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Clinical Research in Cardiovascular Disease

Prof. Paulo Bettencourt
Group Leader


This group is composed mainly by clinical researchers from the Internal Medicine and Cardiology Departments. The focus is clinical research in cardiovascular disease with a particular focus on heart failure. Large clinical databases are kept from patients followed-up at our heart failure or cardiology outpatient clinics as well as from patients admitted to our departments or the emergency department of Centro Hospitalar São João. Blood and 24h-urine samples from these patients are collected and safely stored at our facilities. Part of the group’s activity is concerned with knowledge transfer to the medical and non-medical communities, advanced medical education and clinical case reporting, participation in national and international disease registries and multicentre trials. So far diagnosis and assessment of heart failure progression have been mostly based on non-specific signs and symptoms. Our main goal is to find diagnosis and prognosis biomarkers that may aid clinical decision-making. Early diagnosis and detection of clinical worsening is cornerstone to optimal medical management thus these new biomarker tools are badly warranted. Among the most studied biomarkers are the natriuretic peptides. For over a decade, we have conducted innovative research on the usefulness and use of natriuretic peptides for diagnosis and prognosis in heart failure syndromes. 


We have described for the first time that heart failure patients who fail to decrease B-type natriuretic peptide during an acute decompensation episode are at much higher risk of an adverse outcome. This observation has been reproduced by other groups and recently also by an European research network that we integrated. An important research topic that may help us understand clinical deterioration and identify patients at risk is natriuretic peptide exhaustion in severe heart failure. Another growing area of research interest within our group is the study of systemic complications of heart failure namely inflammation, caquexia, and kidney, lung and liver dysfunction as well as the impact of co-morbidities such as chronic lung disease. Low body-mass index and mal-nutrition associate with adverse outcome in heart failure. We have demonstrated that pre-albumin, a simple low-cost biomarker, closely associates with both mal-nutrition and outcome. We reported for the first time that neutrophil gelatinase-associated lipocalin – a biomarker of kidney injury – can identify acute heart failure patients at very high risk of renal dysfunction and it has important prognostic value. 

These results generate the hypothesis that in these patients, who generally have an ominous prognosis, modulating venous pressure, one of the major factors leading to renal dysfunction in acute heart failure, may substantially improve outcome. Interactions between heart and liver and their clinical consequences are largely unexplored, we recently characterized cardiac function in cirrhosis by advanced echocardiography methodologies. In patients with heart failure and chronic obstructive lung disease we documented worse prognosis and most importantly no association between b-blocker use and adverse respiratory events challenging a long-held empirical medical belief.