Revista Portuguesa De Cardiologia最新文献

Introduction and objectives: Rotational atherectomy (RA) is widely used for the management of calcified coronary stenoses. However, there is limited data on its use, trends, and outcomes. We sought to report our twelve-year experience with RA and explore the trends and outcomes of percutaneous coronary intervention (PCI) with this device.

Methods: Our institutional PCI database was queried to identify all cases of RA-PCI performed between January 2009 and December 2020. We analysed peri-procedural outcomes and major adverse cardiovascular events (MACE) during follow-up: cardiovascular death, myocardial infarction, and target lesion revascularization.

Results: 410 procedures (2.8% of total PCI volume) in 388 patients were included. Mean age was 72.3±9.3 years, 74.0% were male, 53.6% had diabetes, and 33.8% presented with acute coronary syndrome. There was a significant increase in median SYNTAX score (p_trend=0.003) and the proportion of type B2/C lesions (p_trend=0.003). Transradial access was preferred (60.0% overall) with a growing trend over time (p_trend=0.003). Maximum burr size was <1.75 mm in 88.0% of cases (burr-to-artery ratio of 0.49±0.07). Angiographic success rate was consistently high (96.6% overall). Complications were recorded in 9.0% of procedures, with a temporal decline (p_trend=0.029). Clinical follow-up was available for 357 patients (median time of 40 months). At one year, MACE rate was 12.1%. with no significant temporal changes.

Conclusions: RA-PCI was a safe and effective procedure with a high rate of angiographic success and few complications, particularly in recent years, in line with significant technical improvements. The MACE incidence is acceptable considering the clinical risk and angiographic complexity.

Introduction and objectives: This study evaluated commissural malalignment on echocardiography as a predictor of coronary anomalies.

Methods: All newborns diagnosed with transposition of great arteries in the pediatric cardiac intensive care unit between 1 August 2020 and 1 February 2022 were included in this study. The ratio of distances (C-ratio) from the anterior commissure to the right-sided commissure of the pulmonary valve and the distance from the anterior commissure to the left sided commissure of the pulmonary valve were calculated. According to the median effective level (EL50), it was classified as minor alignment or malalignment (C-ratio ≤EL50) or major malalignment((C-ratio>EL50). Preoperative classification results were compared with the intraoperative coronary anomalies defined by the surgeon.

Results: A total of 60 cases were included in the study. Echocardiography revealed 16/38 (42%) commissural malalignment in the patient group with the usual coronary artery pattern and 15/22 (68%) in the patients with abnormal coronary artery patterns. The median commissural rotation angle was 28 ° (IQR 20-42). Although it was associated with the commissural malalignment (cut-off 30 °,sensitivity 80% and specificity 85%, p=0.001),the commissural rotation angle was unrelated to the presence of a coronary artery anomaly. The C-ratio was 42%(0.42) according to the median effective level. Abnormal coronary artery pattern was more common in patients with major malalignment(C-ratio>0.42) (Sensitivity 82% and specificity 88%,p=0.003).

Conclusion: The incidence of coronary artery anomalies in patients with transposition of great arteries increases with major commissural malalignment. A high C-ratio might be a predictor of coronary artery anomaly.

Introduction and objectives: 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.

Methods: 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 1-year, while secondary endpoints included HF hospitalizations, major thrombotic events, and net clinical benefit.

Results: 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 1mg/dL increase in serum LDL-C. The minimum LDL-C value not associated with increased mortality risk was 88mg/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 88mg/dL associated with an increased risk of events.

Conclusion: In patients admitted for acutely decompensated HF, higher LDL-C levels were associated with reduced risk of mortality. An LDL-C value below 88m/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.

The Cardiorenal Program (CRP), implemented within a specialized heart failure and kidney disease clinic, encompasses a multidisciplinary approach to the management of patients with heart failure and kidney disease. It focuses on optimizing therapy and improving patient outcomes. The CRP includes a range of services, including clinical evaluation, diagnostic testing, medical treatment, and patient education. The program provides comprehensive care for patients with cardiorenal syndrome, and includes a variety of healthcare professionals, such as cardiologists, nephrologists, pharmacists, and nurses, working together to provide the best possible care. The program also incorporates specific performance indicators to continuously evaluate and improve patient outcomes. The CRP's integrated multidisciplinary care and patient-centered approach is promising for the management of patients with cardiorenal syndrome.

Introduction and objectives: Cardiopulmonary exercise testing (CPET) is the gold standard for quantifying aerobic functional capacity, yet it is costly and not widely available. The CLINIMEX Aerobic Fitness Questionnaire (C-AFQ) may be a practical alternative as it estimates oxygen consumption at peak exercise (VO₂ peak) based on patients' responses to a list of activities with known energy requirements. However, its applicability in cardiac patients is unclear and has not yet been studied. This study aims to assess the C-AFQ performance in predicting VO₂ peak, measured via CPET, in adult patients with confirmed heart disease.

Methods: This was a single-center prospective study enrolling consecutive patients who underwent CPET from April/2022-January/2023. The main indication for CPET was measuring aerobic functional capacity for cardiovascular risk stratification.

Results: A total of 124 patients (mean age 62±12 years, 75% male, 59% in the early phase post-myocardial infarction, 61% had heart failure, mean left ventricular ejection fraction 47±12%) with maximal CPET were included. Overall, a strong correlation was found between CPET and C-AFQ VO₂ peak values (r=0.723, p<0.001). However, when performing a Bland-Altman plot analysis, we found a heightened confidence interval for the agreement between CPET and C-AFQ VO₂ peak: 0.62±6.93 (95% CI -12.96-14.21) mL.kg^-1.min^-1. CPET VO₂ peak and the VO₂ peak estimated by the exercise test protocol were related (r=0.777, p<0.001).

Conclusion: Although cardiorespiratory fitness estimation from the C-AFQ performs well in a large population, the utility of this questionnaire to estimate cardiorespiratory fitness in this study´s population sample has limited value. However, it may be useful to aid physicians in choosing the adequate exercise test protocol that best fits an individual patient.

Introduction and objectives: Coronary artery disease (CAD) is a globally significant cardiovascular condition, ranking among the leading causes of morbidity and mortality. CAD has been predominantly associated with advanced age and classic cardiovascular risk factors. However, over the past decades, there has been a concerning rise in its occurrence among young adults, including patients under 35 years old. The present study analyzes the clinical features and outcomes of patients aged ≤35 years with CAD, compared to two age-matched control groups.

Method: A nested case-control study of ≤35-year-old patients referred for coronary angiography due to clinical suspicion of CAD. Patients were divided into three groups: patients ≤35 years with CAD, subjects ≤35 years without CAD, and young patients ≥36-40 years with CAD.

Results: Of the 19321 coronary angiographies performed at our center over 10 years, 408 (2.1%) patients were ≤40 years old, 109 patients aged ≤35 years. Risk factors that showed a relationship with the presence of CAD were smoking (OR 2.49; 95% CI 1.03-6.03; p=0.042) and family history of coronary disease (OR 6.70; 95% CI 1.46-30.65; p=0.014). The group aged ≤35 years with CAD exhibited a risk of major cardiovascular adverse events (MACE) (HR 13.3; 95% CI 1.75-100; p<0.001) than subjects ≤35 years without CAD. The probability of major adverse cardiovascular events was associated with being ≤35 years old, diabetes, dyslipidemia, and depression.

Conclusion: Patients aged ≤35 exhibited a poor long-term prognosis, with a high risk of new revascularization and acute myocardial infarction during the follow-up period. Focusing on preventive measures can have a significant impact on overall prognosis.

Introduction and objectives: Left ventricular global longitudinal strain (LVGLS) is an indicator of myocardial function in patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Nevertheless, it is not clear whether LVGLS correlates with filling pressures and cardiac output (CO) in an ambulatory setting. We aimed to assess whether LVGLS is associated with invasive pulmonary artery pressures (PAP) and CO in outpatients using the invasive remote monitoring CardioMEMS™ system.

Methods: This single-center, prospective observational study included patients with HFrEF undergoing remote monitoring using the CardioMEMS™ system, between January 2020 and December 2022. Repeated transthoracic echocardiography (TTE) studies were performed in each patient and invasive hemodynamic data were obtained during the TTE studies using the CardioMEMS™ system. Univariate and multivariate models were used to assess the potential association between LVGLS and invasive PAP and CO.

Results: Twelve patients were included and 46 TTE studies were analyzed. LVGLS was correlated with diastolic (d) PAP (r=0.403, p=0.041) and CO (r=-0.426, p=0.039) in the univariate analysis. In multivariate models, LVGLS was an independent predictor of dPAP and CO, but not mean PAP or systolic PAP. The variation of LVGLS between TTE studies was correlated with the variation of dPAP during follow-up (r=0.60, p=0.017).

Conclusions: In a cohort of HFrEF patients under invasive hemodynamic remote monitoring, LVGLS was independently associated with invasive filling pressures and CO, in an outpatient setting. These findings reinforce the value of LVGLS for the management of outpatients with HFrEF.

Diabetes mellitus 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 Society 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.