Papers by Catarina Vieira
Background: As one of the complications of infective endocarditis (IE), embolization has a great ... more Background: As one of the complications of infective endocarditis (IE), embolization has a great impact on the patient's prognosis. Previous studies that attempted to identify baseline clinical, laboratory and echocardiographic predictors of embolization led to conflicting results. Objectives: To assess the value of clinical, laboratory and echocardiographic variables in predicting embolic events and in-hospital mortality in patients with definite left-sided IE. Methods: This prospective study involved 99 patients with definite left-sided IE recruited from the prospective IE database of Cairo University Hospitals. TTE was performed in all patients. TEE was performed in 62.6% of the patients. Results: Embolization occured in 40.4% of patients during index hospitalization. Female gender was a highly significant risk factor for embolization (p = 0.003). The only echocardiographic variable useful in predicting embolization was vegetation length (p = 0.04). At a cutoff value of 2.095 cm, the sensivity for predicting embolization was 50%, specificity 69.1% and positive predictive value 52.8%. Vegetation length was predictive of embolization in females (p = 0.003), but not in males and in native valves (p = 0.05), but not in prosthetic valves. The overall in-hospital mortality rate was 41.8%. Atrial fibrillation/flutter was a powerful predictor of mortality (p = 0.001) as compared to sinus rhythm. Not having surgery was a powerful predictor of mortality (p < 0.001), even if prosthetic valve IE was excluded from the analysis. Additionally, the presence of heart failure functional class III/IV or fulminant sepsis necessitating inotropic support were significant predictors of mortality (p = 0.007 & <0.001 respectively). The only echocardiographic parameter useful in predicting mortality was the presence of valvular stenosis (p = 0.05). Conclusions: This study clearly shows that female gender is a highly significant risk factor for embolization, and that vegetation length is a useful predictor of embolization in females and in native valve IE. Atrial fibrillation/flutter, not having surgery, advanced heart failure and fulminant sepsis are all useful predictors of mortality, which allows identification of high-risk paients in whom an aggressive strategy will be potentially useful.
Revista Portuguesa de Cardiologia, 2022
Circulation: Cardiovascular Imaging, 2020
BACKGROUND High-grade atrioventricular block (HABV) is associated with poorer outcomes in the seK... more BACKGROUND High-grade atrioventricular block (HABV) is associated with poorer outcomes in the seKng of acute coronary syndromes. Limited informa3on is available on the incidence and death associated with HABV in STEMI pa3ents (pts) receiving contemporary treatment. AIM To evaluate the incidence of HABV and its impact on outcome of STEMI pts, in primary percutaneous coronary interven3on era.
Revista Portuguesa de Cardiologia, 2021
Défice de ferro; Síndromes coronárias agudas; Prognóstico Resumo Introdução: O défice de ferro (D... more Défice de ferro; Síndromes coronárias agudas; Prognóstico Resumo Introdução: O défice de ferro (DeF) é uma condição prevalente em doentes com patologia cardíaca. Naqueles com insuficiência cardíaca (IC) demonstrou-se que esse défice se associa a pior prognóstico. Existem poucos dados na literatura relativamente ao impacto prognóstico do DeF nas síndromes coronárias agudas (SCA), sendo este o principal objetivo deste estudo. Métodos: Estudo observacional retrospetivo que incluiu 817 doentes admitidos por SCA. Definiram-se dois grupos de acordo com a presença (n = 298) ou ausência de DeF (n = 519) à admissão. O evento clínico estudado foi a ocorrência de morte ou IC grave em longo prazo. Calcularam-se os preditores independentes de prognóstico com base na análise de regressão logística. Resultados: Verificou-se que 36% dos doentes tinham DeF. Estes doentes apresentaram maior taxa de mortalidade (p = 0,004) e de IC (p = 0,011) durante o follow-up, bem como maior taxa de readmissões hospitalares (p = 0,048).
Cureus
Primary cardiac angiosarcoma is a rare malignant neoplasm and occurs most frequently in middle-ag... more Primary cardiac angiosarcoma is a rare malignant neoplasm and occurs most frequently in middle-aged males. It has an aggressive nature, with highly variable clinical features, which results in delayed diagnosis and high mortality. We report a 19-year-old man presented to the ED with a three-month history of hemoptysis and one-week history of anterior chest pain. Additionally, an aortic diastolic murmur grade II/VI was found on physical examination. Thoracic CT scan revealed bilateral dispersed hypodense pulmonary nodes with peripheral halo, alveolar densification, and pericardial effusion. The transthoracic echocardiogram confirmed sizeable pericardial effusion and bicuspid aortic valve, without other significant findings. A pericardiocentesis removed 1300 mL of hemorrhagic fluid, consistent with an exudate without malignant cells. Both cardiac magnetic resonance and transesophageal echocardiogram revealed a large mass on the right atrium's anterior wall. Mass biopsy was performed, revealing malignant cardiac angiosarcoma. The biopsy of the lung lesions was compatible with lung metastasis of primary cardiac angiosarcoma. The patient was submitted to palliative chemotherapy but died 12 months after the diagnosis.
We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation ... more We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation in the inferior leads, R>S in V1 and ST depression in the anterior leads due to proximal occlusion of the first obtuse marginal. Primary coronary angioplasty and stenting of this artery were performed. Twelve hours later the patient became hemodynamically unstable and severe mitral regurgitation due to rupture of one of the heads of the anterolateral papillary muscle was diagnosed. Emergency surgery was performed (papillary muscle head reimplantation, mitral annuloplasty with a rigid ring, tricuspid annuloplasty and coronary artery bypass grafting). On surgical inspection, it was observed that the detached muscle head had become trapped in the left ventricle by a secondary cord attached to the other head. This case is unusual in presenting two uncommon features of ischemic papillary muscle: rupture of the anterolateral muscle in myocardial infarction involving the inferoposterior wall...
Fig 1 -Transthoracic echocardiography (TTE) depicted good biventricular global systolic function ... more Fig 1 -Transthoracic echocardiography (TTE) depicted good biventricular global systolic function and an ecodense, heterogeneous mass (30x25mm) at right atrium level, involving tricuspid annulus and basal segment of lateral wall of right ventricle, appearing to extend to pericardium. Fig 2 Computed tomography from thorax to pelvis depicted lymphadenopathy, multiple pulmonary nodules of uncertain aetiology and kidneys with asymmetric dimension with hyperdense nodules on both.
Circulation, 2020
Introduction: Although invasive strategies are the generalized approach in the management of ACS ... more Introduction: Although invasive strategies are the generalized approach in the management of ACS pts, their benefits in pts with significant anemia are unclear, as anemia is strongly associated wit...
Revista Portuguesa de Cardiologia, 2019
Endocardite trombótica não bacteriana; Artrite reumatoide; Válvula mitral Resumo Doente de 83 ano... more Endocardite trombótica não bacteriana; Artrite reumatoide; Válvula mitral Resumo Doente de 83 anos, sexo feminino, com antecedentes de artrite reumatoide há 10 anos, foi internada por infecção do trato urinário com lesão renal aguda em doença renal crónica e insuficiência cardíaca descompensada de etiologia não esclarecida. Ecocardiograma transesofágico (ETE) com vegetação apensa ao folheto posterior da válvula mitral, colocando-se a hipótese de endocardite infeciosa, tendo-se iniciado antibioterapia empírica. Repetição de ecocardiograma transesofágico após antibioterapia com manutenção da vegetação referida e menção a outra de menores dimensões, sendo colocada a hipótese de endocardite trombótica não bacteriana. A investigação clínica não evidenciou qualquer processo infecioso. Após hipocoagulação durante dois meses, foi repetido o ecocardiograma transesofágico com desaparecimento das vegetações anteriormente apresentadas.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 19, 2017
European Heart Journal, 2013
Archives of Cardiovascular Diseases Supplements, 2016
in that it has a skirt designed to prevent paravalvular leak, improved coaxial alignment, and mor... more in that it has a skirt designed to prevent paravalvular leak, improved coaxial alignment, and more accurate positioning. Aims To evaluate paravalvular aortic regurgitations after 30-day after TAVI using the Edwards SAPIEN 3 prosthesis. Methods Prospective monocentric study including 66 high-risk or nonoperable patients with severe aortic stenosis undergoing TAVI using Edwards SAPIEN 3 prosthesis via transfemoral access, between September 2014 and March 2015. Results Mean age of patient was 84±7,1 years (70% female). The MDCT estimated an aortic annular diameter 25,07±2mm. Mean logistic EuroSCORE was 15,8±10,8. In our study, the device success rate was 98.5%. The prosthesis has been deployed correctly in all cases and no failure of valve or embolization had occurred. Post TAVR, mean transaortic gradient decreased from 46,0±12,33mmHg to 8,2±3,37mmHg (p<0.001). No patient had moderate or severe PAR. At 30 days follow up, transthoracic echocardiography (TTE) showed that the PAR was absent or trivial in 66% of patients and mild in the remainder. Possible reasons for this low PAR rate include: 1) the outer polyethylene terephthalate sealing cuff, which enhances paravalvular sealing; 2) more accurate positioning; and 3) improved sizing with adjunctive MDCT. Conclusion In our study, TAVI with Edwards SAPIEN 3 demonstrated lower paravalvular aortic leak rates than earlier generation devices in patients at high risk for surgery.
Revista Portuguesa de Cardiologia (English Edition), 2021
Revista Portuguesa de Cardiologia, 2020
Teixeira p , em nome do GECNRMTC, do GEE e do GEFERC da SPC
The International Journal of Cardiovascular Imaging, 2020
BMJ Case Reports, 2019
A 46-year-old man was admitted to the emergency department with fever and pleuritic thoracic pain... more A 46-year-old man was admitted to the emergency department with fever and pleuritic thoracic pain. Six weeks prior to admission, the patient had undergone cardiac surgery. The ECG showed diffuse ST segment elevation and PR segment depression. The blood tests revealed increased inflammatory markers and negative myocardial necrosis markers. Pericardial and left-sided pleural effusion were noted. Sterile blood cultures were negative. Hence, the hypothesis of Dressler’s syndrome was established. The patient improved clinically and analytically with a short course of anti-inflammatory therapy and was discharged with colchicine and acetylsalicylic acid. A thoracic radiography performed 2 months after showed complete remission of pleural effusion.
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Papers by Catarina Vieira