| 1. |
- Dias-Neto, Marina, et al.
(författare)
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Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000-2015)
- 2020
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 60:1, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000-2004, 2005-2009, and 2010-2015) were compared in patients >= 50 years old to assess the variations over time. Results: A total of 2 275 patients >= 50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 +/- 0.24/100 000/year in 2000-2004, 3.17 +/- 0.39/100 000/year in 2005-2009 and 3.21 +/- 0.28/100 000/year in 2010-2015 (p < .001). When comparing the time periods 2000-2004 to 2005-2009, the age standardised rate of admission (n = 1460) increased from 1.57 +/- 0.25/100 000/year to 2.24 +/- 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 +/- 4.7% to 48.8 +/- 4.7%, p < .001). In 2010-2015, the age standardised rate of admissions due to rAAA decreased (1.98 +/- 0.22/100 000/year). Operative mortality remained stable (48.9 +/- 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 +/- 0.10/100 000/year and 0.93 +/- 0.29/100 000/year, respectively) but later increased (1.14 +/- 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 +/- 0.18/100 000/year, 2.21 +/- 0.27/100 000/year and 2.26 +/- 0.26/100 000/year in 2000-2004, 2005-2009, and 2010-2015, respectively, p < .001). Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.
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| 2. |
- Almeida, Joao G., et al.
(författare)
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Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population
- 2018
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Ingår i: European Heart Journal Cardiovascular Imaging. - : Oxford University Press (OUP). - 2047-2404 .- 2047-2412. ; 19:4, s. 380-386
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Diastolic dysfunction (DD) is frequent in the general population; however, the assessment of diastolic function remains challenging. We aimed to evaluate the impact of the recent 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations in the prevalence and grades of DD compared with the 2009 guidelines and the Canberra Study Criteria (CSC).Methods and results: Within a population-based cohort, a total of 1000 individuals, aged ≥45 years, were evaluated retrospectively. Patients with previously known cardiac disease or ejection fraction <50% were excluded. Diastolic function was assessed by transthoracic echocardiography. DD prevalence and grades were determined according to the three classifications. The mean age was 62.0 ± 10.5 years and 37% were men. The prevalence of DD was 1.4% (n = 14) with the 2016 recommendations, 38.1% (n = 381) with the 2009 recommendations, and 30.4% (n = 304) using the CSC. The concordance between the updated recommendations and the other two was poor (from k = 0.13 to k = 0.18, P < 0.001). Regarding the categorization in DD grades, none of the 14 individuals with DD by the 2016 guidelines were assigned to Grade 1 DD, 64% were classified as Grade 2, 7% had Grade 3, and 29% had indeterminate grade.Conclusion: The application of the new 2016 ASE/EACVI recommendations resulted in a much lower prevalence of DD. The concordance between the classifications was poor. The updated algorithm seems to be able to diagnose only the most advanced cases.
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| 3. |
- Dias-Neto, Marina, et al.
(författare)
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Nationwide Analysis of Intact Abdominal Aortic Aneurysm Repair in Portugal from 2000 to 2015
- 2020
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Ingår i: Annals of Vascular Surgery. - : ELSEVIER SCIENCE INC. - 0890-5096 .- 1615-5947. ; 66:July, s. 54-64
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Tidskriftsartikel (refereegranskat)abstract
- Background: Results on the management of infrarenal abdominal aortic aneurysm (AAA) from Mediterranean countries are scarce. The aim of this study was to evaluate trends in rate of and mortality after repair of intact AAA (iAAA) in Portugal. Methods: iAAA repairs registered in the hospitals' administrative database of the National Health Service from 2000 to 2015 were retrospectively analyzed regarding demographics (age and gender) and type of repair (open surgery [OS] or endovascular repair [EVAR]). Rate and mortality were compared among three time periods: 2000-2004, 2005-2009, and 2010-2015. Results: Age-standardized rate of iAAA repair increased consistently across the time periods under analysis from 3.6 +/- 0.6/100,000/year in 2000-2004, to 5.6 +/- 0.4/100,000/year in 2005-2009 and to 7.1 +/- 0.9/100,000/year in 2010-2015 (P < 0.001). The percentage of EVAR among all iAAA repairs rose steeply from 0 to 21 +/- 19% and then to 58 +/- 7% (P < 0.001). The rate of OS also increased from the first to the second period, but there was a decrease in the third period (P < 0.001). The in-hospital mortality after iAAA repair decreased from 7.5 +/- 1.3% to 6.6 +/- 1.6% and then to 5.1 +/- 1.9% (P < 0.001). This variation corresponded to a decrease in in-hospital mortality after EVAR (from 4.0 +/- 3.5% to 2.8 +/- 0.9%, P < 0.001) and increased in-hospital mortality after OS (7.5 +/- 1.3% to 7.4 +/- 1.1% to 8.3 +/- 3.7%, P < 0.001). Low-volume centers (< 15 repairs/year) did not present higher mortality rates. The number of EVARs per year in a center presented a positive association with EVAR mortality (Spearman correlation of 0.696, P = 0.004). Conclusions: The rate of repair of iAAA continues to grow, especially in patients aged >= 75 years and did not reach an inflection point yet. This is happening along with decreased repair mortality mainly because of the increased use of EVAR. Hospital mortality for iAAA repair is still a matter of concern, warranting further investigation and planning of vascular surgical services.
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| 4. |
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| 5. |
- Trindade, Fábio, et al.
(författare)
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Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy
- 2020
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Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 15:9
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Tidskriftsartikel (refereegranskat)abstract
- Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.
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