Cristina Gavina - Academia.edu (original) (raw)
Papers by Cristina Gavina
European Heart Journal, 2019
The content of these ESC Guidelines has been published for personal and educational use only. No ... more The content of these ESC Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org). Disclaimer: The Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC and EASD are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
Revista Portuguesa de Cardiologia
Aterosclerose; Custo da doença; Custos de cuidados de saúde; Custos diretos; Custos indiretos; Po... more Aterosclerose; Custo da doença; Custos de cuidados de saúde; Custos diretos; Custos indiretos; Portugal Resumo Introdução e objetivos: As doenças cardiovasculares são a principal causa de morte em Portugal, sendo a aterosclerose o processo fisiopatológico subjacente mais comum. O objetivo deste estudo foi quantificar o impacto económico da aterosclerose em Portugal através da estimação dos custos associados. Métodos: A estimativa dos custos foi realizada na ótica da prevalência e na perspetiva da sociedade. A prevalência das principais manifestações focais da aterosclerose foi estimada com recurso a três fontes epidemiológicas nacionais. O custo anual da aterosclerose incluiu custos diretos (consumos de recursos) e indiretos (impacto na produtividade da população). Estes custos foram estimados para o ano de 2016 com base nos dados da Base de Dados de Morbilidade Hospitalar, do Sistema de Informação da Administração Regional de Saúde de Lisboa e Vale do Tejo que integra informação da prática clínica real em ambiente de cuidados de saúde primários e do Inquérito Nacional de Saúde de 2014 e na opinião de peritos. Resultados: O custo da aterosclerose em 2016 totalizou cerca de 1,9 mil milhões de euros (58% e 42% correspondendo a custos diretos e indiretos, respetivamente). A maior parte dos custos diretos esteve associada aos cuidados de saúde primários (55%), seguindo-se o ambulatório hospitalar (27%) e, por último, os episódios de internamento (18%). Os custos indiretos foram principalmente determinados pela não participação no mercado de trabalho (91%). Conclusões: A aterosclerose apresenta um importante impacto económico, correspondendo a uma despesa equivalente a 1% do Produto Interno Bruto nacional e a 11% da despesa corrente em saúde, em 2016.
Cortisol is an indispensable hormoneto life and with a multifaceted effect. It issynthesized in t... more Cortisol is an indispensable hormoneto life and with a multifaceted effect. It issynthesized in the adrenal glands; its production is enhanced during stress ...
European Heart Journal, 2021
Introduction Heart failure (HF) is a clinical syndrome caused by structural and functional cardia... more Introduction Heart failure (HF) is a clinical syndrome caused by structural and functional cardiac abnormalities resulting in impairment of cardiac function, entailing significant morbi-mortality. HF is an age-dependent entity associated with cardiovascular (CV) risk factors such as type 2 diabetes (T2D). Purpose Estimate the prevalence of HF and its subtypes, and characterize HF in a population of integrated care users. Methods Non-interventional cross-sectional study performed in healthcare centre that provides primary and secondary care. All adult patients at 31/12/2019 were included. Echocardiographic parameters [left ventricle ejection fraction (LVEF) and evidence of structural heart disease] and elevated level of natriuretic peptides were used to define two HF phenotypes: i) HF with reduced ejection fraction (HFrEF, LVEF ≤40% and either NT-proBNP ≥400pg/mL (≥600pg/mL if atrial fibrillation (AF)/flutter) or BNP ≥100pg/mL (≥125pg/mL if AF/flutter)and ii) HF with non-reduced ejec...
Revista Portuguesa de Cardiologia (English Edition), 2021
To take or not to take, is it a patient's choice? Adesão do doente aos anticoagulantes orais dire... more To take or not to take, is it a patient's choice? Adesão do doente aos anticoagulantes orais diretos: tomar ou não tomar, uma escolha do doente?
Revista Portuguesa de Cardiologia, 2020
Introduction and Objectives: Several mechanisms contribute to myocardial hypertrophy and fibrosis... more Introduction and Objectives: Several mechanisms contribute to myocardial hypertrophy and fibrosis in aortic stenosis (AS). MicroRNAs are post-transcriptional modulators of such processes. We hypothesized that their expression in myocardial biopsies from patients with AS could be linked with the degree of left ventricular (LV) hypertrophy and remodeling and to plasma levels of important biomarkers of extracellular matrix turnover. Methods: We performed myocardial biopsies in eleven patients with isolated severe AS undergoing aortic valve replacement. Echocardiographic exams and biomarker quantification were also performed. Five explanted hearts were used as controls for microRNA expression. Results: Overexpression of microRNA-101-3p was found in AS, which correlated with higher levels of preoperative valvuloarterial impedance, angiotensin II receptor and angiotensinconverting enzyme, and LV mass regression after surgery. Although not differently expressed in AS compared to controls, both upregulation of miR-4268 and downregulation of microRNA-125-5p were associated with higher LV mass. MicroRNA-125b-5p correlated negatively with LV mass and with relative wall thickness at six-month follow-up. MicroRNA-4268 correlated positively with LV mass regression and was associated with higher plasma angiotensin II receptor levels. Conclusions: MicroRNA-101-3p and microRNA-4268 have potential new roles in the modulation of the hypertrophic response to AS via the renin-angiotensin-aldosterone system and as predictors of reverse remodeling after aortic valve replacement. Our results open new avenues
Revista Portuguesa de Cardiologia (English Edition), 2018
The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous... more The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous and prospective activity. We present an overall picture of the data from this powerful tool. Up to 2016, 45 141 records were included, mostly male (71%), and with a mean age of 66 years. Baseline characteristics remained stable over the years. Of the overall population, 44% of cases were ST-elevation myocardial infarction (STEMI). Over the years there was a significant improvement in compliance with international guidelines, in terms of both diagnostic and therapeutic procedures, as well as for medication. In particular, the rate of reperfusion in STEMI increased to 84%, mainly by primary percutaneous coronary intervention (only 5.2% were treated with thrombolysis in 2016). By contrast, timings in STEMI did not change significantly. Improvements in treatment were accompanied by a reduction in in-hospital mortality from 6.7% in 2002 to 2.5% in 2016 in the overall population. This registry enables analysis of the management and results of acute coronary syndromes over time in Portugal, and hence assessment of improvements in quality of care.
European Journal of Heart Failure Supplements, 2005
Introduction: The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified... more Introduction: The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. Its role in risk stratification in patients with acute coronary syndromes (ACS) is still under evaluation. Objective: We aimed to evaluate the prognostic value of NT-proBNP measured in the first 48 hours after admission due to an acute coronary syndrome. Methods: Our study included 142 patients (aged 62.7±12.0 years, 70.4 % males) admitted to a cardiology unit with an ACS. All laboratory evaluations were performed in the first 48 hours after admission. The mean follow-up was 200 days. Death from any cause or hospitalization because of a major acute cardiovascular event (whichever occurred first) was defined as the end-point. Results: Cardiovascular risk factors were found in a significant proportion of our sample (hypertension in 56.3 %, diabetes mellitus in 38.0 %, current or previous smoking in 51.4 %, dyslipidemia in 67.6 %). Fifty-eight patients had left ventricular systolic dysfunction (LVSD). Serum levels of NT-proBNP were 2174±4801 pg/ml. Variables associated with event-free survival in univariate analysis were: NT-proBNP (HR 1.007, 95 % CI 1.003-1.011, for each 100 pg/ml increment), serum glucose (hazard ratio [HR] 1.007, 95% CI 1.001-1.012, for each 1 mg/dl increment) and maximum cardiac troponin I (cTnI) level (HR 1.005, 95 % CI 1.
Revista Portuguesa de Cardiologia (English Edition), 2019
Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategi... more Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipidlowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, this therapy is associated with significant costs, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.
Revista Portuguesa de Cardiologia, 2018
The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous... more The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous and prospective activity. We present an overall picture of the data from this powerful tool. Up to 2016, 45 141 records were included, mostly male (71%), and with a mean age of 66 years. Baseline characteristics remained stable over the years. Of the overall population, 44% of cases were ST-elevation myocardial infarction (STEMI). Over the years there was a significant improvement in compliance with international guidelines, in terms of both diagnostic and therapeutic procedures, as well as for medication. In particular, the rate of reperfusion in STEMI increased to 84%, mainly by primary percutaneous coronary intervention (only 5.2% were treated with thrombolysis in 2016). By contrast, timings in STEMI did not change significantly. Improvements in treatment were accompanied by a reduction in in-hospital mortality from 6.7% in 2002 to 2.5% in 2016 in the overall population. This registry enables analysis of the management and results of acute coronary syndromes over time in Portugal, and hence assessment of improvements in quality of care.
Circulation, Nov 23, 2010
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 16, 2015
Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and t... more Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospect...
Netherlands Heart Journal, 2010
The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary... more The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary disease (COPD), GOLD grade 3, stable for the past two decades, who was admitted to our center with severe right heart failure. The chest radiograph showed moderate heart enlargement mainly of the right atrium and pulmonary artery, similar to previous chest radiographs in the previous 20 years. The transthoracic echocardiogram showed a pulmonary artery aneurysm (PAA), dilatation of the right chambers with pulmonary artery systolic pressure of 52 mmHg, and preserved right ventricular systolic function. A thoracic computed tomography scan confirmed the presence of a giant PA A 72 mm in diameter. The patient was started on high-dose diuretics, with significant clinical improvement. After optimization of medical therapy right heart catheterization was carried out with the patient in optimal clinical condition, which revealed mild precapillary pulmonary hypertension with a mean pulmonary artery pressure of 26 mmHg. On the basis of the clinical and imaging findings a stable, giant, high-pressure, PA A was diagnosed secondary to pulmonary hypertension induced by COPD, with a 20-year follow-up without need for surgical repair, which helped in our decision to maintain medical surveillance. The recent onset of heart failure is explained by the unfavorable evolution of COPD. This case may change the attitude expressed in previous studies favoring the choice of an invasive approach to treat giant high-pressure PAAs, instead supporting the maintenance of medical treatment.
Cardiovascular Research, 2014
Impact of diabetes mellitus on myofilaments phosphorylation and calcium sensitivity is aortic ste... more Impact of diabetes mellitus on myofilaments phosphorylation and calcium sensitivity is aortic stenosis patients
Nephrology Dialysis Transplantation, 2006
Expert Review of Cardiovascular Therapy, 2004
the b&2-adrenoceptor gene have been shown to have functional consequences as a result of receptor... more the b&2-adrenoceptor gene have been shown to have functional consequences as a result of receptor desensitization associated with certain genetic variants. Accordingly, we hypothesized that the common Argl6IGln27 b&2-adrenoceptor polymorphism would affect pulmonary function in CHF. METHODS. 54 consecutive, stable CHF patients ware genotyped at codon 16 and 27 of the b&2-adrenoceptor gene. Pulmonary
Expert Opinion on Therapeutic Targets, 2010
Current Pharmaceutical Biotechnology, 2012
European Heart Journal, 2019
The content of these ESC Guidelines has been published for personal and educational use only. No ... more The content of these ESC Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org). Disclaimer: The Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The ESC and EASD are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
Revista Portuguesa de Cardiologia
Aterosclerose; Custo da doença; Custos de cuidados de saúde; Custos diretos; Custos indiretos; Po... more Aterosclerose; Custo da doença; Custos de cuidados de saúde; Custos diretos; Custos indiretos; Portugal Resumo Introdução e objetivos: As doenças cardiovasculares são a principal causa de morte em Portugal, sendo a aterosclerose o processo fisiopatológico subjacente mais comum. O objetivo deste estudo foi quantificar o impacto económico da aterosclerose em Portugal através da estimação dos custos associados. Métodos: A estimativa dos custos foi realizada na ótica da prevalência e na perspetiva da sociedade. A prevalência das principais manifestações focais da aterosclerose foi estimada com recurso a três fontes epidemiológicas nacionais. O custo anual da aterosclerose incluiu custos diretos (consumos de recursos) e indiretos (impacto na produtividade da população). Estes custos foram estimados para o ano de 2016 com base nos dados da Base de Dados de Morbilidade Hospitalar, do Sistema de Informação da Administração Regional de Saúde de Lisboa e Vale do Tejo que integra informação da prática clínica real em ambiente de cuidados de saúde primários e do Inquérito Nacional de Saúde de 2014 e na opinião de peritos. Resultados: O custo da aterosclerose em 2016 totalizou cerca de 1,9 mil milhões de euros (58% e 42% correspondendo a custos diretos e indiretos, respetivamente). A maior parte dos custos diretos esteve associada aos cuidados de saúde primários (55%), seguindo-se o ambulatório hospitalar (27%) e, por último, os episódios de internamento (18%). Os custos indiretos foram principalmente determinados pela não participação no mercado de trabalho (91%). Conclusões: A aterosclerose apresenta um importante impacto económico, correspondendo a uma despesa equivalente a 1% do Produto Interno Bruto nacional e a 11% da despesa corrente em saúde, em 2016.
Cortisol is an indispensable hormoneto life and with a multifaceted effect. It issynthesized in t... more Cortisol is an indispensable hormoneto life and with a multifaceted effect. It issynthesized in the adrenal glands; its production is enhanced during stress ...
European Heart Journal, 2021
Introduction Heart failure (HF) is a clinical syndrome caused by structural and functional cardia... more Introduction Heart failure (HF) is a clinical syndrome caused by structural and functional cardiac abnormalities resulting in impairment of cardiac function, entailing significant morbi-mortality. HF is an age-dependent entity associated with cardiovascular (CV) risk factors such as type 2 diabetes (T2D). Purpose Estimate the prevalence of HF and its subtypes, and characterize HF in a population of integrated care users. Methods Non-interventional cross-sectional study performed in healthcare centre that provides primary and secondary care. All adult patients at 31/12/2019 were included. Echocardiographic parameters [left ventricle ejection fraction (LVEF) and evidence of structural heart disease] and elevated level of natriuretic peptides were used to define two HF phenotypes: i) HF with reduced ejection fraction (HFrEF, LVEF ≤40% and either NT-proBNP ≥400pg/mL (≥600pg/mL if atrial fibrillation (AF)/flutter) or BNP ≥100pg/mL (≥125pg/mL if AF/flutter)and ii) HF with non-reduced ejec...
Revista Portuguesa de Cardiologia (English Edition), 2021
To take or not to take, is it a patient's choice? Adesão do doente aos anticoagulantes orais dire... more To take or not to take, is it a patient's choice? Adesão do doente aos anticoagulantes orais diretos: tomar ou não tomar, uma escolha do doente?
Revista Portuguesa de Cardiologia, 2020
Introduction and Objectives: Several mechanisms contribute to myocardial hypertrophy and fibrosis... more Introduction and Objectives: Several mechanisms contribute to myocardial hypertrophy and fibrosis in aortic stenosis (AS). MicroRNAs are post-transcriptional modulators of such processes. We hypothesized that their expression in myocardial biopsies from patients with AS could be linked with the degree of left ventricular (LV) hypertrophy and remodeling and to plasma levels of important biomarkers of extracellular matrix turnover. Methods: We performed myocardial biopsies in eleven patients with isolated severe AS undergoing aortic valve replacement. Echocardiographic exams and biomarker quantification were also performed. Five explanted hearts were used as controls for microRNA expression. Results: Overexpression of microRNA-101-3p was found in AS, which correlated with higher levels of preoperative valvuloarterial impedance, angiotensin II receptor and angiotensinconverting enzyme, and LV mass regression after surgery. Although not differently expressed in AS compared to controls, both upregulation of miR-4268 and downregulation of microRNA-125-5p were associated with higher LV mass. MicroRNA-125b-5p correlated negatively with LV mass and with relative wall thickness at six-month follow-up. MicroRNA-4268 correlated positively with LV mass regression and was associated with higher plasma angiotensin II receptor levels. Conclusions: MicroRNA-101-3p and microRNA-4268 have potential new roles in the modulation of the hypertrophic response to AS via the renin-angiotensin-aldosterone system and as predictors of reverse remodeling after aortic valve replacement. Our results open new avenues
Revista Portuguesa de Cardiologia (English Edition), 2018
The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous... more The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous and prospective activity. We present an overall picture of the data from this powerful tool. Up to 2016, 45 141 records were included, mostly male (71%), and with a mean age of 66 years. Baseline characteristics remained stable over the years. Of the overall population, 44% of cases were ST-elevation myocardial infarction (STEMI). Over the years there was a significant improvement in compliance with international guidelines, in terms of both diagnostic and therapeutic procedures, as well as for medication. In particular, the rate of reperfusion in STEMI increased to 84%, mainly by primary percutaneous coronary intervention (only 5.2% were treated with thrombolysis in 2016). By contrast, timings in STEMI did not change significantly. Improvements in treatment were accompanied by a reduction in in-hospital mortality from 6.7% in 2002 to 2.5% in 2016 in the overall population. This registry enables analysis of the management and results of acute coronary syndromes over time in Portugal, and hence assessment of improvements in quality of care.
European Journal of Heart Failure Supplements, 2005
Introduction: The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified... more Introduction: The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. Its role in risk stratification in patients with acute coronary syndromes (ACS) is still under evaluation. Objective: We aimed to evaluate the prognostic value of NT-proBNP measured in the first 48 hours after admission due to an acute coronary syndrome. Methods: Our study included 142 patients (aged 62.7±12.0 years, 70.4 % males) admitted to a cardiology unit with an ACS. All laboratory evaluations were performed in the first 48 hours after admission. The mean follow-up was 200 days. Death from any cause or hospitalization because of a major acute cardiovascular event (whichever occurred first) was defined as the end-point. Results: Cardiovascular risk factors were found in a significant proportion of our sample (hypertension in 56.3 %, diabetes mellitus in 38.0 %, current or previous smoking in 51.4 %, dyslipidemia in 67.6 %). Fifty-eight patients had left ventricular systolic dysfunction (LVSD). Serum levels of NT-proBNP were 2174±4801 pg/ml. Variables associated with event-free survival in univariate analysis were: NT-proBNP (HR 1.007, 95 % CI 1.003-1.011, for each 100 pg/ml increment), serum glucose (hazard ratio [HR] 1.007, 95% CI 1.001-1.012, for each 1 mg/dl increment) and maximum cardiac troponin I (cTnI) level (HR 1.005, 95 % CI 1.
Revista Portuguesa de Cardiologia (English Edition), 2019
Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategi... more Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipidlowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, this therapy is associated with significant costs, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.
Revista Portuguesa de Cardiologia, 2018
The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous... more The Portuguese Registry of Acute Coronary Syndromes (ProACS) has completed 15 years of continuous and prospective activity. We present an overall picture of the data from this powerful tool. Up to 2016, 45 141 records were included, mostly male (71%), and with a mean age of 66 years. Baseline characteristics remained stable over the years. Of the overall population, 44% of cases were ST-elevation myocardial infarction (STEMI). Over the years there was a significant improvement in compliance with international guidelines, in terms of both diagnostic and therapeutic procedures, as well as for medication. In particular, the rate of reperfusion in STEMI increased to 84%, mainly by primary percutaneous coronary intervention (only 5.2% were treated with thrombolysis in 2016). By contrast, timings in STEMI did not change significantly. Improvements in treatment were accompanied by a reduction in in-hospital mortality from 6.7% in 2002 to 2.5% in 2016 in the overall population. This registry enables analysis of the management and results of acute coronary syndromes over time in Portugal, and hence assessment of improvements in quality of care.
Circulation, Nov 23, 2010
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 16, 2015
Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and t... more Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospect...
Netherlands Heart Journal, 2010
The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary... more The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary disease (COPD), GOLD grade 3, stable for the past two decades, who was admitted to our center with severe right heart failure. The chest radiograph showed moderate heart enlargement mainly of the right atrium and pulmonary artery, similar to previous chest radiographs in the previous 20 years. The transthoracic echocardiogram showed a pulmonary artery aneurysm (PAA), dilatation of the right chambers with pulmonary artery systolic pressure of 52 mmHg, and preserved right ventricular systolic function. A thoracic computed tomography scan confirmed the presence of a giant PA A 72 mm in diameter. The patient was started on high-dose diuretics, with significant clinical improvement. After optimization of medical therapy right heart catheterization was carried out with the patient in optimal clinical condition, which revealed mild precapillary pulmonary hypertension with a mean pulmonary artery pressure of 26 mmHg. On the basis of the clinical and imaging findings a stable, giant, high-pressure, PA A was diagnosed secondary to pulmonary hypertension induced by COPD, with a 20-year follow-up without need for surgical repair, which helped in our decision to maintain medical surveillance. The recent onset of heart failure is explained by the unfavorable evolution of COPD. This case may change the attitude expressed in previous studies favoring the choice of an invasive approach to treat giant high-pressure PAAs, instead supporting the maintenance of medical treatment.
Cardiovascular Research, 2014
Impact of diabetes mellitus on myofilaments phosphorylation and calcium sensitivity is aortic ste... more Impact of diabetes mellitus on myofilaments phosphorylation and calcium sensitivity is aortic stenosis patients
Nephrology Dialysis Transplantation, 2006
Expert Review of Cardiovascular Therapy, 2004
the b&2-adrenoceptor gene have been shown to have functional consequences as a result of receptor... more the b&2-adrenoceptor gene have been shown to have functional consequences as a result of receptor desensitization associated with certain genetic variants. Accordingly, we hypothesized that the common Argl6IGln27 b&2-adrenoceptor polymorphism would affect pulmonary function in CHF. METHODS. 54 consecutive, stable CHF patients ware genotyped at codon 16 and 27 of the b&2-adrenoceptor gene. Pulmonary
Expert Opinion on Therapeutic Targets, 2010
Current Pharmaceutical Biotechnology, 2012