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Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e’ estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH. Abstract Background Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. Objectives We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. Methods Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p

Background Idiopathic pulmonary arterial hypertension (iPAH) is a rare and chronic disease associated with poor outcomes. Previously considered a disease restricted to the pulmonary circulation, PAH is now being recognized as a systemic disorder that is associated with metabolic dysfunction. The aim of this study is to analyze the metabolic reprogramming in the lung and peripheral blood mononuclear cell (PBMCs) of iPAH patients and explore their potential roles in PAH pathophysiology. Methods Five independent datasets, containing transcriptomic data of human PBMCs (GSE22356 and GSE33463) and lung (GSE48149 GSE113439 and GSE117261) samples, from 139 iPAH patients and 96 healthy controls, were downloaded at the GEO database. In each dataset, the samples were normalized and a pair-wise comparison between control and iPAH samples was performed using limma package, for the R programming language. Genes with a p-value lower than 0.05 were considered differentially expressed between the two groups. A subset of metabolism related genes was selected, and their expression was compared across the datasets. Results Among the 13 genes with differential expression identified, only 10 had a coherent expression across all datasets (Figure 1). Firstly, we report an association with insulin resistance through impairment of PI3K signaling in iPAH patients, by expressing lower levels of the heterodimer PIK3CD and regulatory PIK3IP1 and PIKR1 subunits in PBMCs, and by expressing higher levels of its downstream targets in the lung (TBC1D4). However, more extensive metabolic dysfunction was observed. A significant glycolytic shift in the lung and PBMCs was present, as a consequence of deregulation in genes involved in aerobic glycolysis and decreased fatty acid oxidation, namely increased expression of PD1K and lower levels of expression of LDHB. The findings of decreased SLC25A1 protein in both PBMCs and lung suggest impairment of the tricarboxylic acid (TCA) cycle flux in PAH. Additionally, SLC1A5 highlights the involvement of glutamine metabolism and glutaminolysis derangements in PAH. Conversely, SREBP1 is involved in sterol biosynthesis and lower levels in PMBCs results in impaired resolution of inflammatory responses. Finally, although the role of autophagy in iPAH is complex, higher levels of expression of ATG13 in PBMCs and lower levels in the lung confirm autophagy deregulation in iPAH. Interestingly, all the metabolic pathways identified (Figure 2) are hallmarks of the metabolic reprogramming seen in cancer cells, a finding already suggested by the clonal proliferation of pulmonary artery smooth muscle cells described in plexiform lesions. Conclusion Our results provide novel insights into the metabolic regulation in iPAH. Molecularly, these cells exhibit many features common to cancer cells, suggesting the opportunity to exploit therapeutic strategies used in cancer to treat iPAH. Funding Acknowledgement Type of funding sources: None.

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase 3 randomized trials. The EXPosurE Registry RiociguaT in patients with pulmonary hypertension (EXPERT) study was designed to monitor the long-term safety of riociguat in clinical practice. Methods: EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study of patients treated with riociguat. Patients were followed for at least 1 year and up to 4 years from enrollment or until 30 days after stopping riociguat treatment. Primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs) coded using Medical Dictionary for Regulatory Activities preferred terms and System Organ Classes version 21.0, collected during routine clinic visits and collated via case report forms. Results: In total, 956 patients with CTEPH were included in the analysis. The most common AEs in these patients were peripheral edema/edema (11.7%), dizziness (7.5%), right ventricular (RV)/cardiac failure (7.7%), and pneumonia (5.0%). The most common SAEs were RV/cardiac failure (7.4%), pneumonia (4.1%), dyspnea (3.6%), and syncope (2.5%). Exposure-adjusted rates of hemoptysis/pulmonary hemorrhage and hypotension were low and comparable to those in the long-term extension study of riociguat (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase–Stimulator Trial [CHEST-2]). Conclusion: Data from EXPERT show that in patients with CTEPH, the safety of riociguat in routine practice was consistent with the known safety profile of the drug, and no new safety concerns were identified. © 2020 The Authors Eli Lilly and Company; Pfizer; Bayer; GlaxoSmithKline; Merck; Actelion Pharmaceuticals; Meso Scale Diagnostics; United Therapeutics Corporation; Novartis Pharma; Merck Sharp and Dohme; GlaxoSmithKline Australia; Deutsche Forschungsgemeinschaft; Grupo Ferrer Internacional, S.A The EXPERT registry was funded by Bayer AG (Berlin, Germany) and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. The authors acknowledge the database administration by Torsten Tille, Dresden, and the project administration of Mrs Romy Hoppenz and Mrs Linda Kottke at GWT-TUD GmbH, Dresden. Medical writing services provided by Richard Murphy PhD of Adelphi Communications Ltd, Macclesfield, UK were funded by Bayer AG in accordance with Good Publication Practice (GPP3) guidelines. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof Marius M. Hoeper reports personal fees from Bayer AG, during the conduct of the study; personal fees from Actelion, personal fees from Acceleron, personal fees from MSD, personal fees from Jansen, personal fees from Pfizer, outside the submitted work. Dr Hans Klose reports speaker and consultancy fees from Actelion, Bayer AG, GSK, Novartis, Pfizer, and United Therapeutics and research support from Actelion, Bayer AG, GSK, Pfizer, and MSD. Dr Michael Halank reports personal fees and non-financial support from Actelion, AstraZeneca, Bayer AG, Berlin-Chemie, GSK, OMT, MSD, and Novartis. Dr George Giannakoulas reports speaker and consultancy fees from Actelion, Bayer, ELPEN Pharmaceuticals, GSK, Pfizer, Lilly, and United Therapeutics, and research support from GSK, ELPEN Pharmaceuticals, and Galenica. Dr Henning Gall has received honoraria and/or other support from Actelion, AstraZeneca, Bayer, BMS, GSK, Janssen-Cilag, Lilly, MSD, Novartis, OMT, Pfizer, and United Therapeutics. Dr Pavel Jansa reports consultancy and speaker fees from MSD, AOP Orphan, and Actelion. Prof Ekkehard Grünig reports research grants and speaker honoraria/consultancy fees from Actelion and Bayer/MSD, research grants from GSK, United Therapeutics, Bellerophon, OMT GmbH, Pfizer, Reata, and Novartis, and speaker honoraria from Bial, Medscape, and OrPha Swiss GmbH. Prof David Pittrow reports personal fees from Actelion, Bayer AG, Aspen, Boehringer Ingelheim, Sanofi, Biogen, Shire, and MSD outside the submitted work. Silvia Ulrich reports research grants and personal fees from Actelion, Bayer, MSD, and Orpha Swiss. Tobias J. Lange has received personal fees from Actelion, MSD, Pfizer, and OMT orphan. Dr Iraklis Tsangaris reports speaker and consultancy fees from Actelion, Bayer AG, ELPEN, GSK, MSD, Pfizer, and United Therapeutics. Stephan Rosenkranz reports remunerations for lectures and/or consultancy from Abbott, Actelion, Arena, Bayer, Ferrer, GSK, MSD, Novartis, Pfizer, and United Therapeutics; and research support to his institution from Actelion, Bayer, Novartis, Pfizer, and United Therapeutics. Repke J. Snijder reports grants from Pfizer and Actelion Pharmaceuticals. Prof Iveta Šimková reports consultancy and speaker fees from MSD, AOP Orphan, and Actelion. Dr Marc Humbert reports grants and personal fees from Bayer and GSK, and personal fees from Actelion, Merck, and United Therapeutics. Marion Delcroix has received investigator, speaker, consultant, and steering committee member fees from Actelion, Bayer AG, Bellerophon, Eli Lilly, GlaxoSmithKline, MSD, Pfizer, and Reata, and research grants from Actelion. Joan A. Barberà reports receipt of honoraria for consultation or speaker fees from Actelion and Merck; and research support through his institution from Actelion, Merck, GlaxoSmithKline, and Ferrer. Joanna Pepke-Zaba reports research grants and speaker honoraria/consultancy fees from Actelion, Bayer/MSD, and GSK. Jean-Luc Vachiéry reports ongoing consultancies to Actelion, Sonnivie, Arena Pharma, Bial Portela, and Respira Therapeutics, past consultancies to AstraZeneca, BayerShering, CardioMEMS, GlaxoSmithKline, Pfizer, Merck, and United Therapeutics, and current membership of an advisory board or similar group for Actelion and GlaxoSmithKline. Jean-Luc Vachiéry's institution receives funding from Actelion Pharmaceuticals for performing clinical studies. Regina Steringer-Mascherbauer, Jens Klotsche, and Miguel-Angel Gomez Sanchez have no conflicts of interest relevant to the EXPERT study. Hossein-Ardeschir Ghofrani reports personal fees for advisory board work, and payment for lectures including service on speaker bureaus, from Actelion, Bayer, GSK, Novartis, and Pfizer; consultancy fees from Actelion, Bayer, Bellerophon Pulse Technologies, GSK, MSD, Novartis, and Pfizer; and grants from Deutsche Forschungsgemeinschaft (DFG). Pilar Escribano Subias reports personal fees from Actelion, Bayer AG, GlaxoSmithKline, and Merck Sharp & Dohme, and grants from Actelion, Bayer AG, GlaxoSmithKline, and Ferrer, outside the submitted work. Gérald Simonneau reports personal fees and non-financial support from Actelion, personal fees and non-financial support from Bayer, personal fees and non-financial support from MSD, outside the submitted work. Douglas S. Helmersen reports industry-sponsored research with Bayer AG, United Therapeutics, and Gilead Sciences, Inc., and advisory board/speaker fees from Bayer AG and Actelion. David Langleben reports honoraria, consultation fees, research support, and/or travel expenses from Actelion, Arena, Bayer AG, Northern Therapeutics, PhaseBio, Acceleron, Janssen, and United Therapeutics. Anco Boonstra reports consultancy fees from Pfizer BV and hospitality from Teva Nederland. Lisa M. Mielniczuk reports speaker fees and honoraria from Bayer AG, and speaker fees, consultancy fees, and travel fees from Actelion. Evgenia Williams and Christian Meier are employees of Bayer AG.

Introduction Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial. Purpose We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH. Methods A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC. Results There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p Conclusion 2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH. Right atrial strain components Funding Acknowledgement Type of funding source: None

Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities.We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients.Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p0.05.Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027).LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE).Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH.A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p0,05 foram definidos como estatisticamente significativos.A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e’ estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027).O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH.

BACKGROUND : Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. METHODS: Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. RESULTS: The mean LV ejection fraction did not differ across groups. The E/e’ ratio was only preserved in the control group and significantly impaired in the HCM group. LA mechanics were significantly reduced in HCM, compared to the HTN group. LA strain rate in systole (LA-SRs) and late diastole (LA-SRa) were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in systole (LA ɛsys) (AUC 0.76). LA-SRs and LA-SRa had high specificity (89% and 91%, respectively) and LA ɛsys had sensitivity of 80%. LA strain rate in early diastole (LA-SRe) was moderately correlated with the extension of LGE (r 2 0.42, p=0.027) CONCLUSIONS: LA-SRs and LA-SRa were the best discriminators for LVH secondary to HCM. LA-SRe was best correlated with the degree of fibrosis assessed by CMR. These findings suggest that LA mechanics can be potential predictors of disease severity in HCM.

Background There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. Methods We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6–50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). Results In our sample set, values of LV-GLS (− 18.5% vs − 17.1, p = 0.025), E/e’ ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p p p p r2 = 0.6, p r2 = 0.55, p r2 = 0.3 and r2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e’ ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. Conclusions LA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in AS.

Background: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease. Long-term outcomes data are scarce in Portugal. We aimed to estimate survival of newly diagnosed PAH at a Portuguese referral center in the modern management era. Methods: Between January 2009 and November 2015 all incident PAH cases were consecutively enrolled in a prospective cohort study. Sixty-five patients were followed up for a median of 3.1 [interquartile range 1.7â5.4] years. KaplanâMeier survival analysis was used to estimate 1-, 3-, and 5-year survival and to compare it with a historical PAH survival estimated from the NIH cohort. Results: Mean age was 48 ± 19 years with female preponderance (68%). The most common PAH subgroup was congenital heart disease (PAH-CHD) (n = 31; 48%), followed by connective tissue disease (PAH-CTD) (n = 16; 25%), idiopathic (IPAH) (n = 8; 12%) and hereditary (HPAP) (n = 1; 1.5%). BNP values (hazard ratio [HR] 2.07; 95%CI 1.34â3.22; P = 0.001) and male gender [HR 4.34 (1.44â13.09); P = 0.009] were predictors of death. Survival rates at 1-, 3- and 5-years were 95%, 77% and 71%. Survival was not statistically different between PAH etiologies (Log-rank P = 0.7). However, PAH-CHD was associated with a decreased risk of the combined endpoint of all-cause mortality and admission for decompensated heart failure [HR 0.36 (0.15â0.85); P = 0.02]. We found a non-significant numerically higher survival of incident IPAH, HPAH and DPAH patients in comparison with the historical NIH cohort. Conclusions: In this cohort of incident PAH patients, PAH-CHD patients had better overall prognosis. Higher BNP values and male gender were associated with higher mortality. Keywords: Pulmonary arterial hypertension, Survival, Predictors of mortality, Predictors of heart failure

Este artigo propõe-se olhar para a realidade escolar moçambicana no que toca à implementação do ensino bilingue, tema central na discussão educativa africana desde os anos 90. Questiona-se a validade da política da língua única no que esta implica do ponto de vista linguístico e socioeconómico para as populações. O artigo pretende ainda cotejar vantagens e obstáculos dos principais modelos de ensino bilingue em discussão no contexto africano e moçambicano. A terminar, aborda-se a importância da língua local como língua materna e como meio de instrução para o desenvolvimento bem sucedido da escolaridade da população infantil moçambicana. This article aims at looking into the educational policies in Mozambique in what concerns the implementation of bilingual teaching, which has been a central topic of discussion in Africa since the 90s. The single language policy is questioned for its effectivity given its linguistic and socio-economic repercussions for the population. Apart from these considerations, the text also compares advantages and drawbacks stemming from the two main models of bilingual teaching, currently being discussed in Africa and in Mozambique. Lastly, the article tackles the importance of local languages both as first languages and as means of instruction in order to foster a balanced development of mozambican children attending primary school.

Left atrium function is essential for cardiovascular performance and is evaluable by two-dimensional speckle-tracking echocardiography (2D-STE). Our aim was to determine how echocardiographic parameters interrelate with exercise capacity and ventilatory efficiency in subjects with no structural heart disease. Asymptomatic volunteers, in sinus rhythm and with normal biventricular size and function, were recruited from a community-based population. Individuals with moderate-to-severe valvular disease, pulmonary hypertension, and history of cardiac disease were excluded. We performed a transthoracic echocardiogram and assessed left atrial (LA) and left ventricular (LV) mechanics via 2D-STE. Cardiopulmonary exercise testing by treadmill took place immediately thereafter. Peak oxygen uptake (VO2) served as measure of functional capacity and ventilation/carbon dioxide output (VE/VCO2) slope as surrogate of ventilation/perfusion mismatch. 20 subjects were included (age 51 ± 14 years, male gender 65%). Peak VO2 strongly correlated with age (r = −0.83; P

Background: Pulmonary embolism (PE) is a common cardiovascular emergency that, when combined with chronic thromboembolic pulmonary hypertension (PH), is associated with high mortality and morbidity. We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode. Methods: A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010. Clinical data at admission were collected and the incidence of PH as assessed by echocardiography (estimated pulmonary systolic artery pressure over 40 mmHg) was determined. Multivariate analysis was used to determine predictors of development of PH. Results: PH was detected in 12.4% of patients after a mean follow-up of three years. Only age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.02–1.20 per year; p=0.012) and body mass index (HR 1.19, 95% CI 1.04–1.36) per kg/m2, p=0.013) emerged as independent predictors of the development of this complication during follow-up. Conclusions: PH after PE was a relatively common complication in our series. We identified advanced age and increased body mass index as predisposing factors. Resumo: Introdução: A tromboembolia pulmonar (TEP) é uma emergência cardiovascular comum que, juntamente com a hipertensão pulmonar tromboembólica crónica (HPTEC), se associa a alta mortalidade e morbilidade. Não há ainda consenso quanto à consecutividade destas patologias. Este estudo pretende determinar a incidência e fatores de risco para o desenvolvimento de hipertensão pulmonar (HTP) após uma TEP de risco intermédio a elevado. Métodos: Estudámos retrospetivamente 213 doentes com TEP de risco intermédio a elevado, entre 2000–2010, e comparamos dados demográficos, clínicos, laboratoriais e imagiológicos entre os doentes que manifestaram HTP durante o seguimento clínico (doentes que, pelo menos três meses após a alta, mantivessem pressões sistólicas na artéria pulmonar acima de 40 mmHg, estimadas por ecocardiografia) com os doentes que mantiveram pressões normais. Resultados: Identificou-se HTP após a TEP em 12,4% dos doentes. Foram fatores preditores para o desenvolvimento desta complicação a idade (hazard ratio [HR] 1,09 [intervalo de confiança {IC} 95% 1,02–1,20] por ano de idade, p=0,012) e o índice de massa corporal (HR 1,19 [IC 95% 1,04-1,36] por kg m−2, p=0,013). Conclusões: A HTP após uma TEP foi uma complicação relativamente comum na nossa série de doentes com um episódio agudo de TEP de risco intermédio a elevado. Identificamos como fatores preditores do desenvolvimento desta complicação a idade avançada e a obesidade. Keywords: Chronic thromboembolic pulmonary hypertension, Pulmonary embolism, Risk factors, Body mass index, Obesity, Age, Palavras-chave: Hipertensão pulmonar tromboembólica crónica, Tromboembolia-pulmonar, Fatores de risco, Índice de massa corporal, Obesidade, Idade

Resumo: Introdução: A tromboembolia pulmonar (TEP) é uma emergência cardiovascular comum que, juntamente com a hipertensão pulmonar tromboembólica crónica (HPTEC), se associa a alta mortalidade e morbilidade. Não há ainda consenso quanto à consecutividade destas patologias. Este estudo pretende determinar a incidência e fatores de risco para o desenvolvimento de hipertensão pulmonar (HTP) após uma TEP de risco intermédio a elevado. Métodos: Estudámos retrospetivamente 213 doentes com TEP de risco intermédio a elevado, entre 2000-2010, e comparamos dados demográficos, clínicos, laboratoriais e imagiológicos entre os doentes que manifestaram HTP durante o seguimento clínico (doentes que, pelo menos três meses após a alta, mantivessem pressões sistólicas na artéria pulmonar acima de 40 mmHg, estimadas por ecocardiografia) com os doentes que mantiveram pressões normais. Resultados: Identificou-se HTP após a TEP em 12,4% dos doentes. Foram fatores preditores para o desenvolvimento desta complicação a idade (hazard ratio [HR] 1,09 [intervalo de confiança {IC} 95% 1,02-1,20] por ano de idade, p = 0,012) e o índice de massa corporal (HR 1,19 [IC 95% 1,04-1,36] por kg m−2, p = 0,013). Conclusões: A HTP após uma TEP foi uma complicação relativamente comum na nossa série de doentes com um episódio agudo de TEP de risco intermédio a elevado. Identificamos como fatores preditores do desenvolvimento desta complicação a idade avançada e a obesidade. Abstract: Background: Pulmonary embolism (PE) is a common cardiovascular emergency that, when combined with chronic thromboembolic pulmonary hypertension (PH), is associated with high mortality and morbidity. We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode. Methods: A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010. Clinical data at admission were collected and the incidence of PH as assessed by echocardiography (estimated pulmonary systolic artery pressure over 40 mmHg) was determined. Multivariate analysis was used to determine predictors of development of PH. Results: PH was detected in 12.4% of patients after a mean follow-up of three years. Only age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.02-1.20 per year; p=0.012) and body mass index (HR 1.19, 95% CI 1.04-1.36) per kg/m2, p=0.013) emerged as independent predictors of the development of this complication during follow-up. Conclusions: PH after PE was a relatively common complication in our series. We identified advanced age and increased body mass index as predisposing factors. Palavras-chave: Hipertensão pulmonar tromboembólica crónica, Tromboembolia-pulmonar, Fatores de risco, Índice de massa corporal, Obesidade, Idade, Keywords: Chronic thromboembolic pulmonary hypertension, Pulmonary embolism, Risk factors, Body mass index, Obesity, Age

Background: Bosentan is recommended for symptomatic patients with Eisenmenger syndrome due to simple congenital lesions such as atrial and ventricular septal defects (VSD). However, its long-term efficacy and safety in patients with pulmonary arterial hypertension (PAH) associated with complex congenital heart disease (CHD) is unknown. Objectives: We examined the short- and long-term effects and safety profile of bosentan in patients with PAH and complex CHD. Methods: We followed 14 patients with PAH and complex CHD for a mean of four years. Demographic parameters, exercise capacity assessed by the six-minute walking test (6MWT) and oxygen saturation were assessed at baseline, six months and at follow-up. Results: Mean age was 37.1±11.7 years; 90% were in WHO class III or IV. The most common diagnosis was pulmonary atresia with VSD (35.7%), followed by truncus arteriosus (28.6%), patent ductus arteriosus (21.4%) and transposition of the great arteries (14.3%). After six months of treatment, six-minute walking distance (6MWD) increased from 371.9 to 428.4 m (p=0.005) and functional class was improved (p=0.005). After four years, one patient discontinued bosentan due to side effects and four patients were started on sildenafil, after a mean 38 months of bosentan treatment. Mean 6MWD for patients on bosentan monotherapy (n=8) was 440.1±103.8 m, whereas for patients on bosentan-sildenafil combination therapy (n=4) it was 428.8±96.9 m, after four years of therapy. Two patients died during follow-up. Conclusions: Bosentan was safe and was associated with improved exercise capacity in patients with PAH and complex CHD. This improvement was sustained for up to four years and the safety profile was similar to simple CHD patients. Resumo: Introdução: O bosentano é recomendado em doentes com hipertensão arterial pulmonar (HAP) associada a lesões congénitas simples, como comunicações interventriculares (CIV). Contudo, a sua eficácia e segurança a longo prazo em doentes com HAP associada a cardiopatias congénitas complexas (HAP-CCC) é desconhecida. Objectivos: Avaliámos a eficácia e segurança a curto e longo-prazo do bosentano na HAP-CCC. Métodos: Estudaram-se 14 doentes com HAP-CCC, relativamente a parâmetros demográficos, capacidade funcional avaliada pelo teste de marcha de seis minutos (TM6M) e saturação de oxigénio, antes de iniciar terapêutica, aos seis meses e durante o período de seguimento clínico a longo-prazo (quatro anos). Resultados: Noventa por cento dos doentes encontravam-se em classe OMS III ou IV, com idade média de 37,1 ± 11,7 anos. O diagnóstico mais frequente foi a atrésia pulmonar com CIV (35,7%), seguida de truncus arteriosus (28,6%), canal arterial patente (21,4%) e transposição de grandes vasos (14,3%). Após seis meses de tratamento, o TM6M aumentou de 371,9 para 428,4 metros (p = 0,005) e a classe funcional melhorou (p = 0,005). Após quatro anos, um doente suspendeu bosentano devido a efeitos secundários e quatro doentes iniciaram sildenafil, após uma duração média de monoterapia de 38 meses. Após quatro anos de terapêutica, nos doentes em monoterapia com bosentano (n = 8) o TM6M foi de 440,1 ± 103,8 metros, enquanto que nos doentes com bosentano-sildenafil (n = 4) foi de 428,8 ± 96,9 metros. Dois doentes faleceram durante o período de seguimento clínico. Conclusões: O bosentano foi seguro e esteve associado a melhoria na capacidade funcional em doentes com HAP-CCC até aos quatro anos de seguimento clínico. Keywords: Bosentan, Congenital heart disease, Pulmonary hypertension, Palavras chave: Bosentan, Cardiopatia congénita, Hipertensão pulmonar

Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Follow-up all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term all-cause mortality (3.8% vs. 38.8%, p

Background Two-dimensional speckle tracking (2D-ST) echocardiography for the measurement of circumferential ascending thoracic aortic strain (CAAS) in the context of aortic stenosis (AS) is not elucidated. Purpose This study assesses the thoracic ascending aortic deformation using 2D-ST echocardiography in AS patients. Population and methods Forty-five consecutive patients with an aortic valvular area (AVA) ≤0.85 cm2/m2 were included. Regarding aortic deformation, the global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness ( β 2) index was assessed according to ln( P s/ P d)/CAAS. The sample was stratified according to the stroke volume index (SVI) as: Group A (low flow, SVI ≤35 mL/m2; n = 19) and Group B (normal flow, SVI >35 mL/m2; n = 26). Results The mean age was 76.8 ± 10.3 years, 53.3% were male, the mean indexed AVA was 0.43 ± 0.15 cm2/m2, and the mean CAAS was 6.3 ± 3.0%. The CAAS was predicted by SVI ( β = 0.31, P < 0.01) and by valvulo-arterial impedance ( Z va). The corrected CAAS was correlated with the M-mode guided aortic stiffness index (β1) ( r = −0.39, P < 0.01), and was predicted by SVI, Z va, and systemic arterial compliance ( β = 0.15, P < 0.01). The β 2 index was significantly higher for the low-flow patients (16.1 ± 4.8 vs. 9.8 ± 5.3, P < 0.01), and was predicted by SVI ( β −0.58, P < 0.01) and PP ( β = 0.17, P < 0.01). Global CAAS was more accurate to predict low flow than Z va, systolic function and systemic vascular resistance. Conclusion In patients with moderate-to-severe aortic stenosis, SVI and LV afterload-related variables were the most important determinants of 2S-ST global CAAS.

Background Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings. In this systematic review, we summarize the available evidence on the role of exercise echocardiography to estimate exercise-induced elevations in pulmonary and left heart filling pressures in patients with systemic sclerosis. Methods We conducted a systematic review of the literature using MEDLINE, Cochrane Library and Web of Knowledge, using the vocabulary terms: (‘systemic sclerosis’ OR ‘scleroderma’) AND (‘exercise echocardiography’) AND (‘pulmonary hypertension’). Studies including patients with SSc without a prior diagnosis of PAH, and subjected to exercise echocardiography were included. All searches were limited to English and were augmented by review of bibliographic references from the included studies. The quality of evidence was assessed by the Effective Public Health Practice Project system. Results We identified 15 studies enrolling 1242 patients, who were mostly middle-aged and female. Several exercise methods were used (cycloergometer, treadmill and Master’s two step), with different protocols and positions (supine, semi-supine, upright); definition of a positive test also varied widely. Resting estimated sPAP levels varied from 18 to 35 mm Hg, all in the normal range. The weighted means for estimated sPAP were 22.2 ± 2.9 mmHg at rest and 43.0 ± 4.3 mmHg on exercise; more than half of the studies reported mean exercise sPAP ≥40 mmHg. The assessment of left ventricular diastolic function on peak exercise was reported in a minority of studies; however, when assessed, surrogate variables of left ventricular (LV) diastolic dysfunction were associated with higher sPAP on exercise. Conclusions We found very high heterogeneity in the methods, the protocols and the estimated sPAP response to exercise. LV diastolic dysfunction was common and was associated with greater elevation of sPAP on exercise. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1051-9) contains supplementary material, which is available to authorized users.

PURPOSE: Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two-dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD. METHODS: Overall, 73 patients with moderate-to-severe AR and 22 healthy subjects were enrolled, alongside a previously examined cohort (N = 45) with moderate-to-severe AS. Global circumferential ascending aortic strain (CAAS) and strain rate (CAASR) served as indices of aortic deformation; corrected CAAS was calculated as CAAS/pulse pressure (PP). Median clinical follow-up was 438 days. RESULTS: In patients with severe (vs. moderate) AR, CAASR (1.53 ± 0.29/sec vs. 1.90 ± 0.62/sec, P < 0.05) and corrected CAAS (0.14 ± 0.06%/mmHg vs. 0.19 ± 0.08%/mmHg, P < 0.05) were significantly lower, whereas CAAS did not differ significantly. Measurers of aortic mechanics (CAAS, corrected CAAS, CAASR) differed significantly (all P < 0.01) in patients with AS and AR and in healthy subjects, with lower values seen in patients with AS. In follow-up, survival rate of AVD patients with baseline CAASR >0.88/sec was significantly higher (log rank, 97.4% vs. 73.0%; P = 0.03). CONCLUSIONS: Quantitative measures of aortic mechanics were lower for AS patients, suggesting a more significant derangement of aortic elastic properties. In the context of AVD, vascular mechanics assessment proved useful in gauging clinical prognosis. info:eu-repo/semantics/publishedVersion

Pretende-se, neste texto, olhar para o autor de um trabalho académico como um tecelão que, no seu labor de reescrita assente em escrita, combina informação de várias proveniências com vista a conferir à sua produção textual a originalidade esperada em resultado da pesquisa efetuada. Referem-se diferentes conceitos associados à originalidade (autoria, identidade, voz, posição, atribuição, citação, paráfrase, intertextualidade transgressiva, plágio e patchwriting) e apela-se à importância de saber usar as fontes devidamente, após uma leitura cuidada, profunda e crítica das mesmas, a fim de que a interpretação se sobreponha à reprodução, a intertextualidade não seja transgressiva e subsequentemente o patchwriting ou mesmo o plágio só possam ser tolerados como medida pedagógica numa fase inicial da composição. Ademais, lançam-se pistas de intervenção para ajudar os estudantes a encontrarem a sua voz de autores e sublinha-se que a escrita deve ser entendida como um hábito, como uma disciplina, como uma luta e como um ofício que espera muito rigor e empenhamento por parte de quem a pratica. This text aims at viewing the author of academic writing as a weaver who combines information from different research sources into his/her production in order to achieve the degree of originality expected at this level. This implies dealing with different concepts associated with originality, such as authorship, identity, voice, position, attribution, citation, paraphrase, transgressive intertextuality, plagiarism and patchwriting. Furthermore attention is drawn to the proper use of sources after careful critical reading so that interpretation will replace reproduction and intertextuality will not be transgressive, bearing in mind that patchwriting or even plagiarism may only be tolerated in an early stage of written production. Moreover, students are given intervention cues so as to help them find their own voices as authors, and writing is highlighted as a habit that requires discipline and struggling as well as a craft that implies rigour and commitment.

OBJECTIVE: To study the World Health Organization Quality of Life Instrument Bref psychometric properties in a sample of smokers. It is a self-administered instrument to evaluate quality of life. It contains 26 questions allocated to 4 domains: Social, Psychological, Physical and Environmental, there are 2 questions related to the Global domain. METHOD: The sample was formed by 276 tobacco users selected at random. The instruments applied were: World Health Organization Quality of Life Instrument Bref, Fagerström Test for Nicotine Dependence, and Medical Outcomes Study Short-Form 36-item. The statistical analysis was accomplished up by ANOVA, Cronbach's alpha, Pearson's Coefficient and Multiple Regression. RESULTS: The World Health Organization Quality of Life Instrument Bref presented good reliability (Cronbach's alpha 0.9207), converging validation (0.382 < r < 0.753; p < 0.001), discriminant validation and criterion validation (0.554 < r < 0.778; p < 0.001). CONCLUSION: The World Health Organization Quality of Life Instrument Bref proved to be an adequate instrument, with a good level of reliability, being easily and quickly administered.OBJETIVO: Estudar, em uma amostra de tabagistas, as propriedades psicométricas do World Health Organization Quality of Life Instrument Bref, que é um instrumento para avaliar a qualidade de vida. É auto-aplicável e possui 26 questões, divididas em quatro domínios: Físico, Psicológico, Social e Ambiental, além de duas questões que formam o domínio Global. MÉTODO: A amostra foi composta por 276 dependentes de tabaco da população geral selecionados aleatoriamente. Os instrumentos utilizados foram o World Health Organization Quality of Life Instrument Bref , Fagerström Test for Nicotine Dependence e o Medical Outcomes Study Short-Form 36-item. A análise estatística foi realizada por meio dos testes ANOVA, alpha de Cronbach, Coeficiente de Correlação Linear de Pearson e Regressão Linear Múltipla, método setpwise. RESULTADOS: O World Health Organization Quality of Life Instrument Bref apresentou uma boa fidedignidade (alpha de Cronbach 0,9207), validade convergente (0,382 < r < 0,753; p < 0,001), validade discriminante e validade de critério (0,554 < r < 0,778; p < 0,001). CONCLUSÃO: O World Health Organization Quality of Life Instrument Bref demonstrou ser um instrumento adequado e de aplicação fácil e rápida para a aferição da qualidade de vida em tabagistas.

CONTEXTO: A qualidade de vida é um constructo que vem ganhando importância como uma forma de acessar o impacto tanto de uma patologia quanto de uma estratégia terapêutica na vida dos sujeitos. Este parâmetro tem sido pesquisado nas mais variadas áreas, entre as quais o tabagismo. OBJETIVO: Avaliar a associação entre a qualidade de vida e a gravidade da dependência do tabaco. MÉTODO: Foi realizado um estudo transversal, com uma amostra por conveniência de 276 dependentes de tabaco da população geral, sem doenças tabaco-relacionadas. Os instrumentos utilizados foram: World Health Organization Quality of Life Instrument (WHOQOL-BREF), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fagerström Test for Nicotine Dependence e ficha com dados sociodemográficos. RESULTADOS: Foi verificada associação entre a gravidade da dependência de tabaco e piores escores em todos os domínios da qualidade de vida, avaliada por WHOQOL-BREF, tendo sido esse resultado influenciado por sintomas de ansiedade e depressão. CONCLUSÃO: Os tabagistas mais graves têm mais prejuízos na qualidade de vida, no entanto esse grupo é o que apresenta os escores mais elevados de sintomas depressivos e de ansiedade, sendo importante realizar mais estudos a esse respeito.BACKGROUND: Quality of life is a construct that has been increasing its importance as a means to access the impact, either of a given pathology or of a therapeutic strategy applied to a given subject. This parameter has been researched in the most various areas, among which, smoking. OBJECTIVE: Evaluating the association between quality of life and the severity of tobacco dependence. METHOD: A transversal study has been applied, using a convenience sample of 276 tobacco users, selected at random, tobacco-related diseases free. The instruments used were: World Health Organization Quality of Life Instrument (WHOQOL-BREF), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fagerström Test for Nicotine Dependence and a social and demographic data file. RESULTS: It has been found association between the severity of tobacco dependence and the lowest scores in all domains of quality of life, evaluated by WHOQOL-BREF. Such result has been influenced by anxiety and depression symptoms. CONCLUSION: Heavy smokers have less quality of life but this group its also that with heavy depressive and anxiety symptoms, therefore, it is important that more studies are applied on the topic.

Pulmonary hypertension (PH) was until recently an obscure pathology which frequently went unidentified as it lacked a precise diagnostic strategy. Recent years have seen advances in the knowledge of the pathogenesis and mechanisms of vascular lesion of PH. This has led to the scientific community's growing interest in this area, an interest manifested in appreciable progress in the pathology's clinical characterisation, diagnostic strategies and the development of effective drugs. All of this together has been fundamental in changing the previously unfavourable prognosis of this disease. This evolution implies the need to rationalise the use of available resources through organisation of healthcare services, defining the role of each level of care, and developing norms for good clinical management practices in keeping with best medical practice guidelines. These twin aspects have attracted the interest of the scientific community, as shown by the wealth of literature, and have led healthcare authorities to introduce regulatory mechanisms. In order to improve clinical practice, the Pulmonary Vascular Disease Study Group (NEDVP) of the Portuguese Society of Internal Medicine (SPMI), the Pulmonary Hypertension Study Group (GEHTP) of the Portuguese Society of Cardiology and the boards of the Portuguese Societies of Pulmonology and Paediatric Cardiology created an interdisciplinary working group. The group's remit was to draft this document, "Guidelines for the management of pulmonary hypertension patients", based on a review of the literature and the authors' clinical expertise. These guidelines aim to present all the relevant evidence on the diagnostic and treatment strategy of PH and the definition of requirements for referral centres. The organisation of care is fundamental for an appropriate and rational use of the available resources and for the better care of the patient.

Este artigo teve como objetivo realizar uma revisão teórica acerca do construto expectativas de resultados frente ao uso de álcool, maconha e tabaco. As expectativas de resultados são determinadas a partir do que as pessoas acreditam acerca dos efeitos de determinada droga, sendo uma variável importante no tratamento de dependentes químicos. Foram realizadas buscas de artigos publicados nas bases de dados MEDLINE, PsycINFO, ProQuest, Ovid, LILACS e Cork, usando os descritores belief, expectancy, expectation, drugs, psychoactive e effect. Os resultados demonstraram que as expectativas de resultados frente ao uso dessas substâncias podem surgir de fontes como: exposição a estímulos condicionados, dependência física, crenças pessoais e culturais e fatores situacionais e ambientais. Conclui-se que ainda há necessidade de novas pesquisas quanto às expectativas relacionadas às diferentes substâncias psicoativas e faixas etárias para uma melhor compreensão deste construto.This article aims to perform a theoretical review about the outcome expectancy construct considering the use of alcohol, cannabis and tobacco. Outcome expectancy is determined by people's belief about the effects of a drug. It is an important variable for the treatment of chemically dependent patients. Searches in the electronic databases MEDLINE, PsycINFO, ProQuest, Ovid, LILACS and Cork were carried out, using the following descriptors: belief, expectancy, expectation, drugs, psychoactive, and effect. Results showed that outcome expectancy considering the use of those substances can be generated from: exposure to conditioning stimuli, physical dependence, personal and cultural beliefs, and situational and environmental factors. In conclusion, there is the need of new researches on expectancies related to psychoactive substances and age groups in order to have a better understanding of this construct.