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- Navigating the challenges of ST-segment elevation myocardial infarction in womenPublication . Trabulo, Marisa; Timóteo, Ana Teresa; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | Elsevier
- The contribution of genetics to the understanding and management of cardiomyopathiesPublication . Cardoso, Isabel; Nunes, Sofia; Brás, Pedro; Viegas, José Miguel; Marques Antunes, Miguel; Ferreira, André; Almeida, Inês; Custódio, Inês; Trigo, Conceição; Laranjo, Sérgio; Graça, Rafael; Cruz Ferreira, Rui; Oliveira, Mário; Aguiar Rosa, Sílvia; Antunes, Diana; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierGenetics has assumed a pivotal role in clarifying the pathophysiology of cardiomyopathies, facilitating molecular diagnosis, and enabling effective family screening. The advent of next-generation sequencing has revolutionized genetic testing by enabling cost-effective, high-throughput analysis. It is imperative for cardiovascular physicians to mainstream genetic testing into their clinical decision-making. Although a definitive genotype-phenotype correlation may not always be evident, several genotypes have emerged as valuable risk predictors for disease severity and progression. European guidelines emphasize the importance of genetic tests for predicting clinical outcome in cardiomyopathies. While further research is essential to bridge existing gaps in the genetic evidence on cardiomyopathies, there is considerable potential for significant advancements.
- Hemodynamic effect of outpatient levosimendan infusion assessed daily using the CardioMEMS™ invasive remote monitoring systemPublication . Teixeira, Ana Rita; Barbas de Albuquerque, Francisco; Pereira-da-Silva, Tiago; Gonçalves, António Valentim; Ilhão Moreira, Rita; Timóteo, Ana Teresa; Alves, João; Barquinha, Sofia; Mata, Rita; Dias, Mariline; Cacela, Duarte; Cruz Ferreira, Rui; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierIntroduction and Objectives: Levosimendan infusion in the outpatient setting improves the clinical status of heart failure (HF) patients, although its hemodynamic effects are not entirely known. Remote monitoring using the CardioMEMS™ system enables daily assessment of pulmonary artery pressure (PAP) and estimation of cardiac output (CO). We aimed to assess the hemodynamic effects of outpatient levosimendan infusion using CardioMEMS™. Methods: All patients admitted for 6-hour levosimendan infusion (performed every 14 days) and using the CardioMEMS™ remote monitoring system were included in a prospective single-center registry. Clinical and laboratory data were recorded. Systolic, diastolic, and mean PAP, heart rate, CO, and stroke volume (SV) were assessed daily. Results: A total of 25 sessions were performed in three patients. There were no adverse events or significant therapy adjustments. There was a significant reduction in diastolic PAP the day after levosimendan infusion compared to baseline (day prior to infusion) (24.1±4.1 mmHg vs. 21.6±2.9 mmHg, p=0.006). Thereafter, diastolic PAP stabilized and remained significantly lower than baseline up to day 10. There were no significant differences in systolic PAP, mean PAP, heart rate, CO, or SV at any timepoint analyzed, although there was a nonsignificant increase in CO with a peak at day 6. Conclusion: Outpatient levosimendan infusion was associated with an early reduction in diastolic PAP, which was maintained for 10 days. The CardioMEMS™ system may enable a better understanding of outpatient hemodynamics in advanced HF. To our knowledge, there are no published data on this subject.
- A Portuguese expert panel position paper on the management of heart failure with preserved ejection fraction – Part IPublication . 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; Ferreira, João Pedro; 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, Joana; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierHeart failure (HF) with preserved ejection fraction (HFpEF) affects more than 50% of HF patients worldwide, and more than 70% of HF patients aged over 65. This is a complex syndrome with a clinically heterogeneous presentation and a multifactorial pathophysiology, both of which make its diagnosis and treatment challenging. A Portuguese HF expert panel convened to address HFpEF pathophysiology and therapy, as well as appropriate management within the Portuguese context. This initiative resulted in two position papers that examine the most recently published literature in the field. The present Part I includes a review of the HFpEF literature covering pathophysiology, clinical presentation, diagnosis and treatment, including pharmacological and non-pharmacological strategies. Part II, the second paper, addresses the development of a holistic and integrated HFPEF clinical care system within the Portuguese context that is capable of reducing morbidity and mortality and improving patients’ functional capacity and quality of life.
- Correction to the Article "Diagnosis of Chronic Kidney Disease in Adults in PortugalPublication . Malheiro, Jorge; Birne, Rita; Biscaia, André; Almeida, Edgar; Nobre, João; Capela, Nuno; Azinheira, Jorge; Nunes Oliveira, Jorge; Lebre, Luís; Cirne Carvalho, Manuel; Albuquerque, Margarida; De Sousa, Maria José; Paixão, Paulo; Freitas, Pedro; Ribeiro, Rita; Pinto, Rui; Ramalho, Célia; Calçada, Eduardo; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOMFollowing publication of the original article, the authors identified an error in the content. The corrected text is presented in the PDF. The original article has also been corrected. Chronic kidney disease represents a significant public health issue, affecting approximately 9.8% of the adult population in Portugal. Despite this figure, early diagnosis of this disease in high-risk groups remains limited. Although only two parameters are essential for its diagnosis - estimated glomerular filtration rate (eGFR) and albuminuria - in Portugal, over 50% of stage 3 - 5 patients have not undergone simultaneous assessment of eGFR and albuminuria. The insufficient implementation of the simultaneous assessment of these two metrics results in an inadequate evaluation of high-risk populations. A task force of 17 Portuguese experts from the main medical specialties involved in chronic kidney disease management (Nephrology and Family Medicine) and in Clinical Pathology/Laboratory Medicine (representatives of major national laboratories) convened to develop guidelines aimed at standardizing procedures for the prescribing, determination, reporting, and interpretation of diagnostic parameters (albuminuria and eGFR based on serum creatinine) in Portugal. This effort is based on clinical practice, scientific knowledge, and international recommendations. This national consensus among the key stakeholders in the chronic kidney disease screening and diagnosis process culminated in the development of four practical guidelines. These guidelines will enable the consistent provision of eGFR and albuminuria measurements, regardless of the attending physician's medical specialty, the laboratory, or geographic location. Additionally, through this collective effort, experts want to raise awareness among national authorities to the need of developing new guidelines, based on scientific evidence and clinical practice, to address the underassessment of albuminuria and eGFR in this disease's management.
- Errata ao artigo "PRIMARY-HFPublication . Jonathan Dos Santos; João Pedro Nobre; João Pedro Ferreira; Maria Inês M Marques; Miguel Henriques; Nuno Cardim; Tiago Villanueva; Alexandra Gonçalves; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Incremental value of implantable loop recorders in arrhythmia detection and management in cardiomyopathiesPublication . G. Figueiredo, Margarida; Miguel Viegas, José; Cardoso, Isabel; Brás, Pedro; Almeida, Inês; Jacinto, Sofia; Santos, Hélder; Portugal, Guilherme; Lousinha, Ana; Silva Cunha, Pedro; Aguiar Rosa, Silvia; Oliveira, Mário; Cruz Ferreira, Rui; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierIntroduction and objectives: Implantable loop recorders (ILRs) are increasingly being used for the detection of infrequent arrhythmias in patients with cardiomyopathies, especially in the presence of risk markers. The role of these devices in improving the detection of significant arrhythmias requiring a change in clinical management remains to be determined. Our purpose was to evaluate the diagnostic yield, types of arrhythmia, and subsequent management in cardiomyopathy patients receiving an ILR. Methods: Prospective single-centre study in cardiomyopathy patients considered at borderline risk for ventricular arrhythmias, who received an ILR. The primary endpoint was a meaningful arrhythmic event detection leading to a change in clinical management. Results: A total of 45 patients were included, 51% were male, median age was 62 (48–71) years. The underlying disease was hypertrophic cardiomyopathy (HCM) in 31 patients (69%), dilated and non-dilated left ventricle cardiomyopathy (DCM/NDLVC) in 12 patients (26%) and transthyretin amyloid cardiomyopathy (ATTR-CM) in 2 patients (4%). The most frequent risk markers were brief run of nonsustained ventricular tachycardia in 42%, unexplained syncope/pre-syncope in 36%, family history of premature sudden cardiac death (SCD) in a first-degree relative in 36%, and palpitations suspicious of arrhythmic origin in 18% of patients. In the HCM cohort, median HCM Risk-SCD score was 3.07 (2.68–3.76)%, with 19% of patients having an estimated 5-year risk of SCD ≥4%. Mean maximum wall thickness was 20±4 mm, mean left atrial diameter was 43±7 mm, 23% of patients had obstructive HCM, late gadolinium enhancement (LGE) was present in 74% – with 52% of patients presenting extensive LGE – and left ventricle apical aneurysm in 3%. A sarcomeric pathogenic variant was identified in 26%. Among the DCM/NDLVC patients, 58% had left ventricular ejection <50%, 25% carried pathogenic/likely pathogenic variants on genetic testing and 25% exhibited an extensive ring-like scar pattern on cardiac magnetic resonance (CMR). During a mean follow-up of 19±13 months, 44% of patients had, at least, one ILR-guided diagnosis. De novo atrial fibrillation was diagnosed in 24% of patients and was the main detected event. Due to ILR-guided diagnosis, 20% (9 patients) received an implantable cardioverter-defibrillator (ICD), one of which with subsequent appropriate ICD-therapies. Conclusion: This study provides insight into the possible role of ILR in this population, not only for the diagnosis of ventricular arrhythmias, but also for detection of atrial fibrillation, which can lead to a different clinical management.
- Seeing beneath the surfacePublication . Silva Cunha, Pedro; Aguiar Rosa, Silvia; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | Elsevier
- Adrenal failure as an antiphospholipid syndrome manifestationPublication . Santos, Mariana; Gama, C.; Marques, B.; Saldanha, T.; Tremoceiro, J.; Lourenço, M. H.; Gonçalves, Maria João; Costa, M.; Sepriano, Alexandre; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de ReumatologiaAdrenal involvement in antiphospholipid syndrome (APS) is rare but potentially life-threatening. Early recognition reduces morbidity and mortality. We report a 56-year-old male with chronic thrombocytopenia and prolonged activated partial thromboplastin time who developed fatigue, anorexia, and weight loss. On admission, he presented with hypotension, hyperkalemia, thrombocytopenia, anemia, and elevated inflammatory markers. After hospitalization, he underwent an extensive workup study. PET-CT revealed bilateral adrenal uptake, and hormonal tests confirmed primary adrenal insufficiency (PAI). Autoimmune studies showed persistently positive lupus anticoagulant, and high-titer antinuclear and anti-double-stranded DNA antibodies, establishing systemic lupus erythematosus and APS with secondary PAI. Treatment with mineralocorticoids, hydroxychloroquine, anticoagulation, and subsequently high-dose glucocorticoids led to clinical and laboratory improvement. Review of published cases shows that, although APS is more frequent in women, adrenal involvement occurs predominantly in men and usually presents acutely with abdominal pain, hypotension, and electrolyte imbalance. Our patient’s atypical presentation delayed diagnosis. Awareness of such variable presentation is crucial, as early recognition and treatment significantly improve outcomes. Clinicians should consider APS in new-onset adrenal failure and systematically evaluate adrenal involvement in APS patients with compatible symptoms.
- Initial experience with the extravascular implantable cardioverter-defibrillatorPublication . Lousinha, Ana; Kahlbau, Hagen; Coelho, Sara; Jacinto, Sofia; Sousa, Rodrigo; Paulo, Margarida; Covas, Susana; Domingues, Abel; Trindade, Ana; Aguiar Rosa, Sílvia; Cardim, Nuno; Cruz Ferreira, Rui; Oliveira, Mário; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierIntroduction and objectives: Implantable cardioverter-defibrillators (ICDs) are among the most effective interventions for the prevention of sudden cardiac death. However, traditional transvenous systems are associated with venous access and intracardiac lead complications. Subcutaneous ICDs (S-ICD), which were developed to overcome these complications, are unable to provide anti-tachycardia pacing (ATP) or pause prevention pacing. The extravascular ICD (EV-ICD) is a recent technological innovation designed to mitigate these limitations by enabling cardioversion, defibrillation and pacing without entering the central venous system. Our aim was to assess the initial experience with the new EV-ICD system, as a valid alternative to transvenous ICD and S-ICDs, including patient selection, implantation technique, procedure feasibility and safety, functional parameters, and immediate clinical outcomes. Methods: We conducted an observational study of all patients who underwent EV-ICD implantation between November 2024 and June 2025 at two centers. Demographic, clinical, imaging, pharmacologic and procedural data were analyzed. Results: A total of 11 patients were included, with a mean age of 36.3 years (range 19–59); 27% were female. Main diagnoses included hypertrophic cardiomyopathy (n=3), left ventricular non-dilated cardiomyopathy (n=3), dilated cardiomyopathy (n=2), Brugada syndrome (n=1), polymorphic ventricular tachycardia (n=1) and arrhythmogenic right ventricular cardiomyopathy (n=1). There were no procedural or peri-procedural complications. The mean procedure duration (“skin-to-skin”) was 68.2 minutes (range 60–78). Median fluoroscopy time was 3.9 minutes (range 2.5–6.2). Defibrillation threshold (DFT) testing was successful in all cases. During the follow-up, two patients received an inappropriate shock, one due to sinus tachycardia and the other due to oversensing of myopotentials. Conclusions: Our initial experience with the EV-ICD confirms the feasibility and safety of the procedure. This novel system may offer an effective alternative for selected populations, especially young patients with extended life expectancy and high cumulative device exposure. The rate of inappropriate shocks remains a concern and improvements are required to reduce these events.