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Thyroid hormones have a central role in cardiovascular homeostasis. In myocardium, these hormones stimulate both diastolic myocardial relaxation and systolic myocardial contraction, have a pro-angiogenic effect and an important role in extracellular matrix maintenance. Thyroid hormones modulate cardiac mitochondrial function. Dysfunction of thyroid axis impair myocardial bioenergetic status. Both overt and subclinical hypothyroidism are associated with a higher incidence of coronary events and an increased risk of heart failure progression. Endothelial function is also impaired in hypothyroid state, with decreased nitric oxide mediated vascular relaxation. In heart disease, particularly in ischemic heart disease, abnormalities in thyroid hormone levels are common and are an important factor to be considered. In fact, low thyroid hormone levels should be interpreted as a cardiovascular risk factor. Regarding ischemic heart disease, during the late post-myocardial infarction period, thyroid hormones modulate left ventricular structure, function and geometry. Dysfunction of thyroid axis might even be more prevalent in the referred condition since there is an upregulation of type 3 deiodinase in myocardium, producing a state of local cardiac hypothyroidism. In this focused review, we summarize the central pathophysiological and clinical links between altered thyroid function and ischemic heart disease. Finally, we highlight the potential benefits of thyroid hormone supplementation as a therapeutic target in ischemic heart disease.

Purpose of review: Patients with traumatic brain injury (TBI) are typically multiple trauma patients, presenting with various pathological entities that jeopardize their survival. Anemia is one of the most common abnormalities in trauma patients, and is considered a worse prognosis determinant. However, strong recommendations, and high-quality prospective studies to support them, about the best transfusion practices in brain trauma patients are scarce, if not inexistent, leading to major doubts in optimal treatments. This review's intention is to summarized actual evidence regarding this issue, mainly the hemoglobin thresholds and other important triggers used in treating anemic TBI patients. Recent findings: In general intensive and neurocritical care, a restrictive transfusion method has been proven safe and, at least, not inferior to previously advocated liberal thresholds. Nevertheless, another physiological variables have been recently studied in treating anemia in this patients' population, leading to more liberal approaches in red blood cell transfusions, due to recent implemented "triggers". Allowing a normal oxygen delivery and achieving an optimal brain oxygenation is dependent of multiple factors, independent of hemoglobin concentrations. Summary: Nowadays, there is no sufficiently high-quality information to provide practicians with strong general recommendations in managing anemia in traumatic brain injury. Transfusions are one of the main options, but they have both benefits and risks that must be taken in account in every single case.

Objetivo O objetivo foi identificar possíveis factores com impacto no outcome de doentes admitidos com Hemorragia Subaracnoideia espontânea. Métodos Este estudo retrospetivo de série de casos incluiu todos os doentes com Hemorragia Subaracnoideia espontânea admitidos numa Unidade Neurocríticos de um hospital terciário em nível de cuidados intensivos entre 1 de janeiro de 2018 e 30 de junho de 2019. O outcome primário foi definido pela escala de outcome de Glasgow. Resultados Foram incluídos 46 doentes (29 mulheres). A idade mediana foi 55.5 anos (50.0-63.3). Em 41 doentes identificou-se um aneurisma. A idade, a escala de Fisher, o nível de hemoglobina à admissão e a hidrocefalia tiveram impacto no outcome à alta e 28 dias após o evento (P<0.05), enquanto o tipo de intervenção teve impacto aos 180 dias após o evento (P=0.046). Nenhum doente submetido à intervenção neurorradiológica teve mau outcome aos seis meses. Em todos os momentos de seguimento, a escala de Coma de Glasgow à admissão, a escala Hunt & Hess, a duração da ventilação invasiva e a isquemia cerebral tardia tiveram associação com o outcome destes doentes (P<0.05). Conclusões As complicações associadas à Hemorragia Subaracnoideia foram frequentes e associaram-se a piores outcomes, por isso a abordagem de tratamento deve focar-se na prevenção e rápida resolução destas complicações. O tratamento endovascular teve melhores outcomes aos seis meses que a intervenção cirúrgica. / Objective The aim was to identify possible factors with impact in outcome in patients admitted with spontaneous Subarachnoid Hemorrhage. Methods This retrospective case-series study included all patients with spontaneous Subarachnoid Hemorrhage admitted to a Neurocritical Unit of a tertiary hospital at intensive care level between the first january 2018 and the 30th june 2019. Primary outcome was defined by Glasgow Outcome Scale. Results Forty-six patients (29 females) were included. Median age was 55.5 years (50.0-63.3). In 41 patients an aneurysm was identified. Age, Fisher scale, hemoglobin level at admission and hydrocephalus were factors with impact on outcome at discharge and 28 days from the event (P<0.05), while the type of intervention had an impact 180 days from the event (P=0.046). No patient submitted to neuroradiology procedure had a bad outcome at six months. At all moments of follow-up, Glasgow Coma scale at admission, Hunt & Hess scale, duration of invasive ventilation and delayed cerebral ischemia had an association with patients' outcome (P<0.05). Conclusions Subarachnoid Hemorrhage related complications were common and associated with worse outcomes, therefore treatment approach should be focused on its avoidance and prompt resolution. Endovascular treatment had better outcomes at six months than surgical intervention.

Introdução e Objetivos: À medida que a mortalidade após enfarte agudo do miocárdio (EAM) diminui, as estratégias de prevenção secundária adquirem uma relevância crescente na prevenção de eventos recorrentes. O objetivo deste estudo foi avaliar o controlo de fatores de risco cardiovascular (FRCV), nomeadamente, dislipidemia, hipertensão e diabetes mellitus, em doentes após EAM que completaram um programa de reabilitação cardíaca. Métodos: Estudo de coorte retrospetivo, observacional, que incluiu doentes admitidos num centro terciário com o diagnóstico de EAM, entre Novembro de 2012 e Abril de 2017. Foi avaliado o atingimento dos alvos recomendados pelas guidelines da Sociedade Europeia de Cardiologia para colesterol LDL (LDLc), pressão arterial (PA) e hemoglobina glicada (HbA1C). Os parâmetros lipídicos foram avaliados e comparados em três momentos (hospitalização, início e final do programa). Resultados: Foram incluídos 379 doentes (idade média de 58.8 ± 10.6 anos, 81% homens). Considerando as guidelines, 61%, 87% e 71% atingiram os alvos recomendados de LDLc, PA e HbA1c, respetivamente, no final do programa. Combinando os três FRCV, 42% dos indivíduos atingiram os alvos recomendados. Os níveis de proteína C reativa de alta sensibilidade diminuíram entre o início e final do programa [0.14 (0.08-0.29) mg/L vs. 0.12 (0.06-0.26) mg/L; p<0.001]. Conclusão: Apesar de estratégias contemporâneas, uma proporção importante de doentes apresentou um controlo subóptimo dos FRCV. Considerando dislipidemia, hipertensão e diabetes mellitus combinados, menos de metade atingiu os alvos recomendados. Estes dados reforçam a importância da otimização de estratégias de prevenção secundária, dado o potencial impacto em outcomes cardiovasculares. / Introduction and Objectives: As short-term mortality continues to decrease after myocardial infarction (MI), secondary prevention strategies attain increasing relevance in order to prevent recurrent events. This study aimed at evaluating cardiovascular risk factor (CVRF) control, namely dyslipidemia, hypertension and diabetes mellitus, among a contemporary cohort of MI survivors who completed an exercise-based cardiac rehabilitation (EBCR) program. Methods: Observational, retrospective cohort study including patients admitted to a tertiary center with an AMI between November 2012 and April 2017, who completed a phase II EBCR program after discharge. Achievement of LDL cholesterol, blood pressure and HbA1c guideline recommended targets was assessed. Lipid profile parameters were assessed and compared at three separate moments (hospitalization, beginning and end of the program). Results: A total of 379 patients were included. Mean age was 58.8 ± 10.6 years and 81% were male. Considering the ESC guidelines contemporary to the data collection, 61%, 87% and 71% achieved the recommended LDL cholesterol, blood pressure and HbA1c targets, respectively, at the end of the program. Combining all three risk factors, 42% achieved recommended targets. High-sensitivity C reactive protein decreased between the beginning and the end of the program [0.14 (0.08-0.29) mg/L to 0.12 (0.06-0.26) mg/L; p<0.001]. Conclusion: Despite contemporary management strategies, a substantial number of patients presented suboptimal control of CVRF. Considering dyslipidemia, hypertension and diabetes mellitus combined, less than half of individuals achieved the recommended targets. These findings highlight a pivotal unmet need which could be particularly relevant in improving cardiovascular outcomes by enhancing secondary prevention profiles.