NMS - Artigos em revista nacional com arbitragem científica
URI permanente para esta coleção:
Navegar
Entradas recentes
- 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.
- Cardio-oncology meets pharmacoeconomicsPublication . Toste, Júlia Cristina; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Cardiologia | Elsevier
- Corticosteroids and community-acquired pneumoniaPublication . Sweeney, Daniel A.; Póvoa, Pedro; Kalil, Andre C.; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); BioMed Central (BMC)
- Interstitial lung disease in Sjögren’s diseasePublication . Duarte, Ana Catarina; Matias, Susana; Bargado, Carolina; Bandeira, Matilde; Romão, Vasco C.; Marques Gomes, Carlos; Bernardes, Miguel; Correia Natal, Miguel; Moniz, Ana Catarina; Gonçalves, Maria João; Emília Santos, Mariana; Canhão André, Filipa; Cadório, Maria João; Alves Costa, Sara; Vieira, Ana Rita; Mendonça, Beatriz; Barcelos, Filipe; Cunha, Anita; Pontes Ferreira, Maria; Barcelos, Anabela; Pinto Oliveira, Cláudia; Fonseca, Rita; Silva, Catarina; Brites, Luísa; Almeida, Inês; Augusto, Duarte; Belchior Raimundo, Diana; Santos, Maria José; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de ReumatologiaIntroduction: Apart from exocrine glands involvement with sicca symptoms, several extra-glandular manifestations can occur in Sjögren’s disease (SjD) such as pulmonary manifestations. Interstitial lung disease (ILD) is the most common lung manifestation in SjD. We aim to evaluate the presence of ILD in a national cohort of patients with SjD, identify variables associated with its development and progression, as well as describe the treatment used for SjD-ILD and its effectiveness and tolerability. Methods: We conducted an observational multicenter study of SjD-ILD patients prospectively followed in Reuma. pt. Demographic and clinical data were collected. We compared patient characteristics between groups using Chi-square or Fisher’s exact test, Mann–Whitney or independent samples t-test, as appropriate. Logistic regression analysis was used to identify predictors of SjD-ILD. A linear mixed model with random intercept was used to compare results from pulmonary function tests (PFTs) before and after immunosuppression initiation. Results: Of the 1532 patients enrolled in the Reuma.pt-SjD protocol, 1333 (87%) had information on the presence of pulmonary manifestations. Among these, 127 (9.5%) had documented lung involvement, with ILD being the most common manifestation (74%). Ever smoking (OR=2.175; [95%CI:1.214-3.899]; p=0.009) and older age at SjD diagnosis (OR=1.047 per year; [95%CI:1.025-1.069]; p<0.001) were predictors of ILD. Nonspecific interstitial pneumonia was the most frequent ILD pattern (45.7%). Immunosuppression was used in 62 (66%) SjD-ILD patients and antifibrotics in eight patients (in seven of them in association with immunosuppression). Among the 26 patients with serial PFTs available, 10 (38.5%) showed ILD progression. Progressors had a higher forced vital capacity (FVC 96.8 ± 22.1 vs. 71.1 ± 21.4%; p=0.007) and diffusion capacity for carbon monoxide (DLCO 75.5 ± 12.1 vs. 50.2 ± 16.6%; p=0.002) at baseline and tended to have hypergammaglobulinemia more often (80% vs. 43.8%; p=0.069). Nevertheless, immunosuppression interrupted the decline of FVC (absolute value) and DLCO (percent predicted). Conclusion: This work demonstrated that a substantial proportion of SjD-ILD patients present with progressive fibrosis. Immunosuppression seems to delay the progression of lung disease. Therefore, identifying predictors for ILD development and progression is essential for recognizing which patients will require closer monitoring and intervention.
- An Implementation Roadmap to Accelerate Academic Clinical Cancer Research in PortugalPublication . Ana, Ana Sofia; Cardoso Borges, Fábio; Cardoso, Maria João; Oliveira, Júlio; Pais Silva, José; Carvalho, Sónia; Costa, Luís; Fernandes, Isabel; Gomes, Dora; Gomes, Mónica; Milagre, Tamara; Rego, Sónia; Soares, Marta; Sottomayor, Carlos; Joaquim, Ana; Sousa, Nuno; Passos Coelho, José Luís; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Post-implantation syndrome after EVARPublication . Soares Ferreira, Rita; Bastos Gonçalves, Frederico; Abreu, Rodolfo; Camacho, Nelson; Catarino, Joana; Correia, Ricardo; Ferreira, Maria Emília; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Angiologia e Cirurgia VascularIntroduction: Post-implantation syndrome (PIS) is characterized by fever, flu-like symptoms, leukocytosis and elevation of reactive C protein in the postoperative period of EVAR. The authors aim to estimate the incidence of PIS after EVAR in their institution, identify risk factors and determine the association with clinical events
- Planning, EVAR and followup without contrast in chronic kidney diseasePublication . Soares Ferreira, Rita; Bastos Gonçalves, Frederico; Quintas, Anita; Abreu, Rodolfo; Camacho, Nelson; Ferreira, Maria Emília; Albuquerque e Castro, João; Mota Capitão, Luís; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Sociedade Portuguesa de Angiologia e Cirurgia Vascular