1
|
Pedrosa RC, Paulo do Vale Madeiro J, Alberto AC, Limeira GA, de Bragança Pereira B, Matos do Nascimento E, Schlindwein FS, Ng GA. Risk stratifier for sudden cardiac death beyond the left ventricular ejection fraction in Chagas cardiomyopathy. Pacing Clin Electrophysiol 2024; 47:312-320. [PMID: 38140904 DOI: 10.1111/pace.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/18/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) risk markers are needed in Chagas cardiomyopathy (CC). Action potential duration restitution (APDR) dynamics is capable of extracting information on cardiac regional heterogeneity. This study intends to develop a patient-specific variables-based algorithm to predict SCD in the low-intermediate subgroups of the Rassi risk score. METHODS Cross-sectional study of patients who underwent 24-h Holter for research purposes between January 1992 and February 2017. From 4-h ECG segment, RR series were generated and APDR dynamics metrics were calculated. Classification tree and sensitivity analysis were applied. As outcomes, SCD, SCD-free and non-cardiovascular death and 34 variables were included. RESULTS Two hundred twenty-one (129 in the group SCD-free, 80 in the SCD group and 12 non-cardiovascular death group) were analyzed. In the groups with and without SCD (209 patients), the median age was 66 years, 52% were female, the cardiac involvement was mild to moderate in 72% with a Rassi point median of 8 (IQ: 3 to 11). The SCD group had more ventricular remodeling and more ventricular electrical instability. The occurrence of a %beats QTend/TendQ ratio > 1 (AUC, 0.96 (95% CI 0.89-0.98) present in more than 56.7% of the 4-h ECG segments was sufficient to identify patients of the SCD subgroup. Variables representing different stages of CC were also relevant in the model. CONCLUSION It is possible to use APDR dynamics as an adjuvant in the SCD risk assessment in a subgroup of patients with a high risk of SCD and a very low risk of non-CV death with high power of discrimination.
Collapse
Affiliation(s)
- Roberto Coury Pedrosa
- Cardiology Department, Clementino Fraga Filho University Hospital/Edson Saad Heart Institute-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alex C Alberto
- Federal Centre for Technological Education Celso Suckow da Fonseca, Rio de Janeiro, Brazil
| | | | - Basílio de Bragança Pereira
- Federal University of Rio de Janeiro, School of Medicine and Edson Saad Heart Institute, Rio de Janeiro, Brazil
| | | | - Fernando Soares Schlindwein
- University of Leicester, School of Engineering, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gullien André Ng
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Castilhos MPD, Huguenin GVB, Rodrigues PRM, Nascimento EMD, Pereira BDB, Pedrosa RC. Diet Quality of patients with chronic Chagas disease in a tertiary hospital: a case-control study. Rev Soc Bras Med Trop 2018; 50:795-804. [PMID: 29340457 DOI: 10.1590/0037-8682-0237-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/14/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nutritional status has been implicated in the modulation of the immune response, possibly augmenting the pathogenesis of Chagas disease (Cd). We evaluated diet quality and nutritional status in adults and elderly patients with chronic Cd in a tertiary hospital. METHODS A case-control study of Cd patients was conducted, paired for gender, age, and co-morbidities with non-Cd patients. Anthropometric measurements and food frequency questionnaire was used, and diet quality was assessed by the Brazilian Healthy Eating Index-Revised (BHEI-R). The Estimated Average Requirement cut-off points were used to determine the dietary micronutrient adequacy. The Cd group was further grouped according to Los Andes classification. RESULTS The study participants were 67 ± 10 years old, 73.6% elderly and 63% female. The prevalence of overweight/obesity and abdominal fat was high in both groups; however, Cd group showed a lower prevalence of obesity and increased risk of disease according to waist circumference classification. There was no difference in BHEI-R score between groups (p=0.145). The Cd group had sodium and saturated fat intake above recommendations and low intake of unsaturated fat, vitamin D, E, selenium, magnesium, and dairy products; but higher intake of iron. According to Los Andes classification, group III presented lower intake of whole fruit and dietary fiber. CONCLUSIONS Patients with Cd were overweight and the quality of their diet was unsatisfactory based on the recommended diet components for age and sex.
Collapse
Affiliation(s)
- Mariana Pereira de Castilhos
- Hospital Universitario Clementino Fraga Filho, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Grazielle Vilas Bôas Huguenin
- Departamento de Nutrição e Dietética, Universidade Federal Fluminense, Niterói, RJ, Brasil.,Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil
| | | | - Emília Matos do Nascimento
- Departamento de Bioestatistica a Estatistica Aplicada, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Rio de Janeiro, RJ, Brasil
| | - Basílio de Bragança Pereira
- Hospital Universitario Clementino Fraga Filho, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Departamento de Bioestatistica a Estatistica Aplicada, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Rio de Janeiro, RJ, Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitario Clementino Fraga Filho, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
3
|
Merejo Peña CM, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Dysautonomy in different death risk groups (Rassi score) in patients with Chagas heart disease. Pacing Clin Electrophysiol 2018; 41:238-245. [PMID: 29315657 DOI: 10.1111/pace.13270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/02/2017] [Accepted: 12/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been difficult to prove that "catecholamine-induced cardiomyopathy" contributes to the mechanism of sudden cardiac death in Chagas heart disease. Also, it is almost impossible to rule out the possibility that it is not involved in the process. More importantly, the vagal-cholinergic pathway in the ventricle plays a direct role in the prevention of the initiation of complex ventricular arrhythmias, including nonsustained ventricular tachycardia, ventricular fibrillation responsible for sudden death. OBJECTIVE To determine frequency of parasympathetic autonomic indices among the different groups of risk of cardiovascular death when stratified by Rassi score. METHODS Patients with Chagas heart disease were selected and divided into three risk groups by Rassi score. A fourth group, non-Chagas group, was of similar age and gender. All were subjected to analysis of heart rate variability during controlled breathing (RSA) and tilt table passive test (tilt test). High frequency and low frequency/high frequency ratio were calculated and presented by box-plot. Also, t-test was used to compare the two groups. RESULTS It was observed that the parasympathetic and sympathetic component were affected, when the risk group increased the response was worsened to the stimulus (RSA or Tilt). Also, the low-risk group was jeopardized, when compared to the non-Chagas group. CONCLUSION The loss of parasympathetic modulation was present in all Rassi risk groups, including the low risk, indicating that a morphological change of the myocardium represents a detectable neurofunctional change.
Collapse
Affiliation(s)
- Catherine Masiel Merejo Peña
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,National Institute of Cardiology (INC) Research Department
| | - Michel Silva Reis
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ
| | - Basílio de Bragança Pereira
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,Department of Biostatistics and Applied Statistics, Alberto Luiz Coimbra Institute of Graduate Studies and Research in Engineering, Federal University of Rio de Janeiro
| | - Emília Matos do Nascimento
- Department of Biostatistics and Applied Statistics, Alberto Luiz Coimbra Institute of Graduate Studies and Research in Engineering, Federal University of Rio de Janeiro
| | - Roberto Coury Pedrosa
- Cardiology Department, Clementino Fraga Filho University Hospital/Cardiology Institute Edson Saad- UFRJ.,Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| |
Collapse
|
4
|
Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. Rev Port Cardiol 2017; 36:927-934. [PMID: 29223851 DOI: 10.1016/j.repc.2017.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/22/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Anaerobic threshold (AT) is recognized as objective and direct measurement that reflects variations in metabolism of skeletal muscles during exercise. Its prognostic value in heart diseases of non-chagasic etiology is well established. However, the assessment of risk of death in Chagas heart disease is relatively well established by Rassi score. But, the added value that AT can bring to Rassi score has not been studied yet. OBJECTIVES To assess whether AT presents additional effect to Rassi score in patients with chronic Chagas' heart disease. METHODS Prospective research of dynamic cohort by review of 150 medical records of patients. Were selected for cohort 45 medical records of patients who underwent cardiopulmonary exercise testing between 1996-1997 and followed until September 2015. Data analysis to detect association between studied variables can be seen using a logistic regression model. The suitability of the models was verified using ROC curves and the coefficient of determination R2. RESULTS 8 patients (17.78%) died by September 2015, with 7 of them (87.5%) from cardiovascular causes, of which 4 (57.14%) were considered on high risk by Rassi score. With Rassi score as independent variable, and death being the outcome, we obtained an area under the curve (AUC)=0.711, with R2=0.214. Instituting AT as independent variable, we found AUC=0.706, with R2=0.078. When we define Rassi score and AT as independent variables, it was obtained AUC=0.800 and R2=0.263. CONCLUSION when AT is included in logistic regression, it increases by 5% the explanation (R2) to the death estimation.
Collapse
Affiliation(s)
- Roberto Ribeiro da Silva
- Hospital Federal de Bonsucesso, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil; Hospital Universitário Gaffrèe e Guinle - UNIRIO, Serviço de Fisioterapia, Rio de Janeiro, RJ, Brasil.
| | - Michel Silva Reis
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
| | - Basílio de Bragança Pereira
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Emilia Matos do Nascimento
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Rio de Janeiro, RJ, Brasil
| | - Roberto Coury Pedrosa
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Instituto do Coração Edson Saad (Ices), Rio de Janeiro, RJ, Brasil
| |
Collapse
|
5
|
Silva RRD, Reis MS, Pereira BDB, Nascimento EMD, Pedrosa RC. Additional value of anaerobic threshold in a general mortality prediction model in a urban patient cohort with Chagas cardiomyopathy. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
6
|
Queiroz MCDC, Pedrosa RC, Berensztejn AC, Pereira BDB, Nascimento EMD, Duarte MMT, Pereira-Junior PP, Cruz MW. Frequency of Cardiovascular Involvement in Familial Amyloidotic Polyneuropathy in Brazilian Patients. Arq Bras Cardiol 2015; 105:503-9. [PMID: 26351985 PMCID: PMC4651409 DOI: 10.5935/abc.20150112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background Familial amyloidotic polyneuropathy (FAP) is a rare disease diagnosed in Brazil
and worldwide. The frequency of cardiovascular involvement in Brazilian FAP
patients is unknown. Objective Detect the frequency of cardiovascular involvement and correlate the
cardiovascular findings with the modified polyneuropathy disability (PND)
score. Methods In a national reference center, 51 patients were evaluated with clinical
examination, electrocardiography (ECG), echocardiography (ECHO), and 24-hour
Holter. Patients were classified according to the modified PND score and divided
into groups: PND 0, PND I, PND II, and PND > II (which included PND IIIa, IIIb,
and IV). We chose the classification tree as the statistical method to analyze the
association between findings in cardiac tests with the neurological classification
(PND). Results ECG abnormalities were present in almost 2/3 of the FAP patients, whereas ECHO
abnormalities occurred in around 1/3 of them. All patients with abnormal ECHO also
had abnormal ECG, but the opposite did not apply. The classification tree
identified ECG and ECHO as relevant variables (p < 0.001 and p = 0.08,
respectively). The probability of a patient to be allocated to the PND 0 group
when having a normal ECG was over 80%. When both ECG and ECHO were abnormal, this
probability was null. Conclusions Brazilian patients with FAP have frequent ECG abnormalities. ECG is an appropriate
test to discriminate asymptomatic carriers of the mutation from those who develop
the disease, whereas ECHO contributes to this discrimination.
Collapse
Affiliation(s)
| | - Roberto Coury Pedrosa
- Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Emília Matos do Nascimento
- Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Marcia Waddington Cruz
- Centro de Estudos em Paramiloidose Antônio Rodrigues de Mello, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
7
|
Petriz JLF, Gomes BFDO, Rua BS, Azevedo CF, Hadlich MS, Mussi HTP, Taets GDC, Nascimento EMD, Pereira BDB, Silva NADSE. Assessment of myocardial infarction by cardiac magnetic resonance imaging and long-term mortality. Arq Bras Cardiol 2014; 104:159-68. [PMID: 25424161 PMCID: PMC4375660 DOI: 10.5935/abc.20140177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 08/11/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. OBJECTIVE To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. METHODS A total of 1959 reports of "infarct size" were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors - left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named "MET-AMI". The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. RESULTS The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). CONCLUSION The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.
Collapse
Affiliation(s)
| | | | | | | | - Marcelo Souza Hadlich
- Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | |
Collapse
|
8
|
Tassi EM, Continentino MA, Nascimento EMD, Pereira BDB, Pedrosa RC. Relationship between fibrosis and ventricular arrhythmias in Chagas heart disease without ventricular dysfunction. Arq Bras Cardiol 2014; 102:456-64. [PMID: 24918912 PMCID: PMC4051448 DOI: 10.5935/abc.20140052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/07/2014] [Indexed: 01/24/2023] Open
Abstract
Background Patients with Chagas disease and segmental wall motion abnormality (SWMA) have
worse prognosis independent of left ventricular ejection fraction (LVEF). Cardiac
magnetic resonance (CMR) is currently the best method to detect SWMA and to assess
fibrosis. Objective To quantify fibrosis by using late gadolinium enhancement CMR in patients with
Chagas disease and preserved or minimally impaired ventricular function (>
45%), and to detect patterns of dependence between fibrosis, SWMA and LVEF in the
presence of ventricular arrhythmia. Methods Electrocardiogram, treadmill exercise test, Holter and CMR were carried out in 61
patients, who were divided into three groups as follows: (1) normal
electrocardiogram and CMR without SWMA; (2) abnormal electrocardiogram and CMR
without SWMA; (3) CMR with SWMA independently of electrocardiogram. Results The number of patients with ventricular arrhythmia in relation to the total of
patients, the percentage of fibrosis, and the LVEF were, respectively: Group 1,
4/26, 0.74% and 74.34%; Group 2, 4/16, 3.96% and 68.5%; and Group 3, 11/19, 14.07%
and 55.59%. Ventricular arrhythmia was found in 31.1% of the patients. Those with
and without ventricular arrhythmia had mean LVEF of 59.87% and 70.18%,
respectively, and fibrosis percentage of 11.03% and 3.01%, respectively. Of the
variables SWMA, groups, age, LVEF and fibrosis, only the latter was significant
for the presence of ventricular arrhythmia, with a cutoff point of 11.78% for
fibrosis mass (p < 0.001). Conclusion Even in patients with Chagas disease and preserved or minimally impaired
ventricular function, electrical instability can be present. Regarding the
presence of ventricular arrhythmia, fibrosis is the most important variable, its
amount being proportional to the complexity of the groups.
Collapse
Affiliation(s)
- Eduardo Marinho Tassi
- Instituto de Cardiologia Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Roberto Coury Pedrosa
- Instituto de Cardiologia Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
9
|
Pedra F, Tambellini AT, Pereira BDB, Carioca da Costa AC, Albuquerque de Castro H. Mesothelioma Mortality in Brazil, 1980–2003. International Journal of Occupational and Environmental Health 2013; 14:170-5. [DOI: 10.1179/oeh.2008.14.3.170] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
10
|
Thiers CA, Barbosa JL, Pereira BDB, Nascimento EMD, Nascimento JHD, Medei EH, Pedrosa RC. Autonomic dysfunction and anti-M2 and anti-β1 receptor antibodies in Chagas disease patients. Arq Bras Cardiol 2012; 99:732-9. [PMID: 22790404 DOI: 10.1590/s0066-782x2012005000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 02/10/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sudden death is the leading cause of death in Chagas' disease, affecting patients even in the early stages of the disease. The impairment of the autonomic nervous system in this disease has been recognized, as well as its potential as a trigger for malignant arrhythmias when associated with structural or metabolic changes. OBJECTIVE We sought to identify, in Chagas patients with preserved systolic function, the impairment of the autonomic nervous system and its association with functionally active anti-m2 and anti-β1 receptor antibodies. METHODS Using spectral analysis of RR variability during passive tilt test, chronic chagasic patients were compared with healthy controls matched for age. Subsequently, the association of autonomic dysfunction with functionally active antibodies with anti-m2 and anti-β1 action was investigated by the Langendorf method. RESULTS We observed that patients with Chagas disease without ventricular dysfunction express parasympathetic activity against a vagal stimulus, however with less intensity compared to controls. Chagasic patients with anti-m2 or anti-β1 antibodies showed a further significant reduction of the vagal response during respiratory sinus arrhythmia, regardless of the presence of structural lesion. However, the association of both factors promoted response to vagal stimulation similar to that seen in Chagas disease without their presence. CONCLUSION The lower vagal reserve in Chagas patients with preserved function was associated with functionally active anti-m2 or anti-β1 antibodies, and not with the presence of structural heart lesion.
Collapse
|
11
|
Santos Junior JDOD, Pereira BDB. Estudo dinâmico da mortalidade por tuberculose no Estado de São Paulo, Brasil: uma abordagem bayesiana. CAD SAUDE PUBLICA 2011; 27:1415-22. [DOI: 10.1590/s0102-311x2011000700016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 04/26/2011] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho, utilizamos a técnica bayesiana de modelos lineares dinâmicos para estudar a dinâmica da mortalidade por tuberculose (TB) no Estado de São Paulo, Brasil. O estudo confirma os resultados empíricos da literatura, que indicam o decaimento da mortalidade para esse estado na última década. Este trabalho também indica um crescimento no número de óbitos a partir de 2005. A análise das duas causas básicas com maior ocorrência revelou que tal aumento é em razão da coinfecção HIV/TB. Previsões para os próximos dois anos foram realizadas, dando poucas evidências para sustentar a continuidade de tendência decrescente do número de óbitos por TB.
Collapse
|
12
|
Terzi FVDO, Siqueira Filho AGD, Nascimento EMD, Pereira BDB, Pedrosa RC. [Regional left ventricular dysfunction and its association with complex ventricular arrhythmia, in chagasic patients with normal or borderline electrocardiogram]. Rev Soc Bras Med Trop 2011; 43:557-61. [PMID: 21085869 DOI: 10.1590/s0037-86822010000500017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 04/26/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sudden death is the major cause of death among chagasic patients. A significant number of fatal events in patients without apparent heart disease and borderline electrocardiogram, but with contractile ventricular dysfunction, have been documented. This work aimed to determine the association between regional dysfunction and the presence of ventricular arrhythmia in chagasic patients without apparent heart disease. METHODS Forty-nine patients with normal or borderline electrocardiogram were submitted to echocardiogram, exercise stress test and Holter. The presence of cardiac contractile alterations and complex ventricular arrhythmia was analyzed. Statistic analysis used the general Log-Linear model. RESULTS Mean age 56 years-old; 55% women. Regional ventricular dysfunction was verified in 24.5% of patients; positive Holter in 12% and exercise stress test in 18%. An association between complex ventricular arrhythmia and contractile abnormalities in the presence of mild left ventricle dysfunction was verified. CONCLUSIONS Regional contractile abnormalities with mild left ventricle dysfunction in Chagasic patients indicate a group with higher risk of complex ventricular arrhythmias, who require specific follow-up.
Collapse
Affiliation(s)
- Flavia Vernin de Oliveira Terzi
- Serviço de Cardiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ.
| | | | | | | | | |
Collapse
|
13
|
Felix F, Tomita S, Pereira BDB, Cordeiro JR, Carleti G, Barros FDS, Cabral GAPS. Gustatory alteration evaluation in patients with chronic otitis media. Braz J Otorhinolaryngol 2009. [DOI: 10.1590/s1808-86942009000400014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
14
|
Barreto RDPP, Biancardi AL, Nascimento EM, Pereira BDB, Moraes Jr HVD. Uso de ciclosporina 0,05% tópica no tratamento do olho seco de pacientes portadores do vírus HIV. Rev bras oftalmol 2009. [DOI: 10.1590/s0034-72802009000200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
15
|
Lamy R, Fonseca Netto C, Pecego MG, Pecego JGDC, Pereira BDB, Moraes Junior HVD, Dantas AM. Reticulação do colágeno corneano com radiação ultravioleta e riboflavina para tratamento do ceratocone: resultados preliminares de um estudo brasileiro. Rev bras oftalmol 2008. [DOI: 10.1590/s0034-72802008000500006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
16
|
Kruczan DD, Silva NADSE, Pereira BDB, Romão VA, Correa Filho WB, Morales FEC. Doença arterial coronariana em pacientes com valvopatia reumática e não-reumática acompanhados em hospital público do Rio de Janeiro. Arq Bras Cardiol 2008; 90:197-203. [PMID: 18392400 DOI: 10.1590/s0066-782x2008000300010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
|
17
|
Altschüller MBCDM, Pedrosa RC, Pereira BDB, Corrêa Filho WB, Medeiros ASD, Costa PCS, de Carvalho ACC. [Chronic Chagas disease patients with sinus node dysfunction: is the presence of IgG antibodies with muscarinic agonist action independent of left ventricular dysfunction?]. Rev Soc Bras Med Trop 2007; 40:665-71. [PMID: 18200422 DOI: 10.1590/s0037-86822007000600014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 11/06/2007] [Indexed: 02/08/2023] Open
Abstract
Studies have shown that muscarinic agonist IgG antibodies from Chagas disease patients alter the electrical activity of cardiac cells in vitro. Others have considered their presence, along with sinus node dysfunction, to be consequences of progressive cardiac lesions. The aim of this study was to evaluate the relationship between these antibodies and sinus node and left ventricular dysfunction in 65 chronic Chagas disease patients. These patients were divided into group I, composed of 31 patients with sinus node dysfunction, and group II, composed of the patients without this syndrome. Data analysis using the log linear model showed interdependence between sinus node dysfunction and the antibodies (p = 0.0021) and between nodal and ventricular dysfunction (p = 0.0005). However, no relationship was found between the antibodies and ventricular function. Age and sex did not influence any other variables. The chronic Chagas disease patients with sinus node dysfunction had higher prevalence of muscarinic agonist antibodies, independent of the presence of myocardial dysfunction.
Collapse
|
18
|
Abstract
Este trabalho desenvolve um sistema para predição da soroprevalência da Hepatite A. Para isto, são considerados os modelos de regressão de logística e redes neurais artificiais. O desempenho de tais modelos é medido através da taxa de classificação incorreta em uma amostra do município de Duque de Caxias, Rio de Janeiro, que possui elevada prevalência da doença. Resultados mostram que o modelo neural, aplicado sobre a informação relevante extraída do modelo de regressão logística, apresenta um bom desempenho, alcançando uma eficiência de classificação geral acima de 88%.
Collapse
Affiliation(s)
| | | | - Basílio de Bragança Pereira
- Universidade Federal do Rio de Janeiro; Universidade Federal do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | | |
Collapse
|
19
|
|