyzed by two independent investigators.

Results: We included 157 male and 45 female patients with a median age of 66 years. A third of patients had previous ischemic heart disease, 30% peripheral arterial disease, 37% hypertension and 47% dyslipidemia, and 17% were smokers. Acute moderate or severe rejection occurred in 42 patients during the first year. Over a median follow-up of 2920 days, 18% were diagnosed with CAV, with an incidence of 2.91 cases per 100 person-years. Predictors of CAV were previous ischemic heart disease (HR 2.32, 95% CI 1.21-4.45, p=0.01), carotid artery disease (HR 2.44, 95% CI 1.27-4.71, p<0.01), and donor age (HR 1.04, 95% CI 1.00-1.07, p=0.01).

Conclusion: In a single-center cohort of orthotopic heart transplantation patients, predictors of CAV were previous ischemic heart disease, carotid artery disease and donor age.
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http://dx.doi.org/10.1016/j.repc.2019.10.007DOI Listing
April 2020

Aortic valve microcalcification and cardiovascular risk: an exploratory study using sodium fluoride in high cardiovascular risk patients.

Int J Cardiovasc Imaging 2020 Aug 28;36(8):1593-1598. Epub 2020 Apr 28.

Institute of Nuclear Sciences Applied To Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal.

18F-sodium fluoride (18F-NaF) has been used to access aortic stenosis in clinical research setting. It is known that its uptake is related with microcalcification. The purpose of this study was to assess the relationship between 18F-NaF uptake by the aortic valve and cardiovascular risk. Twenty-five patients with risk factors for cardiovascular disease, without known cardiovascular disease or aortic stenosis underwent PET-CT with 18F-NaF. Cardiovascular risk was assessed through the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator. Aortic valve 18F-NaF (AoVCUL) uptake was evaluated through the corrected uptake per lesion (CUL = max SUV - mean blood-pool SUV). Calcium score was obtained through cardiac CT. The patients present a mean age of 63.90 ± 8.60 years and 56% males. The mean ASCVD was of 28.76 ± 18.96 (M 25, IQR 38.50). The mean aortic valve calcium score (AoVCaSc) was of 53.24 ± 164.38 (M 6; IQR 29.75) and the AoVCUL was of 0.50 ± 0.10 (M 0.52, IQR 0.15). The patients were classified according to the ASCVD: patients with a risk greater or equal than the 50th percentile of the ASCVD risk and patients with a risk lower than the 50th percentile. The AoVCUL was evaluated in both groups: AoVCUL = 0.56 ± 0.10 vs 0.42 ± 0.15, p = 0.02; AoVCaSc was of 0 in 11 patients (44%) and those with an ASCVD greater or equal than the 50th percentile had a mean AoVCaSc of 8.00 ± 13.80, and those with an ASCVD risk lower than the 50th percentile had a mean AoVCaSc of 95.00 ± 223.45; p = 0.09. In this study microcalcification, evaluated through 18F-NaF on PET-CT, was related with cardiovascular risk. Although the score of calcium seems to be higher in higher cardiovascular risk patients, no significant difference was found between groups.
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http://dx.doi.org/10.1007/s10554-020-01854-0DOI Listing
August 2020

Renal artery wall 18F-NaF activity and glomerular filtration rate: an exploratory analysis in a high cardiovascular risk population.

Nucl Med Commun 2020 Feb;41(2):126-132

Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto.

Objectives: Atherosclerotic plaque molecular imaging with F-sodium fluoride (NaF) PET with computed tomography (PET-CT) may identify active unstable microcalcification. We sought to explore renal arteries calcification activity in a group of high cardiovascular (CV) risk subjects without manifest CV disease.

Methods: High CV risk hypertensive individuals from a single centre were prospectively scanned with F-NaF-PET-CT in major vascular territories. Renal arterial wall activity was retrospectively analysed and expressed as the ratio between maximum standard uptake value in the lesion and mean blood pool activity in the superior vena cava [tissue-to-background ratio (TBR)]. We explored renal artery wall F-NaF activity's association to CV risk factors and renal function.

Results: Mean age was 64 ± 8.6 years, 56% male, 96% Caucasian and 24% had chronic kidney disease (CKD) (n = 25). Six individuals (24%) showed renal artery wall radiotracer uptake (TBR 1.4 ± 0.4); these subjects were heavier, had higher triglycerides, high-sensitivity C-reactive protein and predicted CV risk (SCORE) compared to the remaining cohort (P < 0.05 for all comparisons). There was a trend toward higher F-NaF uptake in other major vessels and increased thoracic fat volume in subjects with renal artery wall uptake. Glomerular filtration rate (GFR) was lower in subjects with positive renal plaques (93.0 ± 29.7 vs. 65.0 ± 19.7 ml/min, P = 0.04). Renal artery radiotracer uptake and eGFR were inversely correlated (r = -0.42, P = 0.04).

Conclusion: In a high CV risk group without manifest CV disease, higher renal artery wall F-NaF activity is associated with superior predicted CV risk and lower GFR.
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http://dx.doi.org/10.1097/MNM.0000000000001128DOI Listing
February 2020

Myocardial peak systolic velocity-a tool for cardiac screening of HIV-exposed uninfected children.

Eur J Pediatr 2020 Mar 25;179(3):395-404. Epub 2019 Nov 25.

Coimbra Institute for Clinical and Biomedical Researh (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

HIV-uninfected children exposed prenatally to the virus and to prophylactic antiretroviral therapy are at an uncertain risk of long-term myocardial dysfunction. This study aimed to analyse the structure and function of their ventricles and to identify potential screening tools for this at-risk population. One hundred and fifteen children (77 exposed vs 38 controls) aged between 2.7 and 16.2 years were included. An echocardiographic study was performed where both ventricles' dimensions and systolic functions were evaluated. In the left ventricle, parameters related to diastolic function were also analysed. Tissue Doppler values were determined in the basal state and after passive leg raising. Serologic analysis of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was carried out. The two groups had identical ventricular sizes and left ventricular diastolic functions. However, contractility assessed by myocardial peak systolic velocity was significantly inferior in the exposed group. These systolic echocardiographic differences were present despite similar values of NT-proBNP in both groups.Conclusion: HIV-exposed uninfected children may be vulnerable to ventricular systolic dysfunction at long term. Cardiovascular surveillance and periodic monitoring of biventricular function are therefore recommended. Myocardial peak systolic velocity may be a useful screening tool for this purpose.What is Known:• Previous studies on HIV-exposed uninfected children subjected prenatally to antiretroviral therapy have alerted to potential long-term cardiovascular toxicity effects on the left ventricle.What is New:• The study gives new insights on ventricular function and morphology in HIV-exposed uninfected children.• Myocardial peak systolic velocities are significantly inferior in this paediatric sub-group, therefore long-term cardiac surveillance is recommended.
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http://dx.doi.org/10.1007/s00431-019-03477-7DOI Listing
March 2020

Apolipoprotein E2 Genotype Is Associated with a 2-Fold Increase in the Incidence of Type 2 Diabetes Mellitus: Results from a Long-Term Observational Study.

J Lipids 2019 7;2019:1698610. Epub 2019 Aug 7.

Department of Cardiology, Coimbra University Hospital Center, Coimbra, Portugal.

Background: The apolipoprotein E (APOE) polymorphisms are associated with cardiovascular (CV) disease, but its interaction with type 2 diabetes mellitus (T2DM) long-term incidence is unknown. We investigated the association between APOE genotype and long-term (i) CV events and (ii) T2DM incidence in a Southern European primary prevention cohort.

Methods: We assessed individual APOE genotypes in a total of 436 patients followed at a lipid clinic, with a 15-year median follow-up time. We collected data on major CV events (CV death, myocardial infarction, and stroke) and T2DM development.

Results: No differences were found regarding major CV event incidence among the different APOE genotypes. However, after excluding 39 patients with a prior history of T2DM, APOE2 carriers displayed a higher incidence of T2DM during follow-up (42.2%) than APOE3 (27.1%) and APOE4 (28.7%) carriers. The age-, sex-, triglycerides-, and statin usage-adjusted OR for T2DM incidence in APOE2 carriers was 1.8 (95%CI 1.1-2.9, =0.03), compared with wild-type APOE3. To address the role of statins as a confounder, we analyzed T2DM incidence in statin-treated patients. Statin-treated APOE2 carriers also had a higher T2DM incidence (57.9%), in comparison with APOE3 homozygotes (31.6%) and APOE4 carriers (32.5%). After adjustment for confounding, APOE2 carriers on statins displayed a similar twofold increase in T2DM risk compared to APOE3 homozygotes (OR 2.1, 95%CI 1.1-4.0, =0.03).

Conclusion: Our findings suggest a twofold increase in T2DM incidence in APOE2 carriers. This may prompt for a specific glucose dysmetabolism follow-up that might be tailored on the APOE genotype.
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http://dx.doi.org/10.1155/2019/1698610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702854PMC
August 2019

Sodium fluoride in cardiovascular disorders: A systematic review.

J Nucl Cardiol 2019 Aug 6. Epub 2019 Aug 6.

Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba - Celas PT, 3000-548, Coimbra, Portugal.

Background: 18-Fluorine sodium fluoride is a well-known radiotracer used for bone metastasis diagnosis. Its uptake correlation with cardiovascular (CV) risk was primarily suggested in oncological patients. Moreover, as a specific marker of microcalcification, it seems to correlate with CV disease progression and plaque instability.

Methods And Results: Our purpose was to systematically review clinical studies that characterized the use of this marker in CV conditions. In atherosclerosis, most studies report a positive correlation with the burden of CV risk factors and vascular calcification. A higher uptake was found in culprit plaques/rupture sites in coronary and carotid arteries and it was also linked to high-risk features in histology and intravascular imaging analysis of the plaques. In aortic stenosis, this tracer displayed an increasing uptake with disease severity.

Conclusions: Sodium fluoride positron emission tomography is a promising non-invasive technique to identify high-risk plaques, which sets ground to a potential use of this tracer in evaluating atherosclerotic disease progression and degenerative changes in aortic valve stenosis. Nevertheless, there is a need for further prospective evidence that demonstrates this technique's value in predicting clinical events, adjusting treatment strategies, and improving patient outcomes.
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http://dx.doi.org/10.1007/s12350-019-01832-7DOI Listing
August 2019

Cardiovascular Three-Dimensional Printing in Non-Congenital Percutaneous Interventions.

Heart Lung Circ 2019 Oct 23;28(10):1525-1534. Epub 2019 May 23.

Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Three-dimensional (3D) printing technology is emerging as a potential new tool for the planning of medical interventions. In the last few years, increasing data have accumulated on its ability to guide interventional cardiology procedures, going beyond initial reports in congenital heart disease settings. In fact, there is compelling evidence on the advantages of a 3D-printed guided strategy for left atrial appendage closure, suggesting a high success rate with optimal device selection and lower radiation load. Furthermore, there is emerging experience in aortic root printing, which may improve the success rate and safety of transcatheter aortic valve replacement and may be of particular interest for targeting low-risk populations. Additionally, there are stimulating reports in mitral valve intervention, setting the tone for this new field in cardiovascular percutaneous intervention. In this clinically oriented paper, we will review current 3D printing use in interventional cardiology and we will address future directions, with a focus on procedural planning and medical simulation.
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http://dx.doi.org/10.1016/j.hlc.2019.04.020DOI Listing
October 2019

[Evaluation of The Medical Board Exam in Portugal].

Acta Med Port 2018 Nov 30;31(11):670-679. Epub 2018 Nov 30.

Faculdade de Medicina. Universidade de Coimbra. Coimbra. Serviço de Otorrinolaringologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Coimbra Institute for Clinical and Biomedical Research (iCBR). Coimbra. Portugal.

Introduction: There is a high heterogeneity in the structure of postgraduate medical training evaluation worldwide. However, in contrast to other countries, there have been no scientific studies of the final medical board examination, in Portugal. The present study aimed to evaluate the adequacy of the medical board examination including its validity as measured by its association with medical school grade average and national seriation examination.

Material And Methods: Cross-sectional, observational study. We analyzed the final results on the medical board examination of 2439 physicians, across 47 specialties, who completed their training in 2016 and 2017, using measures of central tendency and variability. We assessed the association between these grades and the national exam to initiate residency, and the grade average in Medical School.

Results: Measures of central tendency and variability, and consequent shape measures, revealed that the distribution of the scores of the final medical board exam is extremely negatively asymmetric and leptokurtic. A positive association was also found between the results in this exam and the score on national exam to initiate residency, and the grade average in Medical School.

Conclusion: Although the medical board examination was, in general, positively associated with scores on the national exam to initiate residency, and the mean final Medical School grades, thus indicating its potential validity, our results demonstrate that this exam presents no satisfactory discriminative capacity. Therefore, there is room to improve the actual postgraduate medical examination model, including changes in its classification system and potentially consider other assessment models.
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http://dx.doi.org/10.20344/amp.10646DOI Listing
November 2018

Patient-specific 3D printing simulation to guide complex coronary intervention.

Rev Port Cardiol 2018 06 7;37(6):541.e1-541.e4. Epub 2018 May 7.

Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

The field of three-dimensional printing applied to patient-specific simulation is evolving as a tool to enhance intervention results. We report the first case of a fully simulated percutaneous coronary intervention in a three-dimensional patient-specific model to guide treatment. An 85-year-old female presented with symptomatic in-stent restenosis in the ostial circumflex and was scheduled for percutaneous coronary intervention. Considering the complexity of the anatomy, patient setting and intervention technique, we elected to replicate the coronary anatomy using a three-dimensional model. In this way, we simulated the intervention procedure beforehand in the catheterization laboratory using standard materials. The procedure was guided by optical coherence tomography, with pre-dilatation of the lesion, implantation of a single drug-eluting stent in the ostial circumflex and kissing balloon inflation to the left anterior descending artery and circumflex. Procedural steps were replicated in the real patient's treatment, with remarkable parallelism in angiographic outcome and luminal gain at intracoronary imaging. In this proof-of-concept report, we show that patient-specific simulation is feasible to guide the treatment strategy of complex coronary artery disease. It enables the surgical team to plan and practice the procedure beforehand, and possibly predict complications and gain confidence.
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http://dx.doi.org/10.1016/j.repc.2018.02.007DOI Listing
June 2018

Acute pneumopericardium: when echocardiography is not enough.

Acute Card Care 2016 Dec 16;18(4):85. Epub 2018 Feb 16.

a Cardiology A, University Hospitals of Coimbra , Coimbra , Portugal.

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http://dx.doi.org/10.1080/17482941.2017.1363394DOI Listing
December 2016

Stepwise Intervention for Small Vessel Chronic Total Occlusion.

Heart Lung Circ 2017 Dec 14;26(12):e123-e124. Epub 2017 Jul 14.

Interventional Cardiology Unit, Cardiology Department, Coimbra University Hospital, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.hlc.2017.06.723DOI Listing
December 2017

Fascioliasis-a rare cause of hepatic nodules.

BMJ Case Rep 2017 May 31;2017. Epub 2017 May 31.

Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Fascioliasis is a zoonotic disease that can sometimes affect humans. It presents with non-specific signs and symptoms which makes it difficult to establish an early definitive diagnosis. This can be particularly true in non-endemic countries where a high degree of suspicion is needed to make the diagnosis. Another confounding factor is that many of the initial complains and findings are very similar to those of malignancy. We report a case of an otherwise healthy 47 year-old male presenting with abdominal pain, night-time sweating, anorexia, weight loss and loose stools that had several hepatic nodules visible in the abdominal CT scan. Although the initial hypothesis was hepatic malignancy or liver metastasis of unknown primary neoplasm, the workup performed led us to the correct diagnosis. He was treated successfully for hepatic fascioliasis, with a full recovery.
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http://dx.doi.org/10.1136/bcr-2017-220363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747644PMC
May 2017

Atherosclerotic plaque metabolism in high cardiovascular risk subjects - A subclinical atherosclerosis imaging study with F-NaF PET-CT.

Atherosclerosis 2017 05 10;260:41-46. Epub 2017 Mar 10.

University Hospitals of Coimbra, Cardiology, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health - Faculty of Medicine of the University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine of the University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.

Background And Aims: Atherosclerotic plaque molecular imaging with F-sodium fluoride (NaF) in positron emission tomography with computed tomography (PET-CT) provides potential discrimination between active unstable microcalcification and established dormant calcification. We aimed to study F-NaF atherosclerotic plaque uptake in high cardiovascular (CV) risk participants and its associations with CV risk factors, coronary calcium score and thoracic fat volume.

Methods: High CV risk hypertensive individuals from a single centre were prospectively scanned with F-NaF-PET-CT in the coronary, aortic and carotideal arteries. Atherosclerotic plaque F-NaF uptake was expressed as Corrected Uptake per Lesion (CUL): maximum standard uptake value in each vascular territory subtracted by mean blood pool activity.

Results: Mean age was 64 years, 56% male and 96% Caucasian (n = 25). Ninety six per cent of the subjects showed F-NaF uptake in the aorta (CUL 0.9 ± 0.3), 40% in the carotid arteries (median CUL 0.0, IQR 0.0-0.7) and 64% in the coronary arteries (0.4, IQR 0.0-0.6). Individuals with ≥ five risk factors (60%) had increased overall F-NaF uptake (1.1 ± 0.3 vs. 0.7 ± 0.3, p < 0.01), which was positively correlated with predicted fatal CV risk - SCORE (r = 0.49, p = 0.01). There was no correlation between F-NaF uptake in the coronary arteries and calcium score (p = 0.87). Thoracic fat was moderately correlated with overall CUL (r = 0.41, p = 0.04).

Conclusions: In a high CV risk group, F-NaF atherosclerotic plaque uptake was related to the burden of CV risk factors and thoracic fat volume, but there was no association between coronary uptake and calcium score.
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http://dx.doi.org/10.1016/j.atherosclerosis.2017.03.014DOI Listing
May 2017

Optical Coherence Tomography-Guided Full Plastic Jacket in Spontaneous Coronary Artery Dissection.

JACC Cardiovasc Interv 2017 02 1;10(4):413-414. Epub 2017 Feb 1.

Cardiology A Department, Coimbra Hospital and University Centre, Coimbra, Portugal.

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http://dx.doi.org/10.1016/j.jcin.2016.10.028DOI Listing
February 2017

Assessment of atherosclerotic plaque calcification using F18-NaF PET-CT.

J Nucl Cardiol 2018 10 9;25(5):1733-1741. Epub 2017 Jan 9.

ICNAS (Instituto de Ciências Nucleares Aplicadas à Saúde), Coimbra, Portugal.

Background: The aim of the present study was to evaluate the uptake of F18-NaF by the arterial wall in patients with high cardiovascular (CV) risk profile. The tracer uptake was assessed in relation to gender and the number of CV risk factors.

Methods And Results: 25 patients without known CV disease were included and evaluated by PET-CT with F18-NaF: 14 (56%) men and 11 (44%) women. The mean target-to-background ratio (TBR: max SUV/mean blood-pool SUV) but not the corrected uptake per lesion (CUL: max SUV - mean blood-pool SUV) was higher in men than women (TBR: 1.8 ± 0.6 vs 1.7 ± 0.2; P = 0.04; CUL: 0.7 ± 0.3 vs W 0.6 ± 0.1; P = 0.4). Patients with >3 CV risk factors had higher CUL (0.8 ± 0.1 vs 0.6 ± 0.2; P = 0.01) but not TBR (1.8 ± 0.2 vs 1.7 ± 0.6; P = 0.7) than patients with <3 risk factors.

Conclusions: The TBR but not CUL is higher in men than women while the CUL but not TBR is related to the number of CV risk factors. These results are hypothesis-generating and require validation in larger studies.
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http://dx.doi.org/10.1007/s12350-016-0776-9DOI Listing
October 2018

Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease.

Int J Cardiovasc Imaging 2017 May 24;33(5):635-642. Epub 2016 Dec 24.

Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.

Left atrium function is essential for cardiovascular performance and is evaluable by two-dimensional speckle-tracking echocardiography (2D-STE). Our aim was to determine how echocardiographic parameters interrelate with exercise capacity and ventilatory efficiency in subjects with no structural heart disease. Asymptomatic volunteers, in sinus rhythm and with normal biventricular size and function, were recruited from a community-based population. Individuals with moderate-to-severe valvular disease, pulmonary hypertension, and history of cardiac disease were excluded. We performed a transthoracic echocardiogram and assessed left atrial (LA) and left ventricular (LV) mechanics via 2D-STE. Cardiopulmonary exercise testing by treadmill took place immediately thereafter. Peak oxygen uptake (VO) served as measure of functional capacity and ventilation/carbon dioxide output (VE/VCO) slope as surrogate of ventilation/perfusion mismatch. 20 subjects were included (age 51 ± 14 years, male gender 65%). Peak VO strongly correlated with age (r = -0.83; P < 0.01), with E/e' ratio (r = -0.72; P < 0.01), and with LA reservoir- and conduit-phase mechanics, particularly with LA conduit strain rate (SR) (r = -0.82; P < 0.01), but showed no correlation with LA volume index or LV mechanics. A similar pattern of associations was identified for VE/VCO slope. In multivariate analysis, LA conduit SR (β = -0.69; P = 0.02) emerged as sole independent correlate of peak VO, adjusted for age and for E/e' ratio (adjusted r  = 0.76; P < 0.01). Conduit and reservoir components of LA mechanics displayed strong associations with peak VO and VE/VCO slope. LA conduit-phase SR seems best suited as echocardiographic marker of functional capacity in subjects with no structural heart disease.
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http://dx.doi.org/10.1007/s10554-016-1045-3DOI Listing
May 2017

Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis.

Echocardiography 2016 Aug 16;33(8):1121-30. Epub 2016 Apr 16.

Department of Cardiology, University Unit, Coimbra Hospital and University Center, Coimbra, Portugal.

Purpose: Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two-dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD.

Methods: Overall, 73 patients with moderate-to-severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate-to-severe AS. Global circumferential ascending aortic strain (CAAS) and strain rate (CAASR) served as indices of aortic deformation; corrected CAAS was calculated as CAAS/pulse pressure (PP). Median clinical follow-up was 438 days.

Results: In patients with severe (vs. moderate) AR, CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics (CAAS, corrected CAAS, CAASR) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS. In follow-up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03).

Conclusions: Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis.
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http://dx.doi.org/10.1111/echo.13236DOI Listing
August 2016

[Career Satisfaction of Medical Residents in Portugal].

Acta Med Port 2015 Mar-Apr;28(2):209-21. Epub 2015 May 29.

Serviço de Cardiologia. Centro Hospitalar do Porto. Porto. Portugal.

Introduction: The satisfaction with the medical profession has been identified as an essential factor for the quality of care, the wellbeing of patients and the healthcare systems' stability. Recent studies have emphasized a growing discontent of physicians, mainly as a result of changes in labor relations.

Objectives: To assess the perception of Portuguese medical residents about: correspondence of residency with previous expectations; degree of satisfaction with the specialty, profession and place of training; reasons for dissatisfaction; opinion regarding clinical practice in Portugal and emigration intents.

Material And Methods: Cross-sectional study. Data collection was conducted through the "Satisfaction with Specialization Survey", created in an online platform, designed for this purpose, between May and August 2014.

Results: From a total population of 5788 medical residents, 804 (12.25 %) responses were obtained. From this sample, 77% of the responses were from residents in the first three years. Results showed that 90% of the residents are satisfied with their specialty, 85% with the medical profession and 86% with their place of training. Nevertheless, results showed a decrease in satisfaction over the final years of residency. The overall assessment of the clinical practice scenario in Portugal was negative and 65% of residents have plans to emigrate after completing their residency.

Conclusion: Portuguese residents revealed high satisfaction levels regarding their profession. However, their views on Portuguese clinical practice and the results concerning the intent to emigrate highlight the need to take steps to reverse this scenario.
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May 2017

[Effect of hydroxyethyl starch on acute renal injury in a model of hepatic ischemia-reperfusion].

Acta Med Port 2012 Sep-Oct;25(5):308-16. Epub 2012 Nov 12.

Unidade de Cirurgia Experimental, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.

Background: Hepatic vascular control techniques employed during liver surgery are usually associated with ischemia-reperfusion injury, which could cause acute renal dysfunction. The murine model has been used in the study of this injury. Hydroxyethyl starch has recognized anti-inflammatory properties and improves microcirculation. Third generation hydroxyethyl starches, namely 130/0.4, show a better safety profile than previous molecules.

Objectives: Evaluation of renal injury in a murine model of partial normothermic hepatic ischemia-reperfusion injury and assessment of hydroxyethyl starch 130/0.4 effect on this injury.

Methods: Seventy-two male Wistar rats were randomized into six groups with identical characteristics (n = 12 x 6). In three of them, the ischemia-reperfusion injury groups, we placed a clamp in the vascular pedicle of the median and left liver lobes, inducing hepatic ischemia (70%), and removed the clamp 60 minutes later (IRI + HES and IRI + HS groups, with HES or hypertonic saline (7.5%) administration during reperfusion, respectively, and IRI group, without fluid therapy). The control groups were sham-operated without hepatic ischemia and treated likewise (sham + HES, sham + HS and sham groups). After 120 minutes of reperfusion in the ischemia-reperfusion injury groups and 180 minutes in the controls we drew blood from the aorta artery for creatinine, urea and alanine aminotransferase quantification and removed kidney and liver samples for histopathological analysis.

Results: As already published by our group, the partial hepatic ischemia-reperfusion injury model showed liver injury. In the present work, the IRI group had higher creatinine, urea and histopathological score than sham (p < 0.05). Creatinine and urea mean concentrations were significantly lower both in IRI+HES (23.08 µmol/L and 8.38 mmol/L, respectively) and IRI + HS (26.59 µmol/L and 7.82 mmol/L) when compared to IRI (40.101 µmol/L and 11.25 mmol/L). There was no significant difference between IRI + HES and IRI + HS groups (serum markers and histopathology).

Conclusion: The hepatic ischemia-reperfusion injury murine model was effective in producing kidney injury. Both the hydroxyethyl starch 130/0.4 and the hypertonic saline protected the kidney in this context and were not harmful for this organ in the controls. Further studies are necessary to assess clinical implications of hydroxyethyl starch 130/0.4 administration in liver surgery.
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December 2013