Browsing by Author "Saraiva, F"
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- Acute onset pulmonary toxicity associated to amiodaronePublication . Ferreira, PG; Saraiva, F; Carreira, CAmiodarone is a potent anti-arrhythmic drug with a well-known potential chronic pulmonary toxicity. We describe a case of acute pulmonary toxicity (APT) induced by amiodarone in a 57 year old patient submitted to a perfusion of 900 mg in just 6 hours, to control an auricular flutter with rapid ventricular response. During the administration, the patient developed hemodynamic instability and oxygen dessaturation that led to an electrical cardioversion with return of sinus rhythm. Still, the patient continued in progressive respiratory deterioration with acute bilateral infiltrates on chest x-ray and apparent normal cardiac filling pressures confirmed by echocardiography. Anon-cardiogenic pulmonar edema progressing to clinico-physiological ARDS criteria was diagnosed. Expeditive therapeutic measures were undertaken, namely by initiation of non-invasive positive airway pressure support, that attained a good result.Albeit rare, amiodarone-induced APT might have severe consequences, namely progression to ALI/ARDS with a high mortality index.As it is a frequently prescribed drug, there should be a high clinical suspicion towards this phenomenon, allowing precocious therapeutic measures to be taken in a timely fashion to prevent the associated unfavorable outcome.
- 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.
- Can we improve outcomes in patients with previous coronary artery bypass surgery admitted for acute coronary syndrome?Publication . Teixeira, R; Lourenço, C; António, N; Jorge, E; Baptista, R; Saraiva, F; Mendes, P; Monteiro, S; Gonçalves, F; Monteiro, P; Freitas, M; Providência, LAINTRODUCTION AND OBJECTIVES: Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG. METHODS: This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs. RESULTS: Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B patients more frequently had ST-elevation myocardial infarction, and had a higher median ejection fraction (53% [interquartile range, 47%-60%] vs. 50% [42%-55%]; P< .01) and peak troponin-I concentration. There was no difference in the use of invasive techniques. Regarding medication, Group B patients were more likely to receive dual antiplatelet therapy at discharge. No significant difference was observed in in-hospital mortality (9.5% versus 5.9%; P=.2) or mortality at 1 month, 6 months or 1 year (9.8% versus 9.1%; log-rank test, P=.87) and the cumulative major adverse cardiac event rate was equally low in both groups. The presence of a CABG was associated with more readmissions for unstable angina (11.3% vs. 3.1%; P< .01). CONCLUSIONS: In our ACS patients, the presence of a CABG had no significant influence on short- or medium-term outcomes, such as all-cause mortality and adverse cardiac events.
- Cardiac resynchronization therapy is effective even in elderly patients with comorbiditiesPublication . António, N; Lourenço, C; Teixeira, R; Saraiva, F; Coelho, L; Ventura, M; Cristovão, J; Elvas, L; Gonçalves, L; Providência, LAPURPOSE: The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (> or =65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response. METHODS: This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) > or =15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling. RESULTS: The mean age was 62 +/- 11 years, with 36 elderly patients (41%). The baseline QRS duration was 145 +/- 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (> or =65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm(2) before CRT, but not comorbidities. CONCLUSION: This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.
- Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive proceduresPublication . Saraiva, F; Matos, V; Gonçalves, L; Antunes, MJ; Providência, LABACKGROUND: Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure. METHODS: This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure. RESULTS: Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases. CONCLUSION: EMB proved to be a suitable, safe method to monitor rejection after HT.
- Coronary fistulas after cardiac transplantationPublication . Saraiva, F; Matos, V; Gonçalves, L; Antunes, MJ; Providência, LA
- Embolia coronária aguda em portadora de prótese aórtica mecânica: caso clínicoPublication . Saraiva, F; Matos, V; Gonçalves, L; Providência, LAEmbolic myocardial infarction is a rare entity, which is often difficult to diagnose, and there is little agreement on its treatment. Patients with prosthetic valves are considered an important risk group. A 71-year-old woman with a mechanical aortic prosthesis was admitted with anterior ST segment elevation myocardial infarction after two hours of symptoms. Emergency angiography revealed an image suggestive of a large thrombus at the level of the proximal left anterior descending artery. After several attempts to perform thrombus aspiration and balloon dilatation, TIMI 2 flow was obtained. Effective anticoagulation was immediately started and the clinical outcome was favorable. Angiographically normal coronary arteries one year previously, the patient's discontinuation of warfarin and the present angiographic appearance of the culprit lesion suggested an embolic etiology. This cause is often underdiagnosed and associated with ineffective anticoagulation. Its treatment therefore requires educational intervention.
- Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromesPublication . António, N; Soares, F; Lourenço, C; Saraiva, F; Gonçalves, F; Monteiro, P; Gonçalves, L; Freitas, M; Providência, LAImpact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes
- Invasive strategy in non-ST elevation acute coronary syndromes: risks and benefits in an elderly populationPublication . Lourenço, C; Teixeira, R; António, N; Saraiva, F; Baptista, R; Jorge, E; Monteiro, S; Gonçalves, F; Monteiro, P; Matos, V; Calisto, J; Faria, H; Gonçalves, L; Freitas, M; Providência, LA
- Left ventricular end diastolic pressure and acute coronary syndromesPublication . Teixeira, R; Lourenço, C; Baptista, R; Jorge, E; Mendes, P; Saraiva, F; Monteiro, S; Monteiro, P; Ferreira, MJ; Freitas, M; Providência, LABACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP < 26.5 mmHg (n = 449); group B - LVEDP > 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence.