Gonçalo Costa

This 2026 update of the European Society of Cardiology (ESC) Core Curriculum for the Cardiologist reflects contemporary and emerging requirements for the practice of cardiology and the resulting training needs. The document has three main parts:Section 1 outlining the main training requirements and their presentation in entrustable professional activities (EPAs).Section 2 explaining the requirements for training centres.Section 3 outlining the general skills, knowledge, and attitudes required in cardiology (chapter 1) - and eight chapters outlining EPAs in the different areas of cardiology (chapter 2 to 9). This update has been written over 9 months in a iterative process, involving over 90 representatives as per the initial curriculum, similar to that used for the previous iteration of the core curriculum in 2020. Though much of the 2020 core curriculum remains relevant and unchanged, there was a clear need to amend this previous curriculum to reflect the expanding roles of some areas of cardiology such as data science, digital health, and artificial intelligence. These items have now been specifically included along with general updates to various clinical EPAs due to changes in practice or evidence base.

Background: While female sex has historically been associated with worse outcomes following surgical aortic valve replacement, the evidence regarding sex-related differences after transcatheter aortic valve implantation (TAVI) remains inconclusive. Given that women are more frequently referred for TAVI, clarifying the role of sex in procedural outcomes is clinically relevant. Objectives: To systematically evaluate and summarise randomised clinical trial (RCT) evidence comparing TAVI outcomes between women and men. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024510202). PubMed, EMBASE and Web of Science were searched for English-language RCTs up to 1 July 2024. Studies comparing TAVI outcomes by sex were included. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke or transient ischaemic attack (TIA), major bleeding and permanent pacemaker implantation (PPI). Pooled ORs were calculated using Mantel-Haenszel random-effects models. Results: 14 RCTs with a total of 15 225 participants were included. No overall difference in all-cause mortality was observed between sexes (OR: 0.83; 95% CI 0.65 to 1.06), though a significant protective effect for female sex was found among intermediate-risk patients (OR: 0.64; 95% CI 0.49 to 0.84; I²=0%). Women had a significantly higher risk of major bleeding (OR: 1.35; 95% CI 1.21 to 1.52; I²=15%). No significant sex-based differences were identified in cardiovascular mortality (OR: 0.98), stroke/TIA (OR: 0.96) or PPI (OR: 1.05). Conclusion: Female sex was associated with a lower all-cause mortality among intermediate-risk patients undergoing TAVI, but also with a higher overall risk of major bleeding. These findings suggest the need for further investigation into sex-related anatomical and procedural factors. PROSPERO registration number: CRD42024510202.

This study analyses the research output expected for the final curricular evaluation of Portuguese medical residency programs, with particular focus on cardiology. All publicly available specialty-specific evaluation grids were reviewed in December 2024. Cardiology required 46 research items to attain maximum scoring, including research papers and congress abstracts stratified by journal quartile. This was the highest requirement among all specialties, compared to a median of 11 across all specialties. Uniquely, cardiology was the only specialty to quantitatively specify participation in research projects, clinical trials, and registries. In contrast, it scored below average in the most recent national residency satisfaction survey. However, no significant correlation was observed between the number of required research items and overall satisfaction. These findings suggest a potential misalignment between curricular evaluation criteria and the actual conditions of residency training. Reviewing these requirements may help create a more balanced and sustainable training environment.

Hybrid procedures offer a promising solution for complex cases where open surgery is high risk, relying on the collaboration of anaesthesiologists, cardiac surgeons and interventional cardiologists. We present a male patient in his 70s with severe aortic stenosis, coronary artery disease, ascending aortic aneurysm and heart failure who underwent a hybrid cardiac procedure, including transcatheter aortic valve implantation, percutaneous coronary intervention of the right coronary artery and coronary artery bypass graft surgery. Through this hybrid intervention, involving a minimally invasive transcatheter and an open surgical procedure, the patient remained haemodynamically stable with minimal blood loss. 6 months postprocedure, he showed significant improvement in daily activities, aided by consistent physical therapy and cardiac check-ups. Current literature supports the hybrid approach for optimising risk-benefit outcomes, though further research is needed to define precise indications for its use.

Background: Clinical practice guidelines recommend oral anticoagulation (OAC) for stroke prevention in selected patients with atrial fibrillation (AF). However, some patients still experience thrombo-embolic events despite adequate anticoagulation. The optimal management of these cases remains uncertain, leading to practice pattern variability. We present a series of three cases illustrating the use of left atrial appendage occlusion (LAAO) as an adjunctive stroke prevention strategy in AF patients with recurrent thrombo-embolic events despite adequate anticoagulation. Case summary: Case one describes an 89-year-old female on apixaban who presented with a thrombus and underwent successful mechanical thrombectomy. Left atrial appendage occlusion was performed, and no subsequent thrombo-embolic events were reported. Case 2 involves a 72-year-old female on full-dose apixaban who experienced recurrent strokes despite adequate anticoagulation. Thrombectomy was performed twice, and complications arose during LAAO. The patient was discharged on warfarin + clopidogrel and remained event-free at the six-month follow-up. Case 3 features an 88-year-old female on rivaroxaban who experienced recurrent cerebral ischaemic events and gastrointestinal bleeding. Left atrial appendage occlusion using an Amplatzer Amulet™ device was successful, and the patient remained event-free at the one-year follow-up. Discussion: This case series emphasizes the complexity of stroke prevention in AF patients and underscores the need for an individualized approach. Incorporating LAAO alongside OAC can provide additional stroke protection for patients with inadequate response to anticoagulation. Further randomized controlled trials are needed to evaluate the efficacy and safety of this approach. In light of the limited evidence available, these cases contribute to the growing body of knowledge on the potential role of LAAO in secondary stroke prevention in AF patients with recurrent thrombo-embolic events despite appropriate anticoagulation.