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- On the Way to "Image" the Genotype.Publication . Aguiar Rosa, Sílvia
- Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?Publication . Garcia Brás, Pedro; Gonçalves, António Valentim; Reis, João Ferreira; Moreira, Rita Ilhão; Pereira-da-Silva, Tiago; Rio, Pedro; Timóteo, Ana Teresa; Silva, Sofia; Soares, Rui M; Cruz Ferreira, RuiBackground: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). Methods: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. Results: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. Conclusion: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
- Arrhythmogenic Left Ventricular Cardiomyopathy: A Successful Case of Extracorporeal Cardiopulmonary Resuscitation.Publication . Gama, Mafalda; Cardoso, Isabel; Palma Anselmo, Mónica; Aguiar Rosa, Sílvia; Gaspar da Costa, Pedro; Fortuna, PhilipA 24-year-old man suffered a witnessed cardiac arrest after a padel game. Basic life support was immediately provided. The pre-hospital emergency services team continued the resuscitation efforts, and the patient was accepted for extracorporeal cardiopulmonary resuscitation. The return of spontaneous circulation was achieved in 45 minutes. The initial assessment revealed a ST-segment elevation in leads V4-V6 and a dilated left ventricle with severe systolic dysfunction. Coronary angiography was normal. An improvement in left ventricular systolic function was observed and extracorporeal cardiac support was discontinued after 48 hours. Cardiovascular magnetic resonance imaging demonstrated hypokinesia and subepicardial fatty infiltration of the left ventricle lateral wall. Genetic testing detected a variant of uncertain significance in the ANK2 gene. The diagnosis of arrhythmogenic left ventricular myocardiopathy did not fulfill all the current diagnostic criteria, but it is a very likely diagnosis. An implantable cardioverter-defibrillator was placed. The patient was discharged without physical or cognitive impairment.
- Navigating the Challenges of ST-Segment Elevation Myocardial Infarction in Women: a Closer Look.Publication . Trabulo, Marisa; Timóteo, Ana Teresa
- Overcoming Diagnostic Challenges in Constrictive Pericarditis: Why Volume Is Important?Publication . Teixeira, Bárbara Lacerda; Albuquerque, Francisco; Cardoso, Isabel; Ferreira, Vera; Fiarresga, António; Cardoso, Filipe; Galrinho, Ana; Rosa, Sílvia Aguiar; Thomas, Boban; Cruz Ferreira, RuiA 65-year-old male with chronic liver disease and refractory ascites was being evaluated for liver transplant, when constrictive pericarditis (CP) was suspected. Initial diagnostics were inconclusive due to overdiuresis. After suspension of diuretics, cardiac magnetic resonance confirmed CP, leading to successful pericardiectomy and normalization of liver function, emphasizing volume status and multimodality imaging role in CP diagnosis.
- Dapagliflozin: Improving Heart Failure Outcomes Does Not Necessarily Mean Increasing Costs.Publication . Valentim Gonçalves, António
- Left Ventricular Global Longitudinal Strain Is Associated with Filling Pressure and Cardiac Output in an Outpatient Setting: Insights From CardioMEMS™.Publication . Barbas de Albuquerque, Francisco; Teixeira, Rita; Pereira-da-Silva, Tiago; Ferreira, Vera; Valentim Gonçalves, António; Ilhão Moreira, Rita; Teresa Timóteo, Ana; Galrinho, Ana; Branco, Luísa; Rio, Pedro; Alves, João; Barquinha, Sofia; Cacela, Duarte; Cruz Ferreira, RuiIntroduction 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.
- Pulmonary Endarterectomy's Blind Spot: Is Echocardiography the Answer?Publication . Timóteo, Ana Teresa; Galrinho, Ana
- Portuguese Recommendations for the Management of Transthyretin Amyloid Cardiomyopathy (Part 1 of 2): Screening, Diagnosis and Treatment. Developed by the Task Force on the Management of Transthyretin Amyloid Cardiomyopathy of the Working Group on Myocardial and Pericardial Diseases of the Portuguese Society of Cardiology.Publication . Marques, Nuno; Aguiar Rosa, Sílvia; Cordeiro, Filipa; Menezes Fernandes, Raquel; Ferreira, Catarina; Bento, Dina; Brito, Dulce; Cardim, Nuno; Lopes, Luís; Azevedo, Olga
- Dr. Fernando Matias dos Santos Silva.Publication . Oliveira, Mário Martins