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Browsing by Author "Leal, P"

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  • AVC isquémico pericateterismo cardíaco: a propósito de um caso clínico
    Publication . Magno, P; Loureiro, J; Marques, A; Abreu, PF; Cândido, M; Leal, P; Gil, VM
    O AVC isquémico ocorre em 0,2 a 0,4% dos doentes submetidos a cateterização cardíaca esquerda, sendo responsável por 5-10% da mortalidade relacionada com o procedimento. Estão identificados alguns factores predisponentes para esta complicação como sejam o sexo feminino, a presença de placas de aterosclerose complexas na aorta ascendente e/ou de doença arterial periférica. A oportunidade de intervenção dentro da janela de reperfusão reforça a estratégia de uma vigilância clínica rigorosa no período imediato pós-cateterização. O Cardiologista deve estar bem familiarizado com as diferentes modalidades da terapêutica de reperfusão e suas indicações de acordo com a relação temporal do AVC isquémico com o cateterismo, devendo essa decisão ser partilhada com a Neurologia e Neuro-radiologia.
    2007Journal article Open access Show more
  • Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction.
    Publication . Baptista, SB; Faustino, M; Brízida, L; Loureiro, J; Augusto, J; Abecasis, J; Monteiro, C; Leal, P; Nédio, M; Abreu, PF; Gil, V; Morais, C
    INTRODUCTION AND OBJECTIVES: The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. METHODS: ED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI <1.67. Infarct extension was assessed by troponin I (TnI) release and contrast-enhanced cardiac magnetic resonance (ceCMR). MVO was assessed by ceCMR and by indirect angiographic and ECG indicators. An echocardiogram was also performed in the first 12 h. RESULTS: We included 38 patients (mean age 60.0±13.7 years, 29 male). Mean RHI was 1.87±0.60 and 16 patients (42.1%) had ED. Peak TnI (median 118 mg/dl, IQR 186 vs. 67/81, p=0.024) and AUC of TnI (median 2305, IQR 2486 vs. 1076/1042, p=0.012) were significantly higher in patients with ED, who also showed a trend for more transmural infarcts (63.6% vs. 22.2%, p=0.06) and larger infarct mass on ceCMR (median 17.5%, IQR 15.4 vs. 10.1/10.3, p=0.08). Left ventricular ejection fraction (LVEF) was lower and wall motion score index (WMSI) was higher on both echocardiogram and ceCMR in patients with ED. On ceCMR, MVO was more frequent in patients with RHI <1.67 (54.5% vs. 11.1%, p=0.03). ECG and angiographic indicators of MVO all showed a trend toward worse results in these patients. CONCLUSIONS: The presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.
    2017Journal article Open access Show more
  • Endothelial dysfunction evaluated by peripheral arterial tonometry is related with peak TnI values in patients with ST elevation myocardial infarction treated with primary angioplasty
    Publication . Baptista, SB; Faustino, M; Simões, J; Nédio, M; Monteiro, C; Lourenço, E; Leal, P; Abreu, PF; Gil, V
    PURPOSE: The role of endothelial-dependent function in patients with acute ST elevation myocardial infarction (STEMI) is not clear. Endothelial dysfunction may contribute to the pathophysiological processes occurring after STEMI and influence the extension of myocardial necrosis. Endothelial-dependent dysfunction evaluated by peripheral arterial tonometry (PAT) has already showed to be correlated with microvascular coronary endothelial dysfunction. Our purpose was to evaluate the impact of endothelial dysfunction on peak Troponin I (TnI) values, as a surrogate for the extension of myocardial infarction, in patients with STEMI treated with primary angioplasty (P-PCI). METHODS: 58 patients with STEMI treated with P-PCI (mean age 59.0 ± 14.0 years, 46 males) were included. Endothelial function was assessed by reactive hyperaemia index (RHI) determined by PAT. Patients were divided in two groups according to the previously reported RHI threshold for high risk (1.67). The extension of myocardial necrosis was evaluated by peak TnI levels. RESULTS: RHI median value was 1.78 (IQR0.74);25 patients had endothelial dysfunction (RHI b 1.67). The two groups had no significant differences in age, gender, main risk factors and pain-to-balloon time. Patients with an RHI b 1.67 had significant larger infarcts: TnI 73.5 ng/mL (IQR 114.42 ng/mL) versus TnI 33.2 ng/mL (IQR 65.2 ng/mL); p = 0.028. On multivariate analysis, the presence of an RHI b 1.67 kept significant impact on TnI peak values (p=0.02). CONCLUSIONS: The presence of endothelial-dependent dysfunction, assessed by PAT, is related with higher peak TnI values in STEMI patients treated with P-PCI. These results strength the possibility that endothelial-dependent dysfunction may be a marker of poor prognosis and eventually a therapeutic target in patients with STEMI.
    2016Journal article Restricted access Show more
  • Identificação electrocardiográfica da artéria relacionada com o enfarte em doentes com enfarte agudo do miocárdio inferior
    Publication . Baptista, SB; Abreu, PF; Loureiro, J; Thomas, B; Nédio, M; Gago, S; Leal, P; Morujo, N; Ferreira, R
    Introdução: A mortalidade e morbilidade do enfarte agudo do miocárdio (EAM) de localização inferior são determinados, entre outros factores, pela artéria responsável pelo enfarte (ARE). Têm sido propostos diversos critérios electrocardiográficos para identificar a coronária direita (CD) e a circunflexa como ARE. Recentemente, foi proposto um novo critério para identificação da circunflexa (infradesnivelamento do segmento ST em aVR). Foi objectivo deste trabalho avaliar os critérios electrocardiográficos clássicos e o novo critério (aVR) na discriminação da ARE em doentes com EAM inferior. Métodos: Foram incluídos os doentes com EAM inferior submetidos a angioplastia primária, sendo avaliado o ECG na admissão na sala de hemodinâmica. Foram excluídos os doentes com antecedentes de enfarte e com perturbações da condução intraventricular. A artéria com a lesão mais grave foi considerada a ARE. Foram avaliados os seguintes critérios electrocardiográficos: Infradesnivelamento do segmento ST (Infra ST) em DI, supradesnivelamento do ST (Supra ST) em V1 e V2, Supra ST em DIII > DII, relação Infra ST V3/Supra ST DIII > 1,2 (critérios «clássicos») e Infra ST em aVR. Os desnivelamentos do segmento ST foram medidos 0,06 s após o ponto J. Resultados: Foram incluídos 53 doentes (idade média 59.1 ± 13.9 anos, 38 homens). A CD foi a ARE em 38 doentes e a Circunflexa em 15. Os dois grupos não apresentavam diferenças em termos de idade, sexo, número de vasos doentes, fluxo TIMI inicial e tempo dor-balão. Os critérios «Infra ST em D1», «Supra ST DIII > DII», «relação Infra ST V3/Supra ST DIII > 1,2» e «Infra ST V1 e V2» discriminaram a artéria relacionada com o enfarte. O novo critério «Infra ST aVR» identificou a ARE num número reduzido de casos (sensibilidade 33%, especificidade 71 %), sem significado estatístico. Conclusões: Os quatro critérios «clássicos» ajudaram a descriminar a ARE em doentes com EAM inferior, mas o mesmo não se verificou para o novo critério recentemente proposto (infra ST em aVR).
    2004Journal article Open access Show more
  • The Index of Microcirculatory Resistance as a Predictor of Echocardiographic Left Ventricular Performance Recovery in Patients With ST-Elevation Acute Myocardial Infarction Undergoing Successful Primary Angioplasty.
    Publication . Faustino, M; Baptista, SB; Freitas, A; Monteiro, C; Leal, P; Nédio, M; Antunes, C; Abreu, PF; Gil, V; Morais, C
    BACKGROUND: This study aims to evaluate the relationship between IMR (Index of Microcirculatory Resistance) and the echocardiographic evolution of left ventricular (LV) systolic and diastolic performance after ST-elevation acute myocardial infarction (STEMI), undergoing primary angioplasty (P-PCI). METHODS: IMR was evaluated immediately after P-PCI. Echocardiograms were performed within the first 24 hours (Echo1) and at 3 months (Echo2): LV volumes, ejection fraction (LVEF), wall motion score index (WMSI), E/é ratio, global longitudinal strain (GLS), and left atrial volume were measured. RESULTS: Forty STEMI patients were divided in 2 groups according to median IMR: Group 1 (IMR < 26), with less microvascular dysfunction, and Group 2 (IMR > = 26), with more microvascular dysfunction. In Echo1 GLS was significantly better in Group 1 (-14.9 vs. -12.9 in Group 2, P = 0.005). However, there were no significant differences between the two groups in LV systolic volume, LVEF and WMS. Between Echo1 and Echo2, there were significant improvements in LVEF (0.48 ± 0.06 vs. 0.55 ± 0.06, P < 0.0001), GLS (-14.9 ± 1.3 vs. -17.3 ± 7.6, P = 0.001), and E/é ratio (9.3 ± 3.4 vs. 8.2 ± 2.0, P = 0.037) in Group 1, but not in Group 2: LVEF (0.49 ± 0.06 vs. 0.50 ± 0.05, P = 0.47), GLS (-12.9 ± 2.4 vs. -14.4 ± 3.2, P = 0.052), and E/é ratio (8.8 ± 2.4 vs. 10.0 ± 4.7, P = 0.18). WMSI improved significantly more in Group 1 (reduction of -17.1% vs. -6.8% in Group 2, P = 0.015). CONCLUSION: Lower IMR was associated with better myocardial GLS acutely after STEMI, and with a significantly higher recovery of the LVEF, WMSI, E/E' ratio and GLS, suggesting that IMR is an early marker of cardiac recovery, after acute myocardial infarction.
    2016Journal article Restricted access Show more