Luís Neves Soares

Centro Hospitalar de Setubal, Setúbal, Setúbal, Portugal

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Publications (13)4.89 Total impact

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    ABSTRACT: Os elétrodos de desfibrilhação Riata e Riata ST, com revestimento de silicone, são propensos a exteriorização dos fios condutores por mecanismo de abrasão interna-externa dos fios condutores do sistema de alta voltagem, provocando uma alteração estrutural que pode, ou não, ser acompanhada de alterações elétricas. Ambas as situações são facilmente detetadas, quer por fluoroscopia/radiologia quer por inspeção do traçado endocavitário e/ou medição das impedâncias. No entanto, geradores de famílias mais antigas não fazem automaticamente todas as medições necessárias para aferir a integridade elétrica do sistema de alta voltagem nem possuem sistemas de notificação do doente em caso de disfunção. Descreve-se o caso de um doente cuja alteração estrutural foi detetada na radioscopia aquando da substituição do gerador em exaustão. Discute-se qual a melhor estratégia nestes doentes, face ao atual conhecimento desta disfunção.
    Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 10/2013; 32(10):823-6.
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    ABSTRACT: The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern. After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed. Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern.
    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 09/2013;
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    ABSTRACT: An implanted pacemaker is generally considered a contraindication for magnetic resonance imaging (MRI). The increasing number of indications for MRI and the rising prevalence of implanted cardiac pacemakers have prompted the recent development of MRI-conditional pacemaker systems. We present the case of a 68-year-old woman with left ventricular hypertrophy, hypertension, aortic valve stenosis and a family history of cardiac amyloidosis, who developed complete heart block. In view of the foreseeable need for cardiac MRI, an MRI-conditional dual chamber pacemaker was implanted. The MRI scan confirmed moderate left ventricular hypertrophy and aortic valve stenosis, and showed no delayed enhancement suggestive of amyloid heart disease. This case illustrates the feasibility of cardiac MRI in this setting and the usefulness of the recently introduced MRI-conditional pacemaker systems.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2013; · 0.59 Impact Factor
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    ABSTRACT: The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern. After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed. Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern.
    Revista Portuguesa de Cardiologia. 01/2013; 32(10):807–810.
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    ABSTRACT: INTRODUCTION: Higher values of red blood cell distribution width (RDW) have recently been associated with worse outcome in patients with cardiovascular disease. However, its relation to bleeding events in patients with non-ST elevation acute coronary syndromes has not been established. AIM: To determine the prognostic value of RDW in patients with non-ST segment elevation acute coronary syndromes, particularly regarding the risk of major bleeding. METHODS: We analyzed 513 consecutive patients admitted with non-ST elevation acute coronary syndromes. The population was divided into tertiles of baseline RDW and clinical, laboratory characteristics and adverse events were analyzed for each group. The primary outcome was defined as the occurrence of major bleeding (according to the Crusade bleeding score). The predictive value of RDW for risk of major bleeding was determined. RESULTS: The mean RDW was 15.13%±1.62%. Patients in the third tertile were older and more frequently had renal dysfunction or previous coronary revascularization. Higher values of RDW were associated with greater risk of major bleeding and in-hospital death. RDW >15.7% was an independent predictor of bleeding events (odds ratio 3.1, 95% CI 1.4-6.9). CONCLUSIONS: In a population of patients with non-ST elevation acute coronary syndromes, RDW was associated with higher in-hospital mortality and was an independent predictor of in-hospital major bleeding.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 11/2012; · 0.59 Impact Factor
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    ABSTRACT: Carcinoid tumors are rare, most commonly originating from the neuroendocrine cells in the gastrointestinal tract. Carcinoid syndrome is characterized by flushing, diarrhea, and bronchospasm. Half of these patients have carcinoid heart disease, affecting the right side of the heart, causing tricuspid and pulmonary regurgitation and stenosis and subsequently right heart failure. 73-year-old female was admitted with heart failure associated with episodes of diarrhea and flushing. The echocardiogram showed typical characteristics of carcinoid heart diasease. The CT scan of abdomen showed a small bowel mass. The 24-hour urine 5-hydroxyindoleacetic acid (5HIAA) and indium-111-pentetreotide scintigraphy confirmed the diagnosis. The patient was treated with furosemide, warfarine, digoxin and octreotide and there was clinical improvement. The echocardiogram was very useful, establishing the provisory diagnosis of a rare disease based on pathognomonic echocardiographic features.
    Acta medica portuguesa 09/2011; 24(5):843-8. · 0.15 Impact Factor
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    ABSTRACT: Compare the discriminatory performance of two validated ischemic risk scores and a bleeding risk score for in-hospital adverse events across the spectrum of non-ST elevation acute coronary syndromes (NSTE-ACS). Single center, 516 consecutive patients admitted with the diagnosis of NSTE-ACS. The following risk scores were calculated for each patient: TIMI, GRACE and CRUSADE. The following in-hospital endpoints were used: major bleeding (as defined by the CRUSADE criteria); recurrent ischemia (re-infarction or recurrent angina); and death. Discriminatory performance was measured by the c-statistic and compared. There were 36 major bleeding events, 34 recurrent ischemic events and 10 deaths. TIMI RS, GRACE RS, and CRUSADE RS demonstrated fair discriminatory accuracy for major bleeding (c-statistic = 0.64, 0.58, and 0.61, respectively). GRACE and CRUSADE risk scores demonstrated a better performance than TIMI RS for predicting in-hospital death (c-statistic = 0.92 and 0.86, respectively versus c-statistic = 0.63, P < 0.001). For the combined endpoint of in-hospital death or recurrent ischemia there was no statistically significant difference between CRUSADE RS, GRACE RS, and TIMI RS (c-statistic = 0.58, 0.57, and 0.62, respectively). Both ischemic and bleeding risk scores are able to predict in-hospital bleeding, ischemic and fatal events.
    Acute Cardiac Care 06/2011; 13(2):68-75.
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    ABSTRACT: Patients with acute coronary syndrome (ACS) frequently present chronic noncardiovascular medical comorbidities that can influence treatment and prognosis. Compliance with therapeutic guidelines in ACS is crucial to event reduction and the presence of these comorbidities may be a determining factor in guideline adherence. To assess the prevalence of chronic noncardiovascular medical comorbidities in patients with ACS and their impact on guideline adherence. We studied consecutive patients admitted to the coronary care unit of our institution with a diagnosis of ACS. We identified patients with noncardiovascular comorbidities, divided into five groups: chronic renal failure, pulmonary disease, gastrointestinal disease, blood disease or cancer). We assessed complete adherence to pharmacological therapy plus reperfusion (mechanical or pharmacological) in ST-segment elevation myocardial infarction, and use of coronary angiography in non-ST segment elevation myocardial infarction. We compared guideline adherence according to the presence or absence of comorbidities and their impact on in-hospital mortality. The study sample consisted of 146 patients, mean age 64 +/- 13 years and 71% male. In 53% of the patients at least one comorbidity was identified: chronic renal failure in 23%, pulmonary disease in 14%, gastrointestinal disease in 20%, blood disease in 7% and cancer in 9%. Patients with comorbidities were older, and more frequently had a history of ACS, heart failure and peripheral arterial disease. Complete adherence to guidelines was worse in the group with comorbidities (56% vs. 74%; p = 0.025). The presence of noncardiovascular comorbidities was associated with higher in-hospital mortality (9% vs. 0%, p = 0.011). Noncardiovascular medical comorbidities are frequently found in patients with ACS. Adherence to therapeutic guidelines for ACS is suboptimal, particularly in patients with chronic noncardiovascular comorbidities. Moreover, the presence of such comorbidities influences short-term prognosis in ACS patients.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2010; 29(1):7-21. · 0.59 Impact Factor
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    ABSTRACT: Ventricular resynchronization therapy optimizes cardiac function and induces reverse remodeling of the left ventricle (LV) in patients (pts) with dilated cardiomyopathy and intraventricular conduction disturbances. Improvement of LV mechanical synchrony seems to be the predominant mechanism. There is a growing interest in objective quantification of desynchronization. This study aims to evaluate the effect of ventricular resynchronization therapy on LV remodeling and on LV desynchronization, assessed by tissue Doppler echocardiography. We studied ten pts, eight male, mean age 65 +/- 10 years, with dilated cardiomyopathy, intraventricular conduction disturbances and heart failure, New York Heart Association functional class III or IV. Five pts had coronary artery disease and the others idiopathic dilated cardiomyopathy. All pts had an implanted cardioverter, defibrillator with cardiac resynchronization therapy. The LV pacing electrode was placed in the lateral or posterolateral vein. Before and one month after resynchronization therapy the following parameters were measured with conventional Doppler echocardiography: LV end-diastolic (LVd) and end-systolic (LVs) size, ejection fraction (EF) and mitral regurgitation (MR) area. For diastolic function the maximum velocity of the E wave (MV-E) and A wave (MV-A), E/A ratio, LV filling time (LV-FT) and isovolumetric relaxation time (IVRT) were meadured. Mitral longitudinal motion was studied with pulsed tissue Doppler. Maximum velocity of the systolic S wave (MV-S) and isovolumetric contraction time (IVCT) were measured in the tissue Doppler curve of the septum and lateral, inferior and anterior walls. To evaluate the degree of desynchronization the RV index was calculated for each patient, based on the difference between the maximum and minimum IVCT, normalized for the maximum IVCT. There was a significant reduction in LVd and MR. EF increased significantly (p = 0.003). There were no differences in diastolic function parameters. MV-S did not increase significantly. IVCT increased significantly at the lateral wall (p = 0.037). The RV index demonstrated a significant reduction in ventricular desynchronization (p = 0.001). Ventricular resynchronization therapy induces reverse remodeling and improves LV function in selected pts. Improvement of mechanical LV synchrony seems to be the predominant mechanism. Ventricular desynchronization can be measured by tissue Doppler echocardiography.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/2003; 22(11):1363-71. · 0.59 Impact Factor
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    ABSTRACT: Ventricular resynchronization therapy improves cardiac function in patients (pts) with dilated cardiomyopathy and intraventricular conduction disturbances. The effects of ventricular resynchronization on right ventricular function have been poorly studied. Tricuspid annular motion can be studied with tissue Doppler echocardiography, which enables quantitative assessment of right ventricular function. The aim of this study was to evaluate the effects of ventricular resynchronization on right ventricular function with pulsed tissue Doppler. We studied ten pts, eight male, mean age 65 +/- 10 years, with dilated cardiomyopathy, intraventricular conduction disturbances and heart failure, New York Heart Association functional class III or IV. Five pts had coronary artery disease and the others idiopathic dilated cardiomyopathy. All pts had an implanted cardioverter-defibrillator with ventricular resynchronization. Before and one month after device implantation right ventricular function was evaluated with pulsed wave tissue Doppler study of tricuspid annular motion. The maximum velocity of the S wave (MV-S), E wave (MV-E), and A wave (MV-A), E/A ratio, isovolumetric contraction time (IVCT) and ejection time (ET) were determined. Right ventricular size and left ventricular ejection fraction (EF) were measured. Functional class before and after implantation was assessed. MV-S, MV-E and MV-A did not change significantly. The E/A ratio decreased significantly (p = 0.017). There were no differences in IVCT and ET, nor in right ventricular size before and after resynchronization. EF improved in all but one patient (p = 0.003). All pts had an improvement in functional class, except the one without increased EF. Ventricular resynchronization therapy does not appear to have a deleterious effect on right ventricular function in pts with dilated cardiomyopathy and intraventricular conduction disturbances. The main beneficial effect of this type of therapy appears to be improvement in left ventricular function.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 12/2003; 22(11):1347-55. · 0.59 Impact Factor
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    ABSTRACT: In patients (pts) with dilated cardiomyopathy and intraventricular conduction disturbances, resynchronization therapy improves cardiac function and functional capacity. Determination of the optimal AV interval is essential to optimize the therapy results and various methods have been used in daily practice to obtain such an interval. The aim of this work is to assess optimal AV determined by impedance cardiography and compare it to the interval previously obtained by transmitral flow Doppler echocardiography. Seven pts were evaluated, five men, mean age of 61 +/- 10 years, with dilated cardiomyopathy, intra-ventricular conduction disturbances and heart failure, New York Heart Association functional class III or IV. Four pts had ischemic cardiomyopathy and three idiopathic. All pts had an implanted cardioverter-defibrillator with cardiac resynchronization. The optimal AV delay was estimated by transmitral flow pulsed Doppler using the method previously described by Ritter. Subsequently, cardiac output (CO) was determined by impedance cardiography. CO was estimated for different AV delays, beginning with 80 ms until occurrence of fusion QRS. The optimal AV delay was defined as the value corresponding to the highest measured CO. The ideal AV interval was compared between the two methods used. The AV delay determined by echocardiography varied between 120 and 170 ms (134 +/- 17 ms). The optimum AV delay based on CO estimation varied between 110 and 190 ms (137 +/- 26 ms). There was a correlation between the delays determined by the two methods (r = 0.844; p = 0.017). In pts undergoing ventricular resynchronization therapy, AV delay optimization based on CO determined by impedance cardiography is comparable to that measured by transmitral flow pulsed Doppler. However, impedance cardiography seems a more objective and simpler technique.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 10/2003; 22(9):1091-8. · 0.59 Impact Factor
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    ABSTRACT: To state the incidence of carotid sinus syndrome (CSS) with atrioventricular node manifestation in patients with sinus node dysfunction (SND) and indication for a definitive pacemaker (PM), we propose a new protocol between atrial pacing AAI and double chamber DDD. 69 patients (PTS) (male 71%), median age 65 +/- 10 years, with SND (normal PQ and no intraventricular conduction defect), that had a PM implant following the protocol that included carotid sinus massage for the pacing decision, were followed prospectively between December 1995 and November 1999. During the protocol we implanted DDD PM in PTS with Wenckebach less than 130 or Wenckebach equal/over 130 and CSS. At least, in PTS with Wenckebach equal/over 130 and no CSS we implanted AAI PM. The follow-up was between 4 months and 4 years, with clinical evaluation in the first and fourth months and then half yearly, with carotid sinus massage in the first evaluation. About 1/4 of the 69 patients followed had SND without carotid sinus syndrome, or atrioventricular node repercussion; the SND involved the atrioventricular node in 56% of the patients, and there was a relation between the SND and carotid sinus syndrome in 18.8%. The follow-up revealed, in all patients, a complete remission of the symptoms, and when we repeated the carotid sinus massage in the first evaluation, there was a response like in the surgery room, in all patients. There is a significant number of patients with SND and carotid sinus syndrome. The carotid sinus massage performed in the surgery room does not influence the test sensitivity and specificity in the diagnosis of carotid sinus syndrome. The authors think that carotid sinus massage should be considered in the protocol that defines the pacing mode, in patients with SND, and that influence the choice of pacemaker in 18.8% of patients.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 03/2001; 20(2):167-72. · 0.59 Impact Factor
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    ABSTRACT: To assess the performance of a new radiofrequency catheter, specially designed for inferior vena cava-tricuspid annulus (IVC-TA) isthmus ablation, in the treatment of atrial flutter. IVC-TA isthmus ablation was performed in thirteen patients, eleven men and two women, aged 60 +/- 12, with a diagnosis of typical atrial flutter, symptomatic despite anti-arrhythmic therapy. The flutter was present for more than one year in seven patients and was paroxysmal in the remainder. The echocardiogram showed atrial enlargement in six patients. Atrial flutter was an isolated phenomenon in seven patients and in the remainder was associated with arterial hypertension (two patients), ischemic heart disease (two patients) and dilated cardiomyopathy (two patients). In the electrophysiologic study four diagnostic catheters were used, including one duodecapolar for mapping the tricuspid annulus. In the patients who presented with sinus rhythm, atrial flutter was induced with programmed atrial stimulation, and then the atrial activation circuit was mapped. To demonstrate the entrainment phenomenon the IVC-TA isthmus was over-stimulated, to prove that this was the slow zone of the circuit. The radiofrequency energy was applied in the IVC-TA isthmus with the Medtronic Cosio-Fluttr ablation catheter, for 60 sec per application, with temperature control and with a maximum energy output of 50 W. Criteria for success were not only the disappearance of the atrial flutter during the application of radiofrequency energy, but also the demonstration of bi-directional IVC-TA isthmus block. The primary success rate was 100%. The mean procedure time was 110 +/- 22 min, mean fluoroscopy time was 23 +/- 4 min and the number of radiofrequency energy pulses was 9 +/- 3. There were no complications. The patients were followed for a mean time of 8 +/- 4 months and atrial flutter recurred in only one patient (8%). Atrial flutter ablation with the new Medtronic Cosio-Fluttr catheter, specially designed for the application of radiofrequency at the IVC-TA isthmus, is a safe procedure and has a high success rate. It simplifies ablation, decreasing the number of radiofrequency energy pulses, without using long sheaths and keeping short procedure and fluoroscopy times.
    Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2001; 20(7-8):729-44. · 0.59 Impact Factor