Browsing by Author "Morais, João"
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- 3D deformations by means of monogenic functionsPublication . Morais, João; Ferreira, MiltonIn this paper, the authors compute the coefficient of quasiconformality for monogenic functions in an arbitrary ball of the Euclidean space $\mathbb{R}^3$. This quantification may be needed in applications but also appear to be of intrinsic interest. The main tool used is a 3D Fourier series development of monogenic functions in terms of a special set of solid spherical monogenics. Ultimately, we present some examples showing the applicability of our approach.
- Acute, periprocedural and longterm antithrombotic therapy in older adultsPublication . Andreotti, Felicita; Geisler, Tobias; Collet, Jean-Philippe; Gigante, Bruna; Gorog, Diana A; Halvorsen, Sigrun; Lip, Gregory Y H; Morais, João; Navarese, Eliano Pio; Patrono, Carlo; Rocca, Bianca; Rubboli, Andrea; Sibbing, Dirk; Storey, Robert F; Verheugt, Freek W A; Vilahur, GemmaThe first international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fibrillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantation and left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, despite the complexities of comorbidities, comedications and uncertain ischaemic- vs. bleeding-risk balance. Fourteen updated consensus statements integrate recent trial data and other evidence, with a focus on high bleeding risk. Guideline recommendations, when present, are highlighted, as well as gaps in evidence. Key consensus points include efforts to improve medical adherence through deprescribing and polypill use; adoption of universal risk definitions for bleeding, myocardial infarction, stroke and cause-specific death; multiple bleeding-avoidance strategies, ranging from gastroprotection with aspirin use to selection of antithrombotic-drug composition, dosing and duration tailored to multiple variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration when managing older adults. © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved.
- Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)Publication . Gorog, Diana; Price, Susanna; Sibbing, Dirk; Baumbach, Andreas; Capodanno, Davide; Gigante, Bruna; Halvorsen, Sigrun; Huber, Kurt; Lettino, Maddalena; Leonardi, Sergio; Morais, João; Rubboli, Andrea; Siller-Matula, Jolanta M; Storey, Robert F; Vranckx, Pascal; Rocca, BiancaTimely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.
- Cardiocerebral Infarction: A Combination to PreventPublication . Cabral, Margarida; Ponciano, Ana; Santos, Beatriz; Morais, JoãoBackground The acute complications of myocardial infarction (MI), such as mechanical, arrhythmic, ischemic, and inflammatory sequelae, may be responsible for significant cardiovascular morbimortality. Life-threatening arrhythmias, namely ventricular fibrillation or tachycardia, may be a challenging complication requiring a prompt approach. In some cases, acute ischemia leads to polymorphic ventricular tachycardia (PVT), and, rarely, to potentially lethal torsades de pointes ventricular tachycardia.
- A Clinical Decision Support System for Remote Monitoring of Cardiovascular Disease Patients: A Clinical Study ProtocolPublication . Ventura, Filipa; Sousa, Pedro; Dixe, Maria dos Anjos; Ferreira, Paulo; Martinho, Ricardo; Dias, Sara Simões; Morais, João; Gonçalves, Lino M.Introduction: Cardiovascular diseases (CVD) are the leading cause of death globally, taking an estimated 17. 9 million lives each year. Cardiac rehabilitation is shown to reduce mortality and hospital readmissions, while improving physical fitness and quality of life. Despite the recommendations and proven benefits, acceptance and adherence remain low. Mobile health (mHealth) solutions may contribute to more personalized and tailored patient recommendations according to their specific needs. This study protocol aims to assess the effectiveness of a user-friendly, comprehensive Clinical Decision Support System (CDSS) for remote patient monitoring of CVD patients, primarily on the reduction of recurrent cardiovascular events. Methods and Analysis: The study will follow a multicenter randomized controlled design involving two cardiology units in the Center Region of Portugal. Prospective CVD patients will be approached by the healthcare staff at each unit and checked for eligibility according to the predefined inclusion/exclusion criteria. The CDSS will suggest a monitoring plan for the patient, will advise the mHealth tools (apps and wearables) adapted to patient needs, and will collect data. The clinical study will start in January 2023. Discussion: The success of the mHeart.4U intervention will be a step toward the use of technological interfaces as an integrating part of CR programs. Ethics and Dissemination: The study will undergo ethical revision by the Ethics Board of the two hospital units where the study will unfold. The study was registered in ClinicalTrials.gov on 18th January 2022 with the number NCT05196802. The study findings will be published in international peer-reviewed scientific journals and encounters and in a user-friendly manner to the society.
- Do We Have a Culprit? An Association of Giant Cell Arteritis with Pulmonary EmbolismPublication . Miguel Gonçalves, Carolina; Neves Tavares, Pedro; Saraiva, Fátima; Morais, João; Banza, Maria JesusGiant cell arteritis is the most common type of systemic vasculitis. An increased risk of venous thromboembolism has been described in these patients. We report the case of a 79-year-old woman with a history of polymyalgia rheumatica, who presented with left thoracic pain radiating to the neck and scapula plus temporal headache. She had no changes on physical examination, but work-up tests showed increased D-dimer levels and computed tomography pulmonary angiography revealed signs of a chronic/subacute embolism in the right inferior lobe. Anticoagulation with edoxaban was started after 5 day bridging with enoxaparin. Three weeks after the initial diagnosis the headache still persisted and she developed scalp tenderness. Giant cell arteritis was diagnosed and treated with prednisolone, with complete resolution of symptoms. Extensive diagnostic work-up was performed to identify an alternative cause of pulmonary thromboembolism; however, the investigations were negative. This case supports the hypothesis that this type of vasculitis could be related to the occurrence of pulmonary embolism.
- “A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapyPublication . Feijó, Salvato; Morais, João; Saraiva, Fátima; Silva, Sónia; Cabral, Margarida; Miguel Gonçalves, Carolina; Amorim, DianaBackground: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication. Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment. Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.
- Exuberant microvascular dysfunction: An indirect sign of coronary involvement in acute aortic syndrome?Publication . Cabral, Margarida; Martins, Hélia; Santos, Beatriz; Sousa, Pedro Jerónimo de; Morais, JoãoA 75-year-old obese woman with dyslipidemia and hypertension was admitted for acute chest pain. She presented anterolateral ST-segment elevationand slightly elevated troponin levels. She was transferred to a percutaneous coronary intervention-capable centre.
- Letter to the Editor regarding “Suboptimal control of cardiovascular risk factor control in myocardial infarction survivors in a cardiac rehabilitation program”Publication . Antunes, Alexandre; Cabral, Margarida; Morais, JoãoIn this letter, we report on the experience of the Leiria Hospital Center CR unit, highlighting that in the analysis of our first patient series in which 68 patients had finished the phase II program, 66% achieved both ESC guideline LDL-C targets and 82% achieved one or other of the two targets. Nota: excerto retirado da carta ao Editor.
- Lipoprotein(a) and the Effect of Alirocumab on Revascularization After Acute Coronary SyndromePublication . Steg, P. Gabriel; Szarek, Michael; Valgimigli, Marco; Islam, Shahidul; Zeiher, Andreas M.; Bhatt, Deepak L.; Bittner, Vera A.; Chiang, Chern-En; Diaz, Rafael; Goodman, Shaun G.; Gotcheva, Nina; Harrington, Robert A.; Jukema, J. Wouter; Kim, Hyo-Soo; Kim, Sang-Hyun; Morais, João; Pordy, Robert; Scemama, Michel; White, Harvey D.; Schwartz, Gregory G.; Steg, Ph. GabrielBackground Many patients require revascularization after index acute coronary syndrome (ACS). Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In ODYSSEY OUTCOMES, alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a) levels. We explored whether risk of revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo. Methods In ODYSSEY OUTCOMES alirocumab was compared with placebo in 18,924 patients with ACS and elevated atherogenic lipoprotein levels despite optimized statin treatment. In this post hoc analysis, treatment effects are summarized using competing risks proportional hazard models. Results A total of 1559 (8.2%) patients had coronary, 204 (1.1%) had limb, and 40 (0.2%) had carotid revascularization. Alirocumab reduced coronary revascularization (2.8 vs 3.2 events per 100 patient-years; hazard ratio [HR], 0.88 [95% confidence interval (CI), 0.80-0.97]; P = 0.01) and any revascularization (3.2 vs 3.7 events per 100 patient-years; HR, 0.85 [95% CI, 0.78-0.94]; P = 0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm and inversely related to treatment HRs (all P for trend < 0.01). Alirocumab produced the greatest reduction of coronary revascularization in patients with baseline lipoprotein(a) in the top quartile (≥ 59.6 mg/dL; HR, 0.69 [95% CI, 0.57-0.84]), but no apparent reduction in the bottom quartile (HR, 1.00 [95% CI, 0.82-1.22]). Findings were similar for the effect of alirocumab on any revascularization. Conclusions Alirocumab reduced revascularization rates after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.