This case report highlights the importance of a multimodal approach, tailored therapeutic interventions, and the poor prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) in a young patient with antiphospholipid syndrome (APS). A 39-year-old man was admitted with a diagnosis of a ST elevation myocardial infarction (STEMI), in Killip class III. Angiography showed absence of obstructive epicardial coronary artery disease prompting further evaluation with cardiac magnetic resonance imaging (MRI). It revealed infarction scars in multiple arterial territories and severe left ventricular dysfunction. The patient evolved with heart failure with reduced ejection fraction and a subcutaneous implantable cardioverter-defibrillator was implanted.

Journal Article Massive myocardial calcification as an aetiology of heart failure Get access Marta Catarina Bernardo, Marta Catarina Bernardo Cardiology Department, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal Corresponding author. Tel: +351 918977416, Email: mcrbernardo@chtmad.min-saude.pt https://orcid.org/0009-0005-8753-4615 Search for other works by this author on: Oxford Academic PubMed Google Scholar Sofia Silva Carvalho, Sofia Silva Carvalho Cardiology Department, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal Search for other works by this author on: Oxford Academic PubMed Google Scholar Ilídio Moreira Ilídio Moreira Cardiology Department, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 45, Issue 12, 21 March 2024, Page 1086, https://doi.org/10.1093/eurheartj/ehae009 Published: 23 January 2024

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Alcoholic cardiomyopathy is a severe consequence of chronic alcohol abuse and causes gradual changes in the structure and function of the heart, being a form of dilated cardiomyopathy. Purpose To characterize the population of patients (pts) with alcoholic cardiomyopathy (AC) in terms of baseline characteristics, echocardiographic parameters, alcohol consumption, medication and outcomes. We also intended to evaluate the impact of alcohol reduction/cessation. Methods We performed a retrospective study of the group of pts with the diagnosis of AC, established after exclusion of other aetiologies, followed in the heart failure consultation between 2018 and 2022. We divided the population into patients who maintained (2), reduced (1) (to an average of 2 drinks in men and 1 in women) or discontinued consumption (0). Results A total of 39 pts with a mean age of 68.13 ± 11 years were included. Of these, 35 were males (89.7%). In terms of cardiovascular risk factors, 64.1% had hypertension, 33.3% had diabetes, 53.5% dyslipidaemia, 10.3% had chronic hepatic disease, 30.8% were smokers and 10.3% ex-smokers. The prevalence of atrial fibrillation (AF) was 46.2%, with a median heart rate of 72.50 ± 20.99 bpm. At the beginning of follow-up, this population had a mean left ventricular ejection fraction (LVEF) of 30.46% ± 9.99, a mean indexed LA volume of 58.5 ml/m2 ± 32.63 and a mean indexed LV volume 87.44% ± 27.73. Concerning the alcohol consumption, during the follow-up, 43.6% of the patients stopped drinking alcohol, 10.3% reduced the habits and 20.5% maintained the consumption. Regarding the medication, at the end of follow-up 24.4% were medicated with sacubitril/valsartan, 51.1% with angiotensin-converting enzyme inhibitors, 71.1% with beta blockers, 51.1% with mineralocorticoid receptor antagonists and 35.6% with SGLT2 inhibitors. In a mean follow-up of 26.62± 11.11 months, there was a significant improvement of the ejection fraction (mean of 9.59% ± 12.97, p< 0.001), with a mean LVEF of 40.59% ± 12.78 at the end of follow-up. In fact, in 17.8% of the patients the final LVEF was more than 50%. Regarding indexed LV volume, there was a significant reduction during follow-up (102.250 ± 43.46 ml/m2, p= 0.018). Concerning alcohol consumption, pts who quit drinking had a mean improvement of LVEF of 13,73% ± 15.83 (p= 0.003), pts who reduced alcohol consumption 8.6% ± 5.81 (p=0.03) and pts that kept the consumption 2.67% ± 3.01 (p= 0.82). The variation of LVEF was statistically significant between the groups (p=0.03). These three groups had no statistically significant differences in medical history of hypertension (p=0.37), diabetes (p=0.22), dyslipidaemia (p=0.17), AF (p=0.70) and medication. Conclusion Pts with alcoholic cardiomyopathy had a high prevalence of atrial fibrillation and cardiovascular risk factors. Improvement and even recovery of cardiac function depends on reduction/extinction of alcohol consumption.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right-sided infective endocarditis (RIE) involves native/prosthetic valves and any intracardiac devices present in the right cavities. It's caused by the seeding of any of these structures by bacterial or, less commonly, fungal organisms. It's commonly associated with intravenous drug use, intracardiac devices and central venous catheters, all of which became more prevalent over the past 20 years. Purpose We aimed to characterize the patients with right-sided infective endocarditis, including device endocarditis, admitted to our center and compare them with patients admitted with left-sided infective endocarditis (LIE). Methods We performed a retrospective study of a group of patients (pts) with infective endocarditis (IE) admitted to our center from 2000 to 2020. Pts were categorized with right-sided endocarditis when presented with endocarditis of the native/prosthetic valves right-sided and intracardiac devices. We considered, as composite endpoint, deaths, embolic events and recurrence of endocarditis in a medium follow-up of 37.4 ± 46.0 months. Results A total of 160 pts (106 males, mean age 66,3 ± 16 years) with the diagnosis of IE were included. 32 pts had RIE (11 with involvement of tricuspid valve and 23 with device involvement) and 126 had LIE (100 of native valve and 26 of prosthetic valve). We had 56 (15.5%) pts referred to surgery during hospitalization and 27 (7.5%) died during hospitalization. Compared with LIE, most of the pts with RIE were males (84% versus 61%, p= 0,015). The mean age was similar between the groups (p= 0,584). Pts with RIE had a lesser prevalence of known valvular heart disease (48% versus 21%, p= 0,007). Concerning complications of endocarditis, pts with RIE had less prevalence of fistula (18% versus 0%, p= 0,021). During hospitalization, the proportion of pts undergoing surgery was significantly less in patients with RIE (31% vs 61%, p=0,001). Considering the subgroup of patients with device endocarditis, 14 patients undergo device extraction (8 percutaneous and 6 surgical extraction). During a mean follow-up duration of 37.4 ± 46.0months, pts with the diagnosis of RIE had better outcomes for the composite endpoint (61% vs 33%, p=0.003). Even when we considered the events during the hospitalization (namely embolic events or death), this subgroup had fewer events (83% vs 63%, p=0.034). In a multivariate regression analysis, after adjusting for all the confounders (previous cardiac failure, development of severe valvular regurgitation, presence of fistula/perforation and development of abscess), RIE was an independent predictor of less prevalence of the composite endpoint (HR 0.38; 95% CI: 0.19-0.79). Conclusions RIE was associated with a better outcome, when considering death, embolic events, or recurrence of endocarditis. The patients with right-sided endocarditis were also less frequently submitted to surgery compared to others.

Apesar dos avanços da medicina, há já várias décadas que os exames comparticipados pelo Serviço Nacional de Saúde (SNS) para o estudo e estratificação de risco da doença coronária se mantêm inalterados em cuidados de saúde primários. Apesar do desajuste à prática clínica contemporânea ser há muito evidente, a recente publicação das Recomendações Europeias para o diagnóstico e tratamento da síndrome coronária crónica veio realçar ainda mais este desfasamento e evidenciar a necessidade imperiosa de mudança na forma como são estudados estes pacientes em Portugal. No seguimento desta publicação, o Grupo de Estudo de Cardiologia Nuclear, Ressonância Magnética (RM) e Tomografia Computorizada (TC) Cardíaca, o Grupo de Estudo de Ecocardiografia e o Grupo de Estudos de Patofisiologia do Esforço e Reabilitação Cardíaca da Sociedade Portuguesa de Cardiologia iniciaram um processo de reflexão conjunta sobre as limitações atuais e a forma como poderiam ser aplicadas as recomendações internacionais no nosso país. Para tal, os autores sugerem que os novos métodos de imagem (ecocardiograma de esforço ou de sobrecarga, TC e RM cardíaca) se associem à prova de esforço e cintigrafia de perfusão do miocárdio no portfólio de exames oferecidos pelo SNS. Esta alteração permitiria uma plena adoção das recomendações europeias e uma melhor utilização dos meios, de acordo com o contexto clínico, a disponibilidade e as particularidades locais. A adoção de “normas de orientação clínica” baseadas nestes pressupostos traduzir‐se‐ia numa melhoria qualitativa na abordagem e otimização terapêutica destes pacientes, ao mesmo tempo em que potenciaria uma gestão eficaz dos recursos disponíveis, com potenciais ganhos de saúde e financeiros.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia.

Enhanced recovery after surgery (ERAS) protocol is an evidence-based programme that englobe more restrictive fluid therapy to maintain euvolemia and the use of multimodal analgesia, which includes non-steroidal anti-inflammatory drugs (NSAIDs). Consequently, it's pertinent to assess the risk and potential consequences of acute kidney injury (AKI) in the short and medium term. A descriptive and single-center retrospective study, which included 428 patients that were submitted to colon-rectal surgery according to ERAS protocol between November 2016 and May 2020. AKI was defined according to KDIGO criteria. Data were collected from 428 patients. AKI occurred in 25.2% of patients (108), mostly KDIGO 1 (63.9%) and 6.5% required haemodialysis. The median time of follow-up was 25.6 months (IQ 15.6–38.8). Patient-related variables that positively influenced AKI were ASA Class III/IV [F (1, 426) = 23.2; P < .001], diabetes [F (1, 426) = 9.96; P = .002], severe heart disease [F (1, 426) = 7.12; P = .008], CKD [F (1, 425) = 11.58; P < .001], obesity [F (1, 423) = 14.21; P < .001] and use of ACE inhibitors/ARBs [F (1, 425) = 17.4; P < .001]. Preoperative and surgery-related variables that influenced AKI were preoperative haemoglobin [F (85, 338) = 1.36; P = .030], open approach [F (1, 424) = 21.5; P < .001], NSAIDs [F (1–426) = 5.77; P = .017], iodinated intravenous contrast exposure [F (1, 424) = 26.8; P < .001), postoperative support aminergic [F (1, 424) = 18.9; P < .001], surgery complications [F (1, 426) = 36.5; P < .001] and blood transfusion [F (1, 426) = 10.15; P = 0.002]. AKI group had a superior length of stay (9 versus 6 days; P < .001), ICU admission (31.5% versus 8.8%; P <.001), readmission at 30 days (12% versus 5.6%; P = .027) and mortality (23.1% versus 6.6%; P < .001). Kaplan–Meier analysis showed that the AKI group was associated with lower survival (log-rank test = 26.601; P < .001). We also found that the AKI group was associated with a greater reduction in GFR after 2 years (3.3 mL/min/1.73 m2 versus 1.8 mL/min/1.73 m2; P = .009). AKI was frequent among ERAS patients and was associated with worst outcomes—higher costs (since it was associated to longer hospitalization, higher readmission at 30 days and ICU admission), higher risk of reduction in GFR in the first 2 years and higher mortality.

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The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%.

A 52-year-old Caucasian woman with a history of hypertension since age 30 was referred to cardiology department due to aortic stenosis. She had exertional dyspnoea, without thoracic pain or syncope. There was no blood pressure gradient between upper and lower extremities. Transthoracic echocardiography revealed bicuspid aortic valve, severe valvular aortic stenosis and dilation of ascending aorta (figure 1). There was also a tapering of the descending aorta, with turbulent flow and a systolic peak gradient of 19 mm Hg (figure 2). To assess the thoracic aorta, the patient underwent CT angiography, which revealed elongation of the distal aortic arch, a focal kinking at the aortic isthmus, and absence of significant stenosis and enlarged collateral arteries, consistent with aortic pseudocoarctation (figure 3). …

Introduction: We sought to assess the prognostic impact of left atrial (LA) size on long-term outcomes of ST-segment elevation myocardial infarction (STEMI). Methods: We studied 200 consecutive patients admitted to a single center between January 2010 and December 2014 with non-fatal STEMI treated with primary percutaneous coronary intervention (pPCI) who underwent a comprehensive echocardiographic examination at discharge. LA volume was estimated by the area-length method. The left atrium was classified as normal, mildly, moderately or severely enlarged by LA volume index (LAVI). The endpoints were defined as all-cause mortality, a cardiac composite endpoint (all-cause mortality, reinfarction, unplanned revascularization and hospitalization for heart failure) and a cardiovascular composite endpoint (cardiac endpoint plus atrial fibrillation and ischemic stroke) during follow-up. Results: In this STEMI population, 58% had normal LA size, 22.5% had mild LA enlargement, 10% had moderate LA enlargement and 9.5% had severe LA enlargement. During a median follow-up of 28 (IQR 21-38) months, 14 (7.0%) patients died, 53 (26.5%) had the cardiac and 58 (29%) the cardiovascular composite endpoints. There was a stepwise increase in the incidence of all-cause mortality (p=0.020) and both cardiac (p<0.001) and cardiovascular (p<0.001) endpoints with each increment of LAVI class. In multivariate analysis, severe LA enlargement by LAVI was an independent predictor of all-cause mortality (HR: 11.153; 95% CI: 1.924-64.642, p=0.007) and the cardiac (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) and cardiovascular (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) endpoints during follow-up. Conclusions: This contemporary study confirms the prognostic effect of LA size at discharge, applying the most recent reference values in STEMI patients treated with pPCI. Resumo: Introdução: Este estudo procurou avaliar o impacto prognóstico da dimensão da aurícula esquerda (AE) no enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCSST). Métodos: Foram estudados 200 doentes consecutivos, admitidos num único centro por EAMCSST não fatal, submetidos a intervenção coronária percutânea primária (ICPp) entre janeiro de 2010 e dezembro de 2014, que realizaram ecocardiograma à alta. O volume da AE foi calculado pelo método area-length. A AE foi classificada como normal ou ligeira, moderada ou severamente dilatada pelo volume indexado. Os endpoints primários foram a mortalidade por todas as causas, um endpoint composto cardíaco (morte, re-enfarte, revascularização não planeada e admissão por insuficiência cardíaca) e outro cardiovascular (endpoint cardíaco, fibrilhação auricular e acidente vascular cerebral isquémico) no follow-up. Resultados: Em 58% dos doentes a AE tinha dimensões normais e 22,5% apresentavam dilatação ligeira, 10% dilatação moderada e 9,5% dilatação severa. Durante um follow-up mediano de 28(IIQ 21-38) meses, 14 (4%) doentes morreram, 53(26,5%) tiveram o endpoint composto cardíaco e 58 (29%) o endpoint composto cardiovascular. A incidência de morte (p=0,020) e dos endpoints compostos cardíaco (p<0,001) e cardiovascular (p<0,001) no follow-up foi superior nos maiores graus de dilatação da AE. Na análise multivariada, a dilatação severa da AE foi preditora independente de morte (HR: 11,153; 95% CI: 1,924-64,642, p=0,007) e dos endpoints compostos cardíaco (HR: 4,351; 95% CI: 1,919-9,862, p<0,001) e cardiovascular (HR: 4,351; 95% CI: 1,919-9,862, p<0,001). Conclusões: Este estudo confirma a importância prognóstica do tamanho da AE na alta utilizando os valores de referência mais recentes nos EAMCSST submetidos a ICPp. Keywords: Acute coronary syndrome, ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Left atrial volume, Area-length method, Prognosis, Palavras-chave: Síndrome coronária aguda, Enfarte agudo do miocárdio com supradesnivelamento do segmento ST, Intervenção coronária percutânea primária, Volume da aurícula esquerda, Método area-length, Prognóstico

Mulher de cor branca, 52 anos, foi internada com dor epigastrica intensa irradiando para as costas. O exame fisico e o eletrocardiograma eram normais. Os exames laboratoriais mostraram leucocitose (11100 celulas/µl) e aumento dos niveis de proteina C-reativa (15,6 mg/dl). Devido a suspeita de sindrome aortica aguda (SAA), ela foi submetida a tomografia computadorizada, que mostrou espessamento mural circunferencial da aorta com baixa atenuacao (43 Unidades Hounsfield (HU)), havendo aumento da atenuacao desse espessamento (73 HU) apos administracao de contraste [...]

Mulher de 33 anos deu entrada em nosso hospital apresentando sintomas de dispneia apos exercicio fisico, ortopneia, tosse e edema podal nos ultimos seis meses. Seis anos antes, ela foi submetida ao procedimento de Ross para correcao de uma valvula aortica bicuspide. Exame fisico nao apresentou problemas, exceto por um sopro sistolico de nivel 3 na borda esquerda do esterno. […] Pseudoaneurisma Gigante da Via de Saida do Ventriculo Esquerdo apos Procedimento de Ross

Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.

Charge separation is a vital process in order to achieve high performance TiO2-based photocatalysts. In the current study, to enhance the charge separation and suppress the charge recombination, novel nanocomposites of metal (Co and Cu) and nonmetal (C, N, S) doped TiO2 nanophotocatalyst (labeled as [email protected],N,S-doped TiO2 and [email protected],N,S-doped TiO2) were synthesized via photochemical deposition-assisted sol–gel technique. The crystalline structures and characteristic of the prepared catalysts were analyzed by XRD, SEM, TEM, EDAX, PL, and UV–vis DRS spectroscopies. The photocatalytic performance of the samples was tested through decomposition of methyl orange (MO) aqueous solutions under UV and visible light irradiation. It was found that photodeposition of metals onto TiO2 slowed charge recombination compared to pure TiO2 in addition to formation of higher concentration of OH radicals on the TiO2 photocatalyst surface during light irradiation compared to pure TiO2. Beyond the optimum content of 2 wt% Cu and Co, a decline in photocatalytic performance was observed which was ascribed to metal agglomeration and blockage of the photosensitive TiO2 surface.

Objectives: The incidence of mechanical complications after acute myocardial infarction has markedly declined with the advent of reperfusion. Nevertheless there is some controversy about the equal effectiveness of the different reperfusion therapies in preventing these complications. We aimed to analyse how reperfusion therapy and treatment delay relate to the incidence of mechanical complications in a population of ST-elevation myocardial infarction (STEMI) patients.Methods: We analysed all STEMI patients included in the second phase of the Portuguese Registry on Acute Coronary Syndromes, between October 2010 and July 2015. We compared both conservative medical treatment with reperfusion therapy and thrombolysis with primary percutaneous coronary intervention for mechanical complications. We also evaluated the impact of treatment delay on mechanical complications.Results: Among 5230 STEMIs we observed 77 mechanical complications (1.5%). These were significantly more frequent in the non-reperfused patients (3.3% vs. 1.1%, P<0.001) and they were numerically higher in thrombolysis than in primary percutaneous coronary intervention patients (1.6% vs. 1.0%, respectively, P=0.282). Patients with mechanical complications had higher times from symptom onset to hospitalisation and to reperfusion. In multivariate analysis performing reperfusion therapy (odds ratio 0.52, 95% confidence interval 0.29-0.93) and a time from symptom onset to hospitalisation 6 hours (odds ratio 2.44, 95% confidence interval 1.37-4.33) were independent predictors of mechanical complications. The type of reperfusion did not influence the occurrence of mechanical complications.Conclusion: A longer time from symptom onset to hospitalisation was associated with an increased number of mechanical complications. Timely reperfusion therapy prevented mechanical complications and no significant difference was found between thrombolysis and primary percutaneous coronary intervention.