Biography:

In the past Hélder Dores has collaborated on articles with Aneil Malhotra and Gonçalo Cardoso. One of their most recent publications is Original InvestigationAnterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance. Which was published in journal Journal of the American College of Cardiology.

More information about Hélder Dores research including statistics on their citations can be found on their Copernicus Academic profile page.

Hélder Dores's Articles: (12)

Original InvestigationAnterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance

AbstractBackgroundAnterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardiomyopathy (ARVC). Whereas the 2010 European consensus recommendations for ECG interpretation in young athletes state that ATWI beyond lead V1 warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites.ObjectivesThis study investigated the prevalence and significance of ATWI in a large cohort of young, white adults including athletes.MethodsIndividuals 16 to 35 years of age (n = 14,646), including 4,720 females (32%) and 2,958 athletes (20%), were evaluated by using a health questionnaire, physical examination, and 12-lead ECG. ATWI was defined as T-wave inversion in ≥2 contiguous anterior leads (V1 to V4).ResultsATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p < 0.0001) and more common among athletes than in nonathletes (3.5% vs. 2.0%, respectively; p < 0.0001). T-wave inversion was predominantly confined to leads V1 to V2 (77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V2. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. During a mean follow-up of 23.1 ± 12.2 months none of the individuals with ATWI experienced an adverse event.ConclusionsATWI confined to leads V1 to V2 is a normal variant or physiological phenomenon in asymptomatic white individuals without a relevant family history. ATWI beyond V2 is rare, particularly in men, and may warrant investigation.

Artigo OriginalChoque cardiogénico no enfarte agudo do miocárdio: o que mudou nos últimos 10 anos?Acute myocardial infarction complicated by cardiogenic shock: What changed over a 10-year time span

ResumoIntroduçãoApesar dos avanços terapêuticos, a letalidade do choque cardiogénico (CC) associado ao enfarte agudo do miocárdio (EAM) permanece elevada.ObjetivoComparar 2 grupos de doentes com CC associado ao EAM, admitidos com um intervalo de 10 anos.MétodosAnálise retrospetiva de 2 populações de doentes com CC associado ao EAM admitidos entre maio/1998-maio/2001 (Grupo A) e maio/2008-maio/2011 (Grupo B). Compararam-se as características clínicas, diagnóstico, tratamento e complicações e analisaram-se os preditores de morte aos 6 meses.ResultadosA incidência de CC foi 3,7% no Grupo A (n = 25) e 4,8% no Grupo B (n = 42). Não existiram diferenças significativas nas características demográficas e clínicas, exceto na idade (60,2 ± 12,3 versus 66,5 ± 11,3 anos; p = 0,043) e doentes admitidos com < 6 h de sintomas (29,2 versus 54,8%, p = 0,045). O cateterismo da artéria pulmonar diminuiu (52,0 versus 19,0%, p = 0,005) e as técnicas dialíticas aumentaram (4,0 versus 28,6%, p = 0,014). A proporção de doentes reperfundidos nas primeiras 12 h ou revascularizados foi semelhante, mas a intervenção coronária percutânea (ICP) aumentou (75,0 versus 92,9%, p = 0,042). As complicações intra-hospitalares, mortalidade aos 30 d (32,0 versus 35,7%; p = 0,757) e 6 meses (36,0 versus 42,9%; p = 0,683) não diferiram. A diabetes foi a única característica basal preditora independente de morte aos 6 meses (HR 3,02; IC 95% 1,38-6,60; p = 0,006) e os doentes revascularizados apresentaram menor mortalidade (HR 0,11; IC95% 0,03-0,42; p = 0,001).ConclusãoNos últimos 10 anos, apesar da chegada mais precoce dos doentes ao hospital, da maior utilização de algumas medidas de suporte e acesso à ICP, a mortalidade a curto e médio prazo não se alterou.

Caso clínicoUm caso raro de elevação persistente da troponina em doente com insuficiência cardíaca crónicaA rare case of persistent troponin elevation in a patient with chronic heart failure

ResumoMulher com miocardiopatia hipertrófica, que sofre enfarte do miocárdio aos 28 anos, sem doença coronária angiográfica. Dois anos mais tarde inicia manifestações de insuficiência cardíaca e instala-se disfunção sistólica ventricular esquerda com elevação persistente da troponina I cardíaca. A partir daí houve deterioração progressiva da função ventricular.

Artigo originalVariabilidade na interpretação do eletrocardiograma do atleta: mais uma limitação na avaliação pré‐competitivaVariability in interpretation of the electrocardiogram in athletes: Another limitation in pre‐competitive screening

ResumoIntroduçãoA interpretação do eletrocardiograma (ECG) do atleta permanece controversa, com ausência de estandardização e dificuldade na aplicação de critérios específicos na sua interpretação. O objetivo deste trabalho é avaliar a variabilidade na interpretação do ECG de atletas.MetodologiaVinte ECG de atletas foram avaliados por cardiologistas e internos de cardiologia, 11 normais ou apenas com alterações fisiológicas e nove patológicos. Cada ECG foi classificado pelos inquiridos em normal/com alterações fisiológicas ou patológico, usando ou não critérios específicos na sua interpretação.ResultadosForam incluídas as respostas de 58 médicos, 42 (72,4%) cardiologistas. Dezasseis (27,6%) afirmaram avaliar frequentemente atletas e 32 (55,2%) não usar critérios específicos na interpretação do ECG, sendo os mais usados os critérios de Seattle (n = 13). Em média, cada médico interpretou corretamente 15 ± 2 ECG, correspondendo a 74% dos traçados (variação: 45‐100%). A interpretação dos ECG foi correta em 68% (variação: 22‐100%) dos patológicos e em 79% (variação: 55‐100%) dos normais/com alterações fisiológicas. Não houve diferença significativa na interpretação entre cardiologistas e internos (74 ± 10% versus 75 ± 10%; p = 0,724), nem entre os que avaliam frequentemente ou não atletas (77 ± 12% versus 73 ± 9%; p = 0,286), verificando‐se uma tendência para interpretação mais correta com critérios específicos (77 ± 10% versus 72 ± 10%; p = 0,092). A reprodutibilidade do estudo foi excelente (intraclass correlation coefficient = 0,972; p < 0,001).ConclusãoNa amostra estudada, cerca de um quarto dos ECG foi incorretamente avaliados, havendo uma elevada variabilidade na sua interpretação. O uso de critérios específicos na interpretação do ECG do atleta pode melhorar a acuidade deste exame no screening de atletas, mas são ainda subutilizados.

Original articleNT-proBNP for risk stratification of pulmonary embolismNT-proBNP na estratificação de risco no tromboembolismo pulmonar☆

AbstractIntroductionPulmonary embolism (PE) is an entity with high mortality and morbidity, in which risk stratification for adverse events is essential. N-terminal brain natriuretic peptide (NT-proBNP), a right ventricular dysfunction marker, may be useful in assessing the short-term prognosis of patients with PE.AimsTo characterize a sample of patients hospitalized with PE according to NT-proBNP level at hospital admission and to assess the impact of this biomarker on short-term evolution.MethodsWe performed a retrospective analysis of consecutive patients admitted with PE over a period of 3.5 years. Based on the median NT-proBNP at hospital admission, patients were divided into two groups (Group 1: NT-proBNP < median and Group 2: NT-proBNP ≥ median). The two groups were compared in terms of demographic characteristics, personal history, clinical presentation, laboratory, electrocardiographic and echocardiographic data, drug therapy, in-hospital course (catecholamine support, invasive ventilation and in-hospital death and the combined endpoint of these events) and 30-day all-cause mortality. A receiver operating characteristic (ROC) curve was constructed to determine the discriminatory power and cut-off value of NT-proBNP for 30-day all-cause mortality.ResultsNinety-one patients, mean age 69±16.4 years (51.6% aged ≥75 years), 53.8% male, were analyzed. Of the total sample, 41.8% had no etiological or predisposing factors for PE and most (84.6%) were stratified as intermediate-risk PE. Median NT-proBNP was 2440 pg/ml. Patients in Group 2 were significantly older (74.8±13.2 vs. 62.8±17.2 years, p=0.003) and more had a history of heart failure (35.5% vs. 3.3%, p=0.002) and chronic kidney disease (32.3% vs. 6.7%, p=0.012). They had more tachypnea on initial clinical evaluation (74.2% vs. 44.8, p=0.02), less chest pain (16.1% vs. 46.7%, p=0.01) and higher creatininemia (1.7±0.9 vs. 1.1±0.5 mg/dl, p=0.004). Group 2 also more frequently had right chamber dilatation (85.7% vs. 56.7%, p=0.015) and lower left ventricular ejection fraction (56.4±17.6% vs. 66.2±13.5%, p=0.036) on echocardiography. There were no significant differences in drug therapy between the two groups. Regarding the studied endpoints, Group 2 patients needed more catecholamine support (25.8% vs. 6.7%, p=0.044), had higher in-hospital mortality (16.1% vs. 0.0%, p=0.022) and more frequently had the combined endpoint (32.3% vs. 10.0%, p=0.034). All-cause mortality at 30 days was seen only in Group 2 patients (24.1% vs. 0.0%, p=0.034). By ROC curve analysis, NT-proBNP had excellent discriminatory power for this event, with an area under the curve of 0.848. The best NT-proBNP cut-off value was 4740 pg/ml.ConclusionElevated NT-proBNP levels identified PE patients with worse short-term prognosis, and showed excellent power to predict 30-day all-cause mortality. The results of this study may have important clinical implications. The inclusion of NT-proBNP measurement in the initial evaluation of patients with PE can add valuable prognostic information.

Case reportRenal sympathetic denervation for treatment of resistant hypertensionAblação da atividade simpática renal para tratamento da hipertensão arterial resistente☆

AbstractHypertension is an important cardiovascular risk factor and although there have been many improvements in pharmacological treatment, a significant percentage of patients are still considered resistant. The authors describe two cases of radiofrequency renal sympathetic denervation that illustrate the feasibility of this new technique for the treatment of resistant hypertension. The procedure consists of the application of radiofrequency energy inside the renal arteries to ablate afferent and efferent sympathetic renal activity, which has been implicated in the pathophysiology of hypertension.

Case reportA case of constrictive pericarditis and thoracic aortic aneurysm: A hybrid therapeutic approachUm caso de pericardite constritiva e aneurisma da aorta torácica: abordagem terapêutica híbrida☆

AbstractThe authors describe the case of a 59-year-old man, a former smoker, with hypertension, chronic renal failure undergoing hemodialysis, and a history of stent grafting for repair of an abdominal aortic aneurysm and miliary tuberculosis, who was diagnosed with constrictive pericarditis and a thoracic aortic aneurysm. In a patient with such a complex medical history, there were several etiologies to consider. The treatment consisted of pericardiectomy and a hybrid technique of supra-aortic debranching and subsequent endovascular stent-graft repair.

Original ArticlePercutaneous coronary intervention of unprotected left main disease: Five-year outcome of a single-center registryIntervenção coronária percutânea do tronco comum não protegido: resultados aos cinco anos de um registo de centro único

AbstractIntroduction and AimsPercutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main coronary artery (ULMCA) lesions. We aimed to evaluate the long-term outcome of patients undergoing ULMCA PCI.Methods and ResultsWe retrospectively analyzed 95 consecutive patients (median EuroSCORE I 2.9 [IQR 1.4;6.1]) who underwent ULMCA PCI between 1999 and 2006, included in a single-center prospective registry. The primary outcome was major adverse cardiovascular events (MACE) defined as all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR) at five years. Forty patients (42.1%) were treated in the setting of acute coronary syndrome and 81 patients (85%) had at least one additional significant lesion (SYNTAX score 24.2±11.8). Single ULMCA PCI was performed in 33% (81.1% with drug-eluting stents) and complete functional revascularization was achieved in 79% of the patients. During the observation period, 20 patients died (21.1%), 6 (6.3%) had MI and 11 (11.6%) had TLR (total combined MACE 28.4%). Independent predictors of MACE were previous MI (HR 2.9 95% CI 1.23–6.92; p=0.015), hypertension (HR 5.7 95% CI 1.86–17.47; p=0.002) and the EuroSCORE I (HR 1.1 95% CI 1.03–1.12; p=0.001). Drug-eluting stent implantation was associated with a significantly lower MACE rate, even after propensity score adjustment (AUC=0.84; HR [corrected] 0.1; 95% CI 0.04–0.26; p<0.001).ConclusionsUnprotected left main percutaneous coronary intervention, particularly using drug-eluting stents, can be considered a valid alternative to coronary artery bypass grafting, especially in high-risk surgical patients and with favorable anatomic features.

Original ArticleRenal denervation in patients with resistant hypertension: Six-month resultsDesnervação renal em doentes com hipertensão arterial resistente: resultados aos seis meses de seguimento☆

AbstractIntroductionIncreased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter-based renal denervation (RDN) was recently developed for the treatment of resistant HTN.AimTo assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN.MethodsIn this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥10 mmHg reduction in office systolic blood pressure (SBP) six months after the intervention.ResultsIn a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7±7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six-month follow-up, the response rate was 81.8% (n=18). The mean office SBP reduction was 22 mmHg (174±23 vs. 152±22 mmHg; p<0.001) and 9 mmHg in diastolic BP (89±16 vs. 80±11 mmHg; p=0.006). The number of antihypertensive drugs (5.5±1.0 vs. 4.6±1.1; p=0.010) and pharmacological classes (5.4±0.7 vs. 4.6±1.1; p=0.009) also decreased significantly. Of the 24-hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45±29 vs. 27±26%; p=0.049) and in left ventricular mass index (174±56 vs. 158±60 g/m2; p=0.014).ConclusionIn this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six-month follow-up.

Original ArticleAbnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competitionAlterações eletrocardiográficas em atletas: correlação com a intensidade de desporto e o nível de competição

AbstractIntroductionAthletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition.MethodsA cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (≤20 vs. >20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the ‘Refined Criteria’ (RC).ResultsAbnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; p<0.001).ConclusionsThere is a positive correlation between higher intensity of sports and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation, although the number of abnormal ECGs is lower.

Original ArticleVariability in interpretation of the electrocardiogram in athletes: Another limitation in pre-competitive screeningVariabilidade na interpretação do eletrocardiograma do atleta: mais uma limitação na avaliação pré-competitiva☆

AbstractIntroductionAssessment of the electrocardiogram (ECG) in athletes remains controversial, with lack of standardization and difficulty in applying specific criteria in its interpretation. The purpose of this study was to assess variability in the interpretation of the ECG in athletes.MethodsTwenty ECGs of competitive athletes were assessed by cardiologists and cardiology residents, 11 of them normal or with isolated physiological changes and nine pathological. Each ECG was classified as normal/physiological or pathological, with or without the use of specific interpretation criteria.ResultsThe study presents responses from 58 physicians, 42 (72.4%) of them cardiologists. Sixteen (27.6%) physicians reported that they regularly assessed athletes and 32 (55.2%) did not use specific ECG interpretation criteria, of which the Seattle criteria were the most commonly used (n=13). Each physician interpreted 15±2 ECGs correctly, corresponding to 74% of the total number of ECGs (variation: 45%-100%). Interpretation of pathological ECGs was correct in 68% (variation: 22%-100%) and of normal/physiological in 79% (variation: 55%-100%). There was no significant difference in interpretation between cardiologists and residents (74±10% vs. 75±10%; p=0.724) or between those who regularly assessed athletes and those who did not (77±12% vs. 73±9%; p=0.286), but there was a trend for a higher rate of correct interpretation using specific criteria (77±10% vs. 72±10%; p=0.092). The reproducibility of the study was excellent (intraclass correlation coefficient=0.972; p<0.001).ConclusionsA quarter of the ECGs were not correctly assessed and variability in interpretation was high. The use of specific criteria can improve the accuracy of interpretation of athletes’ ECGs, which is an important part of pre-competitive screening, but one that is underused.

Perspectives in CardiologyMandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of CardiologyCritérios mandatórios para programas de reabilitação cardíaca: normas da Sociedade Portuguesa de Cardiologia 2018

AbstractCardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies.In Portugal, only 8% of patients discharged from hospital after myocardial infarction are included in CR programs. In Europe overall, the percentage admitted to CR programs is 30%, while in the USA it is 20-30%.In view of the underuse of CR in Portugal, we call the attention of the health authorities to the need to increase the number and national coverage of CR programs, while maintaining high quality standards. The aim is for all patients resident in Portugal who are eligible for CR programs to have the same opportunities for access and attendance.In order to preserve the benefits and safety of this intervention, CR needs to be performed according to international guidelines. The fact that various initiatives in this field have been developed by different professional groups, some of them non-medical, that do not follow the European guidelines, has prompted us to prepare a series of norms defining mandatory criteria for CR, based on current knowledge and evidence. In this way we aim to ensure that the required increase in the number of CR programs, linked in a national network of CR centers, does not detract from the need to maintain their efficacy and quality. These criteria should serve as the basis for the future accreditation of CR centers in Portugal.

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