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Antunes MO, Arteaga-Fernandez E, Samesima N, Pereira HG, Matsumoto AY, Verrier RL, Pastore CA, Mady C. Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up. Arq Bras Cardiol 2023; 120:e20220833. [PMID: 37672406 PMCID: PMC10519242 DOI: 10.36660/abc.20220833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain. OBJECTIVE To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up. METHODS Patients diagnosed with HCM and NYHA functional class I-II were consecutively selected. At the beginning of the follow-up, the participants performed the MTWA evaluation using the modified moving average during the stress test. The results were classified as altered or normal. The composite endpoint of SCD, ventricular fibrillation, sustained ventricular tachycardia (SVT) or appropriate implantable cardiac defibrillation (ICD) therapy was assessed. The level of significance was set at 5%. RESULTS A total of 132 patients (mean age of 39.5 ± 12.6 years) were recruited and followed for a mean of 9.5 years. The MTWA test was altered in 74 (56%) participants and normal in 58 (44%). Nine events (6.8%) occurred during the follow-up, with a prevalence of 1.0%/year - six SCDs, two appropriate ICD shocks and one episode of (SVT). Altered MTWA was associated with non-sustained ventricular tachycardia on Holter (p = 0.016), septal thickness ≥30 mm (p < 0.001) and inadequate blood pressure response to effort (p = 0.046). Five patients with altered MTWA (7%) and four patients with normal MTWA (7%) had the primary outcome [OR = 0.85 (95% CI: 0.21 - 3.35, p=0.83)]. Kaplan-Meir event curves showed no differences between normal and altered MTWA. CONCLUSION Altered MTWA was not associated with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients, and the low rate of these events during long-term follow-up suggests the good prognosis of this heart disease.
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Affiliation(s)
- Murillo Oliveira Antunes
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Universidade São FranciscoBragança PaulistaSPBrasilUniversidade São Francisco, Bragança Paulista, SP – Brasil
| | - Edmundo Arteaga-Fernandez
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nelson Samesima
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Horácio Gomes Pereira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | | | - Richard L. Verrier
- Beth Israel Deaconess Medical CenterBostonEUABeth Israel Deaconess Medical Center, Boston – EUA
| | - Carlos Alberto Pastore
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Charles Mady
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Melo RJL, Assunção AN, Morais TC, Nomura CH, Scanavacca MI, Martinelli-Filho M, Ramires FJA, Fernandes F, Ianni BM, Mady C, Rochitte CE. Detection of Early Diffuse Myocardial Fibrosis and Inflammation in Chagas Cardiomyopathy with T1 Mapping and Extracellular Volume. Radiol Cardiothorac Imaging 2023; 5:e220112. [PMID: 37404789 PMCID: PMC10316290 DOI: 10.1148/ryct.220112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/06/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
Purpose To evaluate myocardial T1 mapping and extracellular volume (ECV) parameters in different stages of Chagas cardiomyopathy and determine whether they are predictive of disease severity and prognosis. Materials and Methods Prospectively enrolled participants (July 2013 to September 2016) underwent cine and late gadolinium enhancement (LGE) cardiac MRI and T1 mapping with a precontrast (native) or postcontrast modified Look-Locker sequence. The native T1 and ECV values were measured among subgroups that were based on disease severity (indeterminate, Chagas cardiomyopathy with preserved ejection fraction [CCpEF], Chagas cardiomyopathy with midrange ejection fraction [CCmrEF], and Chagas cardiomyopathy with reduced ejection fraction [CCrEF]). Cox proportional hazards regression and the Akaike information criterion were used to determine predictors of major cardiovascular events (cardioverter defibrillator implant, heart transplant, or death). Results In 107 participants (90 participants with Chagas disease [mean age ± SD, 55 years ± 11; 49 men] and 17 age- and sex-matched control participants), the left ventricular (LV) ejection fraction and the extent of focal and diffuse or interstitial fibrosis were correlated with disease severity. Participants with CCmrEF and participants with CCrEF showed significantly higher global native T1 and ECV values than participants in the indeterminate, CCpEF, and control groups (T1: 1072 msec ± 34 and 1073 msec ± 63 vs 1010 msec ± 41, 1005 msec ± 69, and 999 msec ± 46; ECV: 35.5% ± 3.6 and 35.0% ± 5.4 vs 25.3% ± 3.5, 28.2% ± 4.9, and 25.2% ± 2.2; both P < .001). Remote (LGE-negative areas) native T1 and ECV values were also higher (T1: 1056 msec ± 32 and 1071 msec ± 55 vs 1008 msec ± 41, 989 msec ± 96, and 999 msec ± 46; ECV: 30.2% ± 4.7 and 30.8% ± 7.4 vs 25.1% ± 3.5, 25.1% ± 3.7, and 25.0% ± 2.2; both P < .001). Abnormal remote ECV values (>30%) occurred in 12% of participants in the indeterminate group, which increased with disease severity. Nineteen combined outcomes were observed (median follow-up time: 43 months), and a remote native T1 value greater than 1100 msec was independently predictive of combined outcomes (hazard ratio, 12 [95% CI: 4.1, 34.2]; P < .001). Conclusion Myocardial native T1 and ECV values were correlated with Chagas disease severity and may serve as markers of myocardial involvement in Chagas cardiomyopathy that precede LGE and LV dysfunction.Keywords: MRI, Cardiac, Heart, Imaging Sequences, Chagas Cardiomyopathy Supplemental material is available for this article. © RSNA, 2023.
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Brochet P, Ianni B, Nunes JPS, Frade AF, Teixeira PC, Mady C, Ferreira LRP, Kuramoto A, Pissetti CW, Saba B, Cândido DDS, Dias F, Sampaio M, Marin-Neto JA, Fragata A, Zaniratto RC.F, Siqueira S, Peixoto GDL, Rigaud VOC, Buck P, Almeida RR, Lin-Wang HT, Schmidt A, Martinelli M, Hirata MH, Donadi E, Rodrigues Junior V, Pereira AC, Kalil J, Spinelli L, Cunha-Neto E, Chevillard C. Blood DNA methylation marks discriminate Chagas cardiomyopathy disease clinical forms. Front Immunol 2022; 13:1020572. [PMID: 36248819 PMCID: PMC9558220 DOI: 10.3389/fimmu.2022.1020572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
Chagas disease is a parasitic disease from South America, affecting around 7 million people worldwide. Decades after the infection, 30% of people develop chronic forms, including Chronic Chagas Cardiomyopathy (CCC), for which no treatment exists. Two stages characterized this form: the moderate form, characterized by a heart ejection fraction (EF) ≥ 0.4, and the severe form, associated to an EF < 0.4. We propose two sets of DNA methylation biomarkers which can predict in blood CCC occurrence, and CCC stage. This analysis, based on machine learning algorithms, makes predictions with more than 95% accuracy in a test cohort. Beyond their predictive capacity, these CpGs are located near genes involved in the immune response, the nervous system, ion transport or ATP synthesis, pathways known to be deregulated in CCCs. Among these genes, some are also differentially expressed in heart tissues. Interestingly, the CpGs of interest are tagged to genes mainly involved in nervous and ionic processes. Given the close link between methylation and gene expression, these lists of CpGs promise to be not only good biomarkers, but also good indicators of key elements in the development of this pathology.
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Affiliation(s)
- Pauline Brochet
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Barbara Ianni
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - João P. S. Nunes
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Amanda F. Frade
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Priscila C. Teixeira
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Charles Mady
- Myocardiopathies and Aortic Diseases Unit, Heart Institute, Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila R. P. Ferreira
- RNA Systems Biology Laboratory (RSBL), Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cristina W. Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Darlan D. S. Cândido
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - José A. Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Ricardo C .F. Zaniratto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sergio Siqueira
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giselle D. L. Peixoto
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vagner O. C. Rigaud
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paula Buck
- Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rafael R. Almeida
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Martino Martinelli
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mario H. Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | | | - Alexandre C. Pereira
- Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Lionel Spinelli
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Christophe Chevillard
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
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5
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Brochet P, Ianni BM, Laugier L, Frade AF, Silva Nunes JP, Teixeira PC, Mady C, Ferreira LRP, Ferré Q, Santos RHB, Kuramoto A, Cabantous S, Steffen S, Stolf AN, Pomerantzeff P, Fiorelli AI, Bocchi EA, Pissetti CW, Saba B, Cândido DDS, Dias FC, Sampaio MF, Gaiotto FA, Marin-Neto JA, Fragata A, Zaniratto RCF, Siqueira S, Peixoto GDL, Rigaud VOC, Bacal F, Buck P, Almeida RR, Lin-Wang HT, Schmidt A, Martinelli M, Hirata MH, Donadi EA, Costa Pereira A, Rodrigues Junior V, Puthier D, Kalil J, Spinelli L, Cunha-Neto E, Chevillard C. Epigenetic regulation of transcription factor binding motifs promotes Th1 response in Chagas disease cardiomyopathy. Front Immunol 2022; 13:958200. [PMID: 36072583 PMCID: PMC9441916 DOI: 10.3389/fimmu.2022.958200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023] Open
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is an endemic parasitic disease of Latin America, affecting 7 million people. Although most patients are asymptomatic, 30% develop complications, including the often-fatal Chronic Chagasic Cardiomyopathy (CCC). Although previous studies have demonstrated some genetic deregulations associated with CCCs, the causes of their deregulations remain poorly described. Based on bulk RNA-seq and whole genome DNA methylation data, we investigated the genetic and epigenetic deregulations present in the moderate and severe stages of CCC. Analysis of heart tissue gene expression profile allowed us to identify 1407 differentially expressed transcripts (DEGs) specific from CCC patients. A tissue DNA methylation analysis done on the same tissue has permitted the identification of 92 regulatory Differentially Methylated Regions (DMR) localized in the promoter of DEGs. An in-depth study of the transcription factors binding sites (TFBS) in the DMRs corroborated the importance of TFBS’s DNA methylation for gene expression in CCC myocardium. TBX21, RUNX3 and EBF1 are the transcription factors whose binding motif appears to be affected by DNA methylation in the largest number of genes. By combining both transcriptomic and methylomic analysis on heart tissue, and methylomic analysis on blood, 4 biological processes affected by severe CCC have been identified, including immune response, ion transport, cardiac muscle processes and nervous system. An additional study on blood methylation of moderate CCC samples put forward the importance of ion transport and nervous system in the development of the disease.
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Affiliation(s)
- Pauline Brochet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Barbara Maria Ianni
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Laurie Laugier
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Amanda Farage Frade
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - João Paulo Silva Nunes
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Priscila Camillo Teixeira
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Charles Mady
- Myocardiopathies and Aortic Diseases Unit, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- RNA Systems Biology Laboratory (RSBL), Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Quentin Ferré
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Ronaldo Honorato Barros Santos
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sandrine Cabantous
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Samuel Steffen
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Antonio Noedir Stolf
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Pablo Pomerantzeff
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alfredo Inacio Fiorelli
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Darlan da Silva Cândido
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Fabrício C. Dias
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Ferraz Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Fabio Antônio Gaiotto
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Ricardo Costa Fernandes Zaniratto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sergio Siqueira
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giselle De Lima Peixoto
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vagner Oliveira-Carvalho Rigaud
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Heart Failure Unit, Heart Institute Instituto do Coração (InCor) School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando Bacal
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Martino Martinelli
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Eduardo Antonio Donadi
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Denis Puthier
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Lionel Spinelli
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Aix Marseille Université, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
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Hotta VT, Martinelli LMB, Moisés VA, Mady C, Fernandes F. Left ventricular noncompaction highlighted by three-dimensional and speckle tracking echocardiography. einstein (São Paulo) 2022; 20:eAI6853. [PMID: 35976353 PMCID: PMC9377308 DOI: 10.31744/einstein_journal/2022ai6853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022] Open
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Fonseca KCB, Pessoa FG, Ribeiro ODN, Hotta VT, Ianni BM, Fernandes F, Ferreira Rivero DHR, Saldiva PHN, Mady C, Ramires FJA. Air Pollution’s Impact on Cardiac Remodeling in an Experimental Model of Chagas Cardiomyopathy. Front Cell Infect Microbiol 2022; 12:830761. [PMID: 35928208 PMCID: PMC9343625 DOI: 10.3389/fcimb.2022.830761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chagas disease is characterized by intense myocardial fibrosis stimulated by the exacerbated production of inflammatory cytokines, oxidative stress, and apoptosis. Air pollution is a serious public health problem and also follows this same path. Therefore, air pollution might amplify the inflammatory response of Chagas disease and increase myocardial fibrosis. Methods We studied groups of Trypanosoma cruzi infected Sirius hamsters (Chagas=CH and Chagas exposed to pollution=CH+P) and 2 control groups (control healthy animals=CT and control exposed to pollution=CT+P). We evaluated acute phase (60 days post infection) and chronic phase (10 months). Echocardiograms were performed to assess left ventricular systolic and diastolic diameter, in addition to ejection fraction. Interstitial collagen was measured by morphometry in picrosirius red staining tissue. The evaluation of inflammation was performed by gene and protein expression of cytokines IL10, IFN-γ, and TNF; oxidative stress was quantified by gene expression of NOX1, MnSOD, and iNOS and by analysis of reactive oxygen species; and apoptosis was performed by gene expression of BCL2 and Capsase3, in addition to TUNEL analysis. Results Chagas groups had increased collagen deposition mainly in the acute phase, but air pollution did not increase this deposition. Also, Chagas groups had lower ejection fraction in the acute phase (p = 0.002) and again air pollution did not worsen ventricular function or dilation. The analysis of the inflammation and oxidative stress pathways were also not amplified by air pollution. Apoptosis analysis showed increased expression of BCL2 and Caspase3 genes in chagasic groups in the acute phase, with a marginal p of 0.054 in BCL2 expression among infected groups, and TUNEL technique showed amplified of apoptotic cells by pollution among infected groups. Conclusions A possible modulation of the apoptotic pathway was observed, inferring interference from air pollution in this pathway. However, it was not enough to promote a greater collagen deposition, or worsening ventricular function or dilation caused by air pollution in this model of Chagas cardiomyopathy.
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Affiliation(s)
- Keila Cardoso Barbosa Fonseca
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Fernanda Gallinaro Pessoa
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Orlando do Nascimento Ribeiro
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Viviane Tiemi Hotta
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Barbara Maria Ianni
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Fabio Fernandes
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Dolores Helena Rodriguez Ferreira Rivero
- Department of Pathology, Experimental Air Pollution Laboratory, Laboratório de Investigação Médica 05 (LIM 05) - School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Department of Pathology, Experimental Air Pollution Laboratory, Laboratório de Investigação Médica 05 (LIM 05) - School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Charles Mady
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Felix José Alvarez Ramires
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
- *Correspondence: Felix José Alvarez Ramires,
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Hotta VT, Rassi DDC, Pena JLB, Vieira MLC, Rodrigues ACT, Cardoso JN, Ramires FJA, Nastari L, Mady C, Fernandes F. Análise Crítica e Limitações do Diagnóstico de Insuficiência Cardíaca com Fração de Ejeção Preservada (ICFEp). Arq Bras Cardiol 2022; 119:470-479. [PMID: 35830074 PMCID: PMC9438546 DOI: 10.36660/abc.20210052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
Com o aumento da expectativa de vida da população e a maior frequência de fatores de risco como obesidade, hipertensão arterial e diabetes, espera-se um aumento na prevalência de insuficiência cardíaca com fração de ejeção preservada (ICFEp). Entretanto, no momento, o diagnóstico e o tratamento de pacientes com ICFEp permanecem desafiadores. O diagnóstico sindrômico de ICFEp inclui diversas etiologias e doenças com tratamentos específicos, mas que apresentam pontos em comum em relação à apresentação clínica e à avaliação laboratorial no que diz respeito aos biomarcadores como BNP e NT-ProBNP, à avaliação ecocardiográfica do remodelamento cardíaco e às pressões de enchimento diastólico ventricular esquerdo. Extensos ensaios clínicos randomizados envolvendo a terapia nesta síndrome falharam na demonstração de benefícios para o paciente, fazendo-se necessária uma reflexão acerca do diagnóstico, dos mecanismos de morbidade, da taxa de mortalidade e da reversibilidade. Na revisão, serão abordados os conceitos atuais, as controvérsias e, especialmente, os desafios no diagnóstico da ICFEp através de uma análise crítica do escore da European Heart Failure Association.
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Cardoso LF, Dias RR, Demarchi LMMF, Silveira LMVD, Mady C, Jatene FB. Nonatherosclerotic Giant Right Coronary Artery Aneurysm. Braz J Cardiovasc Surg 2022; 37:271-272. [PMID: 35503700 PMCID: PMC9054151 DOI: 10.21470/1678-9741-2020-0649] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.
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Affiliation(s)
- Lucas Figueredo Cardoso
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lea Maria Macruz Ferreira Demarchi
- Laboratory of Anatomic Pathology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Molinari Veloso da Silveira
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Charles Mady
- Department of Cardiology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Madeira RP, Meneghetti P, Barros LAD, Buck PDC, Mady C, Ianni BM, Fernandez-Becerra C, Torrecilhas AC. Isolation and molecular characterization of circulating extracellular vesicles from blood of chronic Chagas disease patients. Cell Biol Int 2022; 46:883-894. [PMID: 35253308 DOI: 10.1002/cbin.11787] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Extracellular vesicles (EVs) are lipid bilayer envelopes that encase several types of molecules. Their contents mostly reflect their cell origin and possible targets at other locations in the organism and can be modified in pathological conditions to interfere with intercellular communication, thus promoting disease establishment and development. These characteristics, in addition to their presence in virtually all body fluids, make such vesicles ideal for biomarker discovery in human diseases. Here we describe the effect of different anticoagulants and the combination of two purification methods for isolation and characterization of circulating extracellular vesicles from blood of chronic Chagas disease (CCD) patients. We illustrated this procedure by studying a population of patients with Chagas disease at the indeterminate chronic stage, in which the Trypanosoma cruzi is very scarce in circulation. EVs were harvested from blood collected without or with different anticoagulants. Protein and nanoparticle tracking analysis was used to measure EVs size and concentration. The EVs were purified by ultracentrifugation, followed by size exclusion chromatography and characterized by chemiluminescent ELISA and Dot Blot using antibodies that recognized parasite-derived EVs, such as hyperimmune sera, polyclonal and monoclonal antibodies against trans-sialidase and mucins. In parallel, antibodies against classical human EV markers CD9, CD63, CD81 and CD82, were also analyzed. The results showed that anticoagulants did not interfere with the analyzed parameters and circulating EVs from CCD patients contain T. cruzi antigens and classical human exosomal markers. Overall, our protocol is adequate for the isolation of the total circulating extracellular vesicles and can serve as an important basis for further studies on biomarker discovery in Chagas' disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rafael Pedro Madeira
- Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil.,Laboratório de Imunologia Celular e Bioquímica de Fungos e Protozoários, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, Brasil
| | - Paula Meneghetti
- Laboratório de Imunologia Celular e Bioquímica de Fungos e Protozoários, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, Brasil
| | - Lucas Alexandre de Barros
- Laboratório de Imunologia Celular e Bioquímica de Fungos e Protozoários, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, Brasil
| | - Paula de Cassia Buck
- Unidade Clínica de Miocardiopatias, Instituto do Coração, Universidade de São Paulo (USP), São Paulo, Brasil
| | - Charles Mady
- Unidade Clínica de Miocardiopatias, Instituto do Coração, Universidade de São Paulo (USP), São Paulo, Brasil
| | - Barbara Maria Ianni
- Unidade Clínica de Miocardiopatias, Instituto do Coração, Universidade de São Paulo (USP), São Paulo, Brasil
| | - Carmen Fernandez-Becerra
- ISGlobal, Hospital Cl ́ınic - Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacio ́ en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Spain
| | - Ana Claudia Torrecilhas
- Laboratório de Imunologia Celular e Bioquímica de Fungos e Protozoários, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, Brasil
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Fernandes F, Alencar ACD, Bueno BVK, Cafezeiro CRF, Rissato JH, Szor RS, Carvalho MLPD, Mathias W, Lino AMM, Castelli JB, Souza EDO, Ramires FJA, Hotta VT, Soares J, Tavares CDAM, Krieger JE, Rochitte CE, Dabarian A, Hajjar LA, Kalil R, Mady C. Perfil Clínico, Laboratorial e de Métodos de Imagem na Amiloidose Sistêmica em um Centro de Referência Cardiológico Brasileiro. Arq Bras Cardiol 2021; 118:422-432. [PMID: 35262576 PMCID: PMC8856672 DOI: 10.36660/abc.20201003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/24/2021] [Indexed: 01/15/2023] Open
Abstract
Fundamento Amiloidose sistêmica é uma doença com manifestações clínicas diversas. O diagnóstico envolve suspeita clínica, aliada a métodos complementares. Objetivo Descrever o perfil clínico, laboratorial, eletrocardiográfico e de imagem no acometimento cardíaco da amiloidose sistêmica. Métodos Estudo de uma amostra de conveniência, analisando dados clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos, medicina nuclear e ressonância magnética. Considerou-se significância estatística quando p < 0,05. Resultados Avaliaram-se 105 pacientes (com mediana de idade de 66 anos), sendo 62 homens, dos quais 83 indivíduos apresentavam amiloidose por transtirretina (ATTR) e 22 amiloidose por cadeia leve (AL). Na ATTR, 68,7% eram de caráter hereditário (ATTRh) e 31,3% do tipo selvagem (ATTRw). As mutações mais prevalentes foram Val142Ile (45,6%) e Val50Met (40,3%). O tempo de início dos sintomas ao diagnóstico foi 0,54 e 2,15 anos nas formas AL e ATTR (p < 0,001), respectivamente. O acometimento cardíaco foi observado em 77,9% dos ATTR e 90,9% dos AL. Observaram-se alterações de condução atrioventricular em 20% e intraventricular em 27,6% dos pacientes, sendo 33,7 % na ATTR e 4,5% das AL (p = 0,006). A forma ATTRw apresentou mais arritmias atriais que os ATTRh (61,5% x 22,8%; p = 0,001). Ao ecocardiograma a mediana da espessura do septo na ATTRw x ATTRh x AL foi de 15 mm x 12 mm x 11 mm (p = 0,193). Observou-se BNP elevado em 89,5% dos indivíduos (mediana 249 ng/mL, IQR 597,7) e elevação da troponina em 43,2%. Conclusão Foi possível caracterizar, em nosso meio, o acometimento cardíaco na amiloidose sistêmica, em seus diferentes subtipos, através da história clínica e dos métodos diagnósticos descritos.
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Barbosa-Ferreira JM, Mady C, Fernandes F. Diagnostic and Prognostic Importance of Functional Capacity in the Different Evolutionary Forms of Chagas Disease. Arq Bras Cardiol 2021; 117:942-943. [PMID: 34817003 PMCID: PMC8682086 DOI: 10.36660/abc.20210808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- João Marcos Barbosa-Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Universidade do Estado do Amazonas, Manaus, AM - Brasil
| | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fábio Fernandes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Queiroz CMD, Cardoso J, Ramires F, Ianni B, Hotta VT, Mady C, Buck PDC, Dias RR, Nastari L, Fernandes F. Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era. International Journal of Cardiovascular Sciences 2021. [DOI: 10.36660/ijcs.20200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Luz PLD, Mady C, Kalil Filho R, Rochitte CE. Fúlvio Pileggi: An Icon of Brazilian Cardiology. Arq Bras Cardiol 2021; 117:1-4. [PMID: 34320059 PMCID: PMC8294728 DOI: 10.36660/abc.20210461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Protásio L da Luz
- Universidade de São Paulo - Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Charles Mady
- Universidade de São Paulo - Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Universidade de São Paulo - Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Universidade de São Paulo - Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil.,Hospital do Coração (HCor), São Paulo, SP - Brasil
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Mady C. Teachers who were Academic Examples. Arq Bras Cardiol 2021; 116:1172-1173. [PMID: 34133607 PMCID: PMC8288535 DOI: 10.36660/abc.20201161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Charles Mady
- Universidade de São Paulo Faculdade de Medicina - Unidade Clínica de Miocardiopatias e Doenças da Aorta , São Paulo , SP - Brasil
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16
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Atik E, Mady C, Ramires JAF. Radi Macruz - The Legacy of an Icon. Arq Bras Cardiol 2021; 116:679-681. [PMID: 33886710 PMCID: PMC8121405 DOI: 10.36660/abc.20201341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Edmar Atik
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Jose Antonio Franchini Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented lack of control of what was to come. The intent of this document is to provide a balance of how much was ceased to be done for patients with aortic disease, to assess the mortality of these patients, and to show what happened to those who became COVID-19 positive during their hospitalization. Methods From April 1st to July 31st 2020, the worst period of the pandemic in São Paulo, Brazil, the Institute’s aortic surgical patients operated on were evaluated and those were compared with patients operated during the same period in 2019. Results In 2019, 88 surgeries were performed; most of them were elective (66 [75%]), 10 were urgent, and 12 were emergency surgeries. In 2020, during the COVID-19 pandemic, we operated on only 31 patients, being 74.2% non-elective surgeries (P<0,001). There was a higher mortality for patients operated on during the pandemic surge of COVID-19 (P<0,001), but it was not specifically related to infected patients. Conclusion The COVID-19 pandemic had an impact on surgical volume and outcome of patients with aortic disease, although it did not directly increase mortality.
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Affiliation(s)
- Ricardo R Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - José Augusto Duncan Santiago
- Department of Cardiomyopathies and Aortic Diseases, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Vagner Madrini
- Department of Cardiomyopathies and Aortic Diseases, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Charles Mady
- Department of Cardiomyopathies and Aortic Diseases, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Fernandes F, Moreira CHV, Oliveira LC, Souza-Basqueira M, Ianni BM, Lorenzo CD, Ramires FJA, Nastari L, Cunha-Neto E, Ribeiro AL, Lopes RD, Keating SM, Sabino EC, Mady C. Galectin-3 Associated with Severe Forms and Long-term Mortality in Patients with Chagas Disease. Arq Bras Cardiol 2021; 116:248-256. [PMID: 33656072 PMCID: PMC7909980 DOI: 10.36660/abc.20190403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/02/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
Fundamento As características histopatológicas da doença de Chagas (DCC) são: presença de miocardite, destruição das fibras cardíacas e fibrose miocárdica. A Galectina-3 (Gal-3) é um biomarcador envolvido no mecanismo de fibrose e inflamação que pode ser útil para a estratificação de indivíduos com DCC por risco. Objetivos Nosso objetivo foi avaliar se níveis elevados de Gal-3 estão associados a formas graves de cardiomiopatia chagásica (CC) e são preditivos de mortalidade. Métodos Estudamos doadores de sangue (DS) positivos para anti-T. cruzi: não-CC-DS (187 DS sem CC com eletrocardiograma [ECG] e fração de ejeção do ventrículo esquerdo [FEVE] normais); CC-Não-Dis-DS (46 DS com CC e apresentando ECG anormal, mas FEVE normal); e 153 controles negativos correspondentes. Esta amostra foi composta por 97 pacientes com CC grave (CC-Dis). Usamos as correlações de Kruskall-Wallis e Spearman para testar a hipótese de associações, assumindo um p bicaudal <0,05 como significativo. Resultados O nível de Gal-3 foi de 12,3 ng/mL para não-CC-DS, 12,0 ng/mL para CC-Não-Dis-DS, 13,8 ng/mL para controles e 15,4 ng/mL para CC-Dis. FEVE <50 foi associada a níveis mais elevados de Gal-3 (p=0,0001). Em nosso modelo de regressão linear ajustado, encontramos associação entre os níveis de Gal-3 e os parâmetros do ecocardiograma em indivíduos positivos para T. cruzi. Nos pacientes CC-Dis, encontramos uma associação significativa de níveis mais elevados de Gal-3 (≥15,3 ng/mL) e morte ou transplante cardíaco em acompanhamento de cinco anos (Hazard ratio – HR 3,11; IC95% 1,21– 8,04; p=0,019). Conclusões Em pacientes com CC, níveis mais elevados de Gal-3 estiveram significativamente associados a formas graves da doença e maior taxa de mortalidade em longo prazo, o que significa que pode ser um meio efetivo para identificar pacientes de alto risco. (Arq Bras Cardiol. 2021; 116(2):248-256)
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Affiliation(s)
- Fábio Fernandes
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
| | | | | | | | - Barbara Maria Ianni
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
| | | | - Felix José Alvarez Ramires
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
| | - Luciano Nastari
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
| | - Edecio Cunha-Neto
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
| | - Antonio L Ribeiro
- Universidade Federal de Minas Gerais - Centro de Telessaúde - Hospital das Clínicas, Belo Horizonte, MG - Brasil
| | | | - Sheila M Keating
- Blood Systems Research Institute, San Francisco, Califórnia - EUA
| | | | - Charles Mady
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP- Brasil
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19
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Silva TOC, Sales ARK, Araujo GSM, Fonseca GWP, Braga PGS, Faria D, Rocha HNM, Rocha NG, Lima MF, Mady C, Negrão CE, Alves MJNN. Disturbed Blood Flow Acutely Increases Endothelial Microparticles and Decreases Flow Mediated Dilation in Patients With Heart Failure With Reduced Ejection Fraction. Front Physiol 2021; 12:629674. [PMID: 33776792 PMCID: PMC7991910 DOI: 10.3389/fphys.2021.629674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Disturbed blood flow, characterized by high retrograde and oscillatory shear rate (SR), is associated with a proatherogenic phenotype. The impact of disturbed blood flow in patients with heart failure with reduced ejection fraction (HFrEF) remains unknown. We tested the hypothesis that acute elevation to retrograde and oscillatory SR provoked by local circulatory occlusion would increase endothelial microparticles (EMPs) and decrease brachial artery flow-mediated dilation (FMD) in patients with HFrEF. Methods Eighteen patients with HFrEF aged 55 ± 2 years, with left ventricular ejection fraction (LVEF) 26 ± 1%, and 14 control subjects aged 49 ± 2 years with LVEF 65 ± 1 randomly underwent experimental and control sessions. Brachial artery FMD (Doppler) was evaluated before and after 30 min of disturbed forearm blood flow provoked by pneumatic cuff (Hokanson) inflation to 75 mm Hg. Venous blood samples were collected at rest, after 15 and 30 min of disturbed blood flow to assess circulating EMP levels (CD42b−/CD31+; flow cytometry). Results At rest, FMD was lower in patients with HFrEF compared with control subjects (P < 0.001), but blood flow patterns and EMPs had no differences (P > 0.05). The cuff inflation provoked a greater retrograde SR both groups (P < 0.0001). EMPs responses to disturbed blood flow significantly increased in patients with HFrEF (P = 0.03). No changes in EMPs were found in control subjects (P > 0.05). Disturbed blood flow decreased FMD both groups. No changes occurred in control condition. Conclusion Collectively, our findings suggest that disturbed blood flow acutely decreases FMD and increases EMP levels in patients with HFrEF, which may indicate that this set of patients are vulnerable to blood flow disturbances.
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Affiliation(s)
- Thiago O C Silva
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Allan R K Sales
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.,D'OR Institute for Research and Education, São Paulo, Brazil
| | - Gustavo S M Araujo
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Pedro G S Braga
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Diego Faria
- D'OR Institute for Research and Education, São Paulo, Brazil
| | - Helena N M Rocha
- Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Brazil
| | - Natalia G Rocha
- Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Brazil
| | - Marta F Lima
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Charles Mady
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos E Negrão
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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20
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Jordão MR, Pessoa FG, Fonseca KC, Zanoni F, Salemi VM, Souza LE, Ribeiro ON, Fernandes F, Irigoyen MC, Moreira LFP, Mady C, Ramires FJA. Effects of sympathectomy on myocardium remodeling and function. Clinics (Sao Paulo) 2021; 76:e1958. [PMID: 33503174 PMCID: PMC7798118 DOI: 10.6061/clinics/2021/e1958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To evaluate the effects of sympathectomy on the myocardium in an experimental model. METHODS The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached. RESULTS The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09). CONCLUSION These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.
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Affiliation(s)
- Maurício Rodrigues Jordão
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernanda G. Pessoa
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Keila C.B. Fonseca
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernando Zanoni
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vera M.C. Salemi
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro E. Souza
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Orlando N. Ribeiro
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fábio Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Claudia Irigoyen
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Felipe P. Moreira
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Charles Mady
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Felix Jose Alvarez Ramires
- Instituto do Coracao (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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21
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Cardoso S, Azevedo CFD, Fernandes F, Ianni B, Torreão JA, Marques MD, Ávila LFRD, Santos R, Mady C, Kalil-Filho R, Ramires JAF, Bittencourt MS, Rochitte CE. Menor Prevalência e Extensão da Aterosclerose Coronária na Doença de Chagas Crônica por Angiotomografia Coronária. Arq Bras Cardiol 2020; 115:1051-1060. [PMID: 33470300 PMCID: PMC8133709 DOI: 10.36660/abc.20200342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
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22
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Dinato FJ, Dias RR, Duncan JA, Fernandes F, Ramirez FJA, Mady C, Jatene FB. Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? Braz J Cardiovasc Surg 2020; 35:869-877. [PMID: 33113317 PMCID: PMC7731868 DOI: 10.21470/1678-9741-2020-0043] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Methods Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. Results The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). Conclusion Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.
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Affiliation(s)
- Fabrício José Dinato
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Augusto Duncan
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Fernandes
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Felix José Alvares Ramirez
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Charles Mady
- Clinical Unit of Myocardiopathies and Aortic Diseases, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Fernandes F, Ramires FJA, Fernandes FD, Simões MV, Mesquita ET, Mady C. Pericardial Affections in Patients with COVID-19: A Possible Cause of Hemodynamic Deterioration. Arq Bras Cardiol 2020; 115:569-573. [PMID: 33027382 PMCID: PMC9363091 DOI: 10.36660/abc.20200474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Fábio Fernandes
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
| | - Felix José Alvarez Ramires
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
| | | | - Marcus Vinicius Simões
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto,Ribeirão Preto, SP - Brasil
| | | | - Charles Mady
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
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Fonseca GWPD, Garfias Macedo T, Ebner N, Dos Santos MR, de Souza FR, Mady C, Takayama L, Pereira RMR, Doehner W, Anker SD, Negrão CE, Alves MJDNN, von Haehling S. Muscle mass, muscle strength, and functional capacity in patients with heart failure of Chagas disease and other aetiologies. ESC Heart Fail 2020; 7:3086-3094. [PMID: 32860353 PMCID: PMC7524247 DOI: 10.1002/ehf2.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/25/2022] Open
Abstract
Aims Patients with Chagas disease and heart failure (HF) have a poor prognosis similar to that of patients with ischaemic or dilated cardiomyopathy. However, the impact of body composition and muscle strength changes in these aetiologies is still unknown. We aimed to evaluate these parameters across aetiologies in two distinct cohort studies [TESTOsterone‐Heart Failure trial (TESTO‐HF; Brazil) and Studies Investigating Co‐morbidities Aggravating Heart Failure (SICA‐HF; Germany)]. Methods and results A total of 64 male patients with left ventricular ejection fraction ≤40% were matched for body mass index and New York Heart Association class, including 22 patients with Chagas disease (TESTO‐HF; Brazil), and 20 patients with dilated cardiomyopathy and 22 patients with ischaemic heart disease (SICA‐HF; Germany). Lean body mass (LBM), appendicular lean mass (ALM), and fat mass were assessed by dual energy X‐ray absorptiometry. Sarcopenia was defined as ALM divided by height in metres squared <7.0 kg/m2 (ALM/height2) and handgrip strength cut‐off for men according to the European Working Group on Sarcopenia in Older People. All patients performed maximal cardiopulmonary exercise testing. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Chagasic and ischaemic patients had lower total fat mass (16.3 ± 8.1 vs. 19.3 ± 8.0 vs. 27.6 ± 9.4 kg; P < 0.05) and reduced peak oxygen consumption (VO2) (1.17 ± 0.36 vs. 1.15 ± 0.36 vs. 1.50 ± 0.45 L/min; P < 0.05) than patients with dilated cardiomyopathy, respectively. Chagasic patients showed a trend towards decreased LBM when compared with ischaemic patients (48.3 ± 7.6 vs. 54.2 ± 6.3 kg; P = 0.09). Chagasic patients showed lower handgrip strength (27 ± 8 vs. 37 ± 11 vs. 36 ± 14 kg; P < 0.05) and FBF (1.84 ± 0.54 vs. 2.75 ± 0.76 vs. 3.42 ± 1.21 mL/min/100 mL; P < 0.01) than ischaemic and dilated cardiomyopathy patients, respectively. There was no statistical difference in the distribution of sarcopenia between groups (P = 0.87). In addition, FBF correlated positively with LBM (r = 0.31; P = 0.012), ALM (r = 0.25; P = 0.046), and handgrip strength (r = 0.36; P = 0.004). In a logistic regression model using peak VO2 as the dependent variable, haemoglobin (odds ratio, 1.506; 95% confidence interval, 1.043–2.177; P = 0.029) and ALM (odds ratio, 1.179; 95% confidence interval, 1.011–1.374; P = 0.035) were independent predictors for peak VO2 adjusted by age, left ventricular ejection fraction, New York Heart Association, creatinine, and FBF. Conclusions Patients with Chagas disease and HF have decreased fat mass and exhibit reduced peripheral blood flow and impaired muscle strength compared with ischaemic HF patients. In addition, patients with Chagas disease and HF show a tendency to have greater reduction in total LBM, with ALM remaining an independent predictor of reduced functional capacity in these patients. The percentage of patients affected by sarcopenia was equal between groups.
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Affiliation(s)
- Guilherme Wesley Peixoto da Fonseca
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | | | | | - Charles Mady
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wolfram Doehner
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carlos Eduardo Negrão
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
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Alves SMM, Alvarado-Arnês LE, Cavalcanti MDGADM, Carrazzone CDFV, Pacheco AGF, Sarteschi C, Moraes MO, de Oliveira WA, Medeiros CDA, Pessoa FG, Mady C, Lannes-Vieira J, Ramires FJA. Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease. Rev Soc Bras Med Trop 2020; 53:e20190488. [PMID: 32638886 PMCID: PMC7341830 DOI: 10.1590/0037-8682-0488-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
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Affiliation(s)
- Silvia Marinho Martins Alves
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Lúcia Elena Alvarado-Arnês
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Hanseníase, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Camila Sarteschi
- Realcor - Real Hospital Português de Beneficência, Recife, PE,
Brasil
| | - Milton Ozorio Moraes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Wilson Alves de Oliveira
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Carolina de Araújo Medeiros
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Fernanda Gallinaro Pessoa
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Charles Mady
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Joseli Lannes-Vieira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
| | - Felix José Alvarez Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Hotta VT, Giorgi MCP, Fernandes F, Abduch MCD, Falcão AMGM, Mady C. Cardiac amyloidosis: non-invasive diagnosis. ACTA ACUST UNITED AC 2020; 66:345-352. [PMID: 32520156 DOI: 10.1590/1806-9282.66.3.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023]
Abstract
Cardiac amyloidosis is an infiltrative disease which requires a high degree of clinical suspicion for appropriate diagnosis. Early diagnosis and the definition of the type of amyloidosis play a key role in the early treatment and prognosis of this disease. In this context, the use of cardiac biomarkers such as troponins and NT-proBNT associated with analysis by multimodality imaging methods like echocardiographic techniques such as strain, nuclear medicine, and cardiovascular resonance imaging have an increasing role in patients with cardiac amyloidosis. This article details the role of non-invasive diagnostic methods in patients with cardiac amyloidosis.
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Affiliation(s)
- Viviane Tiemi Hotta
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,. Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Maria Clementina Pinto Giorgi
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fábio Fernandes
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Cristina Donadio Abduch
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andréa Maria Gomes Marinho Falcão
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Charles Mady
- . Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Fernandes F, Melo DTPD, Ramires FJA, Sabino EC, Moreira CHV, Benvenutti LA, Hotta VT, Sayegh ALC, Souza FRD, Dias RR, Mady C. Galectin-3 Levels in Patients with Chronic Constrictive Pericarditis. Arq Bras Cardiol 2020; 114:683-689. [PMID: 32491013 DOI: 10.36660/abc.20190152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Galectin-3 (Gal-3) is a proinflammatory, profibrotic molecule implicated in the pathogenesis of heart failure. The role of Gal-3 in patients with chronic constrictive pericarditis (CCP) is not clear. Objective The aim of this study was to assess plasma Gal-3 in patients with CCP and correlate it with clinical, functional and histologic parameters. Methods We prospectively evaluated 25 symptomatic patients with CCP referred for pericardiectomy and 21 healthy controls. Patients underwent clinical assessment, Gal-3 and B-type natriuretic peptide (BNP) measurements, echocardiography, cardiac magnetic resonance imaging and cardiopulmonary exercise test (CPET) at baseline. Six months after pericardiectomy CPET was repeated. An alpha error < 5% was considered statistically significant, with a confidence interval of 95%. Results Twenty-five patients with a median age of 45 years were included. Etiology was mainly idiopathic (n = 19, 76%); and 14 (56%) patients had NYHA functional class III/IV. Median BNP and Gal-3 were 143 (89-209) pg/dL and 14.8 (9.7-17.2) ng/mL, respectively. Gal-3 levels were not significantly higher in CCP patients than in control (p = 0.22). There were no significant correlations of Gal-3 with BNP, echocardiographic and cardiac magnetic resonance measures and histological findings. After pericardiectomy, it was found a statistically significant correlation between Gal-3 and the CPTE measures test duration (r = -0.79; p < 0.001) and exercise time (r = -0.79; p < 0.001). Conclusions Patients with CCP had normal levels of Gal-3 as compared to the controls. Gal-3 did not correlate with morphological and functional measures before pericardiectomy. However, the associations between Gal-3 and exercise intolerance after pericardiectomy may suggest a role of Gal-3 in prognosis prediction after pericardiectomy. (Arq Bras Cardiol. 2020; 114(4):683-689).
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Affiliation(s)
- Fábio Fernandes
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Felix José Alvarez Ramires
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Luiz Alberto Benvenutti
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Viviane Tiemi Hotta
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ana Luiza Carrari Sayegh
- Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Francis Ribeiro de Souza
- Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Ribeiro Dias
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Charles Mady
- HC, FM, USP, São Paulo, SP, Brasil.,Instituto de Medicina Tropical de São Paulo São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
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28
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Affiliation(s)
- Charles Mady
- Instituto do Coração - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
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Hotta VT, Martinelli LMB, Fernandes F, Moises VA, Vieira MLC, Mady C. P697 Left ventricular non compaction highlighted by three-dimensional and speckle tracking echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left ventricular non-compaction (LVNC) is a relatively new cardiomyopathy, first reported by Chin et al. in 1990. Since then, much has been learned about this entity, but until now, there are some limitations for the diagnosis of this disease. Cardiac Magnetic Resonance Imaging is considered the gold standard for the diagnosis of LVNC, but echocardiography remains the first line imaging modality due to its availability and cost efficacy.
Case report
In this case, we report a case of an asymptomatic 21 years old young male with no personal or familiar history of cardiomyopathies. Two dimensional echocardiography (2D Echo) evidenced increased left ventricular trabeculation in the apical segments of lateral and anterior walls and a non compacted myocardium/ (compacted + non compacted myocardium) ratio of 0,33, compatible with LVNC according to Chin´s criteria. 3D Echo provided more detailed LV morphology analysis and 3D Echo Color Doppler evidenced ventricular flow within the intraventricular recesses. Strain analysis by speckle tracking (STE) evidenced global longitudinal strain = - 17% (Normal values < -18%), probably related to an incipient systolic dysfunction not evidenced by the evaluation of left ventricular ejection fraction by 2D Echo.
Conclusions
This case illustrates new echocardiographic modalities for LVNC diagnosis. 3D Echo and STE are new technologies that may play an incremental role in the evaluation of LVNC but need further investigation and validation.
Abstract P697 Figure.
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | - F Fernandes
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - V A Moises
- Fleury Medicina e Saúde, Sao Paulo, Brazil
| | | | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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Hotta VT, Monge NMS, Vieira MLC, Fernandes F, Mady C. 1102 Rare association of left ventricular non-compaction and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
LVNC and HCM are cardiomyopathies with distinct clinical presentation that may present common genetic mutations. Some studies suggest a common genetic basis between HCM and LVNC and the possibility of a phenotypic association of these two cardiomyopathies in the same patient.
Case report
A 39 year old man was referred to our hospital with syncope. His past medical history was unremarkable. His father died of sudden death, at age 49, without investigation of Left ventricular non compaction (LVNC) or Hypertrophic cardiomyopathy (HCM). Physical examination was unremarkable. Electrocardiogram showed sinus rhythm with left chambers overload and isolated ventricular extrasystoles. Transthoracic Echocardiogram (TTE) evidenced significant left ventricular (LV) hypertrophy predominantly in the apical region and inferolateral wall, in the absence of a significant intraventricular gradient at rest and after provocative maneuvers, with preserved LV function, suggesting non-obstructive HCM. Cardiac magnetic resonance imaging (CMRI) showed LV hypertrophy predominantly in the lateral wall, with a maximum thickness of 35 mm, no signs of left ventricular outflow tract (LVOT) obstruction and prominent apical trabeculation, compatible with the association of LVNC and HCM. A genetic test was performed on this patient with inconclusive results.
Conclusions
The association of diagnostic criteria in cardiac imaging tests (TTE and CMRI) compatible with LVNC and HCM in the same patient is uncommon. This patient shows an infrequent location of the most prominent hypertrophy in the inferolateral wall.This case highlights the importance of integrating cardiac imaging methods in the diagnosis of these two disctinct and rare cardiomyopathies.
Legend Figure 1: 2D TTE evidencing prominent hypertropfhy and intraventricular recesses at apical region and inferolateral wall (red arrows), abnormalities suggesting HCM and LVNC at LV apex (blue arrows) in Paraesternal Long Axis (A and B), Short Axis View (C to F), Apical 4 Chambers (G and H) and Apical 2 Chambers View (I and H). Speckle tracking analysis evidencing incipient LV systolic dysfunction by reduced global longitudinal strain (GLS:-8,9%) despite the preserved LVEF (K to N). CMR evidencing findings compatible with the association of LVNC (blue arrows) and HCM (red arrow) in 4 Chambers (O and P), 2 Chambers (Q and R) and Short Axis Views (S to V).
Abstract 1102 Figure 1
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - N M S Monge
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | - F Fernandes
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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Hotta VT, Abduch MCD, Vieira MLC, Ianni BM, Mady C, Bocchi EA. P1396 Three-dimensional cardiac mechanics for prediction of events in Chagas disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.
Methods
This was a convenience sample. Patients with any systemic disease were excluded. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.
Results
Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) < 0.35 (N = 22); Group 2 (G2), LVEF between 0.35 and 0.55 (N = 22); Group 3 (G3), normal LVEF (N = 28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1.
Hospitalization was related do indexed left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS values (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.
Conclusions
In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.
Table 1 INTEROBSERVER INTRAOBSERVER 2D GLS 0.96 ± 0.04 0.90 ± 0.08 3D GLS 0.92 ± 0.07 0.93 ± 0.10 3D GCS 0.88 ± 0.07 0.82 ± 0.15 3D AS 0.93 ± 0.05 0.90 ± 0.05 3D RS 0.85 ± 0.05 0.84 ± 0.11 Table 1. Interobserver and intraobserver variabilities for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS).
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | | | - B M Ianni
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - E A Bocchi
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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de Melo DTP, Nerbass FB, Sayegh ALC, de Souza FR, Hotta VT, Salemi VMC, Ramires FJA, Dias RR, Lorenzi-Filho G, Mady C, Fernandes F. Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis. PLoS One 2019; 14:e0223838. [PMID: 31603935 PMCID: PMC6788706 DOI: 10.1371/journal.pone.0223838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy. Methods We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire—MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index—PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy. Results Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5–209.5) vs 76 (40–117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5–77,5) vs. 18 (8,5–22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index—AHI 15.6 (8.3–31.7) vs. 14.6 (5.75–29.9) events/h, p = 0.253). Conclusion Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.
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Affiliation(s)
- Dirceu Thiago Pessoa de Melo
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Flavia Baggio Nerbass
- Sleep Laboratory, Pulmonary Divison, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Luiza Carrari Sayegh
- Unit of Cardiovascular Rehabilitation and Exercise Physiology Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Francis Ribeiro de Souza
- Unit of Cardiovascular Rehabilitation and Exercise Physiology Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Viviane Tiemi Hotta
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Maria Curi Salemi
- Heart Failure Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Félix José Alvarez Ramires
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Unit of Cardiac Surgery, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Divison, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Charles Mady
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio Fernandes
- Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Freitas P, Ferreira AM, Arteaga-Fernández E, de Oliveira Antunes M, Mesquita J, Abecasis J, Marques H, Saraiva C, Matos DN, Rodrigues R, Cardim N, Mady C, Rochitte CE. The amount of late gadolinium enhancement outperforms current guideline-recommended criteria in the identification of patients with hypertrophic cardiomyopathy at risk of sudden cardiac death. J Cardiovasc Magn Reson 2019; 21:50. [PMID: 31412875 PMCID: PMC6694533 DOI: 10.1186/s12968-019-0561-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying the patients with hypertrophic cardiomyopathy (HCM) in whom the risk of sudden cardiac death (SCD) justifies the implantation of a cardioverter-defibrillator (ICD) in primary prevention remains challenging. Different risk stratification and criteria are used by the European and American guidelines in this setting. We sought to evaluate the role of cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) in improving these risk stratification strategies. METHODS We conducted a multicentric retrospective analysis of HCM patients who underwent CMR for diagnostic confirmation and/or risk stratification. Eligibility for ICD was assessed according to the HCM Risk-SCD score and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) algorithm. The amount of LGE was quantified (LGE%) and categorized as 0%, 0.1-10%, 10.1-19.9% and ≥ 20%. The primary endpoint was a composite of SCD, aborted SCD, sustained ventricular tachycardia (VT), or appropriate ICD discharge. RESULTS A total of 493 patients were available for analysis (58% male, median age 46 years). LGE was present in 79% of patients, with a median LGE% of 2.9% (IQR 0.4-8.4%). The concordance between risk assessment by the HCM Risk-SCD, ACCF/AHA and LGE was relatively weak. During a median follow-up of 3.4 years (IQR 1.5-6.8 years), 23 patients experienced an event (12 SCDs, 6 appropriate ICD discharges and 5 sustained VTs). The amount of LGE was the only independent predictor of outcome (adjusted HR: 1.08; 95% CI: 1.04-1.12; p < 0.001) after adjustment for the HCM Risk-SCD and ACCF/AHA criteria. The amount of LGE showed greater discriminative power (C-statistic 0.84; 95% CI: 0.76-0.91) than the ACCF/AHA (C-statistic 0.61; 95% CI: 0.49-0.72; p for comparison < 0.001) and the HCM Risk-SCD (C-statistic 0.68; 95% CI: 0.59-0.78; p for comparison = 0.006). LGE was able to increase the discriminative power of the ACCF/AHA and HCM Risk-SCD criteria, with net reclassification improvements of 0.36 (p = 0.021) and 0.43 (p = 0.011), respectively. CONCLUSIONS The amount of LGE seems to outperform the HCM Risk-SCD score and the ACCF/AHA algorithm in the identification of HCM patients at increased risk of SCD and reclassifies a relevant proportion of patients.
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Affiliation(s)
- Pedro Freitas
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP 05403-000 Brazil
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - António Miguel Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Edmundo Arteaga-Fernández
- Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Murrilo de Oliveira Antunes
- Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - João Mesquita
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Cardiovascular Department, Hospital dos Lusíadas, Lisbon, Portugal
| | - Hugo Marques
- Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Carla Saraiva
- Radiology Department, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Daniel Nascimento Matos
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Rita Rodrigues
- Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- Advanced Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal
| | - Charles Mady
- Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Eduardo Rochitte
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP 05403-000 Brazil
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Sayegh ALC, Dos Santos MR, Rondon E, de Oliveira P, de Souza FR, Salemi VMC, Alves MJDNN, Mady C. Exercise Rehabilitation Improves Cardiac Volumes and Functional Capacity in Patients With Endomyocardial Fibrosis: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2019; 39:373-380. [PMID: 31397769 DOI: 10.1097/hcr.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy associated with low functional capacity and high mortality rates. Exercise training has been proved to be a nonpharmacological treatment of cardiovascular diseases. Therefore, the purpose of this study was to determine the effects of exercise rehabilitation in EMF patients. METHODS Twenty-two EMF patients, functional classes II and III (New York Heart Association [NYHA]), were randomized to the control (C-EMF) or exercise rehabilitation (Rehab-EMF) group. Patients in the Rehab-EMF group underwent 4 mo of exercise rehabilitation, whereas patients in the C-EMF group were instructed to maintain their usual daily routine. Peak oxygen uptake ((Equation is included in full-text article.)O2), cardiac function, and quality of life were evaluated. All assessments were performed at baseline and after 4 mo. RESULTS After 4 mo of rehabilitation, peak (Equation is included in full-text article.)O2 increased in the Rehab-EMF group (17.4 ± 3.0 to 19.7 ± 4.4 mL/kg/min, P < .001), whereas the C-EMF group showed no difference (15.3 ± 3.0 to 15.0 ± 2.0 mL/kg/min, P = .87). Also, post-intervention, peak (Equation is included in full-text article.)O2 in the Rehab-EMF group was greater than that in the C-EMF group (P < .001). Furthermore, the Rehab-EMF group, when compared to the C-EMF group, showed an increase in left ventricular end-diastolic volume (102.1 ± 64.6 to 136.2 ± 75.8 mL vs 114.4 ± 55.0 to 100.4 ± 49.9 mL, P < .001, respectively) and decrease in left atrial diastolic volume (69.0 ± 33.0 to 34.9 ± 15.0 mL vs 44.6 ± 21.0 to 45.6 ± 23.0 mL, P < .001, respectively). Quality-of-life scores also improved in the Rehab-EMF group, whereas the C-EMF group showed no change (45 ± 23 to 27 ± 15 vs 47 ± 15 to 45 ± 17, P < .001, respectively). CONCLUSION Exercise rehabilitation is a nonpharmacological intervention that improves functional capacity, cardiac volumes, and quality of life in EMF patients after endocardial resection surgery. In addition, exercise rehabilitation should be prescribed to EMF patients to improve their clinical condition.
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Affiliation(s)
- Ana Luiza Carrari Sayegh
- Clinical Unit of Cardiomyopathy, Heart Institute (InCor) (Drs Sayegh and Mady), Cardiovascular Rehabilitation and Exercise Physiology Unit, Heart Institute (InCor-HC-FMUSP) (Drs dos Santos, de Oliveira, and Alves and Messrs Rondon and de Souza), and Clinical Unit of Heart Failure, Heart Institute (InCor) (Dr Salemi), University of São Paulo Medical School, Sao Paulo, Brazil
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Dinato FJ, Dias RR, Duncan JA, Fernandes F, Ramires FJA, Mady C, Jatene FB. The learning curve effect on outcomes with frozen elephant trunk technique for extensive thoracic aorta disease. J Card Surg 2019; 34:796-802. [DOI: 10.1111/jocs.14139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fabrício José Dinato
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Ricardo Ribeiro Dias
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - José Augusto Duncan
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Fábio Fernandes
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Felix José Alvares Ramires
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Charles Mady
- Clinical Unit of Myocardiopathies and Aortic DiseasesHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
| | - Fabio Biscegli Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), University of São Paulo Medical SchoolSão Paulo Brazil
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36
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Fonseca K, Pessoa F, Mady C, Hotta V, Ribeiro ON, Fernandes F, Ianni B, Saldiva P, Ramires F. IMPACT OF AIR POLLUTION ON MYOCARDIAL REMODELING IN CHAGA'S DISEASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fernandes F, Oliveira Antunes M, Tiemi Hotta V, Eduardo Rochitte C, Mady C. Doenças de Depósito como Diagnóstico Diferencial de Hipertrofia Ventricular Esquerda em Pacientes com Insuficiência Cardíaca e Função Sistólica Preservada. Arq Bras Cardiol 2019; 113:979-987. [PMID: 31800724 PMCID: PMC7020972 DOI: 10.36660/abc.20180370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/15/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Fábio Fernandes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Murillo Oliveira Antunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Viviane Tiemi Hotta
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Dabarian AL, Mady C, Barbosa-Ferreira JM, Ianni BM, Hotta VT, Ramires FJA, Lopes HF, Buck PDC, Pessoa FG, Fonseca KCB, Nogueira AR, Fernandes F. Dysregulation of insulin levels in Chagas heart disease is associated with altered adipocytokine levels. Can J Physiol Pharmacol 2018; 97:140-145. [PMID: 30557036 DOI: 10.1139/cjpp-2018-0349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Metabolic, inflammatory, and autonomic nervous system (ANS) dysfunction are present in patients with heart failure. However, whether these changes are due to left ventricular dysfunction or heart failure etiology is unknown. We evaluated metabolism and inflammatory activity in patients with idiopathic dilated cardiomyopathy (IDC) and Chagas cardiomyopathy (CHG) and their correlation with the ANS. Forty-six patients were divided into 3 groups: IDC, CHG, and control. We evaluated adiponectin, leptin, insulin, interleukin-6, and tumor necrosis factor-alpha. ANS were analyzed by heart rate variability in time and frequency domains on a 24-hour Holter monitor. Levels of glucose, cholesterol, leptin, and adiponectin did not show differences between groups. Insulin levels were lower in CHG group (5.4 ± 3.3 μU/mL) when compared with control (8.0 ± 4.9 μU/mL) and IDC (9.9 ± 5.0 μU/mL) groups (p = 0.007). Insulin was positively associated with LFr/HFr ratio (r = 0.562; p = 0.029) and with the LFr component (r = 0.562; p = 0.029) and negatively associated with adiponectin (r = -0.603; p = 0.017) in CHG group. The addition of an adiponectin unit reduced average insulin by 0.332 μg/mL. Insulin levels were decreased in the CHG group when compared with the IDC group and were associated with ANS indexes and adiponectin levels.
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Affiliation(s)
- André Luiz Dabarian
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Charles Mady
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - João Marcos Barbosa-Ferreira
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Barbara Maria Ianni
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Viviane Tiemi Hotta
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Félix José Alvarez Ramires
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Heno Ferreira Lopes
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.,b Universidade Nove de Julho - UNINOVE
| | - Paula de Cássia Buck
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Fernanda Gallinaro Pessoa
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Keila Cardoso Barbosa Fonseca
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Adriana Ramos Nogueira
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Fábio Fernandes
- a Unidade Clínica de Miocardiopatias, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Sayegh ALC, Santos MRD, Oliveira PD, Fernandes F, Rondon E, Souza FRD, Salemi VMC, Alves MJDNN, Mady C. Characterization of Cardiopulmonary Exercise Testing Variables in Patients with Endomyocardial Fibrosis after Endocardial Resection. Arq Bras Cardiol 2018; 109:533-540. [PMID: 29364349 PMCID: PMC5783434 DOI: 10.5935/abc.20170179] [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] [Received: 01/25/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Endomyocardial fibrosis (EMF) is a rare disease, characterized by diastolic dysfunction which leads to reduced peak oxygen consumption (VO2). Cardiopulmonary exercise testing (CPET) has been proved to be a fundamental tool to identify central and peripheral alterations. However, most studies prioritize peak VO2 as the main variable, leaving aside other important CPET variables that can specify the severity of the disease and guide the clinical treatment. OBJECTIVE The aim of this study was to evaluate central and peripheral limitations in symptomatic patients with EMF by different CPET variables. METHODS Twenty-six EMF patients (functional class III, NYHA) were compared with 15 healthy subjects (HS). Functional capacity was evaluated using CPET and diastolic and systolic functions were evaluated by echocardiography. RESULTS Age and gender were similar between EMF patients and HS. Left ventricular ejection fraction was normal in EMF patients, but decreased compared to HS. Peak heart rate, peak workload, peak VO2, peak oxygen (O2) pulse and peak pulmonary ventilation (VE) were decreased in EMF compared to HS. Also, EMF patients showed increased Δ heart rate /Δ oxygen uptake and Δ oxygen uptake /Δ work rate compared to HS. CONCLUSION Determination of the aerobic capacity by noninvasive respiratory gas exchange during incremental exercise provides additional information about the exercise tolerance in patients with EMF. The analysis of different CPET variables is necessary to help us understand more about the central and peripheral alterations cause by both diastolic dysfunction and restrictive pattern.
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Affiliation(s)
- Ana Luiza C Sayegh
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Marcelo R Dos Santos
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Patricia de Oliveira
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Fábio Fernandes
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Eduardo Rondon
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Francis R de Souza
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Vera M C Salemi
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Charles Mady
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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40
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Dabarian A, Mady C, Ferreira JMB, Ianni B, Hotta VT, Ramires FJA, Lopes HF, Fernandes F. P1602Dysregulation of insulin levels in Chagas heart disease is associated with altered adipocytokine levels. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Dabarian
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - C Mady
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - J M B Ferreira
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - B Ianni
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - V T Hotta
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - F J A Ramires
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - H F Lopes
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - F Fernandes
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
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41
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Fernandes F, Mello DTP, Ramires FJA, Sabino EC, Moreira CHV, Benvenutti L, Hotta VT, Sayeg A, Dias RR, Mady C. P695Galectin-3 levels are normal in patients with constrictive pericarditis and are associated with exercise intolerance after pericardiectomy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Fernandes
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - D T P Mello
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - F J A Ramires
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - E C Sabino
- Clinical Hospital of the University of Sao Paulo, Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo,, Sao Paulo, Brazil
| | - C H V Moreira
- Clinical Hospital of the University of Sao Paulo, Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo,, Sao Paulo, Brazil
| | - L Benvenutti
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - V T Hotta
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - A Sayeg
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - R R Dias
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
| | - C Mady
- Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
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Sarmento ASO, Antunes-Correa LM, Alves MJNN, Bacurau AVN, Fonseca KCB, Pessoa FG, Trombetta IC, Rondon MUPB, Ramires FJA, Brasileiro-Santos MS, Brum PC, Mady C, Negrao CE, Thomas S, Ianni BM. P5681Effects of exercise training on cardiovascular autonomic modulation and skeletal muscle tissue in chagasic cardiopathy patients and preserved systolic function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A S O Sarmento
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - L M Antunes-Correa
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M J N N Alves
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - A V N Bacurau
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - K C B Fonseca
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - F G Pessoa
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - I C Trombetta
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M U P B Rondon
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - F J A Ramires
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - M S Brasileiro-Santos
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - P C Brum
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - C Mady
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - C E Negrao
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - S Thomas
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
| | - B M Ianni
- University of Sao Paulo, Researcher at the Institute of the Heart, Sao Paulo, Brazil
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Hotta VT, Tendolo SC, Rodrigues ACT, Fernandes F, Nastari L, Mady C. Limitations in the Diagnosis of Noncompaction Cardiomyopathy by Echocardiography. Arq Bras Cardiol 2018; 109:483-488. [PMID: 29267629 PMCID: PMC5729785 DOI: 10.5935/abc.20170152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/21/2017] [Indexed: 02/02/2023] Open
Affiliation(s)
- Viviane Tiemi Hotta
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil.,Fleury Medicina e Saúde, São Paulo, SP - Brazil
| | | | - Ana Clara Tude Rodrigues
- Hospital das Clínicas - FMUSP, São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
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Antunes MDO, Arteaga-Fernández E, Fernandes F, Soffiatti CD, Buck PDC, Sabino EC, Moreira CHV, Mady C. Evaluation of Galectin-3 and Myocardial Fibrosis in Patients with Hypertrophic
Cardiomyopathy. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Duncan JA, Dias RR, Dinato FJ, Fernandes F, Ramirez FJÁ, Mady C, Jatene FB. Hybrid Approach of Aortic Diseases: Zone 1 Delivery and Volumetric Analysis on the Descending Aorta. Braz J Cardiovasc Surg 2017; 32:361-366. [PMID: 29211214 PMCID: PMC5701099 DOI: 10.21470/1678-9741-2017-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/27/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Conventional techniques of surgical correction of arch and descending aortic
diseases remains as high-risk procedures. Endovascular treatments of
abdominal and descending thoracic aorta have lower surgical risk. Evolution
of both techniques - open debranching of the arch and endovascular approach
of the descending aorta - may extend a less invasive endovascular treatment
for a more extensive disease with necessity of proximal landing zone in the
arch. Objective To evaluate descending thoracic aortic remodeling by means of volumetric
analysis after hybrid approach of aortic arch debranching and stenting the
descending aorta. Methods Retrospective review of seven consecutive patients treated between September
2014 and August 2016 for diseases of proximal descending aorta (aneurysms
and dissections) by hybrid approach to deliver the endograft at zone 1.
Computed tomography angiography were analyzed using a specific software to
calculate descending thoracic aorta volumes pre- and postoperatively. Results Follow-up was done in 100% of patients with a median time of 321 days (range,
41-625 days). No deaths or permanent neurological complications were
observed. There were no endoleaks or stent migrations. Freedom from
reintervention was 100% at 300 days and 66% at 600 days. Median volume
reduction was of 45.5 cm3, representing a median volume shrinkage
by 9.3%. Conclusion Hybrid approach of arch and descending thoracic aorta diseases is feasible
and leads to a favorable aortic remodeling with significant volume
reduction.
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Affiliation(s)
- José Augusto Duncan
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Ricardo Ribeiro Dias
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabrício José Dinato
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fábio Fernandes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Félix José Álvares Ramirez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- 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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Pessoa FG, Mady C, Fonseca KCB, de Oliveira-Fonoff AM, Salemi VMC, Jordão MR, Fernandes F, Ramires FJA. Erythropoietin reduces collagen deposition after myocardial infarction but does not improve cardiac function. Can J Physiol Pharmacol 2017; 96:541-549. [PMID: 29120671 DOI: 10.1139/cjpp-2017-0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Myocardial remodeling includes inappropriate collagen deposition in the interstitium. Erythropoietin (EPO) may have cardioprotective effects. We aimed to assess the role of EPO on myocardial remodeling during the chronic phase. We studied 60 Wistar rats divided into the following groups: control (CT), control + EPO (CT + EPO), myocardial infarction + EPO (MI + EPO), and myocardial infarction (MI). The interstitial collagen volume fraction (ICVF) was quantified and echocardiography was performed. We quantified asymmetric dimethylarginine and glutathione by ELISA, and used real-time PCR to assess apoptosis and inflammation. Western blotting was used to evaluate inflammatory proteins and tissue inhibitors of metalloproteinases (TIMPs), and TUNEL staining was used to detect apoptosis. For matrix metalloproteinases (MMPs), we performed zymography. Parametric and nonparametric analyses were performed according to normality testing. ICVF was greater in MI groups (p < 0.001) and was attenuated by EPO (p = 0.05). The MMP-2 did not show any difference between groups. The TIMP-1 and TIMP-2 did not have difference between groups. The MI groups had worse fraction shortening (p < 0.001), without EPO protection (p = 0.666). The MI groups had increased left ventricle diastolic dimension (p < 0.001) without EPO attenuation (p = 0.79). EPO did not act on oxidative stress. Apoptosis and inflammation were not modulated by EPO. We concluded that EPO attenuated interstitial collagen accumulation, but did not protect from heart dilation or dysfunction.
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Affiliation(s)
- Fernanda Gallinaro Pessoa
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Charles Mady
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Keila Cardoso Barbosa Fonseca
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Adriana Morgan de Oliveira-Fonoff
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Vera Maria Cury Salemi
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Maurício Rodrigues Jordão
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Fabio Fernandes
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
| | - Felix José Alvarez Ramires
- Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil.,Heart Institute (InCor) - University of São Paulo, São Paulo, Brazil
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Fernandes F, Melo DTPD, Ramires FJA, Dias RR, Tonini M, Fernandes VDS, Rochitte CE, Moreira CHV, Mady C. Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis. Arq Bras Cardiol 2017; 109:457-465. [PMID: 28977057 PMCID: PMC5729782 DOI: 10.5935/abc.20170147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background International studies have reported the value of the clinical profile and
laboratory findings in the diagnosis of constrictive pericarditis. However,
Brazilian population data are scarce. Objective To assess the clinical characteristics, sensitivity of imaging tests and
factors related to the death of patients with constrictive pericarditis
undergoing pericardiectomy. Methods Patients with constrictive pericarditis surgically confirmed were
retrospectively assessed regarding their clinical and laboratory variables.
Two methods were used: transthoracic echocardiography and cardiac magnetic
resonance imaging. Mortality predictors were determined by use of univariate
analysis with Cox proportional hazards model and hazard ratio. All tests
were two-tailed, and an alpha error ≤ 5% was considered statically
significant. Results We studied 84 patients (mean age, 44 ± 17.9 years; 67% male). Signs
and symptoms of predominantly right heart failure were present with jugular
venous distention, edema and ascites in 89%, 89% and 62% of the cases,
respectively. Idiopathic etiology was present in 69.1%, followed by
tuberculosis (21%). Despite the advanced heart failure degree, low BNP
levels (median, 157 pg/mL) were found. The diagnostic sensitivities for
constriction of echocardiography and magnetic resonance imaging were 53.6%
and 95.9%, respectively. There were 9 deaths (10.7%), and the risk factors
were: anemia, BNP and C reactive protein levels, pulmonary hypertension
>55 mm Hg, and atrial fibrillation. Conclusions Magnetic resonance imaging had better diagnostic sensitivity. Clinical,
laboratory and imaging markers were associated with death.
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Affiliation(s)
- Fábio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Dirceu Thiago Pessoa de Melo
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Felix José Alvarez Ramires
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Ricardo Ribeiro Dias
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Marcio Tonini
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Vinicius Dos Santos Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | - Charles Mady
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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48
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Jordao M, Zanoni F, Pessoa F, Fonseca K, Salemi V, Souza L, Ribeiro O, Fernandez F, Mady C, Ramires F. P4468Relationship between autonomic activity, beta receptors and catecholamines after sympathectomy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M.R. Jordao
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F. Zanoni
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F.G. Pessoa
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - K.C.B. Fonseca
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - V.M.C. Salemi
- Heart Institute of the University of Sao Paulo (InCor), Heart Failure Department, Sao Paulo, Brazil
| | - L.E. Souza
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - O.N. Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F. Fernandez
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - C. Mady
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
| | - F.J.A. Ramires
- Heart Institute of the University of Sao Paulo (InCor), Myocardial Disease Department, Sao Paulo, Brazil
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49
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Salemi V, Oliveira C, Ribeiro A, Menezes M, Antunes A, Ferreira-Filho J, Sachdev V, Fernandes F, Nastari L, Ianni B, Mady C, Carneiro-Proietti A, Keating S, Busch M, Sabino E. P2434Echocardiographic findings of Trypanosoma cruzi seropositive blood donors. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Sayegh A, Dos Santos M, Oliveira P, Rondon E, De Souza F, Salemi V, Alves M, Mady C. P2504Effect of exercise training on functional capacity and left atrium volume in patients with restrictive cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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