Revista Portuguesa de Cardiologia (English Edition)最新文献

{"title":"Impact of substrate-based ablation for ventricular tachycardia in patients with frequent appropriate implantable cardioverter-defibrillator therapy and dilated cardiomyopathy: Long-term experience with high-density mapping","authors":"Mário Oliveira ,&nbsp;Pedro Cunha ,&nbsp;Bruno Valente ,&nbsp;Guilherme Portugal ,&nbsp;Ana Lousinha ,&nbsp;Mariana Pereira ,&nbsp;Manuel Braz ,&nbsp;Ana Delgado ,&nbsp;Rui C. Ferreira","doi":"10.1016/j.repce.2021.11.006","DOIUrl":"10.1016/j.repce.2021.11.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Recurrent ventricular tachycardia (VT) episodes have a negative impact on the clinical outcome of implantable cardioverter-defibrillator (ICD) patients. Modification of the arrhythmogenic substrate has been used as a promising approach for treating recurrent VTs. However, there are limited data on long-term follow-up.</p></div><div><h3>Aim</h3><p>To analyze long-term results of VT substrate-based ablation using high-density mapping in patients with severe left ventricular (LV) dysfunction and recurrent appropriate ICD therapy.</p></div><div><h3>Methods</h3><p>We analyzed 20 patients (15 men, 55% with non-ischemic cardiomyopathy, age 58±15 years, LV ejection fraction 32±5%) and repeated appropriate shocks or arrhythmic storm (&gt;2 shocks/24 h) despite antiarrhythmic drug therapy and optimal heart failure medication. All patients underwent ventricular programmed stimulation (600 ms/S3) to document VT. A sinus rhythm (SR) voltage map was created with a three-dimensional electroanatomic mapping system (CARTO, Biosense Webster, CA) using a PentaRay® high-density mapping catheter (Biosense Webster, CA) to delineate areas of scarred myocardium (ventricular bipolar voltage ≤0.5 mV – dense scar; 0.5-1.5 mV – border zone; ≥1.5 mV – healthy tissue) and to provide high-resolution electrophysiological mapping. Substrate modification included elimination of local abnormal ventricular activities (LAVAs) during SR (fractionated, split, low-amplitude/long-lasting, late potentials, pre-systolic), and linear ablation to obtain scar homogenization and dechanneling. Pace-mapping techniques were used when capture was possible. The LV approach was retrograde in nine cases, transseptal in five and epi-endocardial in four. In two patients ablation was performed inside the right ventricle.</p></div><div><h3>Results</h3><p>LAVAs and scar areas were modified in all patients. Mean procedure duration was 149 min (105-220 min), with radiofrequency ranging from 18 to 70 min (mean 33 min) and mean fluoroscopy time of 15 min. Non-inducibility was achieved in 75% of cases (in four patients with hemodynamic deterioration and an LV assist device, VT inducibility was not performed). There were two cases of pericardial tamponade, drained successfully. During a follow-up of 50±24 months, 65% had no VT recurrences. Among the seven patients with recurrences, three underwent redo ablation and four, with fewer VT episodes, received appropriate ICD therapy. There were five hospital readmissions due to heart failure decompensation, one patient died in the first week after unsuccessful ablation of a VT storm and three died (stroke and pneumonia) &gt;1 year after ablation.</p></div><div><h3>Conclusion</h3><p>Catheter ablation based on substrate modification is feasible and safe in patients with frequent VTs and severe LV dysfunction. This approach may be of clinical relevance, with potential long-term benefits in reducing VT burden.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 11","pages":"Pages 865-873"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003585/pdfft?md5=46167ae8fae86498cb39a77633871812&pid=1-s2.0-S2174204921003585-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39687216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Galectin-3: A simple tool for a complex clinical issue?","authors":"Tiago Pereira-da-Silva","doi":"10.1016/j.repce.2021.10.020","DOIUrl":"10.1016/j.repce.2021.10.020","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 11","pages":"Pages 837-838"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003251/pdfft?md5=94ac50286735e00d971a2537a884a5e4&pid=1-s2.0-S2174204921003251-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39687207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune cell subsets as a marker of development of heart failure: The application of bioinformatics tools","authors":"Mónica Teresa Abreu ,&nbsp;Rui Baptista ,&nbsp;Henrique Girão","doi":"10.1016/j.repce.2021.10.021","DOIUrl":"10.1016/j.repce.2021.10.021","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 11","pages":"Pages 849-851"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003263/pdfft?md5=94d2d0c172e17a19a88ddf261f361edd&pid=1-s2.0-S2174204921003263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39687209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes monitoring in pulmonary endarterectomy: Paving the road to success","authors":"Maria José Loureiro","doi":"10.1016/j.repce.2021.10.006","DOIUrl":"10.1016/j.repce.2021.10.006","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 753-755"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921002890/pdfft?md5=7c6c2ce966719fa34047cb86c003112c&pid=1-s2.0-S2174204921002890-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39799075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary physiology in clinical practice in Portugal: A problem of technology or a question of attitude?","authors":"Rita Calé","doi":"10.1016/j.repce.2021.10.009","DOIUrl":"10.1016/j.repce.2021.10.009","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 783-784"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S217420492100307X/pdfft?md5=80c35f0a3c97ae0c30890e7d73c0bcb9&pid=1-s2.0-S217420492100307X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beware of regression of electrocardiographic abnormalities on detraining – It may not always mean ‘athlete's heart’","authors":"José Pedro Marques ,&nbsp;António Freitas ,&nbsp;João Abecasis","doi":"10.1016/j.repce.2021.10.012","DOIUrl":"10.1016/j.repce.2021.10.012","url":null,"abstract":"<div><p>Hypertrophic cardiomyopathy is one of the main causes of sudden cardiac death in young athletes. Differentiating between this pathological condition and ‘athlete's heart’ can be quite challenging, warranting a thorough clinical and imaging assessment. Clinicians often rely on detraining-induced attenuation of electrocardiographic and echocardiographic findings as a means of distinguishing between pathological and physiological cardiac remodeling. This report describes detraining-related regression of left ventricular hypertrophy in a young soccer player with a diagnosis of hypertrophic cardiomyopathy. It challenges the dogma that regression of electrocardiographic abnormalities and left ventricular hypertrophy is exclusive to physiological remodeling and questions the impact of exercise training in the phenotypic expression and progression of hypertrophic cardiomyopathy.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 801.e1-801.e6"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003147/pdfft?md5=016ac41aa7e60d0992923bbb3ef445c9&pid=1-s2.0-S2174204921003147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40 821 real-world procedures over a 12-year period","authors":"Luís Raposo ,&nbsp;Mariana Gonçalves ,&nbsp;David Roque ,&nbsp;Pedro Araújo Gonçalves ,&nbsp;Pedro Magno ,&nbsp;João Brito ,&nbsp;Sílvio Leal ,&nbsp;Sérgio Madeira ,&nbsp;Miguel Santos ,&nbsp;Rui Campante Teles ,&nbsp;Pedro Farto e Abreu ,&nbsp;Manuel Almeida ,&nbsp;Carlos Morais ,&nbsp;Miguel Mendes ,&nbsp;Sérgio Bravo Baptista","doi":"10.1016/j.repce.2021.10.008","DOIUrl":"10.1016/j.repce.2021.10.008","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame.</p></div><div><h3>Methods</h3><p>We retrospectively determined the per-procedure prevalence of physiological assessment in 40<!--> <!-->821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed.</p></div><div><h3>Results</h3><p>Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages &lt;40, 40-55 and &gt;55 years, respectively; p&lt;0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology.</p></div><div><h3>Conclusions</h3><p>Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 771-781"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003056/pdfft?md5=25995333273f3f4f352ad3852a23a783&pid=1-s2.0-S2174204921003056-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography","authors":"Ana Gabaldón-Pérez,&nbsp;Rafael De la Espriella,&nbsp;Hector Merenciano-Gonzalez,&nbsp;Enrique Santas,&nbsp;Francisco J. Chorro","doi":"10.1016/j.repce.2021.10.013","DOIUrl":"10.1016/j.repce.2021.10.013","url":null,"abstract":"","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 803-804"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921003159/pdfft?md5=31e48f6e0c136dc0afe7642dafeeb5d5&pid=1-s2.0-S2174204921003159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic evaluation in type 1 diabetes mellitus","authors":"Thaís Rossoni Weber ,&nbsp;Roberto Léo da Silva ,&nbsp;Sandra Cossul ,&nbsp;Marco Stephan Lofrano Alves ,&nbsp;Simone Van der Sander Lee ,&nbsp;Jefferson Luiz Brum Marques","doi":"10.1016/j.repce.2021.08.003","DOIUrl":"10.1016/j.repce.2021.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Type 1 diabetes (T1D) is a chronic disease with peak incidence in adolescence; it has a major impact on morbidity and mortality, especially cardiovascular. Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure. Echocardiography has led to the identification of early cardiac lesions, despite controversial results in the literature in patients with T1D.</p></div><div><h3>Objective</h3><p>The objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two-dimensional Doppler and advanced speckle tracking echocardiography.</p></div><div><h3>Methods</h3><p>This is a case-control study with 40 asymptomatic, normotensive T1D patients aged 20 to 50 years and 40 healthy subjects. Two-dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers. Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function.</p></div><div><h3>Results</h3><p>The mean age was 33 years in both groups, with an average T1D duration of 18 years; 20% of patients with T1D had diabetic retinopathy; 12.5% kidney injury; and 10% peripheral neuropathy. There were differences in the left ventricular diastolic function parameters (lateral E’, middle E’ and S/D ratio) and right ventricle (tricuspid E and tricuspid E’/A’ ratio). The mean value of the global longitudinal strain was -21.7% (+- 2.3) in the T1D group and -21.0% (+-2.0) in the control group (p=0.21).</p></div><div><h3>Conclusion</h3><p>Echocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group, which may be the initial cardiac lesion in diabetes.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 757-765"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S217420492100249X/pdfft?md5=c97acb1a1a55dd80469838a4176b5c54&pid=1-s2.0-S217420492100249X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39686009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of balloon pulmonary angioplasty in a Portuguese pulmonary hypertension expert center","authors":"Rita Calé ,&nbsp;Filipa Ferreira ,&nbsp;Ana Rita Pereira ,&nbsp;Débora Repolho ,&nbsp;Daniel Sebaiti ,&nbsp;Sofia Alegria ,&nbsp;Sílvia Vitorino ,&nbsp;Pedro Santos ,&nbsp;Hélder Pereira ,&nbsp;Philippe Brenot ,&nbsp;Maria José Loureiro","doi":"10.1016/j.repce.2021.05.001","DOIUrl":"10.1016/j.repce.2021.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short-term efficacy and safety of a BPA program.</p></div><div><h3>Methods</h3><p>This prospective single-center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6-min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session.</p></div><div><h3>Results</h3><p>A total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonar vasodilator therapy). Nine patients completed both the BPA program and a minimum six-month follow-up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP &gt;40 mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long-term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths.</p></div><div><h3>Conclusions</h3><p>A BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk-benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.</p></div>","PeriodicalId":101121,"journal":{"name":"Revista Portuguesa de Cardiologia (English Edition)","volume":"40 10","pages":"Pages 727-737"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2174204921001276/pdfft?md5=ff552c3fcb5c8db301aa48a1efadeeb2&pid=1-s2.0-S2174204921001276-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39799074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}