Adelino Leite-Moreira | Universidade do Porto (original) (raw)

Papers by Adelino Leite-Moreira

European Journal of Cardio-Thoracic Surgery, Apr 6, 2018

postoperative haemodynamics, and thus, larger-sized bileaflet mechanical valves are often used to... more postoperative haemodynamics, and thus, larger-sized bileaflet mechanical valves are often used to reduce the risk of PPM. Ozyalcin et al. [6] in their study concluded that an in vivo effective orifice area index (EOAI) <1.19 cm 2 /m 2 strongly suggests a suboptimal haemodynamic recovery following MVR with the bileaflet mechanical prosthesis and observed that although no direct relationship between prosthesis size and in vivo EOAI was demonstrated, the logical approach is to implant a prosthesis of the largest possible size. We also keenly await the completion of the study by Totaro and Pelenghi [1] about their ONyX 'one size fits all' prosthesis to get further insights on the issue of mitral PPM.

Clinical and Experimental Pharmacology and Physiology, Oct 30, 2018

Anthracycline chemotherapy has a prominent role in treating many forms of cancer. Unfortunately, ... more Anthracycline chemotherapy has a prominent role in treating many forms of cancer. Unfortunately, cardiotoxic side effects represent a serious limitation to their use, with doxorubicin being the leading drug of the group. Indeed, anthracycline-induced cardiomyopathy is an important public health concern because it may not be detected for many years and remains a lifelong threat. Even after decades of investigation, neither the exact mode of action of anthracyclines nor the pathways leading to their side effect are fully understood. It is increasingly important to establish collaboration between oncologists and cardiologists to improve the management of cancer patient receiving anthracyclines. This article reviews the clinical course, pathogenesis, cardiac monitoring and new concepts in diagnosing and preventing anthracycline-induced cardiotoxicity.

Heart Failure Reviews, Mar 25, 2012

Heart failure (HF) is one of the major health and economic burdens worldwide, and its prevalence ... more Heart failure (HF) is one of the major health and economic burdens worldwide, and its prevalence is continuously increasing. The study of HF requires reliable animal models to study the chronic changes and pharmacologic interventions in myocardial structure and function and to follow its progression toward HF. Indeed, during the past 40 years, basic and translational scientists have used small animal models to understand the pathophysiology of HF and find more efficient ways of preventing and managing patients suffering from congestive HF (CHF). Each species and each animal model has advantages and disadvantages, and the choice of one model over another should take them into account for a good experimental design. The aim of this review is to describe and highlight the advantages and drawbacks of some commonly used HF rodents models, including both non-genetically and genetically engineered models, with a specific subchapter concerning diastolic HF models.

Physiological Research, 2008

This study investigated whether endothelin (ET)-1-induced increase in myocardial distensibility i... more This study investigated whether endothelin (ET)-1-induced increase in myocardial distensibility is preserved in heart failure (HF) and whether it is modulated by nitric oxide (NO) and prostaglandins. New Zealand white rabbits were treated with doxorubicin (1 mg/kg, intravenously twice a week for 8 weeks, DOX-HF group) or saline (control group). Effects of ET-1 (0.1, 1, 10 nM) were tested in papillary muscles from the DOX-HF group and a control group in the presence of: i) intact endocardial endothelium (EE); ii) damaged EE; iii) N G-nitro-L-arginine (L-NNA; NO synthase inhibitor), and iv) indomethacin (INDO; cyclooxygenase inhibitor). In the presence of an intact EE, ET-1 promoted concentration-dependent positive inotropic and lusitropic effects that were maintained after damaging the EE, in the presence of L-NNA or INDO and in the DOX-HF Group. ET-1 reduced resting tension at the end of the isometric twitch (increased diastolic distensibility) by 3.2±1.3 %, 6.

Arquivos Brasileiros De Cardiologia, 2022

Artigo de Revisão Gonçalves-Teixeira et al. Diagnóstico e Manejo da FA em Pacientes com Câncer

Frontiers in Cardiovascular Medicine

BackgroundHuman umbilical cord matrix-mesenchymal stromal cells (hUCM-MSC) have demonstrated bene... more BackgroundHuman umbilical cord matrix-mesenchymal stromal cells (hUCM-MSC) have demonstrated beneficial effects in experimental acute myocardial infarction (AMI). Reperfusion injury hampers myocardial recovery in a clinical setting and its management is an unmet need. We investigated the efficacy of intracoronary (IC) delivery of xenogeneic hUCM-MSC as reperfusion-adjuvant therapy in a translational model of AMI in swine.MethodsIn a placebo-controlled trial, pot-belied pigs were randomly assigned to a sham-control group (vehicle-injection; n = 8), AMI + vehicle (n = 12) or AMI + IC-injection (n = 11) of 5 × 105 hUCM-MSC/Kg, within 30 min of reperfusion. AMI was created percutaneously by balloon occlusion of the mid-LAD. Left-ventricular function was blindly evaluated at 8-weeks by invasive pressure-volume loop analysis (primary endpoint). Mechanistic readouts included histology, strength-length relationship in skinned cardiomyocytes and gene expression analysis by RNA-sequencing.Res...

arXiv (Cornell University), Feb 24, 2022

The project aimed to define the rules and develop a technological solution to automatically ident... more The project aimed to define the rules and develop a technological solution to automatically identify a set of attributes within free-text clinical records written in Portuguese. The first application developed and implemented on this basis was a structured summary of a patient's clinical history, including previous diagnoses and procedures, usual medication, and relevant characteristics or conditions for clinical decisions, such as allergies, being under anticoagulant therapy, etc. The project's goal was achieved by a multidisciplinary team that included clinicians, epidemiologists, computational linguists, machine learning researchers and software engineers, bringing together the expertise and perspectives of a public hospital, the university and the private sector. Relevant benefits to users and patients are related with facilitated access to the patient's history, which translates into exhaustiveness in apprehending the patient's clinical past and efficiency due to time saving.

Background: In selected cases, aortic valve repair (RVAo) is an alternative to prostesic aortic v... more Background: In selected cases, aortic valve repair (RVAo) is an alternative to prostesic aortic valve replacement. Aim: To compare mid-term survival, need of reoperation and echocardiographic findings associated with RVAo. Methods: Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent RVAo between 2012 and 2017. A comparison was made with a group of patients who underwent mechanical aortic valve replacement (SVAo) in the same period. The groups were characterized and compared using Chi-Square and t-tests for independent samples and survival and reoperation were analyzed using Kaplan-Meier curves and Cox regressions. Results: We included 72 patients submitted to RVAo. Mean follow-up time was 4 years, maximum 7. Although the mean age was relatively low (47±13 years), patients undergoing RVAo presented a lower prevalence of rheumatic etiology (3%). The cardiopulmonary bypass (148±74 minut...

Circulation, 2014

Introduction: Urocortin (UCN)-2 is a peptide highly expressed in the cardiovascular system and it... more Introduction: Urocortin (UCN)-2 is a peptide highly expressed in the cardiovascular system and it has shown promising therapeutic effects in several studies in both humans and animal models of heart failure (HF). However, the role of UCN-2 in right ventricular (RV) failure is still unknown. Hypothesis: This study analyzed the effects of UCN-2 treatment in an animal model of RV HF, secondary to pulmonary arterial hypertension (PAH). Methods: Male Wistar rats (180-200g) randomly received monocrotaline (MCT, 60mg/Kg, s.c.) or vehicle. After 14 days, animals from these groups were randomly assigned to receive treatment with either UCN-2 (2.5μg/Kg/day, i.p.) or vehicle. The study resulted in 4 groups: control (CTRL) (n=12); CTRL+UCN-2 (n=10); MCT (n=9); MCT+UCN-2 (n=8). RV Pressure-Volume measurements were performed 24-25 days after MCT administration. Only significant results (mean±SEM, p<0.05) are given. Results: MCT group developed PAH, as shown by: increased RV end-systolic pressu...

Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 2020

Introduction Perioperative medication in cardiac surgery recommends β-blockers' use but it is... more Introduction Perioperative medication in cardiac surgery recommends β-blockers' use but it is not clear if its prescription should be started before or after cardiac surgery. Objectives To determine the effect of preoperative β-blocker therapy in long-term survival and postoperative complications after coronary artery bypass grafting surgery (CABG). Also, to study if recent acute myocardial infarction (AMI) changes this therapeutic effect. Materials and Methods Retrospective single-center study including consecutive patients submitted to first isolated CABG in 2006-2007. Data was collected through clinical files and informatic databases. Patients were grouped according to their preoperative Bblocker regimen: without (noBB) or with β-blockers (BB). Chi-square, independent t-tests, Kaplan- -Meier curves, Log Rank test and multivariable Cox regression were used. The mean follow-up time was 10 years, maximum 13 years. Results We included 562 patients, 468 (83%) were on preoperative ...

European Heart Journal, 2020

There is currently conflicting evidence regarding the security profile and outcomes of dual antip... more There is currently conflicting evidence regarding the security profile and outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). We aim to compare the effect of early DAPT in short and long-term survival versus acetylsalicylic acid in a monotherapy regimen (ASA). Therapy's safety was evaluated through immediate or early postoperative outcomes, with particular emphasis on the haemorrhagic. Single-centre retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Median follow-up time was 9 years. Pre-, peri- and postoperative data was collected through clinical files and digital databases. The DAPT and ASA groups were defined considering the administration of clopidogrel plus acetylsalicylic acid and only acetylsalicylic acid, respectively, within a 24h window after CABG. T-tests and Pearson's chi-squared tests were used for group comparison. Survival analysis was performed using Kaplan-...

The Journal of Cardiovascular Surgery, 2021

Introduction The benefit of total arterial revascularization versus the use of venous grafts in a... more Introduction The benefit of total arterial revascularization versus the use of venous grafts in addition to an arterial conduit is still an unsettled issue in coronary artery bypass grafting (CABG) surgery, especially in higher-risk subgroups due to lack of evidence, namely in the elderly. Objectives We conducted a meta-analysis of randomized controlled trials (RCTs), and propensity score (PS) studies comparing survival and early results of elderly patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG). Materials and Methods MEDLINE, Web of Science, and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a follow-up ≥ 1 year and early outcomes were evaluated. Outcomes were collected through hazard ratio (HR) and their variance, frequencies from the matched sample, or adjusted odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events). Results Eleven PS cohorts and 2 RCTs comprising >20,000 patients (>6800MAG and >13,200 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.80, 95%CI: 0.72-0.88, p<0.01) at no expense of higher risk of early mortality (pooled OR: 0.81, 95%CI: 0.57-1.15, p=0.24), but a propensity for MAG being associated with increased risk of sternal wound complications (SWC) was found (OR MAG BIMA: 1.42, 95%CI: 0.98-2.06, p=0.07). Conclusions Advanced age should not limit MAG's use considering its long-term survival benefits, even within the elderly. However, the tendency for higher rates of SWC with MAG calls for a careful selection of patients to this challenging technique.

$Research paper thumbnail of Histological and haemodynamic characterization of right ventricle in sedentary and trained rats with heart failure with preserved ejection fraction$

Experimental Physiology, 2021

New Findings What is the central question of this study?Right ventricle (RV) dysfunction is highl... more New Findings What is the central question of this study?Right ventricle (RV) dysfunction is highly prevalent in heart failure with preserved ejection fraction (HFpEF), nearly doubling the risk of death: what are the RV functional and structural changes in HFpEF and how does aerobic exercise impact them? What is the main finding and its importance?The HFpEF ZSF1 rat model presents RV structural and functional changes mimicking the human condition. Aerobic exercise prevented the decline in , lowered surrogate markers of RV overload (e.g., higher mean and maximum systolic pressure) and improved diastolic dysfunction (e.g., end‐diastolic pressure and relaxation time constant). This emphasizes the importance of using exercise to manage HFpEF. Right ventricle (RV) dysfunction is highly prevalent in heart failure with preserved ejection fraction (HFpEF) and is a marker of poor prognosis. We assessed the obese ZSF1 rat model of HFpEF to ascertain if these animals also develop RV dysfunction...

$Research paper thumbnail of Nicotinamide for the treatment of heart failure with preserved ejection fraction$

Science Translational Medicine, 2021

The NAD + precursor nicotinamide improves diastolic dysfunction caused by aging, hypertension, or... more The NAD + precursor nicotinamide improves diastolic dysfunction caused by aging, hypertension, or metabolic syndrome in rodents.

The Journal of Cardiovascular Surgery, 2020

INTRODUCAO: A evidencia existente relativamente aos outcomes da terapia de dupla antiagregacao (D... more INTRODUCAO: A evidencia existente relativamente aos outcomes da terapia de dupla antiagregacao (DAPT) em pacientes submetidos a cirurgia de revascularizacao do miocardio (CABG) e conflituosa. Com este estudo, pretendemos comparar outcomes de sobrevivencia e seguranca da DAPT versus aspirina (ASA) numa janela temporal de 24h apos CABG. METODOS: Estudo unicentrico de coorte retrospetiva, em pacientes submetidos consecutivamente a primeiro CABG isolado em 2010. A analise de sobrevivencia (mediana de follow-up de 9 anos) foi realizada com curvas Kaplan-Meier e regressao multivariada Cox utilizando Propensity Score (PS) como covariavel com DAPT. A hemorragia foi avaliada atraves da transfusao de globulos rubros (RBC), re-exploracao do torax e drenagem pos-operatoria. RESULTADOS: Incluimos 351 pacientes, 251 dos quais sob DAPT (71.5%). As curvas Kaplan-Meier demonstram sobrevivencia cumulativa similar entre grupos (9a: 75% DAPT vs. 67% ASA, Log-rank p=0.103), bem como na analise ajustada por PS (HR DAPT: 0.93, 95%CI:0.57-1.51). Tendo em conta outcomes de seguranca, nao encontramos diferencas na mortalidade precoce (2 no grupo DAPT e 1 no grupo ASA). A transfusao mediana total do cell-saver (300mL vs. 250mL, p=0.318) e a re-exploracao do torax devido a hemorragia (1.6% vs. 4%, p=0.231) tambem nao mostra diferenca estatisticamente significativa. Por outro lado, a drenagem toracica pos-operatoria foi superior no grupo ASA (1220mL DAPT vs. 1300mL ASA, p=0.043). Tambem verificamos, nos pacientes DAPT, uma necessidade inferior de ≥3 transfusoes RBC no peri e pos-operatorio (8.5% vs. 13.3% p<0.001 e 4.8% vs.13%, p=0.009, respetivamente) e uma estadia intra-hospitalar mais curta apos CABG no grupo DAPT (mediana de 7 dias vs. 8 dias para o grupo ASA, p<0.001). Segundo CABG foi realizado em 3 pacientes durante o follow-up (2 DAPT vs 1 ASA). CONCLUSOES: Comparativamente a ASA, a DAPT mostrou um impacto nao significativo na sobrevivencia a longo prazo, mas mostrou ser uma opcao segura, de acordo com os outcomes analisados. Mais estudos sao necessarios para emitir recomendacoes acerca da estrategia terapeutica apos CABG.

Frontiers in Physiology, 2020

Diastolic dysfunction of the heart and decreased compliance of the vasculature and lungs (i.e., i... more Diastolic dysfunction of the heart and decreased compliance of the vasculature and lungs (i.e., increased organ tissue stiffness) are known features of obesity and the metabolic syndrome. Similarly, cardiac diastolic dysfunction is associated with aging. Elevation of the enzyme transglutaminase 2 (TG2) leads to protein cross-linking and enhanced collagen synthesis and participates as a candidate pathway for development of tissue stiffness. With these observations in mind we hypothesized that TG2 may be elevated in tissues of a rat model of obesity/metabolic syndrome (the ZSF 1 rat) and a mouse model of aging, i.e., the senescent SAMP8 mouse. In the experiments reported here, TG2 expression and activity were found for the first time to be spontaneously elevated in organs from both the ZSF1 rat and the SAMP8 mouse. These observations are consistent with a hypothesis that a TG2-related pathway may participate in the known tissue stiffness associated with cardiac diastolic dysfunction in these two rodent models. The potential TG2 pathway needs better correlation with physiologic dysfunction and may eventually provide novel therapeutic insights to improve tissue compliance.

Pediatric Critical Care Medicine, 2016

The aim of this article is to evaluate the clinical utility of brain natriuretic peptide in pedia... more The aim of this article is to evaluate the clinical utility of brain natriuretic peptide in pediatric patients, examining the diagnostic value, management, and prognostic relevance, by critical assessment of the literature. Data Sources: In December 2015, a literature search was performed

Circulation, Nov 20, 2012

Diastolic dysfunction, characterized by relaxation abnormalities and increased myocardial stiffne... more Diastolic dysfunction, characterized by relaxation abnormalities and increased myocardial stiffness, and heart failure with preserved ejection fraction (HFpEF) are increasingly prevalent in Western...