When did you first decide you wanted a career in medicine?
Since I was a child I always used to say I would like to become a doctor to be able to treat sick people. Despite the fact that there are not many doctors in my immediate family, that was a wish I used to express since early childhood. Later on, in high school, there was no other field I would like to follow professionally, although I was very attracted by history but only as a hobby. When already in medical school I became very attracted by clinical work, although in the first years I also enjoyed basic research.
Why did you decide to enter cardiology?
I was very much influenced by someone I worked with in my medical school, Frederico Silveira Machado, who was a doctor of the old school of Internist/Cardiologist. I also enjoyed very much the fact that in cardiology you could do several procedures that could not only help the patients but improve the way you understand pathophysiology and link basic knowledge with actual impact on patient outcome.
Who were your greatest influences?
In Portugal my greatest reference was my mentor Professor Fernando de Pádua, who was the Head of Department in my hospital and who influenced me very much in my career. He himself trained in the US, where he worked with Paul White. He was a great enthusiast and supporter of my career and helped me immensely not only when I started my fellowship in Lisbon University Hospital, but also in the decision to go the US and then when I decided to return to Portugal.
In 1989 I went to Stanford University where I stayed until 1993. There I had the chance to work with a great group of people, but I have to mention my immediate mentor, Richard Popp, who influenced me immensely and to whom I owe a lot of what I am today. He was the Head of the Echo lab at Stanford and then Vice Dean. He is not only a tremendous cardiologist, researcher and scientist but truly what you imagine a mentor should be: inspiring, supporting, hard when he had to be, always knowing what to tell you and how to tell you.
Then I have been fortunate enough to have met a number of outstanding people that have shaped my life. I will not enumerate them since I may be able to forget some, but would also like to say that one of my greatest influences have been my students. The time I spent teaching was as one of my main achievements. It is truly a unique experience, and also a great lesson of humility.
You were one of the pioneers in the introduction of intravascular ultrasound in the clinical arena. How did this come about?
I was a fellow at Stanford University when intravascular ultrasound started so I got very interested in doing it. The project at the time was looking at graft atherosclerosis since Stanford is a well-known centre for cardiac transplantation. Graft atherosclerosis is a major cause of death after the first year after cardiac transplantation and the annual coronary angiography done to these patients was not enough to detect early changes. Therefore the use of IVUS looked very promising as a new tool to detect intimal thickening at the earliest stage of development. The idea was nurtured by my mentor, Richard Popp, the team leaders of the transplant programme, John Schroeder, Sharon Hunt and Hanna Valantine, and together with another fellow and very good friend, Frederick St. Goar, and some other colleagues, we started an innovative programme on the use of IVUS in early detection of graft atherosclerosis. I was so interested that also decided to do a formal interventional cardiology fellowship so I could not only interpret the studies but performed them myself. With the support of Edwin Alderman and Stephen Oesterle, I actually did a formal interventional cardiology fellowship at Stanford (1992–93). It was a great period for me (very busy as well), since I was an interventional fellow in the cath lab and attended the echo lab.
On a professional level what have been your proudest moments?
It is difficult to choose since I have been very fortunate in being involved in several projects which have been quite successful. I have to mention, however, the pioneering work I did at Stanford on the study of graft atherosclerosis; the creation of the Lisbon Cardiovascular Institute in 1999, together with my colleague Jose Fernandes e Fernandes, who is the current Dean at my Medical School; and the creation of the European Association of Echocardiography, of which I was the first president.
Are you currently involved in research? What specific areas are you most interested in and why?
My main current research interests are in the use of ultrasound/imaging in different settings. I am a clinical researcher, therefore my work is done always with a focus on clinical grounds. I have also responsibilities with the pre and post graduate students which are always a great resource of new ideas. My main research projects at the moment are: study of left and right ventricular function parameters by echocardiography in hypertension, looking at new ways of detecting early changes in myocardial function; development of a new model to assess quality control in interventional cardiology; pulmonary hypertension; role of OCT (optical coherence tomography) in interventional cardiology.
You were president and founder of the European Association of Echocardiography. Why have you become involved in medical societies?
I became more deeply involved in medical societies after returning from the US to Europe in the 1990s. First, I became involved with my own national society where I was the chairman of the Working Group on Echocardiography from 1995–97 and, at the same time, started to get involved with the European Society of Cardiology, namely the Working Group on Echocardiography. I became responsible for one of the subgroups at the time (IVUS and vascular) and then in 2000 I was elected as chairman elect and became chairman in 2002. This was a very exciting period in Europe and it coincides with the decision of the European Society of Cardiology to create associations. I worked hard with the ESC leadership at the time to have echocardiography as one of the first ESC associations. In fact, in 2003, in Vienna, the first two associations were created, the EHRA (European Heart Rhythm Association) and EAE (European Association of Echocardiography) and I became the first president of EAE. I believe it was a major decision and very important for the future not only of the subspecialities but mostly for the future of Cardiology in Europe. I am very proud and honoured of having been the first president of EAE.
I continued to serve ESC, first on the Board as Councillor (2004–06), then as representative of ESC on EBSC (European Board for the Speciality of Cardiology), and now I was nominated chairman of the Congress Program Committee (CPC) of ESC for 2009–10, which is certainly one of the biggest challenges I have ever faced in my professional life.
In your opinion, what are the main trends in echocardiography at the moment and what kind of developments can we expect to see in the near future?
There are several developments in echocardiography that are particularly important and that will receive continued attention in the future, but the main advantages of echocardiography that makes it so attractive and so popular are its portability, user friendliness and amount of clinically relevant and reliable information it can provide immediately at the bedside, translating into relevant clinical implications. Besides that, the use of tissue velocities, myocardial deformation parameters, myocardial contrast perfusion assessment, real time 3-dimensional echocardiography, portable echo devices, etc., will certainly continue to make echocardiography as one of the main used imaging modalities in medicine.
But I would also like to say that I believe that cardiovascular imaging will evolve very fast in the future. Right now, we have different imaging technologies, not only echocardiography, but we have multislice computerised tomography, cardiac magnetic resonance imaging and nuclear imaging, all of them with a huge potential for development. What I would like to see in the future is the complementary use of these different technologies in the assessment of different clinical problems. In addition, the development of molecular imaging will also be very important for the future. Some developments already have occurred in fusion imaging: the ability to use some of the advantages of different imaging technologies and put them together (such as ultrasound with cardiac magnetic resonance imaging or with computerised tomography). Continued refinement of the various technologies will result in new developments that will help overcome some of the difficulties