Revista Portuguesa De Cardiologia最新文献

{"title":"Growth rate of the ascending aorta and risk of aortic dissection or reintervention in patients with bicuspid or tricuspid aortic valves undergoing valve interventions: A systematic review and meta-analysis","authors":"João Fernandes Pedro,&nbsp;Ana Rita M. Figueiredo,&nbsp;Rafaela Almeida,&nbsp;Catarina de Sousa,&nbsp;Fausto J. Pinto,&nbsp;Daniel Caldeira","doi":"10.1016/j.repc.2026.03.005","DOIUrl":"10.1016/j.repc.2026.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Bicuspid aortic valve (BAV) is associated with premature valve dysfunction and progressive aortic dilation, potentially leading to dissection. The evolution of aortic dimensions after valve replacement remains uncertain, particularly compared with tricuspid aortic valve (TAV) disease. This systematic review and meta-analysis aimed to compare postoperative aortic growth and the risk of major aortic events between BAV and TAV patients.</div></div><div><h3>Methods</h3><div>A systematic search of MEDLINE, CENTRAL, and Web of Science (from inception to April 2025) identified prospective and retrospective cohort studies including adult patients with BAV or TAV undergoing surgical (SAVR) or transcatheter (TAVI) aortic valve replacement. Studies were required to report longitudinal data on aortic growth rate (mm/year) or the incidence of aortic dissection or reintervention; those with concomitant aortic surgery were excluded. Random-effects meta-analyses estimated mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Fifteen studies were included (n=1772 for aortic growth; n=2307 for aortic dissection; n=2598 for aortic reintervention). There was no significant difference in annual aortic growth between BAV and TAV (MD 0.15 mm/year; 95% CI −0.03 to 0.33; p=0.09; I²=82.6%). Meta-regression confirmed that age differences between BAV and TAV cohorts did not modify the overall neutral effect on aortic growth rate. Subgroup analyses showed similar findings across study designs, but small differences in procedure types (SAVR MD 0.21 mm/year, p=0.07; TAVI MD −0.04 mm/year, p=0.53; p=0.02 for SAVR vs. TAVI differences). No significant differences were found in the risk of aortic dissection (RR 1.34; 95% CI 0.63–2.83; p=0.44) or aortic reintervention (RR 0.95; 95% CI 0.56–1.61; p=0.84).</div></div><div><h3>Conclusions</h3><div>Postoperative aortic growth and event rates were comparable between BAV and TAV patients after valve replacement. These results challenge the long-standing assumption that bicuspid morphology intrinsically accelerates postoperative aortopathy in all patients.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 363-374"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of digoxin in modern heart failure treatment: Rationale and design of the DIG-Mod HF trial","authors":"António Valentim Gonçalves,&nbsp;Nuno Cardim,&nbsp;António Fiarresga,&nbsp;Tiago Pereira-da-Silva,&nbsp;Rita Ilhão-Moreira,&nbsp;Ana Galrinho,&nbsp;Pedro Rio,&nbsp;Ricardo Carvalheiro,&nbsp;Fernando Ferreira,&nbsp;Julien Lopes,&nbsp;Miguel Marques Antunes,&nbsp;Mafalda Selas,&nbsp;Bruno Viana,&nbsp;Lúcia Domingues,&nbsp;Rui Cruz Ferreira","doi":"10.1016/j.repc.2025.12.014","DOIUrl":"10.1016/j.repc.2025.12.014","url":null,"abstract":"<div><h3>Aims</h3><div>Even though it is the oldest heart failure (HF) medication still in use, digoxin has not been evaluated alongside the updated algorithm for treating HF with reduced ejection fraction patients. This could help explain the low use of digoxin in recent HF studies. The main objective is to assess the effectiveness of digoxin in functional capacity and cardiac function when combined with modern HF therapy.</div></div><div><h3>Methods</h3><div>An interventional, open-label, randomised, crossover trial among adults with chronic Heart Failure and reduced ejection fraction (≤45%) was designed to allocate 50 patients for 24 weeks in each arm (48 weeks of study). The arms are daily intake of digoxin 0.125 mg plus standard of care versus standard of care alone. Both patients with sinus rhythm and atrial fibrillation were enrolled. At the end of each 24-week arm, patients will undergo the co-primary outcome measurement of the peak oxygen consumption, evaluated through cardiopulmonary exercise test, and the global work index, measured by transthoracic echocardiography. Key secondary outcome includes a safety composite of death, need for urgent heart transplantation or mechanical assist device, total hospitalizations and sustained ventricular arrhythmias. The study completed recruitment in April 2025 and will complete follow up in March 2026.</div></div><div><h3>Conclusions</h3><div>The use of digoxin could be significantly affected by evidence that it still has a considerable effect on functional capacity and cardiac function in HF patients.</div></div><div><h3>EU CT Number</h3><div>2024-513448-26-00.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 393-400"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification in patients with apical hypertrophic cardiomyopathy with the use of conventional and novel risk scores: An unmet need in clinical practice","authors":"Ana Rita Bello,&nbsp;Rita Almeida Carvalho,&nbsp;Maria Rita Lima,&nbsp;Gonçalo Cunha,&nbsp;Sérgio Maltês,&nbsp;Bruno M. Rocha","doi":"10.1016/j.repc.2026.03.009","DOIUrl":"10.1016/j.repc.2026.03.009","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 401-403"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of left atrial appendage thrombi and associated risks in patients referred for atrial flutter ablation","authors":"Sérgio Ferreira de Ferreira Filho,&nbsp;Pedro Rotta de Ferreira,&nbsp;Gustavo Glotz de Lima,&nbsp;Marcelo Lapa Kruse,&nbsp;Luisa Rohr Schäfer,&nbsp;Marco Antônio Vinciprova Dall’Agnese,&nbsp;Emanuella Lara Tarzo de Medina Coeli,&nbsp;Tiago Luiz Luz Leiria","doi":"10.1016/j.repc.2026.01.010","DOIUrl":"10.1016/j.repc.2026.01.010","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Atrial flutter (AFL) is a common supraventricular arrhythmia, often associated with an increased risk of thromboembolic events. Current guidelines recommend catheter ablation of the cavotricuspid isthmus as first-line therapy. However, thrombotic risk assessment remains essential, particularly through transesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi prior to ablation. This study aimed to determine the prevalence of LAA thrombi in patients with AFL undergoing pre-ablation TEE and to identify clinical, laboratory, and echocardiographic variables associated with thrombus formation.</div></div><div><h3>Methods</h3><div>This retrospective, single-center, cohort study analyzed TEE reports of patients with AFL treated between 2015 and 2022 at a tertiary referral center in Brazil. Demographic, clinical, laboratory, and echocardiographic data were collected and analyzed using chi-square tests, Student's t-tests, and multivariate logistic regression. A clinical score incorporating key predictive variables was developed to improve risk stratification. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and five-fold stratified cross-validation were used for performance assessment.</div></div><div><h3>Results</h3><div>A total of 528 patients were included (mean age: 63.9<!--> <!-->±<!--> <!-->14.2 years; 69.9% male). Pre-ablation TEE identified LAA thrombi in 18.8% of cases. Independent predictors of thrombus formation included heart failure, prior stroke/TIA, left atrial enlargement, and reduced glomerular filtration rate. The clinical score demonstrated 85.4% sensitivity (95% CI: –), 53.2% specificity (95% CI: –), and an area under the curve (AUC) of 0.726, indicating improved discriminative ability compared to the CHA₂DS₂-VASc score (87.6% sensitivity [95% CI: –], 22.2% specificity [95% CI: –]). The model achieved a positive NRI of 28.8% compared with the CHA₂DS₂-VASc score.</div></div><div><h3>Conclusions</h3><div>The prevalence of LAA thrombus was higher than previously reported in similar populations. The newly developed clinical score showed improved discriminative performance relative to the CHA₂DS₂-VASc score and may help identify high-risk patients who could benefit from pre-ablation TEE in the context of AFL.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 345-354"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ascending aorta in bicuspid aortic valves – The bad guy?","authors":"Manuel J. Antunes","doi":"10.1016/j.repc.2026.06.004","DOIUrl":"10.1016/j.repc.2026.06.004","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 375-376"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare mixed-type total anomalous pulmonary venous connection","authors":"Leizhi Ku,&nbsp;Yuhang Wang,&nbsp;Xiaojing Ma","doi":"10.1016/j.repc.2025.12.012","DOIUrl":"10.1016/j.repc.2025.12.012","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 7","pages":"Pages 407-408"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex imbalance in a large Fontan cohort: Biological reality or marker of inequitable care?","authors":"Gabriel Kaleb Martins","doi":"10.1016/j.repc.2026.01.007","DOIUrl":"10.1016/j.repc.2026.01.007","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 6","pages":"Pages 331-332"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lactoferrin: a new ally in mitigating anthracycline cardiotoxicity?","authors":"Tânia Branco Mano,&nbsp;Vera Vaz Ferreira","doi":"10.1016/j.repc.2026.05.003","DOIUrl":"10.1016/j.repc.2026.05.003","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 6","pages":"Pages 305-306"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148247375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventriculo-coronary arterial communication in pulmonary atresia with intact interventricular septum","authors":"Pedro Riesenberger ,&nbsp;Flavio Zuccarino","doi":"10.1016/j.repc.2025.12.011","DOIUrl":"10.1016/j.repc.2025.12.011","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 6","pages":"Pages 329-330"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter cryoablation for atrioventricular nodal reentrant tachycardia and septal accessory pathways: Experience from a tertiary center","authors":"Marta Catarina Bernardo ,&nbsp;Fernando Nascimento Ferreira ,&nbsp;Hélder Santos ,&nbsp;Sofia Jacinto ,&nbsp;Ana Lousinha ,&nbsp;Guilherme Portugal ,&nbsp;Bruno Valente ,&nbsp;Pedro Sousa Cunha ,&nbsp;Mário Oliveira","doi":"10.1016/j.repc.2026.02.007","DOIUrl":"10.1016/j.repc.2026.02.007","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>For atrioventricular nodal tachycardia (AVNRT) and right-septal anatomically high-risk accessory pathways (AP) with risk of atrioventricular (AV) block, cryoablation is accepted as a safer option. The aim was to evaluate the efficacy, safety and recurrence rates of focal catheter cryoablation for the treatment of AVNRT and right-sided septal AP.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-center study of patients undergoing focal cryoablation between January 2007 and May 2025 with the electrophysiologic diagnosis of AVNRT or AP based on electrophysiological criteria. Clinical, electrophysiological, and follow-up data were systematically collected from hospital electronic medical records. Clinical characteristics, procedural data, safety and recurrence were analyzed.</div></div><div><h3>Results</h3><div>We included 49 patients, median age 28 years (interquartile range IQR 17–50) who had been referred for the procedure due to Wolff–Parkinson–White syndrome (WPW – 55%); documented tachycardia (37%) and recurrent palpitations in the remaining patients. Seven patients had previously undergone radiofrequency ablation, with arrhythmia recurrence. Six patients were &gt;65 years and had pre-existing slight conduction system abnormalities. Electrophysiologic evaluation revealed AVNRT in 30.6% and right-septal AP in 69.4% (Table 1). Acute procedural success was 100% in AVNRT (15/15 patients) and 77% in accessory pathways (26/34 patients). Unsuccessful cases involved electrophysiologically low-risk AP in oligosymptomatic patients, one of whom had transient AV block during application. All cases with a history of previous unsuccessful ablation/recurrence achieved acute success with cryoenergy. No-one experienced further recurrences during follow-up (FUP). Zero-fluoroscopy procedures were performed in 24% of cases. No major complications were reported. Over a median FUP of 13 (IQR 1–60) months, recurrence occurred in 5 patients (12.2%; two with AVRNT and three with AP).</div></div><div><h3>Conclusions</h3><div>Cryoablation is an effective and safe approach for the treatment of patients with supraventricular arrhythmias involving the perinodal area, with good acute success rates, low recurrence rates and a favorable safety profile. These findings are especially relevant in younger patients where minimizing the risk of permanent AV block is critical. These results also suggest a role for cryoablation in older patients with baseline conduction system abnormalities.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"45 6","pages":"Pages 269-277"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}