Pub Date : 2024-12-01DOI: 10.1016/j.repc.2024.08.008
António Valentim Gonçalves
{"title":"Dapagliflozin: Improving heart failure outcomes does not necessarily mean increasing costs","authors":"António Valentim Gonçalves","doi":"10.1016/j.repc.2024.08.008","DOIUrl":"10.1016/j.repc.2024.08.008","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 695-697"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113881","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}
Pub Date : 2024-12-01DOI: 10.1016/j.repc.2024.03.004
Miguel Azaredo Raposo , Daniel Inácio Cazeiro , Tatiana Guimarães , Nuno Lousada , Céline Freitas , Joana Brito , Susana Martins , Catarina Resende , Peter Dorfmüller , Rita Luís , Susana Moreira , Pedro Alves da Silva , Luís Moita , Mário Oliveira , Fausto J. Pinto , Rui Plácido
Pulmonary arterial hypertension (PAH) is a form of precapillary pulmonary hypertension caused by a complex process of endothelial dysfunction and vascular remodeling. If left untreated, this progressive disease presents with symptoms of incapacitating fatigue causing marked loss of quality of life, eventually culminating in right ventricular failure and death. Patient management is complex and based on accurate diagnosis, risk stratification, and treatment initiation, with close monitoring of response and disease progression. Understanding the underlying pathophysiology has enabled the development of multiple drugs directed at different targets in the pathological chain. Vasodilator therapy has been the mainstay approach for the last few years, significantly improving quality of life, functional status, and survival. Recent advances in therapies targeting dysfunctional pathways beyond endothelial dysfunction may address the fundamental processes underlying the disease, raising the prospect of increasingly effective options for this high-risk group of patients with a historically poor prognosis.
{"title":"Pulmonary arterial hypertension: Navigating the pathways of progress in diagnosis, treatment, and patient care","authors":"Miguel Azaredo Raposo , Daniel Inácio Cazeiro , Tatiana Guimarães , Nuno Lousada , Céline Freitas , Joana Brito , Susana Martins , Catarina Resende , Peter Dorfmüller , Rita Luís , Susana Moreira , Pedro Alves da Silva , Luís Moita , Mário Oliveira , Fausto J. Pinto , Rui Plácido","doi":"10.1016/j.repc.2024.03.004","DOIUrl":"10.1016/j.repc.2024.03.004","url":null,"abstract":"<div><div>Pulmonary arterial hypertension (PAH) is a form of precapillary pulmonary hypertension caused by a complex process of endothelial dysfunction and vascular remodeling. If left untreated, this progressive disease presents with symptoms of incapacitating fatigue causing marked loss of quality of life, eventually culminating in right ventricular failure and death. Patient management is complex and based on accurate diagnosis, risk stratification, and treatment initiation, with close monitoring of response and disease progression. Understanding the underlying pathophysiology has enabled the development of multiple drugs directed at different targets in the pathological chain. Vasodilator therapy has been the mainstay approach for the last few years, significantly improving quality of life, functional status, and survival. Recent advances in therapies targeting dysfunctional pathways beyond endothelial dysfunction may address the fundamental processes underlying the disease, raising the prospect of increasingly effective options for this high-risk group of patients with a historically poor prognosis.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 699-719"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555791","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}
The development of cardiac fibrosis (CF) and hypertrophy (CH) can lead to heart failure. Mesenchymal stem cells (MSCs) have shown promise in treating cardiac diseases. However, the relationship between MSCs and splicing factor arginine/serine rich-3 (SFRS3) remains unclear. In this study, our objectives are to investigate the effect of MSCs on SFRS3 expression, and their impact on CF and CH. Additionally, we aim to explore the function of the overexpression of SFRS3 in angiotensin II (Ang II)-treated cardiac fibroblasts (CFBs) and cardiac myocytes (CMCs).
Methods
Rat cardiac fibroblasts (rCFBs) or rat cardiac myocytes (rCMCs) were co-cultured with rat MSCs (rMSCs). The function of SFRS3 in Ang II-induced rCFBs and rCMCs was studied by overexpressing SFRS3 in these cells, both with and without the presence of rMSCs. We assessed the expression of SFRS3 and evaluated the cell cycle, proliferation and apoptosis of rCFBs and rCMCs. We also measured the levels of interleukin (IL)-β, IL-6 and tumor necrosis factor (TNF)-α and assessed the degree of fibrosis in rCFBs and hypertrophy in rCMCs.
Results
rMSCs induced SFRS3 expression and promoted cell cycle, proliferation, while reducing apoptosis of Ang II-treated rCFBs and rCMCs. Co-culture of rMSCs with these cells also repressed cytokine production and mitigated the fibrosis of rCFBs, as well as hypertrophy of rCMCs triggered by Ang II. Overexpression of SFRS3 in the rCFBs and rCMCs yielded identical effects to rMSC co-culture.
Conclusion
MSCs may alleviate Ang II-induced cardiac fibrosis and cardiomyocyte hypertrophy by increasing SFRS3 expression in vitro.
{"title":"Mesenchymal stem cells may alleviate angiotensin II-induced myocardial fibrosis and hypertrophy by upregulating SFRS3 expression","authors":"Ling Gu, Xin Wan, Ying Liu, Zhenbin Gong, Rijin Huang, Yundi Shi, Huogen Liu","doi":"10.1016/j.repc.2024.04.010","DOIUrl":"10.1016/j.repc.2024.04.010","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The development of cardiac fibrosis (CF) and hypertrophy (CH) can lead to heart failure. Mesenchymal stem cells (MSCs) have shown promise in treating cardiac diseases. However, the relationship between MSCs and splicing factor arginine/serine rich-3 (SFRS3) remains unclear. In this study, our objectives are to investigate the effect of MSCs on SFRS3 expression, and their impact on CF and CH. Additionally, we aim to explore the function of the overexpression of SFRS3 in angiotensin II (Ang II)-treated cardiac fibroblasts (CFBs) and cardiac myocytes (CMCs).</div></div><div><h3>Methods</h3><div>Rat cardiac fibroblasts (rCFBs) or rat cardiac myocytes (rCMCs) were co-cultured with rat MSCs (rMSCs). The function of SFRS3 in Ang II-induced rCFBs and rCMCs was studied by overexpressing SFRS3 in these cells, both with and without the presence of rMSCs. We assessed the expression of SFRS3 and evaluated the cell cycle, proliferation and apoptosis of rCFBs and rCMCs. We also measured the levels of interleukin (IL)-β, IL-6 and tumor necrosis factor (TNF)-α and assessed the degree of fibrosis in rCFBs and hypertrophy in rCMCs.</div></div><div><h3>Results</h3><div>rMSCs induced SFRS3 expression and promoted cell cycle, proliferation, while reducing apoptosis of Ang II-treated rCFBs and rCMCs. Co-culture of rMSCs with these cells also repressed cytokine production and mitigated the fibrosis of rCFBs, as well as hypertrophy of rCMCs triggered by Ang II. Overexpression of SFRS3 in the rCFBs and rCMCs yielded identical effects to rMSC co-culture.</div></div><div><h3>Conclusion</h3><div>MSCs may alleviate Ang II-induced cardiac fibrosis and cardiomyocyte hypertrophy by increasing SFRS3 expression <em>in vitro</em>.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 645-656"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581296","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}
Pub Date : 2024-12-01DOI: 10.1016/j.repc.2024.04.011
Sílvia Alão , Tomás Silva , António Pedro Leite , Medina do Rosário , Cristina Carvalho , Joana Coelho , Hélder Ferreira , Raquel Ferreira , Joana Abreu , Margarida Rosa , Sofia Azevedo , Cláudia Cunha , Capela Daniel , Belén Juane , Renata Arantes Sousa , Ana Catarina Casais , on behalf of the cMORE study group
Introduction and objectives
Type 2 diabetes poses a significant health challenge in Portugal, increasing the susceptibility to complications/comorbidities such as hypertension, obesity, and cardiovascular (CV) disease. This study aimed to evaluate the prevalence of type 2 diabetes-related vascular complications/comorbidities and their pharmacological management in Portugal.
Methods
cMORE was a non-interventional, cross-sectional, multicenter study conducted in 32 Portuguese primary healthcare units between October 2020 and 2022. Secondary data, including sociodemographic, anthropometric, clinical information, cardiometabolic comorbidities, HbA1c levels, lipid parameters and medication, were collected from electronic medical records.
Results
Seven hundred and eighty adult patients with type 2 diabetes were included, predominantly male (55.5%), with an average age of 67.7 years and a mean disease duration of 10.5 years. Family history of type 2 diabetes (43.1%) and CV disease (32.1%) was prevalent. Mean HbA1c was 7.0%, progressively increasing with disease duration (p<0.001). Microvascular and macrovascular complications occurred in 38.1% and 19.6% of patients, respectively. The most prevalent comorbidities included overweight/obesity (85.5%), dyslipidemia (85.4%), and hypertension (82.6%). Multimorbidity burden was significant (99.3%) and positively correlated with older age, larger waist circumference, and overweight/obesity. Longer type 2 diabetes duration was associated with higher odds of diabetic retinopathy and CV disease/procedures, while dyslipidemia and hypertension were linked with older age, regardless of disease duration. Most patients received oral antidiabetic medications (94.6%), primarily biguanides (92.4%), followed by DPP-4 (39.1%) and SGLT2 inhibitors (34.2%).
Conclusions
The cMORE study reveals a substantial burden of vascular complications/comorbidities among Portuguese patients with type 2 diabetes. Despite the high multimorbidity rates, effective type 2 diabetes management is observed, emphasizing the country's commitment to personalized care.
{"title":"Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes: Results from the cMORE study","authors":"Sílvia Alão , Tomás Silva , António Pedro Leite , Medina do Rosário , Cristina Carvalho , Joana Coelho , Hélder Ferreira , Raquel Ferreira , Joana Abreu , Margarida Rosa , Sofia Azevedo , Cláudia Cunha , Capela Daniel , Belén Juane , Renata Arantes Sousa , Ana Catarina Casais , on behalf of the cMORE study group","doi":"10.1016/j.repc.2024.04.011","DOIUrl":"10.1016/j.repc.2024.04.011","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Type 2 diabetes poses a significant health challenge in Portugal, increasing the susceptibility to complications/comorbidities such as hypertension, obesity, and cardiovascular (CV) disease. This study aimed to evaluate the prevalence of type 2 diabetes-related vascular complications/comorbidities and their pharmacological management in Portugal.</div></div><div><h3>Methods</h3><div>cMORE was a non-interventional, cross-sectional, multicenter study conducted in 32 Portuguese primary healthcare units between October 2020 and 2022. Secondary data, including sociodemographic, anthropometric, clinical information, cardiometabolic comorbidities, HbA<sub>1c</sub> levels, lipid parameters and medication, were collected from electronic medical records.</div></div><div><h3>Results</h3><div>Seven hundred and eighty adult patients with type 2 diabetes were included, predominantly male (55.5%), with an average age of 67.7 years and a mean disease duration of 10.5 years. Family history of type 2 diabetes (43.1%) and CV disease (32.1%) was prevalent. Mean HbA<sub>1c</sub> was 7.0%, progressively increasing with disease duration (p<0.001). Microvascular and macrovascular complications occurred in 38.1% and 19.6% of patients, respectively. The most prevalent comorbidities included overweight/obesity (85.5%), dyslipidemia (85.4%), and hypertension (82.6%). Multimorbidity burden was significant (99.3%) and positively correlated with older age, larger waist circumference, and overweight/obesity. Longer type 2 diabetes duration was associated with higher odds of diabetic retinopathy and CV disease/procedures, while dyslipidemia and hypertension were linked with older age, regardless of disease duration. Most patients received oral antidiabetic medications (94.6%), primarily biguanides (92.4%), followed by DPP-4 (39.1%) and SGLT2 inhibitors (34.2%).</div></div><div><h3>Conclusions</h3><div>The cMORE study reveals a substantial burden of vascular complications/comorbidities among Portuguese patients with type 2 diabetes. Despite the high multimorbidity rates, effective type 2 diabetes management is observed, emphasizing the country's commitment to personalized care.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 669-679"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727971","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}
Pub Date : 2024-12-01DOI: 10.1016/j.repc.2024.03.005
Daniel Faria, Hugo Vinhas, João Bispo, João Guedes, Sandrine Marto, Hugo Palmeiro, Patrícia Franco, Jorge Mimoso
Introduction and objectives
Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a higher risk of procedural complications, suboptimal stent expansion, and in-stent restenosis. Lesion preparation with orbital atherectomy (OA) in severely calcified lesions has been shown to increase procedural success and decrease reintervention rates. In this study, we sought to report the procedural safety and efficacy of our initial experience with OA in a non-surgical center in Portugal.
Methods
Patients with severely calcified coronary lesions who were treated with intended intravascular ultrasound (IVUS) guided OA were included in a prospective single-center registry. We evaluated several endpoints, including: debulking success, defined <50% residual stenosis severity after OA; procedural success, defined as stent implantation according to Optimal-IVUS PCI criteria; use of additional calcium debulking strategies; and procedural complications, including coronary no-reflow, dissection, perforation or side branch occlusion. Patients were followed up for 30 days to assess early cardiovascular or procedure-related death, myocardial infarction, myocardial injury and reintervention.
Results
Between January 2023 and September 2023, 37 patients and 53 coronary arteries underwent OA. IVUS imaging was used in all cases. Debulking and procedural success were achieved in 90.5% and 97.3% of cases, respectively. In 26 (49.1%) lesions, additional calcium debulking techniques were needed. Procedural complications occurred in three cases and one patient died during hospitalization.
Conclusion
Our initial experience with OA for heavily calcified coronary lesions demonstrated high procedural success and overall favorable clinical outcomes.
{"title":"Initial experience with orbital atherectomy in a non-surgical center in Portugal","authors":"Daniel Faria, Hugo Vinhas, João Bispo, João Guedes, Sandrine Marto, Hugo Palmeiro, Patrícia Franco, Jorge Mimoso","doi":"10.1016/j.repc.2024.03.005","DOIUrl":"10.1016/j.repc.2024.03.005","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with a higher risk of procedural complications, suboptimal stent expansion, and in-stent restenosis. Lesion preparation with orbital atherectomy (OA) in severely calcified lesions has been shown to increase procedural success and decrease reintervention rates. In this study, we sought to report the procedural safety and efficacy of our initial experience with OA in a non-surgical center in Portugal.</div></div><div><h3>Methods</h3><div>Patients with severely calcified coronary lesions who were treated with intended intravascular ultrasound (IVUS) guided OA were included in a prospective single-center registry. We evaluated several endpoints, including: debulking success, defined <50% residual stenosis severity after OA; procedural success, defined as stent implantation according to Optimal-IVUS PCI criteria; use of additional calcium debulking strategies; and procedural complications, including coronary no-reflow, dissection, perforation or side branch occlusion. Patients were followed up for 30 days to assess early cardiovascular or procedure-related death, myocardial infarction, myocardial injury and reintervention.</div></div><div><h3>Results</h3><div>Between January 2023 and September 2023, 37 patients and 53 coronary arteries underwent OA. IVUS imaging was used in all cases. Debulking and procedural success were achieved in 90.5% and 97.3% of cases, respectively. In 26 (49.1%) lesions, additional calcium debulking techniques were needed. Procedural complications occurred in three cases and one patient died during hospitalization.</div></div><div><h3>Conclusion</h3><div>Our initial experience with OA for heavily calcified coronary lesions demonstrated high procedural success and overall favorable clinical outcomes.</div></div>","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 659-665"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581295","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}
Pub Date : 2024-12-01DOI: 10.1016/j.repc.2024.08.004
Luís Bronze
{"title":"Real-world evaluation of vascular complications and comorbidities in Portuguese patients with type 2 diabetes: Results from the cMORE study","authors":"Luís Bronze","doi":"10.1016/j.repc.2024.08.004","DOIUrl":"10.1016/j.repc.2024.08.004","url":null,"abstract":"","PeriodicalId":48985,"journal":{"name":"Revista Portuguesa De Cardiologia","volume":"43 12","pages":"Pages 681-683"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914368","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}
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