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- 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
- A Portuguese Expert Panel Position Paper on the Management of Heart Failure with Preserved Ejection Fraction - Part II: Unmet Needs and Organization of Care in Portugal.Publication . Silva-Cardoso, José; Moreira, Emília; Tavares de Melo, Rachel; Moraes-Sarmento, Pedro; Cardim, Nuno; Oliveira, Mário; Gavina, Cristina; Moura, Brenda; Araújo, Inês; Santos, Paulo; Peres, Marisa; Fonseca, Cândida; Pedro Ferreira, João; Marques, Irene; Andrade, Aurora; Baptista, Rui; Brito, Dulce; Cernadas, Rui; Dos Santos, Jonathan; Leite-Moreira, Adelino; Gonçalves, Lino; Ferreira, Jorge; Aguiar, Carlos; Fonseca, Manuela; Fontes-Carvalho, Ricardo; Franco, Fátima; Lourenço, Carolina; Martins, Elisabete; Pereira, Hélder; Santos, Mário; Pimenta, JoanaIn Portugal, a 15.2% prevalence of heart failure with preserved ejection fraction (HFpEF) was recently identified among those aged ≥50 years. HFpEF represents 90% of Portuguese heart failure patients. HFpEF management in Portugal is challenging due to patient heterogeneity, diagnostic and therapeutic complexity, and organizational constraints on the healthcare system. Considering the above, a panel of Portuguese experts convened to address HFpEF management within the national context. This was done in a two-paper set. This, the second paper, identifies unmet needs and suggests a set of measures to improve the current organization of HFpEF management in Portugal. Our purpose is to create a multidisciplinary integrated care system, ensuring a seamless connection between hospitals and primary care. Additionally, we propose a practical approach to the management of HFpEF, including a roadmap for screening, diagnosis, referral and treatment. The aim is to help clinicians improve HFpEF management throughout the disease trajectory.
- Expanding Left Bundle Branch Area Pacing - A New Step in Daily Practice.Publication . Oliveira, Mário
- Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary Cardiology Centre.Publication . Constante, Andreia Duarte; Suarez, Joana; Lourenço, Guilherme; Portugal, Guilherme; Silva Cunha, Pedro; Martins Oliveira, Mário; Trigo, Conceição; Pinto, Fátima; Laranjo, SérgioAtrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. : A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. : The study included 36 paediatric patients (median age: 15 years, IQR: 13-17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. : AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF.
- Targeted Disease-Specific Therapy for Patients with Hereditary Transthyretin Amyloidosis and Cardiac Involvement After Orthotopic Liver Transplantation. Consensus from the Working Group on Myocardial and Pericardial Diseases of the Portuguese Society of Cardiology and National Reference Centers for Familial Amyloidosis.Publication . Aguiar Rosa, Sílvia; Ferreira, Catarina; Conceição, Isabel; Coelho, Teresa; Marques, Nuno; Azevedo, Olga; Elsevier España
- Efficacy of Peritoneal Dialysis in Patients With Refractory Congestive Heart Failure: a Systematic Review and Meta-AnalysisPublication . Timóteo, AT; Mano, T; SpringerRefractory congestive heart failure (RCHF) is a common complication in the natural history of advanced heart failure. Peritoneal dialysis (PD) is a possible alternative in those patients, but studies are scarce, and mostly with small samples. We conducted this meta-analysis to evaluate the effects of PD in patients with RCHF. Articles published before July 2020 in the following databases: PubMed, Web of Science, and CENTRAL. Mean differences (MD) and 95% confidence intervals (CIs) were computed to generate a pooled effect size with a random effects model. We also assessed heterogeneity, risk of bias, publication bias, and quality of evidence. Twenty observational studies (n = 769) were included, with a "before and after intervention" design. PD was associated with a significant reduction in NYHA functional class (MD -1.37, 95% CI -0.78 to -1.96) and length of hospitalisation (MD -34.8, 95% CI -20.6 to -48.9 days/patient/year), a small but significant increase in left ventricular ejection fraction (MD 4.3, 95%CI 1.9 to 6.8%) and a non-significant change in glomerular filtration rate (MD -3.0, 95% CI -6.0 to 0 mL/min/1.73m2). Heterogeneity among studies was significant and overall risk of bias was rated from moderate to critical. No significant publication bias was found, and the overall quality of evidence was very low for all outcomes. PD in patients with RCHF improved functional class, length of hospitalisation, and ventricular functional, and had no impact in renal function. Further randomised clinical trials are warranted to confirm our results that showed some limitations.
- Heart with Mozambique: a Portuguese Contribution to the Eradication of Rheumatic Heart DiseasePublication . Grácio de Almeida, I; Esteves, A; Gil, V
- The Accuracy of PiCCO® in Measuring Cardiac Output in Patients Under Therapeutic Hypothermia: Comparison With Transthoracic EchocardiographyPublication . Souto Moura, T; Aguiar Rosa, S; Germano, N; Cavaco, R; Sequeira, T; Alves, M; Papoila, AL; Bento, LBackground: Invasive cardiac monitoring using thermodilution methods such as PiCCO® is widely used in critically ill patients and provides a wide range of hemodynamic variables, including cardiac output (CO). However, in post-cardiac arrest patients subjected to therapeutic hypothermia, the low body temperature possibly could interfere with the technique. Transthoracic Doppler echocardiography (ECHO) has long proved its accuracy in estimating CO, and is not influenced by temperature changes. Objective: To assess the accuracy of PiCCO® in measuring CO in patients under therapeutic hypothermia, compared with ECHO. Design and patients: Thirty paired COECHO/COPiCCO measurements were analyzed in 15 patients subjected to hypothermia after cardiac arrest. Eighteen paired measurements were obtained at under 36°C and 12 at ≥36°C. A value of 0.5l/min was considered the maximum accepted difference between the COECHO and COPiCCO values. Results: Under conditions of normothermia (≥36°C), the mean difference between COECHO and COPiCCO was 0.030 l/min, with limits of agreement (-0.22, 0.28) - all of the measurements differing by less than 0.5 l/min. In situations of hypothermia (<36°C), the mean difference in CO measurements was -0.426 l/min, with limits of agreement (-1.60, 0.75), and only 44% (8/18) of the paired measurements fell within the interval (-0.5, 0.5). The calculated temperature cut-off point maximizing specificity was 35.95°C: above this temperature, specificity was 100%, with a false-positive rate of 0%. Conclusions: The results clearly show clinically relevant discordance between COECHO and COPiCCO at temperatures of <36°C, demonstrating the inaccuracy of PiCCO® for cardiac output measurements in hypothermic patients.