Publications (14)42.68 Total impact
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Article: Direct Comparison of Cardiac Magnetic Resonance and Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease.
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ABSTRACT: OBJECTIVES: This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). BACKGROUND: MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. METHODS: 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤0.80 in vessels >2mm. RESULTS: On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. CONCLUSIONS: MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.Journal of the American College of Cardiology 01/2013; · 14.16 Impact Factor -
Article: Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: A prospective study.
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ABSTRACT: BACKGROUND: Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a state of the art non-invasive modality for the detection of reversible ischemia. Recent studies have shown its utility in the diagnosis of coronary artery disease (CAD) and superiority over other established techniques. However, only a few studies compared CMR-MPI against the invasive standard including fractional flow reserve (FFR) and clinical validation in non-specialized centers is scarce. The aim of this study was to validate CMR-MPI in a real-world clinical environment and to test its diagnostic accuracy in symptomatic patients with suspected CAD versus FFR as the reference standard of functionally significant disease. METHODS AND RESULTS: 103 symptomatic consecutive patients (62±8.0years, 66% males) with suspected CAD and intermediate or high probability of disease underwent sequential CMR and invasive coronary angiography (XA). The CMR protocol included stress-rest adenosine perfusion, SSFP cine imaging and late-enhancement imaging. Functionally significant CAD was defined as occlusive/sub-occlusive stenoses on XA or non-occlusive stenoses with a FFR measurement of <0.80 in vessels >2mm. On a patient-based model, CMR-MPI had sensitivity, specificity, positive and negative predictive values of 89%, 88%, 85%, and 91%, respectively, with a global accuracy of 88%. On a vessel-based analysis, these values were 80%, 93%, 79% and 94%, respectively, with a global accuracy of 90%. CONCLUSIONS: CMR-MPI had a very high accuracy for detection of functionally significant CAD as assessed by FFR in patients with intermediate to high pretest probability.International journal of cardiology 10/2012; · 7.08 Impact Factor -
Article: Diagnosis of acute myopericarditis by delayed-enhancement multidetector computed tomography.
Journal of the American College of Cardiology 08/2012; 60(9):868. · 14.16 Impact Factor -
Article: Exercise training enhances autonomic function after acute myocardial infarction: A randomized controlled study.
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ABSTRACT: Heart rate recovery, defined as the fall in heart rate during the first minute after exercise, is an indicator of autonomic function, and has been found to be an independent predictor of mortality after acute myocardial infarction. Exercise training has several well-known benefits in terms of cardiorespiratory fitness, modifiable cardiovascular risk factors and prognosis after acute coronary events. However, there are no randomized controlled studies in the literature evaluating the effects of exercise training per se, controlling for changes in medication and diet, on heart rate recovery. Thus, this study aims to assess the effects of exercise training on autonomic function in coronary artery disease patients recovering from acute myocardial infarction. Thirty-eight patients following a first acute myocardial infarction participated in this prospective randomized clinical trial. Patients were randomized into two groups: exercise training or control. The exercise group participated in an 8-week aerobic exercise program, while the control received standard medical care and follow-up. Changes in hemodynamics at rest and at peak exercise (heart rate, systolic and diastolic blood pressure, and rate pressure product), dietary intake, cardiorespiratory fitness, and heart rate recovery were assessed. Medication and diet remained unchanged in both groups during the study period. The exercise-training group improved resting hemodynamics, particularly resting heart rate (from 68.0±9.2 to 62.6±8.7bpm, p=0.030) and systolic blood pressure (from 135±7.1 to 125.6±11.3mmHg, p=0.012), cardiorespiratory fitness (from 30.8±7.8 to 33.9±8.3ml/min/kg, p=0.016), and heart rate recovery (from 20±6 to 24±5bpm, p=0.007). No significant changes were observed in the control group. Exercise training improved autonomic function, assessed by heart rate recovery, resting heart rate and systolic blood pressure, in the absence of changes in diet or medication.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2012; 31(2):135-41. -
Article: Incremental value of an integrated adenosine stress-rest MDCT perfusion protocol for detection of obstructive coronary artery disease.
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ABSTRACT: Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans. To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients. Ninety symptomatic patients with suspected CAD (62 ± 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 μg/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 ± 0.8 mSv). Significant and higher-grade CADs were defined by the presence of ≥50% or ≥70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images. On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect ≥50% or ≥70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%). The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population.Journal of cardiovascular computed tomography 11/2011; 5(6):392-405. -
Article: Incidence and predictors of permanent pacemaker requirement after transcatheter aortic valve implantation with a self-expanding bioprosthesis.
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ABSTRACT: Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single-center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self-expanding bioprosthesis. From August 2007 to October 2009, 32 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV) System (Medtronic Inc., Minneapolis, MN, USA). Three patients paced at baseline and two cases of procedure-related mortality were excluded. We analyzed the 12-lead electrocardiogram at baseline, immediately after procedure and at discharge. Requirements for PPM were documented and potential clinical, electrophysiological, echocardiographic, and procedural predictors of PPM requirement were studied. After TAVI, eight patients (29.6%) required PPM implantation due to high-grade atrioventricular (AV) block. The prevalence of left bundle branch block increased from 13.8% to 57.7% directly after implantation (P = 0.001). Need for PPM was correlated to the depth of prosthesis implantation (r = 0.590; P = 0.001). At a cutoff point of 10.1 mm, the likelihood of pacemaker could be predicted with 87.5% sensitivity and 74% specificity and a receiver operator characteristic curve area of 0.86 ± 0.07 (P = 0.003). Of the seven patients with preexisting right bundle branch block (RBBB), four (57.1%) required PPM implantation after TAVI. High-grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high-grade AV block and subsequent pacemaker implantation.Pacing and Clinical Electrophysiology 11/2010; 33(11):1364-72. · 1.35 Impact Factor -
Article: Endothelial function and atherosclerosis: circulatory markers with clinical usefulness.
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ABSTRACT: The healthy endothelium secretes and expresses at the surface various molecules which help maintain vascular wall structure and vascular homeostasis, as well as regulating vascular tone and leukocyte traffic. In response to various aggressive stimuli, the endothelial cell modulates its properties to restore vascular homeostasis. Usually, changes in the endothelial cell phenotype are transient and do not compromise the subsequent re-establishment of endothelial function. However, in certain pathological conditions, such as atherosclerosis, endothelial function is chronically disturbed, and this alteration is a critical step in the progression of the disease. In recent years, advances in knowledge have improved our understanding of the physiopathology of atherosclerosis, which is now known to be a dynamic and progressive process proceeding from endothelial dysfunction and inflammation of the vascular wall. The evolution and prognosis of atherosclerosis, along with the efficacy of therapeutic modalities, can be assessed by measuring the circulating levels of various biomarkers expressed or released by the endothelium. The purpose of this review is to reappraise the evidene concerning endothelial function under physiological conditions and in atherosclerosis, and to analyze markers of endothelial function with clinical applicability.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 10/2009; 28(10):1121-51. -
Article: Multislice computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease.
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ABSTRACT: Multislice computed tomography (MSCT) has shown high negative predictive value in ruling out obstructive coronary artery disease. Preliminary studies in patients with valvular heart disease (VHD) have demonstrated the potential of MSCT angiography (CTA) in such patients, precluding need for invasive angiography (XA). However, larger prospectively designed studies, including patients with atrial fibrillation and incorporating dose reduction algorithms, are needed. To evaluate the clinical utility of 64-slice CT in the preoperative assessment in patients with VHD, we prospectively studied 452 consecutive patients undergoing routine cardiac catheterization for eligibility. Two hundred thirty-seven patients underwent both MSCT and XA. Segment-based, vessel-based, and patient-based agreement between CTA and XA was estimated assuming that "nonevaluable" segments were positive for significant coronary stenosis. In a patient-based analysis, sensitivity, specificity, positive predictive value, and negative predictive values of CTA were 95%, 89%, 66%, and 99%, respectively; in vessel-based analysis, 90%, 92%, 48%, and 99%, respectively; and in segment-based analysis, 89%, 97%, 38%, and 100%, respectively. No significant differences were found between patients with or without atrial fibrillation. A CAC value of 390 was the best cutoff for the identification of patients with positive or inconclusive CTA (which would not be exempted from XA in the clinical setting). In the preoperative assessment of patients with predominant VHD, the diagnostic accuracy of 64-slice CTA for ruling out the presence of significant coronary artery disease is very good even when including patients with irregular heart rhythm. Using this approach, CAC quantification before CTA can be successfully used to identify patients who should be referred directly to XA, sparing unnecessary exposure to radiation.Circulation Cardiovascular Imaging 07/2009; 2(4):306-13. · 5.94 Impact Factor -
Article: Funcionalidade endotelial e aterosclerose: marcadores sanguíneos com utilidade pública
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 01/2009; 28(10):1121-1151. -
Article: Cardiac rehabilitation in Portugal--developments between 1998 and 2004.
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ABSTRACT: Cardiac rehabilitation (CR) has recognized value in cardiovascular disease. However, according to the 1998 survey of the Portuguese Study Group on Exercise Pathophysiology and Cardiac Rehabilitation, it was still underused in Portugal, with much lower referral rates than other European countries. The aim of the present work was to assess developments in CR in Portugal between 1998 and 2004. A form requesting information on general characteristics, technical staff, program phases and components, and funding, was sent to all CR centers. The rate of referral to CR was calculated by comparing these data with official data from hospital discharges for acute coronary syndromes in 2004. There was a twofold increase in the number of CR centers, mainly because of new public hospitals. The programs are well organized and have actually been improved in recent years. The overall admission rate in 2004 was 1.5%, which, despite representing an increase compared to 1998, is still much lower than the rates of other European countries. Most of the problems previously reported, including the size and location of centers, training, funding and educational and cultural issues, have not been overcome. Although there have been some improvements, the number of patients who are referred to CR in Portugal is still too low. It is essential to address and to resolve most of the issues that are limiting patients' access to this treatment.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 10/2007; 26(9):815-25. -
Article: Determinants of left ventricular systolic function recovery after an acute coronary syndrome.
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ABSTRACT: Ischemic heart disease is a major cause of heart failure in western societies. However, the factors that may influence left ventricular function (LVF) recovery after an acute coronary syndrome (ACS) are still unclear. To identify variables that may influence LVF evolution one year after ACS. 104 patients hospitalized with ACS between 7/1/2001 and 12/31/2002 and with systolic dysfunction--defined as an echocardiographic ejection fraction (EF) < or = 45%--were randomly allocated to a planned coronary follow-up program (FUP) or a general cardiology clinic (GC); patients from both groups were also randomly referred to a structured cardiac rehabilitation program (CRP). EF was re-assessed at one year. We compared differences between patients who recovered left ventricular function (EF > 45%; group 1) and those who did not (group 2). One year after discharge, 44.2% of the patients had recovered function. There were no significant differences between the groups in gender (77.7 vs. 76.5% male), age (56 vs. 59 years), hypertension, diabetes, dyslipidemia, smoking habits or family history. A previous history of cardiovascular events was more frequent in group 2 (11.1% vs. 35.3%, p = 0.03). Cardiac catheterization was performed before discharge in 88.8% and 88.2% in groups 1 and 2 respectively (p = NS); no differences were found in coronary anatomy between the two groups. Angioplasty was performed in 54.2% in group 1 and 50% in group 2 (p = NS). There were no differences in the use of angiotensin-converting enzyme inhibitors (83.3% vs. 87.5%), beta-blockers (87.5% vs. 87.5%), nitrates (37.5% vs. 33.3%), aspirin (95.8% vs. 95.8%), statins (79.1% vs. 75%) or diuretics (20.8% vs. 45.8%). There was no significant difference in LVF recovery between patients randomized to FUP or GC (38.5% vs. 54.5%). 87.5% of patients who completed the CRP had normal EF at one year compared to 32.7% of patients not referred to the program (p = 0.009). Although EF improved in both groups, this improvement was greater in patients who completed a CRP (EF 8% vs. 5%, p = 0.003). A previous cardiovascular event and completion of a CRP were the only variables that influenced LVF recovery. Thus, enrollment in a CRP, in addition to standard therapy, could be an important therapeutic measure in patients with systolic dysfunction after ACS; our data suggest that these programs should be more widely used.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 04/2006; 25(3):321-7. -
Article: Acute coronary syndrome and predictors of quality of life.
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ABSTRACT: Coronary disease in its various forms of presentation is associated with a reduction in the patients' own perception of their quality of life (QoL). QoL is an important measure of effectiveness of treatment; however, the predictors of QoL after admission for acute coronary syndrome (ACS) are not completely clear. To identify the clinical, demographic and psychosocial characteristics of patients admitted for ACS that were predictive of QoL in clinical follow-up. Physical and mental QoL were prospectively evaluated in 278 patients admitted for ACS, using Short Form-36 v2 physical (PCS) and mental (MCS) component summary scales. Based on the median PCS (55) and MCS (56) scores, the population was divided into two groups. Depressive symptoms were assessed using the Beck Depression Inventory. The patients with a better QoL perception were male, young, smokers and had more than 12 years' education. A greater proportion of patients with PCS and MCS below the median score presented prior cardiovascular events and depressive symptoms. A worse physical QoL perception was more common in unmarried, hypertensive and diabetic patients. There was no association between clinical evolution or in-hospital complications and baseline QoL scores. Baseline PCS and MCS were 55 +/- 24 and 55 +/- 27 and at 16 months, 63 +/- 25 and 66 +/- 29. Clinical follow-up was achieved in 181 patients. A worse mental QoL perception at follow-up was related to female gender, baseline MCS < 56 and depressive symptoms. A PCS below median score at follow-up was more frequent in women and in patients with prior cardiovascular events, hypertension, diabetes, dyslipidemia and a lower level of education. Patients with better physical QoL at follow-up were smokers, presented higher baseline PCS and MCS, and had fewer depressive symptoms. Percutaneous myocardial revascularization was associated with a better physical QoL. In a logistic regression model the independent predictors of PCS were: gender, baseline PCS, level of education and prior cardiovascular events. Gender and depressive symptoms were independent predictors of MCS. In the study population, baseline clinical and psychosocial characteristics were the most important predictors of QoL after ACS. Depression was associated with worse mental QoL. In-hospital evolution and treatment did not appear to strongly affect patients' follow-up perceptions of QoL.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 06/2005; 24(6):819-31. -
Article: Impact of cardiac rehabilitation on quality of life and depression after acute coronary syndrome.
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ABSTRACT: To evaluate the impact of cardiac rehabilitation programs (CRP) on quality of life (QL) and depression at one-year follow-up after acute coronary syndrome (ACS). Two hundred and three patients, without previous cardiological follow-up and referred to the outpatient clinic after hospitalization for ACS between 9/1/2001 and 12/31/2002, were randomly allocated to a 12-week, 3-times-a-week CRP or standard cardiology follow-up only, after giving their informed consent. Baseline population characteristics were recorded and, in patients with more than 4 years' education, QL and depression were evaluated during hospitalization and at one-year follow-up by self-reported responses to the SF-36 QL survey and the Beck Depression Inventory (BDI) respectively. Analysis was by intention-to-treat. 31 patients randomized to CRP, mean age 56 years (31-80), 84% male (group A) and 95 patients, mean age 58 years (33-86), 83 % male, allocated to standard follow-up (group B), responded to the questionnaires. There were no significant differences between the two groups in any of the variables evaluated by the questionnaires during hospitalization. At one-year evaluation, the average BDI score was lower in the CRP group (8 vs. 11, p = 0.05). The prevalence of depressive symptoms (37.5 vs. 56.1%) or severe depression (3.1% vs. 12.2%) was also lower, in this group, although not significantly. SF-36 found significant differences in the evaluation of Vitality (average 62 points in A vs. 47 in B, p < 0.02) and General Health (57 points in A vs. 46 points in B, p < 0.02); there were no differences in the other parameters evaluated. When the physical and mental health components were analyzed, a significant difference favoring CRP was found in mental health (70.6 vs. 56.9, p = 0.02) but not in physical health (62.9 in A vs. 56.4 in B, NS). Despite the small sample size, significant differences favorable to CRP after ACS were found. After one-year follow-up, patients referred to CRP have a better BDI score; the Vitality and General Health parameters, as well as the mental health component evaluated by SF-36, are also significantly improved after CRP.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 05/2005; 24(5):687-96. -
Article: Acute coronary syndromes in young women.
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ABSTRACT: Acute coronary syndromes (ACS) in young women are relatively unusual. This subgroup of patients presents a premature risk of death and disability, with significant social repercussions. OBJECTIVE/METHODOLOGY: This retrospective study was undertaken to define risk factors, symptoms and signs at presentation, electrocardiographic and angiographic characteristics, treatment and complications, in pre-menopausal women younger than fifty years old, admitted to the Coronary Care Unit between 1991 and 2002. We evaluated 33 patients (mean age 43.0 years). The most frequent risk factors were hypertension (48.5%) and smoking (45.5%). Typical chest pain (78.7%) and tachycardia (34.1%) were the most prevalent symptom and sign respectively. A history of previous angina was present in 18% of the patients. The most common presenting electrocardiographic finding was ST segment elevation (45.5%). Critical coronary lesions were present in 78.7%, mainly in the left anterior descending (LAD) (54.5%). Single-vessel disease was more frequent than multi-vessel disease (57.6% vs. 18.2%). Coronary arteries were angiographically normal in 9.1%. Left ventricular dysfunction assessed by echocardiography was present in 63.6%. Recurrent angina was the most common complication (24.2%). No fatal cases were recorded. Acute reperfusion therapy was indicated in fifteen patients: direct angioplasty in six, thrombolysis in six and none in three. Elective revascularization was performed in seventeen patients (angioplasty in ten and coronary artery bypass graft in seven). Secondary prevention included platelet antiaggregants in 100%, beta-blockers in 81.5%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 42.2%, and statins in 42.2%. Diagnosis at discharge was Q-wave myocardial infarction (anterior--36.3% and inferior--15.2%), non-Q wave myocardial infarction (27.2%), and unstable angina (21.2%). This study shows that atherosclerosis was the principal etiopathogenic factor in young women with ACS. Hypertension and smoking were the commonest risk factors. Critical LAD stenosis, Q-wave myocardial infarction (mostly anterior) and left ventricular dysfunction were common.Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 02/2004; 23(1):69-77.
Top co-authors
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Institutions
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2009–2013
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University of Porto
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL)
Porto, Distrito do Porto, Portugal
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2006–2012
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Centro Hospitalar de Vila Nova de Gaia/Esphino
Vila Nova de Gaia, Distrito do Porto, Portugal
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