Browsing by Author "Costa, S"
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- Anemia: apenas marcador ou preditor independente de mortalidade na insuficiência cardíaca avançadaPublication . Saraiva, F; Martins, H; Costa, S; Franco, F; Gonçalves, L; Providência, LAINTRODUCTION AND OBJECTIVES: Advanced heart failure (HF) remains a major cause of mortality. Identification of new prognostic risk factors is therefore a priority. Anemia, a frequent comorbidity in HF patients and a recognized trigger of symptoms, has recently received considerable attention in this context. Several studies have demonstrated an association between anemia and increased mortality in stable chronic HF patients. However, the prognostic impact of this comorbidity on the survival of advanced HF patients remains unclear. Our aim was to assess whether anemia is not only a marker of advanced HF, but also an independent predictor of mortality. METHODS: We performed a retrospective study of 391 consecutive patients admitted to a single advanced HF care unit and divided into two groups according to the presence or absence of anemia at admission. Demographic, clinical, laboratory and therapeutic data were compared between the groups. Anemia was defined as hemoglobin at admission of <12 g/dl for women and <13 g/dl for men. Appropriate statistical tests and multivariate analysis were used to identify independent predictors of one-year and overall mortality. Median follow-up was 3.2 years. RESULTS: Group A, anemic patients (n=169, 43.2%), were older (61.7 +/- 14.7 vs. 58.0 +/- 14.5 years, p = 0.01) and included a higher number of patients with ischemic cardiomyopathy (40.7% vs. 28.6%, p = 0.01), but fewer with dilated cardiomyopathy (41.0% vs. 55.8%, p = 0.004). At admission, group A had lower systolic blood pressure (110.1 +/- 24.8 mmHg vs. 115.2 +/- 22.0 mmHg, p = 0.03) and higher mean C-reactive protein (1.90 +/- 3.6 mg/dl vs. 1.19 +/- 2.6 mg/dl, p = 0.004) and creatinine (1.50 +/- 0.9 mg/dl vs. 1.20 +/- 0.5 mg/dl, p < 0.001). Gender, prevalence of cardiovascular risk factors, previous medication and left ventricular ejection fraction were not statistically different between the groups. At discharge, fewer anemic patients received digoxin (71.1% vs. 81.8%, p = 0.03). Mortality rates at 3 months (13.6% vs. 6.7%, p = 0.05), one year (22.9% vs. 11%, p = 0.006) and during follow-up (39.8 % vs. 23.8%, p = 0.002) were significantly higher in Group A. Multivariate analysis demonstrated that anemia was an independent predictor of mortality at one year (p = 0.035) and during median follow-up: (p = 0.014). In the anemic group a linear relationship between hemoglobin levels and mortality was also detected. CONCLUSIONS: In our population, anemia was a frequent comorbidity and had an independent and negative impact on long-term mortality. Its correction could improve outcomes in advanced HF patients.
- Arterite de Takayasu: discussão de 3 casos clínicosPublication . Reis, R; Costa, S; Parente, F; Alexandrino, MB; Moura, JA
- A decade of cardiac transplantation in Coimbra: the value of experiencePublication . Prieto, D; Correia, P; Batista, M; Sola, E; Franco, F; Costa, S; Antunes, PE; Antunes, MJINTRODUCTION AND OBJECTIVES: To analyze the experience gained in 10 years of the heart transplantation program of the University Hospital of Coimbra. METHODS: Between November 2003 and December 2013, 258 patients with a mean age of 53.0±12.7 years (3-72 years) and predominantly male (78%) were transplanted. Over a third of patients had ischemic (37.2%) and 36.4% idiopathic cardiomyopathy. The mean age of donors was 34.4±1.3 years and 195 were male (76%), with gender difference between donor and recipient in 32% of cases and ABO disparity (non-identical groups but compatible) in 18%. Harvest was distant in 59% of cases. In all cases total heart transplantation with bicaval anastomoses, modified at this center, was used. Mean ischemia time was 89.7±35.4 minutes. All patients received induction therapy. RESULTS: Early mortality was 4.7% (12 patients) from graft failure and stroke in five patients each, and hyperacute rejection in two. Thirteen patients (5%) required prolonged ventilation, 25 (11.8%) required inotropic support for more than 48 hours, and seven required pacemaker implantation. Mean hospital stay was 15.8±15.3 days (median 12 days). Ninety percent of patients were maintained on triple immunosuppressive therapy including cyclosporine, the remainder receiving tacrolimus. In 23 patients it was necessary to change the immunosuppression protocol due to renal and/or neoplastic complications and humoral rejection. All but two patients have been followed in the Surgical Center. Fifty patients (19.4%) subsequently died from infection (18), cancer (10), vascular (eight), neuropsychiatric (four), cardiac (two) or other causes (eight). Forty-six patients (17.8%) had episodes of cellular rejection (>2 R on the ISHLT classification), eight had humoral rejection (3.1%), and 22 have evidence of graft vascular disease (8.5%). Actuarial survival at 1, 5, and 8 years was 87±2%, 78±3% and 69±4%, respectively. CONCLUSION: This 10-year series yielded results equivalent or superior to those of centers with wider and longer experience, and have progressively improved following the introduction of changes prompted by experience. This program has made it possible to raise and maintain the rate of heart transplantation to values above the European average.
- Doença de deposição de cadeias leves com atingimento hepático predominantePublication . Costa, S; Dias, P; Gaspar, E; Cipriano, MA; Parente, F; Lourenço, A; Alexandrino, MB; Moura, JA
- Miocardiopatia de etiologia isquémica versus não-isquémica: haverá diferenças no prognóstico? Experiência de um centro de insuficiência cardíaca avançadaPublication . Lourenço, C; Saraiva, F; Martins, H; Baptista, R; Costa, S; Coelho, L; Vieira, H; Monteiro, P; Franco, F; Gonçalves, L; Providência, LAINTRODUCTION: Previous studies have associated heart failure (HF) of ischemic etiology with worse prognosis compared to HF from non-ischemic cardiomyopathy. HF treatment has evolved significantly in recent years. Has this evolution had an impact on this prognostic gap? OBJECTIVE: The aim of our study was to compare patients with advanced HF--nonischemic versus ischemic etiology--in terms of baseline characteristics, treatment, and in-hospital and long-term prognosis (including death, heart transplantation and hospital readmission). METHODS: We performed a retrospective study including 286 consecutive patients with systolic HF admitted to an HF unit between January 2003 and June 2006. We compared two groups according to HF etiology: Group A--ischemic cardiomyopathy (n = 109); Group B--non-ischemic cardiomyopathy (n = 177). Mean follow-up was 41 months. RESULTS: Group A were older (62.2 +/- 10.4 vs. 55.9 +/- 15.2 years, p < 0.001), with a higher proportion of males (80.7 vs. 67.8%, p = 0.017), diabetes, anemia, dyslipidemia and smokers; they required more prolonged treatment with inotropic drugs and more frequent treatment with statins, antiplatelet agents and nitrates. On admission, Group B patients presented with lower serum sodium and higher aminotransferase levels. There were no differences in the occurrence of cardiogenic shock or dysrhythmias, baseline ECG rhythm, frequency of left bundle branch block, renal function, BNP, left ventricular ejection fraction, heart rate or implantation of intracardiac devices. Group A had higher in-hospital mortality (11.0 vs. 4.0%, p = 0.020). Multivariate analysis showed that the only predictor of in-hospital mortality was serum sodium < 133 mmol/l and also showed that HF etiology was not a predictor of this endpoint; previous medication with angiotensin-converting enzyme inhibitors was a protective factor. On Kaplan-Meier analysis, it was observed that, in the long-term, there were no significant differences in either survival rates (70.0 vs. 76.8%, p = 0.258), or the combined endpoints of survival free of death or heart transplantation (55.7 vs. 54.5%, p = 0.899) and survival free of death, heart transplantation or hospital readmission (38.0 vs. 32.8%, p = 0.386). CONCLUSIONS: Although in-hospital mortality was higher in ischemic cardiomyopathy, this variable was not an independent predictor of mortality and the difference appears to fade in the long-term, in contrast to what had been reported in older studies, but in agreement with more recent data
- Miocardiopatia Hipertrófica: Estado da Arte em 2007Publication . Monteiro, S; Costa, S; Monteiro, P; Gonçalves, L; Providência, LAHypertrophic cardiomyopathy (HCM) is a primary disease of the sarcomere, with considerable genetic heterogeneity and variability in phenotypic expression, whose main complication is sudden cardiac death (SCD). Genetic aspects of HCM, its molecular pathophysiology and genotype-phenotype relationships are the subject of this review, which is aimed at better understanding of practical management in this patient population. As HCM is a genetic disease whose initial manifestation can be sudden death, it is essential to establish the diagnosis at an early stage, to proceed with risk stratification and implementation of SCD prevention strategies, and to promote genetic counseling of patients and screening of their families. Detection of pathological mutations through progressive sequencing of the genes most commonly involved is the most efficient way to diagnose HCM, even in the absence of clinical evidence of the disease. Identification of individuals at high risk of SCD is a major challenge in the management of this population, since SCD can be prevented by use of an implantable cardioverter-defibrillator. The selection of patients for prophylactic implantation of these devices, particularly those who have only one major risk factor, is currently the subject of controversy.
- Miocardite Lúpica: a propósito de um caso clínicoPublication . Costa, S; Franco, F; Monteiro, P; Oliveira, L; Vieira, H; Garrido, L; Gonçalves, L; Gomes, H; Campos, M; Providência, LAMyocarditis is one of the many possible forms of cardiac involvement in systemic lupus erythematosus. Its clinical presentation ranges from asymptomatic patients with self-limited disease to fulminant heart failure that can lead to death. In most cases treatment consists of supportive care only. The authors present the case of a patient with lupus myocarditis.
- Origem ectópica da artéria coronária direita: a propósito de um caso clínicoPublication . Costa, S; Sá e Melo, A; Rodrigues, D; Marinho da Silva, A; Providência, LA; Antunes, MJCoronary artery anomalies can occur in isolation or in association with other congenital heart defects. Clinical presentation ranges from asymptomatic forms to sudden cardiac death. The authors report a case of anomalous origin of the right coronary artery from the left sinus of Valsalva, diagnosed with multidetector computed tomography coronary angiography.
- Prognostic value of CA125 in advanced heart failure patientsPublication . Monteiro, S; Franco, F; Costa, S; Monteiro, P; Vieira, H; Coelho, L; Oliveira, L; Providência, LAINTRODUCTION: Serum levels of CA125 are often high in advanced heart failure (AHF) patients. AIM: To determine the predictive value of CA125 in forecasting the occurrence of death or cardiac transplantation in an AHF population. METHODS: 88 AHF patients referred for heart transplantation were divided into 2 groups based on CA125 levels: normal (CA125<38 U/mL) and elevated (>/=38 U/mL). Events (death or heart transplant) were monitored over a period of 13+/-7 months after CA125 determination. RESULTS: Patients with elevated CA125 (n=65) had significantly lower blood pressure, body mass index, serum sodium and peak exercise oxygen consumption, while B-type natriuretic peptide levels were significantly higher. The combined primary endpoint (death or heart transplant) rate was 39.4% and 62.3% in normal and elevated CA125 groups, respectively (p=0.029). Multivariate regression analysis showed that CA125 and sodium levels were the only independent predictors of the combined endpoint. CONCLUSION: In AHF patients, plasma CA125 was an effective prognostic marker. Its determination may contribute to better risk stratification in this population.
- Results of the routine use of 4F catheters for diagnostic catheterization in a cath labPublication . Lourenço, C; António, N; Santos, L; Teixeira, R; Costa, S; Matos, V; Calisto, J; Faria, H; Gonçalves, L; Providência, LAINTRODUCTION: Complications at the site of vascular access are the most common adverse events in cardiac catheterization. The use of small gauge catheters may reduce this risk and allow earlier ambulation, the main disadvantage according to some authors being inferior image quality. The aim of our study was to evaluate the safety and image quality of 4 French diagnostic catheters. METHODS: We performed a retrospective study of 1656 patients who underwent diagnostic cardiac catheterization with 4F catheters via the femoral artery between January 2006 and December 2007, and analyzed the complications during and immediately after the procedure. The quality of the films was assessed in 125 consecutive patients from this group, who were also followed up on average one month after hospital discharge. RESULTS: Cardiac catheterization with 4F catheters was technically possible in all cases. Patients were able to ambulate and were discharged from hospital on average four and six hours respectively after the procedure. Complications during or immediately after the procedure occurred in 5.8% of cases. In the subgroup with clinical follow-up, there was minor bleeding at the access site in 16.4% and hematoma in 14.4%; in the latter group, only one patient had major hematoma requiring therapeutic intervention. No other major complications were recorded and the patients resumed their daily activities on average 7 days after discharge. Image analysis revealed that most of the films were of good quality. Conclusion: The use of 4F catheters for diagnostic cardiac catheterization via the femoral approach enables rapid hemostasis and early ambulation, with a low incidence of complications at the access site. This type of catheter provides good quality images and there were no problems in their handling. 4F catheters are therefore a good option to consider for cardiac catheterization, especially when no therapeutic procedures are expected.