137 results on '"Pedro de Araújo Gonçalves"'
Search Results
2. Predicting obstructive coronary artery disease in heart failure with reduced ejection fraction: A practical clinical score
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Francisco Albuquerque, Afonso Félix Oliveira, Pedro de Araújo Gonçalves, Rui Campante Teles, Manuel de Sousa Almeida, Mariana Gonçalves, Pedro M. Lopes, Gonçalo J.L. Cunha, João Presume, Daniel Matos, Sérgio Madeira, João Brito, Luís Raposo, Henrique Mesquita Gabriel, and Miguel Mendes
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Cardiology and Cardiovascular Medicine - Abstract
Obstructive coronary artery disease (CAD) remains the most common etiology of heart failure with reduced ejection fraction (HFrEF). However, there is controversy whether invasive coronary angiography (ICA) should be used initially to exclude CAD in patients presenting with new-onset HFrEF of unknown etiology. Our study aimed to develop a clinical score to quantify the risk of obstructive CAD in these patients.We performed a cross-sectional observational study of 452 consecutive patients presenting with new-onset HFrEF of unknown etiology undergoing elective ICA in one academic center, between January 2005 and December 2019. Independent predictors for obstructive CAD were identified. A risk score was developed using multivariate logistic regression of designated variables. The accuracy and discriminative power of the predictive model were assessed.A total of 109 patients (24.1%) presented obstructive CAD. Six independent predictors were identified and included in the score: male gender (2 points), diabetes (1 point), dyslipidemia (1 point), smoking (1 point), peripheral arterial disease (1 point), and regional wall motion abnormalities (3 points). Patients with a score ≤3 had less than 15% predicted probability of obstructive CAD. Our score showed good discriminative power (C-statistic 0.872; 95% CI 0.834-0.909: p0.001) and calibration (p=0.333 from the goodness-of-fit test).A simple clinical score showed the ability to predict the risk of obstructive CAD in patients presenting with new-onset HFrEF of unknown etiology and may guide the clinician in selecting the most appropriate diagnostic modality for the assessment of obstructive CAD.
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- 2023
3. Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results from the PARADIGM study
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Hyung-Bok Park, Reza Arsanjani, Ji Min Sung, Ran Heo, Byoung Kwon Lee, Fay Y Lin, Martin Hadamitzky, Yong-Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J Budoff, Ilan Gottlieb, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Jonathon A Leipsic, Sang-Eun Lee, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Kavitha Chinnaiyan, Peter H Stone, Daniel S Berman, Jagat Narula, Leslee J Shaw, Jeroen J Bax, James K Min, and Hyuk-Jae Chang
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Aims To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA). Methods and results We analyzed mild stenosis (25–49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02–3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09–2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07–2.22; P = 0.020). Conclusion In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs. Clinical trial registration ClinicalTrials.gov NCT02803411
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- 2023
4. Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting
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Cláudia Silva, Pedro Lopes, Mariana Gonçalves, António Ventosa, João Calqueiro, Pedro Freitas, Sara Guerreiro, João Brito, João Abecasis, Luís Raposo, Carla Saraiva, Pedro de Araújo Gonçalves, Ana Santos, Rui Campante Teles, Manuel de Sousa Almeida, and António Miguel Ferreira
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Cardiology and Cardiovascular Medicine - Published
- 2023
5. Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels
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Ki-Bum Won, Byoung Kwon Lee, Ran Heo, Hyung-Bok Park, Fay Y. Lin, Martin Hadamitzky, Yong-Jin Kim, Ji Min Sung, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J. Budoff, Ilan Gottlieb, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Jonathon A. Leipsic, Sang-Eun Lee, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Kavitha Chinnaiyan, Daniel S. Berman, Jagat Narula, Jeroen J. Bax, James K. Min, Hyuk-Jae Chang, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
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cardiovascular ,CCTA ,Evaluation of treatments and therapeutic interventions ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,Hematology ,hemoglobin level changes ,hemoglobin ,Δ hemoglobin ,PVC ,Heart Disease ,Clinical Research ,6.1 Pharmaceuticals ,coronary computed tomographic angiography ,CCTA, coronary computed tomographic angiography ,CV, cardiovascular ,PVC, plaque volume changes ,atherosclerosis ,coronary computed tomography angiography ,Δ hemoglobin, hemoglobin level changes ,plaque volume changes ,CV ,Cardiology and Cardiovascular Medicine ,Heart Disease - Coronary Heart Disease - Abstract
Publisher Copyright: © 2022 The Authors Background: Despite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited. Objectives: The authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA). Methods: A total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm3/year) was defined as total PVC divided by the interscan period. Results: Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P = 0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β = −0.114) in overall participants (P < 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β = −2.401; P = 0.004). Conclusions: Serial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411) publishersversion published
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- 2022
6. Worrisome trends of ST-elevation myocardial infarction during the Covid-19 pandemic: Data from Portuguese centers
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Luís Oliveira, Rui Campante Teles, Carina Machado, Sérgio Madeira, Nélson Vale, Carla Almeida, João Brito, Sílvio Leal, Luís Raposo, Pedro de Araújo Gonçalves, António Miguel Pacheco, Henrique Mesquita Gabriel, Manuel Almeida, Dinis Martins, and Miguel Mendes
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Cardiology and Cardiovascular Medicine - Abstract
During the Covid-19 pandemic there has been a general belief that hospital admissions for non-infectious causes, especially cardiovascular diseases, have fallen.To assess the impact of the pandemic on admissions for ST-elevation myocardial infarction (STEMI) during the first pandemic wave.We performed a multicenter retrospective analysis of consecutive patients presenting with STEMI in two Portuguese hospital centers in two sequential periods - P1 (March 1 to April 30) and P2 (May 1 to June 30). Patient's clinical data and hospital outcomes were compared between the years 2017 to 2019 and 2020 for both periods.During P1 in 2020, a reduction in the number of STEMI patients was observed in comparison with previous years (26.0±4.2 vs. 16.5±4.9 cases per month; p=0.033), as well as an increase in the number of mechanical complications (0.0% vs. 3.0%; p=0.029). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs. 9.1%; p=0.033). An overall trend for longer delays in key timings of STEMI care bundles was noted. Mortality was higher during P1 compared to previous years (1.9% vs. 12.1%; p=0.005).During the first Covid-19 wave fewer patients presented with STEMI at the catheterization laboratory for percutaneous coronary intervention. These patients presented more mechanical complications and higher mortality.Recentemente durante a pandemia por Covid-19 houve uma perceção global de uma diminuição de admissões hospitalares por causas não infeciosas, em particular por doenças cardiovasculares.Avaliar o impacto da pandemia nas admissões por enfarte agudo do miocárdio com supradesnivelamento de ST (STEMI), na primeira onda da pandemia.Análise multicêntrica e retrospetiva de doentes consecutivos admitidos em dois hospitais portugueses por STEMI em dois períodos sequenciais - P1 (1 de março a 30 de abril) e P2 (1 de maio a 30 de junho). Foi realizada uma comparação dos dados clínicos e de evolução hospitalar entre 2017 a 2019 e 2020 para os dois períodos.No P1 de 2020 observou-se, relativamente a anos prévios, uma redução do número de doentes com STEMI (26,0±4,2Durante a primeira onda da pandemia Covid-19 houve uma redução do número de doentes submetidos a angioplastia coronária por STEMI. Esses apresentaram mais complicações mecânicas e uma maior mortalidade.
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- 2022
7. Association of Tube Voltage With Plaque Composition on Coronary CT Angiography
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Gianluca Pontone, Jagat Narula, Kavitha Chinnaiyan, Pedro de Araújo Gonçalves, Mouaz H. Al-Mallah, Jonathon Leipsic, Edoardo Conte, Matthew J. Budoff, Sanghoon Shin, Hyuk Jae Chang, Eun Ju Chun, Fay Y. Lin, Ilan Gottlieb, Erica Maffei, Habib Samady, Byoung Kwon Lee, Filippo Cademartiri, Martin Hadamitzky, Leslee J. Shaw, Gaurav S. Gulsin, Hugo Marques, Hidenobu Takagi, Renu Virmani, Peter Stone, Jung Hyun Choi, Ji Min Sung, Praveen Indraratna, Yong Jin Kim, Sang Eun Lee, Jeroen J. Bax, Daniel S. Berman, Elina Khasanova, Daniele Andreini, and Georgios Tzimas
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Aorta ,Necrotic core ,business.industry ,medicine.medical_treatment ,Plaque composition ,Coronary computed tomography angiography ,Coronary ct angiography ,Revascularization ,Coronary plaque ,medicine.artery ,Hounsfield scale ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Objectives This study sought to investigate the impact of low tube voltage scanning heterogeneity of coronary luminal attenuation on plaque quantification and characterization with coronary computed tomography angiography (CCTA). Background The impact of low tube voltage and coronary luminal attenuation on quantitative coronary plaque remains uncertain. Methods A total of 1,236 consecutive patients (age: 60 ± 9 years; 41% female) who underwent serial CCTA at an interval of ≥2 years were included from an international registry. Patients with prior revascularization or nonanalyzable coronary CTAs were excluded. Total coronary plaque volume was assessed and subclassified based on specific Hounsfield unit (HU) threshold: necrotic core, fibrofatty plaque, and fibrous plaque and dense calcium. Luminal attenuation was measured in the aorta. Results With increasing luminal HU ( 500 HU), percent calcified plaque was increased (16%, 27%, and 40% in the median; P Conclusions Low tube voltage usage affected plaque morphology, mainly through an increase in luminal HU with a resultant increase in calcified plaque and a reduction in fibrofatty and necrotic core. These findings should be considered as CCTA-based plaque measures are being used to guide medical management and, in particular, when being used as a measure of treatment response. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411 )
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- 2021
8. Plaque Character and Progression According to the Location of Coronary Atherosclerotic Plaque
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A. Maxim Bax, Umberto Gianni, Filippo Cademartiri, Donghee Han, Yao Lu, Sang Eun Lee, Xiaoyue Ma, Ji Min Sung, Gianluca Pontone, Edoardo Conte, Hugo Marques, Mouaz H. Al-Mallah, Benjamin Goebel, Matthew J. Budoff, Jonathon Leipsic, Ilan Gottlieb, Kavitha Chinnaiyan, Leslee J. Shaw, Daniele Andreini, Jung Hyun Choi, Byoung Kwon Lee, Eun Ju Chun, Martin Hadamitzky, Hyuk Jae Chang, Erica Maffei, Yong Jin Kim, Sanghoon Shin, Benjamin C. Lee, Fay Y. Lin, Jagat Narula, Yeonyee E. Yoon, and Pedro de Araújo Gonçalves
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Computed Tomography Angiography ,Coronary Artery Disease ,Culprit ,Cohort Studies ,Plaque volume ,Internal medicine ,medicine ,Humans ,Registries ,Aged ,business.industry ,Coronary computed tomography angiography ,Mean age ,Middle Aged ,medicine.disease ,Plaque, Atherosclerotic ,Lumen Diameter ,medicine.anatomical_structure ,Disease Progression ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Although acute coronary syndrome culprit lesions occur more frequently in the proximal coronary artery, whether the proximal clustering of high-risk plaque is reflected in earlier-stage atherosclerosis remains unclarified. We evaluated the longitudinal distribution of stable atherosclerotic lesions on coronary computed tomography angiography (CCTA) in 1,478 patients (mean age, 61 years; men, 58%) enrolled from a prospective multinational registry of consecutive patients undergoing serial CCTA. Of 3,202 coronary artery lesions identified, 2,140 left lesions were classified (based on the minimal lumen diameter location) into left main (LM, n = 128), proximal (n = 739), and other (n = 1,273), and 1,062 right lesions were classified into proximal (n = 355) and other (n = 707). Plaque volume (PV) was the highest in proximal lesions (median, 26.1 mm3), followed by LM (20.6 mm3) and other lesions (15.0 mm3, p
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- 2021
9. Pretreatment with a P2Y12 receptor inhibitor and delay to coronary artery bypass surgery in patients with non-ST segment elevation acute coronary syndrome
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Daniel A, Gomes, Bruno M, Rocha, Jorge, Ferreira, Mariana S, Paiva, Rita, Reis Santos, Marina R, Santos, Gonçalo, Cunha, Pedro, de Araújo Gonçalves, Susana, Fevereiro, Marisa, Trabulo, Carlos, Aguiar, Miguel, Sousa-Uva, José, Neves, and Miguel, Mendes
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Cardiology and Cardiovascular Medicine - Abstract
2020 ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against the pretreatment with P2Y12 receptor inhibitors (P2Y12i) in patients undergoing early invasive management (24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable coronary anatomy. This study aimed to analyze the theoretical impact of pretreatment with a P2Y12i on delay to CABG surgery in a real-world population with NSTE-ACS.Single-center retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG or nonobstructive coronary disease were excluded.The total cohort included 262 patients (mean age 68±12 years, 69% male, 15% with unstable angina and mean GRACE score 134±35). Median time from FMC to angiography was 2 (1-4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pretreatment with P2Y12i (clopidogrel or ticagrelor). The median time from angiography to CABG was 12 (7-15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P=0.017 and 82.4% vs. 21.4%, P0.001, respectively), although there were no differences regarding major bleeding.Pretreatment with P2Y12i was a potential but not the sole driver of CABG delay in our cohort. Adopting the new recommendations of withholding pretreatment might decrease this delay, but other factors must be considered.
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- 2022
10. Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40 821 real-world procedures over a 12-year period
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Sílvio Leal, Sérgio Madeira, Miguel M. Santos, Mariana Gonçalves, Pedro Magno, Miguel Mendes, David Roque, Manuel de Sousa Almeida, Pedro de Araújo Gonçalves, Carlos Morais, João Brito, Luís Raposo, Pedro Farto e Abreu, Rui Campante Teles, Sérgio Bravo Baptista, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
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Cardiac Catheterization ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Ischemia ,Fisiologia coronária ,Coronary Artery Disease ,Fractional flow reserve ,FFR ,Coronary artery disease ,Predictive Value of Tests ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Instantaneous wave-free ratio ,General Environmental Science ,Retrospective Studies ,Doença coronária ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,iFR ,Adoção ,Middle Aged ,medicine.disease ,Large cohort ,Fractional Flow Reserve, Myocardial ,Clinical trial ,RC666-701 ,Emergency medicine ,General Earth and Planetary Sciences ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction and Objectives: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. Methods: We retrospectively determined the per-procedure prevalence of physiological assessment in 40 821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. Results: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages 55 years, respectively; p 55 anos, respetivamente; p < 0,001) e a hora de realização do procedimento (2,9% entre as 6-8PM versus 4,4% durante o restante dia) relacionaram-se inversamente com a utilização de fisiologia durante os procedimentos. Conclusões: Esta análise confirma a baixa de utilização da avaliação funcional invasiva na prática clínica. A disponibilidade de evidência sobre o uso de índices não hiperémicos não aumentou a adoção. São necessárias estratégias dirigidas que potenciem a implantação das recomendações, de forma que o manejo dos doentes com doença coronária e os benefícios clínicos da estratificação invasiva possam ser aprimorados.
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- 2021
11. Measurement of compensatory arterial remodelling over time with serial coronary computed tomography angiography and 3D metrics
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Inge J van den Hoogen, Alexander R van Rosendael, Fay Y Lin, Umberto Gianni, Daniele Andreini, Mouaz H Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Edoardo Conte, Hugo Marques, Pedro de Araújo Gonçalves, Ilan Gottlieb, Martin Hadamitzky, Jonathon Leipsic, Erica Maffei, Gianluca Pontone, Sanghoon Shin, Yong Jin Kim, Byoung Kwon Lee, Eun Ju Chun, Ji Min Sung, Sang Eun Lee, Daniel S Berman, Renu Virmani, Habib Samady, Peter H Stone, Jagat Narula, Hyuk Jae Chang, James K Min, Leslee J Shaw, and Jeroen J Bax
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Male ,Computed Tomography Angiography ,Humans ,Female ,Radiology, Nuclear Medicine and imaging ,Coronary Artery Disease ,General Medicine ,Middle Aged ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,Coronary Vessels ,Plaque, Atherosclerotic ,Aged - Abstract
Aims The magnitude of alterations in which coronary arteries remodel and narrow over time is not well understood. We aimed to examine changes in coronary arterial remodelling and luminal narrowing by three-dimensional (3D) metrics from serial coronary computed tomography angiography (CCTA). Methods and results From a multicentre registry of patients with suspected coronary artery disease who underwent clinically indicated serial CCTA (median interscan interval = 3.3 years), we quantitatively measured coronary plaque, vessel, and lumen volumes on both scans. Primary outcome was the per-segment change in coronary vessel and lumen volume from a change in plaque volume, focusing on arterial remodelling. Multivariate generalized estimating equations including statins were calculated comparing associations between groups of baseline percent atheroma volume (PAV) and location within the coronary artery tree. From 1245 patients (mean age 61 ± 9 years, 39% women), a total of 5721 segments were analysed. For each 1.00 mm3 increase in plaque volume, the vessel volume increased by 0.71 mm3 [95% confidence interval (CI) 0.63 to 0.79 mm3, P < 0.001] with a corresponding reduction in lumen volume by 0.29 mm3 (95% CI −0.37 to −0.21 mm3, P < 0.001). Serial 3D arterial remodelling and luminal narrowing was similar in segments with low and high baseline PAV (P ≥ 0.496). No differences were observed between left main and non-left main segments, proximal and distal segments and side branch and non-side branch segments (P ≥ 0.281). Conclusions Over time, atherosclerotic coronary plaque reveals prominent outward arterial remodelling that co-occurs with modest luminal narrowing. These findings provide additional insight into the compensatory mechanisms involved in the progression of coronary atherosclerosis.
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- 2021
12. Predictors of pacemaker implantation after TAVI in a registry including self, balloon and mechanical expandable valves
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R Teles, João Brito, João Abecasis, Pedro de Araújo Gonçalves, Mariana Gonçalves, F Gama, Afonso Oliveira, Pedro Adragão, António Miguel Ferreira, Henrique Mesquita Gabriel, Salomé Carvalho, Manuel de Sousa Almeida, Luís Raposo, and Pedro J. Freitas
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Aortic valve ,Pacemaker, Artificial ,medicine.medical_specialty ,Balloon ,Transcatheter Aortic Valve Replacement ,QRS complex ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Prospective cohort study ,Retrospective Studies ,Univariate analysis ,business.industry ,Aortic Valve Stenosis ,Right bundle branch block ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cohort ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve implantation (TAVI). The aim of our study was to evaluate different anatomical, clinical, electrocardiographic, and procedural variables associated with the development of conduction abnormalities after TAVI across the entire device spectrum. Single-center prospective cohort of consecutive patients who underwent TAVI since March 2017. Final cohort was studied to detect areas of calcium within aortic valve characterized by leaflet sector and region. Membranous septum (MS) length was assessed throughout a modified coronal view. Device selection and positioning were performed according to the operator criteria. Device selection and positioning were performed according to the operator criteria. From the 273 patients included, 57 underwent PPMI (20.8%). Univariate analysis determined right bundle branch block (RBBB), QRS duration, MS length and calcium within LVOT of non-coronary cuspid as independent predictors. After multivariable logistic regression, both RBBB (OR 6.138; 95% CI 1.23–30.73, P = 0.027) and MS length (OR 0.259; 95% CI 0.164–0.399, P
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- 2021
13. Poster No. 104 Impact of pre-treatment with a P2Y12 receptor inhibitor on delay to CABG surgery in a real-world population with non-ST segment elevation acute coronary syndrome
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Daniel Gomes, Bruno M L Rocha, Jorge Ferreira, Mariana Sousa Paiva, Rita Reis Santos, Marina Raquel Santos, Gonçalo Cunha, Pedro de Araújo Gonçalves, Susana Fevereiro, Marisa Trabulo, Carlos Aguiar, Miguel Sousa-Uva, José Neves, and Miguel Mendes
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Physiology ,Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against P2Y12 pre-treatment receptor inhibitors (P2Y12i) in patients undergoing early invasive management (< 24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable anatomy. This study aims to analyze the impact of P2Y12i pre-treatment on delay to CABG surgery in a real-world population with NSTE-ACS. Methods Single-centre retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG (n = 31) or non-obstructive coronary disease (n = 57) were excluded. Results Total cohort included 262 patients (mean age 68 ± 12 years, 69% male, 15% with unstable angina and mean GRACE score 134 ± 35). Median time from first medical contact to angiography was 2 (1–4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pre-treatment with P2Y12i, either clopidogrel or ticagrelor. Median time from angiography to CABG was 12 (7–15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P = 0.017 and 82.4% vs. 21.4%, P < 0.001, respectively), although there were no differences regarding major bleeding. Conclusion Pre-treatment with P2Y12i was a potential driver of CABG delay in our cohort. In the real-world, adopting the new recommendations of withholding pre-treatment might decrease this delay.
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- 2022
14. Low Rate of Invasive Coronary Angiography Following Transcatheter Aortic Valve Implantation: Real-World Prospective Cohort Findings
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Mariana Gonçalves, Henrique Mesquita Gabriel, Manuel de Sousa Almeida, Hector M. Garcia-Garcia, Miguel Mendes, Pedro de Araújo Gonçalves, João Brito, Rui Campante Teles, Afonso Oliveira, José Pedro Neves, Tiago Nolasco, and Luís Raposo
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Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Transcatheter Aortic Valve Replacement ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Percutaneous coronary intervention ,Stent ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Coronary arteries ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim To evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). Methods and results Prospective observational single-center registry, including 563 consecutive patients who underwent TAVI between April 2008 and November 2018, with both self- and balloon-expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of coronary artery bypass grafting, 33% of previous percutaneous coronary intervention (PCI), and 16.6% of myocardial infarction (MI). Twenty-four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median Society of Thoracic Surgeons score was 4.82 (IQ 2.84). In a median follow-up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for invasive coronary angiography: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome. A total of 11 PCIs were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug-eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter support. Conclusion In this population, a strategy of previous guideline-directed revascularization before TAVI was associated with a low rate of MI and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.
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- 2021
15. Tratamento não farmacológico da angina refratária. Dispositivo de redução do seio coronário, uma nova alternativa terapêutica
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Sérgio Madeira, Henrique Mesquita Gabriel, Nélson Vale, Manuel Almeida, Luís Raposo, Sílvio Leal, Pedro de Araújo Gonçalves, João Brito, Rui Campante Teles, and Catarina Brízido
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RC666-701 ,Coronary sinus reducer device ,Diseases of the circulatory (Cardiovascular) system ,Non‐pharmacological antianginal therapy ,Refractory angina ,Coronary artery disease ,Cardiology and Cardiovascular Medicine - Abstract
Resumo: A angina refratária define‐se como a persistência de sintomas superior a três meses apesar da terapêutica médica otimizada e revascularização. É uma entidade em crescimento, resultado da melhoria do prognóstico da doença coronária com a terapêutica farmacológica e com as técnicas de revascularização contemporâneas. A mortalidade a longo prazo enquadra‐se no espetro prognóstico da doença estável assintomática, contudo interfere com a qualidade de vida do doente e tem um impacto significativo nos sistemas de saúde.Múltiplos alvos terapêuticos têm sido investigados, contudo, a maioria com resultados dececionantes. Muitas das técnicas foram abandonadas por ausência de eficácia, problemas de segurança e limitações tanto logísticas como económicas à sua implantação.Esta revisão incide essencialmente sobre o dispositivo de redução do seio coronário, cuja evidência, embora ainda escassa, é promissora relativamente à segurança e eficácia na redução dos sintomas anginosos e na melhoria da qualidade de vida. Para além do seu efeito terapêutico, é uma opção virtualmente acessível a todos os serviços de cardiologia de intervenção. Abstract: Refractory angina is defined as persistent angina (≥3 months) despite optimal medical and interventional therapies. It is increasing in frequency, due to the success of current medical and interventional therapies in improving the prognosis of coronary artery disease. Long‐term mortality is similar to that of patients with asymptomatic stable disease, but it affects patients’ quality of life, and has a significant impact on health care resources.Several therapeutic targets have been investigated, most with disappointing results. Many of the techniques have been abandoned because of lack of efficacy, safety issues, or economic and logistic limitations to wider applicability.The primary focus of this review is the coronary sinus Reducer, supporting evidence for which, although scarce, is promising regarding safety and efficacy in improving anginal symptoms and quality of life. It is also accessible to virtually all interventional cardiology departments.
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- 2021
16. Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden: a retrospective case-control study from the PARADIGM registry
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Ki-Bum Won, Byoung Kwon Lee, Fay Y. Lin, Martin Hadamitzky, Yong-Jin Kim, Ji Min Sung, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J. Budoff, Ilan Gottlieb, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Jonathon A. Leipsic, Sang-Eun Lee, Sanghoon Shin, Jung Hyun Choi, Renu Virmani, Habib Samady, Kavitha Chinnaiyan, Daniel S. Berman, Jagat Narula, Leslee J. Shaw, Jeroen J. Bax, James K. Min, and Hyuk-Jae Chang
- Subjects
Male ,Aging ,Computed Tomography Angiography ,Endocrinology, Diabetes and Metabolism ,Coronary Artery Disease ,Glycemic Control ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Coronary Angiography ,Clinical Research ,Predictive Value of Tests ,Coronary computed tomography angiography ,Humans ,Prospective Studies ,Registries ,Heart Disease - Coronary Heart Disease ,Plaque ,Atherosclerotic ,Aged ,Retrospective Studies ,Glycated Hemoglobin ,Progression ,Prevention ,Middle Aged ,Atherosclerosis ,Coronary Vessels ,Plaque, Atherosclerotic ,Heart Disease ,Cardiovascular System & Hematology ,Hemoglobin A1c ,Case-Control Studies ,Disease Progression ,Biomedical Imaging ,Female ,Cardiology and Cardiovascular Medicine - Abstract
Background The baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images. Methods A total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV). Results During a median inter-scan period of 3.6 years (interquartile range: 2.7–5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048–0.149; P Conclusion In this retrospective case–control study, the glycemic control status was strongly associated with the risk of RPP in patients without a baseline coronary plaque burden. This suggests that regular monitoring of the glycemic control status might be helpful for preventing the rapid progression of coronary atherosclerosis irrespective of the baseline risk factors. Further randomized investigations are necessary to confirm the results of our study. Trial registration ClinicalTrials.gov NCT02803411.
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- 2022
17. Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range
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Felix Mahfoud, Giuseppe Mancia, Roland E. Schmieder, Luis Ruilope, Krzysztof Narkiewicz, Markus Schlaich, Bryan Williams, Flavio Ribichini, Joachim Weil, Hsien-Li Kao, Oriol Rodriguez-Leor, Elias Noory, Tiong Kiam Ong, Thierry Unterseeh, Pedro de Araújo Gonçalves, Andreas Zirlik, Khaled Almerri, Faisal Sharif, Lucas Lauder, Marianne Wanten, Martin Fahy, and Michael Böhm
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Male ,Blood Pressure ,Middle Aged ,Blood Pressure Monitoring, Ambulatory ,Kidney ,Denervation ,Treatment Outcome ,Cardiovascular Diseases ,Risk Factors ,Heart Disease Risk Factors ,Hypertension ,Humans ,Female ,Prospective Studies ,Sympathectomy ,Cardiology and Cardiovascular Medicine ,Antihypertensive Agents ,Aged - Abstract
Renal denervation (RDN) has been shown to lower blood pressure (BP), but its effects on cardiovascular events have only been preliminarily evaluated. Time in therapeutic range (TTR) of BP is associated with cardiovascular events.This study sought to assess the impact of catheter-based RDN on TTR and its association with cardiovascular outcomes in the GSR (Global SYMPLICITY Registry).Patients with uncontrolled hypertension were enrolled and treated with radiofrequency RDN. Office and ambulatory systolic blood pressure (OSBP and ASBP) were measured at 3, 6, 12, 24, and 36 months postprocedure and used to derive TTR. TTR through 6 months was assessed as a predictor of cardiovascular events from 6 to 36 months using a Cox proportional hazard regression model.As of March 1, 2022, 3,077 patients were enrolled: 42.2% were female; mean age was 60.5 ± 12.2 years; baseline OSBP was 165.6 ± 24.8 mm Hg; and baseline ASBP was 154.3 ± 18.7 mm Hg. Patients were prescribed 4.9 ± 1.7 antihypertensive medications at baseline and 4.8 ± 1.9 at 36 months. At 36 months, mean changes were -16.7 ± 28.4 and -9.0 ± 20.2 mm Hg for OSBP and ASBP, respectively. TTR through 6 months was 30.6%. A 10% increase in TTR after RDN through 6 months was associated with significant risk reductions from 6 to 36 months of 15% for major adverse cardiovascular events (P 0.001), 11% cardiovascular death (P = 0.010), 15% myocardial infarction (P = 0.023), and 23% stroke (P 0.001).There were sustained BP reductions and higher TTR through 36 months after RDN. A 10% increase in TTR through 6 months was associated with significant risk reductions in major cardiovascular events from 6 to 36 months. (Global SYMPLICITY Registry [GSR] DEFINE; NCT01534299).
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- 2022
18. Ten-year survival of patients undergoing coronary angioplasty with first-generation sirolimus-eluting stents and bare-metal stents
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Pedro J. Freitas, Nélson Vale, João Brito, Luís Raposo, Manuel de Sousa Almeida, Sílvio Leal, Gustavo Costa Rodrigues, Sérgio Madeira, Henrique Mesquita Gabriel, Afonso Oliveira, Ricardo Seabra Gomes, Rui Campante Teles, Mariana Castro, and Pedro de Araújo Gonçalves
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Bare-metal stent ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_treatment ,Myocardial Infarction ,Revascularization ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Intervenção coronária ,Angioplasty ,medicine ,Humans ,Stent de metal nu ,cardiovascular diseases ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Stent sirolimus-eluting ,Aged ,General Environmental Science ,Sirolimus ,Doença coronária ,business.industry ,Stent ,Percutaneous coronary intervention ,Drug-Eluting Stents ,equipment and supplies ,First generation ,Surgery ,Treatment Outcome ,surgical procedures, operative ,030228 respiratory system ,Metals ,lcsh:RC666-701 ,Conventional PCI ,General Earth and Planetary Sciences ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Introduction: Compared to bare-metal stents (BMS), drug-eluting stents reduce stent restenosis and improve subsequent revascularization rates. The impact on patients’ survival has been the subject of debate. Objective: To assess the long-term (10-year) survival of patients undergoing percutaneous coronary intervention (PCI) with first-generation sirolimus-eluting stents (SES) in comparison with BMS. Methods: In a single-center registry, 600 consecutive patients who underwent successful PCI with SES between April 2002 and February 2003 were compared to 594 patients who underwent PCI with BMS between January 2002 and April 2002, just before the introduction of SES. Clinical and procedural data were collected at the time of intervention and 10-year survival status was assessed via the national life status database. Results: All baseline characteristics were similar between groups except for smaller stent diameter (2.84±0.38 vs. 3.19±0.49 mm; p
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- 2020
19. Secondary mitral regurgitation: Maintaining coherence with the American Society of Echocardiography grading guidelines, which proportionality concept best predicts prognosis in the real world?
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João Presume, Pedro Lopes, Pedro Freitas, Francisco Albuquerque, Carla Reis, Eduarda Horta, Liliana Marta, Sara Guerreiro, Marisa Trabulo, João Abecasis, Pedro de Araújo Gonçalves, Manuel Almeida, Manuel Canada, Miguel Mendes, Maria João Andrade, and Regina Ribeiras
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Cardiology and Cardiovascular Medicine - Abstract
Proportionality of secondary mitral regurgitation (sMR) may be a key factor in deciding whether a patient may benefit from mitral intervention. The aim of this study was to evaluate the prognostic value of two different concepts of proportionality and assess their ability to improve MR stratification proposed by the American Society of Echocardiography (ASE) guidelines.We conducted a retrospective analysis in patients with reduced left ventricular ejection fraction (LVEF) (50%) and at least mild sMR. Proportionality status was calculated using formulas proposed by a) Grayburn et al. - disproportionate sMR defined as EROALVEDV0.14; b) Lopes et al. - disproportionate sMR whenever measured EROAtheoretical EROA (determined as 50%×LVEF×LVEDVMitralVTI). Primary endpoint was all-cause mortality.A total of 572 patients (69±12 years; 76% male) were included. Mean LVEF was 33±9%, with a median left ventricular end-diastolic volume of 174 mL [136;220] and a median effective regurgitant orifice area of 14 mmOf the two formulas available to define disproportionate sMR, Lopes' model emerged as the only one with independent prognostic value while improving the risk stratification proposed by the ASE guidelines.
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- 2022
20. Electrocardiographic imaging (ECGI): What is the minimal number of leads needed to obtain a good spatial resolution?
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Mikhail Chmelevsky, Ana Oliveira Soares, Margarita Budanova, Stepan Zubarev, Pedro Adragão, Rita Marinheiro, Pedro Carmo, Hugo Marques, Joana Pinho, António Ferreira, Pedro de Araújo Gonçalves, Silvia Nunes, Diogo Cavaco, and Leonor Parreira
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Materials science ,Premature atrial contraction ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Isopotential map ,Image resolution ,Site of origin ,business.industry ,Body Surface Potential Mapping ,Arrhythmias, Cardiac ,Ablation ,medicine.disease ,ROC Curve ,Electrocardiographic imaging ,Catheter Ablation ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Aims Assess the minimal number of ECGI leads needed to obtain a good spatial resolution. Methods We enrolled 20 patients that underwent ablation of premature ventricular or atrial contractions using Carto and ECGI with AMYCARD. We evaluated the agreement regarding the site of origin of the arrhythmia between the ECGI and Carto, the area and diameter of the earliest activation site obtained with the ECGI (EASa and EASd). Based on previous studies with pacemapping, we considered a good spatial resolution of the ECGI when the EASd measured on the isopotential map was less than 18 mm. In presence of agreement the ECGI was reprocessed: a) with half the number of electrode bands (8 leads per electrode band) and b) with 6 electrode bands. Results The initial map was obtained with 23 (22-23) electrode bands per patient, corresponding to 143 (130-170) leads. Agreement rate was 85%, the median EASa and EASd were: 0.7 (0.5-1.3) cm2 and 9 (8-13) mm. With half the number of electrode bands including 73 (60-79) leads, agreement rate was 80%, the EASa and EASd were: 2.1 (1.5-6.2) cm2 and 16 (14 -28) mm. With only six electrode bands using 38 (30-42) leads, agreement rate was 55%, EASa and EASd were: 4.0 (3.3-5.0) cm2 and 23 (21-25) mm. The number of leads was a predictor of agreement with a good spatial resolution, OR (95% CI) of 1.138 (1.050–1.234), p = .002. According to the ROC curve, the minimal number of leads was 74 (AUC 0.981; 95% CI: 0.949–1.00, p Conclusion Reducing the number of leads was associated with a lower agreement rate and a significant reduction of spatial resolution. However, the number of leads needed to achieve a good spatial resolution was less than the maximal available.
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- 2020
21. Percutaneous closure of accidental left atrium puncture: a case report
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Gustavo Sá Mendes, Pedro de Araújo Gonçalves, Paulo Oliveira, and Sérgio Madeira
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medicine.medical_specialty ,Percutaneous ,Thoracentesis ,medicine.medical_treatment ,Perforation (oil well) ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Case report ,medicine ,AcademicSubjects/MED00200 ,Vascular closure device ,Coronary heart disease (incl. Cardiac Intervention) ,Left atrium puncture ,business.industry ,valvular heart disease ,medicine.disease ,Surgery ,Heart failure ,Cardiology and Cardiovascular Medicine ,Complication ,business ,030217 neurology & neurosurgery ,Central venous catheter - Abstract
Background Minimally invasive alternatives to surgical closure of cardiac perforations are a recognized need, especially in critically ill patients in whom predicted surgical mortality is prohibitive. To the best of our knowledge, this is the first reported case of an iatrogenic left atrium (LA) puncture closed with a plug-based vascular closure device (VCD). Case summary During a palliative right-sided thoracentesis on a 73-year-old woman, with end-stage heart failure due to rheumatic valvular heart disease, an accidental puncture and insertion of a central venous catheter into an aneurysmatic LA occurred. This complication was successfully managed percutaneously, under transthoracic echocardiographic guidance, after cardiac computed tomography planning, using a plug-based VCD. Discussion This case demonstrates the possible utility of plug-based devices for iatrogenic LA perforation closure, when surgical risk is deemed prohibitive.
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- 2020
22. Risk Reclassification With Coronary Computed Tomography Angiography-Visualized Nonobstructive Coronary Artery Disease According to 2018 American College of Cardiology/American Heart Association Cholesterol Guidelines (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes : An International Multicenter Registry [CONFIRM])
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Filippo Cademartiri, Fay Y. Lin, Yong Jin Kim, Mouaz H. Al-Mallah, Jonathon Leipsic, Hugo Marques, Philipp A. Kaufmann, Jessica M. Peña, Gianluca Pontone, Benjamin J.W. Chow, Yao Lu, Khalil Anchouche, Tracy Q. Callister, Donghee Han, Kavitha Chinnaiyan, Pedro de Araújo Gonçalves, James K. Min, Leslee J. Shaw, Ricardo C. Cury, Martin Hadamitzky, Patricia C. Dunham, Ji Hyun Lee, Stephan Achenbach, Gilbert L. Raff, Hyuk Jae Chang, Todd C. Villines, Jeroen J. Bax, Ronen Rubinshtein, Daniele Andreini, Gudrun Feuchtner, Ashley Beecy, Matthew J. Budoff, Heidi Gransar, Daniel S. Berman, Erica Maffei, Joerg Hausleiter, and Augustin Delago
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Male ,medicine.medical_specialty ,Statin ,Computed Tomography Angiography ,medicine.drug_class ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Global Health ,Risk Assessment ,Asymptomatic ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,medicine ,Humans ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Societies, Medical ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Retrospective cohort study ,American Heart Association ,Guideline ,Middle Aged ,medicine.disease ,Coronary Vessels ,United States ,Survival Rate ,Cholesterol ,Practice Guidelines as Topic ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Mace - Abstract
The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk groups. We determined the risk reclassification by the presence and severity of coronary computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic patients (age 59, 65% male) were identified. Patients were categorized as low risk, borderline risk, statin recommended/intermediate risk or statin recommended/high risk according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive, or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies downward, and the presence of any CAD reclassifies upward. During a median follow-up of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk groups eligible for risk enhancers, the presence or absence of any CCTA-visualized CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified (net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI was not significant among low- or statin-recommended/high-risk patients (all p > 0.05). The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive CAD, significantly improves reclassification in patients eligible for risk enhancers in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant improvement in risk reclassification from CCTA. (C) 2019 Published by Elsevier Inc.
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- 2019
23. Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry
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Kashif Shaikh, Arslan Ahmed, Heidi Gransar, JuHwan Lee, Jonathon Leipsic, Rine Nakanishi, Venkata Alla, Jeroen J. Bax, Benjamin J.W. Chow, Daniel S. Berman, Erica Maffei, Fay Y. Lin, Aiza Ahmad, Augustin DeLago, Gianluca Pontone, Gudrun Feuchtner, Hugo Marques, James K. Min, Joerg Hausleiter, Martin Hadamitzky, Philipp A. Kaufmann, Pedro de Araújo Gonçalves, Ricardo C. Cury, Yong-Jin Kim, Hyuk-Jae Chang, Ronen Rubinshtein, Todd C. Villines, Yao Lu, Leslee J. Shaw, Stephen Acenbach, Mouaz H. Al.Mallah, Daniele Andreini, Filippo Cademartiri, Tracy Q. Callister, and Matthew J. Budoff
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Adult ,Endocrinology ,Endocrinology, Diabetes and Metabolism ,Diabetes Mellitus ,Internal Medicine ,Humans ,Coronary Artery Disease ,Registries ,Middle Aged ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Tomography, X-Ray Computed ,Atherosclerosis - Abstract
Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated.CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwentA total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07-0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06-0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1-99 or ≥100) and SIS.In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.
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- 2022
24. Cardiac remodeling induced by exercise in male master athletes
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N. Cardim, Pedro de Araújo Gonçalves, José Monge, and Hélder Dores
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medicine.medical_specialty ,biology ,Athletes ,business.industry ,Physical therapy ,medicine ,biology.organism_classification ,business - Abstract
Aims: To describe cardiac remodeling in a population of male master athletes evaluated by transthoracic echocardiography and to analyse its relationship with several exercise-related characteristics.Methods and results: A total of 105 male master athletes aged ≥40 years old, mostly involved in endurance sports (81.0%) with a median training-volume of 66 [44; 103] METs/h/week, were studied. Left ventricular end-diastolic and end-systolic volumes were above the references in 84.8% and 75.8% athletes, decreasing in frequency when adjusted for BSA (26.3% and 23.2%). LV geometry was changed in more than half of the athletes (eccentric hypertrophy 28.3%, concentric remodelling 15.2% and concentric hypertrophy 8.1%) and several right ventricular (RV) dimensions were increased. Left atrium was dilated in 53.5% and right atrium in 37.4% athletes; only one athlete had a dilated aorta. Mean LV ejection fraction was 61±7% and global longitudinal strain -18.3±2.0%. Changes in LV geometry were more common in high intensity sports; LV dilation in athletes exercising >10 hours/week and in high intensity sports; RV dilation in athletes exercising >66 MET-hour/week and in endurance sports. In multivariate analysis high intensity sports remained an independent predictor of changes in LV geometry. There was a significant correlation between volume of exercise and cardiac structural adaptations.Conclusions: Cardiac structural adaptations were frequent in male master athletes, more pronounced in those involved in endurance sports, with high intensity and high volume of exercise. This data reinforces the concept that the characteristics of exercise are major determinants of cardiac remodeling and should be considered during athletes’ evaluation.
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- 2021
25. Patients undergoing invasive coronary angiography after a positive single-photon emission computed tomography or a positive stress cardiac magnetic resonance - What to expect at the cath lab
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J Brito, A M Ferreira, Henrique Mesquita Gabriel, Carla Saraiva, PN Freitas, C. Silva, M Almeida, S Guerreiro, M Goncalves, Pedro de Araújo Gonçalves, Luís Raposo, A Ventosa, Petronio Lopes, J Calqueiro, and João Abecasis
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medicine.medical_specialty ,Cath lab ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Ischemia ,Coronary arteriosclerosis ,General Medicine ,Cardiac catheterization lab ,Single-photon emission computed tomography ,medicine.disease ,Revascularization ,Invasive coronary angiography ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
Funding Acknowledgements Type of funding sources: None. Background Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). However, there are few data on whether or not this remains true in routine clinical practice. The aim of this study was to assess the clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after a positive stress CMR or positive SPECT, and to compare their positive predictive value with published results from the CE-MARC trial. Methods In this retrospective tertiary-center analysis, we included 429 patients (mean age 67 ± 10 years, 28% women, 42% diabetic) undergoing ICA between January 2016 and December 2020, after a positive stress CMR or positive SPECT. Regarding stress test, an adenosine protocol was performed in all stress CMR and in 76.4% (n = 272) of stress SPECT. Stress test results, including ischemia location and severity, were classified as reported by their primary readers. Patients with missing data on key variables, and those in whom microvascular disease was considered likely in the original stress test report were excluded. Obstructive CAD was defined as any coronary artery stenosis ≥ 50% in a vessel compatible with the ischemic territory on stress testing. Results Out of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ regarding age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p = 0.046). Overall, 320 patients (75%) had obstructive CAD on ICA. The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p = 0.385). There were also no significant differences in the prevalence of left main or 3-vessel disease (9.0% vs. 9.6%, p = 0.871, and 19.7% vs. 23.3% p = 0.483, respectively). Revascularization was performed or planned in 59.3% of patients in the SPECT group, and 52.1% of those in the stress CMR group (p = 0.255). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial (Figure), and would increase to 88.1% and 89.4% for SPECT and stress CMR, respectively, if patients reported as having only mild ischemia were excluded. Conclusion In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial.
- Published
- 2021
26. Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases
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F Albuquerque, Mariana Gonçalves, António Miguel Ferreira, Hugo Marques, Nuno Cardim, Pedro Lopes, Pedro J Freitas, Pedro de Araújo Gonçalves, and Hélder Dores
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Science ,Population ,Revascularization ,Asymptomatic ,Sudden cardiac death ,Coronary artery disease ,Young Adult ,Internal medicine ,medicine.artery ,medicine ,Humans ,Myocardial infarction ,education ,education.field_of_study ,Multidisciplinary ,business.industry ,Middle Aged ,medicine.disease ,Coronary Vessels ,Right coronary artery ,Cardiology ,Medicine ,Female ,medicine.symptom ,business ,Mace ,Follow-Up Studies - Abstract
Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.
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- 2021
27. Gender Differences and Mortality Trends After Transcatheter Aortic Valve Implantation: A 10-Year Analysis From a Single Tertiary Center
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Mariana, Gonçalves, Rui Campante, Teles, Pedro, de Araújo Gonçalves, Manuel, de Sousa Almeida, Afonso, Félix de Oliveira, João, Brito, Luís, Raposo, Henrique, Mesquita Gabriel, Tiago, Nolasco, José Pedro, Neves, Miguel, Mendes, and Hector M, Garcia-Garcia
- Subjects
Male ,Transcatheter Aortic Valve Replacement ,Sex Factors ,Time Factors ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Humans ,Female ,Aortic Valve Stenosis ,Prospective Studies - Abstract
To evaluate gender differences and mortality trends in a population undergoing transcatheter aortic valve implantation (TAVI) and to analyze the correlates to all-cause mortality at follow-up.The study comprises a prospective cohort of 592 TAVI patients (53.4% female) treated between 2008 and 2018. Mortality differences between genders at different timepoints were assessed according to log rank test. Predictors of all-cause mortality at follow-up were identified using a univariate model and were then analyzed through multivariate Cox proportional hazard models.Compared with female patients, males were younger (81 ± 7.5 years vs 84.3 ± 5.3 years) and presented more comorbidities. Twelve female and 8 male patients (3.5%) died in the first 30 days after TAVI. Despite a higher Society of Thoracic Surgeons (STS) score in women, all-cause mortality rates at 30 days and 1 year were comparable. At long-term follow-up, female patients demonstrated better survival rates, despite a higher number of periprocedural complications. Correlates identified in men were the presence of diabetes and previous history of coronary artery bypass grafting, New York Heart Association class III/IV, pulmonary artery systolic pressure, and non-transfemoral access. None of these variables remained significant in the multivariable analysis. In females, only peripheral artery disease was associated with mortality. Shock and need for renal replacement were predictors of mortality in both genders, as was heart failure readmission after discharge. STS score was also shown to correlate with long-term mortality in both genders.Despite a higher STS score in women, 30-day mortality was not significantly different from men, while women present better clinical outcomes at long-term follow-up.
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- 2021
28. Atraso no tratamento das síndromes coronárias agudas – quando a realidade ainda contrasta com a fisiopatologia
- Author
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Pedro de Araújo Gonçalves
- Subjects
Gynecology ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,lcsh:RC666-701 ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
29. The role of land gravity data in the Neves-Corvo mine discovery and its use in present-day exploration and new target generation
- Author
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João Carvalho, Luís Albardeiro, Pedro Miguel Lopes Sousa, João Xavier Matos, Igor Morais, Fábio Marques, Patrícia Represas, Pedro de Araújo Gonçalves, Vitor Araújo, and Nelson Pacheco
- Subjects
Geophysics ,Iberian Pyrite Belt ,language ,Gravimetry ,Portuguese ,Present day ,010502 geochemistry & geophysics ,01 natural sciences ,Archaeology ,language.human_language ,Geology ,0105 earth and related environmental sciences - Abstract
Several blind massive sulphide deposits associated with the Iberian Pyrite Belt (IPB) Volcano-Sedimentary Complex (VSC) (Figure 1) were discovered in SW Iberia using joint interpretation of geological and geophysical models, such as Neves-Corvo (Albouy et al., 1981; Leca et al., 1983) and Lagoa Salgada (Oliveira et al., 1998) in Portugal, and Valverde and Las Cruces in Spain. In the IPB Portuguese sector, the former government agencies Servico de Fomento Mineiro (SFM) and Instituto Geologico e Mineiro (IGM), as well as LNEG, fostered the acquisition of systematic geophysical surveys, in particular gravimetry, in the region during the second half of the 20th century.
- Published
- 2019
30. Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Non–ST-Elevation Myocardial Infarction and Left Main or Multivessel Coronary Disease
- Author
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Henrique Mesquita Gabriel, Miguel Sousa-Uva, Tiago Nolasco, Manuel Almeida, Pedro J. Freitas, Sérgio Boshoff, Sérgio Madeira, Pedro de Araújo Gonçalves, Pedro Magro, Nélson Vale, Luís Raposo, Marta Canas Marques, Catarina Brízido, Luís Bruges, Ana Braga, João Brito, Miguel Mendes, José Pedro Neves, Sara Ranchordás, Miguel Abecasis, José Calquinha, Márcio Madeira, and F Gama
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Risk of mortality ,Humans ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Non-ST Elevated Myocardial Infarction ,Propensity Score ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,surgical procedures, operative ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Current recommendations on the optimal revascularization strategy in Non-ST-elevation myocardial infarction (NSTEMI) with left main (LM) or multivessel coronary disease (MVD) are based upon randomized clinical trials conducted in stable coronary artery disease. In a real-world contemporary observational registry, we compared the long-term outcome of NSTEMI patients with LM/MVD (n = 1,104) submitted to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimized medical therapy (OMT). The primary end point was 5-year all-cause mortality. Results were assessed in the entire population (CABG 289, PCI 399, and OMT 416) and in a propensity score-matched cohort of CABG (n = 159) and PCI (n = 159). Crude 5-year mortality rates in CABG and PCI were 25.3% versus 29.6%, respectively (unadjusted hazard ratio [HR] 1.2; 95% confidence intervals [CI] 0.9 to 1.6; p = 0.212); OMT, however, was associated with a twofold higher risk of mortality when compared with any revascularization strategy (unadjusted HR 2.0; 95% CI 1.7 to 2.5; p0.001). After propensity score-matching and multivariate analysis, there was a trend toward a higher incidence of the primary end point in patients who underwent PCI versus CABG (31% vs 21%; adjusted HR 1.52; 95% CI 0.93 to 2.50; p = 0.094). This was a consistent finding over subgroups deemed clinically relevant, such as in patients with LM or proximal left anterior descending disease, SYNergy between percutaneous coronary intervention with TAXus ≥23 and left ventricle ejection fraction40%. In conclusion, in a real-world cohort of NSTEMI patients with LM/MVD, those selected for OMT had a dire outcome. Although adjusted 5-year mortality was statistically similar between revascularization strategies, there was a trend favoring CABG, which might be the preferred option in LM, proximal LAD, SYNergy between percutaneous coronary intervention with TAXus ≥23, and left ventricle ejection fraction40% subgroups.
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- 2019
31. On the Pathophysiology of Coronary Artery Disease
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Pedro de Araújo Gonçalves and Hector Manuel Garcia-Garcia
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medicine.medical_specialty ,business.industry ,Plaque progression ,Coronary computed tomography angiography ,030204 cardiovascular system & hematology ,medicine.disease ,Pathophysiology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
32. Tomografia computorizada cardíaca prévia a ablação de fibrilhação auricular – efeitos da evolução tecnológica e otimização de protocolos
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Rita Cruz, António Miguel Ferreira, Rosana dos Santos, Pedro de Araújo Gonçalves, Leonor Parreira, Pedro Adragão, Hugo Marques, João Goyri O'Neill, João R. Mesquita, Lucian Radu, João Luis Callegari Lopes, Pedro Carmo, Francisco Costa, Diogo Cavaco, and João Pisco
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,Fibrilhação Auricular/cirurgia ,Tomografia Computorizada/métodos ,Ablação por Catéter ,Técnicas de Imagem Cardíaca/métodos ,Imagem Tridimensional ,030204 cardiovascular system & hematology ,Técnicas de Imagem Cardíaca/estatística e dados numéricos ,Tomografia Computorizada/estatística e dados numéricos ,03 medical and health sciences ,Aurícula Esquerda ,Estudos de Coortes ,0302 clinical medicine ,030228 respiratory system ,lcsh:RC666-701 ,HSM IMA ,Fibrilhação Auricular/diagnóstico por imagem ,Cardiology and Cardiovascular Medicine ,Dose de Radiação - Abstract
Resumo: Introdução: A capacidade de a TC cardíaca fornecer um mapa anatómico preciso e excluir a presença de trombo intracardíaco é conhecida. O objetivo deste estudo foi avaliar o impacto da otimização de protocolos e evolução tecnológica nas doses de radiação e contraste e na qualidade de imagem dos exames de TC cardíaca prévia a ablação de fibrilhação auricular (FA). Métodos: Registo prospetivo de doentes consecutivos de centro único, foram incluídos os que fizeram TC cardíaca num contexto de avaliação prévia a ablação de FA (n = 270), distribuídos em três grupos: Grupo 1, constituído pelos primeiros 150 doentes; Grupo 2, os últimos 60 doentes feitos no mesmo aparelho; Grupo 3, os primeiros 60 doentes do novo aparelho. Avaliámos a otimização do protocolo com base na dose de radiação, no volume de contraste, na necessidade de aquisição complementar e na avaliação objectiva da qualidade de imagem (rácios sinal/ruído, contraste/ruído e homogeneização de densidade AE/AAE). Resultados: Houve uma redução significativa da radiação entre cada um dos grupos e da dose de contraste entre o primeiro e o último grupo (G1: 5,6 mSv e 100 ml; G2: 1,3 mSv e 90 ml; G3: 0,6 mSv e 65 ml). Apesar das menores doses de radiação e contraste, o Grupo 3 apresentou resultados significativamente melhores de qualidade de imagem (rácios sinal/ruído 13,5; contraste/ruído 14,8; homogeneização de densidade 0,92). Conclusão: A otimização de protocolos e a evolução tecnológica permitiram reduções significativas nas doses de radiação e de contraste usadas na TC cardíaca pré‐ablação de FA, sem prejudicar a qualidade de imagem. Abstract: Background: Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra‐cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation. Methods: From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA). Results: We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6 mSv and 100 ml; G2: 1,3 mSv and 90 ml; G3: 0,6 mSv and 65 ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92). Conclusion: Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality. Palavras‐chave: Tomografia computorizada cardíaca, Fibrilhação auricular, Dose de radiação, Aurícula esquerda, Keywords: Cardiac computed tomography, Atrial fibrilation, Radiation dose, Left atrium
- Published
- 2018
33. Surgical versus transcatheter aortic valve replacement in low-risk patients: A long-term propensity score-matched analysis
- Author
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Miguel Sousa-Uva, Luís Raposo, Tiago Nolasco, Miguel Abecasis, Manuel de Sousa Almeida, Rui Campante Teles, Márcio Madeira, Pedro de Araújo Gonçalves, João Brito, Henrique Mesquita Gabriel, Catarina Brízido, Miguel Mendes, Sérgio Madeira, and José Pedro Neves
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Lower risk ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,Aortic valve replacement ,Valve replacement ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Renal replacement therapy ,education ,Propensity Score ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Ejection fraction ,business.industry ,Atrial fibrillation ,Stroke Volume ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Cardiac surgery ,Treatment Outcome ,Aortic Valve ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real-world data are scarce. METHODS Single-center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score-matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction
- Published
- 2021
34. Vessel-specific plaque features on coronary computed tomography angiography among patients of varying atherosclerotic cardiovascular disease risk
- Author
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A Maxim, Bax, Yeonyee E, Yoon, Umberto, Gianni, Alexander R, van Rosendael, Yao, Lu, Xiaoyue, Ma, Benjamin P, Goebel, Sara W, Tantawy, Daniele, Andreini, Matthew J, Budoff, Filippo, Cademartiri, Kavitha, Chinnaiyan, Jung Hyun, Choi, Edoardo, Conte, Pedro, de Araújo Gonçalves, Ilan, Gottlieb, Martin, Hadamitzky, Jonathon A, Leipsic, Erica, Maffei, Gianluca, Pontone, Sanghoon, Shin, Yong Jin, Kim, Byoung Kwon, Lee, Eun Ju, Chun, Ji Min, Sung, Sang Eun, Lee, Daniel S, Berman, Jagat, Narula, Fay Y, Lin, Hyuk Jae, Chang, and Leslee J, Shaw
- Subjects
Male ,Computed Tomography Angiography ,atherosclerotic cardiovascular disease ,coronary arteries ,coronary artery disease ,coronary computed tomography angiography ,plaque composition ,plaque distribution ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,General Medicine ,Coronary Artery Disease ,Middle Aged ,Atherosclerosis ,Coronary Angiography ,Coronary Vessels ,Plaque, Atherosclerotic ,Cardiovascular Diseases ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Aims The relationship between AtheroSclerotic CardioVascular Disease (ASCVD) risk and vessel-specific plaque evaluation using coronary computed tomography angiography (CCTA), focusing on plaque extent and composition, has not been examined. To evaluate differences in quantified plaque characteristics (using CCTA) between the three major coronary arteries [left anterior descending (LAD), right coronary (RCA), and left circumflex (LCx)] among subgroups of patients with varying ASCVD risk. Methods and results Patients were included from a prospective, international registry of consecutive patients who underwent CCTA for evaluation of coronary artery disease. ASCVD risk groups were Conclusion Among patients with varying risk of ASCVD, plaque in the LCx is decidedly less and is comprised of less non-calcified plaque supporting prior evidence of the lower rates of acute coronary events in this vessel.
- Published
- 2021
35. Lipid profiling of chronic diseases
- Author
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Chris Lauber, João Pedro Marto, Liliana Alves, Mathias J. Gerl, Miguel Viana-Baptista, Otilia V. Vieira, Pedro de Araújo Gonçalves, Gustavo Costa Rodrigues, Winchil L.C. Vaz, Rune Matthiesen, Manuel de Sousa Almeida, Jorge Brantes Ferreira, José Delgado Alves, Neuza Domingues, Julio L. Sampaio, Marisa Neves, Kai Simons, Frederico Batista, Cláudia Borbinha, iNOVA4Health - pólo NMS, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Centro de Estudos de Doenças Crónicas (CEDOC)
- Subjects
Male ,Medicine (General) ,Declaration ,Shotgun ,Disease ,Gastroenterology ,Mass Spectrometry ,Blood plasma ,Lupus Erythematosus, Systemic ,Lipid profiling ,Vascular diseases ,Aged, 80 and over ,General Medicine ,Lipidome ,Middle Aged ,Lipids ,Cohort ,Medicine ,Female ,medicine.symptom ,Adult ,medicine.medical_specialty ,Statin ,medicine.drug_class ,Inflammation ,General Biochemistry, Genetics and Molecular Biology ,R5-920 ,Systemic lupus erythematosus ,Internal medicine ,Lipidomics ,medicine ,Humans ,Pathological ,Aged ,Ischemic Stroke ,Biochemistry, Genetics and Molecular Biology(all) ,business.industry ,Vascular disease ,Lipid biomarker ,Bioethics ,medicine.disease ,Atherosclerosis ,Clinical trial ,Dyslipidemia ,Good clinical practice ,Immunology ,Commentary ,business ,Body mass index ,Biomarkers ,Declaration of Helsinki - Abstract
Aims: Inflammation impacts several acute and chronic diseases causing localized stress and cell death, releasing tissue-specific lipids into the circulation from inflamed cells and tissues. The plasma lipidome may be expected to reflect the type of inflammation. However, deep lipid profiles of major chronic inflammatory diseases have not been compared. Methods and Results: We compared the plasma lipidomes of patients suffering from two etiologically distinct chronic inflammatory diseases, atherosclerosis-related cardiovascular disease (CVD) including ischemic stroke (IS), and systemic lupus erythematosus (SLE), to each other and to age-matched controls. The controls had never suffered from any of these diseases. Plasma lipidomes were screened by a top-down shotgun MS-based analysis without liquid chromatographic separation. Lipid profiling of 596 lipids based on MS was performed on a cohort of 427 individuals. Machine learning classifiers based on the plasma lipidomes of patients suffering from CVD and SLE allowed clear distinction of these two chronic inflammatory diseases from each other. We demonstrate convincing evidence for the capability of lipidomics to separate the studied chronic and inflammatory diseases from controls based on independent validation test set classification performance (CVD vs control - Sensitivity: 0.90, Specificity: 0.98; IS vs control - Sensitivity: 1.0, Specificity: 1.0; SLE vs control – Sensitivity: 1, Specificity: 0.88) and from each other (SLE vs CVD ‒ Sensitivity: 0.91, Specificity: 1). Preliminary linear discriminant analysis plots using all data clearly separated the clinical groups from each other and from the controls. In addition, CVD severities, as classified into five clinical groups, were partially separable by linear discriminant analysis. Conclusions: Dysregulation of the plasma lipidome is characteristic of chronic inflammatory diseases. Lipid profiling accurately identifies the diseases and in the case of CVD also identifies sub-classes. Dysregulated lipids are partially but not fully counterbalanced by statin treatment. Clinical Trial Registration Details: This study was registered with the Clinical Trials number NCT04786431 Funding Information: This work was supported by PTDC/MED-PAT/29395/2017 financially supported by Fundacao paraKS is CEO and shareholder of of Lipotype GmbH. CL and MG are KS is CEO and shareholder of of Lipotype GmbH. CL and MG are employees of Lipotype GmbH. All other authors declare that they do not have any competing interestsemployees of Lipotype GmbH. All other authors declare that they do not have any competing interests424 a Ciencia e a Tecnologia (FCT), through national funds and co-funded by FEDER under the PT2020 Partnership. ND was a holder of PhD fellowship from the FCT (Ref. N°:SFRH/BD/51877/2012), attributed 10 by Inter-University Doctoral Programme in Ageing and Chronic Disease (PhDOC). LA was a holder of a FCT PhD fellowship (PD/BD/114254/2016), attributed by the ProRegem Doctoral Programme in 2016. Declaration of Interests: KS is CEO and shareholder of of Lipotype GmbH. CL and MG are employees of Lipotype GmbH. All other authors declare that they do not have any competing interests. Ethics Approval Statement: The entire process was approved by the Ethical Review Board of the Faculty of Medicine of the New University of Lisbon and the Ethics Committee for Health of the Centro Hospitalar de Lisboa Ocidental, that includes the Hospital Santa Cruz, the Hospital Egas Moniz and Hospital Sao Francisco Xavier, and the Ethics Committee for Health of the Hospital Fernando Fonseca. All experiments were performed in accordance with the guidelines and regulations including, the Universal Declaration on Bioethics and Human Rights of UNESCO, 2005; The Charter of Fundamental rights of the EU, 2012; Ethical principles for medical research involving human subjects - Declaration of Helsinki, 2013; EU Regulation 2016/679 and Good Clinical Practice guidelines (Directive 2001/20/EC) and EU Clinical Trials Directive (2005/28/EC). Moreover, they complied with national legislations for the scientific use of human biological samples (Law No 12/2005 and No 131/2014).
- Published
- 2021
36. Predicting pacemaker implantation after TAVR with procedural CT
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C Brizido, A F Oliveira, F Gama, João Abecasis, M Mendes, Rui Campante Teles, J. R. F. Brito, Aníbal Ferreira, Manuela Guedes de Almeida, and Pedro de Araújo Gonçalves
- Subjects
medicine.medical_specialty ,Aortography ,medicine.diagnostic_test ,business.industry ,RR interval ,Tissue membrane ,medicine.disease ,Pacemaker implantation ,Balloon dilatation ,Abnormal cardiac conduction ,Aortic valve stenosis ,Multidetector computed tomography ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and aim The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve replacement (TAVR). Calcium distribution in the aortic-valvular complex (AVC) and, more recently, membranous septum (MS) length seem to be surrogate markers for conduction abnormalities after specific last generation balloon and self-expandable expandable valves. We sough to evaluate whether such pre-procedural association remains across the entire device spectrum. Methods Single-centre prospective study of 239 consecutive patients (140 women, median age of 84) with severe symptomatic aortic stenosis patients who underwent ECG-gated contrast-enhanced multi-detector computed tomography (MSCT) before TAVR since Jun/2017. Exclusion criteria were those with previous PPMI, previous bioprothesis, congenital bicuspid valve, and poor imaging quality. The J-score with an 850-Hounsfield unit threshold was used to detect areas of calcium in the region of interest. AVC was characterized by leaflet sector and region, using 3mensio Valves software 7.0 TM. An independent team retrospectively measured MS length blindly by determining the thinnest part of the interventricular septum in the coronal view in the better-defined systolic phase (usually at 40% of the R-R interval, Figure). Device selection (75.8% self-expandable devices, 20.1% balloon expandable, 3.1% other) and positioning were performed according to the operator criteria. Final implant depth was assessed based on the pre-release angiogram or final aortography. Results Mortality at 30-days was 1.3% and PPMI occurred in 43 patients (18%). Median MS length was 9.59mm (IQR: 3.11mm). After multivariable logistic regression analysis, MS length emerged as the single significant protective predictor for PPMI (OR: 0.14; 95% 95% CI: 0.05–0.42; p Conclusion In our experience, a short membranous septum was strongly and independently associated with new permanent pacemaker implantation, regardless of the device type. Our findings suggest that this simple measure should be routinely made to help device selection and implantation technique. Funding Acknowledgement Type of funding source: None
- Published
- 2020
37. LV replacement fibrosis in aortic stenosis: prevalence and relation to LV remodelling and function
- Author
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João Abecasis, G Sa Mendes, Aníbal Ferreira, Maria João Andrade, Regina Ribeiras, Carla Saraiva, R. Campante Teles, S Ferreira, M Mendes, Víctor Gil, Pedro de Araújo Gonçalves, and José Pedro Neves
- Subjects
Aortic valve ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Left ventricular hypertrophy ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Aortic valve replacement ,Fibrosis ,Aortic valve stenosis ,Internal medicine ,medicine ,Cardiology ,Myocardial fibrosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). Aim To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis. Methods We prospectively studied 53 consecutive patients (age: 71±8 years [min. 51–max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6–63.2] and aortic valve area 0.74cm2 [IQR 0.61–0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification – using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE. Results Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028–1084]; 22% [IQR 18–25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3–70.8%] (11 patients with reduced EF) and 76.5g/m2 [IQR 57.4–94.8g/m2], respectively. Median GLS was −13.9% [IQR −11.4 to −17.0%] and torsion was 24.2° [IQR 19.8–32.5°]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m2, p=0.001), worse GLS (−14.4% vs −16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure). Conclusions Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease. Funding Acknowledgement Type of funding source: None
- Published
- 2020
38. Patterns of revascularization in stable ischemic heart disease in the pre-ISCHEMIA era
- Author
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M Mendes, M Goncalves, Henrique Mesquita Gabriel, Catarina Brízido, M Almeida, Pedro de Araújo Gonçalves, J Brito, Sérgio Madeira, Sílvio Leal, Luís Raposo, F Albuquerque, and R Teles
- Subjects
Coronary angiography ,medicine.medical_specialty ,Myocardial ischemia ,business.industry ,medicine.medical_treatment ,Ischemia ,Coronary arteriosclerosis ,Disease ,medicine.disease ,Revascularization ,Coronary artery bypass surgery ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Ischemic heart ,business - Abstract
Introduction New evidence on the role of myocardial revascularization in stable ischemic heart disease (SIHD), recently presented, showed that revascularization guided by the presence of moderate-to severe ischemia relieves angina more effectively than optimal medical therapy (OMT), without a significant benefit in hard clinical endpoints. Aim To assess the representativeness of the ISCHEMIA trial in a real-world population and compare management strategies between patients who fulfill the eligibility criteria of the trial (Group 1, G1) and those who do not (Group 2, G2). Methods and population Single centre retrospective analysis including all consecutive patients referred to coronary angiography (CA) for SIHD from January 2018 to December 2019. Patients were stratified in two groups (G1 and G2) according to the ISCHEMIA trial inclusion and exclusion criteria. G1 was compared with G2 and with a subset of G2 with obstructive coronary artery disease (CAD), defined as ≥70% luminal stenosis in at least one coronary artery or >50% for the left main. Results A total of 1020 patients underwent CA, of whom only 124 (12.2%) would have been eligible for the ISCHEMIA trial (G1). Overall, there were no significant differences in baseline characteristics between the two groups. G1 patients had more extensive and severe disease, presenting more frequently with proximal left anterior descending (LAD) involvement (26.6% vs 10.4%; p Conclusions Patients included in the ISCHEMIA trial are underrepresented in a real-world population of SIHD patients referred to coronary angiography. PCI rates were similar among patients with at least one significant coronary artery stenosis, regardless of previous evidence or severity of ischemia. Our findings underline the need for further refinement in criteria for revascularization in SIHD. Funding Acknowledgement Type of funding source: None
- Published
- 2020
39. Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events
- Author
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Alexander R. van Rosendael, Fay Y. Lin, Inge J. van den Hoogen, Xiaoyue Ma, Umberto Gianni, Omar Al Hussein Alawamlh, Subhi J. Al’Aref, Jessica M. Peña, Daniele Andreini, Matthew J. Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Edoardo Conte, Hugo Marques, Pedro de Araújo Gonçalves, Ilan Gottlieb, Martin Hadamitzky, Jonathon Leipsic, Erica Maffei, Gianluca Pontone, Gilbert L. Raff, Sanghoon Shin, Yong-Jin Kim, Byoung Kwon Lee, Eun Ju Chun, Ji Min Sung, Sang-Eun Lee, Donghee Han, Daniel S. Berman, Renu Virmani, Habib Samady, Peter Stone, Jagat Narula, Jeroen J. Bax, Leslee J. Shaw, James K. Min, and Hyuk-Jae Chang
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Plaque progression ,Coronary CTA ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,cardiovascular diseases ,Risk stratification ,Aged ,Coronary ct ,business.industry ,Coronary computed tomography angiography ,Middle Aged ,medicine.disease ,Atherosclerosis ,Prognosis ,Plaque, Atherosclerotic ,Atheroma ,Cardiology ,Disease Progression ,Population study ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Mace - Abstract
Background The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE). Methods The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted. Results The study population comprised 1166 patients (age 60.5 ± 9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P Conclusions Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.
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- 2020
40. Should We Simplify Computed Tomography Angiography Reporting as Black or White vs Describing All Shades of Gray?
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Hector M. Garcia-Garcia, Pedro de Araújo Gonçalves, and Sabin Parajuli
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medicine.diagnostic_test ,business.industry ,Computed Tomography Angiography ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,Gray (unit) ,Computed tomography angiography - Published
- 2020
41. Temporal trends in referral patterns for invasive coronary angiography - a multicenter 10-year analysis
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António Miguel Ferreira, Mariana Gonçalves, Pedro Farto e Abreu, Manuel de Sousa Almeida, Miguel Borges Santos, David Roque, Mariana Faustino, Rui Campante Teles, and Pedro de Araújo Gonçalves
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Male ,medicine.medical_specialty ,Referral ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Myocardial Revascularization ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Referral and Consultation ,Aged ,Tomography, Emission-Computed, Single-Photon ,Portugal ,business.industry ,General Medicine ,medicine.disease ,Invasive coronary angiography ,Stenosis ,Cross-Sectional Studies ,Multicenter study ,Cardiology ,Exercise Test ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIM To assess the temporal trends in the usage pattern of non-invasive testing before invasive coronary angiography (ICA) and its diagnostic yield in patients with suspected coronary artery disease (CAD). METHODS Cross-sectional observational multicenter study of 4805 consecutive patients (60% male, mean age 66 ± 10 years) with suspected CAD undergoing elective ICA due to angina pectoris in two centers, from 2008 to 2017. The use of noninvasive testing and the proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) were assessed. RESULTS There were 4038 (84%) patients referred for ICA with positive noninvasive test, mainly SPECT (38%, n = 1828) and exercise ECG (36%, n = 1731). Obstructive CAD was found in 54.5% (n = 2621) of the patients and 37.9% (n = 1822) underwent revascularization. The prevalence of obstructive CAD was higher in patients with vs. without previous noninvasive testing (55.8% vs. 48.1%, respectively, P < 0.001) and tended to decrease during the study period (P for trend
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- 2020
42. Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study
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Ji Min Sung, Jung Hyun Choi, Yong Jin Kim, Gianluca Pontone, Edoardo Conte, Hyuk Jae Chang, Fay Y. Lin, Peter Stone, Kavitha Chinnaiyan, Eun Ju Chun, James K. Min, Leslee J. Shaw, Matthew J. Budoff, Sang Eun Lee, Jeroen J. Bax, Filippo Cademartiri, Mouaz H. Al-Mallah, Pedro de Araújo Gonçalves, Sanghoon Shin, Daniele Andreini, Jonathon Leipsic, Erica Maffei, Jagat Narula, Renu Virmani, Hugo Marques, Martin Hadamitzky, Ilan Gottlieb, Daniel S. Berman, Habib Samady, and Byoung Kwon Lee
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Risk Assessment ,Lesion ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Coronary computed tomography angiography ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Prospective Studies ,Registries ,Cardiac imaging ,Aged ,medicine.diagnostic_test ,Rupture, Spontaneous ,business.industry ,Statins ,Coronary Stenosis ,Coronary artery atherosclerosis ,Middle Aged ,medicine.disease ,Coronary Vessels ,Confidence interval ,Plaque, Atherosclerotic ,Heart Disease Risk Factors ,Diameter stenosis ,Angiography ,Cardiology ,Disease Progression ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Clinical risk factor - Abstract
To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p
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- 2020
43. Impact of age on coronary artery plaque progression and clinical outcome: A PARADIGM substudy
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Hugo Marques, Erica Maffei, Gianluca Pontone, Fay Y. Lin, Kavitha Chinnaiyan, Peter Stone, Eun Ju Chun, Filippo Cademartiri, Ji Min Sung, Habib Samady, Seokhun Yang, Soongu Kwak, Edoardo Conte, Jagat Narula, Daniel S. Berman, Martin Hadamitzky, Jung Hyun Choi, Minkwan Kim, Hyuk Jae Chang, James K. Min, Leslee J. Shaw, Ilan Gottlieb, Gilbert L. Raff, Sang Eun Lee, Jeroen J. Bax, Mouaz H. Al-Mallah, Renu Virmani, Daniele Andreini, Jonathon Leipsic, Sanghoon Shin, Yong Jin Kim, Seung Pyo Lee, Byoung Kwon Lee, Pedro de Araújo Gonçalves, and Matthew J. Budoff
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Adult ,Male ,Aging ,medicine.medical_specialty ,Acute coronary syndrome ,Computed Tomography Angiography ,Plaque progression ,medicine.medical_treatment ,Coronary Artery Disease ,atherosclerotic plaque ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Vascular Calcification ,Computed tomography ,Aged ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Prognosis ,Plaque, Atherosclerotic ,Clinical trial ,medicine.anatomical_structure ,Quartile ,Heart Disease Risk Factors ,Cardiology ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Calcification - Abstract
BACKGROUND: The association of age with coronary plaque dynamics is not well characterized by coronary computed tomography angiography (CCTA). METHODS: From a multinational registry of patients who underwent serial CCTA, 1153 subjects (61 ± 5 years old, 61.1% male) were analyzed. Annualized volume changes of total, fibrous, fibrofatty, necrotic core, and dense calcification plaque components of the whole heart were compared by age quartile groups. Clinical events, a composite of all-cause death, acute coronary syndrome, and any revascularization after 30 days of the initial CCTA, were also analyzed. Random forest analysis was used to define the relative importance of age on plaque progression. RESULTS: With a 3.3-years' median interval between the two CCTA, the median annual volume changes of total plaque in each age quartile group was 7.8, 10.5, 10.8, and 12.1 mm3/year and for dense calcification, 2.5, 4.6, 5.4, and 7.1 mm3/year, both of which demonstrated a tendency to increase by age (p-for-trend = 0.001 and
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- 2020
44. P955Non-invasive mapping: what is the minimal number of electrodes needed to obtain a good spatial resolution of the activation map?
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J Pinho, Pedro de Araújo Gonçalves, S Nunes, A L Parreira, Stepan Zubarev, Margarita Budanova, Pedro Adragão, Hugo Marques, Pedro Carmo, Diogo Cavaco, and A M Ferreira
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business.industry ,Physiology (medical) ,Electrode ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Image resolution ,Remote sensing - Abstract
Introduction and aims The 12-lead ECG is highly inaccurate for localization of the site of origin of supraventricular and ventricular arrhythmias. Non-invasive mapping systems (ECGI) based on a high number of electrodes recording the electrical activity on the surface of the torso have already proven good accuracy for mapping different arrhythmic substrates. The aim of this study was to assess what is the minimal number of leads needed to obtain a precise mapping with the ECGI. Methods This study enrolled 14 patients (9 male, median age 50 (44-58) years) referred to our center for catheter ablation of premature ventricular contractions (PVC). Patients underwent pre-procedural ECGI using the epicardial and endocardial mapping system . This system uses the DICOM images from contrast computed tomography of the heart and up to 28 adhesive electrodes with 8 leads each, adding up to 224 body-surface leads. All patients underwent invasive electroanatomical mapping and ablation with the magnetic navigation system. We analysed the number of recording leads used to construct the non-invasive activation map of the PVCs and the accuracy and the spatial resolution of the map when comparing to the invasive map. We then reprocessed the exam, using progressively less leads until we only left the leads placed in the standard 12 lead ECG positions and evaluated the concordance with the invasive map as well as the spatial resolution. We considered an earliest activation site (EAS) area of 1 cm2 a good spatial resolution and using a ROC curve we calculated the minimal number of leads necessary to obtain a good spatial resolution. Results The median number of electrodes used for the initial map was 170 (138-177). Concordance between non-invasive and invasive site of origin occurred in 11 out of 14 patients. The results are presented in the Table. The minimal number of electrodes to have a good spatial resolution was 100. The area of EAS was significantly lower when using more than 100 leads, respectively 0.65 (0.5-1) cm2 versus 3 (1.6-5) cm2, p Conclusions The minimal number of leads to achieve a good spatial resolution was high. Reducing the number of leads resulted in a significant decrease in spatial resolution and a lower concordance rate. ECGI data Number of adhesive electrodes Median number of leads Amycard/Carto concordance Median area of EAS in the ECGI (cm2) Maximal nº electrodes 170 (138-177) 11/14 0.64 (0.5-0.9) 12 electrodes 76 (61-80) 11/14 1.6 (1.4-2.6) 6 electrodes (2 Ant, 2 Lat ,2 Post) 38 (32-44) 9/14 4.3 (3.2-5.4) 12 leads 12 0/14 - Ant anterior; Lat: lateral; Post: posterior; EAS: early activation site. Abstract Figure. Area of EAS according to the N of leads
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- 2020
45. Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry
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Erica Maffei, James K. Min, Leslee J. Shaw, Gianluca Pontone, Kavitha Chinnaiyan, Subhi J. Al'Aref, A. Maxim Bax, Filippo Cademartiri, Jeroen J. Bax, Joerg Hausleiter, Fay Y. Lin, Ronen Rubinshtein, Inge J. van den Hoogen, Daniele Andreini, Yao Lu, Stephan Achenbach, Daniel S. Berman, Pedro de Araújo Gonçalves, Jessica M. Peña, Mouaz H. Al-Mallah, Gilbert L. Raff, Jeff M. Smit, Jonathon Leipsic, Martin Hadamitzky, Ricardo C. Cury, Augustin Delago, Philipp A. Kaufmann, Alexander R. van Rosendael, Gudrun Feuchtner, Yong Jin Kim, Matthew J. Budoff, Heidi Gransar, Benjamin J.W. Chow, Tracy Q. Callister, Hyuk Jae Chang, Todd C. Villines, Xiaoyue Ma, and Hugo Marques
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Male ,Aging ,Computed Tomography Angiography ,medicine.medical_treatment ,Coronary Artery Disease ,risk stratification ,030204 cardiovascular system & hematology ,Coronary Angiography ,Cardiovascular ,Coronary artery disease ,0302 clinical medicine ,Risk Factors ,2.1 Biological and endogenous factors ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Hazard ratio ,Diabetes ,imaging ,General Medicine ,Middle Aged ,Prognosis ,Plaque, Atherosclerotic ,Heart Disease ,Cardiology ,Biomedical Imaging ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,4.2 Evaluation of markers and technologies ,medicine.medical_specialty ,Revascularization ,03 medical and health sciences ,Predictive Value of Tests ,Clinical Research ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Heart Disease - Coronary Heart Disease ,Aged ,Proportional hazards model ,business.industry ,preventive cardiology ,Prevention ,medicine.disease ,Atherosclerosis ,coronary computed tomography angiography ,atherosclerosis ,business ,Body mass index ,Mace - Abstract
Aims In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. Methods and results Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3–4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3–2.2) and 1.4 (95% CI 1.1–1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). Conclusion Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
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- 2020
46. Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients
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Filippo Cademartiri, Philipp A. Kaufmann, Jessica M. Peña, Aukelien C. Dimitriu-Leen, Augustin Delago, Gianluca Pontone, Todd C. Villines, Alexander R. van Rosendael, Kavitha Chinnaiyan, Ricardo C. Cury, Daniel S. Berman, Ronen Rubinshtein, Inge J. van den Hoogen, Pedro de Araújo Gonçalves, Erica Maffei, Yong Jin Kim, Martin Hadamitzky, Stephan Achenbach, Gudrun Feuchtner, Matthew J. Budoff, Heidi Gransar, James K. Min, Leslee J. Shaw, Mouaz H. Al-Mallah, Jonathon Leipsic, Hugo Marques, Benjamin J.W. Chow, Yao Lu, Tracy Q. Callister, Joerg Hausleiter, Hyuk Jae Chang, Erica C. Jones, Jeroen J. Bax, Gilbert L. Raff, Jeff M. Smit, Daniele Andreini, Fay Y. Lin, and Arthur J.H.A. Scholte
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Male ,Computed Tomography Angiography ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cardiorespiratory Medicine and Haematology ,Coronary Angiography ,Cardiovascular ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,0302 clinical medicine ,Diabetes mellitus ,Risk Factors ,Clinical endpoint ,Myocardial infarction ,Registries ,Computed tomography ,screening and diagnosis ,Framingham Risk Score ,Diabetes ,Middle Aged ,Prognosis ,Detection ,Heart Disease ,Cohort ,Cardiology ,Disease Progression ,Biomedical Imaging ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,4.2 Evaluation of markers and technologies ,medicine.medical_specialty ,Clinical Sciences ,Risk Assessment ,03 medical and health sciences ,Predictive Value of Tests ,Prognostic application ,Clinical Research ,Internal medicine ,Multidetector Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Propensity Score ,Coronary atherosclerosis ,Risk stratification ,Heart Disease - Coronary Heart Disease ,Aged ,business.industry ,Prevention ,Coronary Stenosis ,medicine.disease ,Atherosclerosis ,Stenosis ,Cardiovascular System & Hematology ,Case-Control Studies ,Propensity score matching ,business - Abstract
Contains fulltext : 220894.pdf (Publisher’s version ) (Closed access) AIMS: We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores - which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) - and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders. METHODS: Out of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability. RESULTS: A total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265). CONCLUSION: Coronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone.
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- 2020
47. Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry
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Asim Rizvi, Hyuk Jae Chang, Pedro de Araújo Gonçalves, James K. Min, Leslee J. Shaw, Sanghoon Shin, Ran Heo, Ilan Gottlieb, Gilbert L. Raff, Jonathon Leipsic, Ki Bum Won, Habib Samady, Hyung Bok Park, Matthew J. Budoff, Byoung Kwon Lee, Jagat Narula, Gianluca Pontone, Ji Min Sung, Edoardo Conte, Erica Maffei, Eun Ju Chun, Sang Eun Lee, Kavitha Chinnaiyan, Jeroen J. Bax, Martin Hadamitzky, Jung Hyun Choi, Daniele Andreini, Fay Y. Lin, Peter Stone, Filippo Cademartiri, Hugo Marques, Daniel S. Berman, Amit Kumar, Yong Jin Kim, and Renu Virmani
- Subjects
Blood Glucose ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Aging ,Time Factors ,Computed Tomography Angiography ,Endocrinology, Diabetes and Metabolism ,Coronary Artery Disease ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Coronary Angiography ,Coronary artery disease ,Medicine ,Registries ,Plaque ,Atherosclerotic ,Original Investigation ,Incidence (epidemiology) ,Confounding ,Middle Aged ,Coronary Vessels ,Plaque, Atherosclerotic ,Heart Disease ,Cardiology ,Disease Progression ,Biomedical Imaging ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Triglyceride glucose index ,Clinical Research ,Predictive Value of Tests ,Internal medicine ,Multidetector Computed Tomography ,Humans ,Coronary computed tomography angiography ,Coronary atherosclerosis ,Heart Disease - Coronary Heart Disease ,Triglycerides ,Angiology ,Aged ,business.industry ,Odds ratio ,medicine.disease ,Atherosclerosis ,Confidence interval ,Atheroma ,Cardiovascular System & Hematology ,lcsh:RC666-701 ,business ,Biomarkers - Abstract
Background The association between triglyceride glucose (TyG) index and coronary atherosclerotic change remains unclear. We aimed to evaluate the association between TyG index and coronary plaque progression (PP) using serial coronary computed tomography angiography (CCTA). Methods A total of 1143 subjects (aged 60.7 ± 9.3 years, 54.6% male) who underwent serial CCTA with available data on TyG index and diabetic status were analyzed from The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. PP was defined as plaque volume (PV) (mm3) at follow-up minus PV at index > 0. Annual change of PV (mm3/year) was defined as PV change divided by inter-scan period. Rapid PP was defined as the progression of percent atheroma volume (PV divided by vessel volume multiplied by 100) ≥ 1.0%/year. Results The median inter-scan period was 3.2 (range 2.6–4.4) years. All participants were stratified into three groups based on TyG index tertiles. The overall incidence of PP was 77.3%. Baseline total PV (group I [lowest]: 30.8 (0.0–117.7), group II: 47.2 (6.2–160.4), and group III [highest]: 57.5 (8.4–154.3); P Conclusion TyG index is an independent predictive marker for the progression of coronary atherosclerosis. Clinical registration ClinicalTrials.gov NCT02803411
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- 2020
48. Non-pharmacological treatment of refractory angina: The coronary sinus reducer, the new kid on the block
- Author
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Nélson Vale, Luís Raposo, Henrique Mesquita Gabriel, Sérgio Madeira, João Brito, Pedro de Araújo Gonçalves, Rui Campante Teles, Manuel Almeida, Sílvio Leal, and Catarina Brízido
- Subjects
medicine.medical_specialty ,Coronary Artery Disease ,Asymptomatic ,Angina Pectoris ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Stable Disease ,Quality of life ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Coronary sinus ,General Environmental Science ,Interventional cardiology ,business.industry ,Coronary Sinus ,medicine.disease ,Treatment Outcome ,030228 respiratory system ,Quality of Life ,General Earth and Planetary Sciences ,medicine.symptom ,business - Abstract
Refractory angina is defined as persistent angina (≥3 months) despite optimal medical and interventional therapies. It is increasing in frequency, due to the success of current medical and interventional therapies in improving the prognosis of coronary artery disease. Long-term mortality is similar to that of patients with asymptomatic stable disease, but it affects patients’ quality of life, and has a significant impact on health care resources. Several therapeutic targets have been investigated, most with disappointing results. Many of the techniques have been abandoned because of lack of efficacy, safety issues, or economic and logistic limitations to wider applicability. The primary focus of this review is the coronary sinus Reducer, supporting evidence for which, although scarce, is promising regarding safety and efficacy in improving anginal symptoms and quality of life. It is also accessible to virtually all interventional cardiology departments.
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- 2020
49. Diagnostic accuracy of computed tomography angiography for the exclusion of coronary artery disease in candidates for transcatheter aortic valve implantation
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Pedro de Araújo Gonçalves, Rui Campante Teles, S. Guerreiro, Gustavo Sá Mendes, Henrique Mesquita Gabriel, João Brito, Manuel de Sousa Almeida, Luís Raposo, C Strong, António Ferreira, João Abecasis, Ana Coutinho Santos, Pedro Freitas, Miguel Mendes, Gonçalo C. Cardoso, and Carla Saraiva
- Subjects
Male ,medicine.medical_specialty ,Transcatheter aortic ,Computed Tomography Angiography ,lcsh:Medicine ,Diagnostic accuracy ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Ischaemia ,Sensitivity and Specificity ,Article ,030218 nuclear medicine & medical imaging ,Transcatheter Aortic Valve Replacement ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Positive predicative value ,Multidetector Computed Tomography ,Humans ,Medicine ,cardiovascular diseases ,lcsh:Science ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,Multidisciplinary ,medicine.diagnostic_test ,business.industry ,lcsh:R ,Coronary Stenosis ,Myocardial Perfusion Imaging ,Retrospective cohort study ,medicine.disease ,Pre- and post-test probability ,Stenosis ,Cardiology ,lcsh:Q ,Female ,business ,Interventional cardiology - Abstract
Coronary CT angiography (CTA) is currently considered a reliable method to exclude obstructive coronary artery disease (CAD) before valvular heart surgery in patients with low pretest probability. However, its role in excluding obstructive CAD before transcatheter aortic valve implantation (TAVI) is less well established. Single-center retrospective study where patients with severe symptomatic aortic stenosis underwent both CTA and invasive coronary angiography (ICA) as part of TAVI planning. CTA exams were conducted on a 64-slice dual source scanner, with a median interval of 45 days to ICA (IQR 25–75 [13–82]). In both tests, obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel ≥2 mm diameter. Per-patient, per-vessel and per-proximal segment analyses were conducted, excluding and including non-evaluable segments. The study included 200 patients (120 women, mean age 83 ± 6 years). The prevalence of obstructive CAD on ICA was 35.5% (n = 71). On a per-patient analysis (assuming non-evaluable segments as stenotic), CTA showed sensitivity of 100% (95% CI, 95–100%), specificity of 42% (95% CI, 33–51%), and positive and negative predictive values of 48% (95% CI, 44–51%) and 100% (95% CI, 92–100%), respectively. CTA was able to exclude obstructive CAD in 54 patients (27%), in whom ICA could have been safely withheld. Despite the high rate of inconclusive tests, pre-procedural CTA is able to safely exclude obstructive CAD in a significant proportion of patients undergoing TAVI, possibly avoiding the need for ICA in roughly one quarter of the cases.
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- 2019
50. Critical Appraisal Of A Clinical Risk Score To Avoid Coronary Computed Tomography In Patients With Calcium Score Of Zero
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F Albuquerque, João Abecasis, A. R. Santos, Pedro de Araújo Gonçalves, Pedro J. Freitas, S. Guerreiro, P. Lopes, C. Saraiva, D. Gomes, Hugo Marques, J Presume, Miguel Mendes, C. Silva, and A. Ferreira
- Subjects
medicine.medical_specialty ,Critical appraisal ,business.industry ,Zero (complex analysis) ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Coronary computed tomography ,Clinical risk factor ,Calcium score - Published
- 2021
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