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- Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE I and II logistic modelsPublication . Madeira, Sérgio; Rodrigues, Ricardo; Tralhão, António; Santos, Miguel; Almeida, Carla; Marques, Marta; Ferreira, Jorge; Raposo, Luís; Neves, José; Mendes, MiguelOBJECTIVES: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been established as a tool for assisting decision- making in surgical patients and as a benchmark for quality assessment. Infective endocarditis often equires surgical treatment and is associated with high mortality. This study was undertaken to (i) validate both versions of the EuroSCORE, the older logistic EuroSCORE I and the recently developed EuroSCORE II and to compare their performances; (ii) identify predictors other than those included in the EuroSCORE models that might further improve their performance. METHODS: We retrospectively studied 128 patients from a single-centre registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Binary logistic regression was used to find independent predictors of mortality and to create a new prediction model. Discrimination and calibration of models were assessed by receiver-operating characteristic curve analysis, calibration curves and the Hosmer–Lemeshow test. RESULTS: The observed perioperative mortality was 16.4% (n = 21). The median EuroSCORE I and EuroSCORE II were 13.9% interquartile range (IQ) (7.0–35.0) and 6.6% IQ (3.5–18.2), respectively. Discriminative power was numerically higher for EuroSCORE II {area under the curve (AUC) of 0.83 [95% confidence interval (CI), 0.75–0.91]} than for EuroSCORE I [0.75 (95% CI, 0.66–0.85), P = 0.09]. The Hosmer– Lemeshow test showed good calibration for EuroSCORE II (P = 0.08) but not for EuroSCORE I (P = 0.04). EuroSCORE I tended to overpredict and EuroSCORE II to under-predict mortality. Among the variables known to be associated with greater infective endocarditis severity, only prosthetic valve infective endocarditis remained an independent predictor of mortality [odds ratio (OR) 6.6; 95% CI, 1.1–39.5; P = 0.04]. The new model including the EuroSCORE II variables and variables known to be associated with greater infective endocarditis severity showed an AUC of 0.87 (95% CI, 0.79–0.94) and differed significantly from EuroSCORE I (P = 0.03) but not from EuroSCORE II (P = 0.4). CONCLUSIONS: Both EuroSCORE I and II satisfactorily stratify risk in active infective endocarditis; however, EuroSCORE II performed better in the overall comparison. Specific endocarditis features will increase model complexity without an unequivocal improvement in predictive ability.
- RISCO PARA DOENÇA CORONÁRIA DE ACORDO COM DECIS DO SCORE GENÉTICO, IDADE E FACTORES DE RISCO CARDIOVASCULAR: ESTUDO POPULACIONAL GENEMACORPublication . Pereira, Andreia; Mendonça, Maria Isabel; Rodrigues, Ricardo; Monteiro, Joel ponte; Neto, Micaela Rodrigues; Freitas, Sónia; Henriques, Eva; Freitas, Ana Isabel; Ornelas, Ilidio; Borges, Sofia; Pereira, Decio; Palma dos Reis, RobertoOs factores de risco cardiovascular, a idade e a prediposição genética interagem na fisiopatogénese da Doença Coronária (DC) Precoce. Pretende-se avaliar a associação dum Score Genético Multiplicativo (SGM) com DC, e estudar a distribuição dos FRCV e a idade de acordo com a informação genética. MÉTODOS: O estudo populacional GENEMACOR inclui 2888 participantes, com idade média de 53,0±7,9 anos, 77,8% do sexo masculino divididos entre 1566 doentes com Doença Coronária documentada por angiografia e 1322 controlos equiparados por grupo etário e sexo. A genotipagem e determinação da frequência alélica do alelo menor nos participantes foram realizadas para 33 variantes genéticas para DC com recurso a primers específicos e com a técnica TaqMan (Applied Biosystems). Foram calculadas as associações com DC de acordo com os decis do score genético multiplicativo (SGM). Foram determinados os respectivos OR e IC. Fez-se uma análise multivariada do SGM e FRCV. RESULTADOS: A mediana do SRG na população foi de 0,36 (0,04-9,29) (5ºdecil). Não se detectaram diferenças quanto à mediana do SGM entre o sexo masculino (0,41 (0,03 – 7,74)) e feminino (0,43 (0,04 – 9,29)), p=0,725 nem nos diferentes grupos etários (p=0,304). O grupo mais jovem apresentou menos FRCV (1.76) do que o grupo mais idoso (2,20, p>0,0001). Os participantes do 1º decil de SGM estavam geneticamente protegidos para DC (OR 0,62 IC 0,439-0,853, p=0.004). Apartir do 6º decil do SGM encontraram-se OR crescentes para DC. Os doentes no 10º decil do SGM apresentaram OR de 2,472 (1,75-3,48) p<0,0001 para DC. Por análise multivariada o SGM foi independente dos factores de risco tradicionais. (OR=1,799 IC 1,524-2,123, p<0,0001). A idade não foi preditor independente para DC no modelo multivariado. CONCLUSÃO: Na nossa população o SGM associou-se com DC de forma crescente passando de protector a risco apartir do 6ºdecil. O SGM foi um preditor independente dos factores de risco cardiovascular e do grupo etário.
- Aortic Dissection Mimicking ST Elevation MyocardialPublication . RODRIGUES, Ricardo; SANTOS, Nuno; PEREIRA, Décio
- Unroofed coronary sinus: multi-modality evaluationPublication . Rodrigues, Ricardo; Serrão, Gomes; Susana, Gomes; Pereira, DécioA 61-year-old man was referred for mild exercise intolerance. He had a previous history of chronic obstructive pulmonary disease, arterial hypertension and was an ex-smoker. Physical examination revealed a systolic murmur and his electrocardiogram showed sinus rhythm and an incomplete right bundle-branch block. A transthoracic echocardiogram was performed and showed mild left ventricular hypertrophy, mild rheumatic mitro-aortic disease, left atrial (LA) enlargement. and dilated right ventricle (figure 1 A-D), dilated coronary sinus (CS) (panel A, small arrow) and a prominent CS flux into right atria (RA) (panel C, D, large arrow). Transoesophageal echocardiography revealed a communication between the LA and the RA through a dilated coronary sinus (panel E, large arrow). A cardiac computed tomography confirmed the diagnosis of an unroofed coronary sinus showing the shunt between LA and RA through a dilated CS (panel F, large arrow). Unroofed coronary sinus: multi-modality evaluation