Browsing by Author "Neto, Micaela"
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- Echocardiography and cardiovascular risk:The relationship in the renal transplant recipientPublication . Neto, Micaela; Gonçalves, Miguel; Resende, Luis; Vieira, Pedro; Gomes, Susana; Durães, José; Rosa, Nuno; Teixeira, José Alves; Silva, GilIntroduction: Cardiovascular disease (CVD) is the major cause of death among renal transplant recipientes (RTR). It is not known whether echocardiographic abnormalities are useful to identify RTR at high risk of CVD. Methods: Retrospective review of RTR with functioning and stable graft and an echocardiography performed in the last year. Risk of major adverse cardiac events (MACE) and death using a risk calculator specific for RTR. Results: Among 107 patients (57.9% males, 50.4±13.9 years), 7-year risk of MACE was >10% in 30.9% of patients and 7-year risk of death >10% in 56.1%. Left ventricular hypertrophy (LVH) was found in 55.1%, diastolic dysfunction in 39.3%, dilated left atrium (LA) in 53.3%, high pulmonary artery systolic pressure (PASP) in 9.0%, valvular calcifications in 22.4% and moderate to severe mitral regurgitation (MR) in 3.7%. Mean Ejection fraction was 68.36±6.87%. Univariate analysis showed an increased risk of MACE and death in patients with LVH, diastolic dysfunction, dilated LA, high PASP, valvular calcifications and MR. Multivariate analysis identified an independente association between the risk of MACE >10% and valvular calcifications and high PASP. Risk of death>10% in multivariate analysis had an independent association with diastolic dysfunction and elevated PASP. Conclusion: Echocardiographic abnormalities identify RTR at increased risk of MACE and death. Valvular calcifications and high PASP are predictors of MACE whereas diastolic dysfunction and high PASP predict death.
- KAsH Score predicts long term mortality after acute myocardialPublication . Monteiro, Joel Ponte; Sousa, João Adriano; Sousa Mendonça, Flávio; Neto, Micaela; Rodrigues, Ricardo; Gomes Serrão, Marco; Silva, Bruno; Mendonça, Maria Isabel; Faria, Ana Paula; Henriques, Eva; Drumond Freitas, AntónioIntroduction: Complex risk scores have limited applicability in the assessment of patients with myocardial infarction (MI). In this work, the authors aimed to develop a simple to use clinical score to stratify the in-hospital mortality risk of patients with MI at first medical contact. Methods: In this single-center prospective registry assessing 1504 consecutively admitted patients with MI, the strongest predictors of in-hospital mortality were selected through multivariate logistic regression. The KAsH score was developed according to the following formula: KAsH=(Killip class×Age×Heart rate)/systolic blood pressure. Its predictive power was compared to previously validated scores using the DeLong test. The score was categorized and further compared to the Killip classification. Results: The KAsH score displayed excellent predictive power for in-hospital mortality, superior to other well-validated risk scores (AUC: KAsH 0.861 vs. GRACE 0.773, p<0.001) and robust in subgroup analysis. KAsH maintained its predictive capacity after adjustment for multiple confounding factors such as diabetes, heart failure, mechanical complications and bleeding (OR 1.004, 95% CI 1.001-1.008, p=0.012) and reclassified 81.5% of patients into a better risk category compared to the Killip classification. KAsH’s categorization displayed excellent mortality discrimination (KAsH 1: 1.0%, KAsH 2: 8.1%, KAsH 3: 20.4%, KAsH 4: 55.2%) and better mortality prediction than the Killip classification (AUC: KAsH 0.839 vs. Killip 0.775, p<0.0001). Conclusion: KAsH, an easy to use score calculated at first medical contact with patients with MI, displays better predictive power for in-hospital mortality than existing scores. © 2019 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa˜na, S.L.U. This is na open access article under the CC BY-NC-ND license