Browsing by Author "Ferreira, AM"
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- Cor Triatriatum num Adulto Assintomático. Diagnóstico por AngioTC CardíacaPublication . Ferreira, F; Ferreira, AM; Lopes, R; Ferreira, J; Correia, MG; Gil, VM
- Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in PortugalPublication . Ferreira, AM; Marques, H; Araújo Gonçalves, P; Cardim, NBACKGROUND: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. OBJECTIVE: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. METHODS: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. RESULTS: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. CONCLUSIONS: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.
- Crazy? Not Really! A Brainstorming on Ideas to Change Anesthesia Practice on the Next Ten YearsPublication . Ferreira, JL; Ferreira, AM; Carneiro, AM; Pires, R
- Defining the Place of Ezetimibe/Atorvastatin in the Management of HyperlipidemiaPublication . Ferreira, AM; Marques da Silva, PStatin-ezetimibe combinations are a potentially advantageous therapeutic option for high-risk patients who need additional lowering of low-density lipoprotein cholesterol (LDL-C). These combinations may overcome some of the limitations of statin monotherapy by blocking both sources of cholesterol. Recently, a fixed-dose combination with atorvastatin, one of the most extensively studied statins, was approved and launched in several countries, including the USA. Depending on atorvastatin dose, this combination provides LDL-C reductions of 50-60%, triglyceride reductions of 30-40%, and high-density lipoprotein cholesterol (HDL-C) increases of 5-9%. Studies comparing the lipid-lowering efficacy of the atorvastatin-ezetimibe combination with the alternatives of statin dose titration or switching to a more potent statin consistently showed that combination therapy provided greater LDL-C reduction, translating into a greater proportion of patients achieving lipid goals. Simvastatin-ezetimibe combinations have been shown to reduce the incidence of major atherosclerotic events in several clinical settings to a magnitude that seems similar to that observed with statins for the same degree of absolute LDL-C lowering. The atorvastatin-ezetimibe combination has also been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone. Atorvastatin-ezetimibe combinations are generally well tolerated. Previous concerns of a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods. In this paper, we examine the rationale for an atorvastatin-ezetimibe combination, review the evidence supporting it, and discuss its potential role in the management of dyslipidemia.
- Documento de Consenso sobre a Realização de Ressonância Magnética em Doentes com Dispositivos Cardíacos Electrónicos ImplantadosPublication . Almeida, A; António, N; Saraiva, C; Ferreira, AM; Hipólito Reis, A; Marques, H; Dias Ferreira, N; Oliveira, MMMagnetic resonance imaging (MRI) is currently considered an essential complementary method for diagnosis in many conditions. Exponential growth in its use is expected due to the aging population and a broader spectrum of clinical indications. Growth in its use, coupled with an increasing number of pacemaker implants, implantable cardioverter-defibrillators and cardiac resynchronization therapy, has led to a frequent clinical need for this diagnostic modality in patients with cardiac implantable electronic devices (CIED). This clinical need has fueled the development of devices specifically designed and approved for use in a magnetic resonance (MR) environment under certain safety conditions (MR-conditional devices). More than a decade after the introduction of the first MR-conditional pacemaker, there are now several dozen MR-conditional devices with different safety specifications. In recent years, increasing evidence has indicated there is a low risk to MRI use in conventional (so-called non-MR-conditional) CIED patients in the right circumstances. The increasing number, as well as the greater diversity and complexity of implanted devices, justify the need to standardize procedures, by establishing institutional agreements that require close collaboration between cardiologists and radiologists. This consensus document, prepared jointly by the Portuguese Society of Cardiology and the Portuguese Society of Radiology and Nuclear Medicine, provides general guidelines for MRI in patients with CIED, ensuring the safety of patients, health professionals and equipment. In addition to briefly reviewing the potential risks of MRI in patients with CIED and major changes to MRI-conditional devices, this article provides specific recommendations on risk-benefit analysis, informed consent, scheduling, programming strategies, devices, monitoring and modification of MRI sequences. The main purpose of this document is to optimize patient safety and provide legal support to facilitate easy access by CIED patients to a potentially beneficial and irreplaceable diagnostic technique.
- Documento de Consenso Sobre Codificação de Exames de Ressonância Magnética Cardíaca em PortugalPublication . Ferreira, AM; Almeida, AG; Oliveira, L; Bettencourt, N; Marques, H; Matos, P; Abecasis, J; Abreu, J; Alpendurada, F; Botelho, A; Campos, P; Castela, S; Cunha, D; Donato, P; Ferreira, MJ; Rocha Lopes, L; Pinho, T; Sá, I; Saraiva, C; Jalles, N; Themudo, RUm dos obstáculos a uma utilização mais frequente e apropriada da ressonância magnética cardíaca (RMC) em Portugal tem sido a ausência de códigos específicos que descrevam adequadamente os exames tal como são efetuados actualmente. Este documento de consenso fornece recomendações para a atualização e uniformização dos códigos empregues na RMC. São igualmente feitas recomendações quanto às técnicas e códigos a utilizar nas indicações clínicas mais frequentes.
- Tomografia Computorizada Cardíaca Prévia a Ablação de Fibrilhação Auricular - Efeitos da Evolução Tecnológica e Otimização de ProtocolosPublication . Marques, H; Araújo Gonçalves, P; Ferreira, AM; Cruz, R; Lopes, J; Santos, R; Radu, L; Costa, F; Mesquita, J; Carmo, P; Cavaco, D; Parreira, L; Pisco, J; Goyri O'Neill, J; Adragão, PIntrodução: A capacidade de a TC cardíaca fornecer um mapa anatómico preciso e excluir a presença de trombo intracardíaco é conhecida. O objetivo deste estudo foi avaliar o impacto da otimização de protocolos e evolução tecnológica nas doses de radiação e contraste e na qualidade de imagem dos exames de TC cardíaca prévia a ablação de fibrilhação auricular (FA). Métodos: Registo prospetivo de doentes consecutivos de centro único, foram incluídos os que fizeram TC cardíaca num contexto de avaliação prévia a ablação de FA (n = 270), distribuídos em três grupos: Grupo 1, constituído pelos primeiros 150 doentes; Grupo 2, os últimos 60 doentes feitos no mesmo aparelho; Grupo 3, os primeiros 60 doentes do novo aparelho. Avaliámos a otimização do protocolo com base na dose de radiação, no volume de contraste, na necessidade de aquisição complementar e na avaliação objectiva da qualidade de imagem (rácios sinal/ruído, contraste/ruído e homogeneizac¸ão de densidade AE/AAE). Resultados: Houve uma redução significativa da radiação entre cada um dos grupos e da dose de contraste entre o primeiro e o último grupo (G1: 5,6 mSv e 100 ml; G2: 1,3 mSv e 90 ml; G3: 0,6 mSv e 65 ml). Apesar das menores doses de radiação e contraste, o Grupo 3 apresentou resultados significativamente melhores de qualidade de imagem (rácios sinal/ruído 13,5; contraste/ruído 14,8; homogeneização de densidade 0,92).Conclusão: A otimização de protocolos e a evolução tecnológica permitiram reduções significativas nas doses de radiação e de contraste usadas na TC cardíaca pré-ablação de FA, sem prejudicar a qualidade de imagem.
- Treatment of Severe Nail Psoriasis with EtanerceptPublication . Dias Coelho, J; Diamantino, F; Lestre, S; Ferreira, AM