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Introduction and Aims: Cardiac allograft vasculopathy (CAV) is one of the most significant complications after orthotopic heart transplantation. We aimed to investigate the incidence and predictors of CAV in a large cohort of orthotopic heart transplantation patients. Methods: We conducted a retrospective analysis on a prospective cohort of 233 patients who underwent transplantation between November 2003 and May 2014. Baseline clinical data and invasive coronary angiograms (n=712) performed as part of the follow-up program were analyzed by two independent investigators. Results: We included 157 male and 45 female patients with a median age of 66 years. A third of patients had previous ischemic heart disease, 30% peripheral arterial disease, 37% hypertension and 47% dyslipidemia, and 17% were smokers. Acute moderate or severe rejection occurred in 42 patients during the first year. Over a median follow-up of 2920 days, 18% were diagnosed with CAV, with an incidence of 2.91 cases per 100 person-years. Predictors of CAV were previous ischemic heart disease (HR 2.32, 95% CI 1.21-4.45, p=0.01), carotid artery disease (HR 2.44, 95% CI 1.27-4.71, p

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020 Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2021-02-26T12:33:16Z No. of bitstreams: 1 BiancaICorreia.pdf: 1087455 bytes, checksum: 6d7e843b41880910dd68528d9b103319 (MD5) Made available in DSpace on 2021-02-26T13:07:01Z (GMT). No. of bitstreams: 1 BiancaICorreia.pdf: 1087455 bytes, checksum: 6d7e843b41880910dd68528d9b103319 (MD5) Previous issue date: 2020-06-19

The role of visceral obesity in atherosclerosis is well recognized by the medical community. On the contrary, the importance of skeletal muscle is almost unknown. Muscle is nowadays understood as an endocrine organ producing myokines with direct action in several physiological and pathological pathways, including atherosclerosis. The myokines reduce the formation of neointima, expression of inflammatory mediators, the recruitment of inflammatory cells and the formation of foam cells. Epidemiological studies are demonstrating the association between reduced muscle mass and cardiovascular atherosclerotic disease. Low muscle mass is associated with an increased prevalence of coronary heart disease, aortic calcification, carotid atherosclerosis, carotid intima-media thickness, intracranial artery stenosis and endothelial dysfunction. In this way resistance training, which increases the muscle size and strength may have a key role in atherosclerosis while endurance training alone might not. The time and type of protein intake by older adults may be critical to the maintenance of muscle mass and to the increase survival. The objective of this paper was to perform a review about the published literature in the last 13 years about the role of skeletal muscle in atherosclerosis., Angiologia e Cirurgia Vascular, Vol 15 No 2 (2019): June

Introduction: Acute carotid stent thrombosis (ACST), defined according to the Academic Research Consortium as occurring in the first 24 hours after the procedure, is described as an exceedingly rare complication of CAS but it can lead to catastrophic neurologic consequences. The European Society for Vascular Surgery updated guidelines state thrombolysis and intravenous abciximab may be effective, but provide no specific recommendations. Given the lack of data concerning the optimal management, the purpose of this review was to evaluate the current literature and report on ACST aetiology and management strategies. Methods: Literature review was performed in the MEDLINE database. Results: No data on ACST is evident in large randomized controlled trials. ACST incidence rate ranges from 0.5-0.8%, reaching as high as 33% in acute-setting. Considering aetiology, it can be subdivided into 2 main groups: systemic causes and technical complications. In the first antiplatelet non-compliance/resistance were the most reported while in the latter carotid artery dissection and plaque protrusion were the most common causes. Also, dual layer stents were associated with greater risk for ACST There are three main approaches for ACST: pharmacologic, endovascular and surgical. Pharmacologic management included anticoagulation, thrombolysis and facilitated thrombolysis. A role for thrombolysis and facilitated thrombolysis is still to be determined. Endovascular treatment was the most common approach to intraprocedural ACST: mechanical thrombectomy with or without concomitant facilitated thrombolysis. Surgical options included carotid endarterectomy with stent explantation which was a bail-out after failed endovascular treatment with excellent recanalization rates. In asymptomatic ACST conservative management with anticoagulation was unanimous. Discussion: As a conclusion, ACST is probably an underestimated clinical entity associated with multiple risk factors. Decision on the best approach depends if ACST occurs intraprocedural or afterwards, on the development of neurologic status deterioration and on centre��s experience. Additional studies must be undertaken to better define optimal management., Angiologia e Cirurgia Vascular, Vol 14 No 4 (2018): December

EBMSP – Escola Baiana de Medicina e Saúde Pública; FBDC – Fundação Baiana para o Desenvolvimento das Ciências; CRDC – Centro de Referência em Doenças Cárdio-Vasculares Dr Adriano Pondé; SCMBA / HSI – Santa Casa de Misercórdia da Bahia / Hospital Santa Izabel. Justificativa e Objetivos: os eventos cardiovasculares representam significativa causa de morbi-mortalidade na população em geral. Quando se considera pacientes diabéticos em especial com doença renal crônica, as estatísticas apontam acidente vascular cerebral e doença coronariana como as maiores causas de óbito e morbidade. . O objetivo deste estudo foi avaliar a doença renal crônica como fator de risco independente para presença de doença carotídea numa população de diabéticos atendidos num serviço secundário de atenção à saúde do SUS, de acordo com a sua função renal. Método: Trata-se de um estudo de corte transversal analítico, abrangendo um total de 120 pacientes atendidos consecutivamente para realização de Duplex-scan de Carótidas e Vertebrais no período de Fevereiro de 2012 a Dezembro de 2013. Em relação à doença renal adotou-se ClCr de 60 ml/min calculado através da fórmula de Cockcroft e Gault como ponto de corte para dicotomização da amostra e assim encontrando-se 65% da amostra (78 indivíduos) com ClCr≥60ml/min e 35% (42 indivíduos) com ClCr

Introdução: As hipodensidades da substância branca de provável etiologia vascular, são uma causa importante de morbilidade, condicionando deterioração cognitiva. No entanto, numerosas dúvidas persistem quanto à sua fisiopatologia. O objectivo deste estudo é clarificar o papel da aterosclerose carotídea e outros factores de risco vascular no desenvolvimento das hipodensidades da substância branca de provável etiologia vascular. Material e Métodos: Realizou-se uma avaliação imagiológica, por tomografia computadorizada crânio-encefálica e ecografia carotídea, com menos de um mês de intervalo. Procedeu-se à recolha de informação sobre os factores de risco vascular. Determinámos associações independentes entre hipodensidades da substância branca de provável etiologia vascular, espessura da íntima média carotídea, estenose carotídea ateromatosa e factores de risco vascular. Resultados: Foram incluídos 472 doentes, idade média de 67,32 (DP: 14.75), 274 (58,1%) sexo masculino. Os preditores independentes da hipodensidades da substância branca de provável etiologia vascular foram: idade (OR: 1,067, 95% IC: 1,049 – 1,086, p < 0,001) e a hipertensão (OR: 1,726, 95% IC: 1,097 – 2,715, p = 0,018). Não foi encontrada uma associação entre a espessura da intima média carotídea (OR: 2,613, 95% IC: 0,886 – 7,708, p = 0,082) ou grau de estenose carotídea (OR: 1,021, 95% IC: 0,785 – 1,328, p = 0,877) e hipodensidades da substância branca de provável etiologia vascular. Discussão: Dos diversos factores de risco analisados, apenas a idade e hipertensão se associaram de forma independente às hipodensidades da substância branca de provável etiologia vascular. Não foi encontrada uma relação entre a aterosclerose extracraniana, expressa pela espessura do complexo intima-média ou grau de estenose, com o desenvolvimento de hipodensidades da substância branca de provável etiologia vascular. Sendo a aterosclerose um fenómeno sistémico, estes achados sugerem que as hipodensidades da substância branca de provável etiologia vascular, tenham um mecanismo alternativo ou concorrente à aterosclerose no seu desenvolvimento. Conclusão: Os dados deste estudo, sugerem que a idade e hipertensão sejam os principais factores de risco no desenvolvimento de hipodensidades da substância branca de provável etiologia vascular. Não foi encontrada uma associação independente entre a aterosclerose carotídea e as hipodensidades da substância branca de provável etiologia vascular. Introduction: White matter hypodensities of presumed vascular origin, are recognized as an important cause of morbidity with established clinical and cognitive consequences. Nonetheless, many doubts remain on its physiopathology. Our goal is to clarify the potential role of carotid atherosclerosis and other vascular risk factors in the development of white matter hypodensities of presumed vascular origin. Material and Methods: We included patients that underwent CT brain scan and neurosonologic evaluation within a one-month period. Full assessment of vascular risks factors was performed. We seek to find independent associations between white matter hypodensities of presumed vascular origin, carotid intima-media thickness and vascular risk factors. Results: 472 patients were included, mean age was 67.32 (SD: 14.75), 274 (58.1%) were male. The independent predictors of white matter hypodensities of presumed vascular origin were age (OR: 1.067, 95% IC: 1.049 – 1.086, p < 0.001) and hypertension (OR: 1.726, 95% IC: 1.097 – 2.715, p = 0.018). No association was found between IMT (OR: 2.613, 95% IC: 0.886 – 7.708, p = 0.082) or carotid artery stenosis (OR: 1.021, 95% IC: 0.785 – 1.328, p = 0.877) and white matter hypodensities of presumed vascular origin. Discussion: Only age and hypertension proved to have an independent association with white matter hypodensities of presumed vascular origin. Carotid atherosclerosis, evaluated by IMT and the degree of carotid artery stenosis, showed no association with white matter hypodensities of presumed vascular origin. Since atherosclerosis is a systemic pathology, these results suggest that alternative mechanisms are responsible for the development of white matter hypodensities of presumed vascular origin. Conclusion: Age and hypertension seem to be the main factors in the development of white matter hypodensities of presumed vascular origin. No association was found between carotid atherosclerosis and white matter hypodensities of presumed vascular origin.

Com finalidade de orientar e oferecer subsídios para a conduta diagnóstica e terapêutica em diferentes situações dentro das doenças cerebrovasculares, a Sociedade Brasileira de Doenças Cerebrovasculares constituiu um comitê composto por especialistas de diferentes áreas do Brasil, que emitiram um parecer, denominado "Opinião Nacional", redigido nos moldes dos consensos. O presente artigo analisa a "Doença Carotídea na Fase Aguda do AVC", abordando separadamente os seguintes tópicos: métodos de detecção de estenose carotídea na fase aguda; quando e como intervir sobre a carótida na fase aguda; tratamento clínico e marcadores de inflamação. São apresentados os comentários, baseados na literatura e na opinião pessoal dos participantes, e é descrito, como conclusão em cada item, a opinião do grupo. The Brazilian Stroke Society constituted a committee composed by specialists from different areas of Brazil that emitted a viewpoint called "National Opinion", in a consensus pattern. The study purpose is to guide and offer subsidies for diagnosis and therapeutical plans for different situations in cerebrovascular disease The present article analyzes "carotid disease in the acute phase of stroke", approaching separately the following topics: methods for detection of carotid stenosis in acute phase; when and how intervene on the carotid during the acute phase; clinical treatment and inflammatory markers. Comments based on literature and participants personal opinion are described, and conclusion are the group opinion.

INTRODUCTION: White matter hypodensities of presumed vascular origin, are recognized as an important cause of morbidity with established clinical and cognitive consequences. Nonetheless, many doubts remain on its physiopathology. Our goal is to clarify the potential role of carotid atherosclerosis and other vascular risk factors in the development of white matter hypodensities of presumed vascular origin. MATERIAL AND METHODS: We included patients that underwent CT brain scan and neurosonologic evaluation within a one-month period. Full assessment of vascular risks factors was performed. We seek to find independent associations between white matter hypodensities of presumed vascular origin, carotid intima-media thickness and vascular risk factors. RESULTS: 472 patients were included, mean age was 67.32 (SD: 14.75), 274 (58.1%) were male. The independent predictors of white matter hypodensities of presumed vascular origin were age (OR: 1.067, 95% IC: 1.049 - 1.086, p < 0.001) and hypertension (OR: 1.726, 95% IC: 1.097 - 2.715, p = 0.018). No association was found between IMT (OR: 2.613, 95% IC: 0.886 - 7.708, p = 0.082) or carotid artery stenosis (OR: 1.021, 95% IC: 0.785 - 1.328, p = 0.877) and white matter hypodensities of presumed vascular origin. DISCUSSION: Only age and hypertension proved to have an independent association with white matter hypodensities of presumed vascular origin. Carotid atherosclerosis, evaluated by IMT and the degree of carotid artery stenosis, showed no association with white matter hypodensities of presumed vascular origin. Since atherosclerosis is a systemic pathology, these results suggest that alternative mechanisms are responsible for the development of white matter hypodensities of presumed vascular origin. CONCLUSION: Age and hypertension seem to be the main factors in the development of white matter hypodensities of presumed vascular origin. No association was found between carotid atherosclerosis and white matter hypodensities of presumed vascular origin.