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It is unknown whether the availability of long drug-eluting stents modify the PCI strategy of long CTO. To describe the contemporary PCI strategy of long chronic total occlusions (CTO) using overlapping (OS) or single long stents (SS) and to analyze its results.2842 consecutive CTO PCIs were included. T hose with an occlusion length ≥20 mm in which ≥ 1 DES was implanted were analyzed. We compared procedural characteristics and clinical outcomes of CTO treated with OS or SS.1088 CTO PCIs were analyzed (79.9% males; 64.7±10.6 years). Mean J-score was 2.8 ± 0.9. A SS was used in 38.5% of cases and OS in 61.5%. Total stent length was 64.1±29.9 mm; it was higher in the OS group (OS:79.9±25.5 mm vs SS:38.3±14.7 mm; p0.0001). Mean number of stents in the OS group was 2.3±1. Very long stents (≥40 mm) were used in 27.4% of cases, more frequently in the OS group (OS:32.4% vs SS:19.3%; p0.0001). After a mean follow-up of 19±15.9 months, the rate of adverse events (MACE) was 2% (cardiac death:1.6%, myocardial infarction:1.6%, target lesion revascularization:1.9% and stent thrombosis: 0.18%) with no significant differences between both groups. Overlapping was not an independent predictor of MACE.In long CTO PCIs, OS is more frequently used than single stenting, especially in more complex procedures. Clinical outcomes at a mid-term follow-up are favorable. Using newer generation DES, overlapping was not an independent predictor of MACE, however a trend toward a higher event rate was observed in the OS group.

Introduction and objectives: In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y12 inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y12 inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI). Methods: This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH). Results: A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y12 inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2 g/dl), Hb drop >2 g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality. Conclusions: Prehospital use of a P2Y12 inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop>2 g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy. Resumo: Introdução e objetivos: No enfarte agudo do miocárdio com supra desnivelamento do segmento ST (EAMcST) é inequívoco o benefício do uso de dupla anti-agregação plaquetar. O tempo ideal para administrar a dose de carga do inibidor do recetor P2Y12 (DC-iP2Y12) é pouco consensual e motivo de debate. O principal objetivo do trabalho foi caracterizar a prática usada em Portugal e avaliar o impacto prognóstico da estratégia de administração da DC-iP2Y12, se antes ou durante/após angioplastia primária (AP). Métodos: Estudo multicêntrico, retrospetivo, baseado no Registo Nacional de Síndromes Coronárias Agudas, com inclusão de doentes com EAMcST e AP realizada de 1/10/2010 a 19/09/2017. Estabelecidos dois grupos: DC-iP2Y12 pré-AP (PRE-DC-iP2Y12) e DC-iP2Y12 durante ou após AP (CAT-DC-iP2Y12). Resultados: Incluídos 4123 doentes, 66,3% do grupo PRE-DC-iP2Y12 e 32,4% do grupo CAT-DC-iP2Y12. Numa análise multivariada o uso de PRE-DC-iP2Y12 foi preditor de HEMATS (endpoint composto por hemorragia major, transfusão de sangue e queda de hemoglobina (Hb)>2 g/dL), queda de Hb>2 g/dL e re-enfarte. Não se verificaram diferenças entre grupos no MACE (endpoint composto por morte hospitalar, acidente vascular cerebral e re-enfarte) e morte hospitalar. Conclusões: O uso de PRE-DC-iP2Y12 associou-se a um aumento do risco hemorrágico, sendo preditor do outcome composto de hemorragia (HEMATS) e de queda de Hb>2 g/dL, sem diferenças significativas na mortalidade e no MACE, o que coloca em questão o benefício desta estratégia.

Item does not contain fulltext OBJECTIVES: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)- and fractional flow reserve (FFR)-guided revascularization strategies. BACKGROUND: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. METHODS: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. RESULTS: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 +/- 0.51 vs. 0.43 +/- 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 +/- 0.09 vs. 0.91 +/- 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 +/- 0.09 vs. 0.85 +/- 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). CONCLUSIONS: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (Functional Lesion Assessment of Intermediate Stenosis to guide Revascularization [DEFINE-FLAIR]; NCT02053038).

Resumen Introduccion y objetivos El impacto de la intervencion coronaria percutanea (ICP) sobre oclusiones coronarias cronicas totales (OCT) presenta controversias. Se analizan los resultados agudos y al seguimiento en nuestro entorno. Metodos Registro prospectivo de ICP sobre OCT en 24 centros durante 2 anos. Resultados Se realizaron 1.000 ICP sobre OCT en 952 pacientes. La mayoria tenia sintomas (81,5%) y cardiopatia isquemica previa (59,2%), y hubo intentos de desobstruccion previos en un 15%. El SYNTAX anatomico fue 19,5 ± 10,6 y tenia J-score > 2 el 17,3%. El procedimiento fue retrogrado en 92 pacientes (9,2%). La tasa de exito fue del 74,9%, mayor en aquellos sin ICP previa (el 82,2 frente al 75,2%; p = 0,001), con J-score ≤ 2 (el 80,5 frente al 69,5%; p = 0,002) y con el uso de ecografia intravascular (el 89,9 frente al 76,2%; p = 0,001), que fue predictor independiente del exito. Por el contrario, lesiones calcificadas, > 20 mm o con munon proximal romo lo fueron de fracaso. El 7,1% tuvo complicaciones, como perforacion (3%), infarto (1,3%) o muerte (0,5%). Al ano de seguimiento, el 88,2% mejoro clinicamente en caso de ICP exitosa (frente al 34,8%; p Conclusiones Los pacientes del Registro Iberico con OCT tratados con ICP presentan complejidad clinico-anatomica, tasas de exito y complicaciones similares a los de otros registros nacionales e importante impacto de la recanalizacion exitosa en la mejoria funcional, que a su vez se asocio con menor mortalidad.

Background The rates of in-hospital mortality following percutaneous interventional procedures (PIP) during the COVID-19 pandemic period compared to the non-pandemic period has not been reported so far. Methods We retrospectively enrolled all consecutive patients admitted for PIP across five centers from February 2020 to May 2020. Results A total of 4092 PIP were performed during the reference periods. The total number of procedures dropped from 2380 to 1712 (28.0% reduction). Overall in-hospital mortality increased from 1.1% in 2019, to 2.6% in 2020 (63% relative increase). Conclusion During the COVID-19 pandemic, in-hospital all-cause mortality significantly increased in patients admitted for cardiological PIP.

Percutaneous coronary intervention of chronic total occlusion is a particular interventional area which requires high level of operator's experience and the support of additional tools based on intracoronary image such as intravascular ultrasound in many cases to clarify difficulties during procedures and to increase success rate. Implantation of long stents in many cases, the presence of stump ambiguity, and the use of specific techniques in this kind of interventions, such as reverse controlled antegrade and retrograde subintimal tracking (CART) and reverse CART make necessary in many cases the use of intravascular ultrasound for a better understanding of the situation, for reducing eventual complications and increasing procedural success rate. We made a review of literature related to most challenging situations in which the use of intravascular ultrasound during chronic total occlusion percutaneous coronary intervention becomes rather indispensable to safely continue and finish the procedure. Besides, two complex percutaneous coronary interventions of chronic total occlusion with unfavourable anatomic features in which intravascular ultrasound was crucial for the procedural success are presented in this manuscript along with support of the literature.

In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2YThis multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH).A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2YPrehospital use of a P2Y

Introduction and objectives: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. Methods: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. Results: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 +/- 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score 20 mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%. Conclusions: Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality. (C) 2018 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.

OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council

Resumo: Introdução e objetivos: No laboratório de cardiologia de intervenção é possível efetuar avaliação do significado funcional de lesões coronárias com recurso à determinação da fração do fluxo de reserva coronária por guia de pressão (FFR) e assim ultrapassar uma das limitações principais da angiografia convencional.O objetivo foi analisar a evolução clínica a longo prazo de doentes submetidos a cateterismo cardíaco no qual se detetaram estenoses coronárias de gravidade intermédia (50-70%) e nas quais a intervenção foi diferida com base no resultado de FFR

Introduction and objectives: Percutaneous coronary intervention (PCI) with paclitaxel drug-eluting balloons (DEBs) is used mainly for treatment of in-stent restenosis (ISR) and small vessel disease. Our objective was to evaluate the clinical efficacy of this strategy in a multicenter registry. Methods: Between 2009 and 2010 a prospective registry from two centers enrolled 156 consecutive patients undergoing PCI with at least one DEB. A primary composite endpoint of major adverse cardiac events (MACE) (all-cause death, myocardial infarction [MI] and target lesion revascularization [TLR]) was assessed at one year follow-up. Stepwise Cox regression was used to determine independent predictors of outcome. Results: DEBs (n=206) were used to treat 184 lesions. Procedural success was obtained in 98% of patients (n=150). At one-year follow-up, 86% (n=134) were free of the primary endpoint (6% death, 6% non-procedure related MI and 5% TLR). The independent predictors of MACE at one year were index PCI in the left anterior descending artery (HR 2.81, 95% CI 1.21–6.51; p=0.02) and a history of MI (HR 3.46, 95% CI 1.35–8.84; p=0.01). ISR and DEB diameter or length were not predictors of events. Conclusions: PCI with DEBs in real-world patients with complex lesions is effective, with a low rate of MACE, including TLR, at one-year follow-up. The results are equally good whether the intervention is for ISR or for native coronary disease. Resumo: Introdução e objectivos: A intervenção coronária percutânea (ICP) com balão eluidor de fármaco (DEB) tem vindo a ser utilizada no tratamento da reestenose intra-stent (RIS) e na doença coronária de pequenos vasos. O objectivo foi avaliar a eficácia clínica desta estratégia num registo multicêntrico. Métodos: Registo prospetivo de dois centros com 156 doentes (dts) consecutivos incluídos, entre 2009 e 2010, submetidos a ICP com pelo menos um balão DEB. Definiu-se como endpoint primário a ocorrência combinada (MACE) de todas as causas de morte, EAM e revascularização da lesão alvo (TLR) a um ano de seguimento. Determinou-se os preditores independentes de prognóstico através da análise de regressão de Cox. Resultados: Foram tratadas 184 lesões com 206 DEB. O sucesso do procedimento foi obtido em 98% (150 dts). A um ano de seguimento, a sobrevida livre de endpoint composto ocorreu em 134 dts e foi de 86% (morte em 6%, EAM em 6% e TLR em 5%). Os preditores independentes de MACE foram a ICP na artéria descendente anterior (HR 2,81, 95% IC 1,21-6,51, p = 0,02) e história prévia de EAM (HR 3,46, 95% IC 1,35-8,84, p = 0,01). O diâmetro ou comprimento do DEB e a RIS não foram preditores de eventos. Conclusões: A ICP com DEB em dts do mundo real e neste cenário complexo de lesões, é eficaz com baixa taxa de MACE a um ano de seguimento, incluindo TLR. Os resultados são igualmente bons se a intervenção é no contexto de RIS ou na doença coronária de novo. Keywords: Drug-eluting balloon, Small coronary vessel disease, In-stent restenosis, Palavras-chave: Balão eluidor de fármaco, Doença coronária dos pequenos vasos, Reestenose intra-stent

BACKGROUND: Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. METHODS: We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk. RESULTS: At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P

Aims Limited data exist on the treatment and outcomes of patients with chronic total occlusions due to in-stent restenosis (CTO-ISR). We sought to evaluate results and clinical outcomes in percutaneous interventions over CTO-ISR. Methods and results We conducted a registry in 16 centres involving consecutive patients undergoing attempted percutaneous intervention over CTO-ISR. A total of 233 patients were included, 192 (82.4%) with a successful acute result. The success rate was significantly lower in patients with: lesion in the circumflex artery, ostial lesions, J score >3 and no femoral access. The presence of tandem lesions (OR 0.19, 95% CI: 0.06-0.68; p=0.01) was identified as an independent predictor for outcome. After a median follow-up of 20 months, cardiac death in the successful vs. failed groups was 3% and 8.3%, respectively (p=0.09). Independent predictors for mortality were previous CABG (HR 8, 95% CI: 1.3-50; p=0.02) and multivessel disease (HR 2.3, 95% CI: 1.2-4.3; p=0.01). In the successful group, TLR was 15%, re-occlusion 6% and definite/probable stent thrombosis 1.8%. Conclusions Percutaneous treatment of CTO due to ISR in contemporary practice shows a high success rate, resulting in good long-term results. The angiographic and procedural predictors identified may contribute to improving procedural outcome through better patient selection.

© 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved., Introduction and Aims: The functional significance of coronary lesions can be assessed in the cardiac catheterization laboratory by determination of fractional flow reserve (FFR), thus overcoming one of the major limitations of conventional angiography. The aim of this study was to analyze the long-term clinical course of patients with intermediate coronary stenosis (50---70%) deferred for intervention based on FFR, A polineuropatia amiloidótica familiar tipo-I (PAF tipo-I) é um tipo raro de amiloidose hereditária e sistémica causada pela mutação Val30Met no gene da transtirretina (TTR). O início das manifestações e o espectro clínico podem ser variáveis e dependem da heterogeneidade fenotípica. As complicações cardíacas (disritmias e perturbac¸ões da conduc¸ão, miocardiopatia e disautonomia) ditam um prognóstico mais reservado, mesmo após transplante hepático. É descrito um caso clínico atípico de PAF tipo-I com ênfase no grave envolvimento cardíaco e nas suas complicac¸ões. O diagnóstico precoce de cardiopatia amiloidótica tem assumido relevância no âmbito de vários ensaios clínicos com fármacos experimentais promissores.

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Effusive-constrictive pericarditis is a rare entity in which clinical suspicion is of paramount importance, and although cardiac catheterization remains the gold standard for diagnosis, noninvasive imaging techniques are very useful in consolidating the diagnosis prior to confirmation by invasive means. The authors describe the case of a 52-year-old man, who had undergone heart surgery in the past, with a long history of heart failure refractory to medical therapy and chronic recurrent pericardial effusion, in whom noninvasive imaging techniques were decisive in arriving at the correct diagnosis of effusive-constrictive pericarditis, which was later confirmed by cardiac catheterization, thus enabling the correct therapeutic approach to be adopted and leading to improvement in clinical status.

The use of drug-eluting stents (DES) is beneficial in patients undergoing percutaneous coronary intervention (PCI) and there is particular interest in long-term follow-up.We aimed to assess and characterize early DES use in Portugal during 2003 and patient follow-up over a 5-year period. We developed a web-based database to collect and organize patient and procedural data from PCI performed in ten cardiovascular interventional centers sharing the same database.This was a multicenter retrospective study that included 1833 consecutive angiographically successful coronary angioplasties in which a DES was implanted in 2003. A subgroup of patients with 5-year clinical follow-up after the initial procedure was selected for which there was at least a 90% follow-up rate during one quarter of 2003. Demographic, clinical and angiographic characteristics of the entire population were assessed. In the clinical follow-up cohort, the incidence of major adverse cardiac events (MACE)--death, myocardial infarction and surgical or percutaneous target lesion revascularization--was analyzed by survival curves and logistic regression analysis.Of the total population, 23% were female, and mean age was 62 +/- 11 years (25-92). The main risk factors were hypertension (60.5%), dyslipidemia (42.9%), smoking (45.1%) and diabetes (23.9%, of whom 13.2% were on insulin therapy). There was a history of myocardial infarction, PCI or bypass surgery respectively in 23.1%, 25.1%, and 9.7% of the patients. Multivessel disease was present in 59.9% of patients (mean of 1.86 +/- 0.81 vessels). PCI was performed on average in 1.24 +/- 0.48 lesions, and complete revascularization in 58.8%. A total of 2058 stents were used (mean of 1.62 +/- 0.84) in 1271 patients. The longitudinal substudy included only 320 PCIs, for which follow-up was achieved in 319 (99%; median: 1875 days, P25: 1457 days, P75: 2045 days). Thirty-seven deaths (11.6%) and 61 MACE (19.1%) occurred in this group, with no differences between insulin-treated and other diabetic patients.This is the first study to analyze the early Portuguese experience with drug-eluting stents. The clinical results compare favorably with the first published international registries. The on-line platform used was successful in collecting data in a standardized format on the clinical experience of multiple centers.

Transient left ventricular apical dyskinesia (apical ballooning syndrome, ABS) is characterized by transient alterations in regional wall motion, involving the mid and apical segments of the left ventricle, as well as electrocardiographic alterations, mimicking ST-elevation acute myocardial infarction, in the absence of obstructive disease of the epicardial coronary arteries. In this article, we present a series of five cases of ABS and a theoretical review of the syndrome.

Acute myocardial infarction (MI) causes left ventricular (LV) diastolic dysfunction, which influences prognosis and clinical evolution. Early flow propagation velocity (FPV), evaluated by color M-mode Doppler, has been demonstrated to be a diastolic function parameter with excellent correlation with relaxation constant tau, and is relatively independent of pre- and afterload.The aim of this study was to evaluate left ventricular relaxation in MI patients treated with acute reperfusion therapy.Patients with ST-elevation MI treated with reperfusion therapy were evaluated by echocardiagraphy in the first 48 hours and after one week. The parameters studied were: early peak filling velocity (E), late peak filling velocity (A), E/A ratio, E-wave deceleration time (EDT), isovolumic relaxation time (IVRT) and FPV. The values obtained at the first and second evaluation were compared; we evaluated the relation between pain-to-reperfusion time (PRT;or =3 hours vs.3 hours) and the presence of single-vessel or multivessel disease with the parameters previously mentioned.40 patients were studied and 19 included, 15 (80%) male, mean age 57+/-14 The most prevalent risk factors were: hypertension (11 patients - 58%), smoking (14 - 74%), diabetes (6 - 30%), and dyslipidemia (12 - 63%). MI location was anterior in six patients (31%) and inferior in 13 (69%). Five patients (26%) underwent fibrinolysis and 14 (74%) direct percutaneous coronary intervention. Mean pain-to-reperfusion time was 3.7+/-2.8 hours. Four patients (21%) had single-vessel disease and 14 (74%) had multivessel disease. Near significance was found for the difference in the E/A ratio between the two evaluations and a significant difference in the FPV. A significant correlation was also found between PRT and E/A ratio at the two evaluations (p=0.003, p=0.05), and between PRT and IVRT after one week (p=0.011). E/A ratio, IVRT and FPV were normal at the two evaluations in patients who had undergone earlier reperfusion therapy. No significance was found between the number of diseased vessels and the parameters of diastolic function assessed.In the early phase of M1 treated with acute reperfusion, a delayed relaxation pattern was observed, which evolved to a normal pattern by the second evaluation, as statistically confirmed by FPV. Earlier reperfusion therapy preserves diastolic function. FPV is a sensitive and independent parameter for assessment of diastolic function in MI patients treated with acute reperfusion therapy.

Evaluation of systolic and diastolic function by non-invasive methods in the acute phase of myocardial infarction (MI) is of great importance for risk stratification and prognosis. Ejection fraction (EF), as determined by echocardiography using the Simpson method, is the main parameter for assessing left ventricular (LV) function. The Tei index (TI), a Doppler-derived index that reflects systolic and diastolic function in MI, has an excellent correlation with prognosis.The purpose of this study was to evaluate systolic and systo-diastolic function in the acute and late phase of ST-elevation MI treated with acute reperfusion therapy.Patients with ST-elevation MI who underwent acute reperfusion therapy were evaluated by echocardiography in the first 48 hours and after one week. The parameters studied were: EF, wall motion score index (WMSI), and TI. The values obtained at the first and second evaluation were compared and correlated with pain to reperfusion time (PRT) (3 vs.or =3 hours), presence of single or multivessel disease, ejection fraction, total CK (1500 oror =1500 UI/l), and MI location (anterior vs. other).40 patients were studied and 19 were included, of whom 15 (80%) were male, mean age 57 +/- 14 years. Risk factors included hypertension (11 patients, 58%), smoking (14, 74%), diabetes (6, 30%), and dyslipidemia (12, 63%). MI location was anterior in 6 patients (32%) and inferior in 13 (68%). Five patients (26%) underwent fibrinolysis and 14 (74%) direct percutaneous coronary intervention. Mean pain to reperfusion time was 3.7 +/- 2.8 hours. Four patients (21%) had single vessel disease and 14 (74%) multivessel disease. Significant differences were found: (a) in mean EF and WMSI between the two evaluations (p0.0001 and p = 0.002 respectively); (b) between PRT and EF (p = 0.001) and WMSI (p = 0.020) at 48 hours; (c) between PRT and EF (p = 0.01) and TI (p = 0.033), and MI location and EF (p = 0.005) after one week.Early systolic function and LV remodeling one week after MI were accurately evaluated by EF and WMSI. Early reperfusion therapy positively influences early and late systolic and systo-diastolic function.

Cardiomyopathy, hypertrophic; coronary disease.A 65 year old woman with recent onset angina was admitted for acute coronary syndrome without ST elevation. EKG show deep T wave inversion on the anterior and lateral leads.At angiography no coronary stenosis were found, but severe “milking” of the midleft anterior descending coronary artery, up to 100% systolic narrowing was observed (fig. 1, 2, 3 and 4). Intraventricular gradient could be elicited at rest by multipurpose catheter during left ventricle pullback (fig. 5). Two dimensional (cross sectional) echocardiography disclosed asymmetric septal hypertrophy (anterior septum 22 mm, posterior wall 10 mm) with severe and diffuse involvement of the entire interventricular septum and anterolateral wall and left intraventricular gradient at rest was confirmed.

The authors report the case of a 20-year-old professional soccer player who underwent medical evaluation because of atypical chest discomfort and dizziness precipitated by strenuous effort. The ECG and echocardiogram findings were normal. The young athlete did a treadmill stress test which was negative for myocardial ischemia. His myocardial perfusion imaging and coronary angiography were also normal. Later during the investigation, he underwent treadmill stress echocardiography, during which he developed an intraventricular gradient of over 100 mmHg with end-systolic peak and systolic anterior movement (SAM) of the mitral valve. These echocardiographic findings were not present at rest and disappeared shortly after termination of exercise. The authors discuss the significance of these findings and their potential link to sudden death.

Real-time three-dimensional (3D) echocardiography has enormous diagnostic potential, enabling acquisition of full-volume three-dimensional images in real time, which can be sliced in several planes and rotated in order to achieve a more accurate study of the target cardiac structures. It is particularly useful because it enables the heart to be visualized from multiple perspectives in the same way a surgeon would see it during an operation. We describe our echocardiographic laboratory's experience with real-time 3D ultrasound study of adolescent and adult congenital heart disease.

We present a case of a patient who underwent coronary angiography in a setting of acute myocardial infarction, which showed an independent origin of all three coronary arteries from the right coronary sinus. This has rarely been described in the medical literature.

Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR). Native coronary artery CTO is relatively rare after stenting and it is an understudied subgroup of CTO interventions. All patients undergoing an attempt of percutaneous coronary intervention (PCI

Tese de doutoramento. Engenharia Informática. Faculdade de Engenharia. Universidade do Porto. 2010

Tese de mestrado integrado. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 2008