CatólicaMed (CM)
Permanent URI for this community
Browse
Browsing CatólicaMed (CM) by Title
Now showing 1 - 10 of 16
Results Per Page
Sort Options
- Arrhythmic risk stratification in patients with left ventricular ring-like scarPublication . Parisi, Vanda; Graziosi, Maddalena; Lopes, Luis R.; Luca, Antonio De; Pasquale, Ferdinando; Tini, Giacomo; Targetti, Mattia; Cueto, Maria R.; Moura, Ana R.; Ditaranto, Raffaello; Torlasco, Camilla; Taglieri, Nevio; Nardi, Elena; Lovato, Luigi; Augusto, João B.; Galiè, Nazzareno; Crotti, Lia; Gasperetti, Alessio; Biffi, Mauro; Autore, Camillo; Merlo, Marco; Olivotto, Iacopo; Sinagra, Gianfranco; Elliott, Perry M.; Biagini, ElenaAims Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischaemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia. Methods and results One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28–52), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [≥3 contiguous segments with sub-epicardial/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events/100 patients/year); at a median follow-up of 4.6 years (IQR 1.7–8.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014–1.046, P < 0.001], QRS width (HR: 4.642, 95% CI: 1.296–16.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001–1.021, per mL/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell’s C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and ≥1 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015). Conclusion In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.
- Catheter-related right atrial endocarditis in a dialysis patientPublication . Ribeiro, Maria Inês; D'Orey, Francisco; Sampaio, João Prosil; Santos, João Grade; Pereira, VeraHemodialysis catheters are frequently used for vascular access in end-stage chronic kidney disease patients lacking mature arteriovenous fistula. The incidence of infective endocarditis in hemodialysis patients is higher than in the general population and is associated with severe and potentially life-threatening complications. A high index of suspicion is imperative for early diagnosis and timely intervention to enhance the prognosis of this high-mortality condition. Imaging studies, like transthoracic and transesophageal echocardiography, are crucial for prompt diagnosis. We present a case of a 36-year-old woman undergoing hemodialysis, whose prolonged use of a permanent catheter led to the development of infective endocarditis complicated with septic pulmonary embolism. Our case report presents an example of right atrial endocarditis with a poor outcome due to delayed diagnosis.
- Correction to: Surgery of the primary tumor in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium (Breast Cancer Research and Treatment, (2024), 203, 2, (351-363), 10.1007/s10549-023-07116-6)Publication . Brandão, Mariana; Martins-Branco, Diogo; Angelis, Claudia De; Vuylsteke, Peter; Gelber, Richard D.; Damme, Nancy Van; Walle, Lien van; Ferreira, Arlindo R.; Lambertini, Matteo; Poggio, Francesca; Verhoeven, Didier; Barbeaux, Annelore; Duhoux, Francois P.; Wildiers, Hans; Caballero, Carmela; Awada, Ahmad; Piccart-Gebhart, Martine; Punie, Kevin; Azambuja, Evandro deIn the original publication of the article, the following article note has been missed to include. “Mariana Brandão and Diogo Martins-Branco have contributed equally to this work.” The original article has been corrected.
- Development and validation of a quantitative coronary CT Angiography model for diagnosis of vessel-specific coronary ischemiaPublication . CREDENCE and PACIFIC-1 Investigators; Nurmohamed, Nick S.; Danad, Ibrahim; Jukema, Ruurt A.; Winter, Ruben W. de; Groot, Robin J. de; Driessen, Roel S.; Bom, Michiel J.; Diemen, Pepijn van; Pontone, Gianluca; Andreini, Daniele; Chang, Hyuk Jae; Katz, Richard J.; Stroes, Erik S. G.; Wang, Hao; Chan, Chung; Crabtree, Tami; Aquino, Melissa; Min, James K.; Earls, James P.; Bax, Jeroen J.; Choi, Andrew D.; Knaapen, Paul; Rosendael, Alexander R. van; Heo, Ran; Park, Hyung Bok; Marques, Hugo; Stuijfzand, Wijnand J.; Choi, Jung Hyun; Doh, Joon Hyung; Her, Ae Young; Koo, Bon Kwon; Nam, Chang Wook; Shin, Sang Hoon; Cole, Jason; Gimelli, Alessia; Khan, Muhammad Akram; Lu, Bin; Gao, Yang; Nabi, Faisal; Al-Mallah, Mouaz H.; Nakazato, Ryo; Schoepf, U. Joseph; Thompson, Randall C.; Jang, James J.; Ridner, Michael; Rowan, Chris; Avelar, Erick; Généreux, Philippe; Waard, Guus A. de; Sprengers, Ralf W.Background: Noninvasive stress testing is commonly used for detection of coronary ischemia but possesses variable accuracy and may result in excessive health care costs. Objectives: This study aimed to derive and validate an artificial intelligence-guided quantitative coronary computed tomography angiography (AI-QCT) model for the diagnosis of coronary ischemia that integrates atherosclerosis and vascular morphology measures (AI-QCTISCHEMIA) and to evaluate its prognostic utility for major adverse cardiovascular events (MACE). Methods: A post hoc analysis of the CREDENCE (Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia) and PACIFIC-1 (Comparison of Coronary Computed Tomography Angiography, Single Photon Emission Computed Tomography [SPECT], Positron Emission Tomography [PET], and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve) studies was performed. In both studies, symptomatic patients with suspected stable coronary artery disease had prospectively undergone coronary computed tomography angiography (CTA), myocardial perfusion imaging (MPI), SPECT, or PET, fractional flow reserve by CT (FFRCT), and invasive coronary angiography in conjunction with invasive FFR measurements. The AI-QCTISCHEMIA model was developed in the derivation cohort of the CREDENCE study, and its diagnostic performance for coronary ischemia (FFR ≤0.80) was evaluated in the CREDENCE validation cohort and PACIFIC-1. Its prognostic value was investigated in PACIFIC-1. Results: In CREDENCE validation (n = 305, age 64.4 ± 9.8 years, 210 [69%] male), the diagnostic performance by area under the receiver-operating characteristics curve (AUC) on per-patient level was 0.80 (95% CI: 0.75-0.85) for AI-QCTISCHEMIA, 0.69 (95% CI: 0.63-0.74; P < 0.001) for FFRCT, and 0.65 (95% CI: 0.59-0.71; P < 0.001) for MPI. In PACIFIC-1 (n = 208, age 58.1 ± 8.7 years, 132 [63%] male), the AUCs were 0.85 (95% CI: 0.79-0.91) for AI-QCTISCHEMIA, 0.78 (95% CI: 0.72-0.84; P = 0.037) for FFRCT, 0.89 (95% CI: 0.84-0.93; P = 0.262) for PET, and 0.72 (95% CI: 0.67-0.78; P < 0.001) for SPECT. Adjusted for clinical risk factors and coronary CTA-determined obstructive stenosis, a positive AI-QCTISCHEMIA test was associated with an HR of 7.6 (95% CI: 1.2-47.0; P = 0.030) for MACE. Conclusions: This newly developed coronary CTA-based ischemia model using coronary atherosclerosis and vascular morphology characteristics accurately diagnoses coronary ischemia by invasive FFR and provides robust prognostic utility for MACE beyond presence of stenosis.
- Do cognitive subtypes exist in people at clinical high risk for psychosis? Results from the EU-GEI studyPublication . EU-GEI High Risk Study; Gifford, George; Avila, Alessia; Kempton, Matthew J.; Fusar-Poli, Paolo; Mccutcheon, Robert A.; Coutts, Fiona; Tognin, Stefania; Valmaggia, Lucia; Haan, Lieuwe de; Gaag, Mark van der; Nelson, Barnaby; Pantelis, Christos; Riecher-Rössler, Anita; Bressan, Rodrigo; Barrantes-Vidal, Neus; Krebs, Marie-Odile; Glenthoj, Birte; Ruhrmann, Stephan; Sachs, Gabriele; Rutten, Bart P. F.; Os, Jim van; McGuire, PhilipBackground and Hypothesis: Cognition has been associated with socio-occupational functioning in individuals at Clinical High Risk for Psychosis (CHR-P). The present study hypothesized that clustering CHR-P participants based on cognitive data could reveal clinically meaningful subtypes. Study Design: A cohort of 291 CHR-P subjects was recruited through the multicentre EU-GEI high-risk study. We explored whether an underlying cluster structure was present in the cognition data. Clustering of cognition data was performed using k-means clustering and density-based spatial clustering of applications with noise. Cognitive subtypes were validated by comparing differences in functioning, psychosis symptoms, transition outcome, and grey matter volume between clusters. Network analysis was used to further examine relationships between cognition scores and clinical symptoms. Study Results: No underlying cluster structure was found in the cognitive data. K-means clustering produced “spared” and “impaired” cognition clusters similar to those reported in previous studies. However, these clusters were not associated with differences in functioning, symptomatology, outcome, or grey matter volume. Network analysis identifed cognition and symptoms/functioning measures that formed separate subnetworks of associations. Conclusions: Stratifying patients according to cognitive performance has the potential to inform clinical care. However, we did not fnd evidence of cognitive clusters in this CHR-P sample. We suggest that care needs to be taken in inferring the existence of distinct cognitive subtypes from unsupervised learning studies. Future research in CHR-P samples could explore the existence of cognitive subtypes across a wider range of cognitive domains.
- Feedback based on experience sampling data: examples of current approaches and considerations for future researchPublication . Bartels, Sara Laureen; van Zelst, Catherine; Melo Moura, Bernardo; Daniëls, Naomi E.M.; Simons, Claudia J.P.; Marcelis, Machteld; Bos, Fionneke M.; Servaas, Michelle N.Methodologies such as the Experience Sampling Method (ESM) or Ecological Momentary Assessment allow the gathering of fine-graded, dynamic, personal data within a patient's daily life. Currently, it is studied whether feedback based on experience sampling data (ESM-based feedback) can be used as a clinical tool to inform shared decision-making in clinical practice. Although the potential of feedback is recognized, little is known on how to generate, use, and implement it. This article (i) presents n = 15 ongoing ESM projects within the Belgian-Dutch network for ESM research wherein ESM-based feedback is provided to various patient populations, and (ii) summarizes qualitative data on experiences with ESM-based feedback of researchers (n = 8) with extensive expertise with ESM (average of 10 years) involved in these ongoing studies. The following aspects appear to be of relevance when providing ESM-based feedback: training for healthcare professionals and researchers, the use of online interfaces and graphical visualizations to present data, and interacting with patients in a face-to-face setting when discussing the contextual relevance and potential implications. Prospectively, research may build on these aspects and create coherent consensus-based guidelines for the use of ESM-based feedback.
- Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021Publication . GBD 2021 Nervous System Disorders Collaborators; Steinmetz, Jaimie D.; Seeher, Katrin Maria; Schiess, Nicoline; Nichols, Emma; Cao, Bochen; Servili, Chiara; Cavallera, Vanessa; Cousin, Ewerton; Hagins, Hailey; Moberg, Madeline E.; Mehlman, Max L.; Abate, Yohannes Habtegiorgis; Abbas, Jaffar; Abbasi, Madineh Akram; Abbasian, Mohammadreza; Abbastabar, Hedayat; Abdelmasseh, Michael; Abdollahi, Mohammad; Abdollahi, Mozhan; Abdollahifar, Mohammad Amin; Abd-Rabu, Rami; Abdulah, Deldar Morad; Abdullahi, Auwal; Abedi, Aidin; Abedi, Vida; Abeldaño Zuñiga, Roberto Ariel; Abidi, Hassan; Abiodun, Olumide; Aboagye, Richard Gyan; Abolhassani, Hassan; Aboyans, Victor; Abrha, Woldu Aberhe; Abualhasan, Ahmed; Abu-Gharbieh, Eman; Aburuz, Salahdein; Adamu, Lawan Hassan; Addo, Isaac Yeboah; Adebayo, Oladimeji M.; Adekanmbi, Victor; Adekiya, Tayo Alex; Adikusuma, Wirawan; Adnani, Qorinah Estiningtyas Sakilah; Adra, Saryia; Afework, Tsion; Afolabi, Aanuoluwapo Adeyimika; Afraz, Ali; Afzal, Saira; Aghamiri, Shahin; Agodi, Antonella; Bettencourt, Paulo J. G.Background: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. Methods: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. Findings: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. Interpretation: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. Funding: Bill & Melinda Gates Foundation.
- Heart with Mozambique: a Portuguese contribution to the eradication of rheumatic heart diseasePublication . Almeida, Inês Grácio de; Esteves, Ana; Gil, Victor
- Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and BelgiumPublication . Franzoi, Maria Alice; Ferreira, Arlindo R.; Lemaire, Antoine; Rodriguez, Joseph; Grosjean, Jessica; Ribeiro, Joana M.; Polastro, Laura; Grellety, Thomas; Artignan, Xavier; Du, Katell Le; Pagliuca, Martina; Nouhaud, Élodie; Autheman, Maximilien; André, Fabrice; Basch, Ethan; Metzger, Otto; Ferté, Charles; Palma, Mario Di; Scotté, Florian; Vaz-Luis, InesBackground: Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice. However, implementation in routine care has been slow and faces several challenges. In this study we report on the real-world multi-center implementation of a RPM pathway encompassing weekly patient symptom ePRO reporting with electronic alert notifications triggered to providers for severe or worsening symptoms. Methods: An RPM pathway was implemented in 33 European cancer centers in France and Belgium between November 2021 and August 2023. The implementation process followed a standardized phasic process of Exploration, Preparation, Implementation and Sustainment. Patient-level and system-level implementation metrics were collected and evaluated according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Findings: Across the 33 cancer centers, the RPM pathway was implemented for 3015 patients cared for by 168 providers. The RPM pathway enabled effective and timely symptom management with 94.6% of all alerts (10,132/10,711) evolving to an improvement two weeks later, among which 88.4% (9468/10,711) showed ≥2 grades of improvement on the 5-point scale of the Patient-Reported Outcomes Common Terminology (PRO-CTCAE). The median time to alert management by the care team was 13 h 41 min (25th percentile: 1 h 42 min, 75th percentile: 1 day + 19 h 54 min), with 80% (36,269/45,334) of alerts managed by a nurse navigator telephone call. Patient adherence with weekly ePRO reporting was 82% (2472/3015). In an experience survey, 87% (32/38) of providers were satisfied with integrating the solution into their organization and 90% (276/307) of the patients felt that ePRO reporting positively impacted their care. As of March 2024, the pathway has been maintained in all participating centers, with activation of an additional 18 centers following data lock, and reimbursement for this RPM pathway approved in France in October 2023. Interpretation: These findings demonstrate the feasibility of implementing and maintaining an RPM pathway during routine care across a diverse group of cancer centers in the European setting, with high levels of patient and provider engagement, and positive clinical impact. Funding: Part of this work was funded Breast Cancer Research Foundation (Career Development Award to Maria Alice Franzoi) and Resilience (nurse navigation and technology support).
- Magnitude and temporal variations of socioeconomic inequalities in the quality of life after early breast cancer: results from the multicentric French CANTO CohortPublication . Sandoval, José Luis; Franzoi, Maria Alice; Di Meglio, Antonio; Ferreira, Arlindo R.; Viansone, Alessandro; André, Fabrice; Martin, Anne Laure; Everhard, Sibille; Jouannaud, Christelle; Fournier, Marion; Rouanet, Philippe; Vanlemmens, Laurence; Dhaini-Merimeche, Asma; Sauterey, Baptiste; Cottu, Paul; Levy, Christelle; Stringhini, Silvia; Guessous, Idris; Vaz-Luis, Ines; Menvielle, GwennPURPOSE: Socioeconomic status (SES) influences the survival outcomes of patients with early breast cancer (EBC). However, limited research investigates social inequalities in their quality of life (QoL). This study examines the socioeconomic inequalities in QoL after an EBC diagnosis and their time trends. PATIENTS AND METHODS: We used data from the French prospective multicentric CANTO cohort (ClinicalTrials.gov identifier: NCT01993498), including women with EBC enrolled between 2012 and 2018. QoL was assessed using the European Organisation for Research and Treatment of Cancer QoL Core 30 questionnaire (QLQ-C30). summary score at diagnosis and 1 and 2 years postdiagnosis. We considered three indicators of SES separately: self-reported financial difficulties, household income, and educational level. We first analyzed the trajectories of the QLQ-C30 summary score by SES group. Then, social inequalities in QLQ-C30 summary score and their time trends were quantified using the regression-based slope index of inequality (SII), representing the absolute change in the outcome along socioeconomic gradient extremes. The analyses were adjusted for age at diagnosis, Charlson Comorbidity Index, disease stage, and type of local and systemic treatment. RESULTS: Among the 5,915 included patients with data on QoL at diagnosis and at the 2-year follow-up, social inequalities in QLQ-C30 summary score at baseline were statistically significant for all SES indicators (SIIfinancial difficulties = -7.6 [-8.9; -6.2], SIIincome = -4.0 [-5.2; -2.8]), SIIeducation = -1.9 [-3.1; -0.7]). These inequalities significantly increased (interaction P <.05) in year 1 and year 2 postdiagnosis, irrespective of prediagnosis health, tumor characteristics, and treatment. Similar results were observed in subgroups defined by menopausal status and type of adjuvant systemic treatment. CONCLUSION: The magnitude of preexisting inequalities in QoL increased over time after EBC diagnosis, emphasizing the importance of considering social determinants of health during comprehensive cancer care planning.