Pedro Matos

Rastreio de doença coronária no diabético assintomático. Como e em quem

Screening for coronary artery disease (CAD) in the asymptomatic diabetic patient is controversial with respect to both patient selection and rational choice of screening methods. Epidemiological studies in the real world and improved knowledge on risk markers have changed the criteria that help refine global risk stratification in a patient population that is per se high risk. Over the past years, it is likely that we have been overestimating the risk when using the classical risk factors. This review highlights the role of novel risk markers in the global assessment of diabetic patients, and identifies the best diagnostic approaches to select those patients who might benefit most from revascularization procedures or more aggressive treatment goals, despite the absence of symptoms. Factors such as the presence of kidney disease, cardiovascular autonomic neuropathy or atherosclerotic disease in other arterial territories, may exponentially increase the risk of poor outcomes in diabetic patients. With the aim of rationalizing the use of diagnostic procedures, we propose a sequential approach that combines anatomic and functional data with the coronary calcium score. This approach may serve as a filter to select patients for further assessment with more expensive and less available tests so as to optimize the cost-benefit ratio of screening.

Documento de consenso sobre codificação de exames de ressonância magnética cardíaca em Portugal

One of the obstacles to more frequent and appropriate use of cardiac magnetic resonance (CMR) in Portugal has been the lack of specific codes that accurately describe these examinations as they are currently performed. In this consensus document, recommendations are made for updating and standardizing CMR codes in Portugal. Guidance on which techniques and codes should be used in the most common clinical scenarios is also provided.

Familiaridade e perceções dos cardiologistas portugueses acerca da ressonância magnética cardíaca e angio-TC cardíaca - dimensão da tarefa à nossa frente

INTRODUCTION Rapid advances in cardiac magnetic resonance (CMR) and cardiac computed tomography angiography (CCTA) pose challenges for practicing physicians in terms of awareness of their indications, contraindications, advantages and pitfalls. METHODS We conducted a nationwide online survey assessing the familiarity, perceptions and patterns of use concerning these imaging modalities based on a questionnaire sent to all physician members of the Portuguese Society of Cardiology. RESULTS The responses from 205 physicians (21% response rate) were analyzed. Roughly half of them requested less than one CMR (51%) or CCTA (52%) per week. Suspected coronary artery disease in symptomatic patients with intermediate pretest probability was considered a good or excellent indication for CCTA by 59% of respondents when performed as a second-line exam, and by 29% as a first-line exam. Cardiac masses, congenital heart disease and cardiomyopathies were considered good or excellent indications for CMR by over 90% of respondents, while assessment of myocardial viability and acute myocardial infarction with normal coronary arteries were considered good or excellent indications by 75% and 65% of respondents, respectively. Less than half (39%) answered all the questions regarding contraindications for CMR correctly, and 15% were unaware that CMR does not involve ionizing radiation. The main reasons for not referring a patient for CMR were limited availability (45%) and cost (36%). CONCLUSIONS Portuguese cardiologists appear to be moderately aware of the indications, contraindications and advantages of these new imaging modalities. Greater efforts should be made to improve physician education on this subject in order to improve patient care.