Left Ventricular Noncompaction

Left ventricular noncompaction (LVNC) is accepted as an unclassified (the American Heart Association) or a genetic cardiomyopathy (the European Society of Cardiology), but some argue that this phenotype may be a morphologic trait shared by different cardiomyopathies. This chapter covers the state of the art on the pathology, underlying mechanisms, its clinical manifestations, and diagnosis and treatment modalities of LVNC. LVNC may be defined as follows: an inner non‐compacted layer with prominent left ventricular trabeculae and deep intertrabecular recesses and a thin outer compacted layer. Mechanisms are still debatable, with the hypothesis of compaction arrest during embryogenesis as the most accepted theory. Genetic data support LVNC as a distinct cardiomyopathy, although evidence for LVNC as a shared morphological trait is not ruled out, since LVNC may be associated with other cardiomyopathies, congenital heart diseases and in some cases may be acquired. Diagnosis is based on imaging and may be confirmed by the use of genetics. Clinical picture and prognosis and the management options are discussed

TC cardíaca na ablação da fibrilhação auricular - one-stop-shop?

© 2018 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license.Cardiac imaging has brought about spectacular innovations in the diagnosis, treatment, monitoring and outcome of cardiovascular disease, and the different imaging modalities constitute a set of tools that are crucial to clinical practice, research and education. The quality and accuracy of the information they provide have improved enormously in the last ten years, in parallel with other impressive technological advances in health care.info:eu-repo/semantics/publishedVersio

Cardiovascular magnetic resonance imaging and its role in the investigation of stroke : an update

© Springer-Verlag GmbH, DE part of Springer Nature 2021Recent advances in complementary diagnostic exams have helped to clarify stroke etiology, not only by helping to confirm established stroke causes but also by unveiling new possible stroke mechanisms. Etiological investigation for cardioembolic stroke has benefited in the last years from information provided by studies analysing serum biomarkers, heart rhythm monitoring and imaging methods like cardiovascular magnetic resonance (CMR) imaging. CMR has been particularly important for the characterization of possible new cardioembolic stroke mechanisms including atrial cardiomyopathy, silent myocardial infarction and cardiomyopathies.info:eu-repo/semantics/publishedVersio

Marfan syndrome revisited : from genetics to the clinic

© 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. Este é um artigo Open Access sob uma licença CC BY-NC-ND.Marfan syndrome is an autosomal dominant connective tissue disease with an estimated incidence of 1 in 5000 individuals. In 90% of cases it is caused by mutations in the gene for fibrillin-1, the main constituent of extracellular microfibrils. Studies on animal models of Marfan syndrome have revealed that fibrillin-1 mutations interfere with local TGF-β signaling, in addition to impairing tissue integrity. The cardinal features involve the cardiovascular, ocular and skeletal systems. The diagnosis of Marfan syndrome is made according to the revised Ghent nosology. Early identification and appropriate management are critical for patients with Marfan syndrome, who are prone to the life-threatening cardiovascular complications of aortic aneurysms and aortic dissection. The standard treatment includes prophylactic beta-blockers in order to slow down dilation of the ascending aorta, and prophylactic aortic surgery. The success of current medical and surgical treatment of aortic disease in Marfan syndrome has substantially improved mean life expectancy, extending it above 72 years. This review aims to provide an overview of this hereditary disorder.info:eu-repo/semantics/publishedVersio

Lime mortars with rice husk ash for ancient masonry

HMC08 - 1st Historical Mortars Conference: Characterization, Diagnosis, Conservation, Repair and Compatibility, LNEC, Lisbon, 24-26 September 2008This paper presents some preliminary results achieved in the aim of a research program with the main objective of evaluating the potential interest of using rice husk ashes on aerial lime based mortars for old buildings. The mechanical and physical characteristics and potential durability of lime mortars formulated with commercial rice husk ashes are analysed and their behaviour compared with a pure lime mortar. The results are also analysed taking into account the main aspects that are responsible for the compatibility between the new mortars and the original building materials. The potential durability of the tested mortars is evaluated through salt crystallization tests performed with sodium chloride and sodium sulphate solutions. The improvement of some properties of the lime mortars due to the presence of rice husk ashes pointed out the interest of the research in this domain, namely in what concerns the design of mortars with a moderately hydraulic behaviour for old buildings

Subclinical cardiotoxicity in cancer therapy : the impact of early detection

© 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. Todos os direitos reservados.Introdução e objetivos A avaliação seriada da fração de ejeção ventricular esquerda (FEVE) é o padrão de referência na vigilância da cardiotoxicidade induzida por quimioterapia (CIT). A avaliação da deformação longitudinal com técnicas de speckle tracking permite uma avaliação mais detalhada da contractilidade miocárdica. O objetivo deste estudo foi avaliar a relação entre a deformação longitudinal global (GLS) e regional e a incidência de CIT. Métodos Foram incluídos 158 pacientes num estudo prospetivo observacional de doentes com neoplasia da mama submetidos a quimioterapia com antraciclinas, com ou sem terapêutica adjuvante com trastuzumab. Foi efetuada uma monitorização ecocardiográfica seriada de parâmetros de função sistólica e diastólica, incluindo a avaliação da deformação miocárdica longitudinal bidimensional. A incidência de CIT foi definida como uma diminuição da FEVE para valor < 53%, de acordo com o documento de consenso da Sociedade Europeia de Imagiologia Cardiovascular (EACVI). Os doentes foram classificados como tendo deterioração da contractilidade miocárdica para um valor de GLS menos negativo que ‐18%, de acordo com os critérios da EACVI. Resultados Durante um período de seguimento médio de 5,4 meses (1‐48 meses), a incidência de CIT foi de 18,9%. Na população global observou‐se uma deterioração significativa do GLS durante o tratamento com quimioterapia (‐20,1 ± 3,5% versus 18,7 ± 3,4%, p = 0,001), com compromisso do GLS detetado durante em algum período do seguimento em 61,4% dos doentes. Esta deterioração foi mais marcada no subgrupo de doentes com CIT (GLS: ‐17,2 ± 2,5%, p = 0,02). Na análise regional da deformação longitudinal, verificou‐se compromisso da contractilidade envolvendo preferencialmente os segmentos septais (seis em seis) e parede anterior (dois em três). Por regressão logística multivariada, o compromisso do GLS esteve independentemente associado ao desenvolvimento de CIT (odds ratio 4,88, IC 1,32‐18,0, p = 0,017). Conclusões O compromisso da deformação longitudinal é frequente em doentes submetidos a quimioterapia e mostrou um padrão de distribuição predominante a nível septal e anterior. A degradação da GLS foi um preditor independente de CIT.Introduction Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) is the gold standard in screening for chemotherapy‐induced cardiotoxicity (CIC). Measurement of myocardial deformation using speckle tracking enables more detailed assessment of myocardial contractility. The aim of this study was to determine the relationship between global and regional longitudinal strain and CIC. Methods This was a prospective study of 158 breast cancer patients undergoing chemotherapy with anthracyclines with or without adjuvant trastuzumab who underwent serial monitoring by transthoracic echocardiography with assessment of myocardial deformation. CIC was defined as a decrease in LVEF to <53%. Global longitudinal strain (GLS) was estimated using EchoPAC BT12 software on a GE Vivid E9 cardiac ultrasound system. Patients were classified according to the 2015 ASE/EACVI criteria as having impaired myocardial deformation when GLS was reduced (less negative), with a cutoff of ‐18%. Results During a mean follow‐up of 5.4 months (1‐48 months), the incidence of CIC was 18.9%. A decrease in GLS was observed during follow‐up for the entire cohort (baseline GLS ‐20.1±3.5% vs. ‐18.7±3.4% at last follow‐up assessment, p=0.001). A total of 97 patients (61.4%) were observed to have impaired myocardial deformation (GLS ≥18%) at some point during follow‐up. This decrease was more significant in patients who eventually developed CIC (GLS ‐17.2±2.5%, p=0.02). On analysis of regional strain, impaired contractility was observed in the septal (6 out of 6) and anterior (2 out of 3) segments. Multivariate logistic regression showed that patients who developed impaired longitudinal strain had a 4.9‐fold increased risk of developing CIC (odds ratio 4.88, confidence interval 1.32‐18.0, p=0.017). Conclusions Worsening of myocardial deformation as assessed by speckle tracking is common in breast cancer patients undergoing chemotherapy, with predominantly septal and anterior wall involvement. Impaired myocardial deformation was independently associated with increased incidence of CIC.info:eu-repo/semantics/publishedVersio

Diagnostic questions in hypertrophic cardiomyopathy : what is the significance of late enhancement on cardiac magnetic resonance?

© 2014 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L. Todos os direitos reservados.info:eu-repo/semantics/publishedVersio

Understanding learning skills in online learning environments by higher education students

Can virtual environments promote learning skills such that higher education students understand them? This paper examines the impact of new online educational scenarios as to how self-learning skills are perceived. The research covered 277 higher education students grouped into classrooms, and their tutoring included an online learning component. At the end of the academic semester, students responded to a range of self-learning skills adapted to learning in virtual environments. All participants attended Social and Human Sciences course units in higher education, in different institutions, respectively the State Public University and Private Polytechnic institutions. The results of the study show that virtual learning environments, anchored in a design focused on the development of skills and in a teaching model based on the principles of constructivism, autonomy and interaction can be positive in how higher education students perceive learning skills, according to the following dimensions: Active Learning, Learning Initiative and Autonomy. The study examines the implications of the findings, from the perspective of both the practical intervention and the reflection on the future of educational processes.Fundação para a Ciência e Tecnologi

Role of microRNAs in the regulation of cardiovascular diseases : focus on remodelling

MicroRNAs (miRNAs) are a large class of noncoding RNAs that regulate the expression of protein-coding genes at the post-transcriptional level . They are recognized as regulators of biological processes underlying cardiovascular disorders including hypertrophy, ischemic heart disease, valvular disease and arrhythmias. Particularly, circulating miRNAs are promising biomarkers of cardiovascular pathology (1). MiRNAs are small, noncoding, RNA molecules with approximately 22 nucleotides in length, which act as post-transcriptional regulators of gene expression. Individual miRNAs have been demonstrated to negatively regulate the expression of multiple gene transcripts by the cleavage or suppression of translation of a target mRNA. Conversely, the expression of individual genes can be regulated by multiple miRNAs. Since their experimental description in 1993 (2), a large number of miRNAs known by their gene-regulatory roles in different biological processes, have been catalogued. In fact, miRNAs are known to regulate approximately one third of all coding gene transcripts in mammals, showing their importance as key process modulators (3). Regarding cardiovascular diseases, miRNAs have been identified as key regulators of complex biological processes linked to several conditions as presented above, including left ventricular remodelling, atherosclerosis and myocardial infarction, heart failure, hypertension and arrhythmias (1). miRNAs are expressed in the cardiovascular system, but their role in cardiovascular diseases has not yet been entirely clarified. Moreover, since the discovery that miRNAs are present in the circulation, they have been investigated as novel biomarker as presented bellow. Only 3% of the human genome codes for proteins. Nevertheless, while noncoding RNAs will not act for coding into proteins they modulate all genomic functions. These noncoding RNAs include short miRNAs with approximately 22 nucleotides) and longer, with >200 nucleotides, long noncoding RNAs (lncRNAs) with important biological functions (4) since they are now clearly recognised to play key roles in gene regulation and may simultaneously represent diagnostic and prognostic biomarkers in cardiovascular diseases. (5,6) there are in excess of 2000 human miRNAs (catalogued in mirBase (http://www.mirbase.org) (7). Of note, the key feature of the mechanism of action of miRNAs is that a single miRNA can regulate the expression of several genes, depending on the specificity of the target sequence. On the other side, individual genes can be regulated by different miRNAs particularly if they involve complementary sequences for more than one miRNA. These factors lead to a highly complex regulatory mechanism, often difficult to understand. (8,9). In the healthy adult heart, data from a large sequencing project and other sequential studies, has identified a number of miRNAs that are highly expressed in healthy cardiac tissue and thus expected to play a key role in both normal cardiac function and disease. (10,11) These include miR-1, miR-16, miR-27b, miR-30d, miR-126, miR-133, miR-143, miR-208 and the let-7 family. However, many others have been identified and are now under study. The concept of miRNA-based therapeutics has been emerging and under development, with synthetic antagonists of miRNAs (antagomiRs or antimirs) and very promising in animal models but awaiting new advances in phase II human trials, still in its infancy (12,13). miRNAs clearly intervene in physiological and pathological processes in the cardiovascular diseases. We will review miRNA biology and its role on LV remodeling in myocardial infarction, heart failure, hypertension and aortic stenosis as additionally a note will be provided on the potential of miRNAs for therapeutics.info:eu-repo/semantics/publishedVersio