Browsing by Author "Martins, J"
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- Acute coronary syndrome in elderly patients - prognostic impact of revascularizationPublication . Arantes, C; Abreu, G; Martins, J; Galvão-Braga, C; Ramos, V; Vieira, C; Azevedo, P; Álvares-Pereira, M; Rocha, S; Correia, A
- An image is worth 1000 wordsPublication . Arantes, C; Galvão-Braga, C; Marques, J; Costa, J; Ribeiro, S; Martins, J; Abreu, G; Quina, C; Rocha, S
- An unusual trigger causing Takotsubo SyndromePublication . Abreu, G; Rocha, S; Bettencourt, N; Azevedo, P; Vieira, C; Rodrigues, C; Arantes, C; Braga, C; Martins, J; Marques, J
- Are there differences on prognosis among patients with previous ischemic heart disease versus cerebrovascular disease admitted with acute coronary syndrome?Publication . Abreu, G; Galvão-Braga, C; Arantes, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Azevedo, P; Álvares-Pereira, M; Marques, JBackground: It is known that patients with previous vascular disease (PVD) have a poorer outcome than those without these previous conditions, and prognosis worsens as the number of affected vascular beds increases. Aim: To evaluate if there are differences in in-hospital and 6-month mortality among patients admitted with acute coronary syndromes with previous ischemic heart disease (IHD) versus cerebrovascular disease (CVD). Methods: We analysed 4871 patients (pts) admitted consecutively in our coronary care unit with a diagnosis of acute coronary syndrome and included in a prospective registry, from January 2002 to October 2013. Patients were divided in three groups: group 1 - pts without PVD, n=3718, 76,3%); group 2 – pts with previous IHD (n=825, 16.9%); group 3 - pts with previous CVD (n=257, 5.3%). We excluded pts with previous IHD plus CVD (n=71, 1.5%). For each group we compared clinical and laboratory features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 98% of patients. Results: The group with previous CVD were older (63±13 vs 67±12 vs 71±11; p<0.001), had higher proportion of women (25% vs 21.9% vs 32.3%; p<0.001) and hypertension (58% vs 73.1% vs 83.7%; p<0.001). Patients with previous IHD had more often body mass index >25kg/m2 (47.1% vs 52.5% vs 50.8%; p=0.016), dyslipidaemia (46% vs 69.3% vs 52.1%; p<0.001), diabetes (23.5% vs 38.8% vs 36.6%; p<0.001). They also were taking more often aspirin (11.6% vs 75% vs 35.8%; p<0.001) and statin (21.6% vs 70.5% vs 37.4%; p<0.001). Patients without PVD had more frequently history of smoking (29.5% vs 19.0% vs 12.8%; p<0.001) and absence of risk factors (8.7% vs 4.0% vs 3.9%; p<0.001). On admission, those with previous CVD presented more often with Killip >1 (19.6 % vs 29.6% vs 34.2%; p<0.001), anaemia (19.8% vs 28.6% vs 33.9%; p<0.001) and renal insufficiency (eGFR <60 ml/min) (19.2% vs 31% vs 40.9%; p<0,001). Patients with previous IHD presented more severe coronary artery disease (left main coronary artery or three vessels) (11.7% vs 22.2% vs 16.7%; p<0.001) and higher prevalence of left ventricular dysfunction (56.2% vs 61.8% vs 58.4%; p=0.034). ST-segment myocardial infarction was more prevalent in patients without PVD (54.5% vs 25.6% vs 51%; p<0.001) on the other hand myocardial infarction without ST-elevation was more frequent in patients with previous IHD (41.2% vs 65% vs 45.5%; p<0.001). In-hospital (4.5% vs 4.7% vs 7.0%; p<0.001) and 6-month mortality (8.7% vs. 10.6% vs. 16.5%; p<0.001) were higher in patients with previous CVD. In multivariate analysis and after adjusting for different baseline characteristics, patients with previous CVD had higher risk of 6-month mortality compared to those without PVD [OR 1.67, 95% CI (1.06-2.63), p=0.026]. Conclusion: Patients with previous vascular disease had higher prevalence of risk factors. Previous cerebrovascular disease remained as a strong predictor of 6-month mortality in patients admitted with acute coronary syndrome.
- Are there differences on prognosis among patients with previous ischemic heart disease versus cerebrovascular disease admitted with acute coronary syndrome?Publication . Abreu, G; Arantes, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Álvares-Pereira, M; Azevedo, P; Marques, JBackground: It is known that patients with previous vascular disease (PVD) have a poorer outcome than those without these previous conditions, and prognosis worsens as the number of affected vascular beds increases. Aim: To evaluate if there are differences in in-hospital and 6-month mortality among patients admitted with acute coronary syndromes with previous ischemic heart disease (IHD) versus cerebrovascular disease (CVD). Methods: We analysed 4871 patients (pts) admitted consecutively in our coronary care unit with a diagnosis of acute coronary syndrome and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups: group 1 - pts without PVD (n=3718, 76.3%); group 2 – pts with previous IHD (n=825, 16.9%); group 3 - pts with previous CVD (n=257, 5.3%). We excluded pts with previous IHD plus CVD (n=71, 1.5%). For each group we compared clinical features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 98% of patients. Results: Pts in group 3 were older (63±13 vs 67±12 vs 71±11;p<0.001), had higher proportion of women (25% vs 21.9% vs 32.3%;p<0.001) and hypertension (58% vs 73.1% vs 83.7%;p<0.001). Group 2 had more often body mass index >25kg/m2 (47.1% vs 52.5% vs 50.8%; p=0.016), dyslipidaemia (46% vs 69.3% vs 52.1%;p<0.001) and diabetes (23.5% vs 38.8% vs 36.6%;p<0.001). Group 1 had more frequently history of smoking (29.5% vs 19.0% vs 12.8%;p<0.001) and absence of conventional risk factors (8.7% vs 4.0% vs 3.9%;p<0.001). On admission, those with previous CVD presented more often Killip >1 (19.6 % vs 29.6% vs 34.2%;p<0.001), anaemia (19.8% vs 28.6% vs 33.9%;p<0.001) and renal insufficiency (eGFR <60 ml/min) (19.2% vs 31% vs 40.9%;p<0,001). Group 2 presented more severe coronary artery disease (11.7% vs 22.2% vs 16.7%;p<0.001) and higher prevalence of left ventricular dysfunction (56.2% vs 61.8% vs 58.4%;p=0.03). ST-segment myocardial infarction was more prevalent in Group 1 (54.5% vs 25.6% vs 51%;p<0.001), while myocardial infarction without ST-elevation was more frequent in group 2 (41.2% vs 65% vs 45.5%;p<0.001). In-hospital (4.5% vs 4.7% vs 7.0%;p<0.001) and 6-month mortality (8.7% vs 10.6% vs 16.5%;p<0.001) were higher in patients with previous CVD. In multivariate analysis and after adjusting for different baseline characteristics, pts with previous CVD had higher risk of 6-month mortality compared to those without PVD [OR 1.67, 95% CI (1.06-2.63),p=0.026]. Conclusion: Previous CVD remained as a strong predictor of 6-month mortality in patients admitted with acute coronary syndrome.
- Biventricular Takotsubo vs Myocarditis – a diagnostic challengePublication . Abreu, G; Azevedo, P; Vieira, C; Arantes, C; Martins, J; Galvão-Braga, C; Rodrigues, C; Salomé, N; Vieira, JBackground: Takotsubo cardiomyopathy (TCM) is an important differential diagnosis of acute coronary syndrome and myocarditis. It is characterized by normal or near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular bed. Variants of the classical left ventricular (LV) apical ballooning are increasing in recognition as cardiac magnetic resonance (CMR) is more extensively used. Case report: We present a case of 69-year-old woman with a previous history of hypertension, diabetes and dyslipidaemia, transferred to our emergency department due to suspected acute coronary syndrome. She had a history of two episodes of an oppressive chest pain longer than 1 hour, orthopnoea and paroxysmal nocturnal dyspnoea 36 hours before. Two weeks before she had had a lower tract respiratory infection, that was not totally resolved. On admission, she only had dyspnoea. On examination, she had wheezing, arrhythmic pulse and hypertension. Breath sounds were absent in lower chest and rales were also noted. Electrocardiogram showed rapid atrial fibrillation, poor R wave progression in anteroseptal leads and inverted T waves in I, aVL and V2-V6 leads. Modest elevation in cardiac troponin (4.55 ng/mL) was observed. Chest x-ray showed bilateral pleural effusion. A transthoracic echocardiography (TTE) was immediately performed and revealed akinesis/dyskinesis of mid to apical segments (apical ballooning) of both ventricles, extended beyond a single epicardial coronary distribution, compatible with biventricular TCM. Cardiac catheterization showed absence of obstructive coronary disease. A CMR, performed two days later, showed moderate biventricular systolic dysfunction, hypokinesis in mid to apical segments of LV and hypokinesis in apical right ventricle. It also showed non-ischemic late gadolinium enhancement in antero-apical and lateral apical segments. After several days of medical management, the patient was discharged from the hospital in stable condition. TTE performed 6-month after evidenced complete biventricular function recovery and no segmental contractility changes. CMR supported the functional recovery and the resolution of contractility abnormalities, but noticed the intramyocardial late gadolinium enhancement in the segments previously reported. Conclusion: There are fewer reports of this unusual presentation of TCM, described by ETT. This case represents a good example of the diagnostic challenge between myocarditis and takotsubo cardiomyopathy. Taking in account the exuberance of the case, the mild elevation of troponin, the full recovery of biventricular function and resolution of contractility abnormalities, it seems more probably to be a TCM, in a patient who, probably had a previous scar of myocarditis. Although, the hypothesis of acute myocarditis as the primary diagnosis cannot be excluded.
- Biventricular Takotsubo vs Myocarditis – a diagnostic challengePublication . Abreu, G; Azevedo, P; Vieira, C; Arantes, C; Martins, J; Galvão-Braga, C; Rodrigues, C; Salomé, N; Marques, JBackground: Takotsubo cardiomyopathy (TCM) is an important differential diagnosis of acute coronary syndrome and myocarditis. It is characterized by normal or near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular bed. Variants of the classical left ventricular (LV) apical ballooning are increasing in recognition as cardiac magnetic resonance (CMR) is more extensively used. Case report: We present a case of 69-year-old woman with a previous history of hypertension, diabetes and dyslipidaemia, transferred to our emergency department due to suspected acute coronary syndrome. She had a history of two episodes of an oppressive chest pain longer than 1 hour, orthopnoea and paroxysmal nocturnal dyspnoea 36 hours before. Two weeks before she had had a lower tract respiratory infection, that was not totally resolved. On admission, she only had dyspnoea. On examination, she had wheezing, arrhythmic pulse and hypertension. Breath sounds were absent in lower chest and rales were also noted. Electrocardiogram showed rapid atrial fibrillation, poor R wave progression in anteroseptal leads and inverted T waves in I, aVL and V2-V6 leads. Modest elevation in cardiac troponin (4.55 ng/mL) was observed. Chest x-ray showed bilateral pleural effusion. A transthoracic echocardiography (TTE) was immediately performed and revealed akinesis/dyskinesis of mid to apical segments (apical ballooning) of both ventricles, extended beyond a single epicardial coronary distribution, compatible with biventricular TCM. Cardiac catheterization showed absence of obstructive coronary disease. A CMR, performed two days later, showed moderate biventricular systolic dysfunction, hypokinesis in mid to apical segments of LV and hypokinesis in apical right ventricle. It also showed non-ischemic late gadolinium enhancement in antero-apical and lateral apical segments. After several days of medical management, the patient was discharged from the hospital in stable condition. TTE performed 6-month after evidenced complete biventricular function recovery and no segmental contractility changes. CMR supported the functional recovery and the resolution of contractility abnormalities, but noticed the intramyocardial late gadolinium enhancement in the segments previously reported. Conclusion: There are fewer reports of this unusual presentation of TCM, described by ETT. This case represents a good example of the diagnostic challenge between myocarditis and takotsubo cardiomyopathy. Taking in account the exuberance of the case, the mild elevation of troponin, the full recovery of biventricular function and resolution of contractility abnormalities, it seems more probably to be a TCM, in a patient who, probably had a previous scar of myocarditis. Although, the hypothesis of acute myocarditis as the primary diagnosis cannot be excluded.
- Cardiogenic shock complicating acute coronary syndromesPublication . Abreu, G; Arantes, C; Galvão-Braga, C; Martins, J; Quina-Rodrigues, C; Vieira, C; Salgado, A; Gaspar, A; Rocha, S; Marques, JINTRODUCTION: Despite advances in the treatment of patients with acute coronary syndromes (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. PURPOSE: Determine characteristics and management of patients with an ACS complicated by CS. Determine predictors of development of CS during hospitalization and predictors of in-hospital mortality. METHODS: Retrospective study of 2064 patients consecutively admitted for ACS in a Coronary Unit over a period of 4 years. RESULTS: During the years under study, 111 patients (5.4%) developed CS. Patients with CS were more likely to be older (69.8 ± 13.2 vs 63.5 ± 13.1 years, p<0.001); there were no significant differences in other clinical characteristics. Myocardial Infarction with ST segment elevation (STEMI) was more frequent in patients with CS (p<0.001). Patients with CS underwent less often coronary angiography (p<0.001), revascularization (p = 0.004) and were less treated with β-blocker (p <0.001) and ACE inhibitors therapy (p <0.001). In multivariate analysis, predictors of occurrence of CS during hospitalization were: tachycardia (OR 3.2, 95% CI 1.6-6.3), systolic blood pressure <100 mmHg (OR 4.1, 95% CI 2.1-8.0), GFR <60ml/min (OR 2.5, 95% CI 1.2-5.2), STEMI (OR 4.1, 95% CI 2.0-8.0) and Killip class > 1 (OR 3.5, 95% CI 1.8-6.8) at admission. The in-hospital mortality of patients with CS was 45%, compared with 1.7% in those who did not develop CS. Factors associated with an increased mortality in patients with CS included absence of coronary revascularization (OR 4.9, 95% CI 1.5-16.0), GFR <60ml/min (OR 4.4, 95% CI 1.3-15.6), advanced age (OR 6.4, 95% CI 1.6-26.2) and LVEF ≤ 35 % (OR 3.9, 95% CI 1.3-12.4). CONCLUSION: According to the literature, our review showed that CS in the context of ACS is associated with a high mortality. We identified clinical markers that are associated with the development of CS and may spot patients at risk earlier. Absence of coronary revascularization remains an independent predictor of mortality in CS.
- Cardiomiopatia periparto – entidade rara, tratamento peculiar! (Caso clínico)Publication . Arantes, C; Gaspar, A; Abreu, G; Martins, J; Galvão-Braga, C; Ramos, V; Vieira, C; Azevedo, P; Álvares-Pereira, M; Rocha, S; Correira, A
- Um caso raro de síncopePublication . Abreu, G; Arantes, C; Martins, J; Galvão-Braga, C; Rodrigues, C; Monteiro, M; Vilaça, A; Veira, C; Azevedo, P; Salomé, N; Pereira, C; Marques, J