Revista Portuguesa De Cardiologia最新文献

{"title":"Establishing a left bundle branch area pacing program: Results from a high-volume pacing center","authors":"João Ferreira ,&nbsp;Diogo Fernandes ,&nbsp;Patrícia Marques-Alves ,&nbsp;Carolina Saleiro ,&nbsp;Luís Elvas ,&nbsp;Lino Gonçalves","doi":"10.1016/j.repc.2024.12.006","DOIUrl":"10.1016/j.repc.2024.12.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Left bundle branch area pacing (LBBAP) is a technique suitable for treating both symptomatic bradycardia and cardiac resynchronization therapy (CRT). Our study aims to describe the first experience of LBBAP in a high-volume cardiac implantable electronic device (CIED) center.</div></div><div><h3>Methods</h3><div>This prospective single-center observational registry included consecutive patients who underwent pacemaker implantation with LBBAP technique for sinus node disease, bradycardia and CRT indications between January 2023 and January 2024. Procedural data, outcomes, and lead parameters were recorded at hospital discharge, at one and six months of follow-up.</div></div><div><h3>Results</h3><div>A total of 164 consecutive patients undergoing LBBAP implantation were included, of whom 142 had a stylet-driven lead. LLBAP was achieved in 94.5% patients. Average QRS duration was 139.8±33.4 ms. Complete atrioventricular block was the most common indication (42.7%). CRT was performed in 24 (14.5%) patients. Mean procedural duration was 82.7±24.4 min and mean fluoroscopy time was 13.7±7.1 min. Average LVAT was 78.8±8.7 ms and paced QRS width 114.8±14.4 ms. Median acute R-wave amplitude was 14.0 mV, pacing threshold was 0.5 V and impedance 526 Ω. No relevant per-operative complications occurred. After one month of follow-up, median pacing threshold had significantly increased to 0.75 V (p&lt;0.001) while R-wave amplitude and impedance remained unchanged (p=0.242 and p=0.101 respectively). During follow-up, no changes occurred in the evaluated parameters. Loss of left bundle branch capture occurred in five patients and macro-dislodgement in 2.</div></div><div><h3>Conclusion</h3><div>LBBAP is a feasible pacing technique which reduces QRS duration and improves LV synchrony and can be adopted at most centers, with favorable success rates and safety profile.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 377-385"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992160","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":"Unraveling the genetic basis of subclinical atherosclerosis: Early genetic detection can improve cardiovascular prevention","authors":"Débora Sá ,&nbsp;Maria Isabel Mendonça ,&nbsp;Marco Serrão ,&nbsp;Francisco Sousa ,&nbsp;Gonçalo Abreu ,&nbsp;Eva Henriques ,&nbsp;Sofia Borges ,&nbsp;Sónia Freitas ,&nbsp;Mariana Rodrigues ,&nbsp;Graça Guerra ,&nbsp;Ilídio Ornelas ,&nbsp;António Drumond ,&nbsp;Ana Célia Sousa ,&nbsp;Roberto Palma dos Reis","doi":"10.1016/j.repc.2025.01.003","DOIUrl":"10.1016/j.repc.2025.01.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Decoding the genetic basis of coronary artery disease (CAD) through an intermediate phenotype – coronary calcification – can help us to better understand this deadly disease and enable the creation of better therapeutic strategies. This work aims to assess the relationship between a set of single nucleotide polymorphisms (SNPs) previously associated with CAD and coronary artery calcium (CAC) score in a Portuguese asymptomatic population.</div></div><div><h3>Methods</h3><div>A prospective study was conducted in a cohort of 1284 subjects (aged 59.3<!--> <!-->±<!--> <!-->8.9 years, 73.6% males) without CAD. CAC score was performed using cardiac computed tomography. Thirty-three SNPs were genotyped using TaqMan real-time PCR. Anthropometric, conventional, and biochemical risk factors were evaluated. Bivariate and multivariate regression analysis estimated variables associated with the CAC score.</div></div><div><h3>Results</h3><div><em>PHACTR1</em> rs1332844 C&gt;T, a downstream regulator of the endothelin-1 gene, showed a significant association with CAC score (p=0.015), together with CDKN2B-AS1 variants rs4977574 A&gt;G (p=0.002) and rs1333049 G&gt;C (p=0.010) in the 9p21.3 <em>locus</em>. <em>MTHFD1L</em> rs6922269 G&gt;A variant encoding a mitochondrial enzyme responsible for homocysteine remethylating showed protection against artery calcification (p=0.013). After multivariate logistic regression, <em>PHACTR1</em> rs1332844 (CT+TT) (OR=1.478; p=0.009) and <em>CDKN2B-AS1</em> rs4977574 (GG) (OR=1.479; p=0.002) remained in the equation as independently associated with arterial calcification. M<em>THFD1L</em> rs6922269 (AA) also remained associated with a lower CAC score (OR=0.558; p=0.027).</div></div><div><h3>Conclusion</h3><div>This study showed that three genetic variants previously linked with CAD are associated with CAC in asymptomatic populations. Understanding these genetic factors, combined with conventional risk factors, could guide lifestyle changes or pharmacologic interventions to mitigate CAD risk before the disease becomes clinical.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 351-358"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587693","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":"The fascinating world of clinical registries. Insights into current practice","authors":"João Morais","doi":"10.1016/j.repc.2025.04.003","DOIUrl":"10.1016/j.repc.2025.04.003","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 347-349"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051141","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":"Frozen tricuspid valve – A case of a carcinoid syndrome","authors":"João Mendes Cravo ,&nbsp;Ana Rita Faria ,&nbsp;Francisco Capinha ,&nbsp;Rafael Cruz ,&nbsp;Ana Spencer","doi":"10.1016/j.repc.2024.11.017","DOIUrl":"10.1016/j.repc.2024.11.017","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 399-400"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789213","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":"Exercise intensity prescription in heart failure: A comparison of different physiological parameters","authors":"David Sá Couto ,&nbsp;Inês Lopes ,&nbsp;Maria Isilda Oliveira ,&nbsp;Cristine Schmidt ,&nbsp;Sandra Magalhães ,&nbsp;Hélder Dores ,&nbsp;Fernando Ribeiro ,&nbsp;Mário Santos","doi":"10.1016/j.repc.2024.11.018","DOIUrl":"10.1016/j.repc.2024.11.018","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Aerobic exercise intensity prescription is critical for the efficacy and safety of heart failure (HF) patients’ rehabilitation programs. This study aims to compare some of the commonly used parameters for range-based exercise intensity prescription, with a ventilatory threshold-based approach.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 163 HF patients across a left ventricle ejection fraction (LVEF) spectrum who underwent maximal cardiopulmonary exercise testing (CPET). We measured percentages of peak oxygen uptake (VO₂), peak heart rate (HR) and heart rate reserve (HRR) at the first ventilatory threshold (VT1). We compared the classification within the different exercise intensity (EI) domains defined by the current guidelines.</div></div><div><h3>Results</h3><div>VT1 was observed at 82<!--> <!-->±<!--> <!-->10% of peak HR, 54<!--> <!-->±<!--> <!-->25% of HRR and 54<!--> <!-->±<!--> <!-->17% of peak VO₂, corresponding to the high intensity for % Peak HR, and moderate intensity domain for %HRR and % Peak VO₂. Using % Peak VO₂, 65% of the patients were accurately classified within the correct EI domain (moderate intensity) at VT1; however, this percentage dropped to 46% when employing %HRR and to 25% when using % Peak HR. The classification accuracy at VT1 was superior in patients with reduced LVEF and in those with higher exercise capacity.</div></div><div><h3>Conclusion</h3><div>Our data show that EI will be misclassified in one out of three patients if guided by current guideline-recommended range-based parameters, which emphasizes the relevance of a ventilatory threshold-based approach to adequate exercise prescription in HF patients.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 6","pages":"Pages 361-371"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002738","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":"Pulmonary endarterectomy's blind spot: Is echocardiography the answer?","authors":"Ana Teresa Timóteo ,&nbsp;Ana Isabel Galrinho","doi":"10.1016/j.repc.2025.05.003","DOIUrl":"10.1016/j.repc.2025.05.003","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 479-480"},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210015","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":"Regional stroke care networks: What can we learn from acute stroke patients on direct oral anticoagulants?","authors":"Miguel Viana-Baptista","doi":"10.1016/j.repc.2025.05.005","DOIUrl":"10.1016/j.repc.2025.05.005","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 487-488"},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210016","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":"Multimorbidity approaches in elderly patients with atrial fibrillation. The upcoming EHRA-PATHS project","authors":"Mário Oliveira ,&nbsp;Michiel Rienstra ,&nbsp;Hein Heidbuchel ,&nbsp;Isabelle Van Gelder ,&nbsp;on behalf of the EHRA-PATHs WP 5 steering committee","doi":"10.1016/j.repc.2025.05.001","DOIUrl":"10.1016/j.repc.2025.05.001","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 503-504"},"PeriodicalIF":1.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992169","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":"Can my echo work as a crystal ball? – Echocardiographic parameters predicting residual pulmonary hypertension after pulmonary endarterectomy","authors":"João Mirinha Luz ,&nbsp;Filipa Ferreira ,&nbsp;Sofia Alegria ,&nbsp;Ana Cláudia Vieira ,&nbsp;Bárbara Ferreira ,&nbsp;Débora Repolho ,&nbsp;Ana Rita Francisco ,&nbsp;Bruno Neves ,&nbsp;Isabel João ,&nbsp;Hélder Pereira","doi":"10.1016/j.repc.2025.04.001","DOIUrl":"10.1016/j.repc.2025.04.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Pulmonary endarterectomy should be considered in all patients with chronic thromboembolic pulmonary hypertension. Twenty five percent of patients maintain pulmonary hypertension after pulmonary endarterectomy, with therapeutic and prognostic implications. We aimed to evaluate echocardiographic parameters at diagnosis as predictors for development of residual pulmonary hypertension.</div></div><div><h3>Methods</h3><div>Retrospective, observational, unicentric study of patients with confirmed chronic thromboembolic pulmonary hypertension who underwent pulmonary endarterectomy between January 2010 and October 2024. All patients underwent transthoracic echocardiogram at diagnosis. After pulmonary endarterectomy, patients had a right heart catheterization to exclude residual pulmonary hypertension (mean pulmonary artery pressure ≥30 mmHg). Right heart echocardiographic parameters were assessed and compared.</div></div><div><h3>Results</h3><div>Thirty-nine patients had chronic thromboembolic pulmonary hypertension and underwent pulmonary endarterectomy during the follow-up period. Mean age at diagnosis was 57.3 years-old. Eighteen patients had documented residual pulmonary hypertension. Tricuspid annular plane systolic excursion (p=0.010), end-diastolic right ventricular area (p&lt;0.001), end-systolic right ventricular area (p&lt;0.001), fractional area change (p=0.006), tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (p=0.002), diastolic (p=0.002) and systolic eccentric ratio (p=0.036) were significantly different between the two groups. End-systolic right ventricular area and end-diastolic right ventricular area were independently associated with residual pulmonary hypertension (p=0.023 and p=0.013), and those with end-diastolic right ventricular area above 27.13 cm² (area under the curve [AUC] 0.88, sensitivity 89%, specificity 85%, odds ratio 44) and end-systolic right ventricular area &gt;19.54 cm² (AUC 0.875, sensitivity 88%, specificity 85%, odds ratio 38.5) had higher probability of developing residual pulmonary hypertension after pulmonary endarterectomy.</div></div><div><h3>Conclusion</h3><div>This study shows that certain echocardiographic parameters could be predictors of development of residual pulmonary hypertension after pulmonary endarterectomy; however, validation in larger cohorts is mandatory.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 8","pages":"Pages 469-477"},"PeriodicalIF":1.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005013","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":"Association of LDL-cholesterol with prognosis in patients admitted for acutely decompensated heart failure","authors":"Joana Brito ,&nbsp;João Rin ,&nbsp;Catarina Duarte ,&nbsp;Sara Pereira ,&nbsp;Pedro Morais ,&nbsp;Nelson Cunha ,&nbsp;Diogo Ferreira ,&nbsp;Rafael Santos ,&nbsp;Joana Rigueira ,&nbsp;Fausto J. Pinto ,&nbsp;Dulce Brito","doi":"10.1016/j.repc.2024.09.004","DOIUrl":"10.1016/j.repc.2024.09.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"44 4","pages":"Pages 191-200"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014437","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}