Browsing by Author "Abreu, Ana"
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- Lockdown measures for COVID-19 outbreak and variation in physical activity in patients with heart failure and cardiac implantable devicesPublication . Silva Cunha, Pedro; Laranjo, Sérgio; Lourenço, André; Rodrigues, Lourenço; Cardoso, Isabel; Portugal, Guilherme; Valente, Bruno; Delgado, Ana Sofia; Ferreira, Rui Cruz; Abreu, Ana; Oliveira, MarioAims: The present study analysed the patterns of physical activity pre-, during and post-lockdown measures for COVID-19 pandemic in patients with chronic heart failure (CHF) and cardiac implantable electronic devices (CIED) under remote monitoring (RM), and assessed the physical activity patterns during these periods. Methods: The raw data from 95 patients with CHF (age 67,7 +/- 15,1 years, 71,5% male) corresponding to 2238 RM transmissions of the Medtronic Carelink (TM) network platform was obtained. The physical exercise profiles and the impact of the lockdown measures on the physical behaviour during and after the measures were analysed. According to the level of activity duration in the pre-lockdown, lockdown and post-lockdown periods, the patterns of behaviour were identified (non-recoverees, incomplete recoverees, recoverees and full-recoverees). Conclusion: RM of CHF patients with CIED using the Carelink (TM) network is useful for close follow-up and identification of heart failure risk status variations. After relieving the confinement measures there were two groups of patients that did not recover the previous physical activity levels. Physical inactivity in patients with CHF can have a significant impact on outcomes.
- Optimizing risk stratification in heart failure and the selection of candidates for heart transplantationPublication . Pereira-da-Silva, Tiago; Soares, Rui M.; Papoila, Ana Luisa; Pinto, Iola; Feliciano, Joana; Morais, Luís Almeida; Abreu, Ana; Ferreira, Rui CruzIntroduction and Aims: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. Methods: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction <= 40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. Results: In the 263 enrolled patients (75% male, age 54 +/- 12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. Conclusions: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope >= 39.0 may benefit from heart transplantation.