ABC | Volume 112, Nº2, February 2019

Review Article Fontes-Carvalho et al The Year in Cardiology 2018: ABC Cardiol and RPC at a glance Arq Bras Cardiol. 2019; 112(2):193-200 Cardiomyopathies and Valvular heart disease In the January 2018 issue of Rev Port Cardiol, Cardim et al. 42 report the overall results of the Portuguese national Registry of Hypertrophic Cardiomyopathy (PRo-HCM), which included 1042 patients from 29 centers. This is one the largest and most significant worldwide registries of HCM, and provides a detailed contemporary assessment of the clinical profile, management strategies and outcomes of HCM in Portugal. The main conclusions were that HCM is characterized by relatively advanced age at diagnosis, with more than one fourth of patients diagnosed over the age of 65 years. There was a limited use of CMR for HCM assessment but, on the contrary, more than 50% performed genetic testing. The long-term mortality (0.65%/year) and the risk of sudden-cardiac death (0.22%/year) was low, but morbidity remained considerable. This registry shows that there are important differences in HCM management between guidelines and clinical practice, which was also demonstrated in other registries. 43,44 This can be the result of different HCM clinical courses representing the heterogeneous spectrum of HCM. Finally, these data reinforce the importance of using clinical registries as an important source of information that should be used to inform practice but also to influence the writing of the guidelines. 45 Advances in non-invasive cardiac imaging have provided important new insights in the pathophysiology of valvular heart disease and cardiomyopathies, and diagnosis of implanted device or bioprosthesis related complications. 46 Gripp et al. 47 used global longitudinal strain to assess the incidence of cardiotoxicity in 49 patients treated for breast cancer, and the independent factors associated with that event. Cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0). They concluded that the 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity. The role of incremental diagnostic and prognostic value of combination of imaging techniques or fusion imaging is growing exponentially. 48 In the Valve Academic Research Consortium-2 (VARC-2) consensus document, quantitative and semi‑quantitative hemodynamic assessments are recommended to assess aortic regurgitation (AR) severity by echocardiogram, andmoderate-to-severe AR is defined as valve failure 48 that is associated with poor outcome and mortality. Miyazaki et al. 49 investigated a quantitative angiographic assessment of AR by videodensitometry before and after Balloon post‑dilatation (BPD) since this technique provides an accurate assessment of the severity of paravalvular leak (PVL) and correlates with increased mortality and impaired reverse cardiac remodeling by echocardiography after transcatheter aortic valve implantation (TAVI). The authors showed that videodensitometry AR (VD-AR) decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5‑19.0]%, and the relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration). Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before, and in 19 patients (31%) after BPD. They concluded that VD-AR after transcatheter heart valve implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy. The increasing number of children with evolving congenital heart diseases who had lower mortality, especially in recent years, demands greater preparation of professionals and institutions that handle them. Jatene surgery became the surgical procedure of choice to repair transposition of the great arteries (TGA) in neonates and infants, and nowadays the behavior of the neo-aortic valve is a cause of concern because of its potential for requiring late reoperation. Martins et al. 50 assessed the prevalence and risk factors of neo-aortic valve regurgitation in 127 patients in the late postoperative period and observed 29% of mild and 18% of moderate neo‑aortic valve regurgitation, in a long follow-up. Those patients had a higher aortic annulus Z-score, although reoperation rate due to neo-aortic regurgitation associated with aortic dilation was only 1.5%, all in patients with complex TGA group. So, this study shows that, despite the low incidence of reoperation after Jatene surgery, these patients require strict vigilance due to the time-dependent phenomenon, and one of the major risk factors for neo-aortic valve regurgitation was the preoperative pulmonary artery diameter. Cardiac function, exercise capacity and heart failure Several studies have shown that left atrium (LA) size and function are important predictors of cardiovascular events in several clinical settings and can be involved in the progression to heart failure. 51-52 In another interesting article published in Rev Port Cardiol, Fontes-Carvalho et al. 53 evaluated in 94 patients after AMI the role of different indices of LA function (assessed by speckle tracking) as determinants of exercise capacity by cardiopulmonary exercise testing. They found a significant correlation between exercise capacity and LA conduit function, but not with contractile function. LA longitudinal strain was also associated with worse exercise capacity parameters, suggesting that this echocardiographic parameter can be used to predict reduced exercise capacity. Finally, it was shown that LA functional parameters were interdependent with LV diastolic function, highlighting the pathophysiologic importance of correct atrioventricular coupling. Therefore, this study highlights that although the LA was frequently viewed as a bystander in the regulation of cardiac function, the availability of new echocardiographic parameters for LA assessment (such as speckle tracking assessment) has shown its clinical utility as an important functional and prognostic marker in several clinical settings, especially in heart failure (HF). 54 Heart failure patients have a significant risk of cardiovascular events. Therefore, several studies have tried to improve risk stratification tools to predict HF hospitalizations or the need for heart transplantation. The most commonly used score is the Seattle Heart Failure Model (SHFM), which is based on 24 clinical variables. 55 Other scores are also available, 56 but there is an ongoing need to improve risk stratification in HF. In the February issue of Rev Port Cardiol, Pereira‑da‑Silva demonstrate that VE/VCO2 slope, obtained from cardiopulmonary exercise testing (CPET), can be a good predictor of events in patients with HF with reduced EF 197