Carlos Aguiar

Bio: Carlos Aguiar is an academic researcher from Federal University of Rio de Janeiro. The author has contributed to research in topics: Myocardial infarction & Population. The author has an hindex of 19, co-authored 115 publications receiving 1764 citations. Previous affiliations of Carlos Aguiar include Rio de Janeiro State University.

TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS.

Abstract: Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63±11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672–0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584–0.674), and TIMI RS (AUC: 0.585; CI: 0.539–0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. Conclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

TIMI, PURSUIT, and GRACE Risk Scores: Sustained Prognostic Value and Interaction With Revascularization in NSTE-ACS

Abstract: Aims Regarding prognosis, patients with a non-ST elevation acute coronary syndrome (ACS) are a very heterogeneous population, with varying risks of early and long-term adverse events. Early risk stratification at admission seems to be essential for a tailored therapeutic strategy. We sought to compare the prognostic value of three ACS risk scores (RSs) and their ability to predict benefit from myocardial revascularization performed during initial hospitalization. Methods and results We studied 460 consecutive patients admitted to our coronary care unit with an ACS [age: 63±11 years, 21.5% female, 55% with myocardial infarction (MI)]. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Platelet glycoprotein IIb/IIIa in Unstable agina: Receptor Suppression Using Integrilin (PURSUIT), and Global Registry of Acute Coronary Events (GRACE) RSs were calculated using specific variables collected at admission. Their prognostic value was evaluated by the combined endpoint of death or MI at 1 year. The best cut-off value for each RS, calculated with receiver operating characteristic curves, was used to assess the impact of myocardial revascularization on the combined incidence of death or MI. Death or MI at 1 year was 15.4% (32 deaths/49 MIs). The best predictive accuracy for death or MI at 1 year was obtained by the GRACE RS (AUC) [area under the curve: 0.715; confidence interval (CI: 0.672–0.756)] but the performance of the PURSUIT RS (AUC: 0.630; CI: 0.584–0.674), and TIMI RS (AUC: 0.585; CI: 0.539–0.631) was also good. We found a statistically significant interaction between the risk stratified by the best cut-off value for the GRACE and PURSUIT RSs and myocardial revascularization, with a better prognosis for the high-risk patients. The high-risk patients represented 36.7, 28.7, and 57.8% of the population, for the GRACE, PURSUIT, and TIMI RSs, respectively. Conclusion The RSs studied demonstrated a good predictive accuracy for death or MI at 1 year and enabled the identification of high-risk subsets of patients who will benefit most from myocardial revascularization performed during initial hospital stay.

Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography

Abstract: Mitral annular disjunction (MAD) consists of an altered spatial relation between the left atrial wall, the attachment of the mitral leaflets, and the top of the left ventricular (LV) free wall, manifested as a wide separation between the atrial wall-mitral valve junction and the top of the LV free wall. Originally described in association with myxomatous mitral valve disease, this abnormality was recently revisited by a surgical group that pointed its relevance for mitral valve reparability. The aims of this study were to investigate the echocardiographic prevalence of mitral annular disjunction in patients with myxomatous mitral valve disease, and to characterize the clinical profile and echocardiographic features of these patients. We evaluated 38 patients with myxomatous mitral valve disease (mean age 57 ± 15 years; 18 females) and used standard transthoracic echocardiography for measuring the MAD. Mitral annular function, assessed by end-diastolic and end-systolic annular diameters, was compared between patients with and without MAD. We compared the incidence of arrhythmias in a subset of 21 patients studied with 24-hour Holter monitoring. MAD was present in 21 (55%) patients (mean length: 7.4 ± 8.7 mm), and was more common in women (61% vs 38% in men; p = 0.047). MAD patients more frequently presented chest pain (43% vs 12% in the absence of MAD; p = 0.07). Mitral annular function was significantly impaired in patients with MAD in whom the mitral annular diameter was paradoxically larger in systole than in diastole: the diastolic-to-systolic mitral annular diameter difference was -4,6 ± 4,7 mm in these patients vs 3,4 ± 1,1 mm in those without MAD (p < 0.001). The severity of MAD significantly correlated with the occurrence of non-sustained ventricular tachycardia (NSVT) on Holter monitoring: MAD›8.5 mm was a strong predictor for (NSVT), (area under ROC curve = 0.74 (95% CI, 0.5-0.9); sensitivity 67%, specificity 83%). There were no differences between groups regarding functional class, severity of mitral regurgitation, LV volumes, and LV systolic function. MAD is a common finding in myxomatous mitral valve disease patients, easily recognizable by transthoracic echocardiography. It is more prevalent in women and often associated with chest pain. MAD significantly disturbs mitral annular function and when severe predicts the occurrence of NSVT.

Smoothed particle hydrodynamics for relativistic heavy-ion collisions

Abstract: A smoothed particle hydrodynamics (SPH) method is developed for the study of relativistic heavy-ion collisions In order to describe the flow of a high-energy but low baryon number density fluid, entropy is taken as the SPH base The method is formulated in terms of a variational principle, and the SPH equations for an arbitrary curvilinear coordinate system are obtained Several examples show that SPH is a promising tool for the study of hadronic flow in relativistic heavy-ion processes

Smoothed Particle Hydrodynamics for Relativistic Heavy Ion Collisions

Abstract: The method of smoothed particle hydrodynamics (SPH) is developped appropriately for the study of relativistic heavy ion collision processes. In order to describe the flow of a high energy but low baryon number density fluid, the entropy is taken as the SPH base. We formulate the method in terms of the variational principle. Several examples show that the method is very promising for the study of hadronic flow in RHIC physics.

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Abstract: ABOARD : Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention ACC : American College of Cardiology ACE : angiotensin-converting enzyme ACS : acute coronary syndromes ACT : activated clotting time ACUITY : Acute Catheterization and Urgent Intervention Triage strategY AF : atrial fibrillation AHA : American Heart Association APPRAISE : Apixaban for Prevention of Acute Ischemic Events aPTT : activated partial thromboplastin time ARB : angiotensin receptor blocker ARC : Academic Research Consortium ATLAS : Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Aspirin With or Without Thienopyridine Therapy in Subjects with Acute Coronary Syndrome BARI-2D : Bypass Angioplasty Revascularization Investigation 2 Diabetes BMS : bare-metal stent BNP : brain natriuretic peptide CABG : coronary bypass graft CAD : coronary artery disease CI : confidence interval CK : creatinine kinase CKD : chronic kidney disease CK-MB : creatinine kinase myocardial band COX : cyclo-oxygenase CMR : cardiac magnetic resonance COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CPG : Committee for Practice Guidelines CrCl : creatinine clearance CRP : C-reactive protein CRUSADE : Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines CT : computed tomography CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CURRENT : Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events CYP : cytochrome P450 DAPT : dual (oral) antiplatelet therapy DAVIT : Danish Study Group on Verapamil in Myocardial Infarction Trial DES : drug-eluting stent DTI : direct thrombin inhibitor DIGAMI : Diabetes, Insulin Glucose Infusion in Acute Myocardial Infarction EARLY-ACS : Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome ECG : electrocardiogram eGFR : estimated glomerular filtration rate ELISA : Early or Late Intervention in unStable Angina ESC : European Society of Cardiology Factor Xa : activated factor X FFR : fractional flow reserve FRISC : Fragmin during Instability in Coronary Artery Disease GP IIb/IIIa : glycoprotein IIb/IIIa GRACE : Global Registry of Acute Coronary Events HINT : Holland Interuniversity Nifedipine/Metoprolol Trial HIT : heparin-induced thrombocytopenia HORIZONS : Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction HR : hazard ratio hsCRP : high-sensitivity C-reactive protein ICTUS : Invasive vs. Conservative Treatment in Unstable coronary Syndromes INR : international normalized ratio INTERACT : Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment ISAR-COOL : Intracoronary Stenting With Antithrombotic Regimen Cooling Off ISAR-REACT : Intracoronary stenting and Antithrombotic Regimen- Rapid Early Action for Coronary Treatment i.v. : intravenous LDL-C : low-density lipoprotein cholesterol LMWH : low molecular weight heparin LV : left ventricular LVEF : left ventricular ejection fraction MB : myocardial band MDRD : Modification of Diet in Renal Disease MERLIN : Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes MI : myocardial infarction MINAP : Myocardial Infarction National Audit Project MRI : magnetic resonance imaging NNT : numbers needed to treat NSAID : non-steroidal anti-inflammatory drug NSTE-ACS : non-ST-elevation acute coronary syndromes NSTEMI : non-ST-elevation myocardial infarction NT-proBNP : N-terminal prohormone brain natriuretic peptide OASIS : Organization to Assess Strategies for Ischaemic Syndromes OPTIMA : Optimal Timing of PCI in Unstable Angina OR : odds ratio PCI : percutaneous coronary intervention PENTUA : Pentasaccharide in Unstable Angina PLATO : PLATelet inhibition and patient Outcomes PURSUIT : Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy RCT : randomized controlled trial RE-DEEM : Randomized Dabigatran Etexilate Dose Finding Study In Patients With Acute Coronary Syndromes (ACS) Post Index Event With Additional Risk Factors For Cardiovascular Complications Also Receiving Aspirin And Clopidogrel REPLACE-2 : Randomized Evaluation of PCI Linking Angiomax to reduced Clinical Events RIKS-HIA : Register of Information and Knowledge about Swedish Heart Intensive care Admissions RITA : Research Group in Instability in Coronary Artery Disease trial RR : relative risk RRR : relative risk reduction STE-ACS : ST-elevation acute coronary syndrome STEMI : ST-elevation myocardial infarction SYNERGY : Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trial SYNTAX : SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery TACTICS : Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy TARGET : Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial TIMACS : Timing of Intervention in Patients with Acute Coronary Syndromes TIMI : Thrombolysis In Myocardial Infarction TRITON : TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction UFH : unfractionated heparin VKA : vitamin K antagonist VTE : venous thrombo-embolism Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the European Society of Cardiology (ESC) Core Curriculum topics. Guidelines and recommendations should help the physicians to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible physician(s). A great number of Guidelines have been issued in recent years by the ESC as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management, and/or prevention of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . …

Stochastic Processes in Physics and Chemistry

Abstract: N G van Kampen 1981 Amsterdam: North-Holland xiv + 419 pp price Dfl 180 This is a book which, at a lower price, could be expected to become an essential part of the library of every physical scientist concerned with problems involving fluctuations and stochastic processes, as well as those who just enjoy a beautifully written book. It provides an extensive graduate-level introduction which is clear, cautious, interesting and readable.

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

Abstract: Jeffrey L. Anderson, MD, FACC, FAHA, Chair Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect Alice K. Jacobs, MD, FACC, FAHA, Immediate Past Chair 2009–2011 [§§][1] Sidney C. Smith, Jr, MD, FACC, FAHA, Past Chair 2006–2008 [§§][1] Cynthia D. Adams, MSN, APRN-BC, FAHA[§§][1] Nancy M