A infeção do local cirúrgico (ILC) e a deiscência do local cirúrgico (DLC) são duas das complicações mais frequentes da ferida cirúrgica, tendo impacto direto no tempo de cicatrização deste tipo de ferida e, consequentemente, no tempo de hospitalização e na necessidade de reintervenção cirúrgica. A terapia por pressão negativa (TPN) tem vindo a ganhar reconhecimento no âmbito da prevenção e tratamento destas complicações, mas ainda se verifica uma ambivalência de opiniões considerável. Posto isto, e com o objetivo de compreender a eficácia da TPN na cicatrização da ferida cirúrgica, procedeu-se à elaboração de uma revisão da literatura conduzida pela abordagem PICO, partindo-se da questão de investigação “Qual a eficácia da TPN na prevenção de complicações e cicatrização da ferida cirúrgica?”. Foi realizada, entre abril e maio de 2025, uma pesquisa nas bases de dados PubMed, CINAHL, MedLine e B-ON, da qual foram selecionados nove estudos realizados com adultos submetidos a cirurgias de certas especialidades – ortopedia, cirurgia geral (restringindo a laparotomias), neurocirurgia e cirurgia vascular – comparando o uso da TPN com o uso dos pensos convencionais e o respetivo resultado na evolução da ferida cirúrgica. De um modo geral, verificam-se melhores resultados com o uso da TPN do que com o uso do penso convencional, apesar de, em alguns estudos, não ter sido possível obter-se significância estatística e de haver determinados tipos de cirurgia em que foram obtidos melhores resultados com o uso da TPN do que noutros. Para além dos resultados obtidos nesta RL terem sido satisfatórios, destacou-se a necessidade de realizar mais estudos nesta área, no sentido de uniformizar o uso da TPN e de direcioná-la a quem realmente necessita e obtém ganhos em saúde com o seu uso.
We aimed to assess the clinical, angiographic, and outcome profiles of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the use of drug-coated balloon (DCB)-only approach in a retrospective multicenter international registry. Data from 309 patients with 312 CTO lesions undergoing successful CTO PCI with DCB-only approach at 42 sites were collected. Angiographic and clinical follow-up was performed at 3 and 6 months, respectively. The primary endpoint was target lesion failure (TLF), defined as composite of cardiac death, target vessel myocardial infarction, or clinically-driven target lesion revascularization (TLR). Secondary endpoints included binary restenosis (≥50% stenosis) and late lumen loss (LLL) on angiography. The mean age was 67 ± 10 years, and 58.9% patients were male. The main indication for DCB was small vessel disease (37.1%), and most CTO were recanalized with intraplaque wiring (93%). TLF was 3.5% with no cardiac death at 6 months. Of 157 CTO with angiographic follow-up (50.3%) at a median of 99 days (IQR: 85 to 136 days), the LLL was -0.1 mm (IQR: -0.3 to 0.3 mm), and 47.8% vessels showed positive remodelling. Binary restenosis and re-occlusion were 24.2% and 4.0%, respectively. Coronary CTO with binary restenosis had significantly higher residual stenosis directly post-PCI (p <0.001) than CTO without restenosis. In conclusion, treatment of CTO with a DCB-only approach is safe, with a low number of TLF at 6-month follow-up. In selected population with angiographic follow-up, suboptimal predilatation result was associated with an increased rate of restenosis and warrants further investigation.
Non-ST-elevation myocardial infarction (NSTEMI) is a prevalent and serious cardiovascular event, particularly among the elderly (over 65 years), who often present with complex clinical profiles and multiple comorbidities. The Gensini score, a quantitative tool derived from coronary angiography, provides a detailed evaluation of coronary artery disease(CAD) burden and severity. This study aimed to investigate the relationship between Gensini scores and clinical as well as analytical factors in elderly patients with NSTEMI. The study included 67 patients aged ≥65 years, diagnosed with NSTEMI at admission between 1st June 2023 and 31st December 2023. All patients underwent coronary angiography, and severity of CAD was quantified using the Gensini score. Blood samples were analyzed for hemoglobin, leukocytes, platelets, creatinine, glomerular filtration rate (GFR), C-reactive protein, high-sensitive troponin, creatine kinase, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), glycated hemoglobin (HbA1c), and lipid profiles. Additionally, the GRACE score was calculated for all patients. Mean age was 78 ± 8 years, with 64% being male. Comorbidities included dyslipidemia (55%), diabetes mellitus (40%), smoking (22%), and chronic kidney disease (24%). Hypertension was the most prevalent risk factor, affecting 84% of the patients. Median Gensini score as 20 (IQ 39). No significant associations were observed between the Gensini score and hypertension (p=0.333), chronic kidney disease (p=0.848), dyslipidemia (p= 0,391) or gender (p=0.111). However, diabetes mellitus (42 vs. 24, p=0.018) and active/former smoker (40 vs. 19, p=0.044) were significantly associated with higher Gensini scores. Among laboratory parameters, no significant correlations were found for lipid profile components—including total cholesterol (p=0.398), LDL cholesterol (p=0.481), HDL cholesterol (p=0.173), triglycerides (p=0.428), and non-HDL cholesterol (p=0.601)—or for hemoglobin (p=0.615), GFR (p=0.176), troponin levels (p=0.153), creatine kinase (p=0.682), NT-proBNP (p=0.367), and HbA1c (p=0.287). A weak but statistically significant correlation was observed for creatinine levels (r=0.258, p=0.037). No association was found between the Gensini score and the GRACE score (p=0.673). Linear regression analysis identified diabetes mellitus as an independent predictor, associated with an average increase of 19 points on the Gensini scale (p=0.013). Active or former smoking was also independently associated, with an average increase of 17 points on the Gensini scale (p=0.046). In elderly NSTEMI patients, a history of diabetes mellitus and smoking are independent risk factors for increased CAD severity as assessed by the Gensini score. Further large-scale studies are needed to validate and expand upon these results.
Remote Monitoring (RM) systems have been introduced in the early 2000s to remotely follow patients with cardiac implantable electronic devices (CIEDs). Initially data transmissions from CIEDs to physicians were performed via radiofrequency transmitters connected to CIEDs. Nowadays Bluetooth technology and smartphone applications allow to connect CIEDs with patients’ mobile avoiding an additional transmitter, and transmitting device diagnostic data to physicians in a timely manner, when relevant arrhythmic or clinical events occur. To assess patient compliance and acceptance in using Bluetooth technology and smartphone applications for CIED RM. The REACTION REGISTRY is a no-profit, International, multicenter, prospective observational conducted in Italy, Spain, Portugal and Greece. Data on connectivity were collected to assess the feasibility and effectiveness while the REMASQ questionnaire was used to assess the patient acceptance. The REMASQ questionnaire is composed by 12 questions aimed at investigating five aspects linked to the acceptance and satisfaction of remote monitoring: (i) relationship with one's hospital, (ii) ease of use of the technology, (iii) related psychological aspects, (iv) health implications and (v) overall satisfaction. Each response is scored on a five-point scale: from 0 to 4. The maximum score achievable in the questionnaire is 48. From September 2021 21 Cardiology Departments have included 228 patients. The demographic characteristics are shown in table 1. 185 patients (81,14%) were able to connect the device implanted with the RM system by themselves. In the remaining 43 patients, RM connection was facilitated by hospital staff, caregivers or device manufacturer technical support teams [Table 2]. Furthermore, 196 patients (85,96%) were able to perform device data transmissions. 66 REMASQ questionnaires were collected at 6 months follow-up. The mean scores for each of the five areas of the REMASQ were: 3.5±0.9 for the relationship with the hospital, 3.2±1.1 for ease of use, 2.4±1.7 for psychological aspects , 3.6±0.8 for clinical implications and 3.6±0.7 for the general satisfaction. The average score on the questionnaire was 38±8. Considering responses with a value ≥ 2 as positive, the total satisfaction with the remote control system was 98.51%. The preliminary results of our real-world registry show a satisfactory use and compliance of the RM through Bluetooth technology and a good acceptance of this method.Demographic Characteristics Connectivity data on Remote Monitoring
Anatomical and function parameters can be obtained by cardiovascular magnetic resonance (CMR), by automatic processing of imaging. Artificial intelligence (AI) utilization in analyzing automatic parameters in CMR for left atrial longitudinal shortening enhances the precision, speed, and depth of assessment. This technology offers immense potential in improving the diagnosis, treatment planning, and research endeavors related to left atrial function and associated cardiovascular conditions. This study aims to determine if there is a relationship between the measurement of longitudinal left atrial shortening and other functional parameters in CMR within a clinical setting. We retrospectively analyzed a population of patients submitted to CMR and divided them into three groups: those without structural disease, those with dilated cardiomyopathy (DCM) and those with hypertrophic cardiomyopathy (HCM). We documented demographic factors, left atrial ejection fraction (LAEF), and the longitudinal LA shortening obtained through AI in CMR for all groups. We then performed univariate analysis by Pearson correlation to establish the relationship between variables. Out of 103 patients, 22,3% (n=23) had no structural disease, considered the control group, 37,9% (n=39) had HCM and 39.8% (n=41) had DCM. 59,2% were male, with mean age of 55±16 years, with no differences between groups. When comparing the control and HCM groups, these patients had significantly lower LAEF (64,8% vs 46,5%, p<0,001) and also lower absolute values of longitudinal LA shortening (-41,1% vs -17,3%, p<0,001). Similar results were verified between the control and DCM group – they had significantly lower LAEF (64,84% vs 47,5%, p=0,001) and longitudinal LA shortening (-41,1% vs -22,1%, p=0,009). Overall, there is a strong positive correlation (r=0,774, p<0,001) between longitudinal LA shortening and the LAEF. A moderate inverse correlation is also proven between the longitudinal LA shortening and left atrial volume (r=-0,443, p<0,001). There is a strong positive correlation between longitudinal LA shortening and the LAEF in patients with cardiomyopathies, and in turn, an inverse correlation between longitudinal shortening and atrial volume. This AI generated parameter could be helpful in diagnosing atrial disfunction and possibly contribute to the prediction of patients at a higher risk of developing supraventricular arrythmias such as atrial fibrillation.
