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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. Resumo: O Plano Estratégico para a Saúde Cardiovascular em Portugal é um projeto da Sociedade Portuguesa de Cardiologia alinhado com o movimento propulsionado pela Sociedade Europeia de Cardiologia e pela World Heart Federation para a elaboração de planos nacionais, à escala e no contexto cultural e socio-económico locais, focados na abordagem da saúde cardiovascular. O objetivo alargado é impulsionar e contribuir para a melhoria contínua e sustentada da saúde cardiovascular da população portuguesa. A metodologia envolvida passou pela identificação dos principais desafios e oportunidades a enfrentar no médio prazo, nomear e destacar áreas de intervenção prioritária e propor linhas estratégicas de intervenção. Este artigo define a conceptualização do projeto e traça as linhas orientadoras para as propostas de atuação a ser elaboradas por grupos designados de peritos e que serão objeto de divulgação subsequente.

Introduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal. Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal. Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified. Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p5% (p5% (p

Introduction: Patient selection for percutaneous coronary intervention (PCI) in chronic total occlusions (CTOs) is crucial to procedural success. Our aim was to identify independent predictors of success in CTO PCI in order to create an accurate score. Methods: In a single-center observational registry of CTO PCI, demographic and clinical data and anatomical characteristics of coronary lesions were recorded. Linear and logistic regression analysis were used to identify predictors of success. A score to predict success was created and its accuracy was measured by receiver operating curve analysis. Results: A total of 377 interventions were performed (334 patients, age 68±11 years, 75% male). The success rate was 65% per patient and 60% per procedure. Predictors of success in univariate analysis were absence of active smoking (OR 2.02, 95% CI 1.243-3.29; p=0.005), presence of tapered stump (OR 5.2, 95% CI 2.7-10.2; p8 with high probability (95%). Conclusion: In our sample only anatomical characteristics were predictors of success. The creation of a score to predict success, with good accuracy, may enable selection of cases that can be treated by any operator, those in which a dedicated operator will be desirable, and those with an extremely low probability of success, which should be considered individually for conservative management, surgical revascularization or PCI by a team experienced in CTO. Resumo: Introdução: Selecionar os doentes para angioplastia (ICP) de oclusão crónica (CTO) é crucial para o êxito do procedimento. Pretende-se identificar preditores independentes de sucesso na ICP de CTOs para criação de um score de boa acuidade. Métodos: Registo observacional unicêntrico de ICP em CTOs. Registaram-se características demográficas, clínicas e características anatómicas das lesões. Identificados preditores de sucesso por regressão linear e logística, posterior construção de score preditor de sucesso cuja acuidade foi aferida por análise com curva ROC. Resultados: Realizaram-se 377 intervenções (334 doentes, 68±11 anos, 75% homens); taxa de sucesso por doente: 65%, por procedimento: 60%. Em análise univariada, foram preditores de sucesso: ausência de tabagismo (OR 2,02; 95%CI 1,243–3,29; p=0,005); coto afilado (C) (OR 5,2; 95%CI 2,7–10,2; p8 a probabilidade elevada (95%). Conclusão: Nesta amostra, apenas as características anatómicas foram preditoras de sucesso. Um score de sucesso poderá permitir selecionar casos passíveis de intervenção por qualquer operador, aqueles que requerem operador dedicado a oclusões e aqueles com probabilidade de sucesso reduzida onde se considere individualmente manejo conservador, revascularização cirúrgica ou ICP por equipa experiente/dedicada.

Introduction: Transcatheter aortic valve replacement (TAVR) has changed the treatment paradigm of severe aortic stenosis (AS). Nevertheless, in Portugal the penetration rate of TAVR is still very low and there is a paucity of data regarding its economic impact on the Portuguese healthcare system. Aims: To perform an economic analysis of the present and future impact of TAVR in Portugal and to propose health policy recommendations for a new reimbursement model. Methods: Hospital data from a high-volume center were used as a sample to calculate the costs of TAVR in Portugal. Information regarding the national penetration rate was derived from the EAPCI Valve for Life initiative. To estimate the future demand for TAVR, three scenarios (S) were constructed: S1, TAVR penetration according to current guidelines; S2, including intermediate-risk patients; and S3, including low-risk patients aged over 75 years. Results: The total cost of each TAVR procedure in Portugal was 22 134.50 euros for the self-expanding valve (SEV) and 23 321.50 euros for the balloon-expanding valves (BEV). Most of the cost was driven by the price of the valve (SEV 74.5% vs. BEV 81.5%). The current national economic impact is estimated at 12 500 000 euros per year. In S1, the expected penetration rate would be 189 procedures per million population; in S2 we estimated an increase of 28% to 241 procedures per million population and in S3 an increase of 107% to 391 procedures per million population. The total economic impact would increase to 43 770 586 euros in S1 and to 90 754 310 euros in S3. Conclusions: TAVR is associated with a significant present and future economic impact on the Portuguese healthcare system. A new model of reimbursement in Portugal should be discussed and implemented. Resumo: Introdução: A válvula aórtica percutânea (VAP) mudou o paradigma de tratamento da estenose aórtica grave. No entanto, em Portugal, a sua penetração é reduzida e dados acerca do impacto económico no Serviço Nacional de Saúde (SNS) são escassos. Objetivos: Analisar o impacto económico atual e futuro do implante de VAP em Portugal e propor um modelo de reembolso específico para as VAP. Métodos: Os custos fixos e variáveis do procedimento em Portugal foram calculados com base numa amostra de um centro de elevado volume de VAP. O impacto económico nacional foi calculado com base na penetração atual reportada na iniciativa EAPCI Valve for Life. As necessidades futuras da tecnologia foram estimadas em três cenários (S): S1 - penetração de acordo com as recomendações atuais; S2 - inclusão de doentes de risco intermédio; S3 - expansão aos doentes de baixo risco e idade > 75 anos. Resultados: O custo total da VAP em Portugal foi estimado em 22.134,5€ com prótese autoexpansível (SEV) e 23.321,5€ com prótese expansível por balão (BEV). A maior parte do custo relacionou-se com o preço da prótese (SEV 74,5% versus BEV 81,5%). O impacto económico nacional estima-se em 12.500.000€/ano. No cenário S1, a taxa esperada de penetração deveria ser 189/milhão; em S2 perspetiva-se aumento de +28% para 241 procedimentos/milhão; em S3 estima-se aumento de +107% para 391 procedimentos/milhão. Assim, o impacto económico poderá aumentar significativamente de 43.770.586€ (S1) até 90.754.310€ (S3). Conclusões: A VAP está associada a um impacto económico presente e futuro significativo no SNS. É essencial discutir e implantar um novo modelo específico de reembolso em Portugal.

Introduction and objectives: Over the last decade, several studies have suggested that left ventricular endomyocardial biopsy is safer and has a higher diagnostic yield than transvenous right ventricular biopsy. In addition, recent publications indicate that the transradial approach is a feasible and safe alternative to the transfemoral approach for sampling the left ventricle. We report our initial experience with transradial endomyocardial biopsy with regards to feasibility, safety and usefulness. Methods: Single-center registry of consecutive patients undergoing intended transradial left endomyocardial biopsy. Clinical and technical data were collected prospectively, with a particular focus on success rate and complications. Results: Twenty-seven patients were screened for left ventricle biopsy. Twenty (25) were selected for an intended transradial approach (mean age 51±18 years old, 22 male). Success rate was 100% with no crossover to femoral approach. There were no major complications. Two patients experienced mild radial spasm. One of them also had a run of non-sustained ventricular tachycardia.Indication for biopsy was either myocarditis or cardiomyopathy of unknown etiology. The final diagnosis was acute lymphocytic myocarditis in five patients, chronic myocarditis in one patient, amyloid light-chain amyloidosis in four patients and transthyretin amyloidosis in six patients. Myocarditis was ruled out in eight patients and amyloidosis in one patient. Conclusions: Transradial left ventricle endomyocardial biopsy is a very safe and feasible method of sampling the myocardium for histopathological analysis, with a good diagnostic yield and clinically meaningful results in properly selected patients. Resumo: Introdução e objetivos: Durante a última década, vários estudos têm sugerido que a biópsia endomiocárdica ventricular esquerda é mais segura e de superior rentabilidade diagnóstica do que a do ventrículo direito. Adicionalmente, várias publicações recentes têm introduzido a abordagem transradial como uma alternativa exequível e segura à transfemoral, para amostrar o ventrículo esquerdo. O objetivo deste estudo é reportar a experiência inicial de um centro em biópsia endomiocárdica ventricular esquerda transradial, relativamente a exequibilidade, segurança e utilidade. Métodos: Registo unicêntrico de doentes consecutivos submetidos a biópsia endomiocárdica ventricular esquerda, com acesso de primeira intenção radial. Registaram-se os dados clínicos e técnicos, com particular foco na taxa de sucesso e complicações. Resultados: Foram submetidos a biópsia endomiocárdica ventricular esquerda 27 doentes, 25 dos quais pré-selecionados para acesso transradial (idade média 51±18, 22 homens). A taxa de sucesso foi de 100%. Não ocorreram complicações major, apenas espasmo radial em dois doentes, num dos quais se observou uma salva de taquicardia ventricular não mantida. A indicação foi miocardite ou miocardiopatia de etiologia a esclarecer. O diagnóstico final foi de miocardite aguda em cinco doentes, miocardite crónica em um doente, amiloidose AL em quatro doentes e ATTR em seis doentes. Excluiu-se miocardite em oito doentes e amiloidose em um doente. Conclusão: A biópsia endomiocárdica ventricular esquerda transradial demonstrou ser segura, exequível e de boa rentabilidade diagnóstica, com resultados clinicamente relevantes em doentes selecionados.

Abstract Background We aimed to evaluate the impact of thrombus aspiration (TA) during primary percutaneous coronary intervention (P-PCI) in ‘real-world’ settings. Methods We performed a retrospective study, using data from the National Registry of Interventional Cardiology (RNCI 2006–2012, Portugal) with ST-elevation myocardial infarction (STEMI) patients treated with P-PCI. The primary outcome, in-hospital mortality, was analysed through adjusted odds ratio (aOR) and 95% confidence intervals (95%CI). Results We assessed data for 9458 STEMI patients that undergone P-PCI (35% treated with TA). The risk of in-hospital mortality with TA (aOR 0.93, 95%CI:0.54–1.60) was not significantly decreased. After matching patients through the propensity score, TA reduced significantly the risk of in-hospital mortality (OR 0.58, 95%CI:0.35–0.98; 3500 patients). Conclusions The whole cohort data does not support the routine use of TA in P-PCI, but the results of the propensity-score matched cohort suggests that the use of selective TA may improve the short-term risks of STEMI.