Papers by Preza Fernandes
PubMed, Sep 28, 2020
Background: The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute m... more Background: The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods: We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results: Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion: As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.
In literature it is largely established the role of physical inactivity as a major risk factor to... more In literature it is largely established the role of physical inactivity as a major risk factor to coronary heart disease. A Cardiac Rehabilitation Program improves functional capacity of the patient with cardiac disease as well as educates for the control of their cardiovascular risk factors. Resumo Na literatura tem sido amplamente estabelecido o papel do sedentarismo como fator de risco major para doença cardíaca isquémica. Os Programas de Reabilitação Cardíaca visam melhorar a capacidade funcional do doente com patologia cardíaca assim como educar e acompanhar no controlo dos seus fatores de risco cardiovasculares. Objetivo: Avaliar a capacidade funcional de doentes com doença cardíaca isquémica submetidos a um Programa de Reabilitação Cardíaca ao longo de 12 meses de follow-up e a sua correlação com mudanças nos hábitos de vida. Métodos: Estudo de coorte prospetivo que inclui os doentes com diagnóstico de doença cardíaca isquémica referenciados consecutivamente para Programa de Reabilitação Cardíaca baseado no exercício, recrutados entre Janeiro de 2008 e Dezembro de 2009. Foram estabelecidos três momentos de avaliação: inicial (primeira consulta da Fase II), 3 e 12 meses, com registo do nível da atividade física realizada em ambulatório através de questionário (International Physical Activity Questionnaire) e avaliação da capacidade funcional através do tempo total e dos equivalentes metabólicos (MET) atingidos durante as provas de esforço realizadas. Resultados: De um total de 329 doentes foram excluídos 73 por não conclusão da fase II do PRC ou por perda de dados no follow-up. Foram estudados 256 doentes (76,2% do sexo masculino; idade média: 61,1 ± 10,6 anos. No final da Fase II ocorreu uma melhoria estatisticamente significativa nos parâmetros estudados, nomeadamente no valor médio da atividade física realizada em ambulatório registados nos scores do IPAQ (70,5%; p <0,0001), tempo (18,9%; p <0,0001 / 23,7; p =0,002) e MET atingidos na prova de esforço (20,4%; p <0,0001). Esta diferença manteve-se estatisticamente significativa aos 12 meses de follow-up. Conclusão: Este estudo salienta a importância de programas de Reabilitação Cardíaca no contexto da prevenção secundária da doença cardiovascular e a necessidade de implementar estratégias que potenciem a manutenção dos benefícios a longo prazo. Palavras-chave: Reabilitação Cardíaca; Capacidade Funcional.
Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação, 2013
In literature it is largely established the role of physical inactivity as a major risk factor to... more In literature it is largely established the role of physical inactivity as a major risk factor to coronary heart disease. A Cardiac Rehabilitation Program improves functional capacity of the patient with cardiac disease as well as educates for the control of their cardiovascular risk factors. Resumo Na literatura tem sido amplamente estabelecido o papel do sedentarismo como fator de risco major para doença cardíaca isquémica. Os Programas de Reabilitação Cardíaca visam melhorar a capacidade funcional do doente com patologia cardíaca assim como educar e acompanhar no controlo dos seus fatores de risco cardiovasculares. Objetivo: Avaliar a capacidade funcional de doentes com doença cardíaca isquémica submetidos a um Programa de Reabilitação Cardíaca ao longo de 12 meses de follow-up e a sua correlação com mudanças nos hábitos de vida. Métodos: Estudo de coorte prospetivo que inclui os doentes com diagnóstico de doença cardíaca isquémica referenciados consecutivamente para Programa de Reabilitação Cardíaca baseado no exercício, recrutados entre Janeiro de 2008 e Dezembro de 2009. Foram estabelecidos três momentos de avaliação: inicial (primeira consulta da Fase II), 3 e 12 meses, com registo do nível da atividade física realizada em ambulatório através de questionário (International Physical Activity Questionnaire) e avaliação da capacidade funcional através do tempo total e dos equivalentes metabólicos (MET) atingidos durante as provas de esforço realizadas. Resultados: De um total de 329 doentes foram excluídos 73 por não conclusão da fase II do PRC ou por perda de dados no follow-up. Foram estudados 256 doentes (76,2% do sexo masculino; idade média: 61,1 ± 10,6 anos. No final da Fase II ocorreu uma melhoria estatisticamente significativa nos parâmetros estudados, nomeadamente no valor médio da atividade física realizada em ambulatório registados nos scores do IPAQ (70,5%; p <0,0001), tempo (18,9%; p <0,0001 / 23,7; p =0,002) e MET atingidos na prova de esforço (20,4%; p <0,0001). Esta diferença manteve-se estatisticamente significativa aos 12 meses de follow-up. Conclusão: Este estudo salienta a importância de programas de Reabilitação Cardíaca no contexto da prevenção secundária da doença cardiovascular e a necessidade de implementar estratégias que potenciem a manutenção dos benefícios a longo prazo. Palavras-chave: Reabilitação Cardíaca; Capacidade Funcional.
Revista portuguesa de cardiologia, Apr 1, 2016
Conclusão: Este estudo salienta a necessidade de novas e individualizadas estratégias de atuação ... more Conclusão: Este estudo salienta a necessidade de novas e individualizadas estratégias de atuação em determinados subgrupos de doentes em PRC.
PubMed, Sep 1, 2006
Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest o... more Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium; its true prevalence is still uncertain. A strong association between noncompaction and neuromuscular disorders has been described. Its major clinical manifestations are heart failure, arrhythmias and systemic embolic events. Diagnosis of noncompaction of ventricular myocardium can be made by conventional two-dimensional and color Doppler echocardiography. Recently contrast echocardiography has been used to provide a definitive diagnosis in most cases in which conventional echocardiography could not do so. We describe the case of a patient with clinical suspicion of noncompaction of ventricular myocardium established by conventional two-dimensional and color Doppler echocardiography and definitive diagnosis, as well as additional information, obtained by cardiac magnetic resonance imaging. We also discuss the difficulties in defining the therapeutic approach.
Revista portuguesa de cardiologia, Apr 1, 2016
Introduction: The effectiveness of cardiac rehabilitation programs (CRP) strongly influences the ... more Introduction: The effectiveness of cardiac rehabilitation programs (CRP) strongly influences the recovery of functional capacity (FC), resulting in improved prognosis and survival. Objective: To determine the cardiovascular risk factors that predict changes in FC in patients on CRP. Methods: We performed a cross-sectional descriptive retrospective study of patients who began a CRP between January 2008 and December 2013. The dependent variable was changes in FC estimated in metabolic equivalents (METs) achieved in stress testing at the beginning and end of the phase II program. The independent variables were age, gender, dyslipidemia, diabetes, smoking, body mass index, physical activity level and reason for referral to the CRP. Results: The sample included 1399 patients, of whom 1125 (80.4%) completed the program. FC improved in most patients (93%), with a mean gain of 1.45±1.19 METs. Patients aged 45-65 and over 65 years achieved a greater increase in FC compared with other age groups. Patients admitted to the CRP after coronary artery bypass graft surgery obtained a greater improvement in FC compared to patients with acute coronary syndrome. Non-diabetic patients benefited more than diabetic patients. No significant differences were seen between the groups in the other variables. Conclusion: This study highlights the need for new and individualized approaches in certain subgroups of patients on CRP.
Cardiology, 2015
Introduction: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity, imp... more Introduction: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity, improve the control of risk factors and the quality of life of patients with coronary artery disease. However, the elderly are underrepresented in most studies and in real-life CR programs. Our goal was to evaluate the impact of CR after an acute coronary syndrome in the elderly population. Methods: A cutoff of 65 years was used to dichotomize age. Our main focus was on the effects of ambulatory supervised exercise training on several surrogate markers, namely total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, body mass index, fasting glucose, glycated hemoglobin, probrain natriuretic peptide, International Physical Activity Questionnaire score, maximal exercise capacity, chronotropic response index and heart rate recovery. We evaluated those variables at the beginning and at the end of phase II of the CR program (after 3 months) and repeated the treadmill test at 12 months. Results: A total of 548 patients with a recent acute coronary syndrome were enrolled; 37% were 65 years old or older. Both age groups had a statistically significant improvement in all the evaluated parameters. Interestingly, at 12 months both groups maintained the improvement in functional capacity seen immediately after 3 months. Conclusions: The benefits of CR in terms of functional capacity, metabolic profile and other prognostic parameters were significant in both younger and older patients. Therefore, all eligible patients should be referred to CR programs, irrespective of age.
Revista portuguesa de cardiologia, Mar 1, 2013
Introduction: Cardiac rehabilitation programs are designed to improve patients' functional capaci... more Introduction: Cardiac rehabilitation programs are designed to improve patients' functional capacity, as well as to educate them and to monitor their cardiovascular risk factors. Aim: The study aims to evaluate the effects of cardiac rehabilitation programs in patients with coronary disease over a 12-month follow-up period with regard to control of cardiovascular risk factors. Methods: This was a prospective study of patients diagnosed with coronary disease who completed an exercise-based cardiac rehabilitation program between January 2008 and December 2009 and who were not lost to follow-up. Patients were evaluated at an early stage (first medical consultation in phase II of the program) and 3, 6 and 12 months later, the following parameters being assessed: weight and body mass index, waist circumference, lipid profile, HbA1c in diabetic patients, blood pressure, smoking status and physical activity (using the International Physical Activity Questionnaire). Results: In the sample of 256 patients (76.2% male, mean age 67 years), dyslipidemia proved to be the most prevalent risk factor (74.2%), followed by overweight (71.5%). There was a statistically significant improvement (p<0.05) in all risk factors studied at the end of phase II of the program, which was maintained at 6 and 12 months of follow-up, with the exception of body mass index (loss of statistical significance at 6-month assessment, p=0.92). Conclusion: This study highlights the need for cardiac rehabilitation programs in the context of secondary prevention of cardiovascular disease and the importance of implementing strategies that promote long-term maintenance of their benefits.
Revista portuguesa de cardiologia, Jul 1, 2020
Cardiac rehabilitation programs for heart failure patients in the time of COVID-19 Programas de r... more Cardiac rehabilitation programs for heart failure patients in the time of COVID-19 Programas de reabilitação cardíaca para doentes com insuficiência cardíaca durante o período do COVID-19
European Heart Journal, Aug 1, 2017
Introdução: Os pacientes que sofrem um evento isquémico cardíaco enfrentam também o risco de dese... more Introdução: Os pacientes que sofrem um evento isquémico cardíaco enfrentam também o risco de desenvolverem sintomas de Doença Arterial Periférica Obstrutiva (DAPO) como manifestação concomitante da doença vascular, com impacto adicional no seu estado funcional e qualidade de vida. Com alguma frequência os sintomas de claudicação intermitente (CI) manifestam-se inicialmente no contexto do exercício supervisionado que integra um Programa de Reabilitação Cardíaca (PRC) instituído por Doença Coronária (DC), influenciando o processo reabilitador. Métodos: Estudo prospectivo visando determinar a prevalência de DAPO e a sua associação com os Factores de Risco Cardiovasculares (FRCV) modificáveis em pacientes com DC, orientados para PRC na UPRCV do Centro Hospitalar do Porto/Hospital de Santo António durante o ano de 2009. Resultados: Foi realizado doppler arterial periférico com medição do Índice Tornozelo-Braço (ITB) a um total de 141 doentes com DC que integraram PRC supervisionado na UPRCV: 115 (81,5%) do sexo masculino e 26 (18,5%) do sexo feminino. Dos 141 doentes 35 (24,8%) apresentavam sintomas sugestivos de CI. O diagnóstico de DAPO por ITB <0,9 foi confirmado em 21 doentes (17 homens e 4 mulheres) traduzindo uma prevalência de 14,8%. Em 11 (7,8%; 52,3% do total de doentes com DAPO) a CI surgiu no decurso do PRC. Verificou-se uma correlação significativa entre a DAPO e tabagismo (p<0,002), presente em 17 dos 21 doentes; sedentarismo (p<0,002), também presente em 17 doentes e HTA (p<0.01). Conclusão: A elevada prevalência da DAPO e a variabilidade da sua apresentação clínica fundamentam a necessidade de incluir o ITB no protocolo de avaliação dos pacientes com DC.É importante implementar nas UPRCV estratégias que envolvem a detecção, prevenção e tratamento das várias manifestações da doença aterosclerótica
European Heart Journal, Aug 2, 2013
Purpose: Although a great proportion of patients with coronary heart disease have more than 65 ye... more Purpose: Although a great proportion of patients with coronary heart disease have more than 65 years old, frequently they are not included in the studies and are less likely to be referred to a Cardiac Rehabilitation Program (CRP). Our aim was to study the effectiveness of CRP in this age range. Methods: We studied 904 consecutive patients that participated in our multidisciplinary CRP. From those, we enrolled patients with known coronary heart disease, after acute coronary syndrome or elective revascularization (729 patients). The subjects performed 45 minutes of supervised aerobic exercise during approximately 12 weeks, 2/week. We measured different laboratory and clinical parameters at the beginning and at the end of the CRP, including a treadmill stress test. A cutoff of 65 years-old was used to dichotomize age. The proBNP levels, maximal exercise capacity, heart rate reserve and chronotropic recovery were evaluated as prognostic markers to access the benefits of the CRP. Results: Approximately 36% of our patients had more than 65 years-old and 75% were male. At baseline, older patients had higher proBNP levels (1253±1802 pg/mL vs 530±590 pg/mL; p<0,001) and lower functional capacity (7,23±2,1 METs vs 9,7±6,29 METs; p<0,001). The heart rate reserve and chronotropic recovery were significantly better in younger patients (51,6±9,4% vs 47,2±10,7%, p<0,001; 23,6±11,1 bmp vs 18,3±8,8 bmp, p<0,001). After the CRP, there was a statistically significant improvement in proBNP levels, maximal exercise capacity, heart rate reserve and chronotropic recovery in both groups. The degree of improvement in heart rate reserve and chronotropic recovery was similar between the groups. Likewise, the change in functional capacity after CRP was not statistically different, but interestingly there was a trend for a greater improvement in older patients. The improvement in proBNP was also higher in elderly patients (-633±78 pg/mL vs-260±23 pg/mL, p<0,001). Conclusions: The benefits of cardiac rehabilitation in terms of functional capacity and prognostic markers were comparable, and even more expressive, in elderly patients. However, since they had lower values at baseline, they could have a greater potential for improvement. Therefore, if these patients don't have limitations that unable them to participate in a CRP, they should be strongly encouraged to perform systematic and initially supervised exercise training. Cardiac Rehabilitation is an important secondary prevention strategy in coronary heart disease patients, regardless of age.
Journal of Cardiovascular Development and Disease
Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure... more Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1...
Revista portuguesa de cardiologia, Feb 1, 2014
Introduction and Objectives: Coronary heart disease is the leading cause of death in women worldw... more Introduction and Objectives: Coronary heart disease is the leading cause of death in women worldwide and several studies have shown that they are under-represented in cardiac rehabilitation therapy. The objectives of this study were to assess the prevalence of women in a cardiac rehabilitation program and to assess their response to this intervention. Methods: This is a retrospective study of 858 patients who attended an exercise-based cardiac rehabilitation program after an acute coronary syndrome or elective percutaneous coronary intervention, between January 2008 and December 2012. The patients were analyzed by gender, and the impact of the intervention on cardiovascular risk factors and NT-proBNP was studied. In a subgroup of 386 patients the impact on functional capacity, resting heart rate, chronotropic index and heart rate recovery was also analyzed. Results: Only 24% of the 858 patients who attended the program were women. Women showed statistically significant improvements in all cardiovascular risk factors, NT-proBNP, functional capacity and heart rate recovery (p<0.05) after the program. There were also improvements in resting heart rate and chronotropic index, but these were not statistically significant (p=0.08 and p=0.40, respectively) and when the improvements in these two parameters were compared between genders, there was no statistically significant difference (p=0.33 and p=0.17, respectively). Conclusions: Only 24% of the patients attending the program were women. We found that they benefited from cardiac rehabilitation therapy, with significant improvements in cardiovascular risk factors and in most of the prognostic markers studied.
Revista portuguesa de …, 2006
Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest o... more Noncompaction of ventricular myocardium is a rare cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium; its true prevalence is still uncertain. A strong association between noncompaction and neuromuscular disorders ...
Journal of Geriatric Cardiology : JGC, 2020
Background The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute my... more Background The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only impro...
Introduction: After an ischemic cardiac event patients often face the increased risk of developin... more Introduction: After an ischemic cardiac event patients often face the increased risk of developing ObstructivePeripheral Arterial Disease (OPAD) symptoms as a manifestation of vascular disease, with additional impact overfunctional capacity and quality of life. Frequently, intermittent claudication (IC) symptoms appear for the firsttime during supervised exercise sessions in the context of a cardiac rehabilitation program (CRP) addressed tocoronary disease (CD), influencing the rehabilitative process. It’s therefore important to implement specific strategies to diagnose and treat OPAD on Cardiovascular Prevention and Rehabilitation Units (CVPRU),incorporated on the established CRP. Methods: Prospective study aiming to determine the real prevalence of OPAD and its association with modifiable Cardiovascular Risk Factors in patients with CD referred to the Cardiovascular Prevention and Rehabilitation Unitin Centro Hospitalar do Porto/Hospital de Santo Antonio during the year 2009. Resu...
The Onshore Kwanza Basin can be faced as a complementary sector in the Oil Scenario, considering ... more The Onshore Kwanza Basin can be faced as a complementary sector in the Oil Scenario, considering the new crisis in the Oil Market. In fact, bearing in mind the already known resources, the Onshore can be considered the next promising exploration area, which is less expensive and the oil production would be quicker than expected in the offshore areas. The main purpose of this paper is to present a pioneer surface organic geochemistry study developed at a regional scale by Sonangol to characterize and identify potential source rocks. The 1/250 000 scale geological maps (Sonangol/Total 1987 and Sonangol/Obrangol 2015) were used to support the sampling programme developed. To implement this work were involved field sampling and laboratorial analyses. A number of 800 outcrop samples were collected in the entire basin, which were strategically selected considering the stratigraphic framework. The methods and analyses selected for the present study were palynostratigraphy, optical organic ...
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Papers by Preza Fernandes