Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes.

Importance: Approximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned.

Objective: To evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography.

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes: PRIME-FFR (Insights From the POST-IT [Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease] and R3F [French FFR Registry] Integrated Multicenter Registries - Implementation of FFR [Fractional Flow Reserve] in Routine Practice).

Background: Fractional flow reserve (FFR) is not firmly established as a guide to treatment in patients with acute coronary syndromes (ACS). Primary goals were to evaluate the impact of integrating FFR on management decisions and on clinical outcome of patients with ACS undergoing coronary angiography, as compared with patients with stable coronary artery disease.

Methods And Results: R3F (French FFR Registry) and POST-IT (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease), sharing a common design, were pooled as PRIME-FFR (Insights From the POST-IT and R3F Integrated Multicenter Registries - Implementation of FFR in Routine Practice).

Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT.

Background: Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome.

Methods And Results: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry.

Trends in percutaneous coronary intervention from 2004 to 2013 according to the Portuguese National Registry of Interventional Cardiology.

Introduction And Objectives: The aim of the present paper is to report trends in Portuguese interventional cardiology from 2004 to 2013 and to compare them with other European countries.

Methods: Based on the Portuguese National Registry of Interventional Cardiology and on official data from the Directorate-General of Health, we give an overview of developments in coronary interventions from 2004 to 2013.

Results: In 2013, 36 810 diagnostic catheterization procedures were performed, representing an increase of 34% compared to 2007 and a rate of 3529 coronary angiograms per million population.

[Severe aortic stenosis and cardiogenic shock: a therapeutic challenge].

Acute heart failure in patients with severe aortic stenosis and left ventricular systolic dysfunction is well known for its dire prognosis and limited therapeutic options. The authors describe the case of a man admitted for non-ST-elevation myocardial infarction. Diagnostic exams revealed severe aortic stenosis, with good left ventricular systolic function, and two-vessel coronary artery disease.

Voluminous fistula between the right coronary artery and a branch of the pulmonary artery causing myocardial ischemia.

A 76-year-old female patient was referred to our institution because of typical chest pain. A continuous murmur was audible at the lower sternal border. A transthoracic echocardiogram showed non-dilated right and left ventricles with mild left ventricular inferior wall hypokinesia and an exercise stress test was positive for myocardial ischemia.

[Glomerular filtration rate: which formula should be used in patients with myocardial infarction?].

Introduction: There is disagreement regarding the best method for assessing renal dysfunction in patients with myocardial infarction (MI). This study aims to compare two commonly used formulas for measuring glomerular filtration rate (GFR) (Cockcroft-Gault [CG] and modification of diet in renal disease [MDRD]) in terms of predicting extent of coronary artery disease (CAD) and short- and long-term cardiovascular risk.

Methods: We studied 452 patients admitted to a cardiac intensive care unit (ICU) with MI (age 69.

[Intracardiac echocardiography imaging for device closure of atrial septal defects--a single-center experience].

Introduction: Device closure of interatrial communications has become a well-established technique to treat left-to-right shunt associated with atrial septal defect (ASD) and to prevent paradoxical embolism in patients with patent foramen ovate (PFO). Guidance by transesophageal echocardiography (TEE) is the standard practice but intracardiac echocardiography (ICE) is a feasible and safe alternative for monitoring these procedures.

Objectives: To report our experience in the percutaneous closure of ASD and PFO guided by ICE.

Mitral regurgitation during a myocardial infarction--new predictors and prognostic significance at two years of follow-up.

Aims: Ischemic Mitral Regurgitation (MR) has early prognostic impact in Myocardial Infarction (MI). Its medium-term importance, especially of mild MR, has not been established.

Purpose: to determine new clinical/analytical predictors of MR in MI-patients and establish its prognostic value during two-year follow-up [endpoints: mortality, decompensated heart failure (dHF)].

[Rotational atherectomy in the drug-eluting stent era: a recent single-center experience].

Introduction: Percutaneous coronary intervention (PCI) of heavily calcified lesions is a challenge for the interventional cardiologist and is associated with a high rate of restenosis and target lesion revascularization (TLR). Adequate lesion preparation by rotational atherectomy followed by drug-eluting stent implantation has shown favorable results.

Objective: To report the recent experience of our center with rotational atherectomy (RA) of complex and heavily calcified coronary lesions.

[Blood pressure control after bilateral carotid angioplasty in a patient with severe hypertension--case report].

Carotid artery angioplasty with stenting is an effective treatment for carotid artery stenosis, but is frequently associated with acute transient hemodynamic changes. We present the case of a 73-year-old female patient with long-standing refractory hypertension who remained normotensive during a three-year follow-up after undergoing staged bilateral carotid angioplasty.

[Prediction of cerebrovascular event risk following myocardial infarction].

Introduction: Patients with coronary artery disease (CAD) are at increased risk of stroke. The aim of this study was to analyze the prognostic accuracy of selected clinical and laboratory variables in stroke risk prediction following discharge after myocardial infarction (MI).

Methods: We analyzed 404 consecutive patients (aged 68.

Screening for warning signs of sudden cardiac death in the young: the SCD-SOS questionnaire.

Introduction: Sudden cardiac death (SCD) is one of the most common causes of death in the young. It may be preceded by "red flags", but screening for these warning signs is not routinely performed.

Objective: To test a new questionnaire for fast clinical assessment of possible warning signs of serious heart disease in a young population.

Importance of Manchester Triage in acute myocardial infarction: impact on prognosis.

Background: Fast and effective diagnosis of patients with acute myocardial infarction (AMI) in the Emergency Department (ED) is needed. Manchester Triage (MT) is based on identification of the patient's main complaint, establishing, through decision flowcharts, a target-time for first observation. This study aimed to evaluate the impact of MT on short-term mortality in AMI and detect potential improvements, and to analyse high-risk groups: diabetic patients, women and older patients.

Echocardiographic assessment of secundum-type atrial septal defects in the adult: role in treatment decisions.

The purpose of this study is to evaluate morphologic patterns of ostium secundum-type atrial septal defects (osASD) in the adult, analyzing their role in treatment decisions. The population was composed of 155 adults (age 43.3 +/- 18.

Percutaneous mitral valvuloplasty complicated by cardiac tamponade in a pregnant patient.

The occurrence of hemopericardium with cardiac tamponade is a complication of percutaneous balloon mitral valvuloplasty (BMV) which, although uncommon, may have severe maternal and fetal consequences. This article describes a case of cardiac tamponade following BMV in a 28-year-old woman with severe rheumatic mitral stenosis in the 20th week of gestation.