Revista Portuguesa De Cardiologia最新文献

英文中文

Surgical revascularization of chronic coronary total occlusions – A systematic review and meta-analysis 慢性冠状动脉全闭塞的外科血运重建术——一项系统回顾和荟萃分析。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.01.006

Ana Luísa Silva , Gonçalo Ferraz Costa , José Luís Martins , Luís Leite , Lino Gonçalves

Introduction and objectives

Chronic coronary total occlusion (CTO) optimal therapeutic management remains a topic of debate despite its association with adverse clinical outcomes. This study aimed to compare clinical outcomes of patients with CTOs treated with coronary artery bypass graft (CABG) versus medical therapy (MT), assessing the effect of CTO revascularization in patients with multivessel disease undergoing CABG.

Methods

In July 2023, PubMed, Embase, Cochrane, and Web of Science databases were systematically searched for studies comparing CTOs treated with CABG versus MT. A sub-analysis of CABG patients, comparing complete surgical revascularization, including CTO bypass, to CABG without CTO bypass, was performed. A pooled odds ratio meta-analysis assessed four main outcomes: mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). The primary outcome was all-cause mortality.

Results

Ten observational studies (6458 patients) comparing CABG-CTO with MT-CTO showed lower all-cause mortality in the CABG group (OR 0.31, 95% CI 0.24–0.40, p<0.001, I²=36%). Despite heterogeneity, CABG exhibited reduced CV mortality and MACE (OR 0.37, 95% CI 0.24–0.57, p<0.001, I²=59%; OR 0.37, 95% CI 0.15–0.92, p=0.03, I²=80%, respectively). The MI rate was lower in the CABG group (OR 0.41, 95% CI 0.30–0.56, p<0.001, I²=0%). Comparing bypassed to non-bypassed CTO groups (5 studies, 1949 patients), the bypassed-CTO group had considerably lower MACE (OR 0.49, 95% CI 0.30–0.81, p=0.005, I²=44%).

Conclusion

This study suggests a clinical benefit of bypassing a CTO in multivessel disease patients during CABG, with significantly lower MACE. The improved outcomes of CABG over MT further underscore these findings, warranting careful consideration by the Heart Team during their decision-making process.

简介和目的：慢性冠状动脉全闭塞（CTO）的最佳治疗管理仍然是一个有争议的话题，尽管它与不良临床结果有关。本研究旨在比较冠状动脉旁路移植术（CABG）与药物治疗（MT）治疗CTOs患者的临床结果，评估冠状动脉旁路移植术对多血管疾病患者血管重建术的影响。方法：于2023年7月，系统检索PubMed、Embase、Cochrane和Web of Science数据库，比较CABG与MT治疗CTOs的研究。对CABG患者进行亚分析，比较包括CTO搭桥术的完全手术血运重建术与不含CTO搭桥术的CABG。合并优势比荟萃分析评估了四个主要结局：死亡率、心肌梗死（MI）、中风和主要不良心血管事件（MACE）。主要结局为全因死亡率。结果：比较CABG- cto和MT-CTO的10项观察性研究（6458例患者）显示，CABG组的全因死亡率较低（OR 0.31, 95% CI 0.24-0.40, p2=36%）。尽管存在异质性，CABG表现出降低CV死亡率和MACE (OR 0.37, 95% CI 0.24-0.57, p2=59%；OR 0.37, 95% CI 0.15-0.92, p=0.03, I2=80%)。CABG组心肌梗死发生率较低（OR = 0.41, 0.30-0.56, p2=0%）。将旁路组与未旁路CTO组（5项研究，1949例患者）进行比较，旁路CTO组的MACE显著降低（OR 0.49, 95% CI 0.30-0.81, p=0.005, I2=44%）。结论：本研究表明，在CABG期间，多血管疾病患者行CTO旁路治疗具有显著降低MACE的临床益处。CABG优于MT的结果进一步强调了这些发现，值得心脏团队在决策过程中仔细考虑。

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引用次数: 0

When atrial fibrillation meets acute myocardial infarction: A hidden risk demanding closer attention 当心房颤动遇到急性心肌梗死：需要密切关注的潜在风险。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.06.001

Ana Margarida Martins , Gustavo Lima da Silva

引用次数: 0

First experience implanting a second leadless pacemaker 第一次植入第二个无铅起搏器。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2024.11.019

Ana Rita Bello, Joana Certo Pereira, Pedro Galvão Santos, Diogo Cavaco, Pedro Adragão

引用次数: 0

Recurrent dissection of left coronary artery with extension to the left main and cardiogenic shock 复发性左冠状动脉解剖延伸至共干及致心性休克。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.02.006

Michele Galasso , Isidoro Pera , Martina Milani , Andrea Farina , Gianluca Tiberti , Silvia Massaro , Giuseppe Uccello

引用次数: 0

Variability of the antithrombotic effect of acetylsalicylic acid with the administration of different dosages: Reality or myth? 不同剂量乙酰水杨酸抗血栓作用的变异性：现实还是神话？

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.01.005

Joana Lima Lopes , Mariana Dias Passos , Carolina Pereira Mateus , Inês Sofia Fialho , Vanessa de Oliveira , Diana Sousa Mendes , João Bicho Augusto , David Cabrita Roque

Introduction and objectives

Acetylsalicylic acid (ASA) has both antithrombotic and anti-inflammatory effects, the latter being achieved when administered at higher doses (500 mg, 1000 mg per os). However, it is not known whether the anti-inflammatory effect decreases the antithrombotic potency of ASA. This experimental study intends to assess whether ASA maintains its antithrombotic effect when administered in an anti-inflammatory dose.

Methods

Twenty healthy volunteers were recruited and randomized into four groups. Each group ingested ASA 100 mg, 300 mg, 500 mg, and 1000 mg respectively. Their basal platelet function was measured using PFA-200 technology and reassessed one hour after ASA ingestion.

Results

The volunteers were all antiaggregated after ingestion of ASA, regardless of the dose taken. No statistical significance was found regarding age or gender. A subanalysis was performed, comparing the two groups that ingested lower dosages (100 mg and 300 mg) against the group that ingested higher dosages (500 mg and 1000 mg). The results were statistically significant, suggesting higher dosages may correspond to a higher antithrombotic effect.

Conclusions

Acetylsalicylic acid maintains its antithrombotic effect when administered in an anti-inflammatory dose. There is no clear association between the potency of antithrombotic effect and the ASA dose administered; however, our subanalysis suggests that higher dosages may correspond to a higher potency of antiaggregation.

简介和目的：乙酰水杨酸（ASA）具有抗血栓和抗炎作用，后者在较高剂量（500mg, 1000mg / s）时实现。然而，目前尚不清楚抗炎作用是否会降低ASA的抗血栓效力。本实验研究旨在评估ASA在抗炎剂量下是否保持其抗血栓作用。方法：招募20名健康志愿者，随机分为4组。各组分别摄入ASA 100 mg、300 mg、500 mg和1000 mg。使用PFA-200技术测量他们的基础血小板功能，并在服用ASA 1小时后重新评估。结果：所有志愿者在摄入ASA后均出现抗聚集，无论服用剂量如何。在年龄和性别方面没有发现统计学意义。进行了一项亚分析，比较摄入较低剂量（100毫克和300毫克）的两组与摄入较高剂量（500毫克和1000毫克）的组。结果具有统计学意义，提示较高的剂量可能对应较高的抗血栓作用。结论：乙酰水杨酸在抗炎剂量下保持其抗血栓作用。抗血栓作用的效力与ASA剂量之间没有明确的关联；然而，我们的亚分析表明，更高的剂量可能对应更高的抗聚集效力。

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引用次数: 0

Post-myocardial infarction patient pathways in Portugal 葡萄牙心肌梗死后患者路径。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2024.12.009

Ricardo Fontes-Carvalho , Ana Abreu , Luísa Bento , Eduardo Infante de Oliveira , Hélder Pereira , João Freitas , Hugo Pedrosa , Filipe Macedo

Acute myocardial infarction (AMI) is a condition that affects 12 000 Portuguese individuals annually. In Portugal, disease management foresees three levels of services according to the Cardiology Referral Network. This study aims to characterize the path taken by AMI patients in Portugal after hospital treatment, at the different hospital levels. Subsequently, it aims to propose recommendations for improvements. A Steering Committee, composed of cardiology experts in AMI was responsible for the project methodology. A literature review was performed to systematize national and international AMI guidelines, followed by structured interviews of stakeholders involved in the management of these patients in seven hospitals different levels in Portugal. The study ended with a consensus meeting to analyze the results and develop recommendations. Regarding communication and liaison between hospitals in the referral network: a clear distinction was observed between hospitals in urban areas with a relatively small referral area for level 2 services versus inland hospitals, to which patients from broader areas were referred. From the point of view of communication between professionals regarding the patient's clinical information, only in level 3 hospitals in the referral network was there a greater interconnection of systems and consequent greater ease in information flows. The latter had structured cardiac rehabilitation programs, which included the integration of in-house and community facilities, in line with European Society of Cardiology recommendations. Finally, regarding the frequency of post-discharge hospital follow-up and the professionals involved, in most hospitals, follow-up was reported with the first visit at three months post-discharge, and then repeated, on average, every six months for a period between one and two years in non-atypical patients. There is high variability in the support and practices implemented to promote secondary prevention of AMI at different hospitals levels in Portugal. There is a need to review the patient pathway considering follow-up by Cardiology in the referring hospital until discharge from the consultation to a General Practitioner; implementation of Smoking Cessation Programs; Nutrition; Psychology and Physical Therapy, adjusted to the different hospital levels. Implementation of a cardiac rehabilitation program is key.

急性心肌梗死（AMI）是一种每年影响12000葡萄牙人的疾病。根据心脏病转诊网络，在葡萄牙，疾病管理预计有三个级别的服务。本研究旨在描述葡萄牙AMI患者在不同医院级别接受医院治疗后所采取的路径。随后，它旨在提出改进建议。由AMI心脏病学专家组成的指导委员会负责该项目的方法学。对文献进行了回顾，将国家和国际AMI指南系统化，随后对葡萄牙七家不同级别医院中参与这些患者管理的利益相关者进行了结构化访谈。研究结束时召开了一次共识会议，分析结果并提出建议。关于转诊网络中医院之间的沟通和联络：在转诊区域相对较小的城市地区的医院与内陆地区的医院之间存在明显区别，内陆地区的患者被转诊到这些地区。从专业人员之间就患者临床信息进行沟通的角度来看，只有在转诊网络中的三级医院，系统之间的互连程度更高，因此信息流动更容易。后者已经制定了心脏康复计划，其中包括内部和社区设施的整合，符合欧洲心脏病学会的建议。最后，关于出院后医院随访的频率和所涉及的专业人员，在大多数医院，随访是在出院后三个月第一次就诊，然后在非典型患者中平均每六个月重复一次，持续一到两年。葡萄牙各级医院在促进急性心肌梗死二级预防的支持和做法方面存在很大差异。考虑到转诊医院的心脏病学随访，有必要审查患者的路径，直到从会诊到全科医生出院；实施戒烟计划；营养;心理和物理治疗，适应不同的医院水平。实施心脏康复计划是关键。

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引用次数: 0

Coronary chronic total occlusions: What's in a name and how do we treat it? 冠状动脉慢性全闭塞：冠名意味着什么？如何治疗？

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.05.004

Pedro Lamares Magro, Miguel Sousa Uva

引用次数: 0

Finding the right dose of acetylsalicylic acid for secondary prevention of atherosclerotic cardiovascular disease 寻找合适剂量的乙酰水杨酸二级预防动脉粥样硬化性心血管疾病

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.06.002

André Garcia, Carlos Aguiar

引用次数: 0

Primary heart failure with preserved ejection fraction: The intertwined pathophysiology and treatment of some of the most relevant phenotypes 原发心力衰竭与保留射血分数：交织病理生理和治疗的一些最相关的表型。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-07-01 DOI: 10.1016/j.repc.2025.02.007

Ryohei Ono , Luiz Menezes Falcão

Heart failure with preserved ejection fraction (HFpEF) is characterized by diverse underlying pathophysiological mechanisms and can be divided into two subgroups based on the identification of the specific cause: primary and secondary HFpEF. Primary HFpEF is caused by primary impairments in myocardial relaxation or compliance with the contribution of several risk factors. Therefore, we have reviewed current literature on pathophysiology and treatment in patients with primary HFpEF. Patients with primary HFpEF represent specific “phenotypes” and are usually elderly, more commonly women, and often with a history of arterial hypertension, obesity, iron deficiency (ID), coronary artery disease (CAD), sleep apnea, diabetes, chronic kidney disease (CKD), and chronotropic incompetence. Some of the main pathophysiological mechanisms for each phenotype of primary HFpEF are as follows: arterial hypertension, which promotes left ventricular hypertrophy and fibrosis; obesity, which contributes through systemic inflammation and metabolic dysregulation; aging, which leads to ventricular-vascular stiffening; gender differences, with women experiencing changes due to smaller heart size and hormonal shifts; ID, which affects mitochondrial function; CAD, which impairs myocardial blood flow; diabetes, which is associated with hyperglycemia, lipotoxicity, insulin resistance, and microvascular rarefaction; CKD, which leads to hypertension, metabolic disturbance, systemic inflammation, and endothelial dysfunction; sleep apnea, which induces cardiac changes through pressure swings and hypoxia; and chronotropic incompetence, which is due to reduced cardiac β-receptor responsiveness. In conclusion, each factor intricately contributes to the complex pathophysiology of HFpEF. Understanding these interrelated mechanisms is critical for tailoring management strategies to improve outcomes in HFpEF patients.

保留射血分数（HFpEF）心力衰竭具有多种潜在的病理生理机制，根据具体原因的确定可分为两个亚组：原发性和继发性HFpEF。原发性HFpEF是由心肌舒张或依从性的原发性损伤引起的，有几种危险因素的影响。因此，我们回顾了目前关于原发性HFpEF患者的病理生理和治疗的文献。原发性HFpEF患者具有特定的“表型”，通常为老年人，更常见的是女性，并且通常有动脉高血压、肥胖、缺铁（ID）、冠状动脉疾病（CAD）、睡眠呼吸暂停、糖尿病、慢性肾脏疾病（CKD）和变时功能不全的病史。原发性HFpEF各表型的一些主要病理生理机制如下：动脉高血压，促进左心室肥厚和纤维化；肥胖，导致全身性炎症和代谢失调；衰老，导致心室血管硬化；性别差异，女性由于心脏尺寸较小和荷尔蒙变化而经历变化；ID，影响线粒体功能；CAD，损害心肌血流；糖尿病，与高血糖、脂肪毒性、胰岛素抵抗和微血管稀疏有关；CKD，导致高血压、代谢紊乱、全身炎症和内皮功能障碍；睡眠呼吸暂停，通过压力波动和缺氧引起心脏变化；以及变时功能不全，这是由于心脏β受体反应性降低所致。总之，每个因素都复杂地参与了HFpEF的复杂病理生理。了解这些相互关联的机制对于调整管理策略以改善HFpEF患者的预后至关重要。

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引用次数: 0

Revascularization versus optimal medical therapy in chronic coronary syndrome in women: A systematic review 女性慢性冠脉综合征的血运重建与最佳药物治疗：一项系统综述。

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia

Pub Date : 2025-06-26 DOI: 10.1016/j.repc.2025.01.009

Mariana Caetano Coelho , Ruben Baptista Ramos , Imad Hassan , Boban Thomas , Rui Cruz Ferreira

Aim

We performed a systematic review to compare revascularization to optimal medical therapy (OMT) alone in reducing mortality and improving cardiovascular outcomes in women with chronic coronary syndrome, due to obstructive coronary artery disease.

Methods

PUBMED/EMBASE and CINAHL were searched for randomized trials comparing routine revascularization versus OMT alone in patients with chronic coronary syndrome. We extracted data regarding cardiovascular death, myocardial infarction, heart failure and relief of angina in women. Published data from sub-group analysis in women were the primary sources.

Results

Four randomized clinical trials that enrolled 10 722 patients followed for a mean 4.5 years of follow-up fulfilled our inclusion criteria. Two thousand four hundred one women were included in these trials. Male patients with preserved left ventricular systolic function and without left-main disease, formed the majority of trial participants. Compared with medical therapy alone, revascularization was not associated with a reduced risk of death or myocardial infarction, among women. Greater relief from angina and reduction in heart failure hospitalization was observed with revascularization in women in some studies.

Conclusions

Routine revascularization was not associated with improved survival or decreased rates of myocardial infarction in women when compared to OMT as an initial approach. Better relief from angina, and decreased hospitalizations due to heart failure were noted. Women continue to be underrepresented in clinical trials which limits our ability to draw robust conclusions.

目的：我们进行了一项系统综述，比较血管重建术与单纯最佳药物治疗（OMT）在降低阻塞性冠状动脉疾病引起的慢性冠状动脉综合征女性患者死亡率和改善心血管结局方面的效果。方法：检索PUBMED/EMBASE和CINAHL，比较常规血运重建术与单独OMT治疗慢性冠状动脉综合征患者的随机试验。我们提取了女性心血管死亡、心肌梗死、心力衰竭和心绞痛缓解的数据。来自女性亚组分析的已发表数据是主要来源。结果：四项随机临床试验纳入了10722例患者，平均随访时间为4.5年，符合我们的纳入标准。2401名妇女参与了这些试验。保留左心室收缩功能且无左主干疾病的男性患者占试验参与者的大多数。与单独的药物治疗相比，在女性中，血运重建与死亡或心肌梗死风险的降低无关。在一些研究中观察到女性血运重建术更能缓解心绞痛和减少心力衰竭住院。结论：与OMT作为初始方法相比，常规血运重建术与女性生存率的提高或心肌梗死发生率的降低无关。心绞痛得到更好的缓解，因心力衰竭而住院的次数减少。妇女在临床试验中的代表性仍然不足，这限制了我们得出有力结论的能力。

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