Browsing by Issue Date, starting with "2023-05"
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- Coronary Sinus Reducer Device for the Treatment of Refractory Angina: a Multicenter Initial ExperiencePublication . Ferreira Reis, J; Brízido, C; Madeira, S; Ramos, R; Almeida, M; Cacela, DIntroduction: The coronary sinus Reducer (CSR) device has emerged as a complementary therapy in patients with severe angina refractory to optimal medical therapy and not amenable to revascularization. Our aim was to assess the safety and efficacy of the CSR in a real-world setting. Methods: Twenty-six patients with refractory angina (RA) and evidence of myocardial ischemia attributable to the left coronary artery considered unsuitable for revascularization were treated with the CSR at two centers between May 2017 and July 2019. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at six-month follow-up, were reduction in CCS class, improvement in quality of life (QoL) assessed using the short version of the Seattle Angina Questionnaire (SAQ-7), and reduction in antianginal therapy. Results: Twenty-three patients had end-stage coronary artery disease without revascularization targets and three had microvascular disease without epicardial stenosis. Procedural success was achieved in 23 patients, with two device/procedure-related complications and one anatomically-related failure to deliver the device. A total of 24 patients had the device implanted and entered the efficacy analysis. Eighteen patients (75.0%) had a reduction of at least one CCS class, 41.7% had a reduction of at least two classes, and 16.7% became asymptomatic, with a mean reduction in CCS class of 1.3±0.2 (p=0.001) at six-month follow-up. All SAQ-7 domains improved, notably physical limitation (p=0.001), angina frequency (p=0.005) and QoL (p=0.006). There was a mean reduction in anti-ischemic drugs from 3.4±1.1 to 2.9±1.2 (p=0.010). Conclusion: In this real-world, multicenter experience, implantation of the CSR was associated with improvement in angina and QoL in patients with RA.
- Lidocaine-Induced Central Nervous System Toxicity During Implantable Cardioverter Defibrillator Placement – A Case Report and Literature ReviewPublication . Nunes Silva, M; Ferro, A; Fragata, ILidocaine, a local anesthetic, is commonly used in various medical procedures. Despite its widespread use, most physicians are not familiar with the life threatening presentation of lidocaine toxicity and its treatment. Our case demonstrates successful management of local lidocaine-induced systemic toxicity in a 53-year-old female during insertion of an implantable cardioverter defibrillator. Our goal was to raise awareness of the risks and symptoms of local anesthetic toxicity, educate regarding the site of administration and dose of anesthetic delivery as independent risk factors for systemic toxicity and highlight the use of intravenous lipid emulsion as an antidote.
- Popeye Deformity: a Red Flag for Wild-Type Transthyretin AmyloidosisPublication . Viegas, JM; Brás, P; Cardoso, I; Aguiar Rosa, S
- Initial Single-Center Experience of a Standardized Protocol for Invasive Assessment of Ischemia and Non-Obstructive Coronary Artery DiseasePublication . Vaz Ferreira, V; Ramos, R; Castelo, A; Mendonça, T; Almeida-Morais, L; Pereira-da-Silva, T; Oliveira, E; Viegas, J; Garcia Brás, P; Grazina, A; Cacela, D; Cruz Ferreira, RIntroduction: Coronary vasomotion disorders (CVDs), including microvascular angina (MVA) and vasospastic angina (VSA), account for significant morbidity among patients with non-obstructive coronary artery disease (NOCAD). However, protocols for CVD assessment in clinical practice are seldom standardized and may be difficult to implement. Purpose: To assess the safety and feasibility of a comprehensive coronary function test (CFT) protocol for assessment of CVD and the prevalence of different phenotypes of CVD in patients with angina and NOCAD (ANOCA). Methods: Patients with persistent angina referred for invasive coronary angiogram and found to have NOCAD were prospectively recruited and underwent a CFT. Functional parameters (fractional flow reserve, coronary flow reserve and index of myocardial resistance) and coronary vasoreactivity were assessed in all patients. Results: Of the 20 patients included, the mean age was 63±13 years and 50% were females. Most patients had persistent typical angina and evidence of ischemia in noninvasive tests (75%). The CFT was successfully performed in all subjects without serious complications. Isolated MVA was found in 25%, isolated VSA in 40%, both MVA and VSA in 10% and noncardiac chest pain in 25% of patients. Antianginal therapy was modified after the results of CFT in 70% of patients. Conclusion: A coronary function test was feasible and safe in a cohort of patients with ANOCA. CVD were prevalent in this selected group of patients, and some presented mixed CVD phenotypes. CFT may provide a definitive diagnosis in patients with persistent angina and prompt the stratification of pharmacological therapy.
- Investigação Clínica da Iniciativa do Investigador em Portugal: Identificação de Problemas e Propostas para MelhoriaPublication . Ferreira, JP; Leite-Moreira, A; Costa-Pereira, A; Soares, AJ; Robalo-Cordeiro, C; Jerónimo, C; Gavina, C; J. Pinto, F; Schmitt, F; Saraiva, F; Vasques-Nóvoa, F; Canhão, H; Cyrne-Carvalho, H; Palmeirim, I; Pimenta, J; Cabral da Fonseca, JE; Firmino-Machado, J; Correia Pinto, J; Gonçalves, L; Castelo Branco, M; Sousa, N; Fontes de Carvalho, R; Machado Luciano, T; Gil Oliveira, T; Resende Oliveira, C
- Decompressive Surgery in Cerebral Venous Sinus Thrombosis Due to Vaccine‐Induced Immune Thrombotic ThrombocytopeniaPublication . Krzywicka, K; Aguiar de Sousa, D; Cordonnier, C; Bode, F; Field, T; Michalski, D; Pelz, J; Skjelland, M; Wiedmann, M; Zimmermann, J; Wittstock, M; Zanotti, B; Ciccone, A; Bandettini di Poggio, M; Borhani‐Haghighi, A; Chatterton, S; Aujayeb, A; Devroye, A; Dizonno, V; Geeraerts, T; Giammello, F; Günther, A; Ichaporia, N; Kleinig, T; Kristoffersen, E; Lemmens, R; De Maistre, E; Mirzaasgari, Z; Payen, JF; Putaala, J; Petruzzellis, M; Raposo, N; Sadeghi‐Hokmabadi, E; Schoenenberger, S; Umaiorubahan, M; Sylaja, P; van de Munckhof, A; Sánchez van Kammen, M; Lindgren, E; Jood, K; Scutelnic, A; Heldner, M; Poli, S; Kruip, M; Arauz, A; Conforto, A; Aaron, S; Middeldorp, S; Tatlisumak, T; Arnold, M; Coutinho, J; Ferro, JBackground and purpose: Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored. Methods: Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included. Results: Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
- The sFlt1/PlGF Ratio Predicts Faster Fetal Deterioration in Early Fetal Growth Restriction: a Historical Cohort StudyPublication . Palma dos Reis, C; Brás, S; Meneses, T; Cerdeira, A; Vatish, M; Martins, ATIntroduction: The velocity of fetal deterioration in fetal growth restriction is extremely variable, which makes monitoring and counseling very challenging. The soluble fms-like tyrosine kinase to placental growth factor (sFlt1/PlGF) ratio provides a readout of the vasoactive environment that correlates with preeclampsia and fetal growth restriction and that could be useful to predict fetal deterioration. Previous studies showed a correlation between higher sFlt1/PlGF ratios and lower gestational ages at birth, although it is unclear whether this is due to the increased incidence of preeclampsia. Our goal was to evaluate whether the sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction. Material and methods: This was a historical cohort study in a tertiary maternity hospital. Data from singleton pregnancies with early fetal growth restriction (diagnosed before 32 gestational weeks) confirmed after birth monitored between January 2016 and December 2020 were retrieved from clinical files. Cases of chromosomal/fetal abnormalities, infection and medical terminations of pregnancy were excluded. The sFlt1/PlGF ratio was acquired at diagnosis of early fetal growth restriction in our unit. The correlation of log10 sFlt1/PlGF with latency to delivery/fetal demise was assessed with linear, logistic (positive sFlt1/PlGF if >85) and Cox regression excluding deliveries for maternal conditions and controlling for preeclampsia, gestational age at time of ratio test, maternal age and smoking during pregnancy. Receiver-operating characteristic (ROC) analysis tested the performance of sFlt1/PlGF ratio in predicting delivery for fetal reasons in the following week. Results: 125 patients were included. Mean sFlt1/PlGF ratio was 91.2 (SD 148.7) and 28% of patients had a positive ratio. A higher log10 sFlt1/PlGF ratio predicted shorter latency for delivery/fetal demise in linear regression after controlling for confounders, β = -3.001, (-3.713 to -2.288). Logistic regression with ratio positivity confirmed these findings (latency for delivery 5.7 ± 3.32 weeks for ratios ≤85 vs 1.9 ± 1.52 weeks for ratios >85); β = -0.698 (-1.064 to -0.332). Adjusted Cox regression showed that a positive ratio confers a significantly positive hazard ratio (HR) for earlier delivery/fetal demise, HR 9.869 (5.061-19.243). ROC analysis showed an area under the curve of 0.847 (SE ± 0.06). Conclusions: sFlt1/PlGF ratio is correlated with faster fetal deterioration in early fetal growth restriction, independently of preeclampsia.