Cardiac Ultrasound in Cardiovascular Emergency and Critical Care. A Clinical Consensus Statement of the European Association of Cardiovascular Imaging (EACVI), the Acute CardioVascular Care Association (ACVC) of the ESC, and the European Association of Cardiothoracic Anaesthesia and Intensive Care (EACTAIC).

Cardiac ultrasound (CUS) has emerged as an indispensable bedside diagnostic and monitoring tool in cardiovascular emergencies and critical care, enabling rapid, noninvasive assessment of cardiac structure and function. This multidisciplinary consensus statement, jointly developed by the EACVI, ACVC, and EACTAIC, provides comprehensive, practical guidance on the use of CUS in acute care settings. The document outlines a pathophysiological framework for applying CUS across a wide spectrum of clinical scenarios, including cardiogenic shock, acute myocardial infarction, mechanical complications, acute heart failure, severe valvular disease, pericardial tamponade, pulmonary embolism, and cardiac arrest.

Prognostic impact of left ventricular reverse remodeling after surgical aortic valve replacement in severe aortic stenosis.

Surgical aortic valve replacement (SAVR) is the treatment of choice for young patients with severe aortic stenosis (AS). Left ventricular (LV) reverse remodeling (RR) after surgery is expected to occur, even though its definition is largely heterogenous and ill-defined. However, LV RR not always occurs following afterload relief, and such may impact the prognosis.

Cardiac imaging in patients with tropical diseases-a scientific statement of the European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DICSBC).

Tropical diseases (TDs), or neglected TDs, affect over 1 billion subjects globally, primarily in impoverished regions. Despite their impact, these diseases are often overlooked on the global health agenda, with limited resources allocated to their control. TDs are caused by various pathogens, including viruses, protozoa, helminths, and bacteria.

The Complex Puzzle of Hypertrophic Phenotype: A Practical Approach for the Clinician.

Left ventricular hypertrophy (LVH) represents a frequent observation in clinical practice. Nonetheless, the hypertrophic phenotype emerges as a common manifestation of diverse conditions, thereby presenting a diagnostic conundrum for clinicians. Differentiation among the etiologies of LVH is imperative for therapy decision-making, as different approaches must be implemented for distinct conditions, such as LVH secondary to loading changes, hypertrophic cardiomyopathy (HCM), or HCM mimics.

A Portuguese expert panel position paper on the management of heart failure with preserved ejection fraction - Part II: Unmet needs and organization of care in Portugal.

In Portugal, a 15.2% prevalence of heart failure with preserved ejection fraction (HFpEF) was recently identified among those aged ≥50 years. HFpEF represents 90% of Portuguese heart failure patients.

PRIMARY-HF: Heart Failure Screening in Primary Care using Point-of-Care.

Introduction: Heart failure is a major health challenge with high morbidity and socioeconomic burden, especially when diagnosis is delayed. In primary care, HF detection can be challenging due to symptoms overlapping with other conditions, limited access to diagnostic tools, and resource constraints. This study explores the use of natriuretic peptides (NT-proBNP) and point-of-care ultrasound (POCUS) with artificial intelligence integration as tools to improve HF screening and management in primary care.

A Portuguese expert panel position paper on the management of heart failure with preserved ejection fraction - Part I: Pathophysiology, diagnosis and treatment.

Heart failure (HF) with preserved ejection fraction (HFpEF) affects more than 50% of HF patients worldwide, and more than 70% of HF patients aged over 65. This is a complex syndrome with a clinically heterogeneous presentation and a multifactorial pathophysiology, both of which make its diagnosis and treatment challenging. A Portuguese HF expert panel convened to address HFpEF pathophysiology and therapy, as well as appropriate management within the Portuguese context.

Suspicion and referral of patients with transthyretin amyloid cardiomyopathy: Recommendations by a Portuguese multidisciplinary expert panel.

Early diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) is crucial for better disease management and outcome. To ensure timely diagnosis, a multidisciplinary panel of Portuguese experts, including cardiologists, internal medicine specialists, and general practitioners, have developed a national consensus to aid physicians in enhancing the referral of patients with suspicion of ATTR-CM in Portugal. A structured approach was used to develop the consensus: (1) an online survey aimed at identifying clinical red flags, patient journeys, and diagnostic tools related to ATTR-CM; (2) a face-to-face roundtable meeting where the survey findings were discussed and a consensus was reached on referral and diagnostic algorithms for ATTR-CM in Portugal; and (3) critical review of the proposed algorithms.

Impact of Aficamten on Disease and Symptom Burden in Obstructive Hypertrophic Cardiomyopathy: Results From SEQUOIA-HCM.

Background: Aficamten is a cardiac myosin inhibitor that mitigates left ventricular outflow gradients in obstructive hypertrophic cardiomyopathy (oHCM). The clinical efficacy of aficamten across multiple outcome domains in oHCM has not been fully defined.

Objectives: This responder analysis from the SEQUOIA-HCM (Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Placebo in Adults With Symptomatic oHCM) trial characterizes the clinical impact of aficamten.

World Heart Federation Cholesterol Roadmap: The Portuguese case.

Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention. At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap.

Chronic thromboembolic pulmonary hypertension: A comprehensive review of pathogenesis, diagnosis, and treatment strategies.

Chronic thromboembolic pulmonary hypertension (CTEPH) is part of group 4 of the pulmonary hypertension (PH) classification and generally affects more than a third of patients referred to PH centers. It is a three-compartment disease involving proximal (lobar-to-segmental) and distal (subsegmental) pulmonary arteries that are obstructed by persistent fibrothrombotic material, and precapillary pulmonary arteries that can be affected as in pulmonary arterial hypertension. It is a rare complication of pulmonary embolism (PE), with an incidence of around 3% in PE survivors.

Aficamten for Symptomatic Obstructive Hypertrophic Cardiomyopathy.

Background: One of the major determinants of exercise intolerance and limiting symptoms among patients with obstructive hypertrophic cardiomyopathy (HCM) is an elevated intracardiac pressure resulting from left ventricular outflow tract obstruction. Aficamten is an oral selective cardiac myosin inhibitor that reduces left ventricular outflow tract gradients by mitigating cardiac hypercontractility.

Methods: In this phase 3, double-blind trial, we randomly assigned adults with symptomatic obstructive HCM to receive aficamten (starting dose, 5 mg; maximum dose, 20 mg) or placebo for 24 weeks, with dose adjustment based on echocardiography results.

Cardiac magnetic resonance patterns of left ventricular remodeling in patients with severe aortic stenosis referred to surgical aortic valve replacement.

Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR).

Histopathological myocardial changes in patients with severe aortic stenosis referred for surgical valve replacement: a cardiac magnetic resonance correlation study.

Aims: Myocardial fibrosis (MF) takes part in left ventricular (LV) remodelling in patients with aortic stenosis (AS), driving the transition from hypertrophy to heart failure. The structural changes that occur in this transition are not fully enlightened. The aim of this study was to describe histopathological changes at endomyocardial biopsy (EMB) in patients with severe AS referred to surgical aortic valve replacement (AVR) and to correlate them with LV tissue characterization from pre-operative cardiac magnetic resonance (CMR).

Exercise Capacity in Patients With Obstructive Hypertrophic Cardiomyopathy: SEQUOIA-HCM Baseline Characteristics and Study Design.

Patients with obstructive hypertrophic cardiomyopathy (oHCM) have increased risk of arrhythmia, stroke, heart failure, and sudden death. Contemporary management of oHCM has decreased annual hospitalization and mortality rates, yet patients have worsening health-related quality of life due to impaired exercise capacity and persistent residual symptoms. Here we consider the design of clinical trials evaluating potential oHCM therapies in the context of SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM).

Subendocardial "ischemic-like" state in patients with severe aortic stenosis: Insights from myocardial histopathology and ultrastructure.

Background: Myocardial adaptation to severe aortic stenosis (AS) is a complex process that involves myocardial fibrosis (MF) beyond cardiomyocyte hypertrophy. Perfusion impairment is believed to be involved in myocardial remodeling in chronic pressure overload.

Aim: To describe morphological and ultrastructural myocardial changes at endomyocardial tissue sampling, possibly reflecting subendocardial ischemia, in a group of patients with severe AS referred to surgical aortic valve replacement (AVR), with no previous history of ischemic cardiomyopathy.