PATRICIA OLIVEIRA GUIMARAES
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conferenceObject Aspirin- Free Prasugrel Monotherapy: 30-Day Clinical Outcome After Percutaneous Coronary Intervention in Chronic Coronary Syndrome and Non- ST-Segment Elevation Acute Coronary Syndrome(2023) NAKAZAWA, Gaku; MIYASHITA, Kotaro; MASUDA, Shinichiro; TOBE, Akihiro; LEMOS, Pedro; GUIMARAES, Patricia; MURAMATSU, Takashi; KOTOKU, Nozomi; KAGEYAMA, Shigetaka; NINOMIYA, Kai; TANABE, Kengo; OZAKI, Yukio; KOZUMA, Ken; ONUMA, Yoshinobu; SERRUYS, Patrick- High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study(2021) GUIMARAES, Patricia O.; SOUZA, Francis R. de; LOPES, Renato D.; BITTAR, Cristina; CARDOZO, Francisco A.; CARAMELLI, Bruno; CALDERARO, Daniela; ALBUQUERQUE, Cicero P.; DRAGER, Luciano F.; FERES, Fausto; BARACIOLI, Luciano; FILHO, Gilson Feitosa; BARBOSA, Roberto R.; RIBEIRO, Henrique B.; RIBEIRO, Expedito; ALVES, Renato J.; SOEIRO, Alexandre; FAILLACE, Bruno; FIGUEIREDO, Estevao; DAMIANI, Lucas P.; VAL, Renata M. do; HUEMER, Natassja; NICOLAI, Lisie G.; HAJJAR, Ludhmila A.; ABIZAID, Alexandre; FILHO, Roberto KalilBackground: Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients. Methods: We included patients with COVID-19 and high risk features according to clinical and/or labo-ratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death. Results: A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality. Conclusions: This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveil-lance and potential subsequent interventional therapies. (c) 2021 Published by Elsevier B.V.
- The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis(2023) SOEIRO, Alexandre M.; BOSSA, Aline S.; CESAR, Maria C.; LEAL, Tatiana C. A. T.; GARCIA, Guilherme; FONSECA, Rafael A.; NAKAMURA, Debora; GUIMARAES, Patricia O.; SOEIRO, Maria C. F. A.; JR, Carlos V. Serrano; SOARES, Paulo R.; MUELLER, Christian; MEBAZAA, Alexandre; FERNANDES, Fabio; NOMURA, Cesar H.; ROCHITTE, Carlos E.; JR, Mucio T. de OliveiraIntroductionThe role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methodsThis was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. ResultsThe mean follow-up was 18.7 & PLUSMN; 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. ConclusionMeasurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
- Effect of Alirocumab on Incidence of Atrial Fibrillation After Acute Coronary Syndromes: Insights from the ODYSSEY OUTCOMES Trial(2022) LOPES, Renato D.; GUIMARAES, Patr Icia O.; SCHWARTZ, Gregory G.; BHATT, Deepak L.; BITTNER, Vera A.; BUDAJ, Andrzej; DALBY, Anthony J.; DIAZ, Rafael; GOODMAN, Shaun G.; HARRINGTON, Robert A.; JUKEMA, J. Wouter; KISS, Robert Gabor; LOY, Megan; PORDY, Robert; POULOUIN, Yann; SZAREK, Michael; WHITE, Harvey D.; STEG, Philippe GabrielBACKGROUND: Using data from the ODYSSEY OUTCOMES trial (NCT01663402), we sought to identify factors associated with the development of incident atrial fibrillation in patients with recent acute coronary syndrome without prior atrial fibrillation and to determine whether alirocumab treatment influenced risk of incident atrial fibrillation. METHODS: ODYSSEY OUTCOMES compared alirocumab treatment with placebo in 18,924 patients with recent acute coronary syndrome and dyslipidemia despite high-intensity or maximum-tolerated statin therapy. The primary outcome of major adverse cardiovascular events (MACE) comprised death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischemic stroke, or unstable angina requiring hospitalization. Patients were classified as having previous atrial fibrillation (present prior to or at randomization) or no previous atrial fibrillation. A multivariable model was used to determine factors associated with incident atrial fibrillation. RESULTS: Among 18,262 participants without prior atrial fibrillation at baseline, 499 (2.7%) had incident atrial fibrillation during follow-up. Older age, history of heart failure or myocardial infarction, and higher body mass index were significantly associated with incident atrial fibrillation. Treatment with alirocumab or placebo did not influence the cumulative incidence of atrial fibrillation (hazard ratio 0.91; 95% confidence interval, 0.77-1.09). Patients with vs without a history of atrial fibrillation had a higher incidence of MACE (8.8 vs 3.7 events per 100 patient-years), without significant interaction between atrial fibrillation and randomized treatment on risk of MACE (P-interaction =.78). CONCLUSIONS: While alirocumab did not modify risk of incident atrial fibrillation after acute coronary syndrome, it did reduce the risk of MACE, regardless of prior atrial fibrillation history. History of atrial fibrillation is an independent predictor of recurrent cardiovascular events after acute coronary syndrome. (c) 2022 The Authors.
conferenceObject A 30-Day Pooled Analysis of Acetyl Salicylic Elimination Trials (ASET) in Brazil and Japan: Synergy Stent with Prasugrel Monotherapy Without Aspirin(2023) ONUMA, Yoshinobu; MASUDA, Shinichiro; MURAMATSU, Takashi; ISHIBASHI, Yuki; KOZUMA, Ken; KAWASHIMA, Hideyuki; NAKAZAWA, Gaku; TAKAHASHI, Kuniaki; TANABE, Kengo; KOGAME, Norihiro; NAKAMURA, Masato; ASANO, Taku; OKAMURA, Takayuki; MIYAZAKI, Yosuke; TATEISHI, Hiroki; OZAKI, Yukio; NAKATANI, Shimpei; KATAGIRI, Yuki; MORINO, Yoshihiro; NINOMIYA, Kai; KAGEYAMA, Shigetaka; KOTOKU, Nozomi; GUIMARAES, Patricia O.; LEMOS, Pedro A.; SERRUYS, Patrick W.conferenceObject Causes of death in patients with atrial fibrillation and a recent acute coronary syndrome or percutaneous coronary intervention: insights from the AUGUSTUS trial(2022) GUIMARAES, P.; WOJDYLA, D. M.; ALEXANDER, J. H.; GOODMAN, S. G.; ARONSON, R.; WINDECKER, S.; MEHRAN, R.; GRANGER, C. B.; LOPES, R. D.conferenceObject THE ASSOCIATION OF ELECTRICAL LEFT AXIS DEVIATION WITH CARDIAC STRUCTURAL ABNORMALITIES IN PATIENTS WITH ADVANCED AGE: AN OBSERVATIONAL STUDY.(2023) TAVARES, Caio A. M.; SAMESIMA, Nelson; GUIMARAES, Patricia; PADRAO, Eduardo; FACIN, Mirella Esmanhotto; NETO, Felippe Lazar; FERREIRA, Elisa; HAJJAR, Ludhmila; PASTORE, Carlos Alberto