Revista Portuguesa De Cardiologia最新文献

英文中文

Ikigai and cardiovascular health in older adults: A missed opportunity for prevention? 老年人的Ikigai和心血管健康：错过了预防的机会？

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-12-01 Epub Date: 2025-10-25 DOI: 10.1016/j.repc.2025.07.005

Mariana Alves

引用次数: 0

20 years of experience with the Fontan procedure: Risk factors for adverse outcomes 20年的丰坦手术经验：不良后果的危险因素。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-10 DOI: 10.1016/j.repc.2025.04.006

Tianyu Chen , Linjiang Han , Hailong Qiu , Zewen Chen , Jianzheng Cen , Shusheng Wen , Jimei Chen , Xiaobing Liu , Jian Zhuang

Introduction and objectives

The Fontan procedure and the management of patients with univentricular physiology have undergone significant evolution over the past five decades. However, the long-term outcomes of these patients remain not fully understood. This study aimed to evaluate the early and long-term outcomes of patients undergoing the Fontan procedure and to identify risk factors associated with adverse clinical events.

Methods

Patients who underwent the Fontan procedure between 2004 and 2023 were included in this study. Multivariable logistic regression analysis was employed to assess risk factors for early mortality, while a Cox proportional hazards regression model was used to evaluate predictors of long-term Fontan failure.

Results

A total of 400 patients were included, with a male predominance (67.3%). Median age at the time of the Fontan procedure was 5.8 years (interquartile range: 4.1–11.0 years). The distribution of ventricular morphology was as follows: dominant right ventricle (33%), dominant left ventricle (35.75%), and two well-developed ventricles (28.75%). The early mortality rate was 5.5%. The overall survival rates at 5-, 10-, and 15-years post-Fontan surgery were 97.5%, 92.6%, and 90.0%, respectively. Multivariable analysis identified asplenia (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.8–36.4; p<0.01), single-stage total cavopulmonary connection (OR, 5.3; 95% CI, 1.7–16.8; p<0.01), and prolonged cardiopulmonary bypass time (OR, 1.0; 95% CI, 1.0–1.0; p<0.01) as significant predictors of early mortality. Cox regression analysis demonstrated that heterotaxy (hazard ratio [HR], 3.5; 95% CI, 1.4–8.7; p<0.01) was an independent risk factor for late Fontan failure.

Conclusion

The staged Fontan strategy was associated with reduced early mortality but did not confer significant benefits on long-term outcomes. Patients with heterotaxy were at an increased risk of late Fontan failure, highlighting the need for tailored management strategies in this high-risk population.

前言和目的：在过去的五十年里，Fontan手术和单心室生理患者的管理经历了重大的演变。然而，这些患者的长期预后仍不完全清楚。本研究旨在评估接受Fontan手术的患者的早期和长期预后，并确定与不良临床事件相关的危险因素。方法：2004年至2023年间接受Fontan手术的患者纳入本研究。采用多变量logistic回归分析评估早期死亡的危险因素，采用Cox比例风险回归模型评估长期Fontan失效的预测因素。结果：共纳入400例患者，男性居多（67.3%）。Fontan手术时的中位年龄为5.8岁（四分位数范围：4.1-11.0岁）。心室形态分布：右心室优势（33%），左心室优势（35.75%），两个心室发育良好（28.75%）。早期死亡率为5.5%。fontan手术后5年、10年和15年的总生存率分别为97.5%、92.6%和90.0%。多变量分析发现，脾功能不全（优势比[OR]， 10.2； 95%可信区间[CI]， 2.8-36.4; p < 0.01）、单期全腔肺连接（OR, 5.3; 95% CI, 1.7-16.8; p < 0.01）和延长体外循环时间（OR, 1.0; 95% CI, 1.0-1.0; p < 0.01）是早期死亡的重要预测因素。Cox回归分析显示，异质性（风险比[HR]为3.5；95% CI为1.4 ~ 8.7;p < 0.01）是晚期Fontan衰竭的独立危险因素。结论：分阶段Fontan策略与降低早期死亡率相关，但对长期预后没有显著益处。异位患者晚期Fontan失败的风险增加，突出了在这一高危人群中定制管理策略的必要性。

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引用次数: 0

Etiology of sudden cardiac arrest: Literature review and proposal for an intensive care unit study protocol 心脏骤停的病因学：文献回顾和重症监护病房研究方案的建议。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-24 DOI: 10.1016/j.repc.2025.04.007

João Cravo , Daniel Inácio Cazeiro , Oana Moldovan , Nuno Cortez-Dias , Doroteia Silva

Sudden cardiac arrest (SCA) affects individuals across all age groups and is defined as the sudden cessation of normal cardiac activity, leading to hemodynamic collapse. Determining the etiology of SCA is challenging due to its wide range of cardiac and noncardiac causes. Structural heart disease, mainly coronary artery disease, is predominant in older adults, while cardiomyopathies and primary electrical diseases are more common in younger individuals. Noncardiac causes, such as intracranial hemorrhage and pulmonary embolism, account for 15–25% of cases. This review examines the epidemiology, etiology, and investigation of SCA and proposes a diagnostic approach for SCA patients admitted to the emergency department and intensive care unit. The study protocol is divided into four main stages: (1) initial evaluation, identification of reversible causes, and exclusion of ischemic heart disease and extracardiac disease; (2) assessment of nonischemic cardiac causes; (3) neuroprognostication; and (4) clinical autopsy and/or genetic testing, if appropriate. We emphasize the importance of a multidisciplinary approach, involving an intensivist, cardiologist, neurologist, geneticist, and pathologist, as well as early genetic testing to identify potential heritable diseases and facilitate early referral of patient relatives. By providing this structured diagnostic algorithm, we aim to improve the management and outcomes of SCA patients.

心脏骤停（SCA）影响所有年龄组的个体，被定义为正常心脏活动突然停止，导致血液动力学崩溃。由于其广泛的心脏和非心脏原因，确定SCA的病因是具有挑战性的。结构性心脏病，主要是冠状动脉疾病，在老年人中占主导地位，而心肌病和原发性电性疾病在年轻人中更常见。非心脏原因，如颅内出血和肺栓塞，占病例的15-25%。本文综述了SCA的流行病学、病因学和调查，并提出了一种用于急诊和重症监护病房的SCA患者的诊断方法。研究方案分为四个主要阶段：(1)初步评估，确定可逆原因，排除缺血性心脏病和心外疾病；(2)评估非缺血性心脏原因；(3) neuroprognostication;(4)临床尸检和/或基因检测，如果合适的话。我们强调多学科方法的重要性，包括重症医师、心脏病专家、遗传学家和病理学家，以及早期基因检测，以识别潜在的遗传性疾病，并促进患者亲属的早期转诊。通过提供这种结构化的诊断算法，我们旨在改善SCA患者的管理和预后。

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引用次数: 0

The long Fontan crusade 漫长的十字军东征。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-03 DOI: 10.1016/j.repc.2025.09.001

José Fragata

引用次数: 0

Silent expansion: A case report of a young adult with ascending aortic aneurysm 无声扩张：1例年轻成人升主动脉瘤。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-10 DOI: 10.1016/j.repc.2025.03.009

Carla Costa , Márcio Madeira , Lígia Mendes

引用次数: 0

Dapagliflozin: A new frontier in mitochondrial cardioprotection 达格列净：线粒体心脏保护的新前沿。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-17 DOI: 10.1016/j.repc.2025.09.004

Carla Marques , Henrique Girão

引用次数: 0

Response to Letter to the Editor, regarding “Use of direct oral anticoagulants in patients with stroke transferred for thrombectomy” 对致编辑的信的回复，关于“直接口服抗凝剂在卒中患者中用于取栓术”。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-10-04 DOI: 10.1016/j.repc.2025.10.001

Gustavo C. Santo , Ana Isabel Rodrigues

引用次数: 0

Left atrial appendage aneurysm: An unexpected finding in a patient with asymptomatic atrial fibrillation 左心房附件动脉瘤：无症状心房颤动患者的意外发现。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-10 DOI: 10.1016/j.repc.2025.03.010

Javier Cantalapiedra Romero , Carlos Izurieta , Marta Zielonka

引用次数: 0

Dapagliflozin alleviates isoprenaline-induced cardiac hypertrophy by promoting mitophagy via AMPKα2 signaling pathway 达格列净通过AMPKα2信号通路促进线粒体自噬减轻异丙肾上腺素诱导的心肌肥厚。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-17 DOI: 10.1016/j.repc.2025.05.008

Yue Feng, Zixiong Zhu, Xin Jing, Yibo Zhang, Yubin He, Xuewen Li

Introduction and objectives

The global prevalence of heart failure (HF) has been increasing in recent years, posing a significant threat to human health. Several studies have shown that impaired mitophagy accelerates HF progression. Dapagliflozin (DAPA) has demonstrated cardioprotective effects in HF patients. This study aims to investigate the therapeutic effects of DAPA on cardiomyocyte hypertrophy and its underlying mechanism.

Methods

The working concentration of isoprenaline (ISO) was determined through combined quantitative real-time polymerase chain reaction (qPCR) and CCK-8 assays. H9c2 cells were stimulated with ISO to induce a hypertrophy model. Cellular hypertrophy was quantified by qPCR and TRITC-phalloidin staining. Mitochondrial ultrastructure and functional integrity was assessed by transmission electron microscopy and JC-1 staining. Mitophagy levels were measured using Western blotting and co-localization assays. AMPKα2 expression levels were determined via Western blotting. Following AMPKα2 siRNA transfection, cellular hypertrophy and mitophagy levels were reassessed.

Results

ISO markedly induced cardiomyocyte hypertrophy, mitochondrial damage and mitophagy inhibition, whereas DAPA effectively attenuated these pathologica changes, with AMPK agonists demonstrating comparable cardioprotective effects. In ISO-treated H9c2 cells, AMPKα2 expression was reduced, while DAPA significantly upregulated its expression. Notably, AMPKα2 inhibition significantly weakened DAPA's protective effect on ISO-induced hypertrophy and mitochondrial injury.

Conclusion

DAPA exerts cardioprotective effects by mitigating ISO-induced cardiac hypertrophy and preserving mitochondrial integrity, mediated through AMPKα2-dependent activation of mitophagy.

前言和目标：近年来，心力衰竭（HF）的全球患病率不断上升，对人类健康构成重大威胁。一些研究表明，线粒体自噬受损会加速心衰的进展。达格列净（DAPA）在心衰患者中显示出心脏保护作用。本研究旨在探讨DAPA对心肌细胞肥厚的治疗作用及其机制。方法：采用实时定量聚合酶链反应（qPCR）和CCK-8联合测定异丙肾上腺素（ISO）的工作浓度。用ISO刺激H9c2细胞，形成细胞肥大模型。采用qPCR和TRITC-Phalloidin染色定量检测细胞肥大。透射电镜和JC-1染色观察线粒体超微结构和功能完整性。用Western blotting和共定位法测定线粒体自噬水平。Western blotting检测AMPKα2的表达水平。转染AMPKα2 siRNA后，重新评估细胞肥大和有丝分裂水平。结果：ISO显著诱导心肌细胞肥大、线粒体损伤和线粒体自噬抑制，而DAPA有效地减轻了这些病理变化，AMPK激动剂显示出类似的心脏保护作用。在iso处理的H9c2细胞中，AMPKα2表达降低，而DAPA显著上调其表达。值得注意的是，AMPKα2抑制显著削弱了DAPA对iso诱导的肥大和线粒体损伤的保护作用。结论：DAPA通过ampk α2依赖性的线粒体自噬激活，减轻iso诱导的心肌肥厚，维持线粒体完整性，发挥心肌保护作用。

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引用次数: 0

Letter to the Editor, regarding the “Use of direct oral anticoagulants in patients with stroke transferred for thrombectomy” recently published by Rodrigues 致编辑的信，关于Rodrigues最近发表的“直接口服抗凝剂在卒中患者中用于取栓”。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-11-01 Epub Date: 2025-09-24 DOI: 10.1016/j.repc.2025.09.005

Matija Zupan , Senta Frol

引用次数: 0

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