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Coimbra, Portugal

Saraiva F.,Coimbra Hospital | Matos V.,Coimbra Hospital | Gonalves L.,Coimbra Hospital | Antunes M.,Coimbra Hospital | Providencia L.A.,Coimbra Hospital
Transplantation Proceedings | Year: 2011

Background: Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure. Methods: This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure. Results: Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases. Conclusion: EMB proved to be a suitable, safe method to monitor rejection after HT. © 2011 Elsevier Inc.


Baptista R.,Coimbra Hospital | Rebelo M.,Coimbra Hospital | Decq-Mota J.,Coimbra Hospital | Dias P.,Coimbra Hospital | And 3 more authors.
Lipids in Health and Disease | Year: 2011

Background: The risk of coronary heart disease (CHD) is related to environmental factors and genetic variants. Apolipoprotein E (apoE) polymorphisms are heritable determinants of total and low-density lipoprotein cholesterol, with some authors suggesting an association between the 4 allele and CHD. We investigated the relationship between apoE genotype and age at referral to a specialized lipid clinic by the primary care physician and whether the benefits of treatment with statin differed between genotypes. Methods. We assessed individual apoE genotypes and lipid blood profile in a total of 463 patients followed at a specialized lipid clinic due to dyslipidemia, with a 3-year median follow-up time. The primary care physician at the time of the referral had no access to the apoE genotyping results. Carriers of apoE 4/2 genotype were excluded. Results: The frequencies of 2, 3 and 4 alleles were 7.8, 78.9 and 13.3%, respectively. There were no significant differences between genders. Although with similar lipid profiles and antidyslipidemic drug usage at baseline, 4-carriers were referred to the clinic at a younger age (44.2 14.7 years) compared with non-4 carriers (50.6 13.8 years) (p < 0.001), with a substantially younger age of referral for homozygous E4/4 and for all genotypes with at least one copy of the 4 allele (p < 0.001 for trend). Although both 4 and non-4 carriers achieved significant reductions in total cholesterol during follow-up (p < 0.001 vs. baseline), the mean relative decrease in total cholesterol levels was higher in non-4 carriers (-19.9 2.3%) compared with 4 carriers (-11.8 2.3%), p = 0.003. Conclusion: Our findings support the concept that there is a reduced response to anti-dyslipidemic treatment in 4 carriers; this can be a contributing factor for the earlier referral of these patients to our specialized lipid clinic and reinforces the usefulness of apoE genotyping in predicting patients response to lipid lowering therapies. © 2011 Baptista et al; licensee BioMed Central Ltd.

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