Terapêutica anti-hipertensiva em doentes diabéticos

Diabetes Mellitus e Hipertensão Arterial são entidades clínicas que se associam frequentemente num mesmo doente; juntas exercem um efeito sinérgico provocando, entre outras, deterioração acelerada da função renal e um aumento do risco cardiovascular. A tensão arterial no doente diabético deve ser rigorosamente controlada de modo a atingir valores inferiores a 130/80 mmHg. Objectivos: Análise das classes farmacológicas de anti-hipertensores mais indicadas no tratamento do diabético hipertenso. Métodos: Revisão bibliográfica incluindo tratados de referência e artigos recentemente publicados nas áreas da Diabetologia e Hipertensão Arterial. Conclusões: Os anti-hipertensores de primeira linha deverão ser os inibidores da enzima de conversão da angiotensina I, devido aos seus efeitos protectores renais e cardiovasculares, ou os antagonistas dos receptores de angiotensina II, caso haja intolerância ou contra-indicação aos primeiros. A estes podem-se associar diuréticos tiazídicos em baixa dose. Numa segunda linha do arsenal terapêutico temos os b-bloqueantes e os bloqueadores dos canais de cálcio. Os diuréticos de ansa, agentes centrais e a-bloqueantes são fármacos de terceira linha a ser empregues face a casos de hipertensão arterial resistente às classes anteriores e/ou em casos específicos

Impact of left atrial volume, sphericity, and fibrosis on the outcome of catheter ablation for atrial fibrillation

INTRODUCTION: To investigate the relation between left atrial (LA) volume, sphericity, and fibrotic content derived from contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) and their impact on the outcome of catheter ablation for atrial fibrillation (AF). METHODS AND RESULTS: In 83 patients undergoing catheter ablation for AF, CE-CMR was used to assess LA volume, sphericity, and fibrosis. There was a significant correlation between LA volume and sphericity (R = 0.535, P < 0.001) and between LA volume and fibrosis (R = 0.241, P = 0.029). Multivariate analyses demonstrated that LA volume was the strongest independent predictor of AF recurrence after catheter ablation (1.019, P = 0.018). CONCLUSION: LA volume, sphericity, and fibrosis were closely related; however, LA volume was the strongest predictor of AF recurrence after catheter ablation

Dessincronia ventricular mecânica em pacientes com função ventricular esquerda diminuída referenciados para cintigrafia de perfusão miocárdica (gated SPECT)

Introduction: Gated SPECT myocardial perfusion imaging (MPI) has been used to quantify mechanical dyssynchrony. Mechanical dyssynchrony appears to be related to response to cardiac resynchronization therapy. Objective: To evaluate the presence and predictors of mechanical dyssynchrony in patients with impaired left ventricular function (LVEF) ≤50%. Methods: The study included 143 consecutive patients referred for gated SPECT MPI with LVEF ≤50%. Gated SPECT MPI was performed according to a stress/rest protocol acquiring images with Tc 99m-tetrofosmin. Emory Cardiac Toolbox software was used for phase analysis and a standard deviation (SD) ≥43◦ was considered to indicate mechanical dyssynchrony. Results: Mechanical dyssynchrony was present in 53.1% of the patients. Its predictors were diabetes (OR 2.0, p≤0.05), summed stress score (OR 1.1, p≤0.0005), summed rest score (OR 1.1, p≤0.0001), end-diastolic volume (OR 1.0, p≤0.0001), LVEF (OR 0.9, p≤0.0001), LVEF ≤35% (OR 3.1, p≤0.005) and LVEF ≤35% and QRS ≥120 ms (OR 3.5, p≤0.05). In this study QRS width and QRS ≥120 ms were not predictors of mechanical dyssynchrony. Conclusions: Myocardial perfusion imaging can be used to assess mechanical dyssynchrony. In patients with impaired ventricular function mechanical dyssynchrony was highly prevalent and was related to parameters of left ventricular function and perfusion.Introduc¸ão: A avaliac¸ão de dessincronia ventricular mecânica através da análise do histograma de fase na cintigrafia de perfusão miocárdica tem sido descrita na literatura. Segundo a evidência atual, a presenc¸a de dessincronia mecânica encontra-se relacionada com a resposta à terapêutica de ressincronizac¸ão. Objectivos: Avaliar a presenc¸a e os preditores de dessincronia ventricular mecânica em pacientes com frac¸ão de ejec¸ão ventricular esquerda (FEVE) ≤ 50%. Métodos: Foram incluídos pacientes que realizaram cintigrafia de perfusão miocárdica e cuja FEVE foi inferior ou igual a 50%. A amostra estudada incluiu 143 pacientes. As imagens de perfusão foram adquiridas de acordo com o protocolo esforc¸o seguido de repouso com Tc-99m Tetrafosmina. A avaliac¸ão de dessincronia baseou-se na determinac¸ão do desvio padrão obtido através da análise do histograma de fase (Emory Toolbox Software). A presenc¸a de dessincronia foi considerada quando o desvio-padrão no histograma de fase foi superior ou igual a 43◦. Resultados: A presenc¸a de dessincronia foi observada 53,1% dos doentes. Foram preditores de dessincronia, a diabetes (OR 2,0, p ≤ 0,05), o score de esforc¸o (OR 1,1, p ≤ 0,0005), o score de repouso (OR 1,1, p ≤ 0,0001), o volume telediastólico (OR 1,0, p ≤ 0,0001), a FEVE (OR 0,9, p ≤ 0,0001), FEVE ≤ 35% (OR 3,1, p ≤ 0,005) e a presenc¸a em simultâneo de FEVE ≤ 35% e QRS ≥120 ms (OR 3,5, p ≤ 0,05). Nesta avaliac¸ão a durac¸ão do QRS ou a presenc¸a de QRS ≥ 120 ms não se relacionaram com a presenc¸a de dessincronia. Conclusões: A cintigrafia de perfusão miocárdica pode ser usada na avaliac¸ão de dessincronia e esta tem uma elevada prevalência em pacientes com FEVE diminuída relacionando-se com parâmetros de func¸ão ventricular e perfusão miocárdica

Involving fishers in scaling up the restoration of cold-water coral gardens on the Mediterranean continental shelf

12 pages, 6 figures, 2 tables, supplementary data https://doi.org/10.1016/j.biocon.2021.109301Cold-water gorgonians dwelling on the continental shelf are a common by-catch of bottom-contact fishing practices. Given the slow growth and limited recruitment of cold-water gorgonians, the impact of fishing activities may seriously compromise the conservation of the highly complex coral gardens communities. For this reason, the development of effective active and passive restoration methods is nowadays a priority in order to enhance the natural recovery of impacted cold-water coral gardens. However, the ecological restoration of mesophotic and deep-sea communities remains extremely limited, due to its technological requirements and associated costs, which bring its wide-scale and long-term application into question. This study reports the preliminary results of the first large-scale active restoration of more than 400 cold-water gorgonians on the Mediterranean continental shelf. By actively involving local fishers during two consecutive fishing seasons, by-catch gorgonians were recovered and returned to the continental shelf (at 80–90 m depth). The monitoring surveys performed by using an Autonomous Underwater Vehicle (AUV) revealed that 460 gorgonian transplants survived over an area of 0.23 ha. The reintroduced cold-water gorgonian population was compared to a reference natural population in terms of size and spatial structure. The cost of the restoration amounted to 140,000 €/ha, which is significantly lower than that of any deep-sea restoration actions performed to date. The results of this cost-effective active restoration highlight the viability of large-scale restoration of impacted cold-water coral communities, with promising results for the conservation and recovery of mesophotic and deep-sea ecosystemsThis work was supported by the European Union's Horizon 2020 research and innovation program, Grant/Award Number: No 689518 (MERCES); the Fundación Biodiversidad of the Spanish Ministry for the Ecological Transition through the Pleamar Programme (RESCAP project), co-funded by the European Maritime and Fisheries Fund; Spanish Ministry for Education, Culture and Sports, Grant/Award Number: FPU 2014_06977 (FPU 2014 grant), and the Spanish Ministry for Economy and Competitiveness, Grant/Award Number: IJCI-2015-23962 (JdC 2015 grant).CL acknowledges the financial support from ICREA [ICREA Academia programme]With the institutional support of the ‘Severo OchoaCentre of Excellence’ accreditation (CEX2019-000928-S)Peer reviewe

Anticoagulation with edoxaban in patients with long Atrial High-Rate Episodes ≥24 hours

BACKGROUND AND AIMS: Patients with long atrial high-rate episodes (AHRE) ≥ 24 hours and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared to no anticoagulation in these patients.METHODS: This secondary prespecified analysis of NOAH-AFNET 6 examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared to placebo in patients with AHRE and stroke risk factors. The primary efficacy outcome was a composite of stroke, systemic embolism, or cardiovascular death. The safety outcome was a composite of major bleeding and death. Key secondary outcomes were components of these outcomes and ECG-diagnosed atrial fibrillation.RESULTS: AHRE ≥24 hours were present at baseline in 259/2389 patients enrolled in NOAH-AFNET 6 (11%, 78 ± 7 years old, 28% women, CHA2DS2-VASc score 4). Clinical characteristics were not different from patients with shorter AHRE. During a median follow-up of 1.8 years, the primary outcome occurred in 9/132 patients with AHRE ≥24 hours (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). AHRE duration did not interact with the efficacy (p-interaction = 0.65) or safety (p-interaction = 0.98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE ≥24 hours developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; p &lt; 0.001).CONCLUSIONS: This hypothesis-generating analysis does not find an interaction between AHRE duration and anticoagulation therapy in patients with device-detected AHRE and stroke risk factors. Further research is needed to identify patients with long AHRE at high stroke risk.</p

Evolução das características morfo-funcionais do coração do atleta durante uma época desportiva

Dissertação de mestrado em Medicina área científica de Medicina Desportiva, apresentado à Faculdade de Medicina da Universidade de CoimbraA presente investigação tem por objectivo estabelecer quais as alterações cardiológicas morfo-funcionais, que ocorrem ao longo de uma época desportiva, em atletas de alta competição com modificações adaptativas previamente induzidas. Para tal, realizaram-se dois exames ecocardiográficos a cada um dos atletas do plantel sénior de uma equipa de futebol profissional, um no início da fase de treinos e outro no período de maior intensidade competitiva, considerado como o pico de esforço. Demonstrou-se que, após o breve período de descondicionamento que correspondeu às férias desportivas, existe lugar a adaptações adicionais, mesmo em atletas com vários anos de prática profissional prévia. Entre as duas avaliações, verificou-se o aumento significativo da espessura das paredes do ventrículo esquerdo e respectiva massa, e do diâmetro da aurícula esquerda, com manutenção do diâmetro telediastólico do ventrículo esquerdo, e dos parâmetros de função diastólica considerados. Uma maior extensão da hipertrofia da musculatura ventricular relacionou-se com maior utilização em competição por parte dos atletas em que ela ocorreu. A principal limitação do estudo prende-se com o pequeno número de atletas estudadosThis research aims to establish the cardiac morphological and functional changes that occur during a sports season in elite athletes with previously induced adaptative changes. Two echocardiographic examinations were performed in each athlete of a senior professional football team, the first at the beginning of the training stage and the other at the peak of the competitive season. It was demonstrated that after the brief period of deconditioning that corresponded to holidays, there was a place for further adjustments, even in these athletes with several years of prior professional practice. Between the two assessments, there was a significant increase in left ventricle wall thickness, in its mass, and in left atrium diameter, with maintenance of left ventricular diastolic diameter, and the diastolic function parameters considered as well. A greater extent of left ventricle wall hyperthrophy was related to higher competition time played by the respective players. The main limitation of the study is the small number of athletes studie

An inverted puzzle: a complex case of CRT in a congenitally corrected transposition of great vessels

TTE: congenitally corrected transposition of great vessels (ccTGA) and a dextrocardia; suspicion of ventricular septal defect (VSD; severely depressed left ventricular function (ejection fraction < 30%) Heart CT scan: confirmation of CCTGA and dextrocardiaN/

Cardioneuroablation: a new era for vagal syncope?

42 years old male athlete Bradycardia and vagal syncope episodes ECGs showed sinus rhythm with bradycardia (40-44 bpm) Transthoracic Echocardiogram: normal TILT test: positive - 2b cardio inhibitory response and 20s asystoleN/

Cardiac arrhythmias in patients presenting with COVID-19 treated in Portuguese hospitals: A national registry from the Portuguese Association of Arrhythmology, Pacing and Electrophysiology

Introduction and objectives: In December 2019, SARS-CoV-2, was discovered as the agent of COVID-19 disease. Cardiac arrhythmias have been reported as frequent but their incidence is unknown. The aim of this research was to assess the real incidence of cardiac arrhythmias among COVID-19 patients admitted to Portuguese hospitals and to understand the underlying prognostic implications. Methods: The Portuguese Association of Arrhythmology, Pacing and Electrophysiology (APAPE) conducted a survey in Portuguese hospitals to assess the occurrence of arrhythmias in COVID-19 patients, their clinical characteristics, the use of experimental therapies and the impact on QT interval.info:eu-repo/semantics/publishedVersio