Revista Portuguesa de Cardiologia (English Edition)最新文献

{"title":"Medication adherence to direct anticoagulants in patients with non-valvular atrial fibrillation – A real world analysis","authors":"Catarina Brízido,&nbsp;António Miguel Ferreira,&nbsp;Pedro Lopes,&nbsp;Christopher Strong,&nbsp;Gustavo Sá Mendes,&nbsp;Francisco Fernandes Gama,&nbsp;Anaí Durazzo,&nbsp;Gustavo Rocha Rodrigues,&nbsp;Daniel Matos,&nbsp;Sara Guerreiro,&nbsp;Sérgio Madeira,&nbsp;Jorge Ferreira,&nbsp;Pedro Adragão,&nbsp;Miguel Mendes","doi":"10.1016/j.repce.2021.07.002","DOIUrl":"10.1016/j.repce.2021.07.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Direct oral anticoagulants (DOACs) changed the landscape of atrial fibrillation (AF) treatment, but also brought with them new challenges in terms of accessibility and compliance. The purpose of this study was to assess adherence to DOACs, and its determinants in a population of AF patients.</p></div><div><h3>Methods</h3><p>Single-center retrospective study including all patients with non-valvular AF treated with a DOAC from the outpatient general cardiology list at a tertiary center, whose first DOAC prescription was between 1 April 2016 and August 2018. The number of pharmacy refills from the day of first prescription to 31 August 2018 was counted (by means of an electronic prescription platform). Medication refill adherence (MRA) was calculated by dividing the total days' supply by the number of days under therapy. Non-compliance was defined as MRA &lt;90%.</p></div><div><h3>Results</h3><p>A total of 264 patients (120 men, mean age 74 ± 12 years) met the inclusion criteria. The median CHA₂DS₂VAS_C score was 3 (interquartile range (IQR) 2-5) and the median HAS-BLED was 1 (IQR 1-2). Rivaroxaban, apixaban, dabigatran and edoxaban were prescribed in 45%, 41%, 24% and 13% of patients, respectively. During the study 51 patients (19%) used at least two DOACs .Patients took DOACs for a median period of 439 days (IQR 269-638), during which the included population adhered to therapy 90% of the time (IQR 75-100%). Half of the patients (51%) were classified as non-compliant; therapy duration (adjusted odds ratio 1.06 per month, 95% confidence interval (CI) 1.03-1.08, p&lt;0.001), DOACs twice daily (adjusted OR 1.73, 95%CI 1.08-2.75, p=0.022), and higher out-of-pocket costs (adjusted OR 2.13, 95%CI 1.28-3.45, p=0.003) were independent predictors of non-compliance.</p></div><div><h3>Conclusion</h3><p>Half of the patients (51%) were classified as non-compliant (medication refill adherence &lt;90%). Therapy duration, DOACs twice daily and higher out out-of-pocket costs were independent predictors of non-compliance, which could be targets to improve patient adherence.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 9","pages":"Pages 669-675"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2021.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39402076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to “Basal takotsubo syndrome: a multifaceted entity with potential implications” and an update assessing myocardial work","authors":"Nikolaos Miaris,&nbsp;Nearchos Kasinos,&nbsp;Maria Karakosta,&nbsp;Sarantos Linardakis,&nbsp;Dimitra Maritsa,&nbsp;Nikolaos Patsourakos,&nbsp;Evangelos Pisimisis","doi":"10.1016/j.repce.2021.08.001","DOIUrl":"10.1016/j.repce.2021.08.001","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 627-630"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2021.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac arrhythmias in patients presenting with COVID-19 treated in Portuguese hospitals: A national registry from the Portuguese Association of Arrhythmology, Pacing and Electrophysiology","authors":"Dinis Mesquita ,&nbsp;Pedro Carmo ,&nbsp;Nuno Cabanelas ,&nbsp;Nuno Santos ,&nbsp;Vítor Martins ,&nbsp;Victor Sanfins ,&nbsp;Helena Cristina Costa ,&nbsp;José Paulo Fontes ,&nbsp;Paulo Fonseca ,&nbsp;Leonor Parreira ,&nbsp;on behalf of the Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE)","doi":"10.1016/j.repce.2020.11.025","DOIUrl":"10.1016/j.repce.2020.11.025","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>In December 2019, SARS-CoV-2, was discovered as the agent of COVID-19 disease. Cardiac arrhythmias have been reported as frequent but their incidence is unknown. The aim of this research was to assess the real incidence of cardiac arrhythmias among COVID-19 patients admitted to Portuguese hospitals and to understand the underlying prognostic implications.</p></div><div><h3>Methods</h3><p>The Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) conducted a survey in Portuguese hospitals to assess the occurrence of arrhythmias in COVID-19 patients, their clinical characteristics, the use of experimental therapies and the impact on QT interval.</p></div><div><h3>Results</h3><p>Twenty hospitals participated, reporting 692 hospitalized patients. An arrhythmic episode occurred in 81 (11.7%) and 64 (79%) had detailed information on these episodes. New onset arrhythmias occurred in 41 (64%) patients, 45 (70.3%) male, median age 73.5 (61-80.3) years. There were 51 (79.7%) with associated comorbidities, mainly arterial hypertension (41, 64.1%). Of 53 patients (82.3%) on experimental therapy, 7 (10.9%) had an increased QTc interval. Regarding arrhythmias, two patients (3.1%) had ventricular tachycardia, 5 (7.8%) sinus bradycardia, 17 (26.6%) paroxysmal supraventricular tachycardia and 40 (62.5%) atrial fibrillation or flutter. At the time of reporting, there had been no deaths due to arrhythmic syndrome or related complications.</p></div><div><h3>Conclusions</h3><p>In a population of COVID-19 patients. The incidence of cardiac arrhythmias is high but not associated with increased cardiac mortality although it does though occur frequently in extremely ill patients and with multiple organ failure. Regardless of the use of experimental drugs, the incidence of ventricular arrhythmias is low and atrial fibrillation and other supraventricular arrhythmias are the most prevalent arrythmias.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 573-580"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2020.11.025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is lipid accumulation product a better cardiovascular risk predictor in elderly individuals than anthropometric measures?","authors":"Samon Henrique Nunes ,&nbsp;Maria Auxiliadora Nogueira Saad ,&nbsp;Rubens Antunes da Cruz Filho ,&nbsp;Antonio José Lagoeiro Jorge ,&nbsp;Márcia Maria Sales dos Santos ,&nbsp;Wolney de Andrade Martins ,&nbsp;Thais Landi de Campos ,&nbsp;Maria Luiza Garcia Rosa","doi":"10.1016/j.repce.2020.09.007","DOIUrl":"10.1016/j.repce.2020.09.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Population aging is associated with increased prevalence of cardiovascular diseases that have a significant impact on overall morbidity and mortality. Insulin resistance (IR) and visceral obesity are risk factors for vascular damage and cardiometabolic diseases.</p></div><div><h3>Aims</h3><p>Estimating the correlation between lipid accumulation product (LAP) and IR in elderly individuals and comparing them to traditional anthropometric indices.</p></div><div><h3>Methods</h3><p>Cross-sectional study comprising 411 individuals &gt;60 years, who were treated in a primary care service. Body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), arm circumference (AC), sagittal abdominal diameter (SAD) and waist-hip ratio (WHR) were recorded. IR was estimated based on HOMA-IR (homeostasis model assessment IR index). LAP^a index was calculated as [WC-65]×[triglyceride (TG)] in men, and as [WC-58]×[TG] in women, whereas LAP^b was calculated by using the minimum WC values recorded for the current sample, i.e., 61.5 cm for women and 71.5 cm for men.</p></div><div><h3>Results</h3><p>There was correlation among LAP^a (0.506), LAP^b (0.515) and HOMA-IR. LAP was better correlated to HOMA-IR and showed higher area under the curve than BMI, NC, WHR and SAD. Based on the receiver operating characteristic curve analysis, LAP^b≥47.40 and LAP^a≥52.5 were the best cut-off values used to identify individuals with IR presenting 68.8% and 68.2% sensitivity, and 68.6% and 68.6% specificity, respectively.</p></div><div><h3>Conclusion</h3><p>LAP may be a useful and simple clinical marker to assess cardiometabolic risk factors in the elderly population treated at a primary care service.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 539-544"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2020.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes","authors":"Joana Rigueira ,&nbsp;João R. Agostinho ,&nbsp;Inês Aguiar-Ricardo ,&nbsp;Inês Gonçalves ,&nbsp;Rafael Santos ,&nbsp;Afonso Nunes-Ferreira ,&nbsp;Tiago Rodrigues ,&nbsp;Nelson Cunha ,&nbsp;N’Zinga André ,&nbsp;Raquel Pires ,&nbsp;Fátima Veiga ,&nbsp;Mónica Mendes Pedro ,&nbsp;Fausto J. Pinto ,&nbsp;Dulce Brito","doi":"10.1016/j.repce.2020.09.008","DOIUrl":"10.1016/j.repce.2020.09.008","url":null,"abstract":"<div><h3>Background</h3><p>Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood.</p></div><div><h3>Objectives</h3><p>To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact.</p></div><div><h3>Methods</h3><p>Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6^th and 12^th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death.</p></div><div><h3>Results</h3><p>43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score &lt;22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA.</p></div><div><h3>Conclusions</h3><p>Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 547-555"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2020.09.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous patent ductus arteriosus closure: Twelve years of experience","authors":"João Antunes Sarmento ,&nbsp;Ana Correia-Costa ,&nbsp;Edite Gonçalves ,&nbsp;Maria João Baptista ,&nbsp;João Carlos Silva ,&nbsp;Jorge Moreira","doi":"10.1016/j.repce.2020.09.009","DOIUrl":"10.1016/j.repce.2020.09.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique.</p></div><div><h3>Methods</h3><p>Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018.</p></div><div><h3>Results</h3><p>A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse).</p></div><div><h3>Conclusions</h3><p>Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 561-568"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2020.09.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left main stenosis: Can a consensus be reached?","authors":"Pedro Magro,&nbsp;Miguel Sousa-Uva","doi":"10.1016/j.repce.2021.07.032","DOIUrl":"10.1016/j.repce.2021.07.032","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 619-622"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2021.07.032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin resistance as a predictor of cardiovascular diseases","authors":"Neuza Domingues","doi":"10.1016/j.repce.2021.07.025","DOIUrl":"10.1016/j.repce.2021.07.025","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 545-546"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2021.07.025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39322991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basal takotsubo syndrome: A multifaceted entity with potential implications","authors":"Kenan Yalta ,&nbsp;Cihan Ozturk ,&nbsp;Tulin Yalta ,&nbsp;Ertan Yetkin","doi":"10.1016/j.repce.2021.07.033","DOIUrl":"10.1016/j.repce.2021.07.033","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 625-626"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2021.07.033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of iron deficiency in acute coronary syndromes","authors":"Carina Silva ,&nbsp;Juliana Martins ,&nbsp;Isabel Campos ,&nbsp;Carina Arantes ,&nbsp;Carlos Galvão Braga ,&nbsp;Nuno Salomé ,&nbsp;António Gaspar ,&nbsp;Pedro Azevedo ,&nbsp;Miguel Álvares Pereira ,&nbsp;Jorge Marques ,&nbsp;Catarina Vieira","doi":"10.1016/j.repce.2020.09.005","DOIUrl":"10.1016/j.repce.2020.09.005","url":null,"abstract":"<div><h3>Background</h3><p>Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study.</p></div><div><h3>Methods</h3><p>Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n=298) or absence of IDef (n=519) on admission. The clinical event under study was the occurrence of death or severe HF in the long term. Independent predictors of prognosis were determined with logistic regression analysis.</p></div><div><h3>Results</h3><p>Thirty-six percent of patients had IDef. There was higher mortality (p=0.004), higher incidence of HF (p=0.011) during follow-up and a higher rate of hospital readmissions (p=0.048) in this group. IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death.</p></div><div><h3>Conclusion</h3><p>IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 8","pages":"Pages 525-536"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.repce.2020.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39311718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}