Biomedical subjects

Fernando Matias

Publications and source records attributed to Fernando Matias.

12 recordsLinked to original sources

PubMed2005

Epidemiology of heart failure in primary care in Madeira: the EPICA-RAM study.

UNLABELLED: Chronic heart failure (CHF) is a serious public health problem all over the world. CHF has a high prevalence, affecting mainly the elderly, and causes severe disability and social and economic costs. AIM: To estimate the prevalence of chronic heart failure in the Autonomous Region of Madeira in 2001. METHODS: This was a community-based epidemiological survey involving subjects attending primary care centers selected by a combined two-stage sampling and stratifying procedure. General practitioners (GPs) randomly selected in proportion to the population of each municipality evaluated subjects aged over 25 years attending primary care centers, recruited consecutively and stratified by age. CHF cases were identified according to the Guidelines of the European Society of Cardiology for CHF diagnosis. RESULTS: Six hundred and eighty-six eligible subjects were evaluated by 30 GPs; 60 patients with CHF were identified. The overall prevalence and 95 % CI of CHF in Madeira was 4.69 % (2.91 % to 6.46 %), 3.53 % in males (0.81 % to 6.26 %), and 5.58 % in females (3.37 % to 7.79 %). CHF prevalence increases with age: 1.24 % (0.00 % to 2.96 %) in the 25 to 49-year-old group, 6.17% (1.31 to 11.03 %) in those aged 50 to 59 years, 7.62 % (0.75 to 14.49 %) in those aged 60 to 69 years, 13.32 % (7.99 % to 14.49 %) in the 70 to 79-year-old group, and 14.34 % in the group over 80 years old (7.59 % to 21.09 %). The prevalence of CHF due to systolic dysfunction was 0.76 % and 2.74 % with normal systolic function. CONCLUSIONS: The overall prevalence of CHF in Madeira was similar to that of mainland Portugal, and slightly higher than that of other European studies. Overall CHF prevalence increases sharply with age. The prevalence of CHF with preserved systolic ventricular function was similar to that reported by other recent European studies. The prevalence of CHF due to systolic dysfunction was much lower. The differences found may correspond to differences in methodology rather than actual differences in the population. CHF with left ventricular systolic dysfunction seems to be rare in primary care in Madeira. This may be related to the different public health organization in Madeira, and deserves further evaluation.

Adult↗

PubMed2004

The diagnosis of heart failure in primary care: value of symptoms and signs.

BACKGROUND: The value of symptoms and signs in the diagnosis of CHF has rarely been tested in large numbers of patients in the community. The aim of this study was to evaluate the importance of symptoms, signs, and past medical history in the diagnosis of CHF in primary care. METHODS: Data on a sample of Portuguese men and women attending 365 primary care centres for any condition other than the treatment of acute infection, metabolic conditions or pregnancy were collected. All subjects who scored three or more points in the sum of categories one and two of the Boston questionnaire (history and physical examination) and those being treated for heart failure with loop or thiazide diuretics were considered to have possible heart failure and referred for further assessment including a resting echocardiogram. The sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio (LR) for the diagnosis of heart failure were calculated. RESULTS: A total of 5434 subjects were identified, of whom 1058 fulfilled the criteria for further assessment; 551 subjects had cardiac dysfunction at rest, of which 35.5% were in NYHA class I and 4.9% in class IV. Prior use of digoxin (LR 24.9) and/or diuretics (LR 10.6), a history of coronary artery disease (LR 7.1) or of pulmonary oedema (LR 54.2), were associated with a greater likelihood of having heart failure. Amongst current symptoms, a history of paroxysmal nocturnal dyspnoea (LR 35.5), orthopnea (LR 39.1) and breathlessness when walking on the flat (LR 25.8) were associated with a diagnosis of heart failure. However, these symptoms were not frequent amongst patients with heart failure within this population (sensitivity <36%). Jugular pressure > 6 cm with hepatic enlargement, and oedema of the lower limbs (LR 130.3), a ventricular gallop (LR 30.0), a heart rate above 110 bpm (LR 26.7), and rales at pulmonary auscultation (LR 23.3) were all associated with a diagnosis of heart failure, but were infrequent findings in patients with heart failure (sensitivity <10%). CONCLUSIONS: Symptoms and signs, and clinical history had limited value in diagnosing heart failure when used alone. The signs and symptoms that best predicted a diagnosis of heart failure were those associated with more severe disease. If investigation is limited to patients with more definite symptoms and signs of heart failure, fewer than 50% of cases will be identified and a large number of patients with mild symptoms will be missed.

Adult↗

PubMed2004

Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care.

AIM: To validate and estimate the performance statistics and concordance of seven clinical questionnaires for the diagnosis of chronic heart failure (HF). METHODS: Community-based epidemiological survey of patients aged >25 years attending a random sample of primary health care centers in Portugal. Heart failure was identified according to the Guidelines of the European Society of Cardiology (ESC). RESULTS: A total of 5434 subjects evaluated by 365 investigators were eligible for analysis, 551 of which had criteria for heart failure. Overall, the questionnaires had high specificity, usually above 90%, but low sensitivity, providing an increase in the likelihood of heart failure from 4.3% pre-test to 25-35% post-test in most cases. The Göteborg questionnaire was the most balanced regarding sensitivity (84%) and specificity (81%) but this may reflect its use of prescription of digoxin or diuretics as diagnostic criteria for diagnosis. The Walma, Framingham and NHANES-I questionnaires performed similarly (Sensitivity: 63%, Specificity: 93%), while the Boston and the Gheorghiade questionnaires had a somewhat lower sensitivity (55%). Concordance was good between the Boston, Framingham, Gheorghiade, NHANES-I and Walma questionnaires. CONCLUSIONS: This study evaluated seven clinical questionnaires for the diagnosis of heart failure in the community. Their low sensitivity impairs their usefulness as diagnostic instruments, but their high specificity makes them useful for the identification of patients with fluid retention and/or exercise intolerance from non-cardiac causes.

Adult↗

PubMed2004

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy.

BACKGROUND: Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care. AIM: To evaluate current drug therapy for CHF in adults with HF diagnosed according to ESC guidelines in the context of the EPICA study. Aetiological features and therapy relevant comorbidities were also analysed. METHODS: EPICA was a community-based epidemiological study conducted in mainland Portugal. The study involved 365 primary care physicians, who evaluated 6300 primary care attendees aged over 25 years. CHF was diagnosed by clinical and echocardiography criteria according to ESC guidelines. RESULTS: Total of 551 cases of CHF were identified, with a mean age of 65+/-9 years. The estimated overall prevalence of CHF in the Portuguese population was 4.4%; 1.3% with and 1.7% without left ventricular systolic dysfunction (LVSD). There are 6,280,792 people aged >25 years in Portugal, which extrapolates to 261,400 cases of heart failure. About 80% of patients had a history of hypertension, 39% had a history of coronary artery disease and 15% had atrial fibrillation. Only 58% of patients were on angiotensin-converting enzyme (ACE) inhibitors and 7% on beta-blockers. The type of ventricular dysfunction, age and presence of renal failure had little effect on prescription rates. Diuretics were prescribed in 78%. Thiazides were used more frequently in those with preserved systolic function and frusemide in those with left ventricular systolic dysfunction. Digoxin was prescribed more often to patients with than without left ventricular systolic dysfunction (34% vs. 17%; p=0.02). Long-acting nitrates were prescribed to 20% and amiodarone to 8% of patients. CONCLUSION: The EPICA study, as in other studies in primary care in Europe, particularly the IMPROVEMENT study, suggests that greater efforts are required to improve training of primary care teams in the management of CHF.

Aged↗

PubMed2004

The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community.

BACKGROUND: There is a common assumption that a normal ECG or a normal heart size on chest X-ray virtually rules out a diagnosis of heart failure. AIMS: To assess the value of the electrocardiogram and chest X-ray in identifying patients with chronic heart failure in the community. METHODS AND RESULTS: This study was a secondary analysis of data prospectively collected at the time of patient's enrollment in the EPICA study, an epidemiological study of the prevalence of heart failure in Portugal. A total of 6300 subjects were clinically evaluated. Patients who presented with symptoms or signs of heart failure, and/or were receiving diuretics for chronic heart failure (CHF) had a chest X-ray, ECG, and echocardiogram. The diagnosis of heart failure was confirmed in 551 cases. Patients with right atrial enlargement, atrial flutter, atrial fibrillation, 2nd degree-Mobitz I atrioventricular block, 1st degree atrioventricular block, left bundle branch block, lung interstitial oedema, and bilateral pleural effusion were more likely to be diagnosed with heart failure. For the diagnosis of heart failure, in the Portuguese population aged over 25 years, an abnormal electrocardiogram had an estimated sensitivity of 81%, and negative predictive value of 75%; an abnormal chest X-ray had an estimated sensitivity of 57%, and negative predictive value of 83%. Twenty five percent of patients with CHF had a normal ECG or chest X-ray. CONCLUSION: Our results show that electrocardiographic and roentgenographic features are not sufficient to allow heart failure to be reliably predicted in the community and support the recommendation that all patients with suspected heart failure should undergo echocardiography.

Adult↗

PubMed2004

Coronary surgery: which method to use?

OBJECTIVE: To compare 4 methods of myocardial protection in GABG in terms of markers of myocardial ischemia, mortality, morbidity and mid-term results. MATERIAL & METHODS: Retrospective study of 241 consecutive patients undergoing isolated > 1 CABG using one of 4 methods: off-pump (OFF, n = 108), cardiopulmonary bypass (CPB) and cardioplegia (CARD, n = 66), CPB and beating heart (BEAT, n = 47), or CPB and ventricular fibrillation (FIBR, n = 20). Mean age was 65.7 +/- 9.3 years and mean EuroSCORE was 3.2 +/- 2.3. The groups were similar in terms of age, gender distribution, body mass index, incidence of smoking, hypertension, renal insufficiency, CCS class, ventricular function and mean EuroSCORE. Serial blood samples were collected for CK-MB and troponin T, preoperatively and 1, 6, 12 and 24 hours after the procedure. RESULTS: Mean number of distal anastomoses was 3.27 BEAT, 2.98 CARD, 2.90 FIBR and 2.55 OFF (p < 0.05 OFF vs. the other 3 groups). Six patients died in hospital (2.5%), 2/47 BEAT (4.2%), 1/66 CARD (1.5%), 1/20 FIBR (5.0%), 2/108 (1.9% OFF) (p = 0.1). The incidence of atrial fibrillation, stroke/TIA and blood transfusion and length of stay were similar between groups (p = 0.1) but there was a tendency for increased incidence of Q-wave MI (p = 0.08) in OFF and combined adverse events in FIBR (p = 0.07). At 12 hours postoperatively, CK-MB and troponin T were significantly higher in FIBR than in CARD or OFF (p < 0.05) and at 24 hours, troponin T remained higher in FIBR than in all other groups (p < 0.05). After a mean follow-up of 19 months, no significant difference was observed between groups in mortality or relief of angina. CONCLUSION: We were unable to demonstrate the superiority of any one revascularization method over another in terms of mortality, morbidity or length of stay. As shown by lower levels of myocardial markers of ischemia, better myocardial protection was obtained with OFF, BEAT and CARD compared to FIBR. Mid-term survival and relief of angina were similar between groups.

Adult↗

PubMed2004

[Epidemiology of heart failure in mainland Portugal: new data from the EPICA study].

Heart failure (HF) is common, costly, disabling and lethal, and can be prevented. The progression of overt HF (CHF) can be slowed by correct management including precise diagnosis and appropriate therapy. Patients with CHF can be misdiagnosed, mainly in primary care, where patients are actually less symptomatic than those seen in hospitals. Accurate diagnosis requires objective evidence of cardiac dysfunction at rest by imaging techniques, according to the European Society of Cardiology (ESC) Guidelines. The EPICA Project (EPidemiologia da Insuficiência Cardiaca e Aprendizagem) was one of the first European studies designed to evaluate the prevalence of CHF according to those criteria. The estimated overall prevalence of CHF in Portugal was 4.36% in adults over 25 years. 1058 individuals were identified by the Boston questionnaire as possible or probable CHF cases; only 551 had objective evidence of cardiac dysfunction at rest by echocardiography. 264 patients in sinus rhythm had a Boston score > 3 and no echocardiographic abnormalities. These patients were predominantly older obese women; coronary artery disease was less prevalent than in patients with proved CHF. The ECG was normal in 40.9%, versus 20% in CHF patients. About one half of these patients were prescribed ACE inhibitors and diuretics; 17% were prescribed digoxin. According to these EPICA data concerning CHF, older obese women are more frequently misdiagnosed and incorrectly medicated.

Heart Failure↗

PubMed2002

Prevalence of chronic heart failure in Southwestern Europe: the EPICA study.

AIM: To estimate the prevalence of chronic heart failure (CHF) in mainland Portugal in 1998. METHODS AND POPULATION: A community-based epidemiological survey involving subjects attending primary care centres selected by a combined two-stage sampling and stratified procedure. General practitioners (GPs) randomly selected in proportion to the population of the District, evaluated subjects attending primary care centres aged over 25 years, recruited consecutively and stratified by age. CHF cases were identified according to the Guidelines of the European Society of Cardiology for CHF diagnosis. RESULTS: 5434 eligible subjects were evaluated by 365 GPs; 551 patients with CHF were identified. The overall prevalence and 95% CI of CHF in mainland Portugal is 4.36% (3.69-5.02%), 4.33% in males (3.19-5.46%), and 4.38% in females (3.64-5.13%). Age-specific CHF prevalence was as follows: 1.36% in the 25-49 years-old group (0.39-2.33%), 2.93% in the 50-59 years-old group (5.58-9.37%), 7.63% in the 60-69 years-old group (5.58-9.37%), 12.67% in the 70-79 years-old group (10.73-14.6%), and 16.14% in group over 80 years old (13.81-18.47%). The prevalence of CHF due to systolic dysfunction was 1.3% and the prevalence of CHF with normal systolic function was 1.7%. CONCLUSIONS: The overall prevalence of CHF in Portugal was slightly higher than that of other European studies and increases sharply with age. The prevalence of CHF due to systolic dysfunction is very similar to that reported by other recent European studies. The differences found may correspond to differences in methodology rather than actual differences in the population.

Adult↗

PubMed2002

Valve orifice area in aortic stenosis evaluated by planimetry, Gorlin and continuity equations: a prospective study.

UNLABELLED: In evaluation of the severity of aortic valve stenosis, multiple parameters can be determined. All of them, except valve orifice area, are influenced by other factors such as cardiac output, heart rate or aortic insufficiency. OBJECTIVES: This is a prospective study which proposes, in the determination of the valve orifice area in aortic stenosis, to evaluate the accuracy of and correlation between three methods--planimetry by multiplane transesophageal echocardiography, the continuity equation by transthoracic echocardiography, and invasive measurement using the Gorlin formula. METHODS: Forty-five patients with known calcified valvular aortic stenosis 27 men, mean age 70 +/- 10 years, (range 27-82), were studied. In all patients the area was determined by planimetry and by the continuity equation. In 25 (56%) patients invasive measurements were obtained using the Gorlin formula. RESULTS: Evaluation of the valve orifice area by planimetry was easily performed and did not prolong the duration of the exam, except in five patients (11%). The area determined by the continuity equation had a mean value of 0.74 +/- 0.25 cm2, by planimetry 0.74 +/- 0.24 cm2 and by the Gorlin formula 0.65 +/- 0.17 cm2. Correlations between areas obtained by the three methods used were: continuity equation and planimetry 0.82; continuity equation and Gorlin formula 0.51; and planimetry and Gorlin formula 0.80. Concordance analysis (Bland and Altman's method) gave mean (Mn) values for the differences in the areas determined by the Gorlin formula and the continuity equation of 0.01 +/- 0.15 cm2 (Mn - 2SD = -0.29, Mn + 2SD = 0.30). The estimated value by the Gorlin formula and planimetry was 0.02 +/- 0.10 (Mn - 2SD = -0.19, Mn + 2SD = 0.23). CONCLUSIONS: 1) Planimetry of the valve orifice area by transesophageal echocardiography is feasible and does not prolong the duration of the exam in the majority of patients. 2) The strong correlation and the results of concordance analysis, in the determination of valve orifice area, between traditional invasive methods and planimetry, support the use of this noninvasive method in clinical practice.

Adult↗

PubMed2002

Fistula from the aortic sinus of Valsalva to the right ventricle--case report.

The authors report a case of a 42-year-old male, with the incidental finding of a fistula from the aortic root (sinus of Valsalva) to the right ventricle in the diagnostic work-up of atypical chest pain. The images and results of the exams are presented and the therapeutic options are discussed after the final diagnosis.

Adult↗

PubMedDate not supplied

Thrombosis and endocarditis in prosthetic heart valves, a case report.

The authors report the case of a 49-year-old female with a history of rheumatic valvular heart disease who underwent valve surgery in 1997, with implantation of St. Jude prosthetic valves in aortic and mitral position. She was asymptomatic until the end of July 2001, when she was admitted to Garcia de Orta Hospital emergency unit because of heart failure, fever and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. Blood cultures were negative. She started empiric antibiotic therapy and the clinical course stabilized in the first week. After ten days of medical therapy her symptoms became worse and TTE and TEE were repeated. TTE showed significant left ventricular-aortic gradient, suggesting aortic valve obstruction. Decreased left ventricular function was now present with hypokinesia in the anterior descending coronary artery territory. In the TEE, a large thrombotic process on the mitral prosthesis valve was seen, with a prosthesis disk blocked. There were similar findings in the aortic valve. Cardiac fluoroscopic images were obtained at the mitral and aortic position confirming the TEE report. The coronary angiogram was normal. Promptly transferred to a cardiac surgery center, the patient underwent aortic and mitral prosthetic valve replacement. The intraoperative findings were compatible with those from echocardiography and cardiac fluoroscopy.

Aortic Valve↗

PubMedDate not supplied

Less invasive coronary artery bypass surgery: early results in 1083 patients operated off-pump.

OBJECTIVE: To analyze the early results of coronary surgery without cardiopulmonary bypass using the EuroSCORE risk model. METHODS: Out of a series of 1104 consecutive patients undergoing CABG during a 20-month period and whose data were prospectively collected, 1083 patients (98.1%) were operated without cardiopulmonary bypass (CPB) and represent the patient population. Mean age was 65.6 +/- 9.9 years (31-90), 23.1% were female, 77.9% hypertensive, 38.0% diabetic, 22.8% had peripheral vascular disease, 73.0% triple-vessel disease, 54.7% previous myocardial infarction and 67.0% were in CCS class III or IV. Three hundred and forty-one patients (31.5%) were operated on urgently. Surgery was performed with the aid of cardiac stabilizers and intracoronary shunts. RESULTS: The mean number of distal anastomoses was 2.9; the left internal mammary artery was used in 99% of patients. In 10 patients (0.9%), conversion to CPB was required, without mortality or morbidity. Sixteen patients (1.5%) had myocardial infarction; mean troponin T and CK-MB at 24 h were 0.20 +/- 0.43 ng/ml and 28.2 +/- 49.9 U/l respectively. Twenty patients (1.8%) had neurologic deficit, 10 (0.9%) required hemofiltration or dialysis, 229 (21%) received blood transfusions and 135 (14.2%) had atrial fibrillation. Median intubation time was 9 h, and median ICU stay was one day. Median hospital stay was 5 days. Twelve patients died in hospital (1.1%). Thirty-day observed mortality and EuroSCORE-predicted mortality were 1.3% and 4.0% respectively (p < 0.01). CONCLUSION: Off-pump CAB surgery has become our preferred method in almost all patients undergoing coronary surgery, without compromising completeness of revascularization. Observed mortality was significantly lower than that predicted by EuroSCORE and the incidence of complications was reasonably low considering the population's risk factors.

Adult↗