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- Effects of digoxin in modern heart failure treatmentPublication . Valentim Gonçalves, António; Cardim, Nuno; Fiarresga, António; Pereira-da-Silva, Tiago; Ilhão-Moreira, Rita; Galrinho, Ana; Rio, Pedro; Carvalheiro, Ricardo; Ferreira, Fernando; Lopes, Julien; Marques Antunes, Miguel; Selas, Mafalda; Viana, Bruno; Domingues, Lúcia; Cruz Ferreira, Rui; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierAims: Even though it is the oldest heart failure (HF) medication still in use, digoxin has not been evaluated alongside the updated algorithm for treating HF with reduced ejection fraction patients. This could help explain the low use of digoxin in recent HF studies. The main objective is to assess the effectiveness of digoxin in functional capacity and cardiac function when combined with modern HF therapy. Methods: An interventional, open-label, randomised, crossover trial among adults with chronic Heart Failure and reduced ejection fraction (≤45%) was designed to allocate 50 patients for 24 weeks in each arm (48 weeks of study). The arms are daily intake of digoxin 0.125 mg plus standard of care versus standard of care alone. Both patients with sinus rhythm and atrial fibrillation were enrolled. At the end of each 24-week arm, patients will undergo the co-primary outcome measurement of the peak oxygen consumption, evaluated through cardiopulmonary exercise test, and the global work index, measured by transthoracic echocardiography. Key secondary outcome includes a safety composite of death, need for urgent heart transplantation or mechanical assist device, total hospitalizations and sustained ventricular arrhythmias. The study completed recruitment in April 2025 and will complete follow up in March 2026. Conclusions: The use of digoxin could be significantly affected by evidence that it still has a considerable effect on functional capacity and cardiac function in HF patients. EU CT Number: 2024-513448-26-00.
- Metabolic reprogramming and molecular crosstalk at the cancer-endothelial interface in ovarian carcinomaPublication . Sousa, Bruna; Chiavassa, Adele; Delgado, Leonor; Gomes, Rafael; Mendes, Cindy; Serpa, Jacinta; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); BioMed Central (BMC)
- Practical guide on acute heart failure managementPublication . Pimenta, Joana; Ferreira, João Pedro; Vasques-Nóvoa, Francisco; Roque, David; Araújo, Inês; Lourenço, César; Dias da Costa, Susana; Gonçalves, Sara; Neto, Ana; Almeida, Filipa; Moraes Sarmento, Pedro; Agostinho, João; Marques, Irene; Martins, Elisabete; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | ElsevierAcute heart failure (AHF) presents significant clinical and economic challenges that require a comprehensive, evidence-based strategy extending from in-hospital management to post-discharge care. Patients with AHF usually require prompt initiation or intensification of HF-directed treatment, which commonly includes intravenous diuretics, and frequently culminates in unplanned hospitalization. Despite therapeutic advances, AHF is still associated with poor outcomes, with in-hospital mortality in Portugal reaching 12.4%. Based on the expertise and clinical experience of a panel of cardiology and internal medicine specialists, this paper provides a practical guide to AHF management over the patient journey, which has been adapted to align with the specificities of the Portuguese national healthcare system: hospital admission, initial management of AHF, in-hospital management of stable phase, pre-discharge and transition of care. This practical guide highlights the importance of optimizing guideline-directed medical therapy by tailoring and rapidly uptitrating treatments to reduce mortality and readmissions. It is equally essential that structured, multidisciplinary transition-of-care programs are established that promote continuity and coordination across care settings.
- As Humanidades no ensino médicoPublication . Gonçalves-Pereira, Manuel; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Universidade Nova de Lisboa, Faculdade de Ciências Sociais e Humanas, Centro de História da CulturaPartindo de uma definição operacional das Humanidades no ensino da Medicina, o autor discorre sobre vertentes dos programas das Escolas Médicas em que o papel das Humanidades é crucial. Em seguida, no contexto das experiências internacionais e nacionais, descreve alguns dados da Faculdade de Ciências Médicas da Universidade NOVA de Lisboa para discutir potencialidades e limitações. Finalmente, levanta questões sobre as dificuldades da integração das Humanidades no ensino médico e aborda caminhos possíveis. Numa época de pressão social sobre o ensino da Medicina e de reflexão sobre opções curriculares, este debate deverá recorrer à investigação e exige consistência nos argumentos.
- Predictors of Response to Anti-CGRP Monoclonal AntibodiesPublication . Ferreira, Vítor Mendes; Serôdio, Miguel; Caetano, André; Viana-Baptista, Miguel; Cabral, Gonçalo; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de NeurologiaIntroduction: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective and well-tolerated therapies for migraine prevention. However, up to 30%–40% of patients do not respond. While some clinical features have been associated with treatment outcomes, evidence remains limited. Methods: We conducted a retrospective study of patients with episodic or chronic migraine followed at a tertiary headache center who initiated anti-CGRP therapy for the first time between April 2021 and April 2024. Patients received either erenumab 70 mg or fremanezumab 225 mg. Demographic and clinical data were collected. Treatment response was defined as a ≥50% reduction in monthly headache days at 3 months. Patients were classified as responders or non-responders. Group comparisons were performed using chi-squared tests for categorical variables and Student’s t-test or Mann–Whitney test for continuous variables, according to data distribution. Results: Sixty-eight patients were included (80.9% female; mean age 43.5 ± 11.5 years). Chronic migraine was present in 48.5%. Responders and non-responders did not differ significantly in age, sex, migraine type, baseline headache frequency, aura, unilateral pain, psychiatric comorbidities, medication overuse, prior preventive failures, or type of anti-CGRP antibody. Responders were more likely to report nausea and/or vomiting (76.6% vs 52.4%, p=0.008), whereas non-responders had a higher prevalence of vascular risk factors (33.3% vs 12.8%, p=0.046). Conclusion: In our study, nausea/vomiting were associated with a favorable response to anti-CGRP therapy, replicating previous literature findings, while vascular risk factors were associated with non-response. These results suggest a potential interaction between vascular risk factors and CGRP-mediated mechanisms.
- NeurologiaPublication . Viana-Baptista, Miguel; Maia, Luís F.; Batista, Sónia; Alves, Pedro Nascimento; Mendonça, Marcelo; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Neurologia
- 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.