Browsing by Author "Costa, Hugo"
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- Bradiarritmias: abordagem em contexto pré e intra-hospitalarPublication . Costa, Hugo; Azevedo, Pedro; Carvalho, Daniela; Candeias, Rui; Jesus, IlidioAs bradiarritmias são eventos arrítmicos frequentes em contexto urgente e emergente. A sua frequência aumenta com a idade devido à evolução degenerativa do sistema de condução cardíaco, embora também possam ser encontradas em idades jovens e atletas treinados. A doença sinoauricular e os bloqueios auriculoventriculares são os mecanismos fisiopatológicos mais comuns no que diz respeito aos distúrbios da condução. Uma correta investigação é essencial na identificação etiológica (intrínseca ou extrínseca ao tecido cardíaco) bem como na forma de instalação e no caráter de reversibilidade. As causas reversíveis devem ser prontamente corrigidas e são essenciais na estabilização do doente. Na presença de bradicardia, a apresentação clínica deve guiar a abordagem inicial, assim como a existência de sinais de gravidade no electrocardiograma. A terapêutica farmacológica e o pacing transcutâneo são medidas/atitudes intermédias de suporte hemodinâmico como ponte para intervenções especializadas. Assim, uma correta avaliação e rápida abordagem em ambiente pré-hospitalar ou hospitalar possibilita a estabilização do doente e posterior encaminhamento para estudo dirigido.
- Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitusPublication . Costa, Hugo; Espírito-Santo, Miguel; Bispo, João; Guedes, João; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and Objectives: Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. Methods: A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all -cause mortality. Results: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65 +/- 11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62 - 2.98). Myocardial infarction and all -cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all -cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85 - 0.99 and p=0.013, HR 0.96, 95% CI 0.93 - 0.99, respectively). Conclusions: T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.
- Clinical results of percutaneous coronary intervention in chronic total occlusions of the right coronary arteryPublication . Costa, Hugo; Espirito-Santo, Miguel; Bispo, João; Guedes, João; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and Objectives: Coronary chronic total occlusions (CTOs) of the right coronary artery (RCA) are a relatively common finding in the context of coronary angiography. However, the benefit of revascularization remains controversial. Methods: A single -center retrospective cohort analysis prospectively collected outcomes of CTO patients undergoing percutaneous coronary intervention (PCI) in 2019 and 2020. Patients were divided into two groups according to the CTO vessel treated (left coronary artery [LCA]-CTO or RCA-CTO). The primary outcome was defined as the recurrence of angina and/or heart failure (HF) symptoms and secondary outcomes were myocardial infarction (MI) and all -cause mortality. Results: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65 +/- 11 years. The primary outcome occurred in 28 (16.6%) patients and was significantly more frequent in RCA-CTO patients (19, 24.7%, p=0.010) in a mean follow-up of 18 months. This was mainly driven by recurrence of HF symptoms (12, 15.6%, p=0.013). Treated RCA-CTO was an independent predictor of the primary outcome (p=0.019, HR 2.66, 95% CI 1.17-6.05). MI and mortality rates were no different between groups (RCA-CTO with 1.3%, p=0.361 and 2.6%, p=0.673, respectively, on survival analysis). Left ventricular ejection fraction was an independent predictor of mortality (p=0.041, HR 0.93, 95% CI 0.87-0.99). Conclusions: Revascularization of CTO lesions by PCI was associated with low rates of symptom recurrence, and clinical outcomes showed no differences regardless of which artery was treated. Recanalization of RCA-CTO was less beneficial in reducing the recurrence of HF symptoms.
- Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratoryPublication . Costa, Hugo; Espírito-Santo, Miguel; Bispo, João; Guedes, João; Paulo, Graciano; Mimoso, Jorge; Palmeiro, Hugo; Gonçalves, Rui Baptista; Vinhas, HugoIntroduction and objectives: Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). Methods: This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (P-KA) and cumulative air kerma (K-a,K-r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (K-a,K-r). Results: A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9 +/- 11.2 years and mostly male (81.4%). DRLs were set in K-a,K-r (3012 mGy) and P-KA (162 Gy cm(2)) for complex PCI. ADs were also set in K-a,K-r (1917 mGy) and P-KA (101 Gy cm(2)). Independent predictors of K-a,K-r with a positive correlation were P-KA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). Conclusions: This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in K-a,K-r (3012 mGy) and P-KA (162 Gy cm(2)). ADs, values to be achieved in future assessment, were set to K-a,K-r (1917 mGy) and P-KA (101 Gy cm(2)).
- Natural carriers for application in tuberculosis treatmentPublication . Costa, Hugo; Grenha, AnaTuberculosis remains the leading cause of preventable deaths worldwide and unsuccessful therapy is mainly due to non-compliance with very prolonged treatments, often associated with severe side-effects. Overcoming this problem demands the introduction of drug carriers releasing the antimicrobial agents in a targeted and sustained manner, allowing reduction in frequency and dosing numbers. Nano and microparticles have taken the forefront of this approach, providing the means for the desired improvement of therapeutic schedules. Natural polymers are strong candidates as matrix forming materials, usually exhibiting biocompatibility, biodegradability, low cost and some technological advantages as compared with synthetic counterparts. In this review, natural particulate carriers developed for tuberculosis therapy are presented, mainly focusing on the use of polysaccharides and lipids. Their effectiveness is discussed taking into account their composition. Finally, considerations on the general potential of natural materials for this application, as well as key factors still to be addressed, are discussed.
- Non-vitamin K versus vitamin K antagonist oral anticoagulants in surgical mitral valve repair or bioprosthetic valve replacement in the first three months after surgeryPublication . Costa, Hugo; Custódio, Pedro; Gonçalves, Rui Baptista; Magro, Pedro Lamares; Uva, Miguel SousaIntroduction and Objectives: Oral anticoagulation (OAC) with non-vitamin K antagonist oral anticoagulants (NOACs) after surgical mitral valve repair (MVR) or bioprosthetic valve replacement (BVR) in mitral position remains a controversial topic among the cardiovascular community, in particular in the early postoperative period. This study aimed to evaluate the efficacy and safety of NOACs in the first three months after MVR or mitral BVR compared to vitamin K antagonists (VKAs). Methods: This was a single-center retrospective study with prospectively collected periintervention outcomes between 2020 and 2021. Records were retrieved and all participants were contacted by telephone. Patients were divided into groups according to OAC strategy. The primary outcome was a composite of death, rehospitalization, myocardial infarction, stroke or transient ischemic attack, systemic embolism, mitral thrombosis, or bleeding during the first three months after surgery. Results: A total of 148 patients were enrolled, with a mean age of 65.5 +/- 12.2 years, 56.8% male. On discharge, 98 (66.2%) patients were on VKAs and 50 (33.8%) were on DOACs for at least three months. The primary outcome occurred in 22 (22.4%) patients in the VKA group and in three (6%) in the NOAC group (p=0.012), mainly driven by more bleeding events in the former. Independent predictors of the primary outcome were smoking (p=0.028) and OAC with VKAs at discharge, the latter predicting three times more events (p=0.046, OR 3.72, 95% CI 1.02-13.5). Conclusions: NOACs were associated with fewer events, supporting their efficacy and safety during the first three months after surgical MVR or mitral BVR.
- A report on a survey among Portuguese Association of Interventional Cardiology associates regarding ionizing radiation protection practices in national interventional cath-labsPublication . Costa, Hugo; Vinhas, Hugo; Calé, Rita; Pereira, Ernesto; Santos, Joana; Paulo, Graciano; Jorge, Elisabete; Brochado, Bruno; Melica, Bruno; Gonçalves, Rui Baptista; Oliveira, Eduardo Infante deIntroduction and objectives: Concerns surrounding the consequences of ionizing radiation (IR) have increased in interventional cardiology (IC). Despite this, the ever-growing complexity of diseases as well as procedures can lead to greater exposure to radiation. The aim of this survey, led by Portuguese Association of Interventional Cardiology (APIC), was to evaluate the level of awareness and current practices on IR protection among its members. Methods: An online survey was emailed to all APIC members, between August and November 2021. The questionnaire consisted of 50 questions focusing on knowledge and measures of IR protection in the catheterization laboratory. Results were analyzed using descriptive statistics. Results: From a response rate of 46.9%, the study obtained a total sample of 159 responses (156 selected for analysis). Most survey respondents (66.0%) were unaware of the radiation exposure category, and only 60.4% reported systematically using a dosimeter. A large majority (90.4%) employed techniques to minimize exposure to radiation. All participants used personal pro- tective equipment, despite eyewear protection only being used frequently by 49.2% of main operators. Ceiling suspended shields and table protectors were often used. Only two-thirds were familiar with the legally established limit on radiation doses for workers or the dose that should trigger patient follow-up. Most of the survey respondents had a non -certified training in IR procedures and only 32.0% had attended their yearly occupational health consultation. Conclusions: Safety methods and protective equipment are largely adopted among interven- tional cardiologists, who have shown some IR awareness. Despite this, there is room for improvement, especially concerning the use of eyewear protection, monitoring, and certification.
- O suporte é básico e salva vidas uma história de sucesso da cadeia de sobrevivência:caso clinicoPublication . Costa, Hugo; Jacob, Miguel; Pereira, Rafaela; Ribeiro, SofiaReportamos um caso clínico de um jovem de 38 anos, vítima de paragem cardiorrespiratória em fibrilhação ventricular. O doente foi recuperado após 7 minutos de suporte básico de vida mais 26 minutos de suporte avançado de vida com 5 choques pelo monitor- desfibrilhador e LUCAS adaptado até à recuperação da circulação espontânea. Após estabilização o doente foi internado na Unidade de Cuidados Intensivos Polivalentes e posteriormente transferido para o serviço de Cardiologia, onde efetuou avaliação da anatomia coronária com coronárias sem lesões. Após descartadas as principais causas para o sucedido e passiveis de tratamento, o doente teve indicação para a colocação de um cardioversor - desfibrilhador- implantável. O caso clínico enaltece a rápida atuação e o elo de ligação da cadeia de sobrevivência, com suporte básico de vida e o contacto precoce com o centro de orientação de doentes urgentes, essenciais para a chegada em tempo útil da equipa de emergência médica e posterior ressuscitação cardiopulmonar avançada.
- Taquidisritmias supraventriculares:abordagem em contexto pré e intra-hospitalarPublication . Costa, Hugo; Azevedo, Pedro; Carvalho, Daniela; Candeias, Rui; de Jesus, IlídioAs taquidisritmias supraventriculares (TSV) são relativamente frequentes, constituem um grupo heterogéneo de arritmias e o seu diagnóstico diferencial é muitas vezes difícil na prática clínica. Apresentam clínica variável que depende da gravidade do evento arrítmico, das comorbilidades associadas bem como das características inerentes ao própriodoente. Embora a maioria das TSV se apresente com complexos QRS estreitos e as taquicardias ventriculares (TV) com complexos QRS largos, isto nem sempre acontece, sendo essencial uma cuidadosa avaliação para um diagnóstico correto.