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Marinho LL, Rached FH, Morikawa AT, Tavoni TM, Cardoso APT, Torres RVA, Assuncao AN, Serrano CV, Nomura CH, Maranhão RC. Safety and possible anti-inflammatory effect of paclitaxel associated with LDL-like nanoparticles (LDE) in patients with chronic coronary artery disease: a double-blind, placebo-controlled pilot study. Front Cardiovasc Med 2024; 11:1342832. [PMID: 38450375 PMCID: PMC10915057 DOI: 10.3389/fcvm.2024.1342832] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Studies in cholesterol-fed rabbits showed that anti-proliferative chemotherapeutic agents such as paclitaxel associated with solid lipid nanoparticles (LDE) have marked anti-atherosclerotic effects. In addition, association with LDE nearly abolishes paclitaxel toxicity. We investigated whether treatment with LDE-paclitaxel changes plaque progression by coronary CT angiography and is safe in patients with chronic coronary artery disease. Methods We conducted a prospective, randomized, double-blind, placebo-controlled pilot study in patients with multi-vessel chronic coronary artery disease. Patients were randomized to receive IV infusions of LDE-paclitaxel (paclitaxel dose: 175 mg/m2 body surface) or LDE alone (placebo group), administered every 3 weeks for 18 weeks. All participants received guideline-directed medical therapy. Clinical and laboratory safety evaluations were made at baseline and every 3 weeks until the end of the study. Analysis of inflammatory biomarkers and coronary CTA was also performed at baseline and 4 weeks after treatment. Results Forty patients aged 65.6 ± 8 years, 20 in LDE-paclitaxel and 20 in placebo group were enrolled. Among those, 58% had diabetes, 50% had myocardial infarction, and 91% were in use of statin and aspirin. Baseline demographics, risk factors, and laboratory results were not different between groups. In all patients, no clinical or laboratory toxicities were observed. From the baseline to the end of follow-up, there was a non-significant trend toward a decrease in IL-6 levels and hsCRP in the LDE-paclitaxel group (-16% and -28%, respectively), not observed in placebo. Regarding plaque progression analysis, variation in plaque parameter values was wide, and no difference between groups was observed. Conclusion In patients with multivessel chronic coronary artery disease and optimized medical therapy, LDE-paclitaxel was safe and showed clues of potential benefits in reducing inflammatory biomarkers. Clinical Trial Registration https://clinicaltrials.gov/study/NCT04148833, identifier (NCT04148833).
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Affiliation(s)
- Lucas Lage Marinho
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Fabiana Hanna Rached
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Aleksandra Tiemi Morikawa
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Thauany Martins Tavoni
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | | | - Carlos Vicente Serrano
- Department of Cardiopneumology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Cesar Higa Nomura
- Department of Radiology, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
| | - Raul Cavalcante Maranhão
- Lipid Metabolism Laboratory, Instituto do Coracao (InCor) Universidade de Sao Paulo, São Paulo, Brazil
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Amaral PTMA, Lemos Neto PA, Serrano CV, Nunes Fonseca EKU, Szarf G. Acute myocardial ischaemia identified on chest angiotomography. Eur Heart J Cardiovasc Imaging 2023; 24:e300. [PMID: 37650564 DOI: 10.1093/ehjci/jead222] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
| | - Pedro Alves Lemos Neto
- Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Jardim Leonor, São Paulo 05652-900, Brazil
| | - Carlos Vicente Serrano
- Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Jardim Leonor, São Paulo 05652-900, Brazil
| | | | - Gilberto Szarf
- Department of Radiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Jardim Leonor, São Paulo 05652-900, Brazil
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Moreira EM, Pinesi HT, Martins EB, Pitta FG, Bolta PMP, Segre CAW, Favarato D, Rached FH, Hueb WA, Lima EG, Kalil R, Garzillo CL, Serrano CV. Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil. Arq Bras Cardiol 2023; 120:e20220440. [PMID: 37909601 PMCID: PMC10586816 DOI: 10.36660/abc.20220440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records. This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Patients with CIHD who reported for clinical evaluation at Instituto do Coração (São Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted. From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 - 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.
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Affiliation(s)
- Eduardo Martelli Moreira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Henrique Trombini Pinesi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Eduardo Bello Martins
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Fábio Grunspun Pitta
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Paula Mathias Paulino Bolta
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Carlos Alexandre Wainrober Segre
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Desiderio Favarato
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Fabiana Hanna Rached
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Whady Armindo Hueb
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Eduardo Gomes Lima
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Roberto Kalil
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Cibele Larrosa Garzillo
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Carlos Vicente Serrano
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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Pereira MDP, Lima EG, Pitta FG, Gowdak LHW, Mioto BM, Carvalho LNS, Darrieux FCDC, Mejia OAV, Jatene FB, Serrano CV. Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial. JTCVS Open 2023; 15:199-210. [PMID: 37808050 PMCID: PMC10556832 DOI: 10.1016/j.xjon.2023.05.006] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 10/10/2023]
Abstract
Objectives Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.
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Affiliation(s)
- Marcel de Paula Pereira
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Eduardo Gomes Lima
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Fabio Grunspun Pitta
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Luís Henrique Wolff Gowdak
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Bruno Mahler Mioto
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Leticia Neves Solon Carvalho
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | - Omar Asdrubal Vilca Mejia
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Fabio Biscegli Jatene
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Carlos Vicente Serrano
- Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
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5
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Henrique de Moraes Cellia P, Lima EG, Agrizzi de Angeli LR, Martins EB, Rached FH, Pitta FG, Cassaro Strunz CM, Serrano CV. Evaluation of cardiovascular risk biomarkers after moderate consumption of red wine and cachaça in a randomized crossover trial: The Wine and Cachaça Study (WICAS). Clin Nutr ESPEN 2022; 52:113-118. [PMID: 36513442 DOI: 10.1016/j.clnesp.2022.10.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Moderate daily consumption of alcohol (MDCA) is associated with cardiovascular risk (CVR) reduction in observational studies. Some researches have suggested that this benefit may be associated not only with red wine consumption but also with other beverages. However, there are no clinical trials evaluating the possible CVR benefit of Brazilian spirit (cachaça) in humans. METHODS This is a prospective, randomized, crossover study including healthy individuals initially assigned to a MDCA of cachaça or red wine for a period of 4 weeks. After a one-week abstinence period, the type of drink was changed for another 4 weeks of intervention. The MDCA for both beverages was determined as a dose equivalent to 28 g of ethanol per day for men and 14 g for women. CVR biomarkers analyses were performed before and after each intervention to assess the serologic status of C-reactive protein, lipid profile, platelet aggregation and glycemic profile. This study is registered on the ISRCTN platform under number 15978506. RESULTS Of the 42 subjects initially randomized, 2 refused to continue in the study. The median age was 44.3 ± 10.3 years and 19 were male (47.5%). Adherence to the protocol was considered ideal with 100% regular use in both interventions and only 3 individuals in each intervention group reported alcohol abuse. There was no significant variation in anthropometric measurements during the study, except for weight gain (0.7 kg) in the red wine group (p = 0.005). The median of the delta of platelet aggregation for MDCA of cachaça was 1.2% (-1.1 to 5.3) and the median of the delta to the MDCA of wine was -1.6% (-4.5 to 2) (p = 0.02). The other biomarkers didn't show any statistically significant variation. CONCLUSION Moderate consumption of wine and cachaça was related to variation in laboratory biomarkers of CVR related to atherosclerosis. There was significant weight gain during the period of wine consumption and there was observed a difference between platelet aggregation values after both interventions.
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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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Soeiro ADM, Biselli B, Leal TC, Bossa AS, César MC, Jallad S, Goldstein PG, Guimarães PO, Serrano CV, Nomura CH, Nakamura D, Rochitte CE, Soares PR, Oliveira MTD. Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares. Arq Bras Cardiol 2021; 118:894-902. [PMID: 35137790 PMCID: PMC9368885 DOI: 10.36660/abc.20210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Fundamento A angiotomografia coronária (ATC) tem sido usada para avaliação de dor torácica principalmente em pacientes de baixo risco, e poucos dados existem com pacientes em risco intermediário. Objetivo Avaliar o desempenho de medidas seriadas de troponinas sensíveis e de ATC em pacientes de risco intermediário. Métodos Um total de 100 pacientes com dor torácica, TIMI score 3 ou 4 e troponina negativa foram prospectivamente incluídos. Todos os pacientes foram submetidos à ATC, e aqueles com obstruções ≥ 50% foram encaminhados à cineangiocoronariografia. Pacientes com lesões < 50% recebiam alta hospitalar, receberam alta e foram contatados 30 dias depois por telefonema para avaliação dos desfechos clínicos. Os desfechos foram hospitalização, morte, e infarto agudo do miocárdio em 30 dias. A comparação entre os métodos foi realizada pelo teste de concordância kappa. O desempenho das medidas de troponina e da ATC na detecção de lesões coronárias significativas e desfechos clínicos foi calculado. Os resultados foram considerados estatisticamente significativos quando p <0,05. Resultados Estenose coronária ≥ 50% na ATC foi encontrada em 38% dos pacientes e lesões coronárias significativas na angiografia coronária foram encontradas em 31 pacientes. Dois eventos clínicos foram observados. A análise de concordância Kappa mostrou baixa concordância entre as medidas de troponina e ATC na detecção de lesões coronárias significativas (kappa = 0,022, p = 0,78). O desempenho da ATC para detectar lesões coronárias significativas na angiografia coronária ou para prever eventos clínicos em 30 dias foi melhor que as medidas de troponina sensível (acurácia de 91% versus 60%). Conclusão ATC teve melhor desempenho que as medidas seriadas de troponina na detecção de doença coronariana significativa em pacientes com dor torácica e risco intermediário para eventos cardiovasculares.
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Pereira MDP, Lima EG, Garzillo CL, Barbosa CTM, Sampaio LPC, Darrieux FCDC, Serrano CV. Occurrence of recently diagnosed atrial fibrillation in the immediate postoperative period of myocardial revascularization surgery. Although common, a devalued complication. ACTA ACUST UNITED AC 2020; 66:1473-1475. [PMID: 33295393 DOI: 10.1590/1806-9282.66.11.1473] [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: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 11/21/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the postoperative period of cardiac surgery, with a prevalence between 15-40% after coronary artery bypass surgery (CABG). Several strategies have been tested for the prevention and management of AF postoperatively. Previous studies and analysis of records have shown higher rates of hospitalization and clinical outcomes associated with this entity, including increased mortality in the short- and long-term. This perspective reviews the topic, and offers recommendations for the management of this arrhythmia in the postoperative period of CABG, with a special focus on anticoagulation strategies.
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Affiliation(s)
- Marcel de Paula Pereira
- Atherosclerosis department - Heart Institute - São Paulo University (INCOR- HCFMUSP), São Paulo, SP, Brasil
| | - Eduardo Gomes Lima
- Atherosclerosis department - Heart Institute - São Paulo University (INCOR- HCFMUSP), São Paulo, SP, Brasil
| | - Cibele Larrosa Garzillo
- Atherosclerosis department - Heart Institute - São Paulo University (INCOR- HCFMUSP), São Paulo, SP, Brasil
| | | | - Leon Pablo Cartaxo Sampaio
- Atherosclerosis department - Heart Institute - São Paulo University (INCOR- HCFMUSP), São Paulo, SP, Brasil
| | | | - Carlos Vicente Serrano
- Atherosclerosis department - Heart Institute - São Paulo University (INCOR- HCFMUSP), São Paulo, SP, Brasil
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Soeiro ADM, Leal TDCAT, Pereira MDP, Lima EG, Figueiredo ACBDS, Petriz JLF, Precoma DB, Serrano CV. Position Statement on the Use of Antiplatelet Agents and Anticoagulants in Patients Infected with the New Coronavirus (COVID-19) - 2020. Arq Bras Cardiol 2020; 115:292-301. [PMID: 32876200 PMCID: PMC8384288 DOI: 10.36660/abc.20200424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Alexandre de Matos Soeiro
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP),São Paulo, SP - Brasil.,Hospital BP Mirante, São Paulo, SP - Brasil
| | | | - Marcel de Paula Pereira
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP),São Paulo, SP - Brasil.,Hospital BP Mirante, São Paulo, SP - Brasil
| | - Eduardo Gomes Lima
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP),São Paulo, SP - Brasil.,Hospital 9 de Julho, São Paulo, SP - Brasil
| | | | | | - Dalton Betolim Precoma
- Sociedade Hospitalar Angelina Caron, Curitiba, PR - Brasil.,Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Carlos Vicente Serrano
- Instituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP),São Paulo, SP - Brasil
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Rezende PC, Hlatky MA, Hueb W, Garcia RMR, da Silva Selistre L, Lima EG, Garzillo CL, Scudeler TL, Boros GAB, Ribas FF, Serrano CV, Ramires JAF, Kalil Filho R. Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease. JAMA Netw Open 2020; 3:e1919666. [PMID: 31968117 PMCID: PMC6991270 DOI: 10.1001/jamanetworkopen.2019.19666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Glycated hemoglobin (HbA1c) values are used to guide glycemic control, but in patients with type 2 diabetes and multivessel coronary artery disease (CAD), the association of the longitudinal values of HbA1c with cardiovascular outcomes is unclear. OBJECTIVE To assess whether longitudinal variation of HbA1c is associated with cardiovascular events in long-term follow-up among patients with diabetes and multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 888 patients with type 2 diabetes and multivessel CAD in the Medicine, Angioplasty, or Surgery Study (MASS) Registry of the Heart Institute of the University of São Paulo from January 2003 to December 2007. Data were analyzed from January 15, 2018, to October 15, 2019. EXPOSURE Longitudinal HbA1c values. MAIN OUTCOMES AND MEASURES The combined outcome of all-cause mortality, myocardial infarction, and ischemic stroke. RESULTS Of 888 patients with type 2 diabetes and multivessel CAD, 725 (81.6%; median [range] age, 62.4 [55.7-68.0] years; 467 [64.4%] men) had complete clinical and HbA1c information during a median (interquartile range) follow-up period of 10.0 (8.0-12.3) years, with a mean (SD) of 9.5 (3.8) HbA1c values for each patient. The composite end point of death, myocardial infarction, or ischemic stroke occurred in 262 patients (36.1%). A 1-point increase in the longitudinal value of HbA1c was significantly associated with a 14% higher risk of the combined end point of all-cause mortality, myocardial infarction, and ischemic stroke (hazard ratio, 1.14; 95% CI, 1.04-1.24; P = .002) in the unadjusted analysis. After adjusting for baseline factors (ie, age, sex, 2-vessel or 3-vessel CAD, initial CAD treatments, ejection fraction, and creatinine and low-density lipoprotein cholesterol levels), a 1-point increase in the longitudinal value of HbA1c was associated with a 22% higher risk of the combined end point (hazard ratio, 1.22; 95% CI, 1.12-1.35; P < .001). CONCLUSIONS AND RELEVANCE Longitudinal increase of HbA1c was independently associated with higher rates of cardiovascular events in patients with type 2 diabetes and multivessel CAD.
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rahmi Garcia
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eduardo Gomes Lima
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Andre Boeing Boros
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Abstract
Myocardial ischemia is considered the cornerstone of the treatment of patients with coronary artery disease (CAD). Although the deleterious effects of myocardial infarction, the maximum expression of ischemia, have been extensively studied and described, the clinical effects of chronic, documented myocardial ischemia are not completely clarified. The first studies that compared therapies for coronary disease focused on the presence of anatomical features and assessed ischemia based on the interpretation of the findings of obstructive atherosclerotic lesions. They suggested that revascularization interventions did not confer any clinical advantage over medical therapy (MT), in terms of cardiac or overall death. Other retrospective studies that were dedicated to assessing the impact of documented stress-induced ischemia on cardiovascular outcomes have suggested a prognostic impact of chronic ischemia. However, this has been questioned in recent studies. Moreover, the previous understanding that chronic ischemia could lead to worsening of ventricular function was not confirmed in a recent study. Thus, the prognostic significance of stress-induced ischemia has been questioned. Regarding treatment options, although some previous analyses have suggested that interventional therapies would reduce cardiovascular events in CAD patients with documented ischemia, recent post-hoc studies and metanalysis have shown distinct results. In this review article, the authors discuss myocardial ischemia, the different responses of the myocardium to ischemic insults, ischemic preconditioning, and the main findings of recent studies about the clinical aspects and treatment of patients with chronic, documented myocardial ischemia.
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Soeiro ADM, Gualandro DM, Bossa AS, Zullino CN, Biselli B, Soeiro MCFDA, Leal TDCAT, Serrano CV, Oliveira Junior MTD. Sensitive Troponin I Assay in Patients with Chest Pain - Association with Significant Coronary Lesions with or Without Renal Failure. Arq Bras Cardiol 2018. [PMID: 29538525 PMCID: PMC5831304 DOI: 10.5935/abc.20170182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Despite having higher sensitivity as compared to conventional troponins,
sensitive troponins have lower specificity, mainly in patients with renal
failure. Objective Study aimed at assessing the sensitive troponin I levels in patients with
chest pain, and relating them to the existence of significant coronary
lesions. Methods Retrospective, single-center, observational. This study included 991 patients
divided into two groups: with (N = 681) and without (N = 310) significant
coronary lesion. For posterior analysis, the patients were divided into two
other groups: with (N = 184) and without (N = 807) chronic renal failure.
The commercial ADVIA Centaur® TnI-Ultra assay (Siemens
Healthcare Diagnostics) was used. The ROC curve analysis was performed to
identify the sensitivity and specificity of the best cutoff point of
troponin as a discriminator of the probability of significant coronary
lesion. The associations were considered significant when p < 0.05. Results The median age was 63 years, and 52% of the patients were of the male sex.
The area under the ROC curve between the troponin levels and significant
coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or
without renal failure, the areas under the ROC curve were 0.703 (95% CI:
0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff
points to discriminate the presence of significant coronary lesion were: in
the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%);
in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%;
specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL
(sensitivity, 80.6%; specificity, 42%). Conclusion In patients with chest pain, sensitive troponin I showed a good correlation
with significant coronary lesions when its level was greater than 0.605
ng/dL. In patients with chronic renal failure, a significant decrease in
specificity was observed in the correlation of troponin levels and severe
coronary lesions.
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Affiliation(s)
| | | | | | | | - Bruno Biselli
- Unidade Clínica de Emergência - InCor - HCFMUSP, 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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Lima EG, Carvalho FPCD, Linhares Filho JPP, Pitta FG, Serrano CV. Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics. Rev Assoc Med Bras (1992) 2017; 63:793-800. [PMID: 29239459 DOI: 10.1590/1806-9282.63.09.793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/03/2017] [Indexed: 12/13/2022]
Abstract
Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.
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Affiliation(s)
- Eduardo Gomes Lima
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Carlos Vicente Serrano
- Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Zakiev E, Rached F, Lhomme M, Serrano CV, Santos R, Chapman J, Orekhov A, Kontush A. Polyunsaturated lipid species of HDL are most strongly affected by genetic apolipoprotein A-I deficiency. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.095] [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: 10/19/2022]
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16
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Pesaro AE, Serrano CV, Katz M, Pereira C, Mangueira CL, de Carvalho AEZ, Salmazi KL, Nomura CH, Franken M, Liberman M. Abstract 594: Matrix Gla Protein Associates With Coronary Artery Calcification and Increases in Subacute Myocardial Infarction Together With Inflammatory Activation by Tumor Growth Factor-β1. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.594] [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] [Indexed: 11/16/2022]
Abstract
Osteogenic Proteins (OP) and atherosclerotic inflammation modulate vascular calcification. Patients with acute myocardial infarction (MI) demonstrate higher inflammation and develop accelerated coronary artery calcification (CAC), compared to stable coronary artery disease patients. We aimed to: (a) test the association of OP and inflammatory proteins with CAC in individuals assessed for primary cardiovascular prevention; (b) evaluate these biomarkers in acute and subacute phases post-MI. We prospectively enrolled 170 patients, divided in 3 groups: (1) primary prevention patients who underwent ambulatory coronary computed tomography with a CAC score ≥ 100, n=100; (2) primary prevention patients with a CAC score=zero, n=30; (3) post-MI patients, n=40, during acute (3±1 days post-MI) and subacute (46±17 days post-MI) phases. Serum OP (osteoprotegerin, RANKL, fetuin-A and Matrix Gla protein [MGP]) and serum inflammatory proteins (C-reactive protein, oxidized LDL, tumoral necrosis factor-α and tumor growth factor [TGF]-β1) were measured by ELISA. Associations of plasma OP and inflammatory proteins levels with CAC were adjusted by age, sex and use of statins. In the post-MI group, all biomarkers were compared both in acute vs. subacute phases and in acute phase vs. CAC zero group. Compared to CAC zero, patients with CAC score ≥ 100 were older, predominantly men and had higher rates of hypertension and diabetes. After adjusted analysis, only MGP was associated with a CAC score ≥ 100 (OR 1.48 [95% CI 1.01-2.16; per 100ng/ml increase; p=0.047). Serum MGP and TGF-β1 were higher in subacute phase compared to acute phase post-MI (median [25-75 percentile], 342 vs. 279ng/ml respectively; p=0.01 and 711 vs. 492pg/ml; p=0.03). All biomarkers were similar in acute phase post-MI vs. CAC zero. In conclusion, serum MGP was associated with higher CAC in primary cardiovascular prevention patients. After MI, both serum MGP and TGF-β1 levels increased in the subacute phase. Our findings unveiled a potential role for MGP as a biomarker of CAC in primary cardiovascular prevention. Additionally, this clinical study unfolds further mechanistic hypothesis of how increased TGF-β1 and MGP may modulate vascular inflammation and CAC progression in subacute MI patients.
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Soeiro ADEM, Leal TDECAT, Soeiro MCFDEA, Serrano CV, Oliveira MT. Atrial fibrillation with high ventricular rate in emergency room: What's the best strategy for treatment? Rev Assoc Med Bras (1992) 2016; 62:879-885. [PMID: 28001264 DOI: 10.1590/1806-9282.62.09.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.
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Affiliation(s)
- Alexandre DE Matos Soeiro
- Unidade Clínica de Emergência, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Tatiana DE Carvalho Andreucci Torres Leal
- Unidade Clínica de Emergência, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Maria Carolina Feres DE Almeida Soeiro
- Unidade Clínica de Emergência, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Vicente Serrano
- Unidade Clínica de Emergência, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Múcio Tavares Oliveira
- Unidade Clínica de Emergência, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
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Soeiro ADM, Fernandes FL, Soeiro MCFDA, Serrano CV, Oliveira MTD. Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil. Einstein (Sao Paulo) 2016; 13:370-5. [PMID: 26466059 PMCID: PMC4943781 DOI: 10.1590/s1679-45082015ao3381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/04/2015] [Accepted: 07/20/2015] [Indexed: 12/27/2022] Open
Abstract
Objective In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population. Methods This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values. Results Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital. Conclusion In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.
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Liberman M, Pesaro AEP, Carmo LS, Serrano CV. Vascular calcification: pathophysiology and clinical implications. Einstein (Sao Paulo) 2014; 11:376-82. [PMID: 24136769 PMCID: PMC4878601 DOI: 10.1590/s1679-45082013000300021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/22/2013] [Indexed: 12/17/2022] Open
Abstract
Vascular calcification in coronary artery disease is gaining importance, both in scientific research and in clinical and imaging applications. The calcified plaque is considered the most relevant form of atherosclerosis within the coronary artery tree and is frequently a challenge for percutaneous intervention. Recent studies showed that plaque calcification is dynamic and is strictly related to the degree of vascular inflammation. Several inflammatory factors produced during the different phases of atherosclerosis induce the expression and activation of osteoblastic cells located within the arterial wall, which, in turn, promote the deposit of calcium. The vascular smooth muscle cells have an extraordinary capacity to undergo osteoblastic phenotypical differentiation. There is no doubt that the role of these factors, as well as the elements of genomics and proteomics, could be a vital strategic point in prevention and treatment. Within this context, we conducted an updating review on coronary calcification focused on pathophysiology, experimental models, and clinical implications of vascular calcification.
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Soeiro ADM, Pinto AL, Henares BB, Ribeiro HB, Lima FG, Serrano CV. Takayasu arteritis: stenosis after bare-metal and drug-eluting stent implantation. Arq Bras Cardiol 2013; 100:e8-e11. [PMID: 23370824 DOI: 10.1590/s0066-782x2013000100019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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Nicolau JC, Moreira HG, Baracioli LM, Serrano CV, Lima FG, Franken M, Giraldez RR, Ganem F, Kalil R, Ramires JAF, Mehran R. The bleeding risk score as a mortality predictor in patients with acute coronary syndrome. Arq Bras Cardiol 2013; 101:511-8. [PMID: 24217405 PMCID: PMC4106809 DOI: 10.5935/abc.20130223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied. OBJECTIVE The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center. METHODS Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained. RESULTS Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001). CONCLUSIONS Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.
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Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor) - Universidade de São Paulo, SP -
Brazil
- Mailing Address: José Carlos NIcolau, Aureliano Coutinho 355, apt. 1401.
Postal Code 01224-020. São Paulo - Brazil. e-mail:
tel.: +55-11-26615058/+55-11-26615196 fax:
+55-11-30883809
| | | | | | | | | | - Marcelo Franken
- Instituto do Coração (InCor) - Universidade de São Paulo, SP -
Brazil
| | | | - Fernando Ganem
- Instituto do Coração (InCor) - Universidade de São Paulo, SP -
Brazil
| | - Roberto Kalil
- Instituto do Coração (InCor) - Universidade de São Paulo, SP -
Brazil
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Soeiro ADM, Bergamin FS, Almeida MCFD, Serrano CV, Falcão BADA, Ganem F. Rare manifestation of acute pulmonary edema associated with acute lupus myocarditis. Arq Bras Cardiol 2013; 98:e78-81. [PMID: 22858658 DOI: 10.1590/s0066-782x2012000500016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is the most common systemic autoimmune disease, occurring more frequently in women, usually aged between 16 and 55 years 1, 2. Although classically the kidneys are the organs most affected in SLE, cardiopulmonary circulation and the heart may also be affected significantly 3. In this context, the occurrence of acute pulmonary edema associated with lupus myocarditis is rare and specific immunosuppressive therapy remains unclear.
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Soeiro ADM, Almeida MCFD, Accorsi TAD, Spina GS, Serrano CV, Tarasoutchi F. Association between immunological diseases and their similar clinical manifestations. Arq Bras Cardiol 2012; 98:e28-31. [PMID: 22378340 DOI: 10.1590/s0066-782x2012000200016] [Citation(s) in RCA: 3] [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: 12/08/2010] [Accepted: 04/15/2011] [Indexed: 11/22/2022] Open
Abstract
We report on a 30-year-old female patient, with biological mitral valve prosthesis due to symptomatic mitral stenosis and a history of acute myocardial infarction and generalized tonic-clonic seizure episodes, visual hallucinations, cerebral thromboembolic events and, at present, chorea and acute carditis. The patient was diagnosed with active rheumatic fever (RF), systemic lupus erythematosus (SLE) and Antiphospholipid syndrome (APS). The combination of three unusual diagnoses in the same patient makes this a unique case, modifying patient treatment and prognosis.
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Affiliation(s)
- Alexandre de Matos Soeiro
- Instituto do Coração Liga de Combate à Febre Reumática, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Hueb W, Gersh BJ, Rezende PC, Garzillo CL, Lima EG, Vieira RD, Garcia RMR, Favarato D, Segre CAW, Pereira AC, Soares PR, Ribeiro E, Lemos P, Perin MA, Strunz CC, Dallan LAO, Jatene FB, Stolf NAG, Hueb AC, Dias R, Gaiotto FA, da Costa LMA, Oikawa FTC, de Melo RMV, Serrano CV, de Ávila LFR, Villa AV, Filho JRP, Nomura C, Ramires JAF, Kalil Filho R. Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial. BMC Cardiovasc Disord 2012; 12:65. [PMID: 22898311 PMCID: PMC3468382 DOI: 10.1186/1471-2261-12-65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/15/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS/DESIGN The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.
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Affiliation(s)
- Whady Hueb
- Heart Institute of the University of São Paulo, São Paulo, Brazil.
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Nicolau JC, Serrano CV, Giraldez RR, Baracioli LM, Moreira HG, Lima F, Franken M, Kalil R, Ramires JAF, Giugliano RP. In patients with acute myocardial infarction, the impact of hyperglycemia as a risk factor for mortality is not homogeneous across age-groups. Diabetes Care 2012; 35:150-2. [PMID: 22028280 PMCID: PMC3241319 DOI: 10.2337/dc11-1170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of hyperglycemia in different age-groups of patients with acute myocardial infarction (AMI). RESEARCH DESIGN AND METHODS A total of 2,027 patients with AMI were categorized into one of five age-groups: <50 years (n = 301), ≥50 and <60 (n = 477), ≥60 and <70 (n = 545), ≥70 and <80 (n = 495), and ≥80 years (n = 209). Hyperglycemia was defined as initial glucose ≥115 mg/dL. RESULTS The adjusted odds ratios for hyperglycemia predicting hospital mortality in groups 1-5 were, respectively, 7.57 (P = 0.004), 3.21 (P = 0.046), 3.50 (P = 0.003), 3.20 (P < 0.001), and 2.16 (P = 0.021). The adjusted P values for correlation between glucose level (as a continuous variable) and mortality were 0.007, <0.001, 0.043, <0.001, and 0.064. The areas under the ROC curves (AUCs) were 0.785, 0.709, 0.657, 0.648, and 0.613. The AUC in group 1 was significantly higher than those in groups 3-5. CONCLUSIONS The impact of hyperglycemia as a risk factor for hospital mortality in AMI is more pronounced in younger patients.
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Affiliation(s)
- José Carlos Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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Pesaro AE, de Matos Soeiro A, Serrano CV, Giraldez RR, Ladeira RT, Nicolau JC. Effect of beta-blockers on the risk of atrial fibrillation in patients with acute myocardial infarction. Clinics (Sao Paulo) 2010; 65:265-70. [PMID: 20360916 PMCID: PMC2845766 DOI: 10.1590/s1807-59322010000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 11/26/2009] [Accepted: 12/07/2009] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Oral beta-blockers improve the prognosis of patients with acute myocardial infarction, while atrial fibrillation worsens the prognosis of this population. The reduction of atrial fibrillation incidence in patients treated with beta-blockers could at least in part explain the benefits of this drug. OBJECTIVE To investigate the effect of beta-blockers on the incidence of atrial fibrillation in patients with acute myocardial infarction. METHODS We analyzed 1401 patients with acute myocardial infarction and evaluated the occurrence or absence of atrial fibrillation, the use of oral beta-blockers and mortality during the first 24 hours. RESULTS a) The use of beta-blockers was inversely correlated with the presence of atrial fibrillation (rho = 0.004; OR = 0.54). b) Correlations with mortality were as follows: 31.5% in patients with atrial fibrillation, 9.2% in those without atrial fibrillation (rho < 0.001; Odds Ratio = 4.52), and 17.5% in patients not treated with beta-blockers and 6.7% in those who received the drug (rho < 0.001; OR = 0.34). c) Adjusted Models: The presence of atrial fibrillation was independently correlated with mortality (OR = 2.48, rho = 0.002). The use of beta-blockers was inversely and independently correlated with mortality (OR = 0.53; rho = 0.002). The patients who used beta-blockers showed a lower risk of atrial fibrillation (OR = 0.59; rho = 0.029) in the adjusted model. CONCLUSION The presence of atrial fibrillation and the absence of oral beta-blockers increased in-hospital mortality in patients with acute myocardial infarction. Oral beta-blockers reduced the incidence of atrial fibrillation, which might be at least partially responsible for the drug's benefit.
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Serrano CV, Ramires JAF, Soeiro ADM, César LAM, Hueb WA, Dallan LA, Jatene FB, Stolff NAG. Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short-and long-term results in ischemic cardiomyopathy. Clinics (Sao Paulo) 2010; 65:947-52. [PMID: 21120292 PMCID: PMC2972609 DOI: 10.1590/s1807-59322010001000004] [Citation(s) in RCA: 4] [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: 05/10/2010] [Accepted: 07/07/2010] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes. METHODS AND MATERIAL Patients (n = 169) with angiographic left ventricular ejection fraction of 22 ± 5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients. RESULTS Cumulative in-hospital and 36-month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I-II, 4% and 13%; CHF class III-IV, 8% and 16%; LVEF,20%, 12% and 26%; LVEF 21-30%, 2% and 6%; gated LVEF exercise/rest .5%, ,1% and 4%; and gated LVEF exercise/rest #5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow-up based on the results of a multivariate analysis. After three years of follow-up, 84% of the patients were in class I/II, LVEF was 45 ± 7%, and gated LVEF ex/rest ratio was 13% higher (p,0.01) compared to the beginning of the study. CONCLUSIONS These data suggest that aneurysmectomy among patients with severe LV dysfunction result in short and long-term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients.
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Affiliation(s)
- Carlos Vicente Serrano
- Hospital das Clínica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Hovnanian AL, Matos Soeiro AD, Serrano CV, Oliveira SAD, Jatene FB, Stolf NAG, Ramires JAF. Surgical myocardial revascularization of patients with ischemic cardiomyopathy and severe left ventricular disfunction. Clinics (Sao Paulo) 2010; 65:3-8. [PMID: 20126339 PMCID: PMC2815280 DOI: 10.1590/s1807-59322010000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 07/21/2009] [Accepted: 09/09/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine long-term survival, identify preoperative factors predictive of a favorable outcome, and assess functional improvement after coronary artery bypass grafting in patients with advanced left ventricular dysfunction. METHODS Between 1995 and 2001, 244 patients who underwent coronary artery bypass grafting and had a preoperative left ventricular ejection fraction less than or equal to 35% were included. left ventricular ejection fraction was determined by uniplanar or biplanar ventriculography during left heart catheterization. Indication for surgery was predominance of tissue viability. Functional improvement was evaluated through echocardiography and gated scintigraphy at exercise/rest. Survival was determined by Kaplan-Meier analysis. RESULTS Mean left ventricular ejection fraction was 29+/-4% (ranged from 9% to 35%). An average of 3.01 coronary bypass grafts per patient were performed. In-hospital mortality was 3.7% (9 patients). The 4-year survival rate was 89.7%. Multivariate correlates of favorable short- and long-term outcome were preoperative New York Heart Association Funcional classification for congestive heart failure class I/II, lower PAsP, higher left ventricular ejection fraction and gated left ventricular ejection fraction Ex/Rest ratio >5%. Left ventricular ejection fraction rise from 32+/-5% to 39+/-5%, p <0.001. Gated left ventricular ejection fraction at exercise/rest increased markedly after surgery: from 27+/-8%/23+/-7% to 37+/-5%/31+/-6%, p <0.001. CONCLUSIONS In selected patients with severe ischemic left ventricular dysfunction and predominance of tissue viability, coronary artery bypass grafting may be capable of implement preoperative clinical/functional parameters in predicting outcome as left ventricular ejection fraction and gated left ventricular ejection fraction at exercise/rest.
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Affiliation(s)
- André L Hovnanian
- Unidade Clínica de Coronariopatia Aguda, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
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Nicolau JC, Baracioli LM, Serrano CV, Giraldez RR, Kalil Filho R, Lima FG, Franken M, Ganem F, Lage RL, Truffa R. The influence of health insurance plans on the long term outcome of patients with acute myocardial infarction. Arq Bras Cardiol 2009; 91:347-51. [PMID: 19142360 DOI: 10.1590/s0066-782x2008001800004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known, especially in our country, about the influence of health insurance plans on the long term outcome of patients after acute myocardial infarction (AMI). OBJECTIVE To assess the outcome of patients with AMI who are covered by the National Health System (SUS) or other health insurance plans. METHODS We analyzed 1,588 patients with AMI (mean age of 63.3 + 12.9 years, 71.7% male) who were included prospectively into a specific database and followed up for up to 7.55 years. Of this total, 1,003 were placed in the "SUS" group and 585 in the "other insurance plans" group. We applied chi-square, log-rank and Cox (stepwise) to the different statistical analyses. The long term multivariate model with mortality as a dependent variable included 18 independent variables. RESULTS In-hospital mortality rates in the "other insurance plans" and "SUS" groups were 11.4% and 10.3%, respectively (p = 0.5); in the long term, survival chances in the groups were respectively, 70.4% + 2.9 and 56.4% + 4.0 (p = 0.001, hazard-ratio = 1.43, or a 43% higher chance of death in the "SUS" group). In the adjusted model, the 'SUS' group had a significantly higher chance of death (a 36% higher chance, p = 0.005). Surgical revascularization and angioplasty improved the prognosis of these patients, whereas age and previous history of infarction, diabetes or heart failure worsened the prognosis. CONCLUSIONS Relative to patients with other insurance plans, SUS users present similar mortality rates during hospital stay, but their prognosis is worse in the long term, thus reinforcing the need for additional efforts to improve the care provided to these patients after hospital discharge.
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Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor HCFMUSP), São Paulo, SP - Brazil.
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Pesaro AE, Gaz MV, Karbstein R, Perin M, Serrano CV, Damico É. Coronary artery bypass surgery, angioplasty and long term anti-platelet treatment in a type B hemophilia patient. Clinics (Sao Paulo) 2009; 64:822-3. [PMID: 19690670 PMCID: PMC2728199 DOI: 10.1590/s1807-59322009000800019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Marco Perin
- CTI, Hospital Albert Einstein - São Paulo/SP, Brazil
| | - Carlos Vicente Serrano
- Cardiology, Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Élbio Damico
- CTI, Hospital Albert Einstein - São Paulo/SP, Brazil
- Hematology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
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Fernandes JL, de Oliveira RTD, Mamoni RL, Coelho OR, Nicolau JC, Blotta MHSL, Serrano CV. Pentoxifylline reduces pro-inflammatory and increases anti-inflammatory activity in patients with coronary artery disease—A randomized placebo-controlled study. Atherosclerosis 2008; 196:434-442. [PMID: 17196208 DOI: 10.1016/j.atherosclerosis.2006.11.032] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [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: 08/13/2006] [Revised: 11/02/2006] [Accepted: 11/22/2006] [Indexed: 11/16/2022]
Abstract
The balance between different immunological stimuli is essential in the progression and stabilization of atherosclerotic plaques. Immune regulation has been suggested as potential target for the treatment of atherosclerotic disease. We sought to determine whether treatment with pentoxifylline, a phosphodiesterase inhibitor with immunomodulating properties, could reduce the pro-inflammatory response observed in patients with acute coronary syndromes (ACS) and increase anti-inflammatory activity. In a double-blind, prospective, placebo-controlled study, 64 patients with ACS were randomized to receive pentoxifylline 400mg TID or placebo for 6 months. Analysis of the pro-inflammatory markers, C-reactive protein (CRP), interleukin (IL)-6, IL-12, interferon-gamma and tumor necrosis factor (TNF)-alpha and the anti-inflammatory cytokines, transforming growth factor (TGF)-beta1 and IL-10 were done at baseline, 1 and 6 months. Pentoxifylline treatment significantly reduced the adjusted levels of CRP and TNF-alpha compared to placebo after 6 months (P=0.04 and P<0.01, respectively). IL-12 increase was significantly less pronounced with pentoxifylline (P=0.04). The levels of the anti-inflammatory cytokine, IL-10, also declined significantly less in the pentoxifylline group compared to placebo (P<0.01) with a trend towards a higher increase of TGF-beta1 in the former group (P=0.16). Pentoxifylline reduces pro-inflammatory and increases anti-inflammatory response in patients with ACS and may have beneficial clinical effects on cardiovascular events.
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Venturinelli ML, Hovnan A, Soeiro ADM, Nicolau JC, Ramires JAF, D'Amico EA, Serrano CV. Platelet activation in different clinical forms of the coronary artery disease (role of P-selectin and others platelet markers in stable and unstable angina). Arq Bras Cardiol 2007; 87:446-50. [PMID: 17128313 DOI: 10.1590/s0066-782x2006001700008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 07/01/2005] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Markers of platelet activation are elevated in coronary artery disease. We sought to identify the presence and the potential associations of different markers of platelet activation. METHODS We studied patients with unstable angina (n=28), patients with stable angina (n=36) and patients without coronary artery disease (n=30); sex and age matched. Blood levels of the adhesion molecule P-selectin, Thromboxane B2 and Serotonin were measured by enzyme immunoassays. RESULTS When we compared the groups the results were: sP-selectin, thromboxane B2 and serotonin levels were significantly higher in patients with unstable angina than in patients with stable angina. CONCLUSION These markers of platelet activation were able to identify unstable forms of coronary artery disease.
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Fernandes JL, Serrano CV, Blotta MHSL, Coelho OR, Nicolau JC, Avila LF, Rochitte CE, Parga Filho JR. Regression of coronary artery outward remodeling in patients with non-ST-segment acute coronary syndromes: a longitudinal study using noninvasive magnetic resonance imaging. Am Heart J 2006; 152:1123-32. [PMID: 17161065 DOI: 10.1016/j.ahj.2006.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 02/17/2006] [Accepted: 06/16/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association of plaques with outward arterial remodeling and acute coronary syndromes (ACS) has been mostly investigated by cross-sectional intravascular ultrasound studies. Magnetic resonance imaging (MRI) has made it possible to noninvasively assess the coronary vessels of patients with chronic coronary artery disease, but no study has been done in patients with ACS. We sought to serially investigate changes in coronary vessel walls of patients with ACS using noninvasive serial MRI. METHODS A total of 42 segments of coronary arteries from 22 patients presenting with non-ST-segment elevation ACS were studied at baseline in the acute phase and at 6 months after stabilization and optimization of medical therapy. Patients received routine medical treatment during this period with control of risk factors. Vessel wall area, maximum wall thickness, mean wall thickness, and lumen area were analyzed longitudinally using MRI. RESULTS Vessel wall area (38.8 +/- 20.0 vs 27.7 +/- 10.4 mm2; P = .001), maximum wall thickness (2.9 +/- 0.7 vs 2.5 +/- 0.6 mm; P < .001), and mean wall thickness (2.0 +/- 0.7 vs 1.6 +/- 0.5 mm; P < .001) were significantly reduced at 6 months compared with baseline, whereas lumen area did not show significant changes (11.5 +/- 4.8 vs 10.9 +/- 5.0 mm2; P = .52). The wall/lumen ratio was significantly reduced from 3.7 +/- 1.7 to 2.9 +/- 1.3 (P = .01), suggesting a regression of outward remodeling. CONCLUSION Patients with ACS have increased coronary vessel wall thickness and area that can regress with stabilization and medical therapy over the period of 6 months. Magnetic resonance imaging can detect and serially follow these changes, monitoring coronary vascular remodeling from the acute to the chronic phase of the disease.
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Salgado Filho W, Martinez Filho EE, Horta P, Lemos PA, Migueletto BC, Serrano CV, Ramires JAF, Martinez TLDR. [Intracoronary inflammatory markers after percutaneous coronary interventions]. Arq Bras Cardiol 2005; 85:180-5. [PMID: 16200264 DOI: 10.1590/s0066-782x2005001600006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze intracoronary release of inflammatory markers (IM) after percutaneous coronary interventions (PCI) and compare their concentrations concerning the type of PCI used (rotablator vs. balloon angioplasty). METHODS Twenty-two patients with average age of 60 +/- 11.9 years old, 12 of male sex, with stable coronary disease, submitted to elective treatment of a single coronary lesion, using rotablator (N = 11) or balloon pre-dilatation (N = 11) for stent implant were randomized. Samples were collected at aorta root and coronary sinus, immediately before and 15 minutes after intervention. All dosages were made before stent implant, and the cytokines TNF-a, IL-6 and IL-1 and the soluble adhesion molecules ICAM-1, E-selectin and P-selectin were analyzed by using ELISA method. RESULTS TNF-a and IL-6 concentrations increased after PCI, respectively from 9.5 +/- 1.5 pg/ml to 9.9 +/- 1.8 pg/ml (p = 0.017) and from 6.0 +/- 2.4 pg/ml to 6.9 +/- 3.0 pg/ml (p < 0.001). There was no significant changes in IL-1, ICAM-1 and P-selectin, and a decrease in E-selectin concentrations after the procedures (52.0 +/- 17.5 ng/ml to 49.3 +/- 18.7 ng/ml; p = 0.009) was observed. There were no significant differences between IM concentrations after PCI, concerning the type of procedure used. CONCLUSION At the early period, post-percutaneous coronary interventions, an increase of intracoronary concentrations of TNF-a and IL-6, and absence of significant difference between concentrations of inflammatory markers released in coronary flow through rotablator and balloon angioplasty were observed.
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Soeiro ADM, Souza JAD, Serrano CV, Benvenuti LA, Miranda RC, Nicolau JC, Ramires JAF, Oliveira SAD. Severe mitral stenosis in the long-term evolution of myotomy-myectomy-septal resection. Arq Bras Cardiol 2004; 83:258-62; 253-7. [PMID: 15375475 DOI: 10.1590/s0066-782x2004001500009] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Piegas LS, Timerman A, Nicolau JC, Mattos LA, Rossi Neto JM, Feitosa GS, Avezum Á, Carvalho ACC, Mansur ADP, Timerman A, Guimarães AC, Bozza AEZ, Markman F. B, Polanczyk CA, Serrano CV, Oliveira CCD, Alves CMR, Précoma DB, Albuquerque DCD, Romano ER, Stefanini E, Knobel E, Santos ES, God EMG, Silva EERD, Brito FSD, Reis G, Feitosa GS, Lima GGD, Atie J, Rossi Neto JM, Marin Neto JA, Nicolau JC, Saraiva JFK, Amino JGDC, Piegas LS, Maia LN, Moreira LF, Mattos LA, Arraes M, Coutinho M, Dutra O, Coelho OR, Leães PE, Rossi PRF, Albuquerque P, Bassan R, Esporcatte R, Giraldez RR, Meneghelo RS, Ramos RF, Carvalho VBD, Mathias W, Guimarães JI. III Diretriz sobre tratamento do infarto agudo do miocárdio. Arq Bras Cardiol 2004. [DOI: 10.1590/s0066-782x2004002200001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Cardiovascular diseases continue to be the first cause of death in Brazil -- responsible for almost 32% of all deaths. In addition, they are the third major cause of admission in the country. Among them, acute myocardial infarction is still one of the major causes of morbidity and mortality. Despite of the last decade's therapeutic advances, acute myocardial infarction still shows remarkable rates of mortality, and great part of the patients do not receive the adequate treatment. The opening of the Coronary Care Units and the introduction of reperfusion treatment with fibrinolytics or primary angioplasty were fundamental to reduce mortality and complications related to myocardial infarction. Important beneficial effects to the current treatment include less ventricular dysfunction and better control of ventricular arrhythmias. The need of early reperfusion is crucial for the good prognosis after a myocardial infarction. The objective of this review is to emphasize the modern basic concepts of the pathophysiology, diagnosis and treatment of acute myocardial infarction, according to national and international guidelines.
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Affiliation(s)
- Antonio Eduardo Pereira Pesaro
- Unidade Clínica de Coronariopatia Aguda, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP
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Marinho de Souza MF, Timerman A, Serrano CV, Santos RD, de Pádua Mansur A. Trends in the risk of mortality due to cardiovascular diseases in five Brazilian geographic regions from 1979 to 1996. Arq Bras Cardiol 2001; 77:562-75. [PMID: 11799431 DOI: 10.1590/s0066-782x2001001200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE - To analyze the trends in risk of death due to cardiovascular diseases in the northern, northeastern, southern, southeastern, and central western Brazilian geographic regions from 1979 to 1996. METHODS - Data on mortality due to cardiovascular, cardiac ischemic, and cerebrovascular diseases in 5 Brazilian geographic regions were obtained from the Ministry of Health. Population estimates for the time period from 1978 to 1996 in the 5 Brazilian geographic regions were calculated by interpolation with the Lagrange method, based on the census data from 1970, 1980, 1991, and the population count of 1996, for each age bracket and sex. Trends were analyzed with the multiple linear regression model. RESULTS - Cardiovascular diseases showed a declining trend in the southern, southeastern, and northern Brazilian geographic regions in all age brackets and for both sexes. In the northeastern and central western regions, an increasing trend in the risk of death due to cardiovascular diseases occurred, except for the age bracket from 30 to 39 years, which showed a slight reduction. This resulted from the trends of cardiac ischemic and cerebrovascular diseases. The analysis of the trend in the northeastern and northern regions was impaired by the great proportion of poorly defined causes of death. CONCLUSION - The risk of death due to cardiovascular, cerebrovascular, and cardiac ischemic diseases decreased in the southern and southeastern regions, which are the most developed regions in the country, and increased in the least developed regions, mainly in the central western region.
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Abstract
BACKGROUND Modern and sophisticated technology for the management of myocardial infarction has progressively devalued medical evaluation. HYPOTHESIS This study was undertaken to assess the importance of the findings of medical evaluation at hospital presentation, in patients with acute myocardial infarction. METHODS Data from 590 thrombolytic-treated myocardial infarction patients were analyzed. The patients were grouped according to their clinical status on arrival at hospital. A modified Forrester classification--subset II was divided according to the absence (IIa) or presence (IIb) of symptoms--was applied. Short- (14 days) and long-term (up to 10 years) survival was analyzed and 19 independent variables were included in the multivariate models. RESULTS Short-term survival was 95.6% for subset I, 83.3% for subset IIa, 60% for subset IIb, 54.6% for subset III, and 34.8% for subset IV (P<0.001). By multiple regression analysis, lower clinical subsets (P<0.001), fewer coronary arteries with disease (P=0.006), younger age (P=0.014), absence of reinfarction (P=0.034), longer interval between streptokinase infusion and coronary arteriography (P=0.016), and higher left ventricular ejection fraction (P=0.037) demonstrated significant and independent correlation with short-term survival. Long-term survival for the total population was 71+/-3.6% for subset I, 54.4+/-8.5% for subset IIa, 20.8+/-9.4% for subset IIb, 54.5+/-15% for subset III, and 0% for subset IV (P<0.001). Using Cox regression analysis, lower clinical subsets (P<0.001), younger age (P<0.001), higher global left ventricular ejection fraction (P<0.001), and fewer coronary arteries with disease (P=0.021) correlated independently and significantly with long-term survival. When excluding data from patients who died before the short-term follow-up (n=532), lower clinical subsets remained an important predictor of long-term survival (P<0.001). CONCLUSION Clinical classification at hospital presentation is a powerful predictor of short- and long-term survival post-myocardial infarction.
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Affiliation(s)
- J C Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, Rua Aureliano Coutinho 355-14o andar, São Paulo, SP 01224-020, Brazil.
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Serrano CV, Yoshida VM, Venturinelli ML, D'Amico E, Monteiro HP, Ramires JA, da Luz PL. Effect of simvastatin on monocyte adhesion molecule expression in patients with hypercholesterolemia. Atherosclerosis 2001; 157:505-12. [PMID: 11472753 DOI: 10.1016/s0021-9150(00)00757-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [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] [Indexed: 11/29/2022]
Abstract
Increased monocyte adherence to the vessel wall is one of the earliest events in atherosclerosis. The mechanism by which hypercholesterolemia causes alterations in endothelial adhesiveness for monocytes is unclear. This study sought to determine if monocyte adhesion molecule expression is affected by low-density lipoprotein (LDL)-cholesterol levels. Patients with hypercholesterolemia and stable coronary artery disease were compared with those without major cardiovascular risk (control). Patients with hypercholesterolemia were treated with simvastatin 20--40 mg/day for 8--10 weeks. Blood samples were examined with flow cytometry assays at baseline and after cholesterol-lowering therapy. Monocyte CD11b and CD14 adhesion molecule expression, measured as fluorescence intensity, were significantly (P<0.0001) higher in hypercholesterolemic patients before the study (176.9+/-9.8 and 138.0+/-4.8, respectively) when compared with that in control subjects (97.2+/-8.1 and 84.0+/-6.4, respectively). Both decreased markedly with treatment: to 118.8+/-6.9 and 103.1+/-3.9, respectively. Monocyte L-selectin expression was significantly lower in patients with hypercholesterolemia before treatment (43.0+/-3.0) when compared with control subjects (79.9+/-2.7), and it increased markedly with treatment (54.2+/-2.5). LDL levels correlated directly with both CD11b and CD14 expression and correlated inversely with L-selectin expression. These data show that hypercholesterolemia affects monocyte adhesion molecule expression which, in turn, decreases with statin-induced plasmatic cholesterol reduction. Such perturbations in monocyte function likely represent a proinflammatory response to hypercholesterolemia and may have a role in the early progression of atherogenesis.
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Affiliation(s)
- C V Serrano
- Heart Institute (InCor) - Medical School, University of São Paulo - Av. Enéas C. de Aguiar, Sao Paulo, SP 05403-000, Brazil.
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Mansur AP, Serrano CV, Nicolau JC, César LA, Ramires JA. Effect of cholesterol lowering treatment on positive exercise tests in patients with hypercholesterolaemia and normal coronary angiograms. Heart 1999; 82:689-93. [PMID: 10573494 PMCID: PMC1729198 DOI: 10.1136/hrt.82.6.689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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] [Indexed: 11/03/2022] Open
Abstract
AIM To assess the impact of cholesterol lowering on positive exercise stress tests in hypercholesterolaemic patients with normal coronary angiograms. METHODS 43 non-diabetic patients aged 43-61 years, with total serum cholesterol concentrations of more than 7.75 mmol/l, positive exercise tests, and normal coronary angiograms, were started on the American Heart Association step 1 diet. After 12 weeks these patients were randomly assigned to treatment for another 16 weeks with the diet alone (diet group, n = 20) or with the diet plus lovastatin or simvastatin (statin group, n = 23). After this 28 week run in period, statins were withdrawn and lipid profile tests and exercise tests were done and repeated 20 weeks later. RESULTS At week 28, the statin group but not the diet group had significant reductions from baseline (week 12) in plasma total cholesterol (p < 0.0001), low density lipoprotein (p < 0.0001), and triglyceride (p < 0.0001). The number of patients with positive exercise tests decreased from 23 to three in the statin group and from 20 to 15 in the diet group (p = 0.01). After the final 20 weeks without statins, lipid profiles returned to baseline levels in all 17 patients remaining in the statin group, and exercise tests were again positive in 15 of these patients. CONCLUSIONS In hypercholesterolaemic patients with normal coronary arteries, cholesterol lowering treatment reduces myocardial ischaemia, as shown by the beneficial effects on exercise testing.
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Affiliation(s)
- A P Mansur
- Heart Institute, São Paulo University, Av Dr Enéas de Carvalho Aguiar 44, 05403-000 São Paulo, Brazil.
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Nicolau JC, Nogueira PR, Pinto MA, Serrano CV, Garzon SA. Early infarct artery collateral flow does not improve long-term survival following thrombolytic therapy for acute myocardial infarction. Am J Cardiol 1999; 83:21-6. [PMID: 10073779 DOI: 10.1016/s0002-9149(98)00776-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [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] [Indexed: 10/18/2022]
Abstract
It is known that acutely developed collaterals can prevent the onset of acute myocardial infarction (AMI) in the presence of a total coronary occlusion. However, there still is controversy concerning long-term follow-up of coronary collateral circulation to the infarct-related artery. In this study we analyze the prognostic role of collateral flow (degrees 0 to 3) as well as anterograde flow (degrees 0 to 3) in patients with AMI treated with thrombolytic therapy. Four hundred twenty-two patients (median age 57 years, 355 men) with AMI were treated with intravenous streptokinase and followed prospectively for up to 8 years. At the end of the study period, patients with collateral coronary flow 3 (n = 30) and those with flow <3 (n = 392) at in-hospital coronary arteriography had survival rates of 66% and 85%, respectively (p <0.12). Meanwhile, patients with coronary anterograde flow 3 (n = 189) and those with flow <3 (n = 233) had survival rates of 89% and 80%, respectively (p <0.04). By censored regression analysis, a negative correlation was found between coronary collateral flow degree and survival (p = 0.0498) and, inversely, a positive correlation was found between coronary anterograde flow degree and survival (p = 0.0053). By Cox multivariate analysis, the following variables showed significant correlations with long-term survival: global left ventricular ejection fraction (p = 0.0003), anterograde flow degree (p = 0.0006), collateral flow degree (negative correlation, p = 0.0179), and medical treatment (negative correlation, p = 0.0464). Thus, patients treated with intravenous streptokinase during AMI and with adequate coronary collateral circulation had a worse prognosis than those who developed adequate anterograde flow, probably because of residual myocardial ischemia. Such patients may benefit from coronary revascularization (angioplasty or surgery) to restore anterograde blood flow and minimize myocardium at risk.
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Affiliation(s)
- J C Nicolau
- Heart Institute, Faculty of Medicine, University of São Paulo, Brazil.
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Spósito AC, Caramelli B, Serrano CV, Mansur AP, Ramires JA. Effect of niacin and etofibrate association on subjects with coronary artery disease and serum high-density lipoprotein cholesterol <35 mg/dl. Am J Cardiol 1999; 83:98-100, A8. [PMID: 10073791 DOI: 10.1016/s0002-9149(98)00787-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Niacin treatment (alone) was compared with etofibrate and niacin combination to treat patients with high-density lipoprotein <35 mg/dl and without hypertriglyceridemia. The niacin and etofibrate combination proved to be safe and increased high-density lipoprotein cholesterol levels to 48%, which was 3 times higher than that obtained with niacin alone.
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Affiliation(s)
- A C Spósito
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
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Serrano CV, Bortolotto LA, César LA, Solimene MC, Mansur AP, Nicolau JC, Ramires JA. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction. Int J Cardiol 1999; 68:75-82. [PMID: 10077404 DOI: 10.1016/s0167-5273(98)00344-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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] [Indexed: 11/25/2022]
Abstract
Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia.
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Affiliation(s)
- C V Serrano
- Heart Institute, Coronary Care Unit, São Paulo, SP, Brazil.
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Serrano CV, Ramires JA, Venturinelli M, Arie S, D'Amico E, Zweier JL, Pileggi F, da Luz PL. Coronary angioplasty results in leukocyte and platelet activation with adhesion molecule expression. Evidence of inflammatory responses in coronary angioplasty. J Am Coll Cardiol 1997; 29:1276-83. [PMID: 9137224 DOI: 10.1016/s0735-1097(97)00070-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.5] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to characterize leukocyte and platelet activation and adhesion molecule expression after coronary angioplasty. BACKGROUND Coronary angioplasty can be regarded as a clinical model of postischemic inflammation because this intervention leads to the release of inflammatory mediators as a result of plaque rupture and endothelial injury. METHODS In 13 patients with stable angina (mean [ +/- SEM] age 56.0 +/- 2.4 years, range 44 to 79), blood samples were drawn from the aorta and coronary sinus immediately before and immediately and 15 min after coronary angioplasty. Subsequently, leukocyte and platelet functions were determined. Eleven control patients (57.5 +/- 2.3 years, range 52 to 78) underwent coronary arteriography. RESULTS Coronary arteriography and angioplasty showed no difference in number of leukocytes between the coronary sinus and the aorta. However, 15 min after coronary angioplasty, there was an increase in neutrophil CD18 and CD11b, monocyte CD14 and platelet glycoprotein IIb/IIIa expression and a decrease in neutrophil L-selectin expression (189 +/- 25%, 163 +/- 27%, 158 +/- 35%, 141 +/- 22% and 31 +/- 10%, respectively, p < 0.01). In the control subjects, no change in adhesion molecule expression occurred. Superoxide production and aggregation in ex vivo-stimulated neutrophils collected from the coronary sinus 15 min after coronary angioplasty was significantly decreased compared with that after coronary arteriography (54 +/- 12% vs. 106 +/- 30% and 58 +/- 11% vs. 102 +/- 29%, respectively, p < 0.01). The reduced responses to phorbol ester stimulation may be explained by previous in vivo activation of neutrophils during coronary angioplasty. CONCLUSIONS Coronary angioplasty increases neutrophil, monocyte and platelet adhesion molecule expression and induces a significant decrease in ex vivo-stimulated neutrophil superoxide generation and aggregation. These findings suggest that coronary angioplasty triggers cellular activation with an inflammatory response that could contribute to restenosis.
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Affiliation(s)
- C V Serrano
- Heart Institute, School of Medicine, University of São Paulo, Brazil
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Serrano CV, Fraticelli A, Paniccia R, Teti A, Noble B, Corda S, Faraggiana T, Ziegelstein RC, Zweier JL, Capogrossi MC. pH dependence of neutrophil-endothelial cell adhesion and adhesion molecule expression. Am J Physiol 1996; 271:C962-70. [PMID: 8843727 DOI: 10.1152/ajpcell.1996.271.3.c962] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neutrophil adhesion to the vascular endothelium is enhanced during tissue ischemia and/or inflammation, conditions that are associated with tissue acidosis. This study examined the effects of hypercarbic acidosis (10 or 20% CO2) and of hypocarbic alkalosis (0% CO2) on human neutrophil CD18 and human aortic endothelial cell intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin expression quantified by flow cytometry. Acidosis with 20% CO2 for 4 h decreased ICAM-1 to 60.6 +/- 9.7% of control. In contrast, alkalosis with 0% CO2 for 4 h enhanced ICAM-1 expression to 143.8 +/- 10.1% of control. There was no pH dependence of VCAM-1 or E-selectin expression. Tumor necrosis factor-alpha (TNF-alpha; 10 ng/ml) increased endothelial ICAM-1, E-selectin, and VCAM-1; under these conditions, acidosis with 20% CO2 blunted both ICAM-1 and E-selectin surface expression compared with 5% CO2-, TNF-alpha-treated cells. Hypercarbic acidosis with 20% CO2 increased neutrophil CD18 expression and enhanced neutrophil adhesion. This latter effect was inhibited by neutrophil pretreatment with an anti-CD18 monoclonal antibody. In contrast, when only endothelial cells were preincubated with the hypercarbic buffer, neutrophil adhesion diminished to 55.6 +/- 7.8% of control. The results suggest that acidosis generated during tissue ischemia/inflammation may induce CD18-mediated neutrophil adhesion despite a decrease in ICAM-1 expression.
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Affiliation(s)
- C V Serrano
- Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Serrano CV, Mikhail EA, Wang P, Noble B, Kuppusamy P, Zweier JL. Superoxide and hydrogen peroxide induce CD18-mediated adhesion in the postischemic heart. Biochim Biophys Acta 1996; 1316:191-202. [PMID: 8781538 DOI: 10.1016/0925-4439(96)00025-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A burst of endothelial derived oxidants including hydrogen peroxide (H2O2) and superoxide (.O2-) occurs on reperfusion of ischemic tissues that directly causes injury; however, it is not known if this also triggers further injury due to subsequent leukocyte adhesion and adhesion molecule expression. Therefore, studies were performed in an isolated heart model developed to enable study of the role of isolated cellular and humoral factors in the mechanism of postischemic injury. Isolated rat hearts were subjected to 20 min of 37 degrees C-global ischemia followed by reperfusion with polymorphonuclear leukocytes (PMNs) and plasma in the presence or absence of superoxide dismutase (SOD), 200 U/ml, or catalase, 500 U/ml. Measurements of contractile function, coronary flow, high-energy phosphates, free radical generation, and PMN accumulation were performed. Adhesion molecule expression was measured on the surface of effluent PMNs by fluorescence flow cytometry and within the tissue using immunohistochemistry. SOD or catalase treatment resulted in 2- to 3-fold higher recoveries of contractile function, coronary flow, and high energy phosphates. EPR spin trapping measurements demonstrated that SOD totally quenched the free radical generation observed upon reperfusion while catalase prevented the formation of hydroxyl and alkyl radicals derived from superoxide. SOD or catalase treatment decreased PMN accumulation in the reperfused heart and prevented the marked upregulation of CD18 expression seen after reperfusion. These experiments demonstrate that in addition to their direct antioxidative actions, SOD and catalase each decrease PMN adhesion and CD18 expression resulting in marked suppression of PMN-mediated injury in the postischemic heart. Thus, endothelial derived H2O2 and .O2- further amplify postischemic injury by triggering CD18 expression on the surface of PMNs leading to increased PMN adhesion within the heart.
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Affiliation(s)
- C V Serrano
- Molecular and Cellular Biophysics Laboratories, Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
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Ramires JA, Serrano CV, Solimene MC, Moffa PJ, Caramelli B, Pileggi F. Prognostic significance of ST-T segment alterations in patients with non-Q wave myocardial infarction. Heart 1996; 75:582-7. [PMID: 8697161 PMCID: PMC484381 DOI: 10.1136/hrt.75.6.582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether, among patients with non-Q wave myocardial infarction, the characteristics of the segment ST-T shifts at presentation in the diagnostic electrocardiogram can identify those with more severe coronary artery disease and predict a poor clinical outcome. DESIGN Prospective controlled clinical trial. SETTING Primary referral medical centre. PATIENTS 93 patients (mean (SD) 62.0 (7.5) years) were studied: 41 with non-Q wave myocardial infarction and T wave inversion and 52 with ST segment depression. Cardiac events and mortality rates were assessed over 42 months. Age, sex, risk factors, creatinine kinase MB isoenzyme peak, and left ventricular function were comparable. RESULTS 31 patients with T wave inversion myocardial infarction (94.6%) had total occlusion of the infarct related artery, compared with 12 patients with ST segment depression myocardial infarction (26.7%) (P < 0.05). When compared with patients with T wave inversion, patients with ST segment depression had a higher incidence of cardiac events during the first month and in the 41 subsequent months: 9.6% and 30.8% v 0% (P < 0.01) and 9.8% (P < 0.02), respectively. For the same observation periods, the mortality rates in patients with T wave inversion were 4.9% and 7.3%, and in patients with ST segment depression they were 5.8% and 9.6%, respectively. CONCLUSION These data suggest that during a non-Q wave myocardial infarction the presence of ST segment depression is related to higher rates of short and long term cardiac events when compared with T wave inversion--possibly because of a higher incidence of residual stenosis of the infarct related artery.
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Affiliation(s)
- J A Ramires
- Heart Institute, University of São Paulo, Brazil
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Fraticelli A, Serrano CV, Bochner BS, Capogrossi MC, Zweier JL. Hydrogen peroxide and superoxide modulate leukocyte adhesion molecule expression and leukocyte endothelial adhesion. Biochim Biophys Acta 1996; 1310:251-9. [PMID: 8599602 DOI: 10.1016/0167-4889(95)00169-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
While endothelial oxidant generation and subsequent leukocyte chemotaxis and activation are important mechanisms of tissue damage in ischemic organs, it is not known if oxidant generation may be involved in triggering the subsequent leukocyte-mediated injury which occurs. Questions remain whether particular oxidants and oxygen-free radicals are capable of modulating the expression of leukocyte adhesion molecules and effecting leukocyte endothelial adhesion. Studies were performed to determine the effect of different biologically occurring oxidant molecules and oxygen free radicals including: .O2-, .OH, and H2O2 on the expression of integrin and selectin adhesion molecules on the surface of human PMNs and to determine the effect of these alterations on PMN adhesion to the endothelium. Adhesion molecule expression on the surface of human PMNs was measured by immunofluorescence flow cytometry. Electron paramagnetic resonance spectroscopy was applied to characterize the presence of exogenous free radical generation as well as that from activated PMNs. It was observed that these oxidants can cause up-regulation of CD11b and CD18 expression with shedding of L-selectin. The kinetics and dose-response of these effects were analyzed and their functional significance determined by measuring PMN adhesion to cultured human aortic endothelial monolayers. These studies demonstrate that oxygen free radicals and non-radical oxidants can directly trigger PMN activation and adhesion to vascular endothelium.
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Affiliation(s)
- A Fraticelli
- Molecular and Cellular Biophysics Laboratories and EPR Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA
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Serrano CV, Ramires JA, Mansur AP, Pileggi F. Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction. Clin Cardiol 1995; 18:84-90. [PMID: 7720295 DOI: 10.1002/clc.4960180210] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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] [Indexed: 01/26/2023] Open
Abstract
It is known that left ventricular (LV) function, severity of coronary artery disease, and the presence of ventricular arrhythmias are major determinants of prognosis in patients surviving an acute myocardial infarction (AMI). However, little is known about the relationship between the time of onset of supraventricular tachyarrhythmias (SVTs) and mortality. Therefore, this study was carried out in a 48-months period on 131 patients with AMI who presented with SVT during hospitalization. Of these, 53 patients (40.5%) had arrhythmia within < 12 h of MI, while 78 patients (59.5%) had arrhythmia between 12 h and 4 days. The arrhythmias studied were atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia. The patients were similar for age, gender, coronary risk factors, creatine kinase-MB peak, cardioversion and LV function. Angiographic features for patients with the < 12-h onset of arrhythmia were: 86.7% of the patients had uniarterial lesions, 8.9% had biarterial lesions, and 4.4% had triarterial lesions. Patients with the 12-h-4-day onset had 16.1%, 53.2%, and 30.6% (p < or = 0.05) of the respective lesions. Inferior wall myocardial infarction was more frequent among patients with the earlier onset (60.4%), while patients with the later onset presented more anterior wall infarctions (50.0%). Only 11.3% of the patients with the earlier onset presented with severe in-hospital congestive heart failure (Killip classes III-IV), versus 62.8% of the patients with the later onset (p < or = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C V Serrano
- Heart Institute, University of São Paulo, School of Medicine, Brazil
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