José Ribeiro

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self-Expanding Bioprosthesis

Background: Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single‐center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self‐expanding bioprosthesis.

Design, development, exploitation and assessment of a Cardiology Web PACS

Healthcare institutions are increasingly turning to digital medical imaging systems to promote better diagnosis and treatment of their patients. The implementation of the Picture Archiving and Communication System (PACS) clearly contributes to an increase in the productivity of health professionals. However, despite the amount of research that has been done in the past two decades, there are still several technological hurdles that hinder the wide adoption of PACS in the Web environment. In this paper, we present a Web-enabled PACS that through the inclusion of several DICOM services and compression methods promotes medical image availability and greater accessibility to users.

Comparison of Coronary Artery Disease Consortium 1 and 2 Scores and Duke Clinical Score to Predict Obstructive Coronary Disease by Invasive Coronary Angiography

The first step in evaluating a patient with suspected stable coronary artery disease (CAD) is the determination of the pretest probability. The European Society of Cardiology guidelines recommend the use of the CAD Consortium 1 score (CAD1), which contrary to CAD Consortium 2 (CAD2) score and Duke Clinical Score (DCS), does not include modifiable cardiovascular risk factors.

Three-dimensional intracardiac echocardiography: a new promising imaging modality to potentially guide cardiovascular interventions.

Echocardiography plays an essential role in guiding complex cardiovascular interventions: atrial septal defect (ASD) closure, left atrial appendage (LAA) occlusion, and transcatheter aortic valve implantation (TAVI). Most procedures are guided by three-dimensional (3D) transoesophageal echocardiography. Intracardiac echocardiography (ICE) has the advantage of not requiring general sedation, does not interfere with fluoroscopy, and provides simultaneous guidance of the entire procedure. However, until now, …

Himage PACS: a new approach to storage, integration, and distribution of cardiologic images

This paper presents a Cardiology oriented information system that provides permanent availability of all clinical history, including alphanumeric and image data, with time and cost-effective transmission (reduced download time), without loss of image diagnosis quality and based on a Web Multimedia Integrated Access Interface. This implies the integration of HIS and PACS in a unique access interface, providing on-line and fast access to authorized healthcare professionals. The benefits obtained from the HIS-PACS integration and from the availability of all historical patient data are unquestionable to practitioners but also to the patients. Moreover, the system includes a telematic platform capable of establishing cooperative telemedicine sessions where our most impressive utilization is a transcontinental work platform for cardiovascular ultrasound. The key point of our approach starts with the construction of a DICOM private transfer syntax that is prepared to support any video encoder installed on a Windows-based station. With this structure it is possible to select the best encoder to a specific modality and work scenario. Good trade-off between compression ratio and diagnostic quality, low network traffic load, backup facilities and data portability are other achievements of this system.

Simultaneous transapical implantation of an inverted transcatheter aortic valve-in-ring in the mitral position and transcatheter aortic valve replacement: first-in-human report.

Cardiology, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; and the yDepartment of Cardiothoracic Surgery, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal. Manuscript received September 20, 2013; revised manuscript received September 28, 2013, accepted October 1, 2013. Journal of the American College of Cardiology Vol. 63, No. 12, 2014 2014 by the American College of Cardiology Foundation ISSN 0735-1097/

Primary diagnosis of quadricuspid aortic valve with multislice computed tomography.

36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.10.090

Appropriate use criteria for transthoracic echocardiography at a tertiary care center

f fi t c a c a o a m A 46-year-old man with hypertension was evaluated for typical chest pain. An echocardiogram showed mild aortic nd mitral regurgitation. A treadmill stress test showed symptomatic 1-mm downsloping ST-segment depression t 6.5 minutes, with rapid resolution of the ST depression in ecovery. He was referred for 64-slice cardiac computed omography (CT) to exclude coronary artery disease. Cariac CT, performed with tube current modulation, showed n abnormal origin of the left main coronary artery with eftward and posterior displacement. The aortic valve was oted to be quadricuspid, with four separate leaflets. Incomlete coaptation of the aortic valve leaflets during diastole as also noted, suggesting the presence of aortic regurgita-

Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population

INTRODUCTION AND OBJECTIVES The American College of Cardiology and American Society of Echocardiography have developed appropriate use criteria for echocardiography. The objective of this study was to assess the rate of appropriate requests for transthoracic echocardiography at a Portuguese tertiary care center and to identify the factors associated with lower adherence to the appropriate use criteria. METHODS All transthoracic echocardiograms (in- and outpatient) performed over a period of one month were analyzed by two independent imaging cardiologists, who matched each request to a specific indication in the appropriate use criteria document. RESULTS Overall, 799 echocardiograms were included in the analysis. In 97.5% of cases it was possible to determine an indication listed in the criteria, according to which 78.7% of classifiable echocardiograms were appropriate, 15.3% inappropriate and 6.0% of uncertain appropriateness. The most common appropriate indication (111 echocardiograms) was initial evaluation of patients with symptoms or conditions potentially related to cardiac etiology, while the main inappropriate indication (59 echocardiograms) was routine surveillance of ventricular function in patients with known coronary artery disease and no change in clinical status or cardiac exam. The proportion of inappropriate echocardiograms was significantly higher among outpatients than among inpatients (18.8 vs. 4.3%, p<0.05) and among cardiologists compared to other specialties (19.3% vs. 10.9%, p<0.05). CONCLUSIONS The majority of requests for transthoracic echocardiograms at a Portuguese tertiary care center were appropriate. Requests by cardiologists and outpatient referrals presented the highest rates of inappropriateness.

New less invasive ventricular reconstruction technique in the treatment of ischemic heart failure

Aims Diastolic dysfunction (DD) is frequent in the general population; however, the assessment of diastolic function remains challenging. We aimed to evaluate the impact of the recent 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations in the prevalence and grades of DD compared with the 2009 guidelines and the Canberra Study Criteria (CSC). Methods and results Within a population-based cohort, a total of 1000 individuals, aged ≥45 years, were evaluated retrospectively. Patients with previously known cardiac disease or ejection fraction <50% were excluded. Diastolic function was assessed by transthoracic echocardiography. DD prevalence and grades were determined according to the three classifications. The mean age was 62.0 ± 10.5 years and 37% were men. The prevalence of DD was 1.4% (n = 14) with the 2016 recommendations, 38.1% (n = 381) with the 2009 recommendations, and 30.4% (n = 304) using the CSC. The concordance between the updated recommendations and the other two was poor (from k = 0.13 to k = 0.18, P < 0.001). Regarding the categorization in DD grades, none of the 14 individuals with DD by the 2016 guidelines were assigned to Grade 1 DD, 64% were classified as Grade 2, 7% had Grade 3, and 29% had indeterminate grade. Conclusion The application of the new 2016 ASE/EACVI recommendations resulted in a much lower prevalence of DD. The concordance between the classifications was poor. The updated algorithm seems to be able to diagnose only the most advanced cases.