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Espinoza Romero C, Catto De Marchi D, Marcondes-Braga FG, Mangini S, Samuel Avila M, Bacal F. Neurochagas in post-heart transplant: clinical and epidemiological analysis of this entity based on a series of cases. Rev Esp Cardiol (Engl Ed) 2024; 77:269-272. [PMID: 37821057 DOI: 10.1016/j.rec.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Cristhian Espinoza Romero
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | - Daniel Catto De Marchi
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Fabiana G Marcondes-Braga
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Sandrigo Mangini
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Mônica Samuel Avila
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Fernando Bacal
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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Delafiori J, Siciliano RF, de Oliveira AN, Nicolau JC, Sales GM, Dalçóquio TF, Busanello ENB, Eguti A, de Oliveira DN, Bertolin AJ, Dos Santos LA, Salsoso R, Marcondes-Braga FG, Durán N, Júnior MWP, Sabino EC, Reis LO, Fávaro WJ, Catharino RR. Comparing plasma and skin imprint metabolic profiles in COVID-19 diagnosis and severity assessment. J Mol Med (Berl) 2024; 102:183-195. [PMID: 38010437 DOI: 10.1007/s00109-023-02396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
As SARS-CoV-2 continues to produce new variants, the demand for diagnostics and a better understanding of COVID-19 remain key topics in healthcare. Skin manifestations have been widely reported in cases of COVID-19, but the mechanisms and markers of these symptoms are poorly described. In this cross-sectional study, 101 patients (64 COVID-19 positive patients and 37 controls) were enrolled between April and June 2020, during the first wave of COVID-19, in São Paulo, Brazil. Enrolled patients had skin imprints sampled non-invasively using silica plates; plasma samples were also collected. Samples were used for untargeted lipidomics/metabolomics through high-resolution mass spectrometry. We identified 558 molecular ions, with lipids comprising most of them. We found 245 plasma ions that were significant for COVID-19 diagnosis, compared to 61 from the skin imprints. Plasma samples outperformed skin imprints in distinguishing patients with COVID-19 from controls, with F1-scores of 91.9% and 84.3%, respectively. Skin imprints were excellent for assessing disease severity, exhibiting an F1-score of 93.5% when discriminating between patient hospitalization and home care statuses. Specifically, oleamide and linoleamide were the most discriminative biomarkers for identifying hospitalized patients through skin imprinting, and palmitic amides and N-acylethanolamine 18:0 were also identified as significant biomarkers. These observations underscore the importance of primary fatty acid amides and N-acylethanolamines in immunomodulatory processes and metabolic disorders. These findings confirm the potential utility of skin imprinting as a valuable non-invasive sampling method for COVID-19 screening; a method that may also be applied in the evaluation of other medical conditions. KEY MESSAGES: Skin imprints complement plasma in disease metabolomics. The annotated markers have a role in immunomodulation and metabolic diseases. Skin imprints outperformed plasma samples at assessing disease severity. Skin imprints have potential as non-invasive sampling strategy for COVID-19.
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Affiliation(s)
- Jeany Delafiori
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Rinaldo Focaccia Siciliano
- Clinical Division of Infectious and Parasitic Diseases, University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Arnaldo, 455 - 01246-903 - Cerqueira César, São Paulo, SP, Brazil
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Arthur Noin de Oliveira
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - José Carlos Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Geovana Manzan Sales
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Talia Falcão Dalçóquio
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Estela Natacha Brandt Busanello
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Adriana Eguti
- Sumaré State Hospital, Sumaré, Brazil - Av. da Amizade, 2400 - 13175-490 - Jardim Bela Vista, Sumaré, SP, Brazil
| | - Diogo Noin de Oliveira
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Adriadne Justi Bertolin
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Luiz Augusto Dos Santos
- Paulínia Municipal Hospital, Paulínia, Brazil - Rua Miguel Vicente Cury, 100 - 13140-000 - Nova Paulínia, Paulínia, SP, Brazil
| | - Rocío Salsoso
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Fabiana G Marcondes-Braga
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil - Av. Dr. Enéas de Carvalho Aguiar, 44 - 05403-900 - Cerqueira César, São Paulo, SP, Brazil
| | - Nelson Durán
- Laboratory of Urogenital Carcinogenesis and Immunotherapy, University of Campinas, Campinas, Brazil - Av. Bertrand Russel, s/n - 13083-865 - Cidade Universitária Zeferino Vaz, Campina, SP, Brazil
| | | | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil - Avenida Dr. Enéas Carvalho de Aguiar, 470 - 05403-000 - Cerqueira César, São Paulo, SP, Brazil
| | - Leonardo Oliveira Reis
- UroScience Laboratory, University of Campinas, Campinas, Brazil - Rua Tessália Vieira de Camargo, 126 - 13083-887 - Cidade, Universitária Zeferino Vaz, Campinas, SP, Brazil
- Center for Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Brazil - Av. John Boyd Dunlop, s/n - 13060-904 - Jd. Ipaussurama, Campinas, SP, Brazil
| | - Wagner José Fávaro
- Laboratory of Urogenital Carcinogenesis and Immunotherapy, University of Campinas, Campinas, Brazil - Av. Bertrand Russel, s/n - 13083-865 - Cidade Universitária Zeferino Vaz, Campina, SP, Brazil
| | - Rodrigo Ramos Catharino
- Innovare Biomarkers Laboratory, Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil - Rua Cinco de Junho, 350 - 13083-970 - Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.
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Filippini FB, Ribeiro HB, Bocchi E, Bacal F, Marcondes-Braga FG, Avila MS, Sturmer JD, Marchi MFDS, Kanhouche G, Freire AF, Cassar R, Abizaid AA, de Brito FS. Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. Arq Bras Cardiol 2023; 120:e20220496. [PMID: 38126512 PMCID: PMC10773459 DOI: 10.36660/abc.20220496] [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: 07/11/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
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Affiliation(s)
- Filippe Barcellos Filippini
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Henrique Barbosa Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Edimar Bocchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fernando Bacal
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Monica S. Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Janine Daiana Sturmer
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Mauricio Felippi de Sá Marchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Antônio Fernando Freire
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Renata Cassar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Alexandre A. Abizaid
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
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Furquim SR, Galbiati LC, Avila MS, Marcondes-Braga FG, Fukushima J, Mangini S, Seguro LFBDC, Campos IWD, Strabelli TMV, Barone F, Paulo ARDSAD, Ohe LA, Galante MC, Gaiotto FA, Bacal F. Survival of Heart Transplant Patients with Chagas' Disease Under Different Antiproliferative Immunosuppressive Regimens. Arq Bras Cardiol 2023; 120:e20230133. [PMID: 37909604 PMCID: PMC10586812 DOI: 10.36660/abc.20230133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/06/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Chagas' disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas' disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown. To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival. Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge ("Change" group). A p-value < 0.05 was considered statistically significant. Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates. This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.
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Affiliation(s)
- Silas Ramos Furquim
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luana Campoli Galbiati
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Monica S Avila
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabiana G Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Julia Fukushima
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Sandrigo Mangini
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Iascara Wozniak de Campos
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Tania Mara Varejão Strabelli
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fernanda Barone
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Luciana Akutsu Ohe
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Mariana Cappelletti Galante
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Antonio Gaiotto
- 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
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de Albuquerque DC, de Barros E Silva PGM, Lopes RD, Hoffmann-Filho CR, Nogueira PR, Reis H, Nishijuka FA, Martins SM, de Figueiredo Neto JA, Pavanello R, de Souza Neto JD, Danzmann LC, Gemelli JR, Rohde LEP, Hernandes ME, Rivera MAM, SimÕes MV, Dos Santos ES, Canesin MF, Zilli AC, Santos RHN, Jesuino IDA, Mourilhe-Rocha R, Moura LZ, Marcondes-Braga FG, Mesquita ET. In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE). J Card Fail 2023:S1071-9164(23)00310-X. [PMID: 37648061 DOI: 10.1016/j.cardfail.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 SUGGESTION FOR REPHRASING: In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.
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Affiliation(s)
| | - Pedro Gabriel Melo de Barros E Silva
- Hcor-Hospital do Coração, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Centro de Pesquisa da Clínica Médica e Cardiologia da UNIFESP, São Paulo, Brazil.
| | | | | | - Helder Reis
- Hospital de Clínicas Gaspar Viana, Paró, Brazil
| | | | | | | | | | | | - Luiz Claudio Danzmann
- Hospital São Lucas-PUCRS, Rio Grande do Sul, Brazil; Universidade Luterana do Brasil-Hospital Universitório de Canoas (RS), Rio Grande do Sul, Brazil
| | | | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento-HMV, Rio Grande do Sul, Brazil
| | | | | | - Marcus Vinícius SimÕes
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Ricardo Mourilhe-Rocha
- Hospital Universitório Pedro Ernesto, Rio de Janeiro, Brazil; Complexo Hospitalar Américas- Vitória e Samaritano Barra, Rio de Janeiro, Brazil
| | | | - Fabiana G Marcondes-Braga
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Instituto do Coração (inCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evandro Tinoco Mesquita
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Benvenuti LA, Marcondes-Braga FG, Bacal F. Cumulative Disorder of Myocardial Lipofuscin after Long-Term Heart Transplantation: A Study Based on Endomyocardial Biopsies. Arq Bras Cardiol 2023; 120:e20220313. [PMID: 37042874 PMCID: PMC10263452 DOI: 10.36660/abc.20220313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 03/30/2023] Open
Affiliation(s)
- Luiz Alberto Benvenuti
- 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
| | - Fabiana G. Marcondes-Braga
- 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
| | - Fernando Bacal
- 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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7
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Albuquerque DC, Barros E Silva PG, Lopes RD, Hoffmann C, Nogueira PR, Reis H, Nishijuka FA, De Figueiredo Neto JA, De Souza Neto JD, Rohde LEP, Simoes MV, Rocha RM, Moura LZ, Marcondes-Braga FG, Mesquita ET. Main results of the first Brazilian Registry of Heart Failure (BREATHE). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure represents a common cause of hospitalization associated with poor short-term clinical outcomes. Little is known about the long-term prognosis of these patients in Latin America.
Methods
The rationale and design of the study were previously published (1). Briefly, BREATHE was the first nation-wide prospective observational study that included patients hospitalized due to acute heart failure in Brazil. In-hospital management as well as 12-month clinical outcomes were assessed. Patients were included during two time periods: from February 2011 to December 2012 (BREATHE I) and from June 2016 to July 2018 (BREATHE Extension). Adherence to evidence-based therapies was also evaluated.
Results
A total of 3,013 patients were included in 71 centers in Brazil. The median follow-up was 346 days. The BREATHE population included 39.3% of women, had a mean age of 65.2 (± 15.6) with a mean ejection fraction of 39.7% (± 17.5). Among the comorbidities, systemic arterial hypertension was the most common, present in almost 75% of the sample. At hospital admission, 83.8% of patients had clear signs of pulmonary congestion and the main cause of decompensation was poor adherence to heart failure medications, representing 27.8% of cases. Among patients with reduced ejection fraction, the concomitant use of renin-angiotensin-aldosterone inhibitors, beta-blocker and spironolactone at hospital discharge was 44.5% and decreased to 35.2% after 3 months (p<0.01). Mortality rate at 12 months was 28.9 for every 100 patient years with 26.2% readmission at 90 days and 46.4% at 365 days. The most common etiology of heart failure was ischemic disease (Figure 1) but the worst prognosis was associated with Chagas disease (Figure 2) including an analysis of a composite outcome encompassing death, myocardial infarction, stroke or cardiac arrest after discharge.
Conclusions
In this large national prospective registry of patients hospitalized with acute heart failure, mortality and readmission were higher than what have been reported globally. Poor adherence to evidence-based therapies was a common both at hospital discharge and 1-year of follow-up.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
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Affiliation(s)
- D C Albuquerque
- Sociedade Brasileira de Cardiologia, Departamento de Insuficiência Cardíaca - DEIC , Rio de Janeiro , Brazil
| | | | - R D Lopes
- Duke Clinical Research Institute , Durham , United States of America
| | - C Hoffmann
- Hospital Regional Hans Dieter Schmidt , Joinville , Brazil
| | - P R Nogueira
- Fundação Faculdade Regional de Medicina de São José do Rio Preto , São José do Rio Preto , Brazil
| | - H Reis
- Hospital de Clinicas Gaspar Viana , Belem , Brazil
| | - F A Nishijuka
- Hospital Naval Marcilio Dias , Rio de Janeiro , Brazil
| | - J A De Figueiredo Neto
- Centro de Pesquisa Clínica do Hospital Universitário da Universidade Federal do Maranhão (CEPEC-HUUF , Sao Luis , Brazil
| | | | - L E P Rohde
- Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - M V Simoes
- Hospital Das Clinicas Fmrp-Usp , Ribeirao Preto , Brazil
| | - R M Rocha
- Pedro Ernesto University Hospital , Rio de Janeiro , Brazil
| | | | - F G Marcondes-Braga
- Sociedade Brasileira de Cardiologia, Departamento de Insuficiência Cardíaca - DEIC , Rio de Janeiro , Brazil
| | - E T Mesquita
- Sociedade Brasileira de Cardiologia, Departamento de Insuficiência Cardíaca - DEIC , Rio de Janeiro , Brazil
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8
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Montera MW, Marcondes-Braga FG, Simões MV, Moura LAZ, Fernandes F, Mangine S, Oliveira Júnior ACD, Souza ALADAGD, Ianni BM, Rochitte CE, Mesquita CT, de Azevedo Filho CF, Freitas DCDA, Melo DTPD, Bocchi EA, Horowitz ESK, Mesquita ET, Oliveira GH, Villacorta H, Rossi Neto JM, Barbosa JMB, Figueiredo Neto JAD, Luiz LF, Hajjar LA, Beck-da-Silva L, Campos LADA, Danzmann LC, Bittencourt MI, Garcia MI, Avila MS, Clausell NO, Oliveira NAD, Silvestre OM, Souza OFD, Mourilhe-Rocha R, Kalil Filho R, Al-Kindi SG, Rassi S, Alves SMM, Ferreira SMA, Rizk SI, Mattos TAC, Barzilai V, Martins WDA, Schultheiss HP. Brazilian Society of Cardiology Guideline on Myocarditis - 2022. Arq Bras Cardiol 2022; 119:143-211. [PMID: 35830116 PMCID: PMC9352123 DOI: 10.36660/abc.20220412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Sandrigo Mangine
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Bárbara Maria Ianni
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil.,Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.,Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Imbroise Bittencourt
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - Marcelo Iorio Garcia
- Hospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | - Monica Samuel Avila
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University,Cleveland, Ohio - EUA
| | | | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil.,Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | - Silvia Moreira Ayub Ferreira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Stéphanie Itala Rizk
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Sírio Libanês, São Paulo, SP - Brasil
| | | | - Vitor Barzilai
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense,Rio de Janeiro, RJ - Brasil.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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9
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Belfort DDSP, Marcondes-Braga FG, Mangini S, Cafezeiro CRF, Furlan DAG, Bacal F. Aortic and Renal Artery Thrombosis as the First Clinical Manifestation of COVID-19 in a Heart Transplant Recipient. Arq Bras Cardiol 2021; 117:1045-1047. [PMID: 34817016 PMCID: PMC8682100 DOI: 10.36660/abc.20201210] [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: 11/12/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Deborah de Sá Pereira Belfort
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Sandrigo Mangini
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Caio Rebouças Fonseca Cafezeiro
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Diógenes Amauri Gonçalves Furlan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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10
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Bacal F, Murad CM, dos Santos Aragão CA, de Campos IW, da Costa Seguro LFB, Avila MS, Mangini S, Gaiotto FA, Strabelli TV, Marcondes-Braga FG. Transplantation for Chagas Heart Disease: a Comprehensive Review. Curr Transpl Rep 2021. [DOI: 10.1007/s40472-021-00348-9] [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: 10/20/2022]
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11
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Simões MV, Fernandes F, Marcondes-Braga FG, Scheinberg P, Correia EDB, Rohde LEP, Bacal F, Alves SMM, Mangini S, Biolo A, Beck-da-Silva L, Szor RS, Marques W, Oliveira ASB, Cruz MW, Bueno BVK, Hajjar LA, Issa AFC, Ramires FJA, Coelho OR, Schmidt A, Pinto IMF, Rochitte CE, Vieira MLC, Mesquita CT, Ramos CD, Soares-Junior J, Romano MMD, Mathias W, Garcia MI, Montera MW, de Melo MDT, Silva SME, Garibaldi PMM, de Alencar AC, Lopes RD, de Ávila DX, Viana D, Saraiva JFK, Canesin MF, de Oliveira GMM, Mesquita ET. Position Statement on Diagnosis and Treatment of Cardiac Amyloidosis - 2021. Arq Bras Cardiol 2021; 117:561-598. [PMID: 34550244 PMCID: PMC8462947 DOI: 10.36660/abc.20210718] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Marcus V. Simões
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | - Fabio Fernandes
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | - Philip Scheinberg
- Hospital da Beneficência Portuguesa de São PauloSão PauloSPBrasilHospital da Beneficência Portuguesa de São Paulo, São Paulo, SP – Brasil
| | - Edileide de Barros Correia
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Luis Eduardo P. Rohde
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil
| | - Fernando Bacal
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil
| | - Sandrigo Mangini
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | - Andréia Biolo
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
| | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil
| | - Roberta Shcolnik Szor
- Fundação Faculdade de MedicinaSão PauloSPBrasilFundação Faculdade de Medicina, São Paulo, SP – Brasil
- Universidade de São PauloSão PauloSPBrasilInstituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Wilson Marques
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | - Acary Souza Bulle Oliveira
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Márcia Waddington Cruz
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilHospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | - Bruno Vaz Kerges Bueno
- Faculdade de Ciências Médicas da Santa Casa de São PauloSão PauloSPBrasilFaculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP – Brasil
| | - Ludhmila Abrahão Hajjar
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
- Universidade de São PauloSão PauloSPBrasilInstituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Aurora Felice Castro Issa
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Felix José Alvarez Ramires
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Otavio Rizzi Coelho
- Universidade Estadual de CampinasCampinasSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP – Brasil
| | - André Schmidt
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | | | - Carlos Eduardo Rochitte
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
- Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil
- Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ – Brasil
| | - Marcelo Luiz Campos Vieira
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Cláudio Tinoco Mesquita
- Universidade Federal FluminenseRio de JaneiroRJBrasilUniversidade Federal Fluminense (UFF), Rio de Janeiro, RJ – Brasil
| | - Celso Dario Ramos
- Universidade Estadual de CampinasCampinasSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP – Brasil
| | - José Soares-Junior
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | - Minna Moreira Dias Romano
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | - Wilson Mathias
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | - Marcelo Iório Garcia
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilHospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | | | | | | | - Pedro Manoel Marques Garibaldi
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoRibeirão PretoBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto – Brasil
| | - Aristóteles Comte de Alencar
- Universidade de São PauloHospital das Clínicas da Faculdade de MedicinaInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil
| | | | - Diane Xavier de Ávila
- Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ – Brasil
- Complexo Hospitalar de NiteróiRio de JaneiroRJBrasilComplexo Hospitalar de Niterói, Rio de Janeiro, RJ – Brasil
- Hospital e Maternidade Christóvão da GamaSanto AndréSPBrasilHospital e Maternidade Christóvão da Gama, Santo André, SP – Brasil
- Hospital Universitário Antônio PedroRio de JaneiroRJBrasilHospital Universitário Antônio Pedro (Huap), Rio de Janeiro, RJ – Brasil
| | - Denizar Viana
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - José Francisco Kerr Saraiva
- Sociedade Campineira de Educação e InstruçãoCampinasSPBrasilSociedade Campineira de Educação e Instrução, Campinas, SP – Brasil
| | - Manoel Fernandes Canesin
- Universidade Estadual de LondrinaLondrinaPRBrasilHospital Universitário da Universidade Estadual de Londrina, Londrina, PR – Brasil
| | - Glaucia Maria Moraes de Oliveira
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseRio de JaneiroRJBrasilUniversidade Federal Fluminense (UFF), Rio de Janeiro, RJ – Brasil
- Centro de Ensino e Treinamento Edson de Godoy BuenoRio de JaneiroRJBrasilCentro de Ensino e Treinamento Edson de Godoy Bueno/UHG, Rio de Janeiro, RJ – Brasil
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12
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Marcondes-Braga FG, Moura LAZ, Issa VS, Vieira JL, Rohde LE, Simões MV, Fernandes-Silva MM, Rassi S, Alves SMM, de Albuquerque DC, de Almeida DR, Bocchi EA, Ramires FJA, Bacal F, Rossi JM, Danzmann LC, Montera MW, de Oliveira MT, Clausell N, Silvestre OM, Bestetti RB, Bernadez-Pereira S, Freitas AF, Biolo A, Barretto ACP, Jorge AJL, Biselli B, Montenegro CEL, dos Santos EG, Figueiredo EL, Fernandes F, Silveira FS, Atik FA, Brito FDS, Souza GEC, Ribeiro GCDA, Villacorta H, de Souza JD, Goldraich LA, Beck-da-Silva L, Canesin MF, Bittencourt MI, Bonatto MG, Moreira MDCV, Avila MS, Coelho OR, Schwartzmann PV, Mourilhe-Rocha R, Mangini S, Ferreira SMA, de Figueiredo JA, Mesquita ET. Emerging Topics Update of the Brazilian Heart Failure Guideline - 2021. Arq Bras Cardiol 2021; 116:1174-1212. [PMID: 34133608 PMCID: PMC8288520 DOI: 10.36660/abc.20210367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fabiana G. Marcondes-Braga
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Lídia Ana Zytynski Moura
- Pontifícia Universidade Católica de CuritibaCuritibaPRBrasilPontifícia Universidade Católica de Curitiba, Curitiba, PR – Brasil.
| | - Victor Sarli Issa
- Universidade da AntuérpiaBélgicaUniversidade da Antuérpia, – Bélgica
| | - Jefferson Luis Vieira
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Luis Eduardo Rohde
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Marcus Vinícius Simões
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoSão PauloSPBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP – Brasil.
| | - Miguel Morita Fernandes-Silva
- Universidade Federal do ParanáCuritibaPRBrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR – Brasil.
- Quanta Diagnóstico por ImagemCuritibaPRBrasilQuanta Diagnóstico por Imagem, Curitiba, PR – Brasil.
| | - Salvador Rassi
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Denilson Campos de Albuquerque
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Dirceu Rodrigues de Almeida
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brasil.
| | - Edimar Alcides Bocchi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Felix José Alvarez Ramires
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil.
| | - Fernando Bacal
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - João Manoel Rossi
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil.
| | - Luiz Claudio Danzmann
- Universidade Luterana do BrasilCanoasRSBrasilUniversidade Luterana do Brasil, Canoas, RS – Brasil.
- Hospital São Lucas da PUC-RSPorto AlegreRSBrasilHospital São Lucas da PUC-RS, Porto Alegre, RS – Brasil.
| | | | - Mucio Tavares de Oliveira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Nadine Clausell
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Odilson Marcos Silvestre
- Universidade Federal do AcreRio BrancoACBrasilUniversidade Federal do Acre, Rio Branco, AC – Brasil.
| | - Reinaldo Bulgarelli Bestetti
- Universidade de Ribeirão PretoDepartamento de MedicinaRibeirão PretoSPBrasilDepartamento de Medicina da Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP – Brasil.
| | | | - Aguinaldo F. Freitas
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Andréia Biolo
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Antonio Carlos Pereira Barretto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Antônio José Lagoeiro Jorge
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - Bruno Biselli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Carlos Eduardo Lucena Montenegro
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Edval Gomes dos Santos
- Universidade Estadual de Feira de SantanaFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana, Feira de Santana, BA – Brasil.
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil.
| | - Estêvão Lanna Figueiredo
- Instituto OrizontiBelo HorizonteMGBrasilInstituto Orizonti, Belo Horizonte, MG – Brasil.
- Hospital Vera CruzBelo HorizonteMGBrasilHospital Vera Cruz, Belo Horizonte, MG – Brasil.
| | - Fábio Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Fabio Serra Silveira
- Fundação Beneficência Hospital de CirurgiaAracajuSEBrasilFundação Beneficência Hospital de Cirurgia (FBHC-Ebserh), Aracaju, SE – Brasil.
- Centro de Pesquisa Clínica do CoraçãoAracajuSEBrasilCentro de Pesquisa Clínica do Coração, Aracaju, SE – Brasil.
| | - Fernando Antibas Atik
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília (UnB), Brasília, DF – Brasil.
| | - Flávio de Souza Brito
- Universidade Estadual Paulista Júlio de Mesquita FilhoSão PauloSPBrasilUniversidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São Paulo, SP – Brasil.
| | - Germano Emílio Conceição Souza
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil.
- Hospital Regional de São José dos CamposSão PauloSPBrasilHospital Regional de São José dos Campos, São Paulo, SP – Brasil.
| | - Gustavo Calado de Aguiar Ribeiro
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas (PUCC), Campinas, SP – Brasil.
| | - Humberto Villacorta
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - João David de Souza
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Livia Adams Goldraich
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Luís Beck-da-Silva
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Manoel Fernandes Canesin
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrasilHospital Universitário da Universidade Estadual de Londrina, Londrina, PR – Brasil.
| | - Marcelo Imbroinise Bittencourt
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
- Hospital Universitário Pedro ErnestoRio de JaneiroRJBrasilHospital Universitário Pedro Ernesto, Rio de Janeiro, RJ – Brasil.
| | - Marcely Gimenes Bonatto
- Hospital Santa Casa de Misericórdia de CuritibaCuritibaPRBrasilHospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR – Brasil.
| | | | - Mônica Samuel Avila
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Otavio Rizzi Coelho
- Universidade Estadual de CampinasFaculdade de Ciências MédicasCampinasSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP – Brasil.
| | - Pedro Vellosa Schwartzmann
- Hospital Unimed Ribeirão PretoRibeirão PretoSPBrasilHospital Unimed Ribeirão Preto, Ribeirão Preto, SP – Brasil.
- Centro Avançado de PesquisaEnsino e Diagnóstico (CAPED)Ribeirão PretoSPBrasilCentro Avançado de Pesquisa, Ensino e Diagnóstico (CAPED), Ribeirão Preto, SP – Brasil.
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Sandrigo Mangini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Silvia Moreira Ayub Ferreira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | | | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
- Treinamento Edson de Godoy Bueno / UHGCentro de EnsinoRio de JaneiroRJBrasilCentro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ – Brasil.
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13
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Mesquita ET, Mendes AP, Moura L, Figueiredo Neto JAD, Marcondes-Braga FG, Bacal F, Moreira MDCV, Clausell NO. The Challenges of Heart Failure Yesterday, Today and Tomorrow and the 20 Years of DEIC. Arq Bras Cardiol 2021; 116:359-362. [PMID: 33656090 PMCID: PMC7909977 DOI: 10.36660/abc.20201200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Ana Paula Mendes
- Universidade Federal Fluminense Hospital Universitário Antônio Pedro, Niterói, RJ - Brasil
| | - Lidia Moura
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | - Fabiana G Marcondes-Braga
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
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14
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Delafiori J, Navarro LC, Siciliano RF, de Melo GC, Busanello EN, Nicolau JC, Sales GM, de Oliveira AN, Val FFA, de Oliveira DN, Eguti A, dos Santos LA, Dalçóquio TF, Bertolin AJ, Abreu-Netto RL, Salsoso R, Baía-da-Silva D, Marcondes-Braga FG, Sampaio VS, Judice CC, Costa FT, Durán N, Perroud MW, Sabino EC, Lacerda MV, Reis LO, Fávaro WJ, Monteiro WM, Rocha AR, Catharino RR. Covid-19 Automated Diagnosis and Risk Assessment through Metabolomics and Machine Learning. Anal Chem 2021; 93:2471-2479. [PMID: 33471512 PMCID: PMC8023531 DOI: 10.1021/acs.analchem.0c04497] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 10/24/2020] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Abstract
COVID-19 is still placing a heavy health and financial burden worldwide. Impairment in patient screening and risk management plays a fundamental role on how governments and authorities are directing resources, planning reopening, as well as sanitary countermeasures, especially in regions where poverty is a major component in the equation. An efficient diagnostic method must be highly accurate, while having a cost-effective profile. We combined a machine learning-based algorithm with mass spectrometry to create an expeditious platform that discriminate COVID-19 in plasma samples within minutes, while also providing tools for risk assessment, to assist healthcare professionals in patient management and decision-making. A cross-sectional study enrolled 815 patients (442 COVID-19, 350 controls and 23 COVID-19 suspicious) from three Brazilian epicenters from April to July 2020. We were able to elect and identify 19 molecules related to the disease's pathophysiology and several discriminating features to patient's health-related outcomes. The method applied for COVID-19 diagnosis showed specificity >96% and sensitivity >83%, and specificity >80% and sensitivity >85% during risk assessment, both from blinded data. Our method introduced a new approach for COVID-19 screening, providing the indirect detection of infection through metabolites and contextualizing the findings with the disease's pathophysiology. The pairwise analysis of biomarkers brought robustness to the model developed using machine learning algorithms, transforming this screening approach in a tool with great potential for real-world application.
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Affiliation(s)
- Jeany Delafiori
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
| | - Luiz Cláudio Navarro
- RECOD
Laboratory, Computing Institute, University
of Campinas, Cidade Universitária Zeferino Vaz,, Campinas, São Paulo 573-13083-852, Brazil
| | - Rinaldo Focaccia Siciliano
- Clinical
Division of Infectious and Parasitic Diseases, University of São Paulo Medical School, São Paulo, São Paulo 01246-903, Brazil
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Gisely Cardoso de Melo
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Amazonas
State University, Manaus, Amazonas 25-69040-000, Brazil
| | - Estela Natacha
Brandt Busanello
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
| | - José Carlos Nicolau
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Geovana Manzan Sales
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
| | - Arthur Noin de Oliveira
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
| | - Fernando Fonseca Almeida Val
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Amazonas
State University, Manaus, Amazonas 25-69040-000, Brazil
| | - Diogo Noin de Oliveira
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
| | - Adriana Eguti
- Sumaré
State Hospital, Sumaré, São Paulo 2400-13175-490, Brazil
| | | | - Talia Falcão Dalçóquio
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Adriadne Justi Bertolin
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Rebeca Linhares Abreu-Netto
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Amazonas
State University, Manaus, Amazonas 25-69040-000, Brazil
| | - Rocio Salsoso
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Djane Baía-da-Silva
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Amazonas
State University, Manaus, Amazonas 25-69040-000, Brazil
| | - Fabiana G Marcondes-Braga
- Instituto
do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Cerqueira César, São Paulo 44-05403-90, Brazil
| | - Vanderson Souza Sampaio
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Health
Surveillance Foundation of Amazonas State, Manaus, Amazonas, 4010-69093-018 Brazil
| | - Carla Cristina Judice
- Laboratory
of Tropical Diseases, Institute of Biology, University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, São Paulo 13083-970 Brazil
| | - Fabio Trindade
Maranhão Costa
- Laboratory
of Tropical Diseases, Institute of Biology, University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, São Paulo 13083-970 Brazil
| | - Nelson Durán
- Laboratory
of Urogenital Carcinogenesis and Immunotherapy, University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, São Paulo 13083-865, Brazil
| | | | - Ester Cerdeira Sabino
- Institute
of Tropical Medicine, University of São
Paulo, São Paulo, São Paulo 470-05403-000,Brazil
| | - Marcus Vinicius
Guimarães Lacerda
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Leônidas and Maria Deane Institute, Manaus, Amazonas, 476-69057-070 Brazil
| | - Leonardo Oliveira Reis
- UroScience
Laboratory, University of Campinas, Cidade
Universitária Zeferino Vaz, Campinas, São Paulo 126-13083-887, Brazil
| | - Wagner José Fávaro
- Laboratory
of Urogenital Carcinogenesis and Immunotherapy, University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, São Paulo 13083-865, Brazil
| | - Wuelton Marcelo Monteiro
- Tropical
Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas 69040-000,Brazil
- Amazonas
State University, Manaus, Amazonas 25-69040-000, Brazil
| | - Anderson Rezende Rocha
- RECOD
Laboratory, Computing Institute, University
of Campinas, Cidade Universitária Zeferino Vaz,, Campinas, São Paulo 573-13083-852, Brazil
| | - Rodrigo Ramos Catharino
- Innovare
Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Cidade Universitária
Zeferino Vaz, Campinas, São Paulo 350-13083-970, Brazil
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15
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Marcondes-Braga FG, Vieira JL, Souza Neto JDD, Calado G, Ayub-Ferreira SM, Bacal F, Clausell N. Emerging Topics in Heart Failure: Contemporaneous Management of Advanced Heart Failure. Arq Bras Cardiol 2021; 115:1193-1196. [PMID: 33470324 PMCID: PMC8133710 DOI: 10.36660/abc.20201194] [Citation(s) in RCA: 2] [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: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Fabiana G Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | | | | | - Gustavo Calado
- Pontifícia Universidade Católica de Campinas (PUCC), Campinas, SP - Brasil
| | - Silvia Moreira Ayub-Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HCFMUSP),São Paulo, SP - Brasil
| | - Nadine Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
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16
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Goldraich LA, Leitão SAT, Scolari FL, Marcondes-Braga FG, Bonatto MG, Munyal D, Harrison J, Ribeiro RVP, Azeka E, Piardi D, Costanzo MR, Clausell N. A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation. Curr Pharm Des 2021; 26:3351-3384. [PMID: 32493185 DOI: 10.2174/1381612826666200603130232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.
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Affiliation(s)
- Livia A Goldraich
- Heart Transplantation Unit, Cardiology Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Santiago A Tobar Leitão
- Cardiovascular Research Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul. Porto Alegre, Brazil
| | - Fernando L Scolari
- Cardiovascular Research Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul. Porto Alegre, Brazil
| | | | - Marcely G Bonatto
- Heart Failure Center, Heart Transplantation Program, Hospital Santa Casa de Misericórdia, Curitiba, Brazil
| | - Dipika Munyal
- Multiorgan Transplant, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Jennifer Harrison
- Multiorgan Transplant, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Rafaela V P Ribeiro
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Estela Azeka
- Heart Institute (InCor-HC.FMUSP), University of Sao Paulo, Sao Paulo, Brazil
| | - Diogo Piardi
- Post-graduation Program in Medical Science: Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria R Costanzo
- Heart Failure Research, Advocate Heart Institute, Medical Director, Edward Hospital Center for Advanced Heart Failure, Naperville, Illinois, United States
| | - Nadine Clausell
- Post-graduation Program in Medical Science: Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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17
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Marcondes-Braga FG, Ramires FJA, Figueiredo EL, Figueiredo Neto JA, Beck-da-Silva L, Rassi S. Emerging Topics in Heart Failure: New Era of Pharmacological Treatment. Arq Bras Cardiol 2020; 115:956-960. [PMID: 33295465 PMCID: PMC8452188 DOI: 10.36660/abc.20201106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fabiana G Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor.HCFMUSP), São Paulo, SP - Brasil
| | - Felix J A Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor.HCFMUSP), São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | | | - Luís Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Salvador Rassi
- Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO - Brasil
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18
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de Figueiredo JA, Marcondes-Braga FG, Moura LZ, de Figueiredo AMES, de Figueiredo VMES, Mourilhe-Rocha R, Mesquita ET. Coronavirus Disease 2019 and the Myocardium. Arq Bras Cardiol 2020; 114:1051-1057. [PMID: 32638896 PMCID: PMC8416129 DOI: 10.36660/abc.20200373] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Infection with the coronavirus known as COVID-19 has promoted growing interest on the part of cardiologists, emergency care specialists, intensive care specialists, and researchers, due to the study of myocardial involvement based on different clinical forms resulting from immunoinflammatory and neurohumoral demodulation.Myocardial involvement may be minimal and identifiable only by electrocardiographic changes, mainly increased cardiac troponins, or, on the other side of the spectrum, by forms of fulminant myocarditis and takotsubo syndrome.The description of probable acute myocarditis has been widely supported by the observation of increased troponin in association with dysfunction. Classical definition of myocarditis, supported by endomyocardial biopsy of inflammatory infiltrate, is rare; it has been observed in only one case report to date, and the virus has not been identified inside cardiomyocytes.Thus, the phenomenon that has been documented is acute myocardial injury, making it necessary to rule our obstructive coronary disease based on increased markers of myocardial necrosis, whether or not they are associated with ventricular dysfunction, likely associated with cytokine storms and other factors that may synergistically promote myocardial injury, such as sympathetic hyperactivation, hypoxemia, arterial hypotension, and microvascular thrombotic phenomena.Systemic inflammatory and myocardial phenomena following viral infection have been well documented, and they may progress to cardiac remodeling and myocardial dysfunction. Cardiac monitoring of these patients is, therefore, important in order to monitor the development of the phenotype of dilated myocardiopathy.This review presents the main etiological and physiopathological findings, a description of the taxonomy of these types of cardiac involvement, and their correlation with the main clinical forms of the myocardial component present in patients in the acute phase of COVID-19.
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Affiliation(s)
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,São Paulo, SP - Brasil
| | - Lidia Zytinski Moura
- Pontifícia Universidade Católica do ParanáCuritibaPRBrasilPontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | | | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de JaneiroHospital Pró-cardíacoBrasilUniversidade do Estado do Rio de Janeiro e Hospital Pró-cardíaco. Brasil
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19
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Marcondes-Braga FG, Gioli-Pereira L, Bernardez-Pereira S, Batista GL, Mangini S, Issa VS, Fernandes F, Bocchi EA, Ayub-Ferreira SM, Mansur AJ, Gutz IGR, Krieger JE, Pereira AC, Bacal F. Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients. ESC Heart Fail 2020; 7:1744-1752. [PMID: 32383349 PMCID: PMC7373929 DOI: 10.1002/ehf2.12736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 11/11/2022] Open
Abstract
Aims Exhaled breath acetone (EBA) has been described as a new biomarker of heart failure (HF) diagnosis. EBA concentration increases according to severity of HF and is associated with poor prognosis, especially in acute decompensated HF. However, there are no data on chronic HF patients. The aim is to evaluate the role of EBA for predicting cardiac and overall mortality in chronic HF patients. Methods and results In GENIUS‐HF cohort, chronic patients were enrolled between August 2012 and December 2014. All patients had left ventricular ejection fraction ≤ 50%, and the diagnosis was established according to Framingham criteria. After consent, patients were submitted to clinical evaluation and exhaled breath collection. EBA identification and quantitative determination were done by spectrophotometry. The clinical characteristics associated with acetone were identified. All participants were followed for 18 months to assess cardiac and overall mortality. Around 700 participants were enrolled in the current analysis. Patients were 55.4 ± 12.2 years old, 67.6% male patients, and 81% New York Heart Association I/II with left ventricular ejection fraction of 32 ± 8.6%. EBA median concentration was 0.6 (0.3–1.2) ug/L. Acetone levels increased with the number of symptoms of HF and were associated with right HF signs/symptoms and liver biochemical changes. EBA at highest quartile (EBA > 1.2ug/L) was associated with a significantly worse prognosis (log rank test, P < 0.001). Cox proportional multivariable regression model revealed that EBA > 1.20ug/L was an independent predictor of cardiac (P = 0.011) and overall (P = 0.010) mortality in our population. Conclusions This study shows that EBA levels reflect clinical HF features, especially right HF signs/symptoms. EBA is an independent predictor of cardiac and overall mortality in chronic HF patients.
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Affiliation(s)
- Fabiana G Marcondes-Braga
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Luciana Gioli-Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Sabrina Bernardez-Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | | | - Sandrigo Mangini
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Victor S Issa
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Fabio Fernandes
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Edimar A Bocchi
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Silvia M Ayub-Ferreira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Alfredo J Mansur
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Ivano G R Gutz
- Institute of Chemistry (IQ-USP), University of Sao Paulo, Sao Paulo, Brazil
| | - Jose E Krieger
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Alexandre C Pereira
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Dr Eneas de Carvalho Aguiar, 44-Cerqueira Cesar, São Paulo, 0540300, Brazil
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20
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Cafezeiro CRF, Lopes MP, Silva CT, Ávila MS, Seguro LFBC, Mangini S, Campos IW, Gaiotto FA, Marcondes-Braga FG, Bacal F. Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation. Am J Transplant 2020; 20:1451-1453. [PMID: 31834977 DOI: 10.1111/ajt.15744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/21/2019] [Revised: 11/19/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
Epipericardial fat necrosis is an uncommon clinical condition of unknown etiology. It typically presents as acute pleuritic chest pain and should be differentiated from acute pulmonary embolism and acute coronary syndrome. This condition is diagnosed by characteristic chest computed tomography findings of an ovoid mediastinal fatty lesion with intrinsic and surrounding soft-tissue stranding. Treatment of epipericardial fat necrosis includes the administration of anti-inflammatory agents, and symptoms usually resolve within a few days after treatment initiation. This disease entity has rarely been reported since it was first described in 1957. Most current knowledge of epipericardial fat necrosis is based on case reports that describe this condition in previously healthy individuals. We present the case of a 39-year-old woman with a history of heart transplant, who presented with chest pain secondary to epipericardial fat necrosis. Serial computed tomography revealed lesion resolution after appropriate treatment.
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Affiliation(s)
- Caio Rebouças Fonseca Cafezeiro
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Mariana Pezzute Lopes
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Caio Tavares Silva
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Mônica Samuel Ávila
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Luis Fernando B C Seguro
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Sandrigo Mangini
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Iáscara Wozniak Campos
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Fábio A Gaiotto
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Fabiana G Marcondes-Braga
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Fernando Bacal
- Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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21
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Gioli-Pereira L, Marcondes-Braga FG, Bernardez-Pereira S, Bacal F, Fernandes F, Mansur AJ, Pereira AC, Krieger JE. Predictors of one-year outcomes in chronic heart failure: the portrait of a middle income country. BMC Cardiovasc Disord 2019; 19:251. [PMID: 31706288 PMCID: PMC6842241 DOI: 10.1186/s12872-019-1226-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/30/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge. We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort. Methods We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use. Results We screened 2314 consecutive patients for eligibility and enrolled 700 participants. The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008–1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347–2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969–0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies. Conclusions High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample. Trial registration Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.
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Affiliation(s)
- Luciana Gioli-Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Fabiana G Marcondes-Braga
- Heart Transplant Department, Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Sabrina Bernardez-Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fernando Bacal
- Heart Transplant Department, Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Fábio Fernandes
- Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Alfredo J Mansur
- Heart Institute (InCor) of University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - José E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) of University of São Paulo Medical School, Avenue Dr. Enéas de Carvalho, Aguiar, 44 Cerqueira César, São Paulo, SP, 05403-000, Brazil
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22
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Bacal F, Marcondes-Braga FG, Rohde LEP, Xavier Júnior JL, Brito FDS, Moura LAZ, Colafranceschi AS, Lavagnoli CFR, Gelape CL, Almeida DR, Gaiotto FA, Atik FA, Figueira FAMS, Souza GEC, Rodrigues H, Campos IW, Souza Neto JDD, Rossi Neto JM, Gasparetto J, Goldraich LA, Benvenuti LA, Seguro LFBC, Ulhôa Júnior MB, Moreira MDCV, Ávila MS, Carneiro R, Mangini S, Ferreira SMA, Strabelli TM. 3ª Diretriz Brasileira de Transplante Cardíaco. Arq Bras Cardiol 2019; 111:230-289. [PMID: 30335870 DOI: 10.5935/abc.20180153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fernando Bacal
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | - Cláudio Leo Gelape
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Fábio Antônio Gaiotto
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Hélcio Rodrigues
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - Iáscara Wozniak Campos
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luiz Alberto Benvenuti
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Mônica Samuel Ávila
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - Rodrigo Carneiro
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE - Brasil
| | - Sandrigo Mangini
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Tânia Mara Strabelli
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
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23
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Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DCD, Rassi S, Colafranceschi AS, Freitas AFD, Ferraz AS, Biolo A, Barretto ACP, Ribeiro ALP, Polanczyk CA, Gualandro DM, Almeida DR, Silva ERRD, Figueiredo EL, Mesquita ET, Marcondes-Braga FG, Cruz FDDD, Ramires FJA, Atik FA, Bacal F, Souza GEC, Almeida GLGD, Ribeiro GCDA, Villacorta H, Vieira JL, Souza JDD, Rossi JM, Figueiredo JAD, Moura LAZ, Goldraich LA, Beck-da-Silva L, Danzmann LC, Canesin MF, Bittencourt MI, Garcia MI, Bonatto MG, Simões MV, Moreira MDCV, Silva MMFD, Olivera MTD, Silvestre OM, Schwartzmann PV, Bestetti RB, Rocha RM, Simões R, Pereira SB, Mangini S, Alves SMM, Ferreira SMA, Issa VS, Barzilai VS, Martins WDA. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol 2019; 111:436-539. [PMID: 30379264 DOI: 10.5935/abc.20180190] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Antonio C. Pereira Barretto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Danielle Menosi Gualandro
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | - Estêvão Lanna Figueiredo
- Hospital Lifecenter, Belo Horizonte, MG - Brasil.,Hospital Vera Cruz, Belo Horizonte, MG - Brasil
| | | | - Fabiana G. Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fátima das Dores da Cruz
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Felix José 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
| | - Germano Emilio Conceição Souza
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Regional de São José dos Campos, São José dos Campos, SP - Brasil
| | | | | | | | | | - João David de Souza
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - Brasil
| | | | | | | | | | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Luiz Claudio Danzmann
- Universidade Luterana do Brasil, Canoas, RS - Brasil.,Hospital da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Maria da Consolação Vieira Moreira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Mucio Tavares de Olivera
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Pedro Vellosa Schwartzmann
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil.,Hospital Unimed Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | | | | | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Sandrigo Mangini
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Silvia Moreira Ayub Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Victor Sarli Issa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Wolney de Andrade Martins
- Universidade Federal Fluminense, Niterói, RJ - Brasil.,Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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24
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Abstract
PURPOSE Heart transplantation is the gold standard treatment for advanced heart failure. Left ventricular assist devices (LVADs), despite being a good option for these patients, are not quite available in developing countries. Time spent in heart transplant waiting list has increased lately even in regions where the number of transplants has also risen showing that a new strategy should be sought. RECENT FINDINGS Transplant process organization combined with multidisciplinary work are linked to better outcomes while improvement in donor's care and in pre-transplant evaluation might be opportunities to change the long waiting list scenario. For the first time in Brazil, a survey with the most expressive heart transplant centers has been made, which allows an overview of treatment of advanced heart failure in a developing country. We also described a model of heart transplant team, which has proved to be a success when compared to the largest heart transplant centers in Latin America.
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Affiliation(s)
- Fabiana G Marcondes-Braga
- Heart Transplantation Department, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
| | | | | | - Fernando Bacal
- Heart Transplantation Department, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
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25
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Siciliano RF, Gualandro DM, Felicio MS, Paixao MR, Marcondes-Braga FG, Oliveira Jr MT, Soeiro A, Tarasoutch F, Caramelli B, Strunz C, Pacanaro AP, Bittencourt MS, Mansur AJ, Pereira-Barretto AC, Strabelli TMV. P4195Biomarkers for the prediction of mortality in patients with infective endocarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R F Siciliano
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
| | - D M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - M S Felicio
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
| | - M R Paixao
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - F G Marcondes-Braga
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - M T Oliveira Jr
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A Soeiro
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - F Tarasoutch
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - C Strunz
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - A P Pacanaro
- Heart Institute (InCor), University of São Paulo Medica School, Laboratory, Sao Paulo, Brazil
| | - M S Bittencourt
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A J Mansur
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - A C Pereira-Barretto
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology, São Paulo, Brazil
| | - T M V Strabelli
- Heart Institute (InCor), University of São Paulo Medical School, Infection Control Team, São Paulo, Brazil
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26
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Seguro LFBC, Seguro LPC, Marcondes-Braga FG, Caparbo VP, Takayama L, Mangini S, Avila MS, Wozniak I, Gaiotto FA, Pereira RMR, Bacal F. P2802Vertebral fractures and bone metabolism impairment after heart transplant: results from a prospective cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2802] [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)
- L F B C Seguro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L P C Seguro
- University of Sao Paulo, Laboratόrio de Metabolismo Ósseo da Faculdade de Medicina da USP, Sao Paulo, Brazil
| | | | - V P Caparbo
- University of Sao Paulo, Laboratόrio de Metabolismo Ósseo da Faculdade de Medicina da USP, Sao Paulo, Brazil
| | - L Takayama
- University of Sao Paulo, Laboratόrio de Metabolismo Ósseo da Faculdade de Medicina da USP, Sao Paulo, Brazil
| | - S Mangini
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M S Avila
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - I Wozniak
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F A Gaiotto
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R M R Pereira
- University of Sao Paulo, Laboratόrio de Metabolismo Ósseo da Faculdade de Medicina da USP, Sao Paulo, Brazil
| | - F Bacal
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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27
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Nadruz W, Gioli-Pereira L, Bernardez-Pereira S, Marcondes-Braga FG, Fernandes-Silva MM, Silvestre OM, Sposito AC, Ribeiro AL, Bacal F, Fernandes F, Krieger JE, Mansur AJ, Pereira AC. Temporal trends in the contribution of Chagas cardiomyopathy to mortality among patients with heart failure. Heart 2018. [PMID: 29523589 DOI: 10.1136/heartjnl-2017-312869] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chagas cardiomyopathy (ChC) prevalence is decreasing in Brazil and medical therapies for heart failure (HF) have improved in the last decade. Whether these changes modified the prognosis of ChC relative to non-Chagas cardiomyopathies (NChC) remains unknown. This study evaluated the temporal trends in population attributable risk (PAR) of ChC for 2-year mortality among patients with HF enrolled at years 2002-2004 (era 1) and 2012-2014 (era 2) in a Brazilian university hospital. METHODS We prospectively studied 362 (15% with ChC) and 582 (18% with ChC) HF patients with ejection fraction ≤50% in eras 1 and 2, respectively and estimated the PAR of ChC for 2-year mortality. RESULTS There were 145 deaths (29 in ChC) in era 1 and 85 deaths (26 in ChC) in era 2. In multivariable Cox-regression analysis adjusted for age, sex, ejection fraction, heart rate, body mass index, hypertension, diabetes mellitus, systolic blood pressure and ischaemic/valvar aetiology, ChC was associated with higher risk of death in era 1 (HR (95% CI)=1.92 (1.00 to 3.71), p=0.05) and era 2 (HR (95% CI)=3.51 (1.94 to 6.36), p<0.001). In fully adjusted analysis, the PAR of ChC for mortality increased twofold from era 1 (PAR (95% CI)=11.0 (2.8 to 18.5)%) to era 2 (PAR (95% CI)=21.9 (16.5 to 26.9)%; p=0.023 versus era 1). CONCLUSION Although the absolute death rates decreased over time in the ChC and NChC groups, the PAR of ChC for mortality increased among patients with HF, driven by increases in the HR associated with ChC. Our results highlight the need for additional efforts aiming to prevent and treat ChC.
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Affiliation(s)
- Wilson Nadruz
- Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | | | | | | | - Miguel M Fernandes-Silva
- Medicine Department, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Research Department, Quanta Diagnósticos e Terapia, Curitiba, Brazil
| | - Odilson M Silvestre
- Department of Internal Medicine, Federal University of Acre, Rio Branco, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Antonio L Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Bacal
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Fernandes
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jose E Krieger
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alfredo J Mansur
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Soeiro ADM, Mansur ADP, Schaan BD, Caramelli B, Rochitte CE, Serrano CV, Garzillo CL, Calderaro D, Gualandro DM, Lima EG, Marcondes-Braga FG, Lima FG, Oliveira FMD, Azevedo FR, Chauhan H, Salles JEN, Soares J, Cardoso JN, Pellanda LC, Sacilotto L, Baracioli L, Bortolotto LA, César LAM, Ochiai ME, Minami MH, Pinheiro MB, Moretti MA, Oliveira MTD, Rezende PC, Lemos PA, Admoni SN, Lottenberg SA, Rocha VZ, Hueb W, Mathias W. I Diretriz sobre Aspectos Específicos de Diabetes (tipo 2) Relacionados à Cardiologia. Arq Bras Cardiol 2018; 102:1-41. [PMID: 27223869 DOI: 10.5935/abc.2014s002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Marcondes-Braga FG, Batista GL, Gutz IGR, Saldiva PHN, Mangini S, Issa VS, Ayub-Ferreira SM, Bocchi EA, Pereira AC, Bacal F. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up. PLoS One 2016; 11:e0168790. [PMID: 28030609 PMCID: PMC5193433 DOI: 10.1371/journal.pone.0168790] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 07/28/2016] [Accepted: 12/06/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis. OBJECTIVES To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF). METHODS After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months. RESULTS The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56-6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels. CONCLUSIONS High EBA levels could be associated to poor prognosis in HFrEF patients.
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Affiliation(s)
- Fabiana G. Marcondes-Braga
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
- * E-mail:
| | - Guilherme L. Batista
- Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270—Cidade Universitária
| | - Ivano G. R. Gutz
- Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270—Cidade Universitária
| | - Paulo H. N. Saldiva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr. Arnaldo, 455, 1° andar
| | - Sandrigo Mangini
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
| | - Victor S. Issa
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia M. Ayub-Ferreira
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edimar A. Bocchi
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil Av.Dr. Eneas de Carvalho Aguiar, 44–10°. andar
| | - Fernando Bacal
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
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Bernardez-Pereira S, Gioli-Pereira L, Marcondes-Braga FG, Santos PCJL, Spina JMR, Horimoto ARVR, Santos HC, Bacal F, Fernandes F, Mansur AJ, Pietrobon R, Krieger JE, Mesquita ET, Pereira AC. Genomic ancestry as a predictor of haemodynamic profile in heart failure. Open Heart 2016; 3:e000434. [PMID: 27547430 PMCID: PMC4975862 DOI: 10.1136/openhrt-2016-000434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/05/2016] [Accepted: 06/28/2016] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study is to assess the association between genetic ancestry, self-declared race and haemodynamic parameters in patients with chronic heart failure (HF). Methods Observational, cross-sectional study. Eligible participants were aged between 18 and 80 years; ejection fraction was ≤50%. Patients underwent genetic analysis of ancestry informative markers, echocardiography and impedance cardiography (ICG). Race was determined by self-classification into two groups: white and non-white. Genomic ancestry was estimated using a panel of 101 348 polymorphic markers and three continental reference populations (European, African and Native American). Results Our study included 362 patients with HF between August 2012 and August 2014. 123 patients with HF declared themselves as white and 234 patients declared themselves as non-white. No statistically significant differences were found regarding the ICG parameters according to self-declared race. The Amerindian ancestry was positively correlated with systolic time ratio (r=0.109, p<0.05). The thoracic fluid content index (r=0.124. p<0.05), E wave peak (r=0.127. p<0.05) and E/e′ ratio (r=0.197. p<0.01) were correlated positively with African ancestry. In multiple linear regression, African ancestry remained associated with the E/e′ ratio, even after adjustment to risk factors. Conclusions The African genetic ancestry was associated with worse parameters of diastolic function; the Amerindian ancestry correlated with a worse pattern of ventricular contractility, while self-declared colour was not helpful to infer haemodynamic profiles in HF. Trials registration number NTC02043431.
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Affiliation(s)
- Sabrina Bernardez-Pereira
- Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil; Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | | | - Fernando Bacal
- Heart Institute, University of São Paulo Medical School , Sao Paulo , Brazil
| | - Fábio Fernandes
- Heart Institute, University of São Paulo Medical School , Sao Paulo , Brazil
| | - Alfredo Jose Mansur
- Heart Institute, University of São Paulo Medical School , Sao Paulo , Brazil
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Ayub-Ferreira SM, Mangini S, Issa VS, Cruz FD, Bacal F, Guimarães GV, Chizzola PR, Conceição-Souza GE, Marcondes-Braga FG, Bocchi EA. Mode of death on Chagas heart disease: comparison with other etiologies. a subanalysis of the REMADHE prospective trial. PLoS Negl Trop Dis 2013; 7:e2176. [PMID: 23638197 PMCID: PMC3636047 DOI: 10.1371/journal.pntd.0002176] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 03/12/2013] [Indexed: 01/01/2023] Open
Abstract
Background Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy. Methods and results We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34–5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04–1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97–0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47–6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01–1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34–0.94; p = 0.014) were independently associated with sudden death mortality. Conclusions In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death. Trial Registration ClinicalTrails.gov NCT00505050 (REMADHE) Chagas disease remains a burden for public health systems in Latin American countries. Several authors believe that sudden death is the main cause of death in this population. So many efforts have been made to prevent sudden death in Chagas disease. In order to verify if sudden death is the leading cause of death in Chagasic heart failure, we performed a subanalysis of the REMADHE prospective trial, which included a population of outpatients in a tertiary referral center for heart failure. We grouped patients according to etiology (Chagas vs non-Chagas) and modes of death that were classified as progressive heart failure death, sudden death, other cardiovascular death, noncardiovascular death or unknown death. Our study showed that in this end of the spectrum of presentation of Chagas disease, with systolic heart dysfunction, progressive heart failure is the main mode of death. These data have implications for the development of new strategies for prevention of chagasic heart failure.
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Affiliation(s)
- Silvia M Ayub-Ferreira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Marcondes-Braga FG, Gutz IGR, Batista GL, Saldiva PHN, Ayub-Ferreira SM, Issa VS, Mangini S, Bocchi EA, Bacal F. Exhaled acetone as a new biomaker of heart failure severity. Chest 2012; 142:457-466. [PMID: 22345382 DOI: 10.1378/chest.11-2892] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity. METHODS Of 235 patients with systolic dysfunction evaluated between May 2009 and September 2010, 89 patients (HF group) fulfilled inclusion criteria and were compared with sex- and age-matched healthy subjects (control group, n = 20). Patients with HF were grouped according to clinical stability (acute decompensated HF [ADHF], n = 59; chronic HF, n = 30) and submitted to exhaled breath collection. Identification of chemical species was done by gas chromatography-mass spectrometry and quantification by spectrophotometry. Patients with diabetes were excluded. RESULTS The concentration of exhaled breath acetone (EBA) was higher in the HF group (median, 3.7 μg/L; interquartile range [IQR], 1.69-10.45 μg/L) than in the control group (median, 0.39 μg/L; IQR, 0.30-0.79 μg/L; P < .001) and higher in the ADHF group (median, 7.8 μg/L; IQR, 3.6-15.2 μg/L) than in the chronic HF group (median, 1.22 μg/L; IQR, 0.68-2.19 μg/L; P < .001). The accuracy and sensitivity of this method in the diagnosis of HF and ADHF were about 85%, a value similar to that obtained with B-type natriuretic peptide (BNP). EBA levels differed significantly as a function of severity of HF (New York Heart Association classification, P < .001). There was a positive correlation between EBA and BNP (r = 0.772, P < .001). CONCLUSIONS EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity.
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Affiliation(s)
- Fabiana G Marcondes-Braga
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Ivano G R Gutz
- Chemistry Institute, University of São Paulo, São Paulo, Brazil
| | | | - Paulo H N Saldiva
- Laboratory of Experimental Air Pollution, Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Silvia M Ayub-Ferreira
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor S Issa
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sandrigo Mangini
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edimar A Bocchi
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Bacal
- Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Bocchi EA, Marcondes-Braga FG, Bacal F, Ferraz AS, Albuquerque D, Rodrigues D. Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012. Arq Bras Cardiol 2012; 98:1-33. [DOI: 10.1590/s0066-782x2012001000001] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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