Cândida Fonseca - Academia.edu (original) (raw)
Papers by Cândida Fonseca
Cureus, Feb 28, 2023
Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major globa... more Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major global public health concern, resulting in significant individual morbimortality and socioeconomic costs. This real-life study aimed to determine the rate and predictors of readmission for WHF in a cohort of outpatients with chronic heart failure (CHF) followed in a heart failure clinic (HFC) at a university hospital. Methods We conducted a longitudinal, observational, and retrospective study of all consecutive CHF patients seen at the HFC of the São Francisco Xavier Hospital, Lisbon, by a multidisciplinary team in 2019. The patients were followed for one year and were on optimized therapy. The inclusion criteria for the study were patients who had been hospitalized and subsequently discharged at least three months prior to their enrollment. Patient demographics, heart failure (HF) characterization, comorbidities, pharmacological treatment, treatments of decompensated HF in the day hospital (DH), hospitalizations for WHF, and death were recorded. We applied logistic regression analysis to assess predictors of hospital readmission for HF. Results A total of 351 patients were included: 90 patients (26%) had WHF requiring treatment with intravenous diuretics in the DH; 45 patients (mean age: 79.1 ± 9.0 years) were readmitted for decompensated HF within one year (12.8%) with no gender difference, while 87.2% of the patients (mean age: 74.9 ± 12.1 years) were never readmitted. Readmitted patients were significantly older than those who were not (p=0.031). Additionally, they had a higher New York Heart Association (NYHA) functional classification (p<.001), were on a higher daily dose of furosemide (p=0.008) at the time of the inclusion visit, were more frequently affected by the chronic obstructive pulmonary disease (COPD) (p=0.004); had been treated more often in the DH for WHF (p<.001) and had a higher mortality rate (p<.001) at one year. Conclusions This study aimed to determine WHF patient readmission rates and predictors. According to our results, a higher NYHA class, the need for treatment in the DH for WHF, a daily dose of furosemide equal to or greater than 80 mg, and COPD were predictors of readmission for WHF. CHF patients continue to experience WHF and recurrent hospitalizations despite therapeutic advances and close follow-up in the HFC with the multidisciplinary team. Besides COPD, the HF readmission risk factors found were mainly related to advanced disease. Furthermore, the structured and multidisciplinary approach of our disease management program likely contributed to our relatively low rate of readmissions.
European Heart Journal, 2018
SVR and plasma renin activity without lowering BP. The CD group also showed significant downregul... more SVR and plasma renin activity without lowering BP. The CD group also showed significant downregulation of genes related to inflammation and apoptosis pathways in both the kidney and heart compared to untreated. Both L-CD and H-CD increased plasma CD and cGMP levels for 2 hours after drug injection and those in H-CD group showed more prolonged and higher increases than L-CD group. BP in L-CD was unchanged but in H-CD group BP tended to be lower for 18 hours but this was not significant. Plasma NT-proBNP levels in L-CD group did not show any change but those in H-CD group tended to be lower following drug injection similar to the change in BP. No adverse events were observed in the study. Conclusions: Chronic peptide therapy with CD provides cardiorenal protective actions via dual GC-A/-B activation in the setting of HF, and SQ CD was successfully absorbed, activated cGMP and well tolerated in patients with LVAD support. Further clinical trials for efficacy are warranted to clarify cardiorenal protective effects of CD as a co-therapy for LVAD support to improve outcomes.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2001
The management of heart failure in Europe is largely conducted by primary care physicians in out-... more The management of heart failure in Europe is largely conducted by primary care physicians in out-patient clinics and by cardiologists and internists in hospitals. Several reports suggest differences among these specialists regarding knowledge and actual practice, and indicate that the application of guidelines is far from optimal. In order to look for differences between cardiologists and internists in terms of implementation of guidelines a survey was carried out among the directors of 83 hospital departments of cardiology and internal medicine in Portugal. The survey included questions about diagnostic and treatment protocols, special areas for management, and suggestions to improve the quality of heart failure patient treatment. The answers suggest that in Portuguese hospitals at least half of the patients with HF are treated by internists. Treatment protocols exist in about 25% of the cardiology departments but are virtually non-existent in internal medicine. The use and availab...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2004
European Journal of Heart Failure Supplements, 2007
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2000
The assessment of the mitral annulus motion with tissue Doppler imaging is claimed to be an accur... more The assessment of the mitral annulus motion with tissue Doppler imaging is claimed to be an accurate method to quantify global left ventricular systolic and diastolic function. However, it is not yet perfectly defined which site of the annulus must be selected. Familial amyloidotic polyneuropathy of the Portuguese type (FAP) is an hereditary systemic disease in which diastolic dysfunction may occur. 1--To determine if in FAP patients the mitral annulus motion is independent of the selected site. 2--To compare pulsed wave Doppler parameters with tissue Doppler parameters in the different annular sites. Of 24 FAP patients studied, 14 were included. In each patient we performed conventional transmitral pulsed wave Doppler and tissue Doppler in the 4 sites of the mitral annulus and measured the velocities of the rapid filling wave e, of the atrial contraction wave a and calculated e/a ratio. According to the transmitral inflow profile, patients were divided in 2 groups: Group I--normal ...
European Geriatric Medicine, 2013
ABSTRACT Background: The prevalence of atrial fibrillation increases substantially with age. As a... more ABSTRACT Background: The prevalence of atrial fibrillation increases substantially with age. As atrial fibrillation carries a higher risk of thromboembolic events, several scores have been developed to estimate thromboembolic and bleeding risk in order to help with the prophylactic decision. Objective: To determine thromboembolic and bleeding risk of elderly with atrial fibrillation according to CHADS2, CHA2DS2-VASc and HASBLED and its repercussions on thromboembolic prophylaxis. Methods: Retrospective, observational study including 142 consecutively hospitalized patients over 65 years old, with non-valvular atrial fibrillation/flutter. CHADS2 and CHA2DS2-VASc were applied and compared and HASBLED score was used to estimate haemorrhagic risk. The adequacy of prescribed antithrombotic therapy was evaluated. Long-term follow-up of thromboembolic and haemorrhagic events was carried out. Results: None of the elderly patients were allocated to the low-risk category according to CHADS2 and CHA2DS2-VASc risk stratification. CHADS2 classified 32 (22.5%) patients at moderate risk, while CHA2DS2-VASc score classified all patients at high risk. Applying the HASBLED score, 57 (40.1%) had high haemorrhagic risk. Although by CHA2DS2-VASc all patients had a formal indication for anticoagulation, only 77 (54.2%) were anticoagulated. Age was found to be a common criteria for withholding oral anticoagulation. The thromboembolic event rate was 2.6% for anticoagulated patients and 11.5% for not anticoagulated ones, while major haemorrhages occurred in 6.5% anticoagulated and 1.5% not anticoagulated patients. Conclusions: All elderly with atrial fibrillation had high thromboembolic risk, better predicted by CHA2DS2-VASc. Anticoagulation, the only factor that can alter prognosis, was underused despite the evidence of the scores. Paradoxically, age alone was frequently considered a contra-indication for anticoagulation.
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
Since the advent of Liver transplant (LT) as the only curative treatment for Familial Amyloidotie... more Since the advent of Liver transplant (LT) as the only curative treatment for Familial Amyloidotie Polyneuropathy flAP), frequent perioperative adverse oardiovascular events have been reported. The association of dysautonomia and FAP's specify cardiomyopathy lead to unpredictable cardiovascular responses. Aim of the study: Pre-operative assessment of cardiovascular responses of FAP patients in active list of LT to pharmacological stress: IV dopamine, S.L, introglicerine and saline overload Population: We evaluated 24 patients (P), 10 women and 14 men aged 41,75+5,34 years (30-50) with FAP specific climes stages II and III (Sales classification), positive TTR met 30 and nerve and gut biopsies positive for amyloid Methodology: All P carried out clinieal examination, EKG, Holter EKG and M+2D+colour/doppler Echoeardiography (ECHO) and were submitted to a perfusion of IV dopamine (dopa) from 5 up to 15 lag/kg/rnm followed by a period of rest till blood pressure (BP) and heart rate (HR.) returned to baseline values. Then they were given 5 rag of sub lingual nitroglicerme (NTG) followed by a saline perfttsion(SL)-200-300 ntl. P were under BP and HR monitoring and ECHO were recorded at rest and after each stage of the protocol. M+2D images were analysed and aortic doppler systolic flow (El measured. To obtain a cardiac output evaluation we used an index (COl) defined as ~F x HR., avoiding the need of aortic root area calculation in the same patient in every stage of the protocol. COl, systolic BP (BPs) and diastolic BP (BPd) at the end of dopamine infusion, after NTG and after SL were compared with data at rest and analysed by paired student t test. Results: 1-DOPAMINE (n=20 P) COl and BPs increased significantly in response to IV Dopamine (15 ~tg/kg/min)
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
European Heart Journal, May 22, 2022
Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) ... more Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF). Methods and results The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. .100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP .100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and .100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP .100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo. Conclusion In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.
SAGE Open Medicine, 2021
Introduction: We aimed to compare clinical features of older age group and young and middle-aged ... more Introduction: We aimed to compare clinical features of older age group and young and middle-aged patients with COVID-19 and analyze mortality predictors. Methods: Retrospective analysis of ongoing collection of prespecified data, on a single institution, including patients hospitalized consecutively due to COVID-19 infection, from March to June 2020. Results: Of 195 patients, 56.9% were ⩾65 years (older age group). Older age group had multimorbidity ( p < 0.001). At admission Early Warning Score-2 ( p < 0.001), C-reactive protein, D-dimer, creatinine, anemia and lymphopenia were higher in older age group, as well as median time of hospitalization (14 vs 10 days, p = 0.004). Complications were more common in older age group, but there were no significant differences in admission to intensive care. There were 18 deaths, 16 in older age group. Modified Early Warning Score at admission (odds ratio = 1.60, 95% confidence interval = 1.07–1.37, p = 0.021) and C-reactive protein >5...
European Journal of Case Reports in Internal Medicine, 2020
Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biolo... more Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biological features similar to those of malaria. In each case, fever, myalgia, fatigue, headaches and gastrointestinal symptoms may be present. Both diseases can also induce a cytokine storm and pro-coagulant states. An appropriate epidemiological approach and differential diagnosis are very important so that the right clinical intervention can be selected. Malaria remains a serious global public health issue, especially in endemic countries. Elimination campaigns are helping to control the disease, but in many countries these programs are now at risk of failure due to logistic and economic problems caused by COVID-19. The authors describe the case of a patient with co-infection with malaria and COVID-19, reminding us that during this coronavirus pandemic it is critical to consider other diagnoses, particularly in people traveling between countries.
Journal of Cardiac Failure, 2019
Revista Portuguesa de Cardiologia, 2019
The aim of this study was to document clinical practice in Portugal regarding the use of electron... more 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.
Sleep & breathing = Schlaf & Atmung, Sep 17, 2018
ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed c... more ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test. Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size. Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m2). Two patients were excluded due to insufficient...
Revista Portuguesa de Cardiologia, 2017
Immunotherapy, Jun 1, 2017
Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the ... more Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the treatment of several advanced cancers. Inhibiting this checkpoint is known to enhance immune response, but is also known to diminish immune tolerance and to increase autoimmune toxicity. We discuss a case of rapid onset fulminant Type 1 diabetes induced by treatment with anti-programmed cell death-1 monoclonal antibody, nivolumab, in a patient with late-stage non-small-cell lung adenocarcinoma. The patient had no history of previous diabetes but did reveal a high-risk genotype for Type 1 diabetes development (DR3-DQ2; DR4-DQ8). This finding supports that acute Type 1 diabetes can be an important adverse effect of immunotherapies targeting T-cell activation regulation. Because of the severity of this adverse effect, physicians should be aware of it, and studies directed to the detection of new biomarkers for early risk stratification (e.g., HLA) should be sought.
Cureus, Feb 28, 2023
Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major globa... more Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major global public health concern, resulting in significant individual morbimortality and socioeconomic costs. This real-life study aimed to determine the rate and predictors of readmission for WHF in a cohort of outpatients with chronic heart failure (CHF) followed in a heart failure clinic (HFC) at a university hospital. Methods We conducted a longitudinal, observational, and retrospective study of all consecutive CHF patients seen at the HFC of the São Francisco Xavier Hospital, Lisbon, by a multidisciplinary team in 2019. The patients were followed for one year and were on optimized therapy. The inclusion criteria for the study were patients who had been hospitalized and subsequently discharged at least three months prior to their enrollment. Patient demographics, heart failure (HF) characterization, comorbidities, pharmacological treatment, treatments of decompensated HF in the day hospital (DH), hospitalizations for WHF, and death were recorded. We applied logistic regression analysis to assess predictors of hospital readmission for HF. Results A total of 351 patients were included: 90 patients (26%) had WHF requiring treatment with intravenous diuretics in the DH; 45 patients (mean age: 79.1 ± 9.0 years) were readmitted for decompensated HF within one year (12.8%) with no gender difference, while 87.2% of the patients (mean age: 74.9 ± 12.1 years) were never readmitted. Readmitted patients were significantly older than those who were not (p=0.031). Additionally, they had a higher New York Heart Association (NYHA) functional classification (p<.001), were on a higher daily dose of furosemide (p=0.008) at the time of the inclusion visit, were more frequently affected by the chronic obstructive pulmonary disease (COPD) (p=0.004); had been treated more often in the DH for WHF (p<.001) and had a higher mortality rate (p<.001) at one year. Conclusions This study aimed to determine WHF patient readmission rates and predictors. According to our results, a higher NYHA class, the need for treatment in the DH for WHF, a daily dose of furosemide equal to or greater than 80 mg, and COPD were predictors of readmission for WHF. CHF patients continue to experience WHF and recurrent hospitalizations despite therapeutic advances and close follow-up in the HFC with the multidisciplinary team. Besides COPD, the HF readmission risk factors found were mainly related to advanced disease. Furthermore, the structured and multidisciplinary approach of our disease management program likely contributed to our relatively low rate of readmissions.
European Heart Journal, 2018
SVR and plasma renin activity without lowering BP. The CD group also showed significant downregul... more SVR and plasma renin activity without lowering BP. The CD group also showed significant downregulation of genes related to inflammation and apoptosis pathways in both the kidney and heart compared to untreated. Both L-CD and H-CD increased plasma CD and cGMP levels for 2 hours after drug injection and those in H-CD group showed more prolonged and higher increases than L-CD group. BP in L-CD was unchanged but in H-CD group BP tended to be lower for 18 hours but this was not significant. Plasma NT-proBNP levels in L-CD group did not show any change but those in H-CD group tended to be lower following drug injection similar to the change in BP. No adverse events were observed in the study. Conclusions: Chronic peptide therapy with CD provides cardiorenal protective actions via dual GC-A/-B activation in the setting of HF, and SQ CD was successfully absorbed, activated cGMP and well tolerated in patients with LVAD support. Further clinical trials for efficacy are warranted to clarify cardiorenal protective effects of CD as a co-therapy for LVAD support to improve outcomes.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2001
The management of heart failure in Europe is largely conducted by primary care physicians in out-... more The management of heart failure in Europe is largely conducted by primary care physicians in out-patient clinics and by cardiologists and internists in hospitals. Several reports suggest differences among these specialists regarding knowledge and actual practice, and indicate that the application of guidelines is far from optimal. In order to look for differences between cardiologists and internists in terms of implementation of guidelines a survey was carried out among the directors of 83 hospital departments of cardiology and internal medicine in Portugal. The survey included questions about diagnostic and treatment protocols, special areas for management, and suggestions to improve the quality of heart failure patient treatment. The answers suggest that in Portuguese hospitals at least half of the patients with HF are treated by internists. Treatment protocols exist in about 25% of the cardiology departments but are virtually non-existent in internal medicine. The use and availab...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2004
European Journal of Heart Failure Supplements, 2007
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2000
The assessment of the mitral annulus motion with tissue Doppler imaging is claimed to be an accur... more The assessment of the mitral annulus motion with tissue Doppler imaging is claimed to be an accurate method to quantify global left ventricular systolic and diastolic function. However, it is not yet perfectly defined which site of the annulus must be selected. Familial amyloidotic polyneuropathy of the Portuguese type (FAP) is an hereditary systemic disease in which diastolic dysfunction may occur. 1--To determine if in FAP patients the mitral annulus motion is independent of the selected site. 2--To compare pulsed wave Doppler parameters with tissue Doppler parameters in the different annular sites. Of 24 FAP patients studied, 14 were included. In each patient we performed conventional transmitral pulsed wave Doppler and tissue Doppler in the 4 sites of the mitral annulus and measured the velocities of the rapid filling wave e, of the atrial contraction wave a and calculated e/a ratio. According to the transmitral inflow profile, patients were divided in 2 groups: Group I--normal ...
European Geriatric Medicine, 2013
ABSTRACT Background: The prevalence of atrial fibrillation increases substantially with age. As a... more ABSTRACT Background: The prevalence of atrial fibrillation increases substantially with age. As atrial fibrillation carries a higher risk of thromboembolic events, several scores have been developed to estimate thromboembolic and bleeding risk in order to help with the prophylactic decision. Objective: To determine thromboembolic and bleeding risk of elderly with atrial fibrillation according to CHADS2, CHA2DS2-VASc and HASBLED and its repercussions on thromboembolic prophylaxis. Methods: Retrospective, observational study including 142 consecutively hospitalized patients over 65 years old, with non-valvular atrial fibrillation/flutter. CHADS2 and CHA2DS2-VASc were applied and compared and HASBLED score was used to estimate haemorrhagic risk. The adequacy of prescribed antithrombotic therapy was evaluated. Long-term follow-up of thromboembolic and haemorrhagic events was carried out. Results: None of the elderly patients were allocated to the low-risk category according to CHADS2 and CHA2DS2-VASc risk stratification. CHADS2 classified 32 (22.5%) patients at moderate risk, while CHA2DS2-VASc score classified all patients at high risk. Applying the HASBLED score, 57 (40.1%) had high haemorrhagic risk. Although by CHA2DS2-VASc all patients had a formal indication for anticoagulation, only 77 (54.2%) were anticoagulated. Age was found to be a common criteria for withholding oral anticoagulation. The thromboembolic event rate was 2.6% for anticoagulated patients and 11.5% for not anticoagulated ones, while major haemorrhages occurred in 6.5% anticoagulated and 1.5% not anticoagulated patients. Conclusions: All elderly with atrial fibrillation had high thromboembolic risk, better predicted by CHA2DS2-VASc. Anticoagulation, the only factor that can alter prognosis, was underused despite the evidence of the scores. Paradoxically, age alone was frequently considered a contra-indication for anticoagulation.
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
Since the advent of Liver transplant (LT) as the only curative treatment for Familial Amyloidotie... more Since the advent of Liver transplant (LT) as the only curative treatment for Familial Amyloidotie Polyneuropathy flAP), frequent perioperative adverse oardiovascular events have been reported. The association of dysautonomia and FAP's specify cardiomyopathy lead to unpredictable cardiovascular responses. Aim of the study: Pre-operative assessment of cardiovascular responses of FAP patients in active list of LT to pharmacological stress: IV dopamine, S.L, introglicerine and saline overload Population: We evaluated 24 patients (P), 10 women and 14 men aged 41,75+5,34 years (30-50) with FAP specific climes stages II and III (Sales classification), positive TTR met 30 and nerve and gut biopsies positive for amyloid Methodology: All P carried out clinieal examination, EKG, Holter EKG and M+2D+colour/doppler Echoeardiography (ECHO) and were submitted to a perfusion of IV dopamine (dopa) from 5 up to 15 lag/kg/rnm followed by a period of rest till blood pressure (BP) and heart rate (HR.) returned to baseline values. Then they were given 5 rag of sub lingual nitroglicerme (NTG) followed by a saline perfttsion(SL)-200-300 ntl. P were under BP and HR monitoring and ECHO were recorded at rest and after each stage of the protocol. M+2D images were analysed and aortic doppler systolic flow (El measured. To obtain a cardiac output evaluation we used an index (COl) defined as ~F x HR., avoiding the need of aortic root area calculation in the same patient in every stage of the protocol. COl, systolic BP (BPs) and diastolic BP (BPd) at the end of dopamine infusion, after NTG and after SL were compared with data at rest and analysed by paired student t test. Results: 1-DOPAMINE (n=20 P) COl and BPs increased significantly in response to IV Dopamine (15 ~tg/kg/min)
Neuromuscular Disorders, 1996
Neuromuscular Disorders, 1996
European Heart Journal, May 22, 2022
Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) ... more Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF). Methods and results The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. .100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP .100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and .100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP .100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo. Conclusion In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.
SAGE Open Medicine, 2021
Introduction: We aimed to compare clinical features of older age group and young and middle-aged ... more Introduction: We aimed to compare clinical features of older age group and young and middle-aged patients with COVID-19 and analyze mortality predictors. Methods: Retrospective analysis of ongoing collection of prespecified data, on a single institution, including patients hospitalized consecutively due to COVID-19 infection, from March to June 2020. Results: Of 195 patients, 56.9% were ⩾65 years (older age group). Older age group had multimorbidity ( p < 0.001). At admission Early Warning Score-2 ( p < 0.001), C-reactive protein, D-dimer, creatinine, anemia and lymphopenia were higher in older age group, as well as median time of hospitalization (14 vs 10 days, p = 0.004). Complications were more common in older age group, but there were no significant differences in admission to intensive care. There were 18 deaths, 16 in older age group. Modified Early Warning Score at admission (odds ratio = 1.60, 95% confidence interval = 1.07–1.37, p = 0.021) and C-reactive protein >5...
European Journal of Case Reports in Internal Medicine, 2020
Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biolo... more Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biological features similar to those of malaria. In each case, fever, myalgia, fatigue, headaches and gastrointestinal symptoms may be present. Both diseases can also induce a cytokine storm and pro-coagulant states. An appropriate epidemiological approach and differential diagnosis are very important so that the right clinical intervention can be selected. Malaria remains a serious global public health issue, especially in endemic countries. Elimination campaigns are helping to control the disease, but in many countries these programs are now at risk of failure due to logistic and economic problems caused by COVID-19. The authors describe the case of a patient with co-infection with malaria and COVID-19, reminding us that during this coronavirus pandemic it is critical to consider other diagnoses, particularly in people traveling between countries.
Journal of Cardiac Failure, 2019
Revista Portuguesa de Cardiologia, 2019
The aim of this study was to document clinical practice in Portugal regarding the use of electron... more 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.
Sleep & breathing = Schlaf & Atmung, Sep 17, 2018
ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed c... more ApneaLink is a portable device for the screening of sleep apnea, a prevalent and underdiagnosed comorbidity in heart failure patients. A prospective cross-sectional study in patients with chronic heart failure was carried out to assess the sensitivity and specificity of apnea-hypopnea index (AHI) measurements using ApneaLink against the standard polysomnography test. Adult patients with a prior hospitalization in an acute heart failure hospital unit were recruited for the study. All participants were tested for sleep apnea using ApneaLink and polysomnography simultaneously during an overnight stay at a sleep laboratory. Global sleep apnea was evaluated according to the AHI, which was analyzed and compared. Subpopulation comparison based on ejection fraction was not realized due to population size. Thirty-five patients with stable chronic heart failure completed the study (mean age 70.9 ± 10.5 years and body mass index 30.0 ± 4.7 kg/m2). Two patients were excluded due to insufficient...
Revista Portuguesa de Cardiologia, 2017
Immunotherapy, Jun 1, 2017
Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the ... more Programmed cell death-1 protein (PD-1) is an immune checkpoint that has gained popularity in the treatment of several advanced cancers. Inhibiting this checkpoint is known to enhance immune response, but is also known to diminish immune tolerance and to increase autoimmune toxicity. We discuss a case of rapid onset fulminant Type 1 diabetes induced by treatment with anti-programmed cell death-1 monoclonal antibody, nivolumab, in a patient with late-stage non-small-cell lung adenocarcinoma. The patient had no history of previous diabetes but did reveal a high-risk genotype for Type 1 diabetes development (DR3-DQ2; DR4-DQ8). This finding supports that acute Type 1 diabetes can be an important adverse effect of immunotherapies targeting T-cell activation regulation. Because of the severity of this adverse effect, physicians should be aware of it, and studies directed to the detection of new biomarkers for early risk stratification (e.g., HLA) should be sought.