FM-CCUL-Artigos em Revistas Nacionais
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- When atrial fibrillation meets acute myocardial infarction: a hidden risk demanding closer attentionPublication . Martins, Ana Margarida; Lima da Silva, GustavoAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and has been observed in up to 21% of hospitalized patients experiencing acute myocardial infarction (AMI). Potential triggers of AF in this context include hemodynamic instability resulting from left ventricular dysfunction, pericardial inflammation, atrial ischemia or infarction, metabolic disturbances, and elevated levels of endogenous or exogenous catecholamines. Multiple studies have investigated the clinical profiles of patients who develop AF during AMI. One of the largest datasets comes from the Cooperative Cardiovascular Project,4 where multivariate analysis identified advanced heart failure (Killip class IV) as the strongest predictor of AF development; other significant predictors included elevated admission heart rate, which may reflect left ventricular dysfunction and hemodynamic compromise, and advanced age.
- In-hospital mortality of high-risk pulmonary embolism: a nationwide population-based cohort study in Portugal from 2010 to 2018Publication . Calé, R.; Ascenção, Raquel; Bulhosa, C.; Pereira, Helder; Borges, Margarida; Costa, J.; Caldeira, DanielBackground: The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data about the incidence, rate of reperfusion and mortality of high-risk PE are not known. Methods: Nationwide population-based temporal trend study in the incidence and outcome of high-risk PE, who were admitted to hospitals of the National Health Service in Portugal between 2010 and 2018. High-risk PE was defined as patients with PE who developed cardiogenic shock or cardiac arrest. International Classification of Diseases (ICD), 9th and 10th revision, Clinical Modification codes, were used for data from the period between 2010 and 2016 (ICD-9-CM) and 2017-2018 (ICD-10-CM), respectively. The assessment focused on trends in the use of reperfusion treatment, which was defined by application of thrombolysis or pulmonary embolectomy. A comparison was made between the use or non-use of reperfusion therapy in order to examine trends in in-hospital mortality among high-risk PE cases. Results: From 2010 and 2018, there were 40.311 hospitalization episodes for PE in adult patients at hospitals of the National Health Service in mainland Portugal. There was a significant increase in the annual incidence of PE (41/100.000 inhabitants in 2010 to 46/100.000 in 2018; R2=0.582, p = 0.010). The average annual incidence was 45/100.000 inhabitants/year, with 2,7% of the PE episodes (1104) categorized as high-risk. The mortality rate associated with high-risk PE was high, although it has decreased over the years (74.2% in 2010 to 63.6% in 2018; R2=0.484; p = 0.022). Thrombolytic therapy was underused in high-risk PE, and its usage has not increased in recent years (17.3% in 2010 to 21.1% in 2018, R2=-0.127; p = 0.763). Surgical pulmonary embolectomy was used in 0.27% of cases, and there was no registry of catheter-directed thrombolysis. Patients with high-risk PE undergoing reperfusion therapy had lower in-hospital mortality compared to non-reperfused patients (OR=0.52; IC95% 0.38-0.70). Conclusion: In Portugal, between 2010 and 2018, very few patients with PE developed high-risk forms of the disease, but the mortality rate among those patients was high. The low reperfusion rate could be associated with high in-hospital mortality and highlights the need to implement advanced therapies, as an alternative to systemic thrombolysis.
- Revolutionizing atrial fibrillation treatment: early results and future prospects for pulsed field ablationPublication . Cortez-Dias, NunoAtrial fibrillation (AF) is the most common sustained arrhythmia in the population, and its treatment is a public health imperative due to its association with increased mortality and morbidity, including stroke, heart failure, and dementia. Early rhythm control strategies are the most effective way to prevent long-term adverse cardiovascular events. While antiarrhythmic drugs remain central to treatment, AF ablation has gained prominence due to its high effectiveness and superiority over pharmacological treatments.
- Will ambulatory invasive hemodynamic monitoring benefit the management of Levosimendan in outpatients with advanced heart failure?Publication . Silva, DoroteiaLevosimendan is an inotropic drug characterized by three mechanisms of action: positive inotropy, vasodilation, and cardioprotection. It is currently recommended in hospitalized patients with decompensated heart failure (HF), especially if there is evidence of low cardiac output (CO) and organ hypoperfusion, as a bridge to mechanical circulatory support or heart transplantation, or as a palliative therapy (class of recommendation IIb, level of evidence C). Intermittent long-term use of levosimendan pulses (repeated low doses) may be also considered in outpatients to improve functional class and quality of life (class IIb, level C). Randomized trials have generally failed to provide compelling evidence that inotropes improve survival in HF patients, although they are an essential part of HF therapy, improving symptoms and quality of life, and potentially reducing HF hospitalizations, all important endpoints in this scenario.
- Association of LDL-cholesterol with prognosis in patients admitted for acutely decompensated heart failurePublication . Brito, Joana; Rin, João; Duarte, Catarina; Couto Pereira, Sara Cristina; Morais, Pedro; Cunha, Nelson; Ferreira, Diogo; Santos, Rafael; Rigueira, Joana; Pinto, Fausto J.; Brito, DulceIntroduction and objectives: The association of low-density lipoprotein cholesterol (LDL-C) levels and prognosis in patients with heart failure (HF) remains uncertain. This study aimed to evaluate the prognostic significance of LDL-C in patients admitted for acutely decompensated HF and establish a safety cut-off value in this population. Methods: This retrospective, observational study included 167 consecutive patients admitted for acute HF. LDL-C levels were measured on hospital admission, and patients were categorized according to their estimated cardiovascular (CV) risk. The primary endpoint was all-cause mortality at one-year, while secondary endpoints included HF hospitalizations, major thrombotic events, and net clinical benefit. Results: During the follow-up period, 14.4% of patients died. Higher LDL-C levels were independently associated with improved survival, with a 4-fold increase in survival probability for each 1 mg/dL increase in serum LDL-C. The minimum LDL-C value not associated with increased mortality risk was 88 mg/dL. Patients with LDL-C below this cut-off had a significantly higher risk of mortality and a tendency for higher HF hospitalization risk. The net clinical benefit endpoint was also influenced by LDL-C levels, with LDL-C below 88 mg/dL associated with an increased risk of events. Conclusion: In patients admitted for acutely decompensated HF, higher LDL-C levels were associated with reduced risk of mortality. An LDL-C value below 88 mg/dL was associated with increased mortality, suggesting the need for a more liberal LDL-C target in this specific patient population. These findings highlight the importance of considering LDL-C levels in the management and risk assessment of patients with HF.
- A Portuguese expert panel position paper on the management of heart failure with preserved ejection fraction: part I: pathophysiology, diagnosis and treatmentPublication . Silva-Cardoso, José; Moreira, Emília; Tavares de Melo, Rachel; Moraes-Sarmento, Pedro; Cardim, Nuno; Oliveira, Mario; Gavina, Cristina; Moura, Brenda; Araújo, Inês; Santos, Paulo; Peres, Marisa; Fonseca, Cândida; Ferreira, João Pedro; Marques, Irene; Andrade, Aurora; Baptista, Rui; Brito, Dulce; Cernadas, Rui; dos Santos, Jonathan; Leite-Moreira, Adelino; Gonçalves, Lino; Ferreira, Jorge; Aguiar, Carlos; Fonseca, Manuela; Fontes-Carvalho, Ricardo; Franco, Fátima; Lourenço, Carolina; Martins, Elisabete; Pereira, Hélder; Santos, Mário; Pimenta, JoanaHeart failure (HF) with preserved ejection fraction (HFpEF) affects more than 50% of HF patients worldwide, and more than 70% of HF patients aged over 65. This is a complex syndrome with a clinically heterogeneous presentation and a multifactorial pathophysiology, both of which make its diagnosis and treatment challenging. A Portuguese HF expert panel convened to address HFpEF pathophysiology and therapy, as well as appropriate management within the Portuguese context. This initiative resulted in two position papers that examine the most recently published literature in the field. The present Part I includes a review of the HFpEF literature covering pathophysiology, clinical presentation, diagnosis and treatment, including pharmacological and non-pharmacological strategies. Part II, the second paper, addresses the development of a holistic and integrated HFPEF clinical care system within the Portuguese context that is capable of reducing morbidity and mortality and improving patients' functional capacity and quality of life.
- The contribution of genetics to the understanding and management of cardiomyopathies: part 1Publication . Cardoso, Isabel; Nunes, Sofia; Brás, Pedro; Viegas, José Miguel; Marques Antunes, Miguel; Ferreira, André; Almeida, Inês; Custódio, Inês; Trigo, Conceição; Laranjo, Sergio; Graça, Rafael; Ferreira, Rui Cruz; Oliveira, Mario; Aguiar Rosa, Sílvia; Antunes, DianaGenetics has assumed a pivotal role in clarifying the pathophysiology of cardiomyopathies, facilitating molecular diagnosis, and enabling effective family screening. The advent of next-generation sequencing has revolutionized genetic testing by enabling cost-effective, high-throughput analysis. It is imperative for cardiovascular physicians to mainstream genetic testing into their clinical decision-making. Although a definitive genotype-phenotype correlation may not always be evident, several genotypes have emerged as valuable risk predictors for disease severity and progression. European guidelines emphasize the importance of genetic tests for predicting clinical outcome in cardiomyopathies. While further research is essential to bridge existing gaps in the genetic evidence on cardiomyopathies, there is considerable potential for significant advancements.
- Aerobic fitness questionnaires: still not enough to estimate VO2 peak in cardiac patients!Publication . Abreu, AnaThe present study by Lima et al. “Validation of an Aerobic Fitness Questionnaire to estimate VO2 peak in a cohort of adult cardiac patients – Is it enough?”, intends to validate the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ),3 comprising a list of activities, in a Portuguese population sample of 124 CV patients (93% male, mean age 61 years old, 61% with heart failure), who were referred for CPET and cardiac rehabilitation. In this prospective study, which enrolled exclusively CV patients (mainly male), C-AFQ was not sufficiently accurate to predict functional capacity measured by VO2 peak. Despite a numerically strong and positive correlation between measured and estimated, by C-AFQ, VO2 peak (r=0.723, p<0.001), high levels of disagreement in the Bland–Altman plot analysis were observed.
- Cardiopulmonary exercise testing in clinical practice: principles, applications, and basic interpretationPublication . Dores, Hélder; Mendes, Miguel; Abreu, Ana; Durazzo, Anaí; Rodrigues, Cidália; Vilela, Eduardo; Cunha, Gonçalo; Gomes Pereira, José; Bento, Luísa; Moreno, Luís; Dinis, Paulo; Amorim, Sandra; Clemente, Susana; Santos, MárioCardiopulmonary exercise testing (CPET) provides a noninvasive and integrated assessment of the response of the respiratory, cardiovascular, and musculoskeletal systems to exercise. This information improves the diagnosis, risk stratification, and therapeutic management of several clinical conditions. Additionally, CPET is the gold standard test for cardiorespiratory fitness quantification and exercise prescription, both in patients with cardiopulmonary disease undergoing cardiac or pulmonary rehabilitation programs and in healthy individuals, such as high-level athletes. In this setting, the relevance of practical knowledge about this exam is useful and of interest to several medical specialties other than cardiology. However, despite its multiple established advantages, CPET remains underused. This article aims to increase awareness of the value of CPET in clinical practice and to inform clinicians about its main indications, applications, and basic interpretation.
- Chronic thromboembolic pulmonary hypertension: a comprehensive review of pathogenesis, diagnosis, and treatment strategiesPublication . Cazeiro, Daniel; Azaredo Raposo, Miguel; Guimarães, Tatiana; Lousada, Nuno; Jenkins, David; Inácio, João R.; Moreira, Susana; Mineiro, Ana; Freitas, Céline; Martins, Susana; Ferreira, Ricardo; Luís, Rita; Cardim, Nuno; Pinto, Fausto J.; Plácido, RuiChronic thromboembolic pulmonary hypertension (CTEPH) is part of group 4 of the pulmonary hypertension (PH) classification and generally affects more than a third of patients referred to PH centers. It is a three-compartment disease involving proximal (lobar-to-segmental) and distal (subsegmental) pulmonary arteries that are obstructed by persistent fibrothrombotic material, and precapillary pulmonary arteries that can be affected as in pulmonary arterial hypertension. It is a rare complication of pulmonary embolism (PE), with an incidence of around 3% in PE survivors. The observed incidence of CTEPH in the general population is around six cases per million but could be three times higher than this, as estimated from PE incidence. However, a previous venous thromboembolic episode is not always documented. With advances in multimodality imaging and therapeutic management, survival for CTEPH has improved for both operable and inoperable patients. Advanced imaging with pulmonary angiography helps distinguish proximal from distal obstructive disease. However, right heart catheterization is of utmost importance to establish the diagnosis and hemodynamic severity of PH. The therapeutic strategy relies on a stepwise approach, starting with an operability assessment. Pulmonary endarterectomy (PEA), also known as pulmonary thromboendarterectomy, is the first-line treatment for operable patients. Growing experience and advances in surgical technique have enabled expansion of the distal limits of PEA and significant improvements in perioperative and mid- to long-term mortality. In patients who are inoperable or who have persistent/recurrent PH after PEA, medical therapy and/or balloon pulmonary angioplasty (BPA) are effective treatment options with favorable outcomes that are increasingly used. All treatment decisions should be made with a multidisciplinary team that includes a PEA surgeon, a BPA expert, and a chest radiologist.