Revista Portuguesa De Cardiologia最新文献

Introduction and objectives: Maintaining or improving quality of life (QoL) is an important therapeutic goal. QoL may be impaired before clinical onset of heart failure (HF). This study aims to describe changes in health status and the effect of spironolactone in people at risk of developing HF.

Methods: The Heart 'omics' in AGEing (HOMAGE) trial randomized participants to spironolactone or usual care over a maximum follow-up of 9 months. Health status was assessed as a post-hoc secondary outcome using EQ-5D-3L (and derived EQ index), EQ-VAS and HOMAGE patient-reported symptom questionnaire.

Results: Health status was available on 98% of the 527 trial participants. The median age was 73 years, 25% were women. The EQ index ranged from 0.18 to 1; 42% of participants had an index of 1 (best possible health status). Participants with poorer health status (EQ index <1) were predominantly women, had obesity, exertional breathlessness and lived alone. Independent baseline associations of deteriorating health status included: breathlessness on moderate exertion, smoking, higher serum galectin-3, higher E/e' and higher left ventricular mass index at baseline. Left ventricular systolic function was associated with worse baseline QoL, but not with changes in EQ index or EQ-VAS during follow-up. Spironolactone did not influence health status during follow-up.

Conclusions: In people at risk of developing HF, obesity was associated with poorer health status. Worsening health status was more likely in patients with exertional breathlessness, echocardiographic signs of raised left ventricular filling pressures, and elevated galectin-3 levels at baseline. Spironolactone did not influence health status.

Introduction and objectives: Cardiovascular diseases are among the leading causes of morbidity and mortality and represent a significant economic burden; having type 2 diabetes is a major risk factor. After identifying that a considerable proportion of patients with type 2 diabetes were not achieving their recommended LDL-C targets, a study was designed to assess LDL-C levels in relation to target values defined by cardiovascular risk (CVR) category and the lipid-lowering therapy (LLT) prescribed.

Methods: This cross-sectional study included a random sample of 245 patients with diabetes, aged 40 to 69 years, who had recent lipid profile and renal function tests and were being followed at a primary care (PC) center. Exclusion criteria were established for macrovascular disease, significant renal impairment, or microvascular complications in multiple territories.

Results: It was observed that 59.2% of patients had LDL-C levels above target, of whom over 75% were classified as high or very high risk. Among these, 27.6% were not receiving any LLT, and only 9% were being treated with high-intensity statins, either alone or in combination with ezetimibe. Among patients receiving this combination, 78.9% achieved target LDL-C levels. CVR category was higher in the SCORE model than the SCORE2-Diabetes in 56.7% of cases, significantly influencing the proportion of patients with LDL-C at target (20.0% vs 40.8%, respectively; p=0.014).

Conclusions: Lipid-lowering therapy remains underutilized in patients with type 2 diabetesTYPE 2 DIABETES, particularly those at high and very high CVR, as over half fail to achieve LDL-C targets. Notably, the SCORE model appears to overestimate CVR compared with SCORE2-Diabetes.

Introduction and objectives: Implantable loop recorders (ILR) are increasingly being used for the detection of infrequent arrhythmias in patients with cardiomyopathies, especially in the presence of risk markers. The role of these devices in improving the detection of significant arrhythmias requiring a change in clinical management remains to be determined. Our purpose was to evaluate the diagnostic yield, types of arrhythmias, and subsequent management in cardiomyopathy patients receiving an ILR.

Methods: Prospective single-center study in cardiomyopathy patients considered at borderline risk for ventricular arrhythmias, who had received an ILR. The primary endpoint was a meaningful arrhythmic event detection leading to a change in clinical management.

Results: A total of 45 patients were included, 51% were male, median age was 62 (48-71) years. The underlying disease was hypertrophic cardiomyopathy (HCM) in 31 patients (69%), dilated and non-dilated left ventricle cardiomyopathy (DCM/NDLVC) in 12 patients (26%) and transthyretin amyloid cardiomyopathy (ATTR-CM) in two patients (4%). The most frequent risk markers were brief run of non-sustained ventricular tachycardia in 42%, unexplained syncope/presyncope in 36%, family history of premature sudden cardiac death (SCD) in a first-degree relative in 36%, and palpitations suspicious of arrhythmic origin in 18% of patients. In the HCM cohort, median HCM Risk-SCD score was 3.07 (2.68 - 3.76)%, with 19% of patients having an estimated 5-year risk of SCD ≥4%. Mean maximum wall thickness was 20±4mm, mean left atrial diameter was 43±7mm, 23% of patients had obstructive HCM, late gadolinium enhancement (LGE) was present in 74% - with 52% of patients presenting extensive LGE-, and left ventricle apical aneurysm in 3%. A sarcomeric pathogenic variant was identified in 26%. Among the DCM/NDLVC patients, 58% had left ventricular ejection <50%, 25% carried pathogenic/likely pathogenic variants on genetic testing and 25% exhibited an extensive ring-like scar pattern on cardiac magnetic resonance (CMR). During a mean follow-up of 19±13 months, 44% of patients had, at least, one ILR-guided diagnosis. De novo atrial fibrillation was diagnosed in 24% of patients and was the main detected event. Due to ILR-guided diagnosis, 20% (9 patients) received an implantable cardioverter-defibrillator (ICD), one of which with subsequent appropriate ICD therapies.

Conclusion: This study provides insight into the possible role of ILR in this population, not only for the diagnosis of ventricular arrhythmias, but also for detection of atrial fibrillation, which can lead to different clinical management.