Biomedical subjects
Publications and source records attributed to Lopes Gomes.
Coronary artery aneurysms, characterized by abnormal dilatations of a localized portion of the coronary artery, are an uncommon finding during angiography. We present a case where a giant right coronary aneurysm was detected during angiography, in a patient admitted with a inferior wall myocardial infarction.
INTRODUCTION AND OBJECTIVE: The clinical relevance of myocardial bridging (MB) is a matter of debate. The objective of this work was to examine its prevalence, clinical presentation, prognosis, and functional features on scintigraphy in a group of patients with no significant atherosclerotic coronary disease. METHODS: We retrospectively examined 7039 consecutive cardiac angiograms performed between January 1994 and December 2004, selecting cases in which MB was not accompanied by significant coronary disease (defined as luminal stenosis > 50%), valvular heart disease or cardiomyopathy. Patient characteristics such as age, gender, vascular risk factors and clinical presentation were recorded. We then contacted these patients by telephone to determine cardiovascular events since diagnosis (hospitalization, infarction, death) or symptoms of angina, and to invite them for myocardial perfusion scintigraphy (MPS) with stress testing. RESULTS: The prevalence of MB was 0.97% (68 patients). The study population without significant coronary disease, valvular heart disease or cardiomyopathy was composed of 31 subjects, mean age 51.45 +/- 13.77 years, 94% (29 patients) male. Clinical presentations were: non-ST elevation acute coronary syndromes with or without biomarkers of necrosis 34% (14 patients), stable angina 23% (7 patients), atypical chest pain 16% (5 patients), ST-elevation myocardial infarction 13% (4 patients), other 3% (1 patient). Left ventricular function was normal in all patients, and angiography showed MB of the left anterior descending artery, 63% (19 patients) in the mid portion, and 33% (12 patients) in the distal portion. All subjects were treated medically. We were able to contact 24 (77%) of the 31 patients, all of whom underwent MPS; mean time since angiography was 61.25 months, with no cardiovascular events (hospitalization, infarction, death) or symptomatic angina. MPS only identified three patients with findings consistent with anterior wall ischemia. CONCLUSIONS: In this series, 58% of the patients with MB and no significant atherosclerotic coronary disease presented with acute coronary syndromes. In all the subjects contacted, the prognosis had been good during the time since diagnosis. In the majority of them, no signs of ischemia were detected on MPS.
The authors report a case of a 68-year-old male, with no known cardiac disease until he suffered a cerebral embolic event related to the presence of a papillary fibroelastoma located in the mid third of the inferior left ventricular wall. They also perform a literature review, particularly of the specific characteristics of the tumor and the surgical approach. They point out that the location of the fibroelastoma described is very unusual; its clinical and echocardiographic characteristics are similar to those described for fibroelastomas with this location and the surgical approach should be decided for each individual patient. Thus transaortotomy, which provided better visualization and enabled complete removal of the tumor (which is essential for good clinical evolution and to avoid recurrence), was the option for surgical removal of this tumor.
Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium; its true prevalence is still uncertain. A strong association between noncompaction and neuromuscular disorders has been described. Its major clinical manifestations are heart failure, arrhythmias and systemic embolic events. Diagnosis of noncompaction of ventricular myocardium can be made by conventional two-dimensional and color Doppler echocardiography. Recently contrast echocardiography has been used to provide a definitive diagnosis in most cases in which conventional echocardiography could not do so. We describe the case of a patient with clinical suspicion of noncompaction of ventricular myocardium established by conventional two-dimensional and color Doppler echocardiography and definitive diagnosis, as well as additional information, obtained by cardiac magnetic resonance imaging. We also discuss the difficulties in defining the therapeutic approach.
OBJECTIVE: This work presents a novel approach for the prediction of mortality in intensive care units (ICUs) based on the use of adverse events, which are defined from four bedside alarms, and artificial neural networks (ANNs). This approach is compared with two logistic regression (LR) models: the prognostic model used in most of the European ICUs, based on the simplified acute physiology score (SAPS II), and a LR that uses the same input variables of the ANN model. MATERIALS AND METHODS: A large dataset was considered, encompassing forty two ICUs of nine European countries. The recorded features of each patient include the final outcome, the case mix (e.g. age) and the intermediate outcomes, defined as the daily averages of the out of range values of four biometrics (e.g. heart rate). The SAPS II score requires 17 static variables (e.g. serum sodium), which are collected within the first day of the patient's admission. A nonlinear least squares method was used to calibrate the LR models while the ANNs are made up of multilayer perceptrons trained by the RPROP algorithm. A total of 13,164 adult patients were randomly divided into training (66%) and test (33%) sets. The two methods were evaluated in terms of receiver operator characteristic (ROC) curves. RESULTS: The event based models predicted the outcome more accurately than the currently used SAPS II model (P<0.05), with ROC areas within the ranges 83.9-87.1% (ANN) and 82.6-85.2% (LR) versus 80% (LR SAPS II). When using the same inputs, the ANNs outperform the LR (improvement of 1.3-2%). CONCLUSION: Better prognostic models can be achieved by adopting low cost and real-time intermediate outcomes rather than static data.
INTRODUCTION: The relation between body mass index (BMI)/obesity and left ventricular hypertrophy (LVH) in ischemic heart disease (IHD) has not been completely established, based on postmortem studies. OBJECTIVE: To study necropsy data of deaths from cardiac ischemia and its relation to macroscopic data of the heart and anthropometry. METHOD: Retrospective study of necropsies conducted by the medical legal services of Porto in 2002-03, with a final diagnosis of "myocardial infarction" or "chronic ischemic heart disease" or with more than 50% obstructive coronary disease. An observation grid was compiled from the necropsy data, with emphasis on anthropometry and cardiac exam. Descriptive and inferential methods (Pearson's correlation, the chi-square test and stepwise multiple regression) were used for the statistical analysis (alpha = 0.05). RESULTS: Of the 231 selected cases, 75.3% were men, of whom 53.7% were diagnosed with myocardial infarction and 46.3% with IHD, with BMI of 26.9 +/- 5.1, body weight of 74.7 +/- 19.9 kg, left ventricular thickness of 16.9 +/- 4.7 mm, and cardiac weight of 517 +/- 163 g. Significant negative correlations (p < 0.001) were found between age, body weight (-0.33), height (-0.33), and BMI (-0.21) and positive correlations between cardiac weight, body weight (0.35), height (0.24), BMI (0.26), and LVH (0.29). Significant differences were found between genders with regard to age, weight, height and heart weight, but no differences in terms of years of education, BMI or left ventricular thickness. Stepwise regression found two predictive variables for heart weight: body weight, accounting for 12.1%, with age increasing this to 15.4%. CONCLUSION: These results seem to confirm objectively by postmortem examination that high values of BMI and body weight, left ventricular hypertrophy and cardiac weight correlate with IHD, with important gender differences to be taken into consideration. Body weight and age are major predictive variables for heart weight. These findings have important public health implications in the prevention of overweight and ischemic heart disease.
The authors report a case of a 78-year-old male, admitted to the Hospital with fever, lumbar pain and a systolic murmur. Viridans streptococcus endocarditis associated with spondylodiscitis was diagnosed. Images and results of the exams are presented. This case is compared with similar studies in the literature.