Revista Portuguesa De Cardiologia最新文献

Diabetes is a significant risk factor for the development of heart disease (HD), with heart failure (HF) being one of the early manifestations of the disease in this population. The diagnostic process is challenging and contributes to a significant number of undiagnosed cases of HD among individuals with diabetes. This is largely due to the non-specific nature of symptoms and signs in the initial stages of disease, making early detection elusive. Timely identification and prevention of HD in patients with diabetes have the potential to significantly improve patient prognosis and alleviate the growing burden of this population on the national healthcare system. Natriuretic peptides (BNP and NT-proBNP) have been recognized as reliable, cost-effective biomarkers for detecting HD and can be further used as risk assessment biomarkers in asymptomatic patients. Despite being recommended in several European and American guidelines to rule out and rule in HF, the routine use of these biomarkers for the diagnosis of HDs in patients with diabetes has only recently been proposed by the American Diabetes Association (ADA) and has not yet been implemented in Portugal. Therefore, a multidisciplinary panel of experts from four medical societies, the Portuguese Society of Endocrinology, Diabetes and Metabolism, the Portuguese Journal of Cardiology, the Diabetes Study Group from the Portuguese Society of Internal Medicine and the Portuguese Association of Family Medicine were convened to discuss and establish consensus recommendations for natriuretic peptide screening in patients with diabetes and its integration into routine diabetes management protocols. This manuscript draws on the consensus recommendations from four Portuguese medical societies, offering clear guidance on natriuretic peptides use tailored to Portuguese clinical practice. Accordingly, this consensus advises the use of NT-proBNP analysis for all patients with diabetes aged 50 years and older, or under 50 if they have risk factors and/or comorbidities. Adjusted rule-out and rule-in values for age, sex and risk factors are provided. NT-proBNP levels above 125 pg/mL should prompt additional testing and cardiovascular investigation. Routine evaluation every two to three years for low-risk patients and annually for high-risk patients is proposed when NT-proBNP is below 125 pg/mL and in the absence of suspected heart disease.

Digital health interventions including telehealth, mobile health, artificial intelligence, big data, robotics, extended reality, computational and high-fidelity bench simulations are an integral part of the path toward precision medicine. Current applications encompass risk factor modification, chronic disease management, clinical decision support, diagnostics interpretation, preprocedural planning, evidence generation, education, and training. Despite the acknowledged potential, their development and implementation have faced several challenges and constraints, meaning few digital health tools have reached daily clinical practice. As a result, the Portuguese Society of Cardiology Study Group on Digital Health set out to outline the main digital health applications, address some of the roadblocks hampering large-scale deployment, and discuss future directions in support of cardiovascular health at large.

Introduction and objectives: Sudden cardiac death (SCD) in athletes is a tragic event, with some evidence remaining controversial. The aim of this study was to evaluate cases of SCD in athletes in Portugal within the last 20 years.

Methods: An advanced Google search using a combination of several keywords and systematic searches on websites of national newspapers/television stations was conducted. Additionally, 54 Portuguese sports federations and the Portuguese Institute of Sports and Youth were contacted by email and/or phone. All sports-related SCD cases in competitive athletes, occurring between 2003 and 2023 in Portugal, were included. The total number of athletes at risk used for the calculation of SCD incidence, was collected from official national records.

Results: A total of 42 SCD cases in athletes were identified, with a median age of 27 [18;42] years, and the great majority were male (n=39; 93%). Most events occurred in outdoor sports (n=28; 67%), especially in football (n=13; 31%), athletics (n=4; 10%) and trail running (n=4; 10%), and during competition or training sessions (n=27; 64%). The higher number of cases were reported in 2021 and 2022, while in several years no occurrences were found. The yearly average SCD incidence was 0.39 cases per 100000 athletes/year.

Conclusions: The incidence of SCD in athletes in Portugal is very low, mainly occurring in male, outdoor sports and during competitions or training sessions. Due to the limitations of passive data collection, prospective registries are needed, with standardization of the most relevant data, especially regarding their etiology and circumstances.