Lusiadas Scientific Journal

Navigating Challenges and Uncovering Opportunities in Private Cardiology in Portugal

Eduardo Infante de Oliveira — 2024-09-30

Heart Failure: A World in Constant Evolution

Doroteia Reis Silva — 2024-09-30

Current and Future Landscape of Structural Heart Interventions

João Brito — 2024-09-30

Current Trends in Catheter-Directed Therapy for Acute Pulmonary Embolism

Silvio Leal — 2024-09-30

Acute pulmonary embolism is a leading cause of in-hospital and cardiovascular mortality, and it keeps posing important diagnostic and therapeutic challenges. Traditional treatment options such as anticoagulation, thrombolysis, and surgery are increasingly being challenged by new catheter-based procedures, including catheter-directed thrombolysis, mechanical thrombectomy, and pharmacomechanical hybrid techniques.

Emerging evidence supports the effectiveness and safety of these percutaneous methods, which may facilitate faster recovery of right ventricular function and hemodynamics in selected patients, with a lower risk of bleeding compared to standard medical therapy. These interventions may be particularly beneficial for high-risk patients for whom thrombolysis is contraindicated or has proven ineffective, as well as for initially stable intermediate-risk patients who experience hemodynamic decline despite appropriate anticoagulation.

Nevertheless, significant knowledge gaps continue to impede the optimization of these techniques and limit the shifting of treatment recommendations for acute pulmonary embolism. This paper provides a summary of the various catheter-directed interventions currently available, highlighting their indications, technical considerations, clinical effectiveness, and potential complications, offering a comprehensive overview of their current future trends in the management of acute pulmonary embolism.

Technological Advances Transforming the Clinical Practice of Atrial Fibrillation

Afonso Nunes-Ferreira — 2024-09-30

Atrial fibrillation (AF) is the most common arrhythmia causing stroke, myocardial infarction, and heart failure. An early diagnosis and treatment are crucial to reduce AF recurrence, progression of the disease and to improve prognosis. Thus, an opportunistic screening is recommended in people older than 65 years.

With the advent of digital medicine, there are a vast variety of wearables to enable an ECG-based or photoplethysmography-based notification for an irregular heart rhythm. Adopting digital health platforms facilitates remote monitoring of these notifications and integrating data from wearable devices, smartphones, and patient-reported outcomes, allowing healthcare providers to track AF in real-time and adjust management strategies proactively, leading to prompt and personalized treatment. However, there are some challenges to overcome such as managing an overwhelming volume of information, and storing health data raises concerns about patient privacy and data that we further develop in this revision.

Indeed, the complexity of AF requires a comprehensive, patient-centered management strategy for optimal outcomes. The AF-CARE pathway simplifies the approach and focuses on managing comorbidities and risk factors, anticoagulation, rate, and rhythm control, and continuous patient reassessment.

Rhythm control strategies employed in the past decade, including the safer use of antiarrhythmic drugs and catheter ablation, have been shown to provide significant symptomatic improvement and reduce cardiovascular mortality and morbidity when initiated early. Technological advances in catheter ablation have enabled a paradigm shift towards single-shot procedures, using specialized catheters that deliver energy to isolate the pulmonary veins in a single application (“single shot”). These ablation techniques, incorporating cryoablation and more recently pulsed field ablation, represent an advancement in the treatment of atrial fibrillation, offering improved outcomes and safety for patients.

As consequence of the benefit and safety of catheter ablation, the 2024 European guidelines state that catheter ablation can be recommended as a first-line option within a shared decision-making rhythm control strategy for patients with paroxysmal AF to reduce symptoms, recurrence, and progression of AF.

The Impact of Technology and Digital Health on Cardiology: A Review of the Present to Reach the Future

Sofia Couto da Rocha — 2024-09-30

The integration of digital health technologies is revolutionizing the field of cardiology, particularly in the diagnosis, treatment, and management of cardiovascular diseases (CVDs). The rapid advancements in wearable devices, artificial intelligence (AI), and telemedicine have enabled more precise, predictable, and personalized care strategies, transforming the landscape of cardiovascular health. Wearable technologies, such as smartwatches with some electrocardiogram (ECG) capabilities, have improved early detection of arrhythmias, particularly atrial fibrillation (AF), enhancing patient outcomes by enabling timely interventions. Similarly, AI-driven diagnostic tools and machine learning (ML) models have demonstrated superior accuracy in interpreting ECGs and identifying complex arrhythmias, often outperforming traditional methods.

Telehealth has also gained traction, particularly during the COVID-19 pandemic, by facilitating remote monitoring of chronic CVDs. Remote monitoring devices, including implantable pacemakers and defibrillators, have further reduced mortality rates by providing real-time data to healthcare providers, allowing for early interventions. AI language models, such as ChatGPT, are being utilized to accelerate research, aid in clinical decision-making, and enhance patient engagement through personalized education and real-time assistance.

In addition to these advancements, digital therapeutics, and mobile health (mHealth) platforms are providing real-time feedback to patients and improving adherence to medication regimens, which is crucial for managing chronic conditions like hypertension and heart failure. Genomic and metabolomic medicine, with its focus on precision cardiology, allows for more personalized treatment plans based on an individual's genetic profile, further enhancing outcomes for those at risk for inherited cardiovascular diseases.

Despite the promising developments, challenges remain, including the need for better integration with healthcare systems, data privacy concerns, and ensuring equitable access to these technologies. Nevertheless, the future of cardiology is expected to be shaped by advancements in AI, wearable technologies, and precision medicine, paving the way for real proactive and personalized care.

Indications for Atrial Fibrillation Ablation: A Practical Guide for Non-Cardiologists

Pedro Silva Cunha — 2024-09-30

Given the increasing incidence of atrial fibrillation and the widespread use of catheter ablation as a form of non-pharmacological treatment, we intended to provide a practical guide for non-cardiologist physicians, concerning the main indications for this intervention based on current guidelines.

Cardiac Amyloidosis, Follow the Trail Not to Miss the Diagnosis

Silvia Ribeiro — 2024-09-30

Amyloidosis is a systemic disease caused by the extracellular deposition of insoluble fibrils of low molecular weight proteins, the most common of which are light chains (AL amyloidosis) and transthyretin (ATTR amyloidosis), the latter in acquired (wild type) or hereditary form. Despite being considered rare, its underdiagnosis is now recognized, meaning that a high index of suspicion is essential in order to modify the morbidity and mortality of patients affected by it.

The authors describe a case report of amyloidosis with cardiac involvement.

A Rare Presentation of an Acute Aortic Syndrome

Nuno Fernando Morais Moreno — 2024-09-30

Arrhythmogenic Left Ventricular Cardiomyopathy Diagnosis: Benefiting from Advanced Cardiac Imaging

Marta Fonseca — 2024-09-30