The Strategic Plan for Cardiovascular Health in Portugal is an initiative of the Portuguese Society of Cardiology, developed together with the European Society of Cardiology to create a European Cardiovascular Health Plan, an initiative which has now been endorsed by the Council of the European Union. Building upon its conceptual framework, the Portuguese Society of Cardiology moved to the implementation phase by establishing Working Groups composed of experts in priority areas. Guided by strategic pillars, these groups formulated proposals for action encompassing health promotion, primary prevention and health determinants, screening and early diagnosis, secondary prevention, as well as rehabilitation and quality of life promotion. This document outlines the results and messages from this project.

Rheumatoid arthritis (RA) increases heart failure (HF) risk. Left atrial strain (LAs) may allow early detection of cardiac disease but has been seldom studied in RA. This study evaluated associations between LAs, clinical, laboratory, and echocardiographic parameters, and outcomes in RA patients without known cardiac disease. In this prospective observational study, RA patients underwent LAs analysis and were stratified into two groups by the median left atrium reservoir strain (LARs). The primary endpoint was a composite of myocardial infarction, stroke, atrial fibrillation, HF hospitalization, or cardiovascular death; secondary endpoints were its individual components and all-cause mortality. Median follow-up was 6.2 years. Of 364 patients enrolled, 260 underwent LAs analysis and comprised the final cohort (median LARs 37.4

The Strategic Plan for Cardiovascular Health in Portugal is an initiative of the Portuguese Society of Cardiology, aligned with efforts by the European Society of Cardiology and the World Heart Federation to develop national plans, at a local level within the cultural and socio-economic contexts, focused on cardiovascular health. The overarching goal is to promote and ensure the continuous and sustained improvement of cardiovascular health in the Portuguese population. The methodology identified key challenges and opportunities for the medium term, highlighted priority areas for intervention, and proposed strategic lines of action. This article outlines the project's design and establishes a guiding framework for the proposed actions, which will be drawn up by designated expert groups and communicated subsequently.

A tri-leaflet mitral valve (MV) is an extremely rare phenomenon, often associated with significant mitral regurgitation (MR). It may represent a phenotypic expression of hypertrophic obstructive cardiomyopathy (HOCM). We present the case of a 69-year-old woman with HOCM, a tri-leaflet MV, and systolic anterior motion (SAM)–induced severe MR. Despite receiving optimal medical therapy, her refractory symptoms and significant MR prompted surgical consideration. The patient underwent surgical myectomy, resulting in improvement of left ventricular outflow tract obstruction, SAM-induced MR, and symptomatic relief. This case illustrates a unique presentation of HOCM with a tri-leaflet MV and significant MR, successfully managed with a tailored surgical myectomy.

Introduction and Objectives: Cardiology has not been seen as an attractive specialty, and women have avoided it for many years. Some surveys have been performed in other countries, but in Portugal, the situation is largely unknown. Methods: An online survey on perceptions of cardiology and professional preferences was sent to 1371 members of the Portuguese Society of Cardiology, of whom 18.2% completed the survey. Results: We included 219 cardiologists or cardiology trainees, of whom 50.2% were female, with decreasing proportions from younger to older age groups, in which males still predominate. Women are less often married and more frequently childless, particularly those working in an invasive subspecialty, where they represent only 16% of all respondents working in these areas. Men's perception is that women do not choose these areas due to family reasons, radiation concerns and difficult working conditions, but from the female perspective, male dominance, lack of female role models and restricted access are the main barriers. Women consider it is difficult for them to obtain a leadership role, but men do not think the same (75.5% vs. 27.5%). Conclusion: In Portugal, females predominate in younger age groups, suggesting a paradigm change. Women are less frequently married and more frequently childless, particularly women working in invasive subspecialties. Women consider that it is more difficult for them to obtain a leadership role. Moreover, the barriers reported by women are substantially different from men regarding the reasons for not choosing an invasive subspecialty. (c) 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan a, S.L.U. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/bync-nd/4.0/).

Patients with rheumatoid arthritis (RA) have an increased risk of cardiac dysfunction and heart failure (HF) due to a pro-inflammatory state. Detecting cardiac dysfunction in RA is challenging as these patients often present preserved ejection fraction (EF) but may have subclinical ventricular dysfunction. Echocardiographic strain analysis is a promising tool for early detection of subclinical left ventricular systolic dysfunction (LVSD). This study assesses the prognostic role of strain analysis in RA. Prospective study of 277 RA patients without known heart disease and preserved EF, categorized by left ventricular global longitudinal strain (GLS): normal GLS (≤ − 18

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.repc.2022.10.004. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Subvalvular aortic stenosis manifesting as a subaortic membrane predisposes to bacterial endocarditis, which typically affects the aortic valve (AoV) or, less frequently, the left ventricular outflow tract (LVOT). We present the case of a 60-year-old woman expressing an odd form of a subvalvular aortic membrane in conjunction with a left Valsalva sinus pseudoaneurysm as a result of an endocarditis complication.

Global warming is a result of the increased emission of greenhouse gases. The consequences of this climate change threaten society, biodiversity, food and resource availability. The consequences include an increased risk of cardiovascular (CV) disease and cardiovascular mortality.In this position paper, we summarize the data from the main studies that assess the risks of a temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently support global warming/heat waves (extreme temperatures) as cardiovascular threats. Achieving neutrality in emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent steps are required to adapt the society and individuals to this new climatic context that is potentially harmful for cardiovascular health. Multidisciplinary teams should plan and intervene healthcare related to temperature changes and heat waves and advocate for a change in environmental health policy.(c) 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).

Correspondência: Sofia Cabral • Serviço de Cardiologia, Centro Hospitalar Universitário do Porto, Hospital Santo António – Largo do Prof. Abel Salazar, 4099-001 Porto Portugal E-mail: msofiacabral@gmail.com Palavras-chave Covid-19/complicações; Ultrassonografia/métodos; Dilatação Fluxo Mediada; Endotélio Vascular; Inflamação. No início de 2020, o mundo enfrentou o aparecimento de uma nova pandemia, a Doença do Coronavírus 2019 (COVID-19), causada por um novo coronavírus (vírus SARS-CoV-2). Rapidamente descobrimos que, embora o trato respiratório fosse o principal alvo, muitos outros sistemas de orgãos também podiam ser afetados. As manifestações cardiovasculares (CV) da COVID-19 estão entre as mais comuns e temidas e podem se apresentar como lesão miocárdica, arritmias, síndromes coronarianas agudas, insuficiência cardíaca, disfunção vascular e doença tromboembólica.1 Tanto a doença cardiovascular preexistente quanto a comórbida bem como a presença concomitante de fatores de risco CV são indicadores de pior evolução e prognóstico da doença.2 Digno de nota, o envolvimento CV agudo é um forte preditor independente de mortalidade hospitalar por COVID-19.3 A interação entre a infecção e o sistema CV é ainda objeto de estudo mas, além da lesão celular directa pelo vírus, acredita-se que a ativação de vias inflamatórias desempenhe um papel fundamental. Uma descrição detalhada da fisiopatologia do envolvimento CV na COVID-19 está para além do âmbito deste comentário e foi amplamente abordado em outros trabalhos.4 Sendo reconhecidas como comuns as desregulação cardíaca e vascular na fase aguda da infecção, as preocupações concentram-se agora nas anormalias CV residuais a longo prazo. Huang et al.,5 relataram que mais da metade dos pacientes convalescentes com COVID-19 apresentavam sinais de inflamação miocárdica ou fibrose na ressonância magnética cardíaca (RMC).5 Na mesma linha, a meta-análise de Kim et al.,6 mostrou que quase metade dos pacientes recuperados de COVID-19 apresentavam um ou mais resultados anormais de RMC.6 Da mesma forma, e sem surpresa, a infecção também pode induzir lesão vascular sustentada. À luz do tropismo do SARS-CoV-2 para células que expressam a enzima conversora de angiotensina 2 ligada à membrana, não é de admirar que o endotélio vascular seja um dos principais tecidos envolvidos na infecção. No entanto, os efeitos da infecção por COVID-19 no endotélio vascular e a interação complexa entre os dois ainda são pouco compreendidos. Na sua essência, a homeostase CV depende principalmente do papel do endotélio. Ele regula o tônus vascular, a adesão celular, a tromboresistência, a proliferação de células musculares lisas e, no final, a inflamação da parede do vaso. Sempre que o endotélio é ativado, resultando em disfunção endotelial, a sinalização celular muda de processos vasodilatadores mediados pelo oxido nítrico para processos redox vasoconstritores. Isso pode ocorrer como um fenômeno agudo transitório, com pouca ou nenhuma consequência, ou como uma ativação endotelial prejudicial sustentada, eventualmente levando a um meio pró-aterogênico e pró-trombótico.7

Air pollution is one of the main environmental risk factors for health and is linked to cardiovascular diseases, which are the leading cause of mortality worldwide.In this position paper, we discuss the main air pollutants and how they can promote the development of cardiovascular disease or cardiovascular events. We also summarise the main evidence supporting the association between air pollution and cardiovascular events, such as coronary events (acute coronary syndromes/myocardial infarction; chronic coronary syndromes), stroke, heart failure and mortality. Some recommendations are made based on these data and the European Society of Cardiology guidelines on cardiovascular disease prevention, acknowledging that it is important to increase awareness and literacy on this topic in Portugal.

The main objective of this consensus statement from the Portuguese Society of Cardiology, the Portuguese Society of Gynecology, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Portuguese Society of Contraception, Portuguese Association of General Practice and Family Medicine is to improve cardiovascular care for women. It includes a brief review of the state-of-the-art of cardiovascular diseases in women and of the links to other fields such as Gynaecology, Obstetrics and Endocrinology. It also provides final recommendations to help clinicians working in care of women's health.