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Bichuette LD, Lottenberg MP, Caramelli B. Hypertrophic cardiomyopathy as a high-risk feature on perioperative care: How to deal with this self-fulfilling prophecy? Int J Cardiol 2024; 399:131683. [PMID: 38158137 DOI: 10.1016/j.ijcard.2023.131683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
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Souza FD, Barbato KBG, Ferreira VBM, Gualandro DM, Caramelli B. Prognostic value of perioperative high sensitivity troponin in patients undergoing hip and knee arthroplasty. Clinics (Sao Paulo) 2024; 79:100342. [PMID: 38484585 PMCID: PMC10950797 DOI: 10.1016/j.clinsp.2024.100342] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/25/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
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Affiliation(s)
- Fábio de Souza
- Department of Internal Medicine, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Cardiology Discipline, Departamento de Medicina Especializada (DEMESP), Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | | | | | - Danielle Menosi Gualandro
- Cardiology Department and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Instituto do Coração (InCor), Hospital das Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil.
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Rochitte CE, Silva DC, Otaduy MC, Chaim KT, Nomura CH, Caramelli B. Cardiac Magnetic Resonance Imaging in a 7 Tesla Magnetic Field: Initial Experience with Hydrogen and Sodium Nuclei. Arq Bras Cardiol 2023; 120:e20220762. [PMID: 37556655 PMCID: PMC10382146 DOI: 10.36660/abc.20220762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/19/2023] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Carlos E. Rochitte
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular do, São Paulo, SP – Brasil
| | - Douglas C. Silva
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular do, São Paulo, SP – Brasil
| | - Maria C. Otaduy
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Departamento de Radiologia e Oncologia do, São Paulo, SP – Brasil
| | - Khallil T. Chaim
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Departamento de Radiologia e Oncologia do, São Paulo, SP – Brasil
| | - Cesar H. Nomura
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Setor de Ressonância Magnética e Tomografia Computadorizada Cardiovascular do, São Paulo, SP – Brasil
| | - Bruno Caramelli
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) – Unidade de Medicina Interdisciplinar em Cardiologia, São Paulo, SP – Brasil
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Puelacher C, Gualandro DM, Glarner N, Lurati Buse G, Lampart A, Bolliger D, Steiner LA, Grossenbacher M, Burri-Winkler K, Gerhard H, Kappos EA, Clerc O, Biner L, Zivzivadze Z, Kindler C, Hammerer-Lercher A, Filipovic M, Clauss M, Gürke L, Wolff T, Mujagic E, Bilici M, Cardozo FA, Osswald S, Caramelli B, Mueller C. Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery. Eur Heart J 2023; 44:1690-1701. [PMID: 36705050 PMCID: PMC10263270 DOI: 10.1093/eurheartj/ehac798] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 03/27/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
AIMS Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed. METHODS AND RESULTS Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into 'extra-cardiac' if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and 'cardiac', further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45-98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis. CONCLUSION At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments. STUDY REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02573532.
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Affiliation(s)
- Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
- Department of Cardiology, Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Giovanna Lurati Buse
- Department of Anaesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Andreas Lampart
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Mario Grossenbacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Katrin Burri-Winkler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Hatice Gerhard
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Olivier Clerc
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Laura Biner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Zaza Zivzivadze
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Christoph Kindler
- Department of Anaesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Miodrag Filipovic
- Department of Anaesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Martin Clauss
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Lorenz Gürke
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas Wolff
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Edin Mujagic
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Murat Bilici
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Francisco A Cardozo
- Department of Cardiology, Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Bruno Caramelli
- Department of Cardiology, Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
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Toyoshima MTK, Santana MFM, Silva ARM, Mello GB, Santos-Bezerra DP, Goes MFS, Bosco AA, Caramelli B, Ronsein GE, Correa-Giannella ML, Passarelli M. Proteomics of high-density lipoprotein subfractions and subclinical atherosclerosis in type 1 diabetes mellitus: a case-control study. Diabetol Metab Syndr 2023; 15:42. [PMID: 36899434 PMCID: PMC10007776 DOI: 10.1186/s13098-023-01007-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Subclinical atherosclerosis is frequently observed in type 1 diabetes (T1D) although the mechanisms and markers involved in the evolution to established cardiovascular disease are not well known. High-density lipoprotein cholesterol in T1D is normal or even high, and changes in its functionality and proteomics are considered. Our aim was to evaluate the proteomics of HDL subfractions in T1D and control subjects and its association with clinical variables, subclinical atherosclerosis markers and HDL functionality. METHODS A total of 50 individuals with T1D and 30 matched controls were included. Carotid-femoral pulse wave velocity (PWV), flow-mediated vasodilation (FMD), cardiovascular autonomic neuropathy (CAN), and ten-year cardiovascular risk (ASCVDR) were determined. Proteomics (parallel reaction monitoring) was determined in isolated HDL2 and HDL3 that were also utilized to measure cholesterol efflux from macrophages. RESULTS Among 45 quantified proteins, 13 in HDL2 and 33 in HDL3 were differentially expressed in T1D and control subjects. Six proteins related to lipid metabolism, one to inflammatory acute phase, one to complement system and one to antioxidant response were more abundant in HDL2, while 14 lipid metabolism, three acute-phase, three antioxidants and one transport in HDL3 of T1D subjects. Three proteins (lipid metabolism, transport, and unknown function) were more abundant in HDL2; and ten (lipid metabolism, transport, protease inhibition), more abundant in HDL3 of controls. Individuals with T1D had higher PWV and ten-year ASCVDR, and lower FMD, Cholesterol efflux from macrophages was similar between T1D and controls. Proteins in HDL2 and HDL3, especially related to lipid metabolism, correlated with PWV, CAN, cholesterol efflux, HDLc, hypertension, glycemic control, ten-year ASCVDR, and statins use. CONCLUSION HDL proteomics can be predictive of subclinical atherosclerosis in type 1 diabetes. Proteins that are not involved in reverse cholesterol transport may be associated with the protective role of HDL.
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Affiliation(s)
- Marcos Tadashi K Toyoshima
- Laboratorio de Lipides (LIM10), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo 455, Room 3305, Sao Paulo, SP, 01246-000, Brazil
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Monique F M Santana
- Laboratorio de Lipides (LIM10), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo 455, Room 3305, Sao Paulo, SP, 01246-000, Brazil
| | - Amanda R M Silva
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela B Mello
- Laboratorio de Lipides (LIM10), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo 455, Room 3305, Sao Paulo, SP, 01246-000, Brazil
| | - Daniele P Santos-Bezerra
- Laboratório de Carboidratos e Radioimunoensaio (LIM18), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marisa F S Goes
- Laboratório de Aterosclerose, Instituto do Coração, Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Adriana A Bosco
- Laboratório de Carboidratos e Radioimunoensaio (LIM18), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia (UnMic), Instituto do Coração, Hospital das Clinicas (InCor, HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Graziella E Ronsein
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Lucia Correa-Giannella
- Laboratório de Carboidratos e Radioimunoensaio (LIM18), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marisa Passarelli
- Laboratorio de Lipides (LIM10), Hospital das Clinicas (HCFMUSP) Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo 455, Room 3305, Sao Paulo, SP, 01246-000, Brazil.
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho, São Paulo, SP, Brazil.
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Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri-Winkler K, Mork C, Wussler D, Shrestha S, Heidelberger I, Fält M, Hidvegi R, Bolliger D, Lampart A, Steiner LA, Schären S, Kindler C, Gürke L, Rikli D, Lardinois D, Osswald S, Buser A, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur J Heart Fail 2023; 25:347-357. [PMID: 36644890 DOI: 10.1002/ejhf.2773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/27/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
AIMS Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery. METHODS AND RESULTS A total of 9164 consecutive high-risk patients undergoing 11 262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, were determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%); 51% of pAHF occurred in patients without known heart failure (de novo pAHF), and 49% in patients with chronic heart failure. Among patients with chronic heart failure, 10% developed pAHF, and among patients without a history of heart failure, 1.5% developed pAHF. Chronic heart failure, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99th percentile, chronic obstructive pulmonary disease, anaemia, peripheral artery disease, coronary artery disease, and age, were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p < 0.001) and AHF readmission (15% vs. 2%, p < 0.001) within 1 year than patients without pAHF. After Cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3-2.2]; p < 0.001) and AHF readmission (aHR 2.3 [95% CI 1.5-3.7]; p < 0.001). Findings were confirmed in an external validation cohort using a prospective multicentre cohort of 1250 patients (incidence of pAHF 2.4% [95% CI 1.6-3.3%]). CONCLUSIONS Postoperative AHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.
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Affiliation(s)
- Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michelle S Chew
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Giovanna Lurati Buse
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Noemi Glarner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daria Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francisco A M Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Katrin Burri-Winkler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Constantin Mork
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samyut Shrestha
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Isabelle Heidelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mikael Fält
- Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Reka Hidvegi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Bolliger
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Lampart
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland
| | - Christoph Kindler
- Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Lorenz Gürke
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Clinic for Orthopedics and Trauma Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Didier Lardinois
- Department of Thoracic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Buser
- Department of Hematology and Blutspendezentrum, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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7
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Artioli T, Gualandro DM, Cardozo FAM, Rojas MCE, Calderaro D, Yu PC, Casella IB, de Luccia N, Caramelli B. Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries. PLoS One 2023; 18:e0279873. [PMID: 36602973 PMCID: PMC9815593 DOI: 10.1371/journal.pone.0279873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/18/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Conflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures. METHODS 1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge. RESULTS After adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1-2.3], P = 0.015 and aHR 1.7 [95%CI 1.3-2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1-1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9-1.7], P = 0.074). CONCLUSIONS In patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.
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Affiliation(s)
- Thiago Artioli
- Department of Medicine, ABC Medical College University Center, Santo André, São Paulo, Brazil
| | - Danielle Menosi Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Universitätsspital CH, Basel, Switzerland
| | - Francisco Akira Malta Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - María Carmen Escalante Rojas
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Pai Ching Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Ivan Benaduce Casella
- Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Nelson de Luccia
- Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
- * E-mail:
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8
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Lottenberg MP, Bichuette LD, Bortolotto LA, Gowdak LHW, Darrieux FCDC, Binotto MA, Kalil R, Caramelli B. Programa de Residência Médica em Cardiologia de Adultos do InCor em 2022: 40 Anos Formando Cardiologistas para as Demandas do Brasil. Arq Bras Cardiol 2022; 119:43-51. [DOI: 10.36660/abc.20220457] [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] [Received: 06/24/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
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9
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Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri K, Mork C, Wussler D, Bolliger D, Osswald S, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Primary acute heart failure (AHF) is an established and common cause of hospitalization. AHF may also develop secondarily, e.g. postoperatively (pAHF). Little is known about pAHF.
Purpose
To assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.
Methods
We prospectively included 9,164 consecutive patients at high cardiovascular risk undergoing 11,262 non-cardiac surgeries. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, was determined. Logistic regression models identified the risk factors for pAHF. Cox regression analysis compared mortality and AHF readmission within 1 year in patients with and without pAHF. External validation was performed using a prospective cohort multicenter study of 1250 patients.
Results
The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2–2.8%). pAHF most often occurred on postoperative day 2 (median day 4). About half of pAHF (51%) occurred in patients without known HF (de novo pAHF), and 49% in patients with chronic HF. Preserved left ventricular ejection fraction (LVEF) was the dominant phenotype among de novo pAHF (72%), while reduced LVEF was dominant among pAHF in chronic HF (43%). Age, coronary artery disease, peripheral artery disease, diabetes, urgent/emergent surgery, chronic HF, atrial fibrillation, chronic obstructive pulmonary disease, anemia, and chronic myocardial injury were independent predictors of pAHF. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p<0.001) and AHF readmission (15% vs. 2%, p<0.001) within 1 year than patients without pAHF. pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3–2.2]; P<0.001) and AHF readmission (aHR 2.7 [95% CI 1.7–4.2]; P<0.001) within 1 year. Findings were confirmed in an external validation cohort of 1250 patients, e.g. incidence of pAHF 2.4% (95% CI, 1.6–3.3%).
Conclusions
pAHF frequent developed following non-cardiac surgery, being de novo in about half of cases, and associated with an unacceptable high mortality. Strategies focusing on early detection and treatment of pAHF seem warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
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Affiliation(s)
| | - C Puelacher
- University Hospital Basel , Basel , Switzerland
| | - M S Chew
- Linköping University , Linköping , Sweden
| | | | - G Lurati Buse
- University Hospital Düsseldorf , Düsseldorf , Germany
| | - N Glarner
- University Hospital Basel , Basel , Switzerland
| | - D Mueller
- University Hospital Basel , Basel , Switzerland
| | - F A M Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - K Burri
- University Hospital Basel , Basel , Switzerland
| | - C Mork
- University Hospital Basel , Basel , Switzerland
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel , Basel , Switzerland
| | - S Osswald
- University Hospital Basel , Basel , Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
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10
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Puelacher C, Gualandro D, Glarner N, Lurati Buse G, Lampart A, Bolliger D, Steiner L, Gerhard H, Clerc O, Kindler C, Cardozo FA, Caramelli B, Osswald S, Mueller C. Risk stratification of perioperative myocardial infarction/injury following noncardiac surgery in high risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Perioperative myocardial infarction/injury (PMI) screening is increasingly recommended by current guidelines. PMI is often caused by type 2 myocardial infarction, and risk stratification tools for these patients are lacking.
Purpose
To derive and internally validate a risk prognostication model for PMI of likely type 2 infarction (lT2MI)
Methods
We included consecutive high-risk patients undergoing noncardiac surgery into this prospective multicenter study. Patients received a systematic routine PMI screening with pre- and postoperative measurement of cardiac troponin (cTn). PMI was prospectively defined as an absolute increase of cTn above the preoperative value. PMI etiology was centrally adjudicated and hierarchically classified by 2 independent physicians based on all clinical information obtained during index hospitalization and selected those with lT2MI for further analyses. To identify risk factors and allow risk stratification in lT2MI, we prespecified that only perioperative variables should be included into the model. We constructed a logistic binary regression model for major adverse cardiac events (MACE) within 120 days, including variables available at time of clinical evaluation: additional symptoms or ECG-criteria required according to the Universal Definition of Myocardial Infarction, absolute increase in cTn (categorized according to level of absolute increase 1–<2 times the 99th percentile, ≥2 to <4 times, and ≥4 times), urgency of procedure, perioperative bleeding (drop in haemoglobin >30g/L or deemed relevant for PMI by adjudicator), and ESC/ESA surgery risk (low, medium, high risk of cardiac events). Variables were omitted from the final model if the p-value was >0.05. Variable levels with similar odds ratios were grouped for simplification of the prognostic model. We constructed a calibration plot and calculated the area under the receiver-operating characteristics curve (AUC) and Brier Score. For internal validation we calculated the predicted probabilities and classified patients into low-risk (predicted event rate <10%), intermediate range (10–20%), and high-risk (>20%), and compared the predicted with the observed event rate.
Results
PMI occurred in 1016/7754 patients (13.1%) of which 750/1016 (73.8%) were adjudicated as lT2MI. MACE within 120 days occurred in 118/750 (15.7%) patients. The initial and final logistic prognostic model for 120-day MACE or death is shown in the table. Internal validation found a good fit of predicted and observed event rate following bootstrapping of 1000 iterations (Figure 1), a good AUC of 0.71 and a Brier score of 0.12.
Conclusion
The derived risk prognostication model for PMI of lT2MI can aid in the stratification of patients and support clinical decision making following noncardiac surgery.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
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Affiliation(s)
- C Puelacher
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - N Glarner
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - G Lurati Buse
- University Hospital Dusseldorf, Anaesthesiology , Dusseldorf , Germany
| | - A Lampart
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - L Steiner
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - H Gerhard
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - O Clerc
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - C Kindler
- Cantonal Hospital Aarau, Department of Anaesthesiology , Aarau , Switzerland
| | - F A Cardozo
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - B Caramelli
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - S Osswald
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology , Basel , Switzerland
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11
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Puelacher C, Gualandro D, Glarner N, Lurati Buse G, Lampart A, Bolliger D, Grossenbacher M, Steiner L, Burri K, Biner L, Caramelli B, Cardozo FA, Osswald S, Mueller C. Long term outcomes in different aetiologies of perioperative myocardial infarction/injury after noncardiac surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Perioperative myocardial infarction/injury (PMI) occurring in the first 48h following noncardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies is urgently needed.
Aim
To explore the association of different aetiologies of PMI with long term outcomes.
Methods
In this prospective multicenter observational study, PMI aetiology was centrally adjudicated and hierarchically classified by two independent physicians based on all information obtained during clinically-indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major noncardiac surgery. PMI aetiology was classified into “extracardiac” if caused by a primarily extracardiac disease such as severe sepsis or pulmonary embolism; and “cardiac”, further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACE) including T1MI, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 365-days follow-up.
Results
PMI occurred in 1016/7754 patients (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 365 days. MACE and all-cause death occurred in 51% (95% CI 31–60) and 38% (95% CI 29–47), 41% (95% CI 28–51) and 27% (95% CI 16–34), 57% (95% CI 41–69) and 40% (95% CI 25–53), 64% (95% CI 45–76) and 49% (95% CI 30–62), as well as 25% (95% CI 22–28%) and 17% (95% CI 14–20) of patients with extracardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI, respectively. These associations were confirmed in multivariable analysis.
Conclusion
At 365 days, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationRoche Diagnostics
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Affiliation(s)
- C Puelacher
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - N Glarner
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - G Lurati Buse
- University Hospital Dusseldorf, Anaesthesiology , Dusseldorf , Germany
| | - A Lampart
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | | | - L Steiner
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - K Burri
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - L Biner
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - B Caramelli
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F A Cardozo
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - S Osswald
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology , Basel , Switzerland
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12
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Gnanenthiran SR, Borghi C, Burger D, Caramelli B, Charchar F, Chirinos JA, Cohen JB, Cremer A, Di Tanna GL, Duvignaud A, Freilich D, Gommans DHF, Gracia-Ramos AE, Murray TA, Pelorosso F, Poulter NR, Puskarich MA, Rizas KD, Rothlin R, Schlaich MP, Schreinlecher M, Steckelings UM, Sharma A, Stergiou GS, Tignanelli CJ, Tomaszewski M, Unger T, van Kimmenade RRJ, Wainford RD, Williams B, Rodgers A, Schutte AE. Renin-Angiotensin System Inhibitors in Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials Led by the International Society of Hypertension. J Am Heart Assoc 2022; 11:e026143. [PMID: 36000426 PMCID: PMC9496439 DOI: 10.1161/jaha.122.026143] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences University of Bologna Italy
| | - Dylan Burger
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Ottawa Hospital Research Institute University of Ottawa Canada
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor University of Sao Paulo Brazil
| | - Fadi Charchar
- School of Health and Life Sciences Federation University Australia Ballarat VIC Australia
| | - Julio A Chirinos
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Antoine Cremer
- Department of Cardiology and Hypertension, Hypertension Excellence Center Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux & University Bordeaux Bordeaux France
| | - Gian Luca Di Tanna
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux & University Bordeaux Bordeaux France
| | | | - D H Frank Gommans
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Abraham E Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza" Instituto Mexicano del Seguro Social Mexico City Mexico.,Departamento de Medicina Interna Hospital Regional de Alta Especialidad de Zumpango Estado de Mexico Mexico
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis MN
| | - Facundo Pelorosso
- Asociacion Argentina de Medicamentos Ciudad Autonoma de Buenos Aires Argentina.,Servicio de Anatomía Patologica, Hospital de Alta Complejidad El Calafate SAMIC Santa Cruz Argentina
| | - Neil R Poulter
- Imperial Clinical Trials Unit Imperial College London London UK
| | - Michael A Puskarich
- Department of Emergency Medicine Hennepin County Medical Center University of Minnesota Minneapolis MN
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I Ludwig Maximilian University Hospital Munich Munich Germany
| | - Rodolfo Rothlin
- Asociacion Argentina de Medicamentos Ciudad Autonoma de Buenos Aires Argentina.,Sociedad Argentina de Farmacología Clínica, Asociacion Medica Argentina Buenos Aires Argentina
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit-Royal Perth Hospital Medical Research Foundation University of Western Australia Perth Australia
| | - Michael Schreinlecher
- Department of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Innsbruck Austria
| | | | - Abhinav Sharma
- Division of Cardiology McGill University Health Centre Montreal Quebec Canada
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital National and Kapodistrian University of Athens Athens Greece
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health University of Manchester Manchester UK.,Manchester Academic Health Science Centre Manchester University National Health Service Foundation Trust Manchester Manchester UK
| | - Thomas Unger
- Cardiovascular Research Institute Maastricht-School for Cardiovascular Diseases Maastricht University Maastricht The Netherlands
| | - Roland R J van Kimmenade
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Richard D Wainford
- Department of Pharmacology and Experimental Therapeutics and the Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA
| | - Bryan Williams
- Institute of Cardiovascular Science University College London and National Institute for Health Research University College London Hospitals Biomedical Research Centre London UK
| | - Anthony Rodgers
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Aletta E Schutte
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
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13
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Boccara F, Caramelli B, Calmy A, Kumar P, López JAG, Bray S, Cyrille M, Rosenson RS. Long-term effects of evolocumab in participants with HIV and dyslipidemia: results from the open-label extension period. AIDS 2022; 36:675-682. [PMID: 35025817 DOI: 10.1097/qad.0000000000003175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES People with HIV (PWH) are at an increased risk of atherosclerotic cardiovascular disease. Suboptimal responses to statin therapy in PWH may result from antiretroviral therapies (ARTs). This open-label extension study aimed to evaluate the long-term safety and efficacy of evolocumab up to 52 weeks in PWH. DESIGN This final analysis of a multinational, placebo-controlled, double-blind, randomized phase 3 trial evaluated the effect of monthly subcutaneous evolocumab 420 mg on low-density lipoprotein cholesterol (LDL-C) during the open-label period (OLP) following 24 weeks of double-blind period in PWH with hypercholesterolemia/mixed dyslipidemia. All participants enrolled had elevated LDL-C or nonhigh-density lipoprotein cholesterol (non-HDL-C) and were on stable maximally tolerated statin and stable ART. METHODS Efficacy was assessed by percentage change from baseline in LDL-C, triglycerides, and atherogenic lipoproteins. Treatment-emergent adverse events (TEAEs) were examined. RESULTS Of the 467 participants randomized in the double-blind period, 451 (96.6%) received at least one dose of evolocumab during the OLP (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). By the end of the 52-week OLP, the overall mean (SD) percentage change in LDL-C from baseline was -57.8% (22.8%). Evolocumab also reduced triglycerides, atherogenic lipid parameters (non-HDL-C, apolipoprotein B, total cholesterol, very-low-density lipoprotein cholesterol, and lipoprotein[a]), and increased HDL-C. TEAEs were similar between placebo and evolocumab during the OLP. CONCLUSION Long-term administration of evolocumab lowered LDL-C and non-HDL-C, allowing more PWH to achieve recommended lipid goals with no serious adverse events. TRAIL REGISTRATION NCT02833844. VIDEO ABSTRACT http://links.lww.com/QAD/C441.
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Affiliation(s)
- Franck Boccara
- Sorbonne Université, GRC n°22, C MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN)
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine Service de Cardiologie, Paris, France
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor, University of São Paulo, São Paulo, Brazil
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Princy Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, District of Columbia
| | | | - Sarah Bray
- Global Development, Amgen Inc., Thousand Oaks, California
| | | | - Robert S Rosenson
- Metabolism and Lipoprotein Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Arslani K, Gualandro DM, Puelacher C, Lurati Buse G, Lampart A, Bolliger D, Schulthess D, Glarner N, Hidvegi R, Kindler C, Blum S, Cardozo FAM, Caramelli B, Gürke L, Wolff T, Mujagic E, Schaeren S, Rikli D, Campos CA, Fahrni G, Kaufmann BA, Haaf P, Zellweger MJ, Kaiser C, Osswald S, Steiner LA, Mueller C. Cardiovascular imaging following perioperative myocardial infarction/injury. Sci Rep 2022; 12:4447. [PMID: 35292719 PMCID: PMC8924205 DOI: 10.1038/s41598-022-08261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/20/2021] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
Patients developing perioperative myocardial infarction/injury (PMI) have a high mortality. PMI work-up and therapy remain poorly defined. This prospective multicenter study included high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program. The frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction (T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/cardiologist, who determined selection/timing of cardiovascular imaging. T1M1 was considered with the presence of a new wall motion abnormality within 30 days in transthoracic echocardiography (TTE), a new scar or ischemia within 90 days in myocardial perfusion imaging (MPI), and Ambrose-Type II or complex lesions within 7 days of PMI in coronary angiography (CA). In patients with PMI, 21% (268/1269) underwent at least one cardiac imaging modality. TTE was used in 13% (163/1269), MPI in 3% (37/1269), and CA in 5% (68/1269). Cardiology consultation was associated with higher use of cardiovascular imaging (27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and 63% of CA. Most patients with PMI did not undergo any cardiovascular imaging within their PMI work-up. If performed, MPI and CA showed high yield for signs indicative of T1MI.Trial registration: https://clinicaltrials.gov/ct2/show/NCT02573532 .
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Affiliation(s)
- Ketina Arslani
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland. .,Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giovanna Lurati Buse
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.,Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Andreas Lampart
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - David Schulthess
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Noemi Glarner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Reka Hidvegi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Anaesthesiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christoph Kindler
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Steffen Blum
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francisco A M Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lorenz Gürke
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Wolff
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Edin Mujagic
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Schaeren
- Department of Spinal Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Rikli
- Department Orthopedic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Carlos A Campos
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gregor Fahrni
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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15
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Tavares CAM, Gualandro DM, Cardozo FAM, Filho MO, Mello Ando S, Calderaro D, Caramelli B. Psoas muscle area and one‐year mortality in a cohort of patients undergoing vascular surgery. J Am Geriatr Soc 2022; 70:2150-2153. [DOI: 10.1111/jgs.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/28/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Caio Assis Moura Tavares
- Unidade de Cardiogeriatria, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
- Academic Research Organization (ARO) Hospital Israelita Albert Einstein Sao Paulo Brazil
| | - Danielle Menosi Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel University of Basel Basel Switzerland
| | - Francisco Akira Malta Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
| | - Marcelo Oranges Filho
- Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
| | - Sabrina Mello Ando
- Instituto de Radiologia (InRad), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil
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16
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Back IDC, Barros NFD, Caramelli B. Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health. J Pediatr (Rio J) 2022; 98 Suppl 1:S19-S26. [PMID: 34801487 PMCID: PMC9510931 DOI: 10.1016/j.jped.2021.09.005] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To discuss the associations between habits and environment in childhood and cardiovascular effects on adults. SOURCE OF DATA Search in PubMed, Scielo and Science databases, cohort or case-control studies, and systematic or scope-based reviewson the causal relationship among exposures in the pediatric age group and cardiovascular effects in adults. SYNTHESIS OF DATA The authors identified 41 eligible articles, which demonstrated an impact on cardiovascular health (characterized as surrogate events - structural or functional vascular alterations or left ventricular dysfunction - or clinical events - myocardial infarction, stroke or cardiovascular death) with environmental aspects (intrauterine or economically poor environment, violence, reduced life expectancy and serious infections) and habits (nutrition, physical activity and tobacco exposure). In addition to the direct and independent associations between exposures and outcomes, several traditional cardiovascular risk factors (CVRF) or family histories are also intermediate pathophysiological pathways in the described phenomena. CONCLUSIONS There are direct relationships between lifestyle and inadequate environments in childhood and cardiovascular effects, although the observed associations showed divergences in terms of results and interpretation. In spite of these, it is recommended to encourage healthy lifestyles and protection against childhood adverse exposures, as habit formation occurs at this age, and its relationship with CVRF since childhood has already been well established. On the other hand, the format and intensity of the stimulus must respect the social, cultural and psychological aspects of each population, aiming to obtain the best and most lasting result without generating harmful consequences for the individuals.
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Affiliation(s)
| | - Nelson Filice de Barros
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Saúde Coletiva, Campinas, SP, Brazil
| | - Bruno Caramelli
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Unidade Interdisciplinar de Medicina, São Paulo, SP, Brazil
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17
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Calderaro D, Bichuette LD, Maciel PC, Cardozo FAM, Ribeiro HB, Gualandro DM, Baracioli LM, Soeiro ADM, Serrano CV, Costa RAD, Caramelli B. Update of the Brazilian Society of Cardiology's Perioperative Cardiovascular Assessment Guideline: Focus on Managing Patients with Percutaneous Coronary Intervention - 2022. Arq Bras Cardiol 2022; 118:536-547. [PMID: 35262593 PMCID: PMC8856674 DOI: 10.36660/abc.20220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniela Calderaro
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luciana Dornfeld Bichuette
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Pamela Camara Maciel
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Francisco Akira Malta Cardozo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Danielle Menosi Gualandro
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel - Suíça
| | - Luciano Moreira Baracioli
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio Libanês, São Paulo, SP - Brasil
| | - Alexandre de Matos Soeiro
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital BP Mirante, São Paulo, SP - Brasil
| | - Carlos Vicente Serrano
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Bruno Caramelli
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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18
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Bogniotti LAC, Teivelis MP, Cardozo FAM, Caramelli B, Wolosker N, Puech-Leão P, De Luccia N, Calderaro D. Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes. Clinics (Sao Paulo) 2022; 77:100090. [PMID: 36088886 PMCID: PMC9474302 DOI: 10.1016/j.clinsp.2022.100090] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hemodynamic Depression (HD) characterized by hypotension and bradycardia is a complication of carotid surgery due to direct autonomic stimulation in the carotid sinus. The authors believe the incidence of HD is high and possibly related to major cardiac complications. METHODS Analysis of patient records during admissions for carotid surgery between January 2014 and December 2018 in two hospitals. HD was defined as bradycardia or hypotension in the first 24 postoperative hours. Bradycardia was defined as heart rate < 50bpm; hypotension as systolic blood pressure < 90 mmHg, continuous use of vasopressors, or a drop in SBP > 20% compared to preoperative values. Myocardial infarction, stroke, and cardiovascular death were defined as adverse events. RESULTS Overall, 237 carotid surgeries (178 endarterectomies, 59 angioplasties) were studied, and the global incidence of HD was 54.4% (hypotension in 50.2%, bradycardia in 11.0%, and hypotension and bradycardia in 6.8%). The independent predictors of HD were asymptomatic carotid stenosis (OR = 1.824; 95% CI 1.014-3.280; p = 0.045), endovascular surgery (OR = 3.319; 95% CI 1.675-6.576; p = 0.001) and intraoperative hypotension or bradycardia (OR = 2.144; 95% CI 1.222-3.762; p = 0.008). Hypotension requiring continuous vasopressor infusion was the only factor independently associated with adverse cardiovascular events (OR = 5.504; 95% CI 1.729-17.529; p = 0.004). DISCUSSION/CONCLUSION Incidence of Hemodynamic Depression after carotid surgery is high and independently associated with surgical technique, symptomatic repercussion of the carotid stenosis, and intraoperative hypotension or bradycardia. Hypotension requiring the continuous infusion of vasopressors was independently associated with the occurrence of MACE.
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Affiliation(s)
- Lauro A C Bogniotti
- Anesthesiology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Marcelo P Teivelis
- Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Francisco A M Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Nelson Wolosker
- Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Vascular Surgery Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Vascular Surgery Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Nelson De Luccia
- Vascular Surgery Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Guimarães PO, de Souza FR, Lopes RD, Bittar C, Cardozo FA, Caramelli B, Calderaro D, Albuquerque CP, Drager LF, Feres F, Baracioli L, Feitosa Filho G, Barbosa RR, Ribeiro HB, Ribeiro E, Alves RJ, Soeiro A, Faillace B, Figueiredo E, Damiani LP, do Val RM, Huemer N, Nicolai LG, Hajjar LA, Abizaid A, Kalil Filho R. High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study. Int J Cardiol Heart Vasc 2021; 36:100853. [PMID: 34345648 PMCID: PMC8321709 DOI: 10.1016/j.ijcha.2021.100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND 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 laboratory 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 surveillance and potential subsequent interventional therapies.
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Affiliation(s)
- Patrícia O. Guimarães
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Francis R. de Souza
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renato D. Lopes
- Duke University Medical Center – Duke Clinical Research Institute, Duke Health, Durham, United States
| | - Cristina Bittar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francisco A. Cardozo
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cícero P. Albuquerque
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano F. Drager
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Luciano Baracioli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Lucas P. Damiani
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata M. do Val
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natassja Huemer
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lisiê G. Nicolai
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ludhmila A. Hajjar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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20
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Furlan L, Caramelli B. The regrettable story of the "Covid Kit" and the "Early Treatment of Covid-19" in Brazil. Lancet Reg Health Am 2021; 4:100089. [PMID: 34611650 PMCID: PMC8484817 DOI: 10.1016/j.lana.2021.100089] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 10/28/2022]
Affiliation(s)
- Leonardo Furlan
- University of São Paulo Medical School, São Paulo, Brazil,Corresponding Author: Leonardo Furlan, Address: Av. Dr. Arnaldo, 455 – Cerqueira César, CEP: 01246903, São Paulo, SP, Brasil, Telephone: +55 11 3061 7379
| | - Bruno Caramelli
- University of São Paulo Medical School, São Paulo, Brazil,Interdisciplinary Medicine in Cardiology Unit, InCor, São Paulo, Brazil
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21
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Gualandro DM, Puelacher C, Lurati Buse G, Glarner N, Cardozo FA, Vogt R, Hidvegi R, Strunz C, Bolliger D, Gueckel J, Yu PC, Liffert M, Arslani K, Prepoudis A, Calderaro D, Hammerer-Lercher A, Lampart A, Steiner LA, Schären S, Kindler C, Guerke L, Osswald S, Devereaux PJ, Caramelli B, Mueller C. Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I. Clin Res Cardiol 2021; 110:1450-1463. [PMID: 33768367 PMCID: PMC8405484 DOI: 10.1007/s00392-021-01827-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/21/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. METHODS We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. RESULTS Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8-10%), including PMIInfarct 2.6% (95% CI 2.0-3.2) and PMIInjury 6.1% (95% CI 5.3-6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14-16%), PMIInfarct 3.7% (95% CI 3.0-4.4) and PMIInjury 11.3% (95% CI 10.2-12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1-6.0], and aHR 2.8 [95% CI 1.4-5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2-3.3], and aHR 1.8 [95% CI 1.2-2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. CONCLUSIONS Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality.
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Affiliation(s)
- Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland.
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Giovanna Lurati Buse
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Noemi Glarner
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Francisco A Cardozo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Ronja Vogt
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Reka Hidvegi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Strunz
- Laboratory Medicine, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Daniel Bolliger
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johanna Gueckel
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Pai C Yu
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Marcel Liffert
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ketina Arslani
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Alexandra Prepoudis
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - Daniela Calderaro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Andreas Lampart
- Department of Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius A Steiner
- Department of Laboratory Medicine, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland
| | - Christoph Kindler
- Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorenz Guerke
- Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
| | - P J Devereaux
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Anesthesiology, Perioperative Medicine, and Surgical Research Unit C/o Hamilton General Hospital, McMaster University, Hamilton, Canada
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, CH-4056, Basel, Switzerland
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22
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Borges-Júnior FA, Silva dos Santos D, Benetti A, Polidoro JZ, Wisnivesky AC, Crajoinas RO, Antônio EL, Jensen L, Caramelli B, Malnic G, Tucci PJ, Girardi AC. Empagliflozin Inhibits Proximal Tubule NHE3 Activity, Preserves GFR, and Restores Euvolemia in Nondiabetic Rats with Induced Heart Failure. J Am Soc Nephrol 2021; 32:1616-1629. [PMID: 33846238 PMCID: PMC8425656 DOI: 10.1681/asn.2020071029] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 07/19/2020] [Accepted: 02/15/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND SGLT2 inhibitors reduce the risk of heart failure (HF) mortality and morbidity, regardless of the presence or absence of diabetes, but the mechanisms underlying this benefit remain unclear. Experiments with nondiabetic HF rats tested the hypothesis that the SGLT2 inhibitor empagliflozin (EMPA) inhibits proximal tubule (PT) NHE3 activity and improves renal salt and water handling. METHODS Male Wistar rats were subjected to myocardial infarction or sham operation. After 4 weeks, rats that developed HF and sham rats were treated with EMPA or untreated for an additional 4 weeks. Immunoblotting and quantitative RT-PCR evaluated SGLT2 and NHE3 expression. Stationary in vivo microperfusion measured PT NHE3 activity. RESULTS EMPA-treated HF rats displayed lower serum B-type natriuretic peptide levels and lower right ventricle and lung weight to tibia length than untreated HF rats. Upon saline challenge, the diuretic and natriuretic responses of EMPA-treated HF rats were similar to those of sham rats and were higher than those of untreated HF rats. Additionally, EMPA treatment prevented GFR decline and renal atrophy in HF rats. PT NHE3 activity was higher in HF rats than in sham rats, whereas treatment with EMPA markedly reduced NHE3 activity. Unexpectedly, SGLT2 protein and mRNA abundance were upregulated in the PT of HF rats. CONCLUSIONS Prevention of HF progression by EMPA is associated with reduced PT NHE3 activity, restoration of euvolemia, and preservation of renal mass. Moreover, dysregulation of PT SGLT2 may be involved in the pathophysiology of nondiabetic HF.
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Affiliation(s)
- Flávio A. Borges-Júnior
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Danúbia Silva dos Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Acaris Benetti
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Juliano Z. Polidoro
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Aline C.T. Wisnivesky
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renato O. Crajoinas
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ednei L. Antônio
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Leonardo Jensen
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Gerhard Malnic
- Department of Physiology and Biophysics, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo J. Tucci
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana C.C. Girardi
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Abizaid A, Campos CM, Guimarães PO, Costa JDR, Falcão BAA, Mangione F, Caixeta A, Lemos PA, de Brito FS, Cavalcante R, Bezerra CG, Cortes L, Ribeiro HB, de Souza FR, Huemer N, do Val RM, Caramelli B, Calderaro D, Lima FG, Hajjar LA, Mehran R, Filho RK. Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study. Catheter Cardiovasc Interv 2021; 98:E370-E378. [PMID: 33904638 PMCID: PMC8239511 DOI: 10.1002/ccd.29709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
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Affiliation(s)
- Alexandre Abizaid
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Hospital do Coração (HCor), São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Instituto Prevent Senior, São Paulo, Brazil
| | - Patrícia O Guimarães
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José de Ribamar Costa
- Hospital do Coração (HCor), São Paulo, Brazil.,Department of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Breno A A Falcão
- Department of Cardiology, Hospital de Messejana, Fortaleza, Brazil
| | - Fernanda Mangione
- Department of Cardiology, Hospital Beneficência Portuguesa, Sao Paulo, Brazil
| | - Adriano Caixeta
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio S de Brito
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Department of Cardiology, Hospital São Camilo, Sao Paulo, Brazil
| | | | | | - Leandro Cortes
- Department of Cardiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Henrique B Ribeiro
- Department of Cardiology, Hospital Samaritano Paulista, Sao Paulo, Brazil
| | - Francis R de Souza
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Natassja Huemer
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renata M do Val
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Felipe G Lima
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Kalil Filho
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil
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Caramelli B, Escalante-Rojas MC, Chauhan HKC, Siciliano RF, Bittencourt MS, Micelli AC. The "false-positive" conundrum: IgA reference level overestimates the seroprevalence of antibodies to SARS-CoV-2. J Glob Health 2021; 11:05001. [PMID: 33604032 PMCID: PMC7882210 DOI: 10.7189/jogh.11.05001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/23/2022] Open
Abstract
Background On 12 June 2020, Brazil reached the second position worldwide in the number of COVID-19 cases. Authorities increased the number of tests performed, including the identification of antibodies to SARS-CoV-2 (IgG, IgA, and IgM). There was an overflooding of the market with several tests, and the presence of possible false-positive results became a challenge. The purpose of this study was to describe the seroprevalence and immunoglobulin blood levels in a group of asymptomatic individuals using the reference levels provided by the manufacturer. Methods Levels of IgG and IgA antibodies to SARS-CoV-2 were determined in blood serum by the same ELISA (enzyme-linked immunoassay) test. Patients must be free of symptoms. Results From 20 to 22 May 2020, 938 individuals were tested. There were 441 (47%) men, age 53 years (interquartile range (IQR) = 39-63.2). The sample included 335 (35.7%) subjects aged ≥60 years old. Subjects with a positive test were 54 (5.8%) for IgG and 96 (10.2%) for IgA and 42 (4.5%) for both IgG and IgA. The prevalence of IgG and IgA positive test was not different in men and women and not different in individuals under 60 and over 60 years of age. Conversely, analysing only individuals with positive tests, the levels of IgG in positive subjects were significantly higher than those with an IgA positive test, 3.00 (IQR = 1.68-5.65), and 1.95 (IQR = 1.40-3.38), respectively; P = 0.017. Additionally, individuals with isolated IgA positive tests had significantly lower levels of IgA than those with both IgA and IgG positive tests: 1.95 (IQR = 1.60-2.40) and 3.15 (IQR = 2.20-3.90), respectively, P = 0.005. These latter data suggest that IgA shows a deviation of the distribution to the left in comparison to IgG distribution data. Indeed, many subjects reported as IgA positive had immunoglobulin levels slightly elevated. Conclusions In conclusion, we strongly suggest caution in the interpretation of IgA test results. This recommendation is more important for those with positive IgA just above the reference level.
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Affiliation(s)
| | | | | | | | - Marcio S Bittencourt
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
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25
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Santorio NC, Cardozo FAM, Miada RF, Pitta FG, Tavares CDAM, Habrum FC, Pinesi HT, Magalhães IR, Menezes MCS, Caramelli B, Calderaro D. Cardiology referral during the COVID-19 pandemic. Clinics (Sao Paulo) 2021; 76:e3538. [PMID: 34878033 PMCID: PMC8610220 DOI: 10.6061/clinics/2021/e3538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study presents the cardiology referral model adopted at the University of São Paulo-Hospital das Clínicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with in-hospital mortality. CONCLUSIONS A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease.
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26
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Cardozo F, Artioli T, Caramelli B, Calderaro D, Yu P, Rojas M, Casella I, De Luccia N, Gualandro D. Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries.
Purpose
Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures.
Methods
Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries.
Results
Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p<0.001). There was no significant difference in the incidence of PMI between groups (p=0.8).
Conclusions
In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE.
Mortality and MACE at one year
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo
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Affiliation(s)
- F.A.M Cardozo
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - T Artioli
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - B Caramelli
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - D Calderaro
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - P.C Yu
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - M.C.E Rojas
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - I.B Casella
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - N De Luccia
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
| | - D.M Gualandro
- Heart Institute of the University of Sao Paulo (InCor), InCor, Sao Paulo, Brazil
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27
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Gualandro D, Puelacher C, Liffert M, Arslani K, Meister R, Glarner N, Luratibuse G, Cardozo F, Bolliger D, Steiner L, Caramelli B, Osswald S, Mueller C. Direct comparison of the accuracy of preoperative high-sensitivity cardiac troponin T to predict mortality, acute heart failure and perioperative myocardial infarction/injury after non-cardiac surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Death, acute heart failure (AHF) and perioperative myocardial infarction/injury (PMI) are the most relevant cardiovascular complications following non-cardiac surgery. Unfortunately, the incidence of these complications are higher than expected. Currently available tools to predict these complications have only modest accuracy.
Purpose
To determine the accuracy of preoperative high-sensitivity cardiac troponin T (hs-cTnT) concentrations for prediction of mortality, AHF and PMI after non-cardiac surgery.
Methods
We prospectively included 4,709 patients at high cardiovascular risk undergoing non-cardiac surgery. Hs-cTnT concentrations were measured before surgery and, daily after surgery, for two days. PMI was defined as an absolute increase of 14ng/L (the 99th percentile of the assay used) from hs-cTnT baseline values. The primary endpoint was the diagnostic accuracy of preoperative hs-cTnT concentration to predict death, AHF and PMI within 30 days, as quantified by the area under the receiving-operating curve (AUC). Multivariate logistic regression analysis was performed to test the association between preoperative hs-cTnT and each endpoint.
Results
All-cause mortality occurred in 133 (3%), AHF in 84 (2%) and PMI in 742 (16%) patients. Preoperative hs-cTnT concentrations had good accuracy for prediction of death, AHF and PMI (AUC = 0.75 [95% CI, 0.71–0.79], 0.72 [95% CI, 0.67–0.77] and 0.73 [95% CI, 0.71–0.75], respectively). After adjusting for confounders, hs-cTnT remained an independent predictor for death with an adjusted odds ratio (aOR) of 2.1 (95% CI, 1.7–2.7, P<0.001) and for PMI (aOR 2.2, 95% CI, 1.9–2.4, P<0.001), but not for AHF (aOR 1.0, 95% CI, 0.7–1.4, P=0.99). An hs-cTnT concentration below 5ng/L was found in 526 (11%) patients, and this cut-off yielded a negative predictive value of 99.6% for the occurrence of death, 99.2% for AHF and 95.6% for PMI.
Conclusion
The preoperative hs-cTnT concentration has a good accuracy to predict mortality, AHF and PMI after non-cardiac surgery, but is an independent predictor only for mortality and PMI. A cut-off value of 5ng/L identifies a subgroup of patients at low risk for these complications.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Foundation, Swiss Herat Foundation
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Affiliation(s)
- D Gualandro
- University Hospital Basel, Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | - M Liffert
- University Hospital Basel, Basel, Switzerland
| | - K Arslani
- University Hospital Basel, Basel, Switzerland
| | - R Meister
- University Hospital Basel, Basel, Switzerland
| | - N Glarner
- University Hospital Basel, Basel, Switzerland
| | - G Luratibuse
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - F.A Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - D Bolliger
- University Hospital Basel, Basel, Switzerland
| | - L Steiner
- University Hospital Basel, Basel, Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Pinto CJM, Fornari LS, Oyama SMR, Rodrigues MMD, Davanço T, Caramelli B. Children First Study II: an educational programme on cardiovascular prevention in public schools can reduce parents' cardiovascular risk. Rev Assoc Med Bras (1992) 2020; 66:1217-1224. [PMID: 33027448 DOI: 10.1590/1806-9282.66.9.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze whether the implementation of a multidisciplinary educational programme for cardiovascular prevention in public schools can contribute to reducing the FramINGHAM CARDIOVASCULAR RISK SCORE OF THE CHILDREN'S PARENTS AFTER ONE YEAR. METHODS This was a prospective, community-based, case-control study carried out in public schools in Sao Paulo, Brasil. Students were randomized to receive healthy lifestyle recommendations by two different approaches. The control group received written cardiovascular health educational brochures for their parents. The intervention group received the same brochures for the parents, and the children were exposed to a weekly educational programme on cardiovascular prevention with a multidisciplinary health team for one year. Clinical and laboratorial data were collected at the onset and end of the study. RESULTS We studied 265 children and their 418 parents. At the baseline, the rate of parents with intermediate or high Framingham scores (risk of cardiovascular disease over the next 10 years greater than 10%) was 6.9% in the control group and 13.3% in the intervention group. After one year, the rate of parents with intermediate or high Framingham risk score was reduced by 22.2% in the intervention group and increased by 33.3% in the control group (p=0.031). The cardiovascular risk factors that improved in the intervention group were blood pressure, LDL-cholesterol (low-density lipoprotein cholesterol), and glucose levels. CONCLUSION An educational programme on cardiovascular prevention for school-age children in public schools can reduce the cardiovascular risk of their parents.
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Caramelli B. A Síndrome de Takotsubo Existe como uma Doença Específica? Arq Bras Cardiol 2020; 115:217-218. [PMID: 32876187 PMCID: PMC8384284 DOI: 10.36660/abc.20200470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Uchoa RB, Caramelli B. Troponin I as a mortality marker after lung resection surgery - a prospective cohort study. BMC Anesthesiol 2020; 20:118. [PMID: 32429842 PMCID: PMC7236915 DOI: 10.1186/s12871-020-01037-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular complications associated with thoracic surgery increase morbidity, mortality, and treatment costs. Elevated cardiac troponin level represents a predictor of complications after non-cardiac surgeries, but its role after thoracic surgeries remains undetermined. The objective of this study was to analyze the relationship between troponin I elevation and morbidity and mortality after one year in patients undergoing lung resection surgery. METHODS This prospective cohort study evaluated 151 consecutive patients subjected to elective lung resection procedures using conventional and video-assisted thoracoscopic techniques at a University Hospital in Brazil, from July 2012 to November 2015. Preoperative risk stratification was performed using the scores obtained by the American College of Physicians (ACP) and the Society of Cardiology of the state of São Paulo (EMAPO) scoring systems. Troponin I levels were measured in the immediate postoperative period (POi) and on the first and second postoperative days. RESULTS Most patients had a low risk for complications according to the ACP (96.7%) and EMAPO (82.8%) scores. Approximately 49% of the patients exhibited increased troponin I (≥0.16 ng/ml), at least once, and 22 (14.6%) died in one year. Multivariate analysis showed that the elevation of troponin I, on the first postoperative day, correlated with a 12-fold increase in mortality risk within one year (HR 12.02, 95% CI: 1.82-79.5; p = 0.01). CONCLUSIONS In patients undergoing lung resection surgery, with a low risk of complications according to the preoperative evaluation scores, an increase in troponin I levels above 0.16 ng/ml in the first postoperative period correlated with an increase in mortality within one year.
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Affiliation(s)
- Ricardo B Uchoa
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Maestro Elias Lobo 596, São Paulo, SP, CEP 01433-000, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Maestro Elias Lobo 596, São Paulo, SP, CEP 01433-000, Brazil.
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31
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Boccara F, Kumar PN, Caramelli B, Calmy A, López JAG, Bray S, Cyrille M, Rosenson RS. Evolocumab in HIV-Infected Patients With Dyslipidemia: Primary Results of the Randomized, Double-Blind BEIJERINCK Study. J Am Coll Cardiol 2020; 75:2570-2584. [PMID: 32234462 DOI: 10.1016/j.jacc.2020.03.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 02/14/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and are prone to statin-related adverse events from drug-drug interactions with certain antiretroviral regimens. OBJECTIVES This study sought to evaluate the efficacy and safety of evolocumab in dyslipidemic PLHIV. METHODS BEIJERINCK (EvolocumaB Effect on LDL-C Lowering in SubJEcts with Human Immunodeficiency VirRus and INcreased Cardiovascular RisK) is a randomized, double-blind, multinational trial comparing monthly subcutaneous evolocumab 420 mg with placebo in PLHIV with hypercholesterolemia/mixed dyslipidemia taking maximally-tolerated statin therapy. The primary endpoint was the percent change (baseline to week 24) in low-density lipoprotein cholesterol (LDL-C); secondary endpoints included achievement of LDL-C <70 mg/dl and percent change in other plasma lipid and lipoprotein levels. Treatment-emergent adverse events were also examined. RESULTS A total of 464 patients were analyzed (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). ASCVD was documented in 35.6% of patients, and statin intolerance/contraindications to statin use were present in 20.7% of patients. Evolocumab reduced LDL-C by 56.9% (95% confidence interval: 61.6% to 52.3%) from baseline to week 24 versus placebo. An LDL-C level of <70 mg/dl was achieved in 73.3% of patients in the evolocumab group versus 7.9% in the placebo group. Evolocumab also significantly reduced other atherogenic lipid levels, including non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (all p < 0.0001). Evolocumab was well tolerated, and treatment-emergent adverse events patient incidence was similar among evolocumab and placebo groups. CONCLUSIONS Evolocumab was safe and significantly reduced lipid levels in dyslipidemic PLHIV on maximally-tolerated statin therapy. Evolocumab is an effective therapy for lowering atherogenic lipoproteins in PLHIV with high cardiovascular risk. (Safety, Tolerability & Efficacy on LDL-C of Evolocumab in Subjects With HIV & Hyperlipidemia/Mixed Dyslipidemia; NCT02833844).
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Affiliation(s)
- Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France.
| | - Princy N Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, DC
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor, University of São Paulo, São Paulo, Brazil
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sarah Bray
- Global Development, Amgen Inc., Thousand Oaks, California
| | | | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
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Siciliano RF, Gualandro DM, Bittencourt MS, Paixão M, Marcondes-Braga F, Soeiro ADM, Strunz C, Pacanaro AP, Puelacher C, Tarasoutchi F, Di Somma S, Caramelli B, de Oliveira Junior MT, Mansur AJ, Mueller C, Barretto ACP, Strabelli TMV. Biomarkers for prediction of mortality in left-sided infective endocarditis. Int J Infect Dis 2020; 96:25-30. [PMID: 32169690 DOI: 10.1016/j.ijid.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/02/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. METHODS Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis factor α (TNF-α), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. RESULTS Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P<0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P=0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P=0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P=0.018), TNF-α (OR 1.8; 95%CI 1.1-2.9; P=0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P=0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-α 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-α 0.554, CRP 0.759). CONCLUSION S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE.
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Affiliation(s)
- Rinaldo F Siciliano
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network.
| | - Danielle M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Milena Paixão
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | | | - Célia Strunz
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | - Christian Puelacher
- GREAT (Global Research on Acute Conditions Team) Network; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine University of Rome Sapienza, Italy; GREAT (Global Research on Acute Conditions Team) Network
| | - Bruno Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Mucio Tavares de Oliveira Junior
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Christian Mueller
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Boccara F, Kumar P, Caramelli B, Calmy A, Lopez JAG, Bray S, Cyrille M, Rosenson RS. EVOLOCUMAB USE IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS AND DYSLIPIDEMIA: PRIMARY RESULTS OF A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY (BEIJERINCK). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32459-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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D T Scanavino M, Ventuneac A, Caramelli B, Naufal L, S D Santos Filho C, Nisida IVV, Amaral MLS, Vieira JC, Parsons JT. Cardiovascular and psychopathological factors among non-sexually compulsive, sexually compulsive, and hypersexual individuals in Sao Paulo, Brazil. PSYCHOL HEALTH MED 2019; 25:121-129. [PMID: 31713436 DOI: 10.1080/13548506.2019.1687916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/25/2022]
Abstract
We decided to explore the frequency of cardiovascular risk factors, according to three levels of severity of compulsive sexual behavior (CSB), namely, non-sexually compulsive (1), sexually compulsive (2), and sexually compulsive, and hypersexual (3). We also investigated the impact of a psychiatric co-morbidity on the Framingham heart risk score (FRS). 94 non-sexually compulsive, 57 sexually compulsive, and 60 hypersexual individuals underwent psychiatric interview, blood collection, self-responsiveness, and anthropometric measurement. The analyses were repeated with individuals aged up to 44 and aged more than 44 years old. Regarding the total sample, we observed significant association among those sexually compulsive, and hypersexual participants with presenting the HIV serologic status, and a greater proportion of psychiatric conditions as much as the severity of CSB increases. Individuals with substance-related disorder predicted higher Framingham scores. The analyses with people aged more than 44 years old presented some different results, such as association among presenting low FRS and the sexually compulsive participants, and sexual compulsivity predicted lower scores of the Framingham. The study points out to the relevance of comprehensive psychiatric examination of whom presenting CSB and opens an avenue forward investigation of the effect of high rates of sexual activity on cardiovascular risk.
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Affiliation(s)
- Marco D T Scanavino
- Excessive Sexual Drive and Prevention of Negative Outcome Associated with Sexual Behavior Outpatient Unit AISEP, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Ventuneac
- Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST), City University of New York (CUNY), New York, NY, USA
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Heart Institute INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas Naufal
- Excessive Sexual Drive and Prevention of Negative Outcome Associated with Sexual Behavior Outpatient Unit AISEP, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos S D Santos Filho
- Institute of Physical Medicine and Rehabilitation IMREA, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabelle V V Nisida
- Excessive Sexual Drive and Prevention of Negative Outcome Associated with Sexual Behavior Outpatient Unit AISEP, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Rape Care Unit. Infectious Disease Division. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria L S Amaral
- Excessive Sexual Drive and Prevention of Negative Outcome Associated with Sexual Behavior Outpatient Unit AISEP, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Julie C Vieira
- Excessive Sexual Drive and Prevention of Negative Outcome Associated with Sexual Behavior Outpatient Unit AISEP, Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jeffrey T Parsons
- Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST), City University of New York (CUNY), New York, NY, USA.,Department of Psychology, Hunter College and the Graduate Center, City University of New York (CUNY), New York, NY, USA
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Azevedo FR, Santoro S, Correa-Giannella ML, Toyoshima MT, Giannella-Neto D, Calderaro D, Gualandro DM, Yu PC, Caramelli B. A Prospective Randomized Controlled Trial of the Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition. Obes Surg 2019; 28:3012-3019. [PMID: 29704228 DOI: 10.1007/s11695-018-3239-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
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Affiliation(s)
- Fernanda R Azevedo
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | | | - Maria L Correa-Giannella
- Laboratorio de Carboidratos e Radioimunoinsaio, LIM 18, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Marcos T Toyoshima
- Serviço de Onco-Endocrinologia, ICESP, HCFMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Giannella-Neto
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Danielle M Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Pai C Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil.
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36
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Gualandro DM, Puelacher C, Hidvegi R, Cardozo FA, Marbot S, Yu PC, Vogt R, Calderaro D, Gueckel J, Strunz C, Bolliger D, Rentsch K, Caramelli B, Mueller C. P2532Incidence and outcome of perioperative myocardial infarction/injury after non-cardiac surgeries diagnosed by high-sensitivity cardiac troponin I. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In order to differentiate perioperative myocardial infarction/injury (PMI) after non-cardiac surgery from preexisting cardiomyocyte injury from chronic disorders, recent studies have shown the importance of using an acute absolute increase as a criterion for PMI. For high-sensitivity troponin T (hs-cTnT), PMI defined as an absolute increase of 14ng/L (the 99th percentile) has been shown to be strongly associated with 30-day mortality. Until now, no data on hs-cTnI are available. This is a major unmet clinical need, as relevant differences between hs-cTnT and hs-cTnI have recently been identified and, as worldwide hs-cTnI is more commonly used as compared to hs-cTnT. We hypothesized that applying the same criterion to hs-cTnI, would reveal a similar association with outcomes.
Purpose
To evaluate the incidence and outcome of PMI diagnosed by hs-cTnI after non-cardiac surgery.
Methods
We included prospectively consecutive high cardiovascular risk patients undergoing non-cardiac surgery. Hs-cTnI concentrations were measured before surgery and, daily after surgery, for three days. PMI was defined as an absolute rise of ≥26ng/L (the 99th percentile of the assay studied) from baseline values. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, acute heart failure and arrhythmias, and the secondary outcome was all-cause mortality, within 30 days and one year.
Results
We included 2,018 patients submitted to 2,551 surgeries. Patients had median age of 73 years (IQR 68–79) and 56% were male. After surgery, 231 patients (9%, 95% CI 8–10%) fulfilled PMI diagnostic criterion. Patients with PMI had higher rates of MACE than patients without PMI, at 30 days (13% vs. 2%; P<0.001) and, at one-year follow-up (25% vs. 8%; P<0.001). All-cause mortality was also higher in PMI patients within 30 days and one year (9% vs. 1.5% and, 22% vs. 8%, respectively; P<0.001). In multivariate cox regression analysis, PMI showed a hazard ratio (HR) of 4.7 (95% CI, 2.9–7.6; P<0.001) within 30 days, and a HR of 2.7 (95% CI, 2.0–3.7; P<0.001) within one year for the occurrence of MACE. For total mortality, PMI showed a HR of 3.8 (95% CI, 2.1–6.8; P<0.001) within 30 days and a HR of 2.0 (95% CI, 1.4–2.7; P<0.001) after one year.
Conclusion
PMI is frequent and associated with high rates of MACE and mortality in short- and long-term follow-up after non-cardiac surgery, regardless of the high-sensitivity troponin assay used for diagnosis.
Acknowledgement/Funding
Swiss Heart Foundation, University basel, Abbott, Astra zeneca, Forschungsfond Kantonsspital Aarau, Cardiovascular Research Foundation Basel, FAPESP
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Affiliation(s)
| | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | - R Hidvegi
- University Hospital Basel, Basel, Switzerland
| | - F A Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - S Marbot
- University Hospital Basel, Basel, Switzerland
| | - P C Yu
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - R Vogt
- University Hospital Basel, Basel, Switzerland
| | - D Calderaro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - J Gueckel
- University Hospital Basel, Basel, Switzerland
| | - C Strunz
- Heart Institute of the University of Sao Paulo (InCor), Laboratory medicine, Sao Paulo, Brazil
| | - D Bolliger
- University Hospital Basel, Basel, Switzerland
| | - K Rentsch
- University Hospital Basel, Basel, Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Yu PC, Caramelli B. Communication gap between health professionals and patients on anticoagulant therapy in the WhatsApp era. Arq Neuropsiquiatr 2019; 76:805-806. [PMID: 30698201 DOI: 10.1590/0004-282x20180139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Pai Ching Yu
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, São Paulo SP, Brasil
| | - Bruno Caramelli
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, São Paulo SP, Brasil
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Kumagai B, Caramelli B. From Journals to Bedside: We Must Improve the Compliance with Practice Guidelines. Arq Bras Cardiol 2018; 111:605-606. [PMID: 30365682 PMCID: PMC6199522 DOI: 10.5935/abc.20180186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Barbara Kumagai
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, HCFMUSP, São Paulo, SP - Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, HCFMUSP, São Paulo, SP - Brazil
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Gualandro DM, Puelacher C, LuratiBuse G, Lampart A, Strunz C, Cardozo FA, Yu PC, Jaffe AS, Barac S, Bock L, Badertscher P, du Fay de Lavallaz J, Marbot S, Sazgary L, Bolliger D, Rentsch K, Twerenbold R, Hammerer-Lercher A, Melo ES, Calderaro D, Duarte AJ, de Luccia N, Caramelli B, Mueller C. Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. Am Heart J 2018; 203:67-73. [PMID: 30041065 DOI: 10.1016/j.ahj.2018.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. METHODS We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. RESULTS Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). CONCLUSIONS Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
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Affiliation(s)
- Danielle M Gualandro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.
| | - Christian Puelacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanna LuratiBuse
- Department of Anaesthesiology, University Hospital Düsseldorf, Germany; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Andreas Lampart
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Celia Strunz
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Francisco A Cardozo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Pai C Yu
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Allan S Jaffe
- Department of Cardiology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Sanela Barac
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lukas Bock
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Stella Marbot
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Lorraine Sazgary
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | | | - Edielle S Melo
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Daniela Calderaro
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Alberto Js Duarte
- Laboratory of Immunogenetics and Experimental Transplantation, University of Sao Paulo Medical School, Brazil
| | - Nelson de Luccia
- Vascular and Endovascular Surgery Clinic of the Clinics Hospital, University of São Paulo Medical School, Brazil
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Siciliano RF, Gualandro DM, Felicio MS, Paixao MR, Marcondes-Braga FG, Oliveira Jr MT, Soeiro A, Tarasoutch F, Caramelli B, Strunz C, Pacanaro AP, Bittencourt MS, Mansur AJ, Pereira-Barretto AC, Strabelli TMV. P4195Biomarkers for the prediction of mortality in patients with infective endocarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R F Siciliano
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
| | - D M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - M S Felicio
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
| | - M R Paixao
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - F G Marcondes-Braga
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - M T Oliveira Jr
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A Soeiro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - F Tarasoutch
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Strunz
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - A P Pacanaro
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - M S Bittencourt
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A J Mansur
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A C Pereira-Barretto
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - T M V Strabelli
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
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Toyoshima M, Santos-Bezerra D, Machado-Lima A, Goes M, Caramelli B, Correa-Giannella M, Passarelli M. In type 1 diabetes mellitus impaired vascular function relates to the expression of MYD88 in lymphomononuclear cells but not to dietary advanced glycation end-products. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.172] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gualandro DM, Shinjo SK, Santoro J, Calderaro D, Yu PC, Strunz C, Silva MG, Caramelli B. P3487The role of high-sensitivity troponin I for risk prediction in patients with systemic autoimmune myopathies. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - S K Shinjo
- Clinics Hospital, University of São Paulo Medical School, Reumathology, São Paulo, Brazil
| | - J Santoro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - D Calderaro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - P C Yu
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Strunz
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - M G Silva
- Clinics Hospital, University of São Paulo Medical School, Reumathology, São Paulo, Brazil
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
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Puelacher C, Lurati Buse G, Rinderknecht T, Du Fay De Lavallaz J, Hidvegi R, Wildi K, Sazgary L, Lampart A, Gualandro DM, Osswald S, Caramelli B, Mueller C. P5429Use and effect of statins in non-cardiac surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Puelacher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Lurati Buse
- University Hospital Dusseldorf, Anaesthesiology, Dusseldorf, Germany
| | - T Rinderknecht
- University Hospital Basel, Cardiology, Basel, Switzerland
| | | | - R Hidvegi
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - K Wildi
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - L Sazgary
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Lampart
- University Hospital Basel, Anaesthesiology, Basel, Switzerland
| | - D M Gualandro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - B Caramelli
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
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Kara-Junior N, Koch CR, Santhiago MRD, Fornari L, Caramelli B. Anticoagulants and antiplatelet drugs during cataract surgery. Arq Bras Oftalmol 2018; 81:348-353. [PMID: 29995131 DOI: 10.5935/0004-2749.20180069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022] Open
Abstract
Patients undergoing cataract surgery are generally elderly, and many take drugs with systemic effects. The surgeon must be aware of the risks of continuing or discontinuing such medications perioperatively. Antiplatelet drugs and anticoagulants, prescribed to reduce the incidence of thromboembolic events, are often used in this population. This paper aims to review the perioperative use of antiplatelet and anticoagulant drugs in the setting of cataract surgery. Topical or intracameral anesthesia is preferred over anesthesia injected with needles. Aspirin can be safely continued in patients undergoing cataract surgery. Warfarin has been extensively studied, and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range. Only a few studies of direct oral anticoagulants are available, and therefore no definite recommendations regarding those agents can be made at this time. Anesthesia in cataract surgery carries a low risk, even for patients taking anticoagulant or antiplatelet drugs. The discontinuation of this class of drugs before cataract surgery may increase the risk of thromboembolism.
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Affiliation(s)
- Newton Kara-Junior
- Department of Ophthalmology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camila Ribeiro Koch
- Department of Ophthalmology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcony Rodrigues de Santhiago
- Department of Ophthalmology, Universidade de São Paulo, São Paulo, SP, Brazil.,Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luciana Fornari
- Department of Cardiology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno Caramelli
- Department of Cardiology, Universidade de São Paulo, São Paulo, SP, Brazil
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Caramelli B, Gualandro DM. Both glucocentric and cardiocentric approaches are necessary for a resilient disease such as diabetes. Rev Assoc Med Bras (1992) 2018; 64:212-213. [PMID: 29641785 DOI: 10.1590/1806-9282.64.03.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus (DM) is a complex disease that compromises almost all systems in the human organism. Independently of the intrinsic mechanisms, the source of all consequences of DM is hyperglycemia, a condition associated to intense metabolic changes that will lead to increased morbidity and mortality in the long term. Several different therapeutic hypoglycemic oral agents were developed and significantly facilitated the treatment of hyperglycemia acting at different sites, since patients could take more than one agent. This glucocentric approach was somehow criticized as those hypoglycemic drugs have shown weaker than expected benefits in terms of cardiovascular outcomes and there was a sub use of statins and antihypertensive agents in this population. On the other hand, the catastrophic cardiovascular consequences of hypoglycemia in older adults submitted to tight glycemic control and the results of recent clinical trials that showed impressive reduction in cardiovascular outcomes with less potent antidiabetic agents seem to pave the way to a cardiocentric approach including a lax treatment of DM. Interestingly, the results obtained in recent studies with SGLT2 inhibitors are being mostly attributed to mechanisms other than its hypoglycemic effect in spite of including patients at high cardiovascular risk already taking hypoglycemic agents. Considering the worldwide growing number of patients with diabetes, caregivers must follow a dialectical thinking and choose a synthesis approach where glycemic control is the first and foremost target to be achieved, followed by control of cardiovascular risk factors.
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Affiliation(s)
- Bruno Caramelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Soeiro ADM, Mansur ADP, Schaan BD, Caramelli B, Rochitte CE, Serrano CV, Garzillo CL, Calderaro D, Gualandro DM, Lima EG, Marcondes-Braga FG, Lima FG, Oliveira FMD, Azevedo FR, Chauhan H, Salles JEN, Soares J, Cardoso JN, Pellanda LC, Sacilotto L, Baracioli L, Bortolotto LA, César LAM, Ochiai ME, Minami MH, Pinheiro MB, Moretti MA, Oliveira MTD, Rezende PC, Lemos PA, Admoni SN, Lottenberg SA, Rocha VZ, Hueb W, Mathias W. I Diretriz sobre Aspectos Específicos de Diabetes (tipo 2) Relacionados à Cardiologia. Arq Bras Cardiol 2018; 102:1-41. [PMID: 27223869 DOI: 10.5935/abc.2014s002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oliveira FR, Oliveira VH, Oliveira ÍM, Lima JW, Calderaro D, Gualandro DM, Caramelli B. Hypertension, mitral valve disease, atrial fibrillation and low education level predict delirium and worst outcome after cardiac surgery in older adults. BMC Anesthesiol 2018; 18:15. [PMID: 29390969 PMCID: PMC5796436 DOI: 10.1186/s12871-018-0481-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/23/2018] [Indexed: 12/02/2022] Open
Abstract
Background Delirium is a common complication after cardiac surgery in older adult patients. However, risk factors and the influence of delirium on patient outcomes are not well established. We aimed to determine the incidence, predisposing and triggering factors of delirium following cardiac surgery. Methods One hundred seventy-three consecutive patients aged ≥60 years were studied. Patients’ characteristics and two cognitive function assessment tests were recorded preoperatively. Perioperative variables were blood transfusion, orotracheal intubation time (OIT), renal dysfunction, and hypoxemia. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. The composite outcome consisted of death, infection, and perioperative myocardial infarction until hospital discharge or 30 days after surgery, and for up to 18 months. Results One hundred six patients (61.27%) were men and the age was 69.5 ± 5.8 years. EuroSCORE II index was 4.06 ± 3.86. Hypertension was present in 75.14%, diabetes in 39.88%, and 30.06% were illiterate. Delirium occurred in 59 patients (34.1%). Education level (OR 0.81, 0.71–0.92), hypertension (OR 2.73, 1.16–6.40), and mitral valve disease (OR 2.93, 1.32–6.50) were independent predisposing factors for delirium, and atrial fibrillation after surgery (OR 2.49, 1.20–5.20) represented the potential triggering factor. Delirium (OR 2.35, 1.20–4.58) and OIT ≥ 900 min (OR 2.50; 1.30–4.80) were independently associated with the composite outcome. Conclusions In older adult patients submitted to cardiac surgery, delirium is a frequent complication that is associated with worst outcome. Independent risk factors for delirium included education level, hypertension, mitral valve disease, and atrial fibrillation after cardiac surgery.
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Affiliation(s)
- Fátima R Oliveira
- Heart Institute (InCor), University of Sao Paulo, Brazil. Av. Dr. Enéas Carvalho de Aguiar 44, Sao Paulo, CEP, São Paulo, 05403-000, Brazil.,Hospital de Messejana Dr. Carlos Alberto Studart Gomes SESA, Fortaleza, Ceará, Brazil
| | - Victor H Oliveira
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes SESA, Fortaleza, Ceará, Brazil
| | - Ítalo M Oliveira
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes SESA, Fortaleza, Ceará, Brazil
| | - José W Lima
- Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Daniela Calderaro
- Heart Institute (InCor), University of Sao Paulo, Brazil. Av. Dr. Enéas Carvalho de Aguiar 44, Sao Paulo, CEP, São Paulo, 05403-000, Brazil
| | - Danielle M Gualandro
- Heart Institute (InCor), University of Sao Paulo, Brazil. Av. Dr. Enéas Carvalho de Aguiar 44, Sao Paulo, CEP, São Paulo, 05403-000, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor), University of Sao Paulo, Brazil. Av. Dr. Enéas Carvalho de Aguiar 44, Sao Paulo, CEP, São Paulo, 05403-000, Brazil.
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Faludi AA, Izar MCDO, Saraiva JFK, Chacra APM, Bianco HT, Afiune A, Bertolami A, Pereira AC, Lottenberg AM, Sposito AC, Chagas ACP, Casella A, Simão AF, Alencar ACD, Caramelli B, Magalhães CC, Negrão CE, Ferreira CEDS, Scherr C, Feio CMA, Kovacs C, Araújo DBD, Magnoni D, Calderaro D, Gualandro DM, Mello EPD, Alexandre ERG, Sato EI, Moriguchi EH, Rached FH, Santos FCD, Cesena FHY, Fonseca FAH, Fonseca HARD, Xavier HT, Mota ICP, Giuliano IDCB, Issa JS, Diament J, Pesquero JB, Santos JED, Faria JR, Melo JXD, Kato JT, Torres KP, Bertolami MC, Assad MHV, Miname MH, Scartezini M, Forti NA, Coelho OR, Maranhão RC, Santos RDD, Alves RJ, Cassani RL, Betti RTB, Carvalho TD, Martinez TLDR, Giraldez VZR, Salgado W. ATUALIZAÇÃO DA DIRETRIZ BRASILEIRA DE DISLIPIDEMIAS E PREVENÇÃO DA ATEROSCLEROSE - 2017. Arq Bras Cardiol 2017; 109:1-76. [PMID: 28813069 DOI: 10.5935/abc.20170121] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gualandro DM, Puelacher C, LuratiBuse G, Llobet GB, Yu PC, Cardozo FA, Glarner N, Zimmerli A, Espinola J, Corbière S, Calderaro D, Marques AC, Casella IB, de Luccia N, Oliveira MT, Lampart A, Bolliger D, Steiner L, Seeberger M, Kindler C, Osswald S, Gürke L, Caramelli B, Mueller C. Prediction of major cardiac events after vascular surgery. J Vasc Surg 2017; 66:1826-1835.e1. [DOI: 10.1016/j.jvs.2017.05.100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/06/2017] [Indexed: 12/20/2022]
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Gualandro D, Puelacher C, Lurati-Buse G, Strunz C, Cardozo F, Yu P, Jaffe A, Twerenbold R, Hammerer-Lercher A, Melo E, Calderaro D, Duarte A, Luccia N, Caramelli B, Mueller C. P6224Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6224] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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