Author: "Pedro Monteiro" / Topic: cardiology and cardiovascular medicine - Searchworks@Jio Institute Digital Library Search Results

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1. Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care

Author: Paulus Kirchhof, Ladislav Pecen, Ameet Bakhai, Carlo de Asmundis, Joris R de Groot, Jean Claude Deharo, Peter Kelly, Pierre Levy, Esteban Lopez-de-Sa, Pedro Monteiro, Jan Steffel, Johannes Waltenberger, Thomas W Weiss, Petra Laeis, Marius Constantin Manu, José Souza, Raffaele De Caterina, Clinical sciences, and Heartrhythmmanagement
Subjects: Aged, 80 and over, Male, Heart Failure, Embolism, Anticoagulants, Hemorrhage, Middle Aged, non-vitamin K oral anticoagulant, Brain Ischemia, Stroke, Treatment Outcome, Real-world, REGISTRY, Atrial Fibrillation, edoxaban, Humans, Female, Pharmacology (medical), Prospective Studies, Cardiology and Cardiovascular Medicine, Aged, Factor Xa Inhibitors
Abstract: Aims Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes. Methods and results The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P Conclusion Patients treated with edoxaban in ETNA-AF-Europe reported low 2-year event rates in unselected AF patients. Prior stroke, reduced kidney function, and HF identify patients at high risk of stroke, bleeding and all-cause/cardiovascular death, respectively.
Published: 2022
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2. Poster No. 009 In-hospital bleeding in acute coronary syndrome: new antithrombotics, old problems

Author: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, José Pedro Sousa, João Lopes, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, and Lino Gonçalves
Subjects: Physiology, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background Progress in decreasing ischemic complications in acute coronary syndrome (ACS) has come at the expense of increased risk of bleeding. This study sought to determine the incidence, predictors, and prognosis of in-hospital bleeding (IHB) in ACS patients. Material and methods We retrospectively analyzed patients consecutively admitted to the coronary care unit (CCU) with ACS. Patients who suffered clinically significant IHB were compared to the remaining ACS patients. The primary endpoint was all-cause in-hospital death. Results and conclusions From a total of 1032 ACS patients, clinically significant IHB was identified in 5.6% (n = 58) of patients, of whom 13 patients presented serious bleeding. Patients with IHB were older (P = 0.003), more often female (P = 0.012), were more likely to have prior heart failure (P = 0.007) and chronic kidney disease (P = 0.001). At admission, they presented more often with Killip-Kimball class > I (P = 0.001), lower hemoglobin (P = 0.013), lower eGFR (P = 0.005), and a higher CRUSADE score (P < 0.001). In multivariate logistic regression, female sex (OR = 2.26, 1.17–4–38, P = 0.023), acute kidney injury (OR = 2.23, 1.12–4.45, P = 0.028), and non-radial access in coronary angiography (OR = 2.04, 1.08–3.87, P = 0.028), were identified as independent predictors of IHB. The primary endpoint occurred in 5.8% of ACS patients. Patients who suffered IHB were at higher risk of death during hospitalization (OR = 2.39, 95% CI 1.03–5.51, P = 0.042), but not during the 2-year follow-up (P = 0.429). In conclusion, IHB is not an uncommon complication in ACS patients and is associated with an increased risk of in-hospital mortality.
Published: 2022
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3. Oral Presentation No. 10 Pharmacological therapy in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): long-term prognosis

Author: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, Gonçalo Costa, Eric Monteiro, Diogo Fernandes, Joana Guimarães, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, and Lino Gonçalves
Subjects: Physiology, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background The optimal management of myocardial infarction with nonobstructive coronary arteries (MINOCA) is still uncertain. This study sought to determine the association between pharmacological therapies after hospital discharge and the long-term prognosis of MINOCA patients. Material and methods We analyzed patients consecutively admitted to the coronary care unit with myocardial infarction (MI). Multivariate analysis was performed to determine which drugs were implicated in the prognosis of MINOCA patients. The primary endpoint was all-cause mortality at 5 years. Results and conclusions From a total of 3721 MI patients, MINOCA was identified in 11.6% (n = 430), of whom 56 (13.0%) experienced the primary endpoint. Median age was 66 years (IQR 19), and 51.6% (n = 222) of patients were male. At discharge, 81.2% of MINOCA patients were prescribed aspirin, 87.4% a statin, 78.6% beta-blockers, and 66.7% angiotensin-converting enzyme inhibitors (ACEI). MINOCA patients were less likely to be prescribed these medications compared to patients with obstructive coronary artery disease (all P < 0.001). 1.4% (n = 6) of MINOCA patients died in the hospital, and the 5-year mortality rate was 13.0% (n = 56). In multivariate Cox regression, treatment with ACEI at discharge was found to be independently associated with a 5-year mortality benefit (HR = 0.29, 95% CI 0.12–0.67, adjusted P = 0.004) in MINOCA patients. In conclusion, compared with patients with obstructive CAD, patients with MINOCA are less likely to be treated with secondary prevention drugs and are at lower risk of all-cause mortality during long-term follow-up. Treatment with ACEI seems to provide an additional mortality benefit in MINOCA patients.
Published: 2022
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4. Poster No. 012 Premature myocardial infarction: a decade-long analysis of patients admitted to a single-center coronary care unit

Author: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, Gonçalo Costa, Eric Monteiro, Diogo Fernandes, Joana Guimarães, João Ferreira, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, and Lino Gonçalves
Subjects: Physiology, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background Despite being primarily a disease of older patients, acute myocardial infarction (AMI) has been increasingly recognized in young individuals. This study sought to characterize and determine the prognosis of AMI in patients aged ≤ 45 years old. Methods We retrospectively analyzed patients consecutively admitted to the coronary care unit with AMI. Two groups were identified: patients aged ≤ 45 and > 45 years old. Results and conclusions A total of 5696 AMI patients were included in the analysis: median age of 70 (IQR 19) years and 68.6% (n = 3906) were male; 5.6% (n = 318) of patients were aged ≤ 45 years old. In contrast to the older patients, those aged ≤ 45 years old were more likely to be male (P < 0.001), presented more often with a history of smoking (P < 0.001), and family history of premature coronary artery disease (P < 0.001), but less often hypertension, hyperlipidemia, and diabetes. In coronary angiography, most younger patients presented a single-vessel disease (57.1%), more commonly affecting the left anterior descending artery (51.7%); left main involvement was rare (0.8%); and 14.2% presented MINOCA (vs. 11.4% of older patients). Regarding prognosis, 6.4% (n = 366) of patients died in the hospital and 24.2% (n = 1380) died during the 5-year follow-up. Younger patients had a lower risk of in-hospital mortality (OR 0.22, 95% CI 0.09–541, P = 0.001) and 5-year mortality (OR 0.12, 95% CI 0.06–0.201, P < 0.001), compared to the older patients. In conclusion, patients with premature AMI have a different proportion of risk factors, less extensive coronary artery disease, and more commonly present MINOCA, compared to the older patients.
Published: 2022
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5. Edoxaban Treatment in routiNe clinical prActice in patients with non-valvular Atrial Fibrillation (ETNA-AF) in Iberia: Baseline data

Author: Pedro Monteiro
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Fibrilhação auricular, Pyridines, Non valvular atrial fibrillation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Baseline, Edoxaban, Internal medicine, Atrial Fibrillation, Humans, Medicine, In patient, Medical history, 030212 general & internal medicine, Dosing, General Environmental Science, Aged, business.industry, Anticoagulants, Edoxabano, Atrial fibrillation, Baseline data, medicine.disease, Stroke, Thiazoles, 030228 respiratory system, chemistry, lcsh:RC666-701, Cohort, General Earth and Planetary Sciences, Vida real, Cardiology and Cardiovascular Medicine, business, Factor Xa Inhibitors
Abstract: Introduction and Objectives: Atrial fibrillation (AF) is the most common form of arrhythmia worldwide and a significant health burden. Edoxaban, a recent novel oral anticoagulant (NOAC), is being investigated in the European real-world ETNA-AF study of patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to characterize the Iberian edoxaban-treated cohort of ETNA-AF at baseline and to compare it with previously retrieved Portuguese data. Methods: Patients with NVAF treated with edoxaban and followed in Portuguese and Spanish centers were consecutively enrolled between June 2017 and January 2018. Only patients with a previous clinical decision to receive edoxaban were included. Patients’ baseline demographic and clinical parameters, medical history, and AF-related characteristics were retrieved. Results: A total of 892 NVAF patients, with a mean age of 73.9 years, were included, 75.3% of whom received high-dose (60 mg) and 24.7% low-dose (30 mg) edoxaban. Most patients (55.9%) were male. Of the patients receiving 30 mg and 60 mg edoxaban, 55.9% and 37.9%, respectively, had an estimated CHA2DS2-VASc score ≥4. Previous bleeding event rates were low, with a predominance of clinically relevant non-major bleeding (1.9%). Most patients (47.5%) with NVAF had paroxysmal AF, followed by 26.4% with permanent AF. Median overall CHA2DS2-VASc score was 3.0 and median HAS-BLED score was 2.0. Previous treatments mostly included vitamin K antagonists (35.7%). A considerably higher proportion of patients on low-dose edoxaban required dose adjustments (71.4% vs. 8.6%). Overall adherence to label dosing recommendations was 86.5%. Conclusions: This study provides valuable data on disease and patient profiles and will provide valuable insights into disease management and progression, as well as the safety, effectiveness, and patterns of cardiovascular events associated with edoxaban. Resumo: Introdução e objetivos: A fibrilhação auricular (FA) é a arritmia mais comum globalmente e associa-se a um substancial ónus de saúde. O novo anticoagulante oral (NOAC) edoxabano está a ser investigado no estudo europeu de vida real ETNA-AF em doentes com fibrilhação auricular não valvular (FANV). O objetivo deste estudo é caracterizar a coorte ibérica do ETNA-AF na base de dados e compará-la com dados portugueses prévios. Métodos: Doentes com FANV tratados com edoxabano e seguidos em centros portugueses e espanhóis foram consecutivamente incluídos no estudo entre junho de 2017 e janeiro de 2018. Apenas doentes com indicação prévia para receber edoxabano foram incluídos e os seus dados clínicos e demográficos, história clínica e características relacionadas com a FA foram registados. Resultados: Fora, incluídos 892 doentes com FANV, com média de 73,9 anos, 75,3% dos quais receberam a dose elevada (60 mg) e 24,7% a dose reduzida (30 mg) de edoxabano. A maioria dos doentes (55,9%) era do sexo masculino. Dos doentes que receberam 30 mg e 60 mg de edoxabano, 55,9% e 37,9%, respetivamente, tinham CHA2DS2-VASc estimado ≥ 4. As taxas de eventos hemorrágicos prévios foram baixas, com predominância de hemorragia não major clinicamente relevante (1,9%). A maioria (47,5%) dos doentes com FANV tinha FA paroxística, seguidos de 26,4% com FA permanente. A mediana de CHA2DS2-VASc global foi 3,0 e a mediana de HAS-BLED, 2,0. Os tratamentos prévios incluíram sobretudo VKAs (35,7%). Uma proporção consideravelmente maior de doentes a receber dose reduzida de edoxabano necessitou de ajustes de dose (71,4% versus 8,6%). A adesão global às recomendações de dose foi de 86,5%. Conclusões: Este estudo fornece dados importantes sobre a doença e o perfil dos doentes e possibilitará considerações futuras acerca da gestão e progressão da doença, bem como de segurança, efetividade e padrões de eventos cardiovasculares associados a edoxabano.
Published: 2020
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6. NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction

Author: Domingo Pascual-Figal, Rolf Wachter, Michele Senni, Weibin Bao, Adele Noè, Heike Schwende, Dmytro Butylin, Margaret F. Prescott, Jacek Gniot, Maria Mozheiko, Malgorzata Lelonek, Antonio Reyes Dominguez, Thomas Horacek, Enrique Garcia del Rio, Zhanna Kobalava, Christian Eugen Mueller, Yuksel Cavusoglu, Ewa Straburzynska-Migaj, Miroslav Slanina, Juergen vom Dahl, Alisdair Ryding, Andrew Moriarty, Manuel Beltran Robles, Julio Nunez Villota, Antonio Garcia Quintana, Thorsten Nitschke, Jose Manuel Garcia Pinilla, Luis Almenar Bonet, Said Chaaban, Samia Filali zaatari, Jindrich Spinar, Wlodzimierz Musial, Khaled Abdelbaki, Jan Belohlavek, Wolfgang Fehske, Michael Carlos Bott, Geir Hoegalmen, Marisa Crespo Leiro, Ismail Turkay Ozcan, Wilfried Mullens, Radim Kryza, Riadh Al-Ani, Krystyna Loboz-Grudzien, Lyudmila Ermoshkina, Silvia Hojerova, Alberto Alfredo Fernandez, Lenka Spinarova, Harald Lapp, Efraim Bulut, Filipa Almeida, Alexander Vishnevsky, Margita Belicova, Domingo Pascual, Klaus Witte, Kenneth Wong, Walter Droogne, Marc Delforge, Martin Peterka, Hans-Georg Olbrich, Stefano Carugo, Jadwiga Nessler, Thao Huynh McGill, Burkhard Huegl, Ibrahim Akin, Ilidio Moreira, Andrey Baglikov, Jeetendra Thambyrajah, Chris Hayes, Marcelo Raul Barrionuevo, Zerrin Yigit, Hakki Kaya, Zdenek Klimsa, Martin Radvan, Christoph Kadel, Ulf Landmesser, Giuseppe Di Tano, Malgorzata Buksinska Lisik, Candida Fonseca, Luis Oliveira, Irene Marques, Luis Miguel Santos, Egon Lenner, Peter Letavay, Manuel Gomez Bueno, Paula Mota, Aaron Wong, Kristian Bailey, Paul Foley, Eduardo Hasbani, Sean Virani, Tony Abdel Massih, Shukri Al-Saif, Milos Taborsky, Marta Kaislerova, Zuzana Motovska, Aron Ariel Cohen, Damien Logeart, Dierk Endemann, Daniel Ferreira, Dulce Brito, Peter Kycina, Entela Bollano, Enrique Galve Basilio, Lorenzo Facila Rubio, Marcos Garcia Aguado, Lilia Beatriz Schiavi, Daniel Francisco Zivano, Eva Lonn, Ali El Sayed, Anne-Catherine Pouleur, Alex Heyse, Alexandr Schee, Rostislav Polasek, Marek Houra, Christophe Tribouilloy, Marie France Seronde, Michel Galinier, Michel Noutsias, Peter Schwimmbeck, Ingo Voigt, Dirk Westermann, Giovanni Pulignano, Johnny Vegsundvaag, Jose Alexandre Da Silva Antunes, Pedro Monteiro, Jan Stevlik, Eva Goncalvesova, Beata Hulkoova, Antonio Juan Castro Fernandez, Ceri Davies, Iain Squire, Philippe Meyer, Richard Sheppard, Tayfun Sahin, Karel Sochor, Guillaume De Geeter, Alexander Schmeisser, Joachim Weil, Ana Oliveira Soares, Olga Bulashova Vasilevna, Andrey Oshurkov, Shahid Junejo Sunderland, Jason Glover, Tomas Exequiel, Eric Decoulx, Sven Meyer, Thomas Muenzel, Fernando Frioes, Georgy Arbolishvili, Anna Tokarcikova, Patric Karlstrom, Joan Carles Trullas Vila, Gonzalo Pena Perez, Rajiv Sankaranarayanan, Thuraia Nageh, Diego Cristian Alasia, Marwan Refaat, Burcu Demirkan, Jehad Al-Buraiki, and Shadi Karabsheh
Subjects: medicine.medical_specialty, Ejection fraction, Acute decompensated heart failure, business.industry, medicine.drug_class, 030204 cardiovascular system & hematology, medicine.disease, Sacubitril, 03 medical and health sciences, 0302 clinical medicine, Valsartan, Heart failure, Internal medicine, Natriuretic peptide, Cardiology, Medicine, Decompensation, cardiovascular diseases, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, hormones, hormone substitutes, and hormone antagonists, Sacubitril, Valsartan, medicine.drug
Abstract: Objectives This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. Background NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Methods Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. Results In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p Conclusions In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)
Published: 2020
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7. Cardiac Intensive Care in Portugal: the Time for Change

Author: Cláudio Guerreiro, Marisa Silva, Daniel Caeiro, João Morais, Doroteia Silva, Carlos Aguiar, José Barbosa dos Santos, António Tralhão, Pedro Monteiro, Sílvia Monteiro, Víctor Gil, and Ana Teresa Timóteo
Subjects: Cardiac intensive care units, lcsh:Diseases of the circulatory (Cardiovascular) system, Portugal, Critical Care, Coronary Care Units, HSM CAR, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, lcsh:RC666-701, Acute Disease, Intensive Care Units, Humans, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Organizational models
Abstract: Resumo: Nos últimos anos, temos assistido a um aumento do número de doentes com necessidade de cuidados cardíacos agudos, com patologia cardiovascular progressivamente mais complexa, muitas vezes complicada por comorbilidades não cardiovasculares agudas ou crónicas, com impacto na abordagem e prognóstico destes doentes. As unidades coronárias têm evoluído para unidades de cuidados intensivos cardíacos, caracterizadas por cuidados de saúde altamente especializados ao doente cardíaco crítico. Tendo em conta que os recursos humanos e técnicos nesta área são limitados, considerámos ser urgente uma reflexão profunda sobre o modelo de organização dos cuidados ao doente cardíaco agudo, incluindo a definição do nível de cuidados, a constituição e formação da equipa e a criação de redes de referenciação.Paralelamente, é fundamental um investimento claro dos serviços nesta área central da cardiologia, de forma a alavancar o desenvolvimento contínuo e sustentado de outras áreas cardiológicas essenciais, nomeadamente a eletrofisiologia e a cardiologia de intervenção, assegurando cuidados de excelência e de elevada diferenciação a todos os doentes cardíacos críticos. Abstract: In recent years, the number of patients requiring acute cardiac care has increased, with progressively more complex cardiovascular conditions, often complicated by acute or chronic non‐cardiovascular comorbidities, which affects the management and prognosis of these patients. Coronary care units have evolved into cardiac intensive care units, which provide highly specialized health care for the critical heart patient. In view of the limited human and technical resources in this area, we consider that there is an urgent need for an in‐depth analysis of the organizational model for acute cardiac care, including the definition of the level of care, the composition and training of the team, and the creation of referral networks. It is also crucial to establish protocols and to adopt safe clinical practices to improve levels of quality and safety in the treatment of patients. Considering that acute cardiac care involves conditions with very different severity and prognosis, it is essential to define the level of care to be provided for each type of acute cardiovascular condition in terms of the team, available techniques and infrastructure. This will lead to improvements in the quality of care and patient prognosis, and will also enable more efficient allocation of resources.
Published: 2020

8. Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab

Author: Emil Hagström, P. Gabriel Steg, Michael Szarek, Deepak L. Bhatt, Vera A. Bittner, Nicolas Danchin, Rafael Diaz, Shaun G. Goodman, Robert A. Harrington, J. Wouter Jukema, Evangelos Liberopoulos, Nikolaus Marx, Jennifer McGinniss, Garen Manvelian, Robert Pordy, Michel Scemama, Harvey D. White, Andreas M. Zeiher, Gregory G. Schwartz, Pierluigi Tricoci, Matthew T. Roe, Kenneth W. Mahaffey, Jay M. Edelberg, Corinne Hanotin, Guillaume Lecorps, Angèle Moryusef, William J. Sasiela, Jean-François Tamby, Philip E Aylward, Heinz Drexel, Peter Sinnaeve, Mirza Dilic, Renato D. Lopes, Nina N Gotcheva, Juan-Carlos Prieto, Huo Yong, Patricio López-Jaramillo, Ivan Pećin, Zeljko Reiner, Petr Ostadal, Steen Hvitfeldt Poulsen, Margus Viigimaa, Markku S Nieminen, Vakhtang Chumburidze, Pablo Carlos, Montenegro Valdovinos, Hung-Fat Tse, Robert Gabor Kiss, Denis Xavier, Doron Zahger, Marco Valgimigli, Takeshi Kimura, Hyo Soo Kim, Sang-Hyun Kim, Andrejs Erglis, Aleksandras Laucevicius, Sasko Kedev, Khalid Yusoff, Gabriel Arturo Ramos López, Marco Alings, Sigrun Halvorsen, Roger M Correa Flores, Rody G. Sy, Andrzej Budaj, Joao Morais, Maria Dorobantu, Yuri Karpov, Arsen D. Ristic, Terrance Chua, Jan Murin, Zlatko Fras, Anthony J Dalby, José Tuñón, H. Asita de Silva, Ulf Landmesser, Christian Müller, Chern-En Chiang, Piyamitr Sritara, Sema Guneri, Alexander Parkhomenko, Kausik K. Ray, Patrick M. Moriarty, Robert Vogel, Bernard Chaitman, Sheryl F. Kelsey, Anders G. Olsson, Jean-Lucien Rouleau, Maarten L. Simoons, Karen Alexander, Chiara Meloni, Robert Rosenson, Eric J.G. Sijbrands, John H. Alexander, Luciana Armaganijan, Akshay Bagai, Maria Cecilia Bahit, J. Matthew Brennan, Shaun Clifton, Adam D. DeVore, Shalonda Deloatch, Sheila Dickey, Keith Dombrowski, Grégory Ducrocq, Zubin Eapen, Patricia Endsley, Arleen Eppinger, Robert W. Harrison, Connie Ng Hess, Mark A. Hlatky, Joseph Dedrick Jordan, Joshua W. Knowles, Bradley J. Kolls, David F. Kong, Sergio Leonardi, Linda Lillis, David J. Maron, Jill Marcus, Robin Mathews, Rajendra H. Mehta, Robert J. Mentz, Humberto Graner Moreira, Chetan B. Patel, Sabrina Bernardez Pereira, Lynn Perkins, Thomas J. Povsic, Etienne Puymirat, William Schuyler Jones, Bimal R. Shah, Matthew W. Sherwood, Kenya Stringfellow, Darin Sujjavanich, Mustafa Toma, Charlene Trotter, Sean F.P. van Diepen, Matthew D. Wilson, Andrew Tze-Kay Yan, Lilia B Schiavi, Marcelo Garrido, Andrés F Alvarisqueta, Sonia A Sassone, Anselmo P Bordonava, Alberto E Alves De Lima, Jorge M Schmidberg, Ernesto A Duronto, Orlando C Caruso, Leonardo P Novaretto, Miguel Angel Hominal, Oscar R Montaña, Alberto Caccavo, Oscar A Gomez Vilamajo, Alberto J Lorenzatti, Luis R Cartasegna, Gustavo A Paterlini, Ignacio J Mackinnon, Guillermo D Caime, Marcos Amuchastegui, Oscar Salomone, Oscar R Codutti, Horacio O Jure, Julio OE Bono, Adrian D Hrabar, Julio A Vallejos, Rodolfo A Ahuad Guerrero, Federico Novoa, Cristian A Patocchi, Cesar J Zaidman, Maria E Giuliano, Ricardo D Dran, Marisa L Vico, Gabriela S Carnero, Pablo N Guzman, Juan C Medrano Allende, Daniela F Garcia Brasca, Miguel H Bustamante Labarta, Sebastian Nani, Eduardo DS Blumberg, Hugo R Colombo, Alberto Liberman, Victorino Fuentealba, Hector L Luciardi, Gabriel D Waisman, Mario A Berli, Ruben O Garcia Duran, Horacio G Cestari, Hugo A Luquez, Jorge A Giordano, Silvia S Saavedra, Gerardo Zapata, Osvaldo Costamagna, Susana Llois, Jonathon H Waites, Nicholas Collins, Allan Soward, Chris LS Hii, James Shaw, Margaret A Arstall, John Horowitz, Daniel Ninio, James F Rogers, David Colquhoun, Romulo E Oqueli Flores, Philip Roberts-Thomson, Owen Raffel, Sam J Lehman, Constantine Aroney, Steven GM Coverdale, Paul J Garrahy, Gregory Starmer, Mark Sader, Patrick A Carroll, Ronald Dick, Robert Zweiker, Uta Hoppe, Kurt Huber, Rudolf Berger, Georg Delle-Karth, Bernhard Frey, Franz Weidinger, Dirk Faes, Kurt Hermans, Bruno Pirenne, Attilio Leone, Etienne Hoffer, Mathias CM Vrolix, Luc De Wolf, Bart Wollaert, Marc Castadot, Karl Dujardin, Christophe Beauloye, Geert Vervoort, Harry Striekwold, Carl Convens, John Roosen, Emanuele Barbato, Marc Claeys, Frank Cools, Ibrahim Terzic, Fahir Barakovic, Zlatko Midzic, Belma Pojskic, Emir Fazlibegovic, Azra Durak-Nalbantic, Mehmed Kulić, Dusko Vulic, Adis Muslibegovic, Boris Goronja, Gilmar Reis, Luciano Sousa, Jose C Nicolau, Flavio E Giorgeto, Ricardo P Silva, Lilia Nigro Maia, Rafael Rech, Paulo RF Rossi, Maria José AG Cerqueira, Norberto Duda, Renato Kalil, Adrian Kormann, José Antonio M Abrantes, Pedro Pimentel Filho, Ana Priscila Soggia, Mayler ON de Santos, Fernando Neuenschwander, Luiz C Bodanese, Yorghos L Michalaros, Freddy G Eliaschewitz, Maria H Vidotti, Paulo E Leaes, Roberto V Botelho, Sergio Kaiser, Euler Roberto F Fernandes Manenti, Dalton B Precoma, Jose C Moura Jorge, Pedro Silva, Jose A Silveira, Wladmir Saporito, Jose A Marin Neto, Gilson S Feitosa, Luiz Eduardo F Ritt, Juliana A de Souza, Fernando Costa, Weimar KSB Souza, Helder JL Reis, Leandro Machado, José Carlos Aidar Ayoub, Georgi V Todorov, Fedya P Nikolov, Elena S Velcheva, Maria L Tzekova, Haralambi O Benov, Stanislav L Petranov, Haralin S Tumbev, Nina S Shehova-Yankova, Dimitar T Markov, Dimitar H Raev, Mihail N Mollov, Kostadin N Kichukov, Katya A Ilieva- Pandeva, Raya Ivanova, Maryana Gospodinov, Valentina M Mincheva, Petar V 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Sandy Sundram, Diwakar Jain, Mark Zainea, Carlos Bayron, Ronald Karlsberg, Suhail Dohad, Henry Lui, William Keen, Donald Westerhausen, Sandeep Khurana, Himanshu Agarwal, Jessica Birchem, William Penny, Mark Chang, Sherrill Murphy, John Henry, Branislav Schifferdecker, John M Gilbert, Gopal Chalavarya, Charles Eaton, John F Schmedtje, Stuart Christenson, Imran Dotani, Douglas Denham, Alexander Macdonell, Paul Gibson, Aref Rahman, Tammam Al Joundi, Nizar Assi, Gary Conrad, Purushotham Kotha, Michael Love, Gregory Giesler, Howard Rubenstein, Dawood Gamil, Laura Akright, Justine Krawczyk, Joanne Cobler, Terry Wells, James Welker, Robert Foster, Richard Gilmore, Jay Anderson, Douglas Jacoby, Bill Harris, Geraldine Gardner, Ramprasad Dandillaya, Kishor Vora, John Kostis, John Hunter, David Laxson, Eric Ball, Flavia Egydio, Anelise Kawakami, Janaina Oliveira, Julianna Wozniak, Alexander Matthews, Caroline Ratky, Janine Valiris, Lisa Berdan, Anita Hepditch, Kirby Quintero, Tyrus Rorick, Melissa Westbrook, Madeleine Bezault, Elodie Drouet, Tabassome Simon, Caroline Alsweiler, Anne Luyten, Julie Butters, Liddy Griffith, Michelle Shaw, Lena Grunberg, Shahidul Islam, Marie-France Brégeault, Nathalie Bougon, Douglas Faustino, Sylvie Fontecave, Judith Murphy, Jean- Francois Tamby, Melanie Verrier, Veronique Agnetti, Dorthe Andersen, Emmy Badreddine, Mhamed Bekkouche, Cecile Bouancheau, Imane Brigui, Maddy Brocklehurst, Joseph Cianciarulo, Dawn Devaul, Szilvia Domokos, Cecile Gache, Caroline Gobillot, Severine Guillou, Jan Healy, Megan Heath, Gayatri Jaiwal, Carine Javierre, Julien Labeirie, Myriam Monier, Ulises Morales, Asmaa Mrabti, Bicky Mthombeni, Betim Okan, Lucile Smith, Jennifer Sheller, Sebastien Sopena, Valerie Pellan, Fadela Benbernou, Nafissa Bengrait, Maud Lamoureux, Katarina Kralova, Raphael Bejuit, Anthony Coulange, Christelle Berthou, Jérôme Repincay, Christelle Lorenzato, Alexis Etienne, Valerie Gouet, Virginie Loizeau, Mickael Normand, Anne Ourliac, Christelle Rondel, Antony Adamo, Pascale Beltran, Pauline Barraud, Helene Dubois-Gache, Benjamin Halle, Lamia Metwally, Maxime Mourgues, Marc Sotty, Marion Vincendet, Raluca Cotruta, Zhu Chengyue, Dominique Fournie-Lloret, Christine Morrello, Aurelie Perthuis, Patrick Picault, Isabelle Zobouyan, Helen M. 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McClanahan, Roe, Matthew T., Blicharski, Tomasz, Bystryk, Leszek, Szpajer, Michal, Korol, Marek, Czerski, Tomasz, Gniot, Jacek, Lubinski, Andrzej, Gorny, Jerzy, Franek, Edward, Raczak, Grzegorz, Vogel, Robert, Szwed, Hanna, Monteiro, Pedro, Mesquita Bastos, Jose, Pereira, Helder H., Morais, Joao, Seixo, Filipe, Mendonça, Carlos, Botelho, Ana, Caetano, Francisca, Minescu, Bogdan, Chaitman, Bernard, Istratoaie, Octavian, Tesloianu, Dan N., Dorobantu, Maria, Cristian, Gabriel, Dumitrescu, Silviu, Podoleanu, Cristian Gc, Constantinescu, Mircea Ca, Bengus, Cristina M., Militaru, Constantin, Rosu, Doina, Kelsey, Sheryl F., Parepa, Irinel R., Matei, Adrian V., Alexandru, Tom M., Malis, Mihaela, Coman, Ioan, Shvarts, Yury, Orlikova, Olga, Kobalava, Zhanna, Barbarash, Olga L., Markov, Valentin, Olsson, Anders G., Lyamina, Nadezhda, Gordienko, Alexander, Zrazhevsky, Konstantin, Vishnevsky, Alexander Y., Gurevich, Victor, Stryuk, Raisa, Lomakin, Nikita V., Bokarev, Igor, Khlevchuk, Tatiana, Shalaev, Sergey, Rouleau, Jean-Lucien, Khaisheva, Larisa, Chizhov, Petr, Viktorova, Inna, Osokina, Natalya, Shchekotov, Vladimir, Akatova, Evgenia, Chumakova, Galina, Libov, Igor, Voevoda, Mikhail I., Tretyakova, Tatyana V., Simoons, Maarten L., Baranov, Evgeny, Shustov, Sergey, Yakushin, Sergey, Gordeev, Ivan, Khasanov, Niiaz, Reshetko, Olga, Sotnikova, Tatiana, Molchanova, Olga, Nikolaev, Konstantin, Gapon, Liudmila, Alexander, Karen, Baranova, Elena, Kosmachova, Elena, Karpov, Yuriy, Karpov, Yuri, Povzun, Anton, Egorova, Liudmila, Tyrenko, Vadim V., Ivanov, Igor G., Ilya, Masterov, Kanorsky, Sergey, Meloni, Chiara, Simic, Dragan, Ivanovic, Nikola, Davidovic, Goran, Tasic, Nebojsa, Asanin, Milika R., Stojic, Stevo, Apostolovic, Svetlana R., Ilic, Stevan, Tosic, Biljana Putnikovic, Stankovic, Aleksandar, Rosenson, Robert, Arandjelovic, Aleksandra, Radovanovic, Slavica, Todic, Branislava, Ristic, Arsen D., Balinovac, Jovan, Dincic, Dragan V., Seferovic, Petar, Karadzic, Ana, Dodic, Slobodan, Dimkovic, Sinisa, Sijbrands, Eric J. G., Jakimov, Tamara, Poh, Kian-Keong, Yee Ong, Hean, Tang I-Shing, Justin, Micko, Karol, Nociar, Jan, Pella, Daniel, Fulop, Peter, Hranai, Marian, Palka, Juraj, Tricoci, Pierluigi, Mazur, Juraj, Majercák, Ivan, Dzupina, Andrej, Fazekas, František, Gonsorcik, Jozef, Bugan, Viliam, Murin, Jan, Selecky, Juraj, Kamensky, Gabriel, Strbova, Jaroslava, Alexander, John H., Smik, Rudolf, Dukat, Andrej, Olexa, Peter, Žuran, Ivan, Poklukar, Janez, Šuligoj, Nataša Černič, Cevc, Matija, Fras, Zlatko, Cyster, Henry P., Ranjith, Naresh, Armaganijan, Luciana, Corbett, Clive, Bayat, Junaid, Makoali Makotoko, Ellen, du Toit Theron, Hendrik, Kapp, Ilse E., de V Basson, Matthys M., Lottering, Hanlie, Van Aswegen, Dina, Van Zyl, Louis J., Sebastian, Peter J., Bagai, Akshay, Pillay, Thayabran, Saaiman, Jan A., Commerford, Patrick J., Cassimjee, Soraya, Riaz, Garda, Ebrahim, Iftikhar O., Sarvan, Mahomed, Mynhardt, Joseph H., Dalby, Anthony J., Reuter, Helmuth, Bahit, Maria Cecilia, Moodley, Rajendran, Vida, Manuel, Fillat, Angel R. 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Matthew, Worner Diz, Fernando, Garcia-Dorado, David, Iñiguez, Andres, Gonzalez-Juanatey, Jose R., Portales, Javier Fernandez, Murillo, Fernando Civeira, Pericas, Laia Matas, Zamorano, Jose Luis, De Mora Martin, Manuel, Cortada, Jordi Bruguera, Clifton, Shaun, Alonso Martin, Joaquin J., Serrano Antolin, Jose Maria, De Berrazueta Fernández, José R., Vázquez de Prada, José Antonio, Díaz Fernández, Jose Francisco, García Lledó, José Alberto, Cosín Sales, Juan, Rodriguez, Javier Botas, Tragant, Gabriel Gusi, Benedicto, Amparo, DeVore, Adam D., Gonzalez-Juanatey, Carlos, Camprubí Potau, Mercedes, Perez, Ignacio Plaza, De La Tassa, César Morís, Rincon, Pablo Loma-Osorio, Recena, Javier Balaguer, Escudier, Juan M., Payeras, Antonio Coca, Orcajo, Norberto Alonso, Constantine, Godwin, Deloatch, Shalonda, Haniffa, Ruvaiz, Tissera, Nirmali, Amarasekera, Stanley, Ponnamperuma, Chandrike, Fernando, Nimali, Fernando, Kaputella, Jayawardena, Jayanthimala, Wijeyasingam, Santharaj, Ranasinghe, Gotabhaya, Ekanayaka, Ruvan, Dickey, Sheila, Mendis, Sepalika, Senaratne, Vajira, Mayurathan, Gnanamoorthy, Rajapaksha, Ajantha, Sirisena, Thilak, Herath, Jagath I., Amarasena, Naomali, Berglund, Stefan, Rasmanis, Gundars, Hagström, Emil, Dombrowski, Keith, Vedin, Ola, Witt, Nils, Mourtzinis, Georgios, Nicol, Peter, Hansen, Ole, Romeo, Stefano, Jensen, Steen Agergaard, Torstensson, Ingemar, Ahremark, Ulf, Sundelin, Torbjörn, Ducrocq, Grégory, Moccetti, Tiziano, Müller, Christian, Mach, Francois, Binde, Ronald, Landmesser, Ulf, Gämperli, Oliver, Chiang, Chern-En, Tsai, Wei-Chuan, Ueng, Kwo-Chang, Lai, Wen-Ter, Eapen, Zubin, Liu, Ming-En, Hwang, Juey-Jen, Yin, Wei-Hsian, Hsieh, I.-Chang, Hsieh, Ming-Jer, Hsiang Lin, Wei, Kuo, Jen-Yuan, Huang, Tsuei-Yuan, Fang, Chih-Yuan, Kaewsuwanna, Pinij, Endsley, Patricia, Soonfuang, Wasant, Jintapakorn, Woravut, Sukonthasarn, Apichard, Sritara, Piyamitr, Wongpraparut, Nattawut, Sastravaha, Krisada, Sansanayudh, Nakarin, Kehasukcharoen, Wirash, 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Eduardas, Knowles, Joshua W., Braganza, Denise, Sarkar, David, Storey, Robert, Griffiths, Huw, Mcclure, Sam, Muthusamy, Rangasamy, Smith, Simon, Kurian, John, Levy, Terry, Barr, Craig, Kolls, Bradley J., Kadr, Honer, Gerber, Robert, Simaitis, Audrius, Soran, Handrean, Brodison, Adrian, Ayaz, Mohammad, Cheema, Muhammad, Oliver, Richard, Thackray, Simon, Mudawi, Telal, Kong, David F., Rahma, Gohar, Sultan, Ayyaz, Reynolds, Timothy, Sharman, David, Spriging, David, Butler, Rob, Wilkinson, Peter, Lip, Gregory Yh, Ossei-Gerning, Nicholas, Vardi, Gil, Leonardi, Sergio, Baldari, Duccio, Brabham, David, Treasure Ii, Charles, Dahl, Charles, Palmer, Bruce, Wiseman, Alan, Khan, Abul, Puri, Sanjeev, Mohart, Ann Elizabeth, Ince, Carlos, Lillis, Linda, Flores, Enrique, Wright, Scott, Cheng, Shi-Chi, Rosenberg, Michael, Rogers, William, Kosinski, Edward, Forgosh, Les, Waltman, Jonathan, Shoukfeh, Mohammad, Dagher, Georges, Lopes, Renato D., Cambier, Patrick, Lieber, Ira, Kumar, Priya, East, Cara, Krichmar, Perry, Hasan, Mian, White, Lindsey, Knickelbine, Thomas, Haldis, Thomas, Gillespie, Eve, Maron, David J., Amidon, Thomas, Suh, David, Arif, Imran, Abdallah, Mouhamad, Akhter, Faiq, Carlson, Eric, D'Urso, Michael, El-Ahdab, Fadi, Nelson, William, Moriarty, Katie, Mahaffey, Kenneth W., Harris, Barry, Cohen, Steven, Carter, Luther, Doty, Daniel, Sabatino, Kenneth, Haddad, Tariq, Rao, Sunder, Mulkay, Angel, Jovin, Ion, Klancke, Kim, Marcus, Jill, Malhotra, Vinay, Devarapalli, Sai K., Koren, Michael, Chandna, Harish, Dodds Iii, George, Goraya, Tauqir, Bengston, James, Janik, Matthew, Moran, Joseph, Sumner, Andrew, Mathews, Robin, Kobayashi, John, Davis, William, Yazdani, Shahram, Pasquini, John, Thakkar, Maitreya, Vedere, Amarnath, Leimbach, Wayne, Rider, James, Fenton, Sarah, Singh, Narendra, Mehta, Rajendra H., Shah, Anil V., Moriarty, Patrick M., Janosik, Denise, Pepine, Carl, Berman, Brett, Gelormini, Joseph, Daniels, Christopher, Richard, Kerensky, Keating, Friederike, Kondo, Nicholas I., Mentz, Robert J., Shetty, Sanjay, Levite, Howard, Waider, Winfried, Takata, Theodore, Abu-Fadel, Mazen, Shah, Vipul, Aggarwal, Rahul, Kumar, Anil, Hattler, Brack, Do, Rose, Moreira, Humberto Graner, Link, Chad, Bortnick, Anna, Kinzfogl Iii, George, Ghitis, Arnold, Larry, John, Teufel, Edward, Kuhlman, Peter, Mclaurin, Brent, Zhang, Wenwu, Thew, Stephen, Patel, Chetan B., Abbas, Jalal, White, Matthew, Islam, Othman, Subherwal, Sumeet, Ranadive, Nandkishore, Vakili, Babak, Gring, Christian, Henderson, David, Schuchard, Timothy, Farhat, Naim, Pereira, Sabrina Bernardez, Kline, Geoffrey, Mahal, Sharan, Whitaker, Jack, Speirs, Shawn, Andersen, Rolf, Daboul, Nizar, Horwitz, Phillip, Zahr, Firas, Ponce, George, Jafar, Zubair, Perkins, Lynn, Mcgarvey, Joseph, Panchal, Vipul, Voyce, Stephen, Blok, Thomas, Sheldon, William, Azizad, Masoud M., Schmalfuss, Carsten, Picone, Mark, Pederson, Robert, Herzog, William, Povsic, Thomas J., Friedman, Keith, Lindsey, Jason, Timothy, Eichenlaub, Leonard, Parilak, Lepor, Norman, El Shahawy, Mahfouz, Weintraub, Howard, Irimpen, Anand, Alonso, Alvaro, May, Wade, Puymirat, Etienne, Christopher, Daniels, Galski, Thomas, Chu, Alan, Mody, Freny, Ramin, Ebrahimi, Hodes, Zachary, Rossi, Joseph, Rose, Gregory, Fairlamb, James, Lambert, Charles, Raisinghani, Ajit, Abbate, Antonio, Vetrovec, George, King, Marilyn, Carey, Charles, Gerber, Jaime, Younis, Liwa, Park, Hyeun Tom, Vidovich, Mladen, Knutson, Thomas, Jones, William Schuyler, Friedman, Dennis, Chaleff, Fred, Loussararian, Arthur, Rozeman, Phillip, Kimmelstiel, Carey, Kuvin, Jeffrey, Silver, Kevin, Foster, Malcolm, Tonnessen, Glen, Espinoza, Andrey, Shah, Bimal R., Amlani, Mohamadali, Wali, Andreas, Malozzi, Christopher, Jong, Geert T., Massey, Clara, Wattanakit, Keattiyoat, O'Donnell, Philip J., Singal, Dinesh, Jaffrani, Naseem, Banuru, Sridhar, Sherwood, Matthew W., Fisher, Daniel, Xenakis, Mark, Perlmutter, Neal, Bhagwat, Ravi, Strader, James, Blonder, Ronald, Akyea-Djamson, Ayim, Labroo, Ajay, Lee, Kwan, Marais, H. John, Stringfellow, Kenya, Claxton, Edmund, Weiss, Robert, Kathryn, Rohr, Berk, Martin, Rossi, Peter, Joshi, Parag, Khera, Amit, Khaira, Ajit S., Kumkumian, Greg, Lupovitch, Steven, Sujjavanich, Darin, Purow, Joshua, Welka, Stephen, Hoffman, David, Fischer, Stuart, Soroka, Eugene, Eagerton, Donald, Pancholy, Samir, Ray, Michael, Erenrich, Norman, Farrar, Michael, Toma, Mustafa, Pollock, Stewart, French, William J., Diamantis, Steve, Guy, Douglas, Gimple, Lawrence, Neustel, Mark, Schwartz, Steven, Pereira, Edward, Albert, Seals, Spriggs, Douglas, Trotter, Charlene, Strain, Janet, Mittal, Suneet, Vo, Anthony, Chane, Majed, Hall, Jason, Vijay, Nampalli, Lotun, Kapildeo, Lester, F. Martin, Nahhas, Ahed, Pope, Theodore, van Diepen, Sean F. P., Nager, Paul, Vohra, Rakesh, Sharma, Mukesh, Bashir, Riyaz, Ahmed, Hinan, Berlowitz, Michael, Fishberg, Robert, Barrucco, Robert, Yang, Eric, Radin, Michael, Wilson, Matthew D., Sporn, Daniel, Stapleton, Dwight, Eisenberg, Steven, Landzberg, Joel, Mcgough, Martin, Turk, Samir, Schwartz, Michael, Sundram, P. Sandy, Jain, Diwakar, Zainea, Mark, Tze-Kay Yan, Andrew, Bayron, Carlos, Karlsberg, Ronald, Dohad, Suhail, Lui, Henry, Keen, William, Westerhausen, Donald, Khurana, Sandeep, Agarwal, Himanshu, Birchem, Jessica, Penny, William, Schiavi, Lilia B., Chang, Mark, Murphy, Sherrill, Henry, John, Schifferdecker, Branislav, Gilbert, John M., Chalavarya, Gopal, Eaton, Charles, Schmedtje, John F., Christenson, Stuart, Dotani, Imran, Garrido, Marcelo, Denham, Douglas, Macdonell, Alexander, Gibson, Paul, Rahman, Aref, Al Joundi, Tammam, Assi, Nizar, Conrad, Gary, Kotha, Purushotham, Love, Michael, Giesler, Gregory, Alvarisqueta, Andrés F., Rubenstein, Howard, Gamil, Dawood, Akright, Laura, Krawczyk, Justine, Cobler, Joanne, Wells, Terry, Welker, James, Foster, Robert, Gilmore, Richard, Anderson, Jay, Sassone, Sonia A., Jacoby, Douglas, Harris, Bill, Gardner, Geraldine, Dandillaya, Ramprasad, Vora, Kishor, Kostis, John, Hunter, John, Laxson, David, Ball, Eric, Bordonava, Anselmo P., Egydio, Flavia, Kawakami, Anelise, Oliveira, Janaina, Goodman, Shaun G., Wozniak, Julianna, Alves De Lima, Alberto E., Matthews, Alexander, Ratky, Caroline, Valiris, Janine, Berdan, Lisa, Hepditch, Anita, Quintero, Kirby, Rorick, Tyrus, Westbrook, Melissa, Danchin, Nicolas, Schmidberg, Jorge M., Bezault, Madeleine, Drouet, Elodie, Simon, Tabassome, White, Harvey D., Alsweiler, Caroline, Sinnaeve, Peter, Luyten, Anne, Aylward, Philip E., Butters, Julie, Griffith, Liddy, Duronto, Ernesto A., Shaw, Michelle, Grunberg, Lena, Szarek, Michael, Islam, Shahidul, Brégeault, Marie-France, Bougon, Nathalie, Faustino, Douglas, Fontecave, Sylvie, Murphy, Judith, Caruso, Orlando C., Tamby, Jean-Francois, Verrier, Melanie, Agnetti, Veronique, Andersen, Dorthe, Badreddine, Emmy, Bekkouche, Mhamed, Bouancheau, Cecile, Brigui, Imane, Brocklehurst, Maddy, Cianciarulo, Joseph, Novaretto, Leonardo P., Devaul, Dawn, Domokos, Szilvia, Gache, Cecile, Gobillot, Caroline, Guillou, Severine, Healy, Jan, Heath, Megan, Jaiwal, Gayatri, Javierre, Carine, Labeirie, Julien, Hominal, Miguel Angel, Monier, Myriam, Morales, Ulises, Mrabti, Asmaa, Mthombeni, Bicky, Okan, Betim, Smith, Lucile, Sheller, Jennifer, Sopena, Sebastien, Pellan, Valerie, Benbernou, Fadela, Montaña, Oscar R., Bengrait, Nafissa, Lamoureux, Maud, Kralova, Katarina, Scemama, Michel, Bejuit, Raphael, Coulange, Anthony, Berthou, Christelle, Repincay, Jérôme, Lorenzato, Christelle, Etienne, Alexis, Caccavo, Alberto, Gouet, Valerie, Lecorps, Guillaume, Loizeau, Virginie, Normand, Mickael, Ourliac, Anne, Rondel, Christelle, Adamo, Antony, Beltran, Pascale, Barraud, Pauline, Dubois-Gache, Helene, Gomez Vilamajo, Oscar A., Halle, Benjamin, Metwally, Lamia, Mourgues, Maxime, Sotty, Marc, Vincendet, Marion, Cotruta, Raluca, Chengyue, Zhu, Fournie-Lloret, Dominique, Morrello, Christine, Perthuis, Aurelie, Lorenzatti, Alberto J., Picault, Patrick, Zobouyan, Isabelle, Colhoun, Helen M., Dempsey, Michael A., McClanahan, Mark A., Cartasegna, Luis R., Paterlini, Gustavo A., Mackinnon, Ignacio J., Caime, Guillermo D., Amuchastegui, Marcos, Salomone, Oscar, Codutti, Oscar R., Jure, Horacio O., Bono, Julio Oe, Hrabar, Adrian D., Vallejos, Julio A., Ahuad Guerrero, Rodolfo A., Novoa, Federico, Patocchi, Cristian A., Zaidman, Cesar J., Giuliano, Maria E., Schwartz, Gregory G., Dran, Ricardo D., Vico, Marisa L., Carnero, Gabriela S., Guzman, Pablo N., Medrano Allende, Juan C., Garcia Brasca, Daniela F., Bustamante Labarta, Miguel H., Nani, Sebastian, Blumberg, Eduardo Ds, Colombo, Hugo R., Bhatt, Deepak L., Liberman, Alberto, Fuentealba, Victorino, Luciardi, Hector L., Waisman, Gabriel D., Berli, Mario A., Garcia Duran, Ruben O., Cestari, Horacio G., Luquez, Hugo A., Giordano, Jorge A., Saavedra, Silvia S., Bittner, Vera A., Zapata, Gerardo, Costamagna, Osvaldo, Llois, Susana, Waites, Jonathon H., Collins, Nicholas, Soward, Allan, Hii, Chris Ls, Shaw, James, Diaz, Rafael, Arstall, Margaret A., Horowitz, John, Ninio, Daniel, Rogers, James F., Colquhoun, David, Oqueli Flores, Romulo E., Roberts-Thomson, Philip, Raffel, Owen, Lehman, Sam J., Aroney, Constantine, Coverdale, Steven Gm, Garrahy, Paul J., Starmer, Gregory, Sader, Mark, Carroll, Patrick A., Dick, Ronald, Zweiker, Robert, Hoppe, Uta, Drexel, Heinz, Huber, Kurt, Harrington, Robert A., Berger, Rudolf, Delle-Karth, Georg, Frey, Bernhard, Weidinger, Franz, Faes, Dirk, Hermans, Kurt, Pirenne, Bruno, Leone, Attilio, Hoffer, Etienne, Jukema, J. 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Der Wal, Ruud Ma, Zwart, Peter, Monraats, Pascalle, Van Kesteren, Henricus, Karalis, Ioannis, de Silva, H. Asita, Jukema, Johan, Verdel, Gerardus Je, Brueren, Bart Rg, Troquay, Roland P. Th, Viergever, Eric P., Al-Windy, Nadea Yy, Bartels, Gerard L., Cornel, Jan H., Hermans, Walter Rm, Herrman, Johannes Pr, Bos, Robert J., Groutars, Reginald Gej, Van Der Zwaan, Coenraad C., Kaplan, Refik, Ronner, Eelko, Groenemeijer, Bjorn E., Bronzwaer, Patrick Na, Liem, Anho Ah, Rensing, Bernard Jwm, Bokern, Marcel Jja, Nijmeijer, Remco, Hersbach, Ferry Mrj, Willems, Frank F., Gosselink, Antonius Tm, Rasoul, Saman, Elliott, John, Wilkins, Gerard, Fisher, Raewyn, Scott, Douglas, Hart, Hamish, Stewart, Ralph, Harding, Scott, Ternouth, Ian, Fisher, Nicholas, Wilson, Samuel, Aitken, Denise, Anscombe, Russell, Davidson, Laura, Tomala, Tadeusz, Nygård, Ottar, Sparby, Jon Arne, Andersen, Kjell, Gullestad, Lars, Jortveit, Jarle, Munk, Peter S., Singsaas, Erlend Gyllensten, Hurtig, Ulf, Calderon Ticona, Jorge R., Durand Velasquez, Julio R., Negron Miguel, Sandra A., Sanabria Perez, Enrique S., Carrion Chambilla, Jesus M., Chavez Ayala, Carlos A., Castillo Leon, Reynaldo P., Vargas GonzalesC, Rolando J., Hernandez Zuniga, Jose D., Camacho Cosavalente, Luis A., Bravo Mannucci, Jorge E., Landeo, Javier Heredia, Llerena Navarro, Nassip C., Roldan Concha, Yudy M., Rodriguez Chavez, Víctor E., Anchante Hernandez, Henry A., Zea Nunez, Carlos A., Ramos, Walter Mogrovejo, Ferrolino, Arthur, Sy, Rosa Allyn G., Tirador, Louie, Matiga, Generoso, Coching, Raul Martin, Bernan, Alisa, Rogelio, Gregorio, Morales, Dante D., Tan, Edgar, Sulit, Dennis Jose, Wlodarczak, Adrian, Skonieczny, Grzegorz, Ray, Kausik K., Pawlowicz, Lidia, Wojewoda, Pawel, Busz-Papiez, Benita, Bednarski, Janusz, Goch, Aleksander, Staneta, Pawel, Dulak, Elzbieta, Saminski, Krzysztof, Krasowski, Wlodzimierz, Sudnik, Wanda, Zurakowski, Aleksander, Skorski, Marcin, Lysek, Roman, Miklaszewicz, Beata, Lipko, Jan Andrzej, Kostarska-Srokosz, Edyta, Piepiorka, Marek, Drzewiecka, Anna, Stasiewski, Arkadiusz, Bhatt, Deepak L, Bittner, Vera A, Goodman, Shaun G, Harrington, Robert A, Jukema, J Wouter, White, Harvey D, Zeiher, Andreas M, Roe, Matthew T, Mahaffey, Kenneth W, Edelberg, Jay M, Sasiela, William J, Aylward, Philip E, Lopes, Renato D, Gotcheva, Nina N, Nieminen, Markku S, Laucevičius, Aleksandras, Correa Flores, Roger M, Sy, Rody G, Ristic, Arsen D, Dalby, Anthony J, de Silva, H Asita, Ray, Kausik K, Moriarty, Patrick M, Kelsey, Sheryl F, Olsson, Anders G, Simoons, Maarten L, Sijbrands, Eric J G, Alexander, John H, Brennan, J Matthew, DeVore, Adam D, Harrison, Robert W, Hlatky, Mark A, Knowles, Joshua W, Kolls, Bradley J, Kong, David F, Maron, David J, Mehta, Rajendra H, Mentz, Robert J, Patel, Chetan B, Povsic, Thomas J, Shah, Bimal R, Sherwood, Matthew W, van Diepen, Sean F P, Wilson, Matthew D, Schiavi, Lilia B, Alvarisqueta, Andrés F, Sassone, Sonia A, Bordonava, Anselmo P, Alves De Lima, Alberto E, Schmidberg, Jorge M, Duronto, Ernesto A, Caruso, Orlando C, Novaretto, Leonardo P, Montaña, Oscar R, Gomez Vilamajo, Oscar A, Lorenzatti, Alberto J, Cartasegna, Luis R, Paterlini, Gustavo A, Mackinnon, Ignacio J, Caime, Guillermo D, Codutti, Oscar R, Jure, Horacio O, Hrabar, Adrian D, Vallejos, Julio A, Ahuad Guerrero, Rodolfo A, Patocchi, Cristian A, Zaidman, Cesar J, Giuliano, Maria E, Dran, Ricardo D, Vico, Marisa L, Carnero, Gabriela S, Guzman, Pablo N, Medrano Allende, Juan C, Garcia Brasca, Daniela F, Bustamante Labarta, Miguel H, Colombo, Hugo R, Luciardi, Hector L, Waisman, Gabriel D, Berli, Mario A, Garcia Duran, Ruben O, Cestari, Horacio G, Luquez, Hugo A, Giordano, Jorge A, Saavedra, Silvia S, Waites, Jonathon H, Arstall, Margaret A, Rogers, James F, Oqueli Flores, Romulo E, Lehman, Sam J, Garrahy, Paul J, Carroll, Patrick A, Wolf, Luc De, Nicolau, Jose C, Giorgeto, Flavio E, Silva, Ricardo P, Abrantes, José Antonio M, Bodanese, Luiz C, Michalaros, Yorghos L, Eliaschewitz, Freddy G, Vidotti, Maria H, Leaes, Paulo E, Botelho, Roberto V, Manenti, Euler Roberto F Fernandes, Precoma, Dalton B, Moura Jorge, Jose C, Silveira, Jose A, Neto, Jose A Marin, Feitosa, Gilson S, Ritt, Luiz Eduardo F, de Souza, Juliana A, Todorov, Georgi V, Nikolov, Fedya P, Velcheva, Elena S, Tzekova, Maria L, Benov, Haralambi O, Petranov, Stanislav L, Tumbev, Haralin S, Shehova-Yankova, Nina S, Markov, Dimitar T, Raev, Dimitar H, Mollov, Mihail N, Kichukov, Kostadin N, Ilieva-Pandeva, Katya A, Mincheva, Valentina M, Lazov, Petar V, Dimov, Bojidar I, Prieto, Juan C, Raffo, Carlos A, Luna Botia, Diana C, De Salazar, Dora I Molina, Bonfanti, Alberto J Cadena, Barrera Silva, Sandra I, Garcia Lozada, Henry J, Coronel Arroyo, Julian A, Accini Mendoza, Jose L, Fernandez Ruiz, Ricardo L, Quintero Ossa, Alvaro M, Manzur Jatin, Fernando G, Urina Triana, Miguel A, Trujillo, Angela M Fernandez, Poulsen, Steen H, Bang, Lia E, Hove, Jens D, Kristensen, Kjeld S, Lomholdt, Jens D, Klausen, Ib C, Fausto Ovando, Sergio R, Arango Benecke, Juan L, Rodriguez De Leon, Edgar R, Premchand, Rajendra K, Abhyanakar, Atul D, Govinda, Ravishankar A, Patil, Sachin N, Joshi, Abhijeet B, Pothineni, Ramesh B, Monteiro, Minguel R, Iyengar, Shamanna S, Fulwani, Mahesh C, Chopra, Vijay K, Goyal, Naresh K, Manakshe, Gajendra V, Pellegrin, Annamaria De, De Cesare, Nicoletta B, Piatti, Piermarco, Luca, Giuseppe De, Leo, Alessandro De, Petrulionienė, Žaneta, Šakalytė, Gintarė, Šlapikas, Rimvydas, Liew, Houng B, Breedveld, Robert W, Wiersma, Jacobijne J, Troquay, Roland PTh, Viergever, Eric P, Bartels, Gerard L, Cornel, Jan H, Bos, Robert J, Van Der Zwaan, Coenraad C, Groenemeijer, Bjorn E, Willems, Frank F, Munk, Peter S, Calderon Ticona, Jorge R, Durand Velasquez, Julio R, Negron Miguel, Sandra A, Sanabria Perez, Enrique S, Carrion Chambilla, Jesus M, Chavez Ayala, Carlos A, Castillo Leon, Reynaldo P, Vargas GonzalesC, Rolando J, Hernandez Zuniga, Jose D, Camacho Cosavalente, Luis A, Bravo Mannucci, Jorge E, Llerena Navarro, Nassip C, Roldan Concha, Yudy M, Rodriguez Chavez, Víctor E, Anchante Hernandez, Henry A, Zea Nunez, Carlos A, Sy, Rosa Allyn G, Morales, Dante D, Pereira, Helder H, Tesloianu, Dan N, Bengus, Cristina M, Parepa, Irinel R, Matei, Adrian V, Alexandru, Tom M, Barbarash, Olga L, Vishnevsky, Alexander Y, Lomakin, Nikita V, Voevoda, Mikhail I, Tretyakova, Tatyana V, Tyrenko, Vadim V, Ivanov, Igor G, Asanin, Milika R, Apostolovic, Svetlana R, Dincic, Dragan V, Cyster, Henry P, Kapp, Ilse E, de V Basson, Matthys M, Aswegen, Dina Van, Van Zyl, Louis J, Sebastian, Peter J, Saaiman, Jan A, Commerford, Patrick J, Ebrahim, Iftikhar O, Mynhardt, Joseph H, Fillat, Angel R Cequier, Cruz Fernández, Jose M, Gonzalez-Juanatey, Jose R, Alonso Martin, Joaquin J, De Berrazueta Fernández, José R, Escudier, Juan M, Herath, Jagath I, Hsieh, I-Chang, Barna, Olga M, Aggarwal, Rajesh K, Wong, Yuk-Ki, Devarapalli, Sai K, Shah, Anil V, Kondo, Nicholas I, Azizad, Masoud M, Jong, Geert T, O'Donnell, Philip J, Marais, H John, Khaira, Ajit S, French, William J, Lester, F Martin, Sundram, P Sandy, Gilbert, John M, Schmedtje, John F, Colhoun, Helen M, Dempsey, Michael A, and McClanahan, Mark A
Subjects: Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use, Anticholesteremic Agents/adverse effects, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], prevention & control, heart disease risk factors, diagnosis [Cardiovascular Diseases], Antibodies, Monoclonal, Humanized, PCSK9 inhibitors, acute coronary syndrome, apolipoproteins B, LDL cholesterol, Antibodies, acute coronary syndrome, LDL, drug therapy [Atherosclerosis], Risk Factors, Physiology (medical), therapeutic use [Hydroxymethylglutaryl-CoA Reductase Inhibitors], Monoclonal, Humans, Cardiac and Cardiovascular Systems, Humanized, Cardiovascular Diseases/diagnosis, Apolipoproteins B, Kardiologi, diagnosis [Acute Coronary Syndrome], Anticholesteremic Agents, PCSK9 inhibitors, apolipoproteins B, cholesterol, LDL, cholesterol, Atherosclerosis/drug therapy, Cholesterol, LDL, Atherosclerosis, Acute Coronary Syndrome/diagnosis, drug therapy, Cholesterol, Treatment Outcome, Cardiovascular Diseases, Heart Disease Risk Factors, epidemiology, adverse effects [Anticholesteremic Agents], Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine
Abstract: Circulation : an official journal of the American Heart Association / ed.-in-chief Ephraim Donosco 146(9), 657-672 (2022). doi:10.1161/CIRCULATIONAHA.121.057807, Published by Ovid, [Erscheinungsort nicht ermittelbar]
Published: 2022
Full Text: View/download PDF

9. Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty

Author: Alberto Cordero, Belén Cid-Alvarez, Pedro Monteiro, Jose M García-Acuña, Fernando Gonçalves, David Escribano, Ramiro Trillo, Belén Alvarez-Alvarez, Lino Gonçalves, Vicente Bertomeu-Gonzalez, and José R González-Juanatey
Subjects: Cardiology and Cardiovascular Medicine
Abstract: The Zwolle risk score was designed to stratify in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) and for decision-making in the unit where patients are admitted. We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation compared with the GRACE score in all patients (n = 4446) admitted for STEMI in 3 university hospitals. Only one fourth of the patients were classified as high-risk by the Zwolle risk score vs 60% by the GRACE score. In-hospital mortality was 10.6%. A statistically significant increase in in-hospital mortality, adjusted by age, gender, and revascularization, was observed with both scores. The assessment of the optimal cut-off points verified the accuracy of Zwolle score ≥4 as optimal threshold for high-risk categorization. In contrast, GRACE score ≥140 had very low specificity as well as percentage of patients correctly classified; GRACE score ≥175 was fairly better. The reclassification index of the Zwolle score after applying the GRACE score was 35.5%. Selection of high-risk STEMI patients treated with pPCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful in clinical practice.
Published: 2022
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10. Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol

Author: Gregory G. Schwartz, Michael Szarek, Vera A. Bittner, Rafael Diaz, Shaun G. Goodman, J. Wouter Jukema, Ulf Landmesser, Patricio López-Jaramillo, Garen Manvelian, Robert Pordy, Michel Scemama, Peter R. Sinnaeve, Harvey D. White, Ph Gabriel Steg, P.h. Gabriel Steg, Deepak L. Bhatt, Robert A. Harrington, Andreas M. Zeiher, Pierluigi Tricoci, Matthew T. Roe, Kenneth W. Mahaffey, Jay M. Edelberg, Corinne Hanotin, Guillaume Lecorps, Angèle Moryusef, William J. Sasiela, Jean-François Tamby, Philip E. Aylward, Heinz Drexel, Peter Sinnaeve, Mirza Dilic, Renato D. Lopes, Nina N. Gotcheva, Juan-Carlos Prieto, Huo Yong, Ivan Pećin, Zeljko Reiner, Petr Ostadal, Steen Hvitfeldt Poulsen, Margus Viigimaa, Markku S. Nieminen, Nicolas Danchin, Vakhtang Chumburidze, Nikolaus Marx, Evangelos Liberopoulos, Pablo Carlos Montenegro Valdovinos, Hung-Fat Tse, Robert Gabor Kiss, Denis Xavier, Doron Zahger, Marco Valgimigli, Takeshi Kimura, Hyo Soo Kim, Sang-Hyun Kim, Andrejs Erglis, Aleksandras Laucevicius, Sasko Kedev, Khalid Yusoff, Gabriel Arturo Ramos López, Marco Alings, Sigrun Halvorsen, Roger M. Correa Flores, Rody G. Sy, Andrzej Budaj, Joao Morais, Maria Dorobantu, Yuri Karpov, Arsen D. Ristic, Terrance Chua, Jan Murin, Zlatko Fras, Anthony J. Dalby, José Tuñón, H. Asita de Silva, Emil Hagström, Christian Müller, Chern-En Chiang, Piyamitr Sritara, Sema Guneri, Alexander Parkhomenko, Kausik K. Ray, Patrick M. Moriarty, Robert Vogel, Bernard Chaitman, Sheryl F. Kelsey, Anders G. Olsson, Jean-Lucien Rouleau, Maarten L. Simoons, Karen Alexander, Chiara Meloni, Robert Rosenson, Eric J.G. Sijbrands, John H. Alexander, Luciana Armaganijan, Akshay Bagai, Maria Cecilia Bahit, J. Matthew Brennan, Shaun Clifton, Adam D. DeVore, Shalonda Deloatch, Sheila Dickey, Keith Dombrowski, Grégory Ducrocq, Zubin Eapen, Patricia Endsley, Arleen Eppinger, Robert W. Harrison, Connie Ng Hess, Mark A. Hlatky, Joseph Dedrick Jordan, Joshua W. Knowles, Bradley J. Kolls, David F. Kong, Sergio Leonardi, Linda Lillis, David J. Maron, Jill Marcus, Robin Mathews, Rajendra H. Mehta, Robert J. Mentz, Humberto Graner Moreira, Chetan B. Patel, Sabrina Bernardez Pereira, Lynn Perkins, Thomas J. Povsic, Etienne Puymirat, William Schuyler Jones, Bimal R. Shah, Matthew W. Sherwood, Kenya Stringfellow, Darin Sujjavanich, Mustafa Toma, Charlene Trotter, Sean F.P. van Diepen, Matthew D. Wilson, Andrew Tze-Kay Yan, Lilia B. Schiavi, Marcelo Garrido, Andrés F. Alvarisqueta, Sonia A. Sassone, Anselmo P. Bordonava, Alberto E. Alves De Lima, Jorge M. Schmidberg, Ernesto A. Duronto, Orlando C. Caruso, Leonardo P. Novaretto, Miguel Angel Hominal, Oscar R. Montaña, Alberto Caccavo, Oscar A. 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Oqueli Flores, Philip Roberts-Thomson, Owen Raffel, Sam J. Lehman, Constantine Aroney, Steven G.M. Coverdale, Paul J. Garrahy, Gregory Starmer, Mark Sader, Patrick A. Carroll, Ronald Dick, Robert Zweiker, Uta Hoppe, Kurt Huber, Rudolf Berger, Georg Delle-Karth, Bernhard Frey, Dirk Faes, Kurt Hermans, Bruno Pirenne, Attilio Leone, Etienne Hoffer, Mathias C.M. Vrolix, Luc De Wolf, Bart Wollaert, Marc Castadot, Karl Dujardin, Christophe Beauloye, Geert Vervoort, Harry Striekwold, Carl Convens, John Roosen, Emanuele Barbato, Marc Claeys, Frank Cools, Ibrahim Terzic, Fahir Barakovic, Zlatko Midzic, Belma Pojskic, Emir Fazlibegovic, Azra Durak-Nalbantic, Mehmed Kulić, Dusko Vulic, Adis Muslibegovic, Boris Goronja, Gilmar Reis, Luciano Sousa, Jose C. Nicolau, Flavio E. Giorgeto, Ricardo P. Silva, Lilia Nigro Maia, Rafael Rech, Paulo R.F. Rossi, Maria José A.G. Cerqueira, Norberto Duda, Renato Kalil, Adrian Kormann, José Antonio M. Abrantes, Pedro Pimentel Filho, Ana Priscila Soggia, Mayler O.N. de Santos, Fernando Neuenschwander, Luiz C. Bodanese, Yorghos L. Michalaros, Freddy G. Eliaschewitz, Maria H. Vidotti, Paulo E. Leaes, Roberto V. Botelho, Sergio Kaiser, Euler Roberto F. Fernandes Manenti, Dalton B. Precoma, Jose C. Moura Jorge, Pedro Silva, Jose A. Silveira, Wladmir Saporito, Jose A. Marin Neto, Gilson S. Feitosa, Luiz Eduardo F. Ritt, Juliana A. de Souza, Fernando Costa, Weimar K.S.B. Souza, Helder J.L. Reis, Leandro Machado, José Carlos Aidar Ayoub, Georgi V. Todorov, Fedya P. Nikolov, Elena S. Velcheva, Maria L. Tzekova, Haralambi O. Benov, Stanislav L. Petranov, Haralin S. Tumbev, Nina S. Shehova-Yankova, Dimitar T. Markov, Dimitar H. Raev, Mihail N. Mollov, Kostadin N. Kichukov, Katya A. Ilieva-Pandeva, Raya Ivanova, Maryana Gospodinov, Valentina M. Mincheva, Petar V. Lazov, Bojidar I. Dimov, Manohara Senaratne, James Stone, Jan Kornder, Stephen Pearce, Danielle Dion, Daniel Savard, Yves Pesant, Amritanshu Pandey, Simon Robinson, Gilbert Gosselin, Saul Vizel, Gordon Hoag, Ronald Bourgeois, Anne Morisset, Eric Sabbah, Bruce Sussex, Simon Kouz, Paul MacDonald, Ariel Diaz, Nicolas Michaud, David Fell, Raymond Leung, Tycho Vuurmans, Christopher Lai, Frank Nigro, Richard Davies, Gustavo Nogareda, Ram Vijayaraghavan, John Ducas, Serge Lepage, Shamir Mehta, James Cha, Robert Dupuis, Peter Fong, Sohrab Lutchmedial, Josep Rodes-Cabau, Hussein Fadlallah, David Cleveland, Thao Huynh, Iqbal Bata, Adnan Hameed, Cristian Pincetti, Sergio Potthoff, Juan C. Prieto, Monica Acevedo, Arnoldo Aguirre, Margarita Vejar, Mario Yañez, Guillermo Araneda, Mauricio Fernandez, Luis Perez, Paola Varleta, Fernando Florenzano, Laura Huidobro, Carlos A. Raffo, Claudia Olivares, Leonardo Nahuelpan, Humberto Montecinos, Jiyan Chen, Yugang Dong, Weijian Huang, Jianzhong Wang, Shi'An Huang, Zhuhua Yao, Xiang Li, Lan Cui, Wenhua Lin, Yuemin Sun, Jingfeng Wang, Jianping Li, Xuelian Zhang, Hong Zhu, Dandan Chen, Lan Huang, Shaohong Dong, Guohai Su, Biao Xu, Xi Su, Xiaoshu Cheng, Jinxiu Lin, Wenxia Zong, Huanming Li, Yi Feng, Dingli Xu, Xinchun Yang, Yuannan Ke, Xuefeng Lin, Zheng Zhang, Zeqi Zheng, Zhurong Luo, Yundai Chen, Chunhua Ding, Yi Zhong, Yang Zheng, Xiaodong Li, Daoquan Peng, Shuiping Zhao, Ying Li, Xuebo Liu, Meng Wei, Shaowen Liu, Yihua Yu, Baiming Qu, Weihong Jiang, Yujie Zhou, Xingsheng Zhao, Zuyi Yuan, Ying Guo, Xiping Xu, Xubo Shi, Junbo Ge, Guosheng Fu, Feng Bai, Weiyi Fang, Xiling Shou, Xiangjun Yang, Jian'An Wang, Meixiang Xiang, Yingxian Sun, Qinghua Lu, Ruiyan Zhang, Jianhua Zhu, Yizhou Xu, Zhongcai Fan, Tianchang Li, Chun Wu, Nicolas Jaramillo, Gregorio Sanchez Vallejo, Diana C. Luna Botia, Rodrigo Botero Lopez, Dora I. Molina De Salazar, Alberto J. Cadena Bonfanti, Carlos Cotes Aroca, Juan Diego Higuera, Marco Blanquicett, Sandra I. Barrera Silva, Henry J. Garcia Lozada, Julian A. Coronel Arroyo, Jose L. Accini Mendoza, Ricardo L. Fernandez Ruiz, Alvaro M. Quintero Ossa, Fernando G. Manzur Jatin, Aristides Sotomayor Herazo, Jeffrey Castellanos Parada, Rafael Suarez Arambula, Miguel A. Urina Triana, Angela M. Fernandez Trujillo, Maja Strozzi, Siniša Car, Melita Jerić, Davor Miličić, Martina Lovrić Benčić, Hrvoje Pintarić, Đeiti Prvulović, Jozica Šikić, Viktor Peršić, Dean Mileta, Kresimir Štambuk, Zdravko Babić, Vjekoslav Tomulic, Josip Lukenda, Stanka Mejic-Krstulovic, Boris Starcevic, Jindrich Spinar, David Horak, Zdenek Velicka, Josef Stasek, David Alan, Vilma Machova, Ales Linhart, Vojtech Novotny, Vladimir Kaucak, Richard Rokyta, Robert Naplava, Zdenek Coufal, Vera Adamkova, Ivo Podpera, Jiri Zizka, Zuzana Motovska, Ivana Marusincova, Premysl Svab, Petr Heinc, Jiri Kuchar, Petr Povolny, Jiri Matuska, Steen H. Poulsen, Bent Raungaard, Peter Clemmensen, Lia E. Bang, Ole May, Morten Bøttcher, Jens D. Hove, Lars Frost, Gunnar Gislason, John Larsen, Peter Betton Johansen, Flemming Hald, Peter Johansen, Jørgen Jeppesen, Tonny Nielsen, Kjeld S. Kristensen, Piotr Maria Walichiewicz, Jens D. Lomholdt, Ib C. 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Fausto Ovando, Juan L. Arango Benecke, Edgar R. Rodriguez De Leon, Bryan P.Y. Yan, David C.W. Siu, Tibor Turi, Bela Merkely, Imre Ungi, Geza Lupkovics, Lajos Nagy, András Katona, István Édes, Gábor Müller, Iván Horvath, Tibor Kapin, Zsolt Szigeti, József Faluközy, Mukund Kumbla, Manjinder Sandhu, Sharath Annam, Naveen Reddy Proddutur, Reddy Regella, Rajendra K. Premchand, Ajaykumar Mahajan, Sudhir Pawar, Atul D. Abhyanakar, Prafulla Kerkar, Ravishankar A. Govinda, Abraham Oomman, Dhurjati Sinha, Sachin N. Patil, Dhiman Kahali, Jitendra Sawhney, Abhijeet B. Joshi, Sanjeev Chaudhary, Pankaj Harkut, Santanu Guha, Sanjay Porwal, Srimannarayana Jujjuru, Ramesh B. Pothineni, Minguel R. Monteiro, Aziz Khan, Shamanna S. Iyengar, Jasprakash Singh Grewal, Manoj Chopda, Mahesh C. Fulwani, Aparna Patange, Patil Sachin, Vijay K. Chopra, Naresh K. Goyal, Rituparna Shinde, Gajendra V. Manakshe, Nitin Patki, Sumeet Sethi, Vengatesh Munusamy, Sunil Karnaand Sunil Thanvi, Srilakshmi Adhyapak, Chandrakant Patil, Ulhas Pandurangi, Rishabh Mathur, Jugal Gupta, Suhas Kalashetti, Ajit Bhagwat, Bagirath Raghuraman, Shiv Kumar Yerra, Prasant Bhansali, Rohidas Borse, Patil Rahul, Srihari Das, Vinay Kumar, Jabir Abdullakutty, Shireesh Saathe, Priya Palimkar, Jabir Abdullkutty, Shireesh Sathe, Shaul Atar, Michael Shechter, Morris Mosseri, Yaron Arbel, Chorin Ehud, Havakuk Ofer, Chaim Lotan, Uri Rosenschein, Amos Katz, Yaakov Henkin, Adi Francis, Marc Klutstein, Eugenia Nikolsky, Robert Zukermann, Yoav Turgeman, Majdi Halabi, Alon Marmor, Ran Kornowski, Michael Jonas, Offer Amir, Yonathan Hasin, Yoseph Rozenman, Shmuel Fuchs, Vered Zvi, Osamah Hussein, Dov Gavish, Zvi Vered, Yoseph Caraco, Mazen Elias, Naveh Tov, Efrat Wolfovitz, Michael Lishner, Nizar Elias, Giancarlo Piovaccari, Annamaria De Pellegrin, Raffaella Garbelotto, Gabriele Guardigli, Valgimigli Marco, Giovanni Licciardello, Carla Auguadro, Filippo Scalise, Claudio Cuccia, Alessandro Salvioni, Giuseppe Musumeci, Michelle Senni, Paolo Calabrò, Salvatore Novo, Pompilio Faggiano, Marco Metra, Nicoletta B. 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Liew, Wan Mohd Izani Wan Mohamed, Armando García Castillo, Jorge Carrillo Calvillo, Pedro Fajardo Campos, Juan Carlos Núñez Fragoso, Edmundo Alfredo Bayram Llamas, Marco Antonio Alcocer Gamba, Jaime Carranza Madrigal, Luis Gerardo González Salas, Enrique López Rosas, Belinda González Díaz, Eduardo Salcido Vázquez, Alfredo Nacoud Ackar, Guillermo Antonio Llamas Esperón, Carlos Rodolfo Martínez Sánchez, María Guerrero De Leon, Rodrigo Suarez Otero, Guillermo Fanghänel Salmón, Jesús Antonio Pérez Ríos, José Angel Garza Ruíz, Robert W. Breedveld, Margriet Feenema-Aardema, Alida Borger-Van Der Burg, Pieter A.M. Hoogslag, Harry Suryapranata, Antonius Oomen, Paulus Van Haelst, Margriet Feenema-Aradema, Jacobijne J. Wiersma, Dirk Basart, Ruud M.A. Van Der Wal, Peter Zwart, Pascalle Monraats, Henricus Van Kesteren, Ioannis Karalis, Johan Jukema, Gerardus J.E. Verdel, Bart R.G. Brueren, Roland PTh Troquay, Eric P. Viergever, Nadea Y.Y. Al-Windy, Gerard L. Bartels, Jan H. Cornel, Walter R.M. 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Bravo Mannucci, Javier Heredia Landeo, Nassip C. Llerena Navarro, Yudy M. Roldan Concha, Víctor E. Rodriguez Chavez, Henry A. Anchante Hernandez, Carlos A. Zea Nunez, Walter Mogrovejo Ramos, Arthur Ferrolino, Rosa Allyn G. Sy, Louie Tirador, Generoso Matiga, Raul Martin Coching, Alisa Bernan, Gregorio Rogelio, Dante D. 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Bengus, Constantin Militaru, Doina Rosu, Irinel R. Parepa, Adrian V. Matei, Tom M. Alexandru, Mihaela Malis, Ioan Coman, Rodica Stanescu-Cioranu, Doina Dimulescu, Yury Shvarts, Olga Orlikova, Zhanna Kobalava, Olga L. Barbarash, Valentin Markov, Nadezhda Lyamina, Alexander Gordienko, Konstantin Zrazhevsky, Alexander Y. Vishnevsky, Victor Gurevich, Raisa Stryuk, Nikita V. Lomakin, Igor Bokarev, Tatiana Khlevchuk, Sergey Shalaev, Larisa Khaisheva, Petr Chizhov, Inna Viktorova, Natalya Osokina, Vladimir Shchekotov, Evgenia Akatova, Galina Chumakova, Igor Libov, Mikhail I. Voevoda, Tatyana V. Tretyakova, Evgeny Baranov, Sergey Shustov, Sergey Yakushin, Ivan Gordeev, Niiaz Khasanov, Olga Reshetko, Tatiana Sotnikova, Olga Molchanova, Konstantin Nikolaev, Liudmila Gapon, Elena Baranova, Zaur Shogenov, Elena Kosmachova, Yuriy Karpov, Anton Povzun, Liudmila Egorova, Vadim V. Tyrenko, Igor G. 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Sebastian, Thayabran Pillay, Jan A. Saaiman, Patrick J. Commerford, Soraya Cassimjee, Garda Riaz, Iftikhar O. Ebrahim, Mahomed Sarvan, Joseph H. Mynhardt, Helmuth Reuter, Rajendran Moodley, Manuel Vida, Angel R. Cequier Fillat, Vicente Bodí Peris, Francisco Fuentes Jimenez, Francisco Marín, Jose M. Cruz Fernández, Rafael Jesus Hidalgo Urbano, Blas Gil-Extremera, Pablo Toledo, Fernando Worner Diz, David Garcia-Dorado, Andres Iñiguez, José Tuñón Fernández, Jose R. Gonzalez-Juanatey, Javier Fernandez Portales, Fernando Civeira Murillo, Laia Matas Pericas, Jose Luis Zamorano, Manuel De Mora Martin, Jordi Bruguera Cortada, Joaquin J. Alonso Martin, Jose Maria Serrano Antolin, José R. De Berrazueta Fernández, José Antonio Vázquez de Prada, Jose Francisco Díaz Fernández, José Alberto García Lledó, Juan Cosín Sales, Javier Botas Rodriguez, Gabriel Gusi Tragant, Amparo Benedicto, Carlos Gonzalez-Juanatey, Mercedes Camprubí Potau, Ignacio Plaza Perez, César Morís De La Tassa, Pablo Loma-Osorio Rincon, Javier Balaguer Recena, Juan M. Escudier, Antonio Coca Payeras, Norberto Alonso Orcajo, Pedro Valdivielso, Godwin Constantine, Ruvaiz Haniffa, Nirmali Tissera, Stanley Amarasekera, Chandrike Ponnamperuma, Nimali Fernando, Kaputella Fernando, Jayanthimala Jayawardena, Santharaj Wijeyasingam, Gotabhaya Ranasinghe, Ruvan Ekanayaka, Sepalika Mendis, Vajira Senaratne, Gnanamoorthy Mayurathan, Ajantha Rajapaksha, Thilak Sirisena, Jagath I. Herath, Naomali Amarasena, Stefan Berglund, Gundars Rasmanis, Ola Vedin, Nils Witt, Georgios Mourtzinis, Peter Nicol, Ole Hansen, Stefano Romeo, Steen Agergaard Jensen, Ingemar Torstensson, Ulf Ahremark, Torbjörn Sundelin, Tiziano Moccetti, Francois Mach, Ronald Binde, Oliver Gämperli, Wei-Chuan Tsai, Kwo-Chang Ueng, Wen-Ter Lai, Ming-En Liu, Juey-Jen Hwang, Wei-Hsian Yin, I-Chang Hsieh, Ming-Jer Hsieh, Wei Hsiang Lin, Jen-Yuan Kuo, Tsuei-Yuan Huang, Chih-Yuan Fang, Pinij Kaewsuwanna, Wasant Soonfuang, Woravut Jintapakorn, Apichard Sukonthasarn, Nattawut Wongpraparut, Krisada Sastravaha, Nakarin Sansanayudh, Wirash Kehasukcharoen, Dilok Piyayotai, Paiboon Chotnoparatpat, Ahmet Camsari, Hakan Kultursay, Bulent Mutlu, Murat Ersanli, Mustafa Demirtas, Cevat Kirma, Ertan Ural, Lale Koldas, Oleksandr Karpenko, Alexander Prokhorov, Ihor Vakaluyk, Halyna Myshanych, Dmytro Reshotko, Valeriy Batushkin, Leonid Rudenko, Ihor Kovalskyi, Mykola Kushnir, Vira Tseluyko, Yuriy Mostovoy, Mykola Stanislavchuk, Yulian Kyiak, Yuriy Karpenko, Yaroslav Malynovsky, Andriy Klantsa, Oles Kutniy, Ekaterina Amosova, Viktor Tashchuk, Oleh Leshchuk, Mykola Rishko, Mykola Kopytsya, Andriy Yagensky, Mykola Vatutin, Andriy Bagriy, Olga M. Barna, Olexiy Ushakov, Georgiy Dzyak, Borys Goloborodko, Anatolii Rudenko, Volodymyr Zheleznyy, Jasper Trevelyan, Azfar Zaman, Kaeng Lee, Andrew Moriarty, Rajesh K. Aggarwal, Piers Clifford, Yuk-Ki Wong, Syed M.R. Iqbal, Eduardas Subkovas, Denise Braganza, David Sarkar, Robert Storey, Huw Griffiths, Sam Mcclure, Rangasamy Muthusamy, Simon Smith, John Kurian, Terry Levy, Craig Barr, Honer Kadr, Robert Gerber, Audrius Simaitis, Handrean Soran, Anthony Mathur, Adrian Brodison, Mohammad Ayaz, Muhammad Cheema, Richard Oliver, Simon Thackray, Telal Mudawi, Gohar Rahman, Ayyaz Sultan, Timothy Reynolds, David Sharman, null david Sprigings, Rob Butler, Peter Wilkinson, Gregory Y.H. Lip, Julian Halcox, Sean Gallagher, Nicholas Ossei-Gerning, Gil Vardi, Duccio Baldari, David Brabham, Charles Treasure, Charles Dahl, Bruce Palmer, Alan Wiseman, Abul Khan, Sanjeev Puri, Ann Elizabeth Mohart, Carlos Ince, Enrique Flores, Scott Wright, Shi-Chi Cheng, Michael Rosenberg, William Rogers, Edward Kosinski, Les Forgosh, Jonathan Waltman, Misal Khan, Mohammad Shoukfeh, Georges Dagher, Patrick Cambier, Ira Lieber, Priya Kumar, Cara East, Perry Krichmar, Mian Hasan, Lindsey White, Thomas Knickelbine, Thomas Haldis, Eve Gillespie, Thomas Amidon, David Suh, Imran Arif, Mouhamad Abdallah, Faiq Akhter, Eric Carlson, Michael D'Urso, Fadi El-Ahdab, William Nelson, Katie Moriarty, Barry Harris, Steven Cohen, Luther Carter, Daniel Doty, Kenneth Sabatino, Tariq Haddad, Amir Malik, Sunder Rao, Angel Mulkay, Ion Jovin, Kim Klancke, Vinay Malhotra, Sai K. Devarapalli, Michael Koren, Harish Chandna, George Dodds, Tauqir Goraya, James Bengston, Matthew Janik, Joseph Moran, Andrew Sumner, John Kobayashi, William Davis, Shahram Yazdani, John Pasquini, Maitreya Thakkar, Amarnath Vedere, Wayne Leimbach, James Rider, Sarah fenton, Narendra Singh, Anil V. Shah, Denise Janosik, Carl Pepine, Brett Berman, Joseph Gelormini, Christopher Daniels, Kerensky Richard, Friederike Keating, Nicholas I. Kondo, Sanjay Shetty, Howard Levite, Winfried Waider, Theodore Takata, Mazen Abu-Fadel, Vipul Shah, Rahul Aggarwal, Mark Izzo, Anil Kumar, Brack Hattler, Rose Do, Chad Link, Anna Bortnick, George Kinzfogl, Arnold Ghitis, John Larry, Edward Teufel, Peter Kuhlman, Brent Mclaurin, Wenwu Zhang, Stephen Thew, Jalal Abbas, Matthew White, Othman Islam, Sumeet Subherwal, Nandkishore Ranadive, Babak Vakili, Christian Gring, David Henderson, Timothy Schuchard, Naim Farhat, Geoffrey Kline, Sharan Mahal, Jack Whitaker, Shawn Speirs, Rolf Andersen, Nizar Daboul, Phillip Horwitz, Firas Zahr, George Ponce, Zubair Jafar, Joseph Mcgarvey, Vipul Panchal, Stephen Voyce, Thomas Blok, William Sheldon, Masoud M. Azizad, Carsten Schmalfuss, Mark Picone, Robert Pederson, William Herzog, Keith Friedman, Jason Lindsey, Rosemary Nowins, Eichenlaub Timothy, Parilak Leonard, Norman Lepor, Mahfouz El Shahawy, Howard Weintraub, Anand Irimpen, Alvaro Alonso, Wade May, Daniels Christopher, Thomas Galski, Alan Chu, Freny Mody, Ebrahimi Ramin, Zachary Hodes, Joseph Rossi, Gregory Rose, James Fairlamb, Charles Lambert, Ajit Raisinghani, Antonio Abbate, George Vetrovec, Marilyn King, Charles Carey, Jaime Gerber, Liwa Younis, Hyeun Park, Mladen Vidovich, Thomas Knutson, Dennis Friedman, Fred Chaleff, Arthur Loussararian, Phillip Rozeman, Carey Kimmelstiel, Jeffrey Kuvin, Kevin Silver, Malcolm Foster, Glen Tonnessen, Andrey Espinoza, Mohamadali Amlani, Andreas Wali, Christopher Malozzi, Geert T. Jong, Clara Massey, Keattiyoat Wattanakit, Philip J. O'Donnell, Dinesh Singal, Naseem Jaffrani, Sridhar Banuru, Daniel Fisher, Mark Xenakis, Neal Perlmutter, Ravi Bhagwat, James Strader, Ronald Blonder, Ayim Akyea-Djamson, Ajay Labroo, Kwan Lee, H. John Marais, Edmund Claxton, Robert Weiss, Rohr Kathryn, Martin Berk, Peter Rossi, Parag Joshi, Amit Khera, Ajit S. Khaira, Greg Kumkumian, Steven Lupovitch, Joshua Purow, Stephen Welka, David Hoffman, Stuart Fischer, Eugene Soroka, Donald Eagerton, Samir Pancholy, Michael Ray, Norman Erenrich, Michael Farrar, Stewart Pollock, William J. French, Steve Diamantis, Douglas Guy, Lawrence Gimple, Mark Neustel, Steven Schwartz, Edward Pereira, Seals Albert, Douglas Spriggs, Janet Strain, Suneet Mittal, Anthony Vo, Majed Chane, Jason Hall, Nampalli Vijay, Kapildeo Lotun, F. Martin Lester, Ahed Nahhas, Theodore Pope, Paul Nager, Rakesh Vohra, Mukesh Sharma, Riyaz Bashir, Hinan Ahmed, Michael Berlowitz, Robert Fishberg, Robert Barrucco, Eric Yang, Michael Radin, Daniel Sporn, Dwight Stapleton, Steven Eisenberg, Joel Landzberg, Martin Mcgough, Samir Turk, Michael Schwartz, P. Sandy Sundram, Diwakar Jain, Mark Zainea, Carlos Bayron, Ronald Karlsberg, Suhail Dohad, Henry Lui, William Keen, Donald Westerhausen, Sandeep Khurana, Himanshu Agarwal, Jessica Birchem, William Penny, Mark Chang, Sherrill Murphy, John Henry, Branislav Schifferdecker, John M Gilbert, Gopal Chalavarya, Charles Eaton, John F. Schmedtje, Stuart Christenson, Imran Dotani, Douglas Denham, Alexander Macdonell, Paul Gibson, Aref Rahman, Tammam Al Joundi, Nizar Assi, Gary Conrad, Purushotham Kotha, Michael Love, Gregory Giesler, Howard Rubenstein, Dawood Gamil, Laura Akright, Justine Krawczyk, Joanne Cobler, Terry Wells, James Welker, Robert Foster, Richard Gilmore, Jay Anderson, Douglas Jacoby, Bill Harris, Geraldine Gardner, Ramprasad Dandillaya, Kishor Vora, John Kostis, John Hunter, David Laxson, Eric Ball, Flavia Egydio, Anelise Kawakami, Janaina Oliveira, Julianna Wozniak, Alexander Matthews, Caroline Ratky, Janine Valiris, Lisa Berdan, Anita Hepditch, Kirby Quintero, Tyrus Rorick, Melissa Westbrook, Andrea Pascual, Carla Rovito, Madeleine Bezault, Elodie Drouet, Tabassome Simon, Caroline Alsweiler, Anne Luyten, Julie Butters, Liddy Griffith, Michelle Shaw, Lena Grunberg, Shahidul Islam, Marie-France Brégeault, Nathalie Bougon, Douglas Faustino, Sylvie Fontecave, Judith Murphy, Melanie Verrier, null Veronique Agnetti, Dorthe Andersen, Emmy Badreddine, Mhamed Bekkouche, Cecile Bouancheau, Imane Brigui, Maddy Brocklehurst, Joseph Cianciarulo, Dawn Devaul, Szilvia Domokos, Cecile Gache, Caroline Gobillot, Severine Guillou, Jan Healy, Megan Heath, Gayatri Jaiwal, Carine Javierre, Julien Labeirie, Myriam Monier, Ulises Morales, Asmaa Mrabti, Bicky Mthombeni, Betim Okan, Lucile Smith, Jennifer Sheller, Sebastien Sopena, Valerie Pellan, Fadela Benbernou, Nafissa Bengrait, Maud Lamoureux, Katarina Kralova, Raphael Bejuit, Anthony Coulange, Christelle Berthou, Jérôme Repincay, Christelle Lorenzato, Alexis Etienne, Valerie Gouet, Virginie Loizeau, Mickael Normand, Anne Ourliac, Christelle Rondel, Antony Adamo, Pascale Beltran, Pauline Barraud, Helene Dubois-Gache, Benjamin Halle, Lamia Metwally, Maxime Mourgues, Marc Sotty, Marion Vincendet, Raluca Cotruta, Zhu Chengyue, Dominique Fournie-Lloret, Christine Morrello, Aurelie Perthuis, Patrick Picault, Isabelle Zobouyan, Helen M. Colhoun, Michael A. Dempsey, Mark A. McClanahan, Masira, and Laucevičius, Aleksandras
Subjects: Male, Acute coronary syndrome, medicine.medical_specialty, Cardiac & Cardiovascular Systems, Randomization, PCSK9 inhibitor, LOW-DENSITY-LIPOPROTEIN, Antibodies, Monoclonal, Humanized, acute coronary syndrom, Placebo, Gastroenterology, lipoprotein(a), Internal medicine, medicine, Humans, Low-density lipoprotein cholesterol, Aged, Alirocumab, RISK, low-density lipoprotein cholesterol, Science & Technology, biology, business.industry, PCSK9, PCSK9 Inhibitors, Hazard ratio, ALIROCUMAB, acute coronary syndrome, Cholesterol, LDL, Lipoprotein(a), Middle Aged, EFFICACY, medicine.disease, Cardiovascular Diseases, CARDIOVASCULAR-DISEASE, SAFETY, Cardiovascular System & Cardiology, biology.protein, Female, lipids (amino acids, peptides, and proteins), STATIN, low-density lipoprotein, cholesterol PCSK9 inhibitor, CORONARY, Cardiology and Cardiovascular Medicine, business, Life Sciences & Biomedicine, Mace
Abstract: Digital, Background Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402), Ciencias Médicas y de la Salud
Published: 2021
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11. Myocardial infarction in young adults: are the risk profile and mortality outcomes different from older patients?

Author: A Freitas, Lino Gonçalves, G Campos, Francisco Q. Gonçalves, J Borges-Rosa, J A Ferreira, Pedro Monteiro, R Baptista, C Ferreira, JL Almeida, V Goncalves, Sílvia Monteiro, J Milner, Manuel Oliveira-Santos, and S Martinho
Subjects: Coronary angiography, medicine.medical_specialty, Epidemiology, business.industry, Coronary arteriosclerosis, medicine.disease, Risk profile, Older patients, Diabetes mellitus, Internal medicine, medicine, Cardiology, Myocardial infarction, Young adult, Cardiology and Cardiovascular Medicine, business
Abstract: Funding Acknowledgements Type of funding sources: None. Introduction The incidence of acute myocardial infarction (AMI) among young patients is increasing. The YOUNG-MI Registry reported that those under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from southern European. Methods We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with AMI. We only included patients Results From the 1233 patients included (mean age 50.5 ± 6.5 years, 82.2% male), 53% had STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p Conclusion Among patients who suffer AMI, those under 50 years old have a different risk profile, compared to the 50-60 years cohort. However, there is no significant difference in all-cause mortality. Abstract Figure.
Published: 2021
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12. Inequalities after STEMI in National Health Service: is there really a postcode lottery?

Author: Célia Ferreira, A Freitas, Fabienne Gonçalves, Pedro Monteiro, G Campos, A Martinho, Rui Baptista, A.I Ribeiro, V Goncalves, J A Ferreira, J Milner, J Rosa, Juliano Pinheiro de Almeida, L Goncalves, and S. Monteiro
Subjects: Lottery, Actuarial science, Inequality, business.industry, media_common.quotation_subject, Medicine, Cardiology and Cardiovascular Medicine, National health service, business, media_common
Abstract: Background and purpose Failure to address the impact of social determinants of health attenuates efficacy of proven prevention recommendations, namely because important considerations related to socioeconomic disadvantage are not captured by existing cardiovascular disease (CDV) risk stratification methods. We aimed to assess how socioeconomic determinants influence recurrent MI and all-cause death after myocardial infarction (MI) in Portugal. Methods We conducted a retrospective, observational cohort study, including all patients with a ST-elevation MI (STEMI) admitted to and discharged alive from an intensive cardiac care unit between 2004 and 2017 (n=1809). The median (interquartile range) follow-up was 6 (4–9) years. We used survival models to assess the relationship between their municipal (i) income by purchasing power per capita (PPC), (ii) geographical accessibility to health care, (iii) illiteracy, iv) residential socioeconomic deprivation and recurrent MI and all-cause mortality. To assess residential socioeconomic deprivation, each individual's residential postcode was matched to the recently validated Portuguese version of European Deprivation Index (EDI). The index was categorized into quintiles (Q1-least deprived to Q5-most deprived). Results The mean age was 64±14 years; 74% were male. Regarding individual socioeconomic variables, PPC (HR 1.19; 95% CI 0.97–1.47 for Tertile 1 vs Tertile 2; HR 1.28; 95% CI 1.04–1.56 for Tertile 1 vs Tertile 3 and HR 1.07; 95% CI 0.85–1.34 for Tertile 2 vs Tertile 3) and medical appointments in primary health centers per inhabitant (HR 0.90; 95% CI 0.75–1.09 for Tertile 1 vs Tertile 2; HR 1.23; 95% CI 0.95–1.61 for Tertile 1 vs Tertile 3 and HR 1.37; 95% CI 1.06–1.76 for Tertile 2 vs Tertile 3) were predictors of all-cause mortality, but not recurrent MI; however, in multivariate analysis adjusted for sex, age and ejection fraction, this association was no longer significant (HR 1.00; 95% CI 0.99–1.00 and, HR 1.00; 95% CI 0.89–1.17, respectively). Additionally, no evident association between illiteracy and all-cause mortality or MI was present. Concerning EDI, demographic data was similar among the quintiles (Table 1). Although EDI quintiles were not associated with all-cause mortality (HR 1.17; 95% CI 0.82–1.66 for Q5 vs Q1), the EDI was an independent predictor of recurrent MI (Figure 1). On multivariate analysis, adjusted for age, sex, hypertension, diabetes and LDL cholesterol, the HR for the most deprived (Q5) to the least deprived (Q1) quintile was 1.91 (95% CI 1.05–3.49) for MI. Conclusions Our study shows clear socioeconomic differentials in cardiovascular outcomes in patients with STEMI which suggests that accounting for socioeconomic deprivation might improve risk prediction and therefore disease prognosis. Funding Acknowledgement Type of funding source: None
Published: 2020
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13. A real world analysis of NSTE-ACS in more than 4000 patients: accuracy of GRACE and TIMI scores in mortality prediction

Author: J Borges-Rosa, S. Monteiro, Manuel Oliveira-Santos, Rui Baptista, Fabienne Gonçalves, L Goncalves, Pedro Monteiro, and J Ferreira
Subjects: medicine.medical_specialty, biology, Unstable angina, business.industry, Hospital mortality, medicine.disease, Troponin, Internal medicine, Epidemiology, Cardiology, medicine, biology.protein, Mortality prediction, Cardiology and Cardiovascular Medicine, business, Nste acs, TIMI
Abstract: Introduction The TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) risk scores identify high-risk patients with Non-ST elevation acute coronary syndrome (NSTE-ACS) who can benefit from an early invasive strategy. Purpose We aimed to compare both scores predictive accuracy for mortality in a real-world cohort of patients presenting with NSTE-ACS. Methods We retrospectively evaluated 4264 patients admitted to our coronary intensive care unit between 2004 and 2017 with a diagnosis of NSTE-ACS. The TIMI and GRACE scores were calculated for each patient, and all-cause mortality was recorded during hospitalization, at one month and one year. To better characterize global troponin release, we defined Total Troponin (TT) as the sum of initial and discharge troponin. We used the area under the receiver operating characteristic curve (AUC) to compare the predictive value of both scores for mortality during hospitalization, at one month and one year. Results Mean patient age was 67.6±12.4 years and 66.4% were male (n=2833). Mean GRACE score was 124.6±35.8 and mean TIMI score was 2.7±1.6. There was a weak correlation between GRACE and TIMI score (r=0.3, p Conclusion In patients with NSTE-ACS, GRACE risk score is a better predictor of in-hospital, one month and one-year mortality, compared to TIMI risk score. TT, as a measure of ischemia burden, might improve accuracy of GRACE score in predicting short and long-term mortality. Figure 1 Funding Acknowledgement Type of funding source: None
Published: 2020
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14. Management of a rapidly expanding celiac artery aneurysm with the chimney technique

Author: Clara Nogueira, Ricardo Gouveia, Alexandra Canedo, Ana Carolina Semião, Andreia Coelho, and Pedro Monteiro
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, medicine.medical_treatment, lcsh:Surgery, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Celiac artery aneurysm, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Celiac artery, medicine.artery, Case report, Medicine, cardiovascular diseases, Embolization, Endovascular treatment, Computed tomography angiography, medicine.diagnostic_test, business.industry, nutritional and metabolic diseases, lcsh:RD1-811, medicine.disease, Thrombosis, digestive system diseases, Endovascular procedures, lcsh:RC666-701, cardiovascular system, Infectious etiology, Surgery, Radiology, Cardiology and Cardiovascular Medicine, business, Infected
Abstract: Infective celiac artery aneurysm is an extremely rare diagnosis, with few reported cases in the literature. We present the case of a rapidly expanding celiac artery aneurysm involving the ostia, probably infectious, successfully treated in an urgent setting by aneurysm exclusion resorting to the chimney technique. On follow-up, computed tomography angiography revealed complete aneurysm thrombosis and patent celiac artery. Previous reports of endovascular treatment of infective celiac artery aneurysm involved its embolization. This is the first reported case of chimney technique used to exclude a celiac artery aneurysm, with a clinical suspicion of infectious etiology, preserving celiac artery patency. Short-term results are encouraging, but implantation of prosthetic material in an infected environment is a concern. Keywords: Aneurysm, Infected, Celiac artery, Endovascular procedures
Published: 2018
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15. Estudo Safira: reflexões sobre a prevalência e os padrões de tratamento de fibrilhação auricular e risco cardiovascular em 7500 indivíduos com 65 ou mais anos

Author: Pedro Monteiro
Subjects: 03 medical and health sciences, lcsh:Diseases of the circulatory (Cardiovascular) system, 0302 clinical medicine, 030228 respiratory system, lcsh:RC666-701, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine
Abstract: Resumo: Introduçã e objetivo: A fibrilhação auricular (FA) é um dos mais importantes problemas de saúde pública em Portugal, representa simultaneamente um importante fator e marcador de risco cardiovascular. Avaliar, numa população representativa com 65 ou mais anos, a prevalência, epidemiologia e caracterização clínica e terapêutica da FA. Métodos: Foram avaliados 7500 indivíduos de 65 anos ou mais, recrutados em todas as regiões administrativas e representativos da população idosa residente em Portugal continental. A todos eles foi feito um ECG e, na ausência de FA, um subgrupo fez ainda Holter de 24 h ou implantou um registador de eventos durante sete dias. Em toda essa população foram avaliados dados epidemiológicos, clínicos e farmacológicos. Resultados: A população estudada (41,9% do sexo masculino e 58,1% feminino), com média de 68,9 anos, apresentou uma prevalência global de FA de 9,0%. Desses 35,9% desconheciam ter FA e 18,6% apresentavam FA paroxística. Nessa população, a prevalência de HTA foi de 85,3%, de dislipidemia foi de 75,4% e de diabetes de 22,7%. O valor mediano do score de Chads‐vasc foi de 3,5 +/‐1,2. Em termos de abordagem terapêutica, 56,3% dos doentes não estavam anticoagulados (29,8% dos doentes estavam antiagregados) e, de entre os medicados com antivitamínicos K, o valor médio de TTR foi de 41,7%. Conclusões: Este estudo mostra a muito elevada prevalência de FA na população idosa portuguesa, bem como uma taxa subótima de diagnóstico, anticoagulação e controlo efetivo dos fatores de risco cardiovasculares. Abstract: Introduction and Aim: Atrial fibrillation (AF) is a common arrhythmia and an important risk factor for ischemic stroke. The current ESC guidelines state that all patients aged 65 and over should be regularly screened for AF. The SAFIRA study aimed to determine the prevalence, epidemiology and clinical and therapeutic characterization of AF in the Portuguese elderly population. Methods: The study population (7500 subjects) were recruited from all Portuguese administrative regions. Demographic, clinical and drug treatment data were collected, risk scores were calculated, and an electrocardiogram (ECG) was performed in all subjects. In those not found to have AF on the resting ECG, a randomized subset (400 subjects) underwent 24‐hour Holter monitoring and 200 subjects were fitted with an event recorder for two weeks, in order to identify patients with paroxysmal AF. The primary endpoint was AF prevalence; secondary endpoints (in the AF population) included prevalence of paroxysmal AF, mean and median CHA2DS2‐VASc and HAS‐BLED scores, rates of anticoagulant and antiplatelet therapy, previous stroke, previous stroke/transient ischemic attack, previous bleeding, and time in therapeutic range (if on vitamin K antagonists). Results: The prevalence of AF was 9.0%. Of these, 35.9% were unaware of the diagnosis and 18.6% had paroxysmal AF. Median CHA2DS2‐VASc score was 3.5±1.2 and 56.3% of patients were not anticoagulated. In the AF subpopulation, the stroke rate was 11.2%. Overall, only 25.8% of the anticoagulated patients were considered to be adequately treated. Conclusions: This study shows the high prevalence of AF in the elderly population, as well as suboptimal rates of diagnosis, anticoagulation and effective control of cardiovascular risk factors. Palavras‐chave: Epidemiologia, Fibrilhação auricular, Idosos, Keywords: Epidemiology, Atrial fibrillation, Elderly
Published: 2018

16. Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

Author: Sónia Martins Santos, Rui Baptista, Mariano Pego, Pedro Monteiro, Sílvia Monteiro, Susana Cunha, and Francisco Rocha Gonçalves
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Administration, Oral, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, Tromboembolismovenoso, 030212 general & internal medicine, General Environmental Science, Aged, 80 and over, CHAVEAnticoagulantes, Anticoagulant, Intermediate-high risk, Real world, Middle Aged, Pulmonary embolism, Cohort, Embolia pulmonar, Risco intermédio aelevado, Cardiology, Female, Cardiology and Cardiovascular Medicine, Venous thromboembolism, medicine.drug, Adult, medicine.medical_specialty, medicine.drug_class, Risk Assessment, Young Adult, 03 medical and health sciences, medicine.artery, Internal medicine, medicine, Humans, Mundo real, Aged, Retrospective Studies, business.industry, Warfarin, Anticoagulants, VarfarinaExperiência, Retrospective cohort study, medicine.disease, Blood pressure, lcsh:RC666-701, Pulmonary artery, Etiology, General Earth and Planetary Sciences, Pulmonary Embolism, business
Abstract: Introduction: Intermediate-high risk pulmonary embolism (IHR-PE) has a poor prognosis, but is under-represented in trials of direct oral anticoagulants (DOACs) in venous thromboembolic disease (VTE). We aimed to assess whether the administration of DOACs was equivalent to the conventional (CONV) treatment of low-molecular weight heparin bridged with warfarin for treating IHR-PE. Methods: We conducted a retrospective cohort study including 59 consecutive patients admitted with IHR-PE and followed for up to three months after discharge. Two groups were created based on the anticoagulant strategy: CONV (n=35) and DOAC (n=24). The efficacy endpoints were death, recurrent PE, estimated pulmonary artery systolic pressure (PASP), right ventricular systolic function (RVSF) at discharge, and length of stay; the safety endpoint was major bleeding. Results: The two groups were similar regarding demographics, PE etiology and markers of clinical severity. There were four in-hospital deaths in the CONV group and none in the DOAC group. No recurrent PE or major bleeding event was recorded in either group. At discharge, neither PASP nor RVSF was different between the groups. Patients in the DOAC group were discharged 1.7 days earlier on average than patients in the CONV group (4.7±2.4 vs. 3.0±1.5 days, p=0.002). Conclusions: The adoption of a DOAC treatment strategy in this real-world cohort of IHR-PE patients was associated with similar efficacy and safety to the CONV approach. The fact that monitoring of anticoagulation effect was unnecessary probably led to the significant reduction in length of stay. Resumo: Introdução: O tromboembolismo pulmonar de risco intermédio-elevado (TEP-IE) condiciona um prognóstico mais agravado, mas se encontra sub-representado nos ensaios dos anticoagulantes orais diretos (ACOd) na doença tromboembólica venosa (DTV). Avaliamos se a administração de ACOd foi equivalente à estratégia terapêutica convencional (CONV) (heparina de baixo peso molecular (HBPM) + varfarina) no tratamento do TEP-IE. Métodos: Fez-se um estudo de coorte retrospetivo com 59 doentes consecutivos internados por TEP-IE, seguidos até três meses após a alta. Criaram-se dois grupos, baseados na estratégia terapêutica anticoagulante: CONV (n = 35) e DOAC (n = 24) (ACOd). Os desfechos de eficácia foram a morte, o TEP recorrente, a pressão sistólica na artéria pulmonar (PSAP), a função ventricular direita (FVD) e a duração do internamento; o desfecho de segurança foi a hemorragia major. Resultados: Os grupos eram comparáveis relativamente aos aspetos demográficos, à etiologia do TEP e aos marcadores de gravidade clínica. Ocorreram quatro mortes intra-hospitalares no grupo CONV e nenhuma no grupo DOAC. Nenhum evento de TEP recorrente ou hemorragia major ocorreu em qualquer dos grupos. À data de alta, quer a PSAP quer a FVD não diferiram entre os dois grupos. A alta ocorreu 1,7 dia mais cedo no grupo DOAC do que no grupo CONV (4,7±2,4 versus 3,0±1,5 dias, p = 0,002). Conclusões: A adoção de uma estratégia de tratamento com ACOd associou-se a um perfil de eficácia e segurança semelhante à abordagem convencional. A ausência da necessidade de monitoração do efeito anticoagulante provavelmente motivou a redução na duração de internamento. Keywords: Anticoagulants, Venous thromboembolism, Real world, Pulmonary embolism, Intermediate-high risk, Warfarin, Palavras-chave: Anticoagulantes, Tromboembolismo venoso, Mundo real, Embolia pulmonar, Risco intermédio a elevado, Varfarina
Published: 2017
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17. P3122Complete versus culprit-vessel only revascularization for patients with acute coronary syndromes and multivessel disease

Author: Pedro Monteiro, Rui Baptista, Jorge Ferreira, S. Monteiro, Fabienne Gonçalves, and Lino Gonçalves
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Internal medicine, medicine, Cardiology, Multivessel disease, Cardiology and Cardiovascular Medicine, Revascularization, Multi vessel coronary artery disease, business, Culprit
Abstract: Background Recent randomized clinical trials have suggested that complete revascularization (CR) instead of culprit-vessel only revascularization (CVO) strategies may take a stand in the optimal management of patients admitted for acute myocardial infarction (AMI) with multivessel (MV) disease undergoing primary percutaneous coronary intervention (P-PCI). However, despite the 2017 ST-elevation acute coronary syndrome (STEMI) guidelines update with a new class of recommendation for CR, it remains controversial whether this strategy leads to better outcomes. Purpose To compare CR versus CV strategies during hospitalization in patients presenting with AMI with multivessel disease at P-PCI. Methods We analyzed data from all patients admitted with non-ST acute myocardial infarction (NSTEMI) and STEMI in a portuguese coronary care unit (CCU), between 2007 and 2016. We then evaluated potential differences of CR versus CVO with PCI during hospitalization in AMI patients with multivessel disease, defined by at least 2 different diseased main coronary vessels, saphenous vein or mammary artery conduits. We used 1:1 ratio propensity score matching to study the impact of CR on patient mortality and adjusted data for relevant risk factors at admission time. Results A total of 4758 patients were admitted for AMI, 2690 NSTEMI (56.5%) and 2068 STEMI (43.5%). Access to PCI records was possible in 3162 (66.5%) patients, of which 1707 (54%) underwent CR versus 1455 (46%) who underwent CVO. CVO patients were older (67.9±11.8 vs. 63.5±13.1 years, p Conclusions In patients presenting with AMI and MV disease, CR strategy during hospitalization leads to greater 6-month and 1-year survival when compared with CVO strategy. Despite not having found significant differences when STEMI was directly compared to NSTEMI, we believe this was due to the great loss of patient numbers after propensity matching, requiring larger trials to prove the effect.
Published: 2019
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18. Efeito da empagliflozina para além do controlo glicémico: benefício cardiovascular em doentes com DMT2 e doença cardiovascular estabelecida

Author: Pedro Matos, Jorge Polónia, Pedro Monteiro, Joaquim Calado, Patrícia Branco, Miguel Melo, Rita Birne, Carlos Aguiar, and José Silva-Nunes
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Insuficiência cardíaca, Empagliflozin, Subgroup analysis, Heart failure, Type 2 diabetes, Empagliflozina, chemistry.chemical_compound, Internal medicine, Diabetes mellitus, medicine, Glycemic, business.industry, Diabetes, Doença cardiovascular, medicine.disease, Cardiovascular disease, Clinical trial, chemistry, lcsh:RC666-701, Glycated hemoglobin, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract: Resumo: A prevalência da diabetes mellitus tipo 2 (DMT2) continua a aumentar e a sua associação com a doença cardiovascular (CV) tem levado à incorporação e valorização de endpoints CV nos ensaios clínicos sobre o tratamento da DMT2.Este artigo faz uma revisão dos vários ensaios já realizados e em desenvolvimento, neste âmbito, com especial enfoque no estudo EMPA‐REG OUTCOME. Neste estudo, a empagliflozina, um inibidor do cotransportador tipo 2 de sódio/glicose (iSGLT2), demonstrou efeitos benéficos na redução do risco CV em doentes com DMT2 e doença CV estabelecida, para além de segurança CV e diminuição dos valores de HbA1c, representando uma mudança de paradigma com impacto ao nível das recomendações internacionais para o tratamento da DMT2. Estes resultados mantiveram‐se em análises de subgrupos posteriores, nomeadamente na insuficiência cardíaca, doença renal crónica e doença arterial periférica, ainda que muitas questões se coloquem sobre os mecanismos envolvidos nestes efeitos – se efeitos hemodinâmicos, efeitos metabólicos ou se a diminuição das concentrações de sódio citoplasmático no miocárdio.Com a diminuição do risco de eventos CV major em doentes com DMT2, os resultados do estudo EMPA‐REG OUTCOME demonstraram, pela primeira vez, proteção CV associada ao efeito de um fármaco anti‐hiperglicémico e iniciaram uma nova era no tratamento e gestão da DMT2. Este estudo levou ao desenvolvimento de outros ensaios, ainda a decorrer, que permitirão estabelecer quais os doentes que mais beneficiarão desta terapêutica, nomeadamente na relação à existência de comorbilidades. Abstract: The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D.This article explores the various trials already performed and under development in this field, with particular focus on the EMPA‐REG OUTCOME trial. In this trial, empagliflozin, a sodium‐glucose co‐transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations.With this reduction in risk for major CV events in patients with T2D, the EMPA‐REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities. Palavras‐chave: Empagliflozina, Diabetes, Doença cardiovascular, Insuficiência cardíaca, Keywords: Empagliflozin, Diabetes, Cardiovascular disease, Heart failure
Published: 2019

19. P6420Can machine learning help us improve risk stratification of diabetic patients with acute coronary syndromes? The answer will blow your mind

Author: F Balazard, L Li, Lino Gonçalves, C Simpson, J Milner, S. Monteiro, Pedro Monteiro, S Schopf, M Zaslavskiy, A Rousset, D Dellamonica, and M He
Subjects: medicine.medical_specialty, business.industry, Risk stratification, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract: Background Risk stratification following an acute coronary syndrome (ACS) is of utmost importance, in order to identify patients at higher risk of subsequent cardiovascular events. Diabetic patients have a significantly worse prognosis, so new risk prediction tools are important to better identify and risk stratify high risk patients within this important ACS subpopulation. Aim The aim of this study was to identify the best predictors of a new ACS, in a single-center database of ACS, resorting to machine learning and artificial intelligence, and to compare the Global Registry of Acute Coronary Events (GRACE) risk score's relevance for risk discrimination in a general ACS population versus a subpopulation of diabetic patients. Methods In a single center, 5977 patients admitted due to ACS between 2004 and 2017 and alive at discharge were studied. In the subpopulation of diabetic patients (n=3429), each covariate present in the database was analyzed separately with a Cox proportional hazard model with three terms – subpopulation belonging indicator, covariate, interaction term. The p-value of the interaction term was used to rank variables. The more significant the interaction term, the stronger the change in relationship between patients in the subpopulation and the risk of a new ACS, compared to the one in the general population. Results During long term follow-up, 13% of patients (n=771) experienced a second event. Kaplan-Meier curve represents how ACS free-survival depends on the GRACE risk score and group of interest. In the general population and in the subpopulation of diabetic patients, the GRACE score was used to further divide patients into 3 terciles, of which only the lower and upper tercile are shown (GRACE ≤113 and GRACE >144, respectively). The solid lines represent Kaplan-Meier curves for diabetic patients, and the dotted lines in the general population. Pink or grey colour of the curves represent the stratification level of the covariate. Conclusions In our model, the GRACE risk score was found to be a better discriminator of risk of futher ACS in diabetic patients than in the general ACS population. Strikingly, a higher GRACE score predicts a lower rate of readmission, probably because many patients will die in the index hospitalization or out of hospital. This finding reinforces the usefulness of the GRACE score in high risk patients and may improve risk stratisfication in diabetic post-ACS patients, making sure that they are closely followed and submitted to optimal risk factor management, in order to improve their post-ACS prognosis.
Published: 2019
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20. P6404Myocardial infarction with nonobstructive coronary arteries: does aspirin have a place in the treatment of this entity?

Author: S. Monteiro, V Marinho, Pedro Monteiro, Lino Gonçalves, Rui Baptista, C Ferreira, Fatima R. Freitas, V Goncalves, Jorge Ferreira, J Milner, and Paulo C. Alves
Subjects: Coronary arteries, Aspirin, medicine.medical_specialty, medicine.anatomical_structure, business.industry, Internal medicine, medicine, Cardiology, Infarction, Cardiology and Cardiovascular Medicine, medicine.disease, business, medicine.drug
Abstract: Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) is still a clinical enigma that is being increasingly recognised, as the number of coronary angiographies we perform in our centres also increase. However, the treatment for this entity is still a matter of important debate, not only due to the different causative mechanisms of this disease but also because there are no major trials regarding MINOCA treatment. Purpose To determine the association between acetylsalicylic acid (ASA) use after discharge and mortality after discharge in MINOCA patients admitted to a coronary care unit (CCU). Methods We analyzed data from 370 (11.7% of the global sample) patients admitted with MINOCA in our CCU. Patients with other final diagnoses, missing mortality data, previous acute myocardial infarction, contra-indications to aspirin and known heart failure before admission were excluded. All patients underwent transthoracic echocardiography and coronary angiography at any point during hospitalisation. After adjusting data for relevant comorbidities we then compared mortality after hospital discharge between the ASA group and the no-ASA group. Results Of all MINOCA patients admitted in our CCU, 84 (22.7%) were diagnosed with ST-elevation myocardial infarction (STEMI) and 286 (77.3%) with non-ST elevation myocardial infarction (NSTEMI). 296 (80%) patients received ASA after discharge. Both groups were homogeneous as we did not find any significant differences between groups regarding age (p=0.106), left ventricle ejection fraction (p=0.100), GRACE score at hospitalisation (p=0.150), Killip-Kimball class at hospitalisation (p=0.604), incidence of acute kidney injury (p=0.450), maximum c-reactive protein during stay (p=0.804) and low-density lipoprotein levels at hospitalization (p=0.055). There was also no difference in the incidence of diabetes (p=0.350), exposure to daily stress (p=0.767), active smoking (p=0.569), dyslipidemia (p=0.229), hypertension (p=0.057) and type of myocardial infarction (STEMI vs NSTEMI – p=0.215). In this MINOCA cohort (5 years follow-up) a total of 47 patients died (12.7%). ASA vs. no-ASA 1-month (3.1% vs. 0.0%, p=0.214), 6-month (4.5% vs. 1.4%, p=0.317), 1-year (5.9% vs 5.6%, p=0.900), 3-year (10.5% vs. 8.3%, p=0.668) and 5-year (13.3% vs. 12.5%, p=0.860) all-cause mortality was not significantly different. The same non-significant trend towards higher mortality with ASA was obtained when survival curves were taken into account. Conclusions MINOCA remains a challenging entity. In our study, the systematic use of ASA in all patients following MINOCA was not associated with better survival after long-term follow-up.
Published: 2019
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21. Internal Carotid Pseudo-Aneurysm Caused by Migration of a Coronary Guidewire Fragment: The Case of a Broken Arrow

Author: Nuno Coelho, Victor Martins, Evelise Pinto, Rita Augusto, Pedro Monteiro, Alexandra Canedo, Ricardo Gouveia, João Pedro Ribeiro, João Peixoto, Carolina Semião, and Luís Fernandes
Subjects: Physics, lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:RC666-701, Fragment (computer graphics), lcsh:Surgery, Surgery, lcsh:RD1-811, Anatomy, Pseudo aneurysm, Cardiology and Cardiovascular Medicine
Published: 2021
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22. Is hemoglobin variation a linear predictor of mortality in acute coronary syndrome?

Author: R. Ferreira, Francisco Rocha Gonçalves, Pedro Monteiro, Sílvia Monteiro, Francisco Soares, Mariano Pego, and Sofia Mendes
Subjects: medicine.medical_specialty, Acute coronary syndrome, lcsh:Diseases of the circulatory (Cardiovascular) system, Anemia, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Clinical endpoint, Medicine, 030212 general & internal medicine, Hemoglobin, business.industry, Mortality rate, Retrospective cohort study, medicine.disease, Confidence interval, Risk factors, lcsh:RC666-701, Cardiology, Coronary care unit, Coronary artery syndromes, Cardiology and Cardiovascular Medicine, business
Abstract: Background and objectives: Coronary artery disease is a common health problem. The aim of this study was to evaluate the prognosis impact on mortality of the variation of hemoglobin (Hb) levels during hospitalization time. Methods: The retrospective observational study included 2640 patients admitted for acute coronary syndrome in a single coronary care unit from May 2004 until June 2013. The primary endpoint was all cause of death at 1 year of follow up time, and secondary endpoint was all cause of death at 2 years of the follow up time. Results: Four groups were created according to the quartiles of Hb variation (admission Hb minus lowest Hb value) during the hospitalization time: group 1: ≥2.1 g/dL with 627 patients; group 2: >1.1 and 0.3 and ≤1.1 g/dL with 686 patients and group 4: ≤0.3 g/dL with 661 patients. A total of 84 patients (3.2%) died during the first year of the follow up. More patients died in group 1 and 4 (6.4% vs 3.7% vs 3.7% vs 6.8%, Log-Rank = 0.023). At 2 years of follow-up, the results were similar, with higher mortality in group 4 (7.3% vs 4.3% vs 4.6% vs 9.2%, Log-Rank = 0.003). Multivariate analysis showed that Hb variation >1.1 was an independent predictor of mortality (hazard ration = 0309 95% confidence interval, 0.136–0.702; P = 0.005). Conclusion: The patients with the lower baseline hemoglobin and the variability of Hb highest than 1.1 mg/dL had the worse prognosis with high mortality rate during the follow up time.
Published: 2016
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23. Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis

Author: Javier Suárez de Lezo, José Suárez de Lezo, Elisabete Jorge, Faria H, Manuel Pan, Pedro Monteiro, Miguel Romero, Soledad Ojeda, Rui Baptista, João Calisto, and Mariano Pego
Subjects: Balloon Valvuloplasty, Male, Cardiac Catheterization, medicine.medical_specialty, Time Factors, Hypertension, Pulmonary, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Mitral valve stenosis, Risk Factors, Interquartile range, Cause of Death, Internal medicine, Mitral valve, medicine, Humans, Mitral Valve Stenosis, Prospective Studies, Prospective cohort study, Survival rate, Retrospective Studies, Cardiac catheterization, Portugal, business.industry, Incidence, Middle Aged, Prognosis, medicine.disease, Pulmonary hypertension, Surgery, Survival Rate, Stenosis, Treatment Outcome, medicine.anatomical_structure, 030228 respiratory system, Echocardiography, Spain, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. In addition, the persistence of pulmonary hypertension (PH) after PMV is a complication for which mechanisms and prognostic implications are unclear. Our aims were (1) to report the long-term outcomes of patients with rheumatic mitral stenosis treated with PMV; (2) to determine the risk factors for long-term poor outcomes; and (3) to analyze the prevalence and predictors of persistent PH. We prospectively enrolled 532 patients who underwent PMV from 1987 to 2011 at 2 hospitals. The following end points were assessed after PMV: all-cause mortality, mitral reintervention, a composite end point of all-cause mortality and mitral reintervention, and PH persistence. Survival status was available for 97% patients; the median follow-up was 10 years (interquartile range 4 to 18 years). Procedural success was achieved in 85% patients. During the follow-up, 21% patients died and 27% required mitral reintervention. Before PMV, 74% patients had PH that persisted after PMV in 45% of patients (p0.001). Unfavorable valve anatomy (Wilkins score8) and post-PMV mean pulmonary arterial pressure (PAP) were independent predictors of all-cause mortality, mitral reintervention, and the composite end point. Post-PMV mean PAP was significantly correlated with a mitral valve area (MVA)2.5 cm(2) (p0.001); in addition, on the echocardiographic follow-up, MVA was an independent predictor of systolic PAP (p0.001). In conclusion, PMV represents an advantageous therapeutic option for patients with mitral stenosis in terms of long-term outcomes. Unfavorable valve anatomy and persistent PH were the most important predictors of long-term outcomes. The persistence of PH is associated with the MVA obtained after PMV.
Published: 2016
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24. Optical coherence tomography of the pulmonary arteries: A systematic review

Author: Pedro Monteiro, Rui Baptista, Mariano Pego, Elisabete Jorge, Faria H, João Calisto, and Manuel Pan
Subjects: medicine.medical_specialty, genetic structures, medicine.medical_treatment, Chronic thromboembolic pulmonary hypertension, Pulmonary Artery, 030204 cardiovascular system & hematology, Cochrane Library, Pulmonary arterial hypertension, Balloon, Pulmonary hypertension, 03 medical and health sciences, Coronary circulation, 0302 clinical medicine, Optical coherence tomography, Thromboembolism, Angioplasty, Internal medicine, medicine.artery, Humans, Medicine, 030212 general & internal medicine, medicine.diagnostic_test, business.industry, Vascular disease, medicine.disease, eye diseases, Pulmonary artery, Radiography, medicine.anatomical_structure, Cardiology, sense organs, Radiology, Cardiology and Cardiovascular Medicine, business, Angioplasty, Balloon, Tomography, Optical Coherence
Abstract: Optical coherence tomography (OCT) is an imaging technique extensively used for visualizing the coronary circulation, where it assists clinical decision-making. Along with the new interventional procedures being introduced for pulmonary vascular disease, there is an increasing need for intravascular imaging of the pulmonary arteries. Additionally, measurements of the wall thickness of the pulmonary arteries of patients with various types of pulmonary hypertension (PH) may provide relevant diagnostic and prognostic information. The aim of this review is to summarize all the available evidence on the use of OCT for imaging the pulmonary bed and to describe a simple protocol for OCT image acquisition. We conducted a systematic review of the literature using electronic reference databases through February 2015 (MEDLINE, Cochrane Library, Web of Knowledge, and references cited in other studies) and the search terms “optical coherence tomography,” “pulmonary hypertension,” and “pulmonary arteries.” Studies in which OCT was used to image the pulmonary vessels were considered for inclusion. We identified 14 studies reporting OCT imaging data from the pulmonary arteries. OCT was able to identify intravascular thrombi in patients with chronic thromboembolic PH (CTEPH), and an increase in vessel wall thickness was found in most patients with PH, compared with the controls. OCT has also been reported to be useful for the selection of balloon size in the setting of balloon pulmonary angioplasty for CTEPH. The main limitations include lack of standardization, little data on outcomes, cost, and the technical limitations involved in visualizing small-diameter (
Published: 2016
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25. Transapical Off-pump Mitral Valve Repair with NeoChord Implantation: Initial experience in Portugal

Author: João Pedro Monteiro, Sara Simões Costa, Daniel Martins, and Paulo Neves
Subjects: Mitral valve repair, medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine, Cardiology and Cardiovascular Medicine, business, Mitral valve regurgitation, medicine.disease, Surgery
Abstract: Objective: Transapical off-pump NeoChord repair is a minimally invasive surgical procedure, to treat degenerative mitral valve regurgitation, of increasing interest. The procedure is performed usin...
Published: 2020
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26. P1749Predictors of acute kidney injury in patients admitted with acute coronary syndromes in a coronary care unit

Author: M Santos, Paulo C. Alves, J Milner, Fatima R. Freitas, C Ferreira, M. Pego, V Marinho, Jorge Ferreira, S. Monteiro, Pedro Monteiro, and C Domingues
Subjects: medicine.medical_specialty, business.industry, Emergency medicine, medicine, Coronary care unit, Acute kidney injury, In patient, Cardiology and Cardiovascular Medicine, medicine.disease, business
Published: 2018
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27. 4055Should we use beta-blockers in all patients after st-segment elevation acute myocardial infarction?

Author: S. Monteiro, M. Pego, C Ferreira, Pedro Monteiro, C Domingues, J Milner, M Santos, Fatima R. Freitas, Jorge Ferreira, Paulo C. Alves, and V Marinho
Subjects: medicine.medical_specialty, business.industry, Internal medicine, medicine, Cardiology, Elevation, ST segment, Myocardial infarction, Cardiology and Cardiovascular Medicine, Beta (finance), business, medicine.disease
Published: 2018
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28. P1024Implantable cardioverter-defibrillator therapy in patients presenting with acute coronary syndromes - useful before 40 days?

Author: C Ferreira, M Santos, Paulo C. Alves, M. Pego, V Marinho, C Domingues, Fatima R. Freitas, Pedro Monteiro, J Milner, S. Monteiro, and Jorge Ferreira
Subjects: medicine.medical_specialty, business.industry, Emergency medicine, medicine, In patient, Cardiology and Cardiovascular Medicine, business
Published: 2018
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29. P1748Should we care for stress hyperglycaemia in patients admitted with acute coronary syndromes?

Author: M Santos, Paulo C. Alves, J Milner, C Ferreira, C Domingues, Jorge Ferreira, M. Pego, Pedro Monteiro, S. Monteiro, V Marinho, and Fatima R. Freitas
Subjects: medicine.medical_specialty, business.industry, Internal medicine, medicine, In patient, Cardiology and Cardiovascular Medicine, business
Published: 2018
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30. Glucemia en los síndromes coronarios agudos. ¿Hasta qué nivel debe reducirse?

Author: Francisco Rocha Gonçalves, Mariano Pego, Sílvia Monteiro, Pedro Monteiro, and Hélia Martins
Subjects: business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract: Resumen Introduccion y objetivos La hiperglucemia al ingreso parece identificar a un subgrupo de pacientes con sindromes coronarios agudos que muestran una peor evolucion clinica. El objetivo de este estudio es evaluar la influencia de la variacion de la glucemia durante la hospitalizacion en la mortalidad a largo plazo de los pacientes no diabeticos. Metodos Estudio retrospectivo de 2.043 pacientes consecutivos sin diabetes mellitus conocida que ingresaron por un sindrome coronario agudo en una misma unidad coronaria entre mayo de 2007 y agosto de 2013. La poblacion se dividio en cuartiles en funcion de los valores de glucemia al ingreso (≤ 90 mg/dl, n = 374; 90-140 mg/dl, n = 1.307; 141-180 mg/dl, n = 230; ≥ 181 mg/dl, n = 111) y se determino la tasa de mortalidad de los pacientes con variaciones de la glucemia por encima o por debajo de la media de su respectivo cuartil. La mediana de seguimiento fue de aproximadamente 1.200 dias. Resultados La mortalidad por cualquier causa durante el seguimiento fue sucesiva y significativamente mayor en los cuartiles superiores (el 9,1, el 9,7, el 13,5 y el 18,9%; p = 0,007). El analisis de regresion multivariable puso de manifiesto que la hiperglucemia al ingreso (≥ 181 mg/dl) es un potente factor independiente predictivo de la mortalidad durante el seguimiento (hazard ratio = 1,74; intervalo de confianza del 95%, 1,07-2,8; p = 0,027). En el cuarto cuartil (≥ 181 mg/dl), la mortalidad fue superior entre los pacientes con mayores variaciones de la glucemia (el 37,5 frente al 8,5%; p Conclusiones La hiperglucemia al ingreso es un factor predictivo de la mortalidad por cualquier causa en nuestra poblacion. La mortalidad es mas elevada entre los pacientes con mayores variaciones de la glucemia. Se necesitan mas estudios para confirmar estos datos.
Published: 2015
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31. P2721Epidemiologic trends in an acute coronary unit: a 12 year report

Author: S. Monteiro, Fabienne Gonçalves, Rui Baptista, Manuel Oliveira-Santos, M. Pego, V Marinho, Pedro Monteiro, Paulo C. Alves, J Milner, and Jorge Ferreira
Subjects: medicine.medical_specialty, biology, Unstable angina, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, medicine.disease, Troponin, Triage, Unit (housing), Transplantation, Coronary artery bypass surgery, Epidemiology, biology.protein, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published: 2017
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32. Preditores de hipertensão pulmonar após tromboembolia pulmonar de risco intermédio a elevado

Author: Luís A Providência, Elisabete Jorge, Graça Castro, Antony Nogueira, Pedro Monteiro, Rui Baptista, Rogério Teixeira, and André Barros
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:RC666-701, Cardiology and Cardiovascular Medicine
Abstract: Resumo: Introdução: A tromboembolia pulmonar (TEP) é uma emergência cardiovascular comum que, juntamente com a hipertensão pulmonar tromboembólica crónica (HPTEC), se associa a alta mortalidade e morbilidade. Não há ainda consenso quanto à consecutividade destas patologias. Este estudo pretende determinar a incidência e fatores de risco para o desenvolvimento de hipertensão pulmonar (HTP) após uma TEP de risco intermédio a elevado. Métodos: Estudámos retrospetivamente 213 doentes com TEP de risco intermédio a elevado, entre 2000-2010, e comparamos dados demográficos, clínicos, laboratoriais e imagiológicos entre os doentes que manifestaram HTP durante o seguimento clínico (doentes que, pelo menos três meses após a alta, mantivessem pressões sistólicas na artéria pulmonar acima de 40 mmHg, estimadas por ecocardiografia) com os doentes que mantiveram pressões normais. Resultados: Identificou-se HTP após a TEP em 12,4% dos doentes. Foram fatores preditores para o desenvolvimento desta complicação a idade (hazard ratio [HR] 1,09 [intervalo de confiança {IC} 95% 1,02-1,20] por ano de idade, p = 0,012) e o índice de massa corporal (HR 1,19 [IC 95% 1,04-1,36] por kg m−2, p = 0,013). Conclusões: A HTP após uma TEP foi uma complicação relativamente comum na nossa série de doentes com um episódio agudo de TEP de risco intermédio a elevado. Identificamos como fatores preditores do desenvolvimento desta complicação a idade avançada e a obesidade. Abstract: Background: Pulmonary embolism (PE) is a common cardiovascular emergency that, when combined with chronic thromboembolic pulmonary hypertension (PH), is associated with high mortality and morbidity. We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode. Methods: A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010. Clinical data at admission were collected and the incidence of PH as assessed by echocardiography (estimated pulmonary systolic artery pressure over 40 mmHg) was determined. Multivariate analysis was used to determine predictors of development of PH. Results: PH was detected in 12.4% of patients after a mean follow-up of three years. Only age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.02-1.20 per year; p=0.012) and body mass index (HR 1.19, 95% CI 1.04-1.36) per kg/m2, p=0.013) emerged as independent predictors of the development of this complication during follow-up. Conclusions: PH after PE was a relatively common complication in our series. We identified advanced age and increased body mass index as predisposing factors. Palavras-chave: Hipertensão pulmonar tromboembólica crónica, Tromboembolia-pulmonar, Fatores de risco, Índice de massa corporal, Obesidade, Idade, Keywords: Chronic thromboembolic pulmonary hypertension, Pulmonary embolism, Risk factors, Body mass index, Obesity, Age
Published: 2013
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33. Digoxin in advanced heart failure patients: A question of rhythm

Author: Fátima Franco, Hélia Martins, Elisabete Jorge, Pedro Monteiro, Susana Costa, L. Coelho, H. Vieira, Fátima Saraiva, Rui Baptista, and Luís A. Providência
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Digoxin, medicine.medical_specialty, Fibrilhação auricular, Cardiotonic Agents, Advanced heart failure, Prognóstico, Insuficiência cardíaca avançada, Severity of Illness Index, Group B, law.invention, law, Internal medicine, Atrial Fibrillation, Severity of illness, polycyclic compounds, medicine, Humans, Sinus rhythm, cardiovascular diseases, Retrospective Studies, General Environmental Science, Heart Failure, business.industry, Atrial fibrillation, Retrospective cohort study, Middle Aged, Prognosis, medicine.disease, Intensive care unit, lcsh:RC666-701, Heart failure, Cardiology, General Earth and Planetary Sciences, Female, Digoxina, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background: The impact of digoxin on outcomes of patients with advanced heart failure (HF) remains uncertain and its effect may be different for patients in atrial fibrillation (AF) or sinus rhythm (SR). Objectives: To determine the impact of digoxin on outcomes of advanced HF patients and to assess whether prognosis differs in patients in AF and SR. Methods: A total of 268 consecutive patients admitted to an intensive care unit with decompensated HF were evaluated. Patients were divided into two groups: A – patients with AF (n=89), and B – patients in SR (n=179). For each group we compared patients medicated and not medicated with digoxin. A mean follow-up of 3.3 years was performed. Results: Addition of digoxin to contemporary standard HF therapy showed no impact on mortality of patients in group B (all-cause mortality in follow-up: 19.1% vs. 22.5%, p=0.788). Regarding group A, we observed significantly lower medium-term mortality for patients on digoxin therapy (18.6% vs. 46.6%, p=0.048). Digoxin therapy did not influence readmissions for decompensated HF. Among AF patients, no differences were found regarding demographic, clinical, echocardiographic and laboratory variables between patients medicated and not medicated with digoxin. Conclusions: Digoxin therapy may improve the prognosis of advanced HF patients with AF under optimal medical therapy. However, no benefit of digoxin was demonstrated for patients in SR. These results may help to improve patient selection for digoxin therapy. Resumo: Introdução: O impacto prognóstico da digoxina na insuficiência cardíaca (IC) avançada permanece mal esclarecido. A relevância da terapêutica digitálica pode ser diferente na fibrilhação auricular (FA) relativamente ao ritmo sinusal (RS). Objectivos: Determinar o impacto prognóstico da digoxina na IC e verificar se este é diferente consoante se encontrem em FA ou em RS. Métodos: Estudaram-se 268 doentes internados numa unidade de cuidados intensivos por IC descompensada. Dividiu-se a população em dois grupos: A – 89 doentes em FA; grupo B – 179 doentes em RS. Para cada grupo compararam-se os doentes medicados com os não medicados com digoxina. Realizou-se um seguimento clínico com a duração mediana de 3,3 anos. Resultados: A digoxina não teve impacto na mortalidade dos doentes com IC avançada que se encontravam em RS (mortalidade a 3,3 anos: 19,1% versus 22,5%, p = 0,788), adicionada à terapêutica médica otimizada. Nos doentes em FA observou-se uma redução significativa da mortalidade nos doentes medicados com digoxina (18,6% versus 46,6%, p = 0,048). A digoxina não alterou a taxa de reinternamentos por IC descompensada. No grupo A não se verificaram diferenças entre os doentes medicados e não medicados com digoxina relativamente aos parâmetros demográficos, clínicos, ecocardiográficos ou laboratoriais. Conclusão: Este estudo sugere que a digoxina pode melhorar o prognóstico dos doentes com IC avançada e FA, sob terapêutica médica optimizada. Contudo, esta não demonstrou benefício nos doentes em RS. Estes resultados podem contribuir para uma melhor seleção dos doentes a medicar com digoxina, otimizando a relação risco/benefício desta terapêutica. Keywords: Advanced heart failure, Digoxin, Atrial fibrillation, Prognosis, Palavras-chave: Insuficiência cardíaca avançada, Digoxina, Fibrilhação auricular, Prognóstico
Published: 2013
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34. Diabetes and acute coronary syndromes: a practical approach

Author: Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, and Mariano Pego
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Prognóstico, medicine.medical_treatment, MEDLINE, Type 2 diabetes, Acute coronary syndromes, Revascularization, Diabetes mellitus, Diagnosis, Antithrombotic, medicine, In patient, Risk factor, Intensive care medicine, Outcome, Rehabilitation, Síndromes coronárias agudas, business.industry, Diagnóstico, Diabetes, medicine.disease, lcsh:RC666-701, Cardiology and Cardiovascular Medicine, business
Abstract: Resumo: A diabetes mellitus tipo 2 é actualmente reconhecida como um importante factor de risco de morbilidade e mortalidade cardiovascular, particularmente em doentes admitidos com síndromes coronárias agudas (SCA). Apesar dos recentes avanços do diagnóstico, estratificação de risco e tratamento destas entidades clínicas, a sua associação no mesmo doente continua a representar um prognóstico sombrio. O objectivo deste artigo é sistematizar a caracterização e abordagem da diabetes no contexto das SCA, em termos de diagnóstico, estratificação de risco e prognóstico a curto e longo prazo, visando desta forma contribuir para a disseminação das boas práticas clínicas na abordagem da diabetes no âmbito das SCA.A diabetes é importante factor de risco cardiovascular, sendo os diabéticos uma relevante população no contexto das SCA. Estratégias como a revascularização precoce e completa, o recurso à insulinoterapia intensiva aguda, à realização sistemática de PTGO em doentes sem diagnóstico prévio de diabetes e um enfoque particular na identificação e mitigação de comorbilidades e factores de risco, complementados por uma terapêutica antidiabética, antitrombótica e anti-isquémica optimizadas e o recurso frequente à reabilitação cardíaca e à promoção multidisciplinar da compliance terapêutica e de estilos de vida saudáveis são traves mestras de uma estratégia bem sucedida para a optimização do prognóstico das SCA no contexto de diabetes. Abstract: Type 2 diabetes is currently recognized as an important risk factor for cardiovascular morbidity and mortality, particularly in patients admitted with acute coronary syndromes (ACS). The aim of this paper is to characterize, in a sistematic way, how to approach diabetes and ACS, regarding prognosis, risk stratification and short and long-term prognosis, therefore contributing to improve good clinical practices regarding diabetes and ACS.Diabetes is an important crdiovascular risk factor, being diabetics an inportant ACS subpopulation. A comprehensive diabetes and ACS management, including early and complete revascularization, sistematic OGTT peformance in patients lacking a previous diagnosis of diabetes and a particular focus on identifying and decreasing comorbidities and risk factors, as well as in optimizing antidiabetic, antithrombotic and anti-ischemic medication, using cardiac rehabilitation and the multidisciplinary promotion of therapeutic compliance and healthy lifestyles are key factors in a successful strategy to optimize prognosis of ACS in diabetics. Palavras-chave: Síndromes coronárias agudas, Diabetes mellitus, Diagnóstico, Prognóstico, Keywords: Acute coronary syndromes, Diabetes, Diagnosis, Outcome
Published: 2013
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35. Long-term effect of bosentan in pulmonary hypertension associated with complex congenital heart disease

Author: Pedro Monteiro, Luís A Providência, António Marinho da Silva, Graça Castro, and Rui Baptista
Subjects: Adult, Heart Defects, Congenital, Male, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Hipertensão pulmonar, Sildenafil, Hypertension, Pulmonary, Persistent truncus arteriosus, Pulmonary hypertension, chemistry.chemical_compound, Ductus arteriosus, Internal medicine, medicine, Humans, Cardiopatia congénita, Familial Primary Pulmonary Hypertension, Prospective Studies, Antihypertensive Agents, General Environmental Science, Congenital heart disease, Sulfonamides, business.industry, Bosentan, medicine.disease, respiratory tract diseases, medicine.anatomical_structure, chemistry, Great arteries, lcsh:RC666-701, Eisenmenger syndrome, Cardiology, General Earth and Planetary Sciences, Female, Cardiology and Cardiovascular Medicine, Pulmonary atresia, business, medicine.drug, Follow-Up Studies
Abstract: Background: Bosentan is recommended for symptomatic patients with Eisenmenger syndrome due to simple congenital lesions such as atrial and ventricular septal defects (VSD). However, its long-term efficacy and safety in patients with pulmonary arterial hypertension (PAH) associated with complex congenital heart disease (CHD) is unknown. Objectives: We examined the short- and long-term effects and safety profile of bosentan in patients with PAH and complex CHD. Methods: We followed 14 patients with PAH and complex CHD for a mean of four years. Demographic parameters, exercise capacity assessed by the six-minute walking test (6MWT) and oxygen saturation were assessed at baseline, six months and at follow-up. Results: Mean age was 37.1±11.7 years; 90% were in WHO class III or IV. The most common diagnosis was pulmonary atresia with VSD (35.7%), followed by truncus arteriosus (28.6%), patent ductus arteriosus (21.4%) and transposition of the great arteries (14.3%). After six months of treatment, six-minute walking distance (6MWD) increased from 371.9 to 428.4 m (p=0.005) and functional class was improved (p=0.005). After four years, one patient discontinued bosentan due to side effects and four patients were started on sildenafil, after a mean 38 months of bosentan treatment. Mean 6MWD for patients on bosentan monotherapy (n=8) was 440.1±103.8 m, whereas for patients on bosentan-sildenafil combination therapy (n=4) it was 428.8±96.9 m, after four years of therapy. Two patients died during follow-up. Conclusions: Bosentan was safe and was associated with improved exercise capacity in patients with PAH and complex CHD. This improvement was sustained for up to four years and the safety profile was similar to simple CHD patients. Resumo: Introdução: O bosentano é recomendado em doentes com hipertensão arterial pulmonar (HAP) associada a lesões congénitas simples, como comunicações interventriculares (CIV). Contudo, a sua eficácia e segurança a longo prazo em doentes com HAP associada a cardiopatias congénitas complexas (HAP-CCC) é desconhecida. Objectivos: Avaliámos a eficácia e segurança a curto e longo-prazo do bosentano na HAP-CCC. Métodos: Estudaram-se 14 doentes com HAP-CCC, relativamente a parâmetros demográficos, capacidade funcional avaliada pelo teste de marcha de seis minutos (TM6M) e saturação de oxigénio, antes de iniciar terapêutica, aos seis meses e durante o período de seguimento clínico a longo-prazo (quatro anos). Resultados: Noventa por cento dos doentes encontravam-se em classe OMS III ou IV, com idade média de 37,1 ± 11,7 anos. O diagnóstico mais frequente foi a atrésia pulmonar com CIV (35,7%), seguida de truncus arteriosus (28,6%), canal arterial patente (21,4%) e transposição de grandes vasos (14,3%). Após seis meses de tratamento, o TM6M aumentou de 371,9 para 428,4 metros (p = 0,005) e a classe funcional melhorou (p = 0,005). Após quatro anos, um doente suspendeu bosentano devido a efeitos secundários e quatro doentes iniciaram sildenafil, após uma duração média de monoterapia de 38 meses. Após quatro anos de terapêutica, nos doentes em monoterapia com bosentano (n = 8) o TM6M foi de 440,1 ± 103,8 metros, enquanto que nos doentes com bosentano-sildenafil (n = 4) foi de 428,8 ± 96,9 metros. Dois doentes faleceram durante o período de seguimento clínico. Conclusões: O bosentano foi seguro e esteve associado a melhoria na capacidade funcional em doentes com HAP-CCC até aos quatro anos de seguimento clínico. Keywords: Bosentan, Congenital heart disease, Pulmonary hypertension, Palavras chave: Bosentan, Cardiopatia congénita, Hipertensão pulmonar
Published: 2013

36. One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Author: Graça Castro, Elisabete Jorge, Rogério Teixeira, Luís A Providência, Luís Curvo-Semedo, Filipe Caseiro-Alves, Paulo Mendes, Pedro Monteiro, Inês Santiago, and Rui Baptista
Subjects: Adult, Male, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, Population, Risk Assessment, law.invention, Young Adult, Risk Factors, law, Internal medicine, Multidetector Computed Tomography, medicine, Humans, Young adult, education, General Environmental Science, Aged, Retrospective Studies, Aged, 80 and over, education.field_of_study, business.industry, Tomografia Computorizada, Retrospective cohort study, Thrombolysis, Middle Aged, Prognosis, medicine.disease, Intensive care unit, Pulmonary embolism, Embolia Pulmonar, lcsh:RC666-701, Acute Disease, cardiovascular system, Cardiology, General Earth and Planetary Sciences, Female, Radiology, Azygos vein, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, Risk assessment, business
Abstract: Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Follow-up all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term all-cause mortality (3.8% vs. 38.8%, p
Published: 2013

37. Platelet aggregation at discharge: A useful tool in acute coronary syndromes?

Author: Carlos Tavares, Gilberto P Marques, João Mariano Pego, Alda Reboredo, Margarida Lourenço, Graça Ribeiro, Luís A Providência, Francisco Rocha Gonçalves, Maria João Ferreira, Mário Freitas, Rogério Teixeira, Pedro Monteiro, and Sílvia Monteiro
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, lcsh:Diseases of the circulatory (Cardiovascular) system, Ticlopidine, Platelet Aggregation, Platelet Function Tests, medicine.medical_treatment, Population, Context (language use), Internal medicine, Clinical endpoint, medicine, Humans, Myocardial infarction, Longitudinal Studies, Prospective Studies, Acute Coronary Syndrome, education, General Environmental Science, education.field_of_study, business.industry, Unstable angina, Percutaneous coronary intervention, Middle Aged, medicine.disease, Clopidogrel, Patient Discharge, lcsh:RC666-701, Cardiology, General Earth and Planetary Sciences, Female, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Introduction: Inhibition of platelet aggregation appears two hours after the first dose of clopidogrel, becomes significant after the second dose, and progresses to a steady-state value of 55% by day seven. Low response to clopidogrel has been associated with increased risk of stent thrombosis and ischemic events, particularly in the context of stable heart disease treated by percutaneous coronary intervention. Objective: To stratify medium-term prognosis of an acute coronary syndrome (ACS) population by platelet aggregation. Methods: We performed a prospective longitudinal study of 70 patients admitted for an ACS between May and August 2009. Platelet function was assessed by ADP-induced platelet aggregation using a commercially available kit (Multiplate® analyzer) at discharge. The primary endpoint was a combined outcome of mortality, non-fatal myocardial infarction, or unstable angina, with a median follow-up of 136.0 (79.0–188.0) days. Results: The median value of platelet aggregation was 16.0 U (11.0–22.5 U) with a maximum of 41.0 U and a minimum of 4.0 U (normal value according to the manufacturer: 53–122 U). After ROC curve analysis with respect to the combined endpoint (AUC 0.72), we concluded that a value of 18.5 U conferred a sensitivity of 75.0% and a specificity of 68% to that result. We therefore created two groups based on that level: group A – platelet aggregation
Published: 2012

38. CYP2C19*2 and prognosis after an acute coronary syndrome: Insights from a Portuguese center

Author: Luís A. Providência, Margarida Lourenço, Rogério Teixeira, Pedro Monteiro, Alda Reboredo, Gilberto Marques, João Mariano Pego, Mário Freitas, Carlos Tavares, Graça Ribeiro, Francisco Gonçalves, Maria João Ferreira, and Sílvia Monteiro
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, lcsh:Diseases of the circulatory (Cardiovascular) system, Population, CYP2C19, Internal medicine, medicine, Humans, Longitudinal Studies, Prospective Studies, Myocardial infarction, Acute Coronary Syndrome, education, Aged, General Environmental Science, education.field_of_study, Framingham Risk Score, Portugal, Unstable angina, business.industry, Middle Aged, Prognosis, medicine.disease, Clopidogrel, Surgery, Cytochrome P-450 CYP2C19, lcsh:RC666-701, Coronary care unit, General Earth and Planetary Sciences, Female, Aryl Hydrocarbon Hydroxylases, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background: Clopidogrel requires oxidation dependent on the cytochrome P450 enzyme 2C19 (CYP2C19) to form its active metabolite. The importance of loss-of-function alleles (particularly CYP2C19*2, 681G>A) in poor platelet response to clopidogrel is well recognized. Objective: To investigate the prevalence and prognostic impact of the CYP2C19*2 allele in a local acute coronary syndrome (ACS) population. Methods: We performed a prospective, longitudinal study of 95 patients admitted for an ACS between March and October 2009 to a single coronary care unit. Patients aged under 75 who survived hospital stay and for whom clopidogrel was prescribed were included. At discharge, CYP2C19 was genotyped using a commercially available kit. Patients were divided into two groups: Group A (non-carriers, normal metabolizers, CYP2C19*1/*1), n = 69; and Group B (carriers, slow metabolizers, CYP2C19*2/*1 or *2/*2), n = 26. The primary endpoint was a combined outcome of cardiovascular death, non-fatal myocardial infarction or re-admission for unstable angina; median follow-up was 136.0 (79.0–188.0) days. Results: The median age of the population was 62.0 (51.0–68.0) years, and 83.2% were male. The CYP2C19*2 (A) allele had a frequency of 14.2%. There were no differences between the groups with respect to demographic data or history of cardiovascular disease. Coronary anatomy, left ventricular ejection fraction and renal function were also similar. The groups were also homogenous with respect to GRACE risk score (118.0 (95.0–136.5) vs. 115.0 (96.0–133.0), p = 0.68), medical treatment and percutaneous revascularization during hospital stay. Event-free survival was higher for Group A (94.0% vs. 75.0%, log-rank p = 0.010). Three readmissions for MI were documented, all in the slow metabolizers group. Conclusion: In our ACS population, the CYP2C19*2 allele was a medium-term prognostic marker. Resumo: Introdução: Polimorfismos no complexo enzimático P450, como CYP2C19*2, 681G>A parecem estar na base de fraca resposta ao clopidogrel. Objectivo: Caracterizar a prevalência e o impacto prognóstico do alelo CYP2C19*2(A) numa população local de doentes com síndrome coronária aguda (SCA). População e métodos: Estudo longitudinal, prospectivo, de 95 doentes admitidos por SCA entre Março e Outubro de 2009. Foram incluídos doentes com idade inferior a 75 anos, que sobreviveram à hospitalização, e que tiveram alta medicados com clopidogrel. Foi determinado o genótipo do alelo CYP2C19 no momento da alta hospitalar. Foram criados dois grupos; grupo A (metabolizadores normais, CYP2C19 *1/*1) n = 69 e grupo B (metabolizadores lentos, CYP2C19 *2/*1 ou *2/*2) n = 26. No seguimento foi analisado um resultado combinado de morte cardiovascular, enfarte agudo do miocárdio não fatal, e readmissão por angina instável (tempo mediano de seguimento: 136 (79–188) dias. Resultados: A idade mediana da população era de 62,0 (51,0–68,0) anos, e 83,2% eram do género masculino. O alelo CYP2C19*2(A) teve uma frequência de 14,2%. Não existiram diferenças entres os grupos relativamente a dados demográficos, e antecedentes cardiovasculares. A anatomia coronária, a fracção de ejecção ventricular esquerda e a função renal eram semelhantes. Os grupos eram também homogéneos relativamente ao score GRACE (118,0 (95,0–136,5) versus 115,0 (96,0–133,0), p = 0,68), tratamento médico e taxa de revascularização percutânea durante hospitalização. No final do seguimento clínico a sobrevida livre de eventos foi superior para o grupo A (94,0% versus 75,0%, log rank p = 0,010). Foram documentadas três readmissões por enfarte agudo do miocárdio, todas no grupo B. Conclusões: Na população referida, o alelo CYP2C19*2 (A) foi um marcador de prognóstico a médio prazo. Keywords: CYP2C19*2, Clopidogrel, Acute coronary syndromes, Prognosis, Palavras-chave: CYP2C19*2, Clopidogrel, Síndrome coronária aguda, Prognóstico
Published: 2012
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39. Hemoglobina: um mero valor analítico ou um poderoso preditor de risco em doentes com síndromes coronárias agudas?

Author: Luís A. Providência, Natália António, Mário Freitas, Lino Gonçalves, ME Ferreira, Pedro Monteiro, and Francisco Gonçalves
Subjects: Gynecology, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, business.industry, lcsh:RC666-701, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Resumo: Introdução: A anemia tem sido associada a um pior prognóstico, e particularmente a uma mortalidade mais elevada em diversas condições patológicas. Contudo, poucos estudos analisaram especificamente o seu impacto a curto e a longo prazo, em doentes com Síndrome Coronária Aguda. Este artigo tem como objetivo analisar a associação entre diferentes quartis de hemoglobina na admissão hospitalar e o prognóstico a curto e a longo prazo em doentes com síndrome coronária aguda. População e métodos: Estudo retrospetivo de 1303 doentes consecutivamente admitidos com síndrome coronária aguda numa unidade de cuidados intensivos coronários, procurando analisar a associação entre os níveis basais de hemoglobina e a morbilidade e mortalidade intra-hospitalar e num seguimento clínico de 12 meses. Esta população de doentes foi dividida em quartis de concentração da hemoglobina ([Hb]): Q1: 1, e os preditores de mortalidade no follow-up foram: idade ≥ 69,5 anos, classe Killip na admissão> 1, diabetes mellitus, existência de depressão do segmento ST no ECG de admissão hospitalar e uma concentração de hemoglobina inferior a 10,8 g/dL. Discussão e conclusões: Em doentes com síndromes coronárias agudas, os valores mais baixos de hemoglobina encontram-se frequentemente associados a outras comorbilidades, mas por si só, a anemia parece ser um preditor independente de mortalidade um ano após uma síndrome coronária aguda. Abstract: Introduction: Anemia has been shown to be associated with a worse prognosis, especially higher mortality in various pathological conditions. However, few studies have specifically examined its impact in acute coronary syndrome (ACS) patients. The purpose of our study was to assess the association between different quartiles of hemoglobin on admission and short- and long-term prognosis in patients with ACS. Methods: We performed a retrospective analysis of 1303 consecutive ACS patients admitted to a coronary care unit and analyzed the association between baseline hemoglobin and morbidity and mortality, in-hospital and at 12-month follow-up. The population was divided into groups according to quartiles of hemoglobin concentration (Hb): Q1: 1 at admission. The independent predictors of long-term mortality were age ≥69.5 years, Killip class >1 at admission, diabetes mellitus, ST-segment depression on admission ECG and Hb
Published: 2012

40. Implicações prognósticas da pressão telediastólica do ventrículo esquerdo nas síndromes coronárias agudas com fracção de ejecção maior ou igual a 40%

Author: Rui Baptista, Luís A. Providência, Mário Freitas, Pedro Monteiro, Elisabete Jorge, Rogério Teixeira, Fátima Saraiva, Carolina Lourenço, Paulo Mendes, Francisco Gonçalves, Maria João Ferreira, and Sílvia Monteiro
Subjects: Gynecology, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, lcsh:RC666-701, business.industry, medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Resumo: Introdução: Permanecem dúvidas sobre o impacto prognóstico a longo prazo da pressão telediastólica do ventrículo esquerdo (PTDVE) no contexto de uma síndrome coronária aguda (SCA). Objectivo: Caracterizar a PTDVE e o seu impacto prognóstico numa população de doentes com SCA e fracção de ejecção ventricular esquerda (FEVE) ≥ a 40%. População e métodos: Estudo prospectivo, longitudinal e contínuo de 1329 doentes admitidos (n = 489) numa unidade de cuidados intensivos coronários entre 2004 e 2006. Foram seleccionados os doentes submetidos a uma estratégia invasiva, no qual foi determinada a PTDVE, com FEVE ≥ 40%. A população foi divida em três grupos: A — PTDVE ≤ 19 mmHg (n = 186); grupo B — PTDVE > 19 ≤ 27 mmHg (n = 172) e; grupo C — PTDVE > 27 mmHg (n = 131). O resultado primário desta análise foi a readmissão por insuficiência cardíaca congestiva (ICC) no ano seguinte à SCA. Resultados: A PTDVE média da população foi de 22,8 mmHg ± 7,8 mmHg. Os grupos eram homogéneos entre si no que disse respeito ao género, idade, factores de risco cardiovascular, história cardiovascular e medicação prévia à admissão. Quanto maior a PTDVE maior a probabilidade de uma admissão por enfarte agudo do miocárdio com supradesnivelamento do segmento ST (35,4 versus 45,9 versus 56,7%, p 40% were excluded (n = 489). The population was divided into three groups: A — LVEDP ≤19 mmHg (n = 186); B — LVEDP >19 and ≤27 mmHg (n = 172); and C — LVEDP >27 mmHg (n = 131). The primary endpoint of the analysis was readmission for congestive heart failure in the year following the index admission. Results: Mean LVEDP was 22.8 ± 7.8 mmHg. The groups were similar age, gender, cardiovascular risk factors, cardiovascular history, and medication prior to admission. There was an association between higher LVEDP and: admission for ST-elevation acute myocardial infarction (35.4 vs. 45.9 vs. 56.7%, p
Published: 2011
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41. ¿Podemos mejorar la evolución de los pacientes con antecedentes de cirugía de bypass coronario ingresados por un síndrome coronario agudo?

Author: Fátima Saraiva, Francisco Rocha Gonçalves, Rui Baptista, Luís A Providência, Natália António, Mário Freitas, Paulo Mendes, Carolina Lourenço, Sílvia Monteiro, Rogério Teixeira, Pedro Monteiro, and Elisabete Jorge
Subjects: Gynecology, medicine.medical_specialty, business.industry, medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Introduccion y objetivos. El pronostico y el tratamiento en el hospital de los pacientes con sindrome coronario agudo (SCA) y antecedentes de cirugia de bypass coronario (CABG) es motivo de controversia. El objetivo de este estudio es caracterizar a los pacientes con SCA que tienen antecedentes de CABG y comparar su evolucion intrahospitalaria y extrahospitalaria con la de los pacientes sin antecedentes de CABG. Metodos. Estudio prospectivo observacional continuo de 1.495 ingresos consecutivos por SCA en una misma unidad coronaria, con un seguimiento medio de 19 meses. Se dividio a los pacientes en dos grupos: grupo A (n = 73) con CABG previa y grupo B (n = 1.223) sin CABG previa. Resultados. Los pacientes del grupo A eran con mayor frecuencia varones (el 86,3 frente al 69,1%; p = 0,002), tenian antecedentes mas frecuentes de diabetes mellitus, infarto de miocardio previo e insuficiencia cardiaca. Los pacientes del grupo B tenian mas infartos agudos de miocardio con elevacion del ST, una fraccion de eyeccion mas alta (53% [47%-60%] frente a 50% [42%-55%]; p < 0,01) y valores superiores de concentracion maxima de troponina I. No se observaron diferencias en cuanto al uso de una estrategia invasiva. Por lo que respecta a la medicacion, los pacientes del grupo B tenian una mayor probabilidad de recibir doble tratamiento antiagregante al alta. No se observaron diferencias significativas en cuanto a la mortalidad hospitalaria (el 9,5 frente al 5,9%; p = 0,2) ni en la mortalidad a 1 mes, 6 meses o 1 ano (el 9,8 frente al 9,1%; log-rank test, p = 0,87), y la ausencia acumulativa de eventos adversos cardiovasculares mayores fue tambien similar en ambos grupos. Los antecedentes de CABG se asociaron a una mayor frecuencia de reingresos por angina inestable (el 11,3 frente al 3,1%; p < 0,01). Conclusiones. En nuestra poblacion con SCA, el antecedente de CABG no influyo de manera significativa en la evolucion a corto y medio plazo en cuanto a la mortalidad por cualquier causa o eventos adversos cardiovasculares mayores.
Published: 2010
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42. Magnitud de la variación de la glucemia: ¿un nuevo instrumento para la evaluación del riesgo en el síndrome coronario agudo?

Author: Francisco Rocha Gonçalves, Sílvia Monteiro, Luís A Providência, Mário Freitas, and Pedro Monteiro
Subjects: business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract: Introduccion y objetivos Evaluar la relacion entre la magnitud de la variacion de la glucemia durante la hospitalizacion y la mortalidad hospitalaria y a largo plazo y otras variables de valoracion posteriores al alta, en dos poblaciones con sindrome coronario agudo: pacientes con o sin diagnostico previo de diabetes. Metodos Estudiamos a 1.210 pacientes ingresados por sindrome coronario agudo entre mayo de 2004 y julio de 2007. Dividimos la poblacion en dos subgrupos: pacientes con un diagnostico previo de diabetes (n = 386) y pacientes no diabeticos (n = 824). Cada una de estas subpoblaciones se dividio en cuatro grupos, segun los cuartiles de variacion de la glucemia: diabeticos (Q1 Resultados En los pacientes diabeticos no hubo relacion alguna entre la magnitud de variacion de la glucemia y las variables de valoracion intrahospitalarias y posteriores al alta. En los no diabeticos, no se observaron diferencias significativas en cuanto a la morbimortalidad hospitalaria, pero si hubo diferencias estadisticamente significativas en el seguimiento clinico. Tras un analisis de regresion multiple, el cuartil Q4 frente al Q1, la edad ≥ 70 anos y los antecedentes previos de tratamiento con antiagregantes plaquetarios o con inhibidores de la enzima de conversion de angiotensina fueron factores predictivos independientes para las variables de valoracion posteriores al alta en el grupo no diabetico. Conclusiones En los pacientes con sindrome coronario agudo no diabeticos, la magnitud de variacion de la glucemia durante la hospitalizacion es un factor predictivo independiente y potente de las variables de valoracion posteriores al alta.
Published: 2009
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43. Glycemia at admission: the metabolic echocardiography in acute coronary syndrome patients

Author: Natália António, Luis A. Providěncia, Francisco Q. Gonçalves, Pedro Monteiro, Mário Freitas, and Sílvia Monteiro
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Time Factors, Epidemiology, Population, Stress hyperglycemia, Risk Assessment, Ventricular Dysfunction, Left, Patient Admission, Predictive Value of Tests, Risk Factors, Internal medicine, Odds Ratio, medicine, Humans, Hospital Mortality, Myocardial infarction, Acute Coronary Syndrome, education, Aged, Ultrasonography, education.field_of_study, Unstable angina, business.industry, Mortality rate, Age Factors, Middle Aged, medicine.disease, Logistic Models, Treatment Outcome, Hyperglycemia, Heart failure, Coronary care unit, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Ventricular dysfunction in acute coronary syndrome (ACS) patients is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, hyperglycemia at admission has been considered as an important marker of poor in-hospital prognosis.To characterize an ACS population and to identify independent predictors of one-year mortality.This study included 1179 consecutive patients admitted to a single coronary care unit for acute coronary syndrome between May 2004 and December 2006. Patients were followed up for 12 months after ACS.In our population, 70.9% of patients were male, with a mean age of 66.6+/-12.5 years; 15.7% were admitted by unstable angina, 44.7% by non-ST elevation myocardial infarction and 38.5% by ST elevation myocardial infarction; 16% of patients had left ventricular systolic dysfunction during the index admission. In-hospital mortality was 3.5% and complications occurred in 5.6% of patients. Mortality rate at 1-year of follow-up was 8.8% and rehospitalization rate for heart failure was 5.5%. After multivariate regression analysis, left ventricular systolic dysfunction [odds ratio (OR): 3.58; confidence interval (CI): 1.57-8.16], glycemia at admission137 mg/dl (OR: 3.58; CI: 1.52-8.47) and age65 years (OR: 2.67; CI: 1.08-6.59) were independent predictors of 1-year mortality.In this population, hyperglycemia at admission was an independent predictor of 1-year mortality, with a predictive value equivalent to that of left ventricular systolic dysfunction. This fact, never before described, emphasizes the importance of metabolic abnormalities and their control in the prognosis of ACS patients.
Published: 2009
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44. Pulmonary vascular remodeling in mitral valve disease: An optical coherence tomography study

Author: Elisabete Jorge, Pedro Monteiro, João Calisto, Rui Baptista, Mariano Pego, Cristina Silva, Manuel Pan, and Faria H
Subjects: Male, medicine.medical_specialty, Disease, 030204 cardiovascular system & hematology, Pulmonary Artery, Vascular Remodeling, 03 medical and health sciences, 0302 clinical medicine, Mitral valve stenosis, Optical coherence tomography, Internal medicine, Mitral valve, medicine.artery, medicine, Humans, Mitral Valve Stenosis, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Pulmonary hypertension, medicine.anatomical_structure, 030228 respiratory system, Pulmonary artery, Vascular resistance, Cardiology, Female, Radiology, Cardiology and Cardiovascular Medicine, Wall thickness, business, Tomography, Optical Coherence
Published: 2015

45. Carvedilol: Just Another Beta-Blocker or a Powerful Cardioprotector?

Author: Pedro Monteiro, Providência La, R.S. Carreira, and Lino Gonçalves
Subjects: Chronotropic, Inotrope, medicine.medical_specialty, Cardiotonic Agents, Heart disease, medicine.drug_class, Adrenergic beta-Antagonists, Carbazoles, Myocardial Reperfusion Injury, Pharmacology, Antioxidants, Mitochondria, Heart, Oxidative Phosphorylation, Propanolamines, Internal medicine, medicine, Animals, Humans, Carvedilol, Beta blocker, Cardioprotection, Cardiotoxicity, Antibiotics, Antineoplastic, business.industry, Hematology, General Medicine, medicine.disease, Adrenergic beta-1 Receptor Antagonists, Doxorubicin, Heart failure, Cardiology, Molecular Medicine, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Beta-blockers have been used to treat ischemic heart disease, due to negative chronotropic and inotropic properties, thus inducing a decrease in myocardial consumption of oxygen and nutrients, allowing a better balance between nutritional needs and the supply provided by the coronary blood flow. Recent developments in cell biology allowed us to understand that not all beta-blockers are equal, as their intracellular mechanisms of action can be very different. This paper will focus on carvedilol, a non-selective beta-blocker with alfa-blocker properties, currently used to treat hypertension, heart failure and coronary artery disease. Effects of carvedilol on cardiac mitochondria, their relation to its antioxidant properties, and how these can improve cardiomyocyte resistance to aggression and cardiac function will be discussed. We will begin by depicting the effect of carvedilol on mitochondrial parameters, namely oxidative phosphorylation, calcium homeostasis and energy production. Then we will focus on the mitochondrial permeability transition (MPT) and how the antioxidant properties of carvedilol can be used to minimize oxidative stress, a powerful inducer of MPT. Carvedilol will also be highlighted as an enzyme modulator, focusing on its importance to prevent doxorubicin (DOX) cardiotoxicity. The mitochondrial-related mechanism of cardioprotection involving carvedilol will also be addressed, as we will discuss some clinical pieces of evidence showing the importance of mechanisms previously depicted. In conclusion, based upon its molecular mechanisms of action, carvedilol seems to be a unique beta-blocker. These unique characteristics can help us understand the positive impact of carvedilol on the prognosis of patients with heart disease.
Published: 2006
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46. Newly identified synergy between clopidogrel and calcium-channel blockers for blood pressure regulation possibly involves CYP2C19 rs4244285

Author: Maria G. Stathopoulou, Sophie Visvikis-Siest, Nathalie Thilly, Said El Shamieh, Luís S. Santos, Gérard Siest, Pedro Monteiro, Eva M Peñas-Lledó, Payman Shahabi, Adrián LLerena, Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Faculty of Medicine, University of Coimbra, 3000, Hospital of the University of Coimbra, Universidad de Extremadura (UEX), Portuguese Catholic University, Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Gériatrie [CHRU Nancy], and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
Subjects: Adult, Male, Acute coronary syndrome, medicine.medical_specialty, Ticlopidine, medicine.medical_treatment, Myocardial Infarction, Hemodynamics, 030204 cardiovascular system & hematology, CYP2C19 polymorphism, Angina, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, Humans, Medicine, Angina, Unstable, Myocardial infarction, ComputingMilieux_MISCELLANEOUS, Aged, 030304 developmental biology, Calcium-channel blockers, 0303 health sciences, business.industry, Percutaneous coronary intervention, Drug Synergism, Middle Aged, Calcium Channel Blockers, medicine.disease, Clopidogrel, 3. Good health, Cytochrome P-450 CYP2C19, Synergy, Blood pressure, [SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics, Anesthesia, Cardiology, Female, Aryl Hydrocarbon Hydroxylases, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: coronary revascularization in the elderly. Eur Heart J 2006;27(14):1690–8. [7] Moore R, Pedel S, Lowe R, PerryR. Health-related quality of life followingpercutaneous coronary intervention: the impact of age on outcome at 1 year. Am J Geriatr Cardiol 2006;15(3):161–4. [8] Agarwal S, Schechter C, Zaman A. Assessment of functional status and quality of life after percutaneous coronary revascularisation in octogenarians. Age Ageing 2009;38(6):748–51. [9] Shah P, Najafi AH, Panza JA, Cooper HA. Outcomes and quality of life in patients N or =85 years of age with ST-elevation myocardial infarction. Am J Cardiol 2009;103(2):170–4. [10] Li R, Yan BP, DongM, et al. Quality of life after percutaneous coronary intervention in the elderly with acute coronary syndrome. Int J Cardiol 2012;155(1):90–6.
Published: 2013
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47. LBPS 02-52 EFFECT OF EMPAGLIFLOZIN ON HEART FAILURE OUTCOMES IN SUBGROUPS BY AGE

Author: Hans-Juergen Woerle, Dae Wook Lee, Stefan Hantel, Douglas Clark, Silvio E. Inzucchi, David Fitchett, and Pedro Monteiro
Subjects: 0301 basic medicine, medicine.medical_specialty, Physiology, business.industry, 030209 endocrinology & metabolism, medicine.disease, Outcome (game theory), 03 medical and health sciences, chemistry.chemical_compound, 030104 developmental biology, 0302 clinical medicine, chemistry, Internal medicine, Heart failure, Internal Medicine, medicine, Empagliflozin, Cardiology and Cardiovascular Medicine, business, EMPA
Published: 2016
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48. Exercise-induced pulmonary hypertension in scleroderma patients: a common finding but with elusive pathophysiology

Author: Manuel Gomes, Rui Martins, Sara Serra, M. Pego, Graça Castro, José António Pereira da Silva, Maria João Salvador, Lèlita Santos, Rui Baptista, and Pedro Monteiro
Subjects: Male, Cardiac output, medicine.medical_specialty, Hypertension, Pulmonary, Diastole, Sensitivity and Specificity, Diagnosis, Differential, Esclerodermia Sistémica, medicine.artery, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Pulmonary wedge pressure, Scleroderma, Systemic, business.industry, Reproducibility of Results, Middle Aged, medicine.disease, Pulmonary hypertension, medicine.anatomical_structure, Blood pressure, Ventricle, Echocardiography, Pulmonary artery, Vascular resistance, Cardiology, Exercise Test, Teste de Esforço, Female, Cardiology and Cardiovascular Medicine, business, Hipertensão Pulmonar, Ecocardiografia
Abstract: BACKGROUND: The etiology of exercise-induced pulmonary hypertension (exPH) in systemic sclerosis (SSc) remains a complex task, as both left ventricle (LV) diastolic dysfunction and pulmonary vascular disease can contribute to its development. We determined the incidence of exPH in SSc and examined the association between pulmonary artery systolic pressure (PASP) and tissue Doppler-derived indexes of pulmonary capillary wedge pressure (PCWP). METHODS: Thirty-eight patients with SSc were studied, using a cycloergometer protocol; 10 were excluded due to resting PH or absence of tricuspid regurgitation (TR); TR and mitral E-wave velocities, LV outflow tract time-velocity integral and LV septal E'-wave were measured before and in peak exercise to calculate cardiac output (CO), PCWP and pulmonary vascular resistance (PVR). RESULTS: Mean age of diagnosis was 57.9 ± 8.9 years. At a mean workload of 64 ± 29 Watts, 48% of patients increased PASP ≥ 50 mmHg. PCWP, assessed by the E/e' ratio, did not change significantly during exercise (10.2 ± 3.1-10.0 ± 5.1; P = NS). Only 3 patients had elevations of the E/e' ratio ≥ 13 during exercise; 2 of them had an exercise PASP ≥ 50 mmHg, yielding a proportion of exPH due to elevated LV filling pressures of 2/11 (18%). Patients with exPH had lower DLCO and had more frequently the diffuse SSc. CONCLUSION: The elevation of PASP during exercise in most patients of this cohort seems to be related to a reduced pulmonary vascular reserve, and not to an increase in PCWP. Further studies are warranted to determine the therapeutic, as well as prognostic implications of these findings. info:eu-repo/semantics/publishedVersion
Published: 2012

49. Databases in cardiology: From intervention to information

Author: Pedro Monteiro
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, lcsh:RC666-701, Cardiology and Cardiovascular Medicine, Cardiologia
Published: 2012

50. Mean pulmonary arterial pressure after percutaneous mitral valvuloplasty predicts long-term adverse outcomes

Author: Rui Baptista, Luís A Providência, Faria H, João Calisto, Vítor Matos, Elisabete Jorge, Lino Gonçalves, and Pedro Monteiro
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Time Factors, Population, Blood Pressure, Pulmonary Artery, Catheterization, Estenose da Válvula Mitral, Internal medicine, medicine.artery, Mitral valve, medicine, Humans, Mitral Valve Stenosis, Prospective Studies, Prospective cohort study, education, General Environmental Science, education.field_of_study, Proportional hazards model, business.industry, Middle Aged, Prognosis, medicine.disease, Stenosis, Blood pressure, medicine.anatomical_structure, lcsh:RC666-701, Heart failure, Pulmonary artery, Cardiology, General Earth and Planetary Sciences, Female, Cardiology and Cardiovascular Medicine, business, Hipertensão Pulmonar, Follow-Up Studies
Abstract: Introduction and aim: Percutaneous mitral valvuloplasty (PMV) is an effective treatment option for mitral stenosis (MS), but its success is assessed on the basis of clinical and echocardiographic outcomes in studies with relatively short follow-up. We aimed to characterize a cohort of patients undergoing PMV with long-term follow-up and to determine independent predictors of post-PMV mitral re-intervention and event-free survival. Methods: We studied 91 consecutive patients with MS who underwent PMV with a median clinical follow-up duration of 99 months. Two endpoints were considered: post-PMV mitral re-intervention (PMV or mitral surgery) and a composite clinical events endpoint including cardiovascular death, mitral valve re-intervention and hospital admission due to decompensated heart failure. We compared patients who required post-PMV mitral re-intervention with those who did not during follow-up. Results: The study population included 83.5% females and mean age was 48.9 ± 13.9 years. The 1-, 3-, 5-, 7- and 9-year rates of clinical event-free survival were 93.0 ± 2.8%, 86.0 ± 3.9%, 81.0 ± 4.4%, 70.6 ± 5.6%, and 68.4 ± 5.8%, respectively. The 1-, 3-, 5-, 7- and 9-year rates of mitral re-intervention-free survival were 98.8 ± 1.2%, 97.5 ± 1.7%, 92.1 ± 3.1%, 85.5 ± 4.5%, and 85.5 ± 4.5%, respectively. The median time to mitral re-intervention was 6.2 years. Patients who required mitral re-intervention during follow-up were younger (43.3 vs. 51.2 years, p=0.04) and had higher pre- and post-PMV mitral gradient (14.9 vs. 11.5 mmHg, p=0.02 and 6.4 vs. 2.1 mmHg, p
Published: 2012

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