Divisão de Pesquisa

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    Relationship-centred care: antidote, guidepost or blind alley? The epistemology of 21st century health care
    (Journal of Evaluation in Clinical Practice, 2014-06) Wyer, Peter; Silva, Suzana Alves da; Post, Stephen G; Quinlan, Patricia
    Contemporary health care is increasing in complexity and lacks a unifying understanding of epistemology, methodology and goals. Lack of conceptual consistency in concepts such as 'patient-centred care' (PCC) typifies system-wide discordance. We contrast the fragmented descriptions of PCC and related tools to its own origins in the writings of Balint and to a subsequent construct, relationship-centred care (RCC). We identify the explicit and elaborated connection between RCC and a defined epistemological foundation as a distinguishing feature of the construct and we demonstrate that this makes possible the recognition of alignments between RCC and independently developed constructs. Among these, we emphasize Schon's reflective practice, Nonaka's theory of organizational knowledge creation and the research methodology of realist synthesis. We highlight the relational principles common to these domains and to their common epistemologies and illustrate unsatisfying consequences of adherence to less adequate epistemological frameworks such as positivism. We offer RCC not as an 'antidote' to the dilemmas identified at the outset but as an example that illuminates the value and importance of explicit identification of the premises and assumptions underlying approaches to improvement of the health care system. We stress the potential value of identifying epistemological affinities across otherwise disparate fields and disciplines. Keywords: evidence-based medicine; patient-centred care; person-centred medicine.
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    Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings
    (BMC Cardiovascular Disorders, 2015) Migowski, Arn; Ribeiro, Antonio Luiz; Carvalho, Marilia Sá; Azevedo, Vitor Manuel Pereira; Chaves, Rogério Brant Martins; Hashimoto, Lucas de Aquino; Xavier, Carolina de Aquino; Xavier, Regina Maria de Aquino
    Background: The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS). Methods: All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models. Results: There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02). Conclusions: The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
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    'One mission accomplished, more important ones remain': commentary on Every-Palmer, S., Howick, J. (2014) How evidence-based medicine is failing due to biased trials and selective publication. Journal of Evaluation in Clinical Practice, 20 (6), 908-914
    (Journal of Evaluation in Clinical Practice, 2015-06) Wyer, Peter; Silva, Suzana Alves da
    Every-Palmer and Howick suggest that evidence-based medicine (EBM) is failing in its mission because of contamination of research by manufacturer and researcher-motivated bias and self-interest. They fail to define that mission and to distinguish between the EBM movement and the research enterprise it was developed to critique. An educational movement, EBM accomplished its mission to simplify and package clinical epidemiological concepts in a form accessible to clinical learners. Its wide adoption within educational circles fostered critical literacy among several generations of practitioners. Illumination of bias, subterfuge and incomplete reporting of research has been a strength of EBM. Increased uptake and use of clinical research within the health care system properly defines the failing mission that eludes Every-Palmer and Howick. Responsibility for failure to make progress towards its achievement is shared by virtually all relevant streams within the system, including policy, clinical guideline development, educational movements and the development of approaches to evidence synthesis. Discordance between the epistemological premises pervading today’s research and health care community and the complex social processes that ultimately determine research use constitutes an important factor that must be addressed as part of a remedy. Enhanced emphasis on and demonstration of alternative approaches to research such as realism and realist synthesis and the momentum towards development of a learning health care system hold promise as guideposts for the rapidly evolving health care environment.
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    Aborted sudden cardiac death in A 12 old girl - a rare manifestation of a common disease
    (Cambridge University Press, 2023) Machado, Hérica Falci Ferreira; Araujo, Yasmin Farias Rodrigues; Innocenze, Adriana Macintyre; Malan, Iara Atié; Tzirulnik, Pedro Cunha; Soares, Viviane Xavier; Faria, Catharina de Almeida Serra; Marins, Marina Conrado Riedel; Silva, Renata Mattos
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    Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses
    (Tropical Medicine and Infectious Disease, 2024) Moreira, Gabriel Santiago; Feijóo, Nícolas de Albuquerque Pereira; Tinoco-da-Silva, Isabella Braga; Aguiar, Cyntia Mendes; Conceição, Francijane Oliveira da; Castro, Gustavo Campos Monteiro de; Carvalho, Mariana Giorgi Barroso de; Almeida, Thatyane Veloso de Paula Amaral de; Garrido, Rafael Quaresma; Lamas, Cristiane da Cruz
    Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8–34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.
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    TAKAYASU ARTERITIS: DIFFERENTIAL DIAGNOSIS OF AORTIC COARCTATION IN ADULTS
    (Journal of the American College of Cardiology, 2024) Nishijuka, Fabio Akio; Carnevale, Bruna; Carrasco, Maria Clara; Fernandes, Larissa; Loureiro, Mariana; Santos, Natália Carvalheira; Carvalho, Maria Cecilia; Sieiro, Ana Gabriela Vidal; Pereira, Milena Oliveira Costa; Innocenzi, Adriana Macintyre; Oliveira, Regis; Monteiro, Thaissa; Gottgtroy, Carla
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    Diretrizes da Sociedade Brasileira de Cardiologia: Novas Normas, Novos Desafios
    (Arquivos Brasileiros de Cardiologia, 2024) Polanczyk, Carisi A.; Luna, Leonardo Castro; Rey, Helena Cramer Veiga; Moreira, Humberto Graner; Arruda, José Airton de; Silva, Pedro Gabriel Melo de Barros e; Rocha, Mario de Seixas
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    Biomarcadores na Avaliação de Pacientes Submetidos à Quimioterapia com Antraciclinas
    (Arquivos Brasileiros de Cardiologia, 2024) Issa, Aurora Felice Castro
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    Ingestão de Ácidos Graxos na Prevenção Cardiovascular: A Incessante Busca pela Adequação
    (Arquivos Brasileiros de Cardiologia, 2024) Santos, Elisa Maia dos; Huguenin, Grazielle Vilas Bôas
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    Cardiac and Liver Fibrosis Assessed by Multiparametric MRI in Patients with Fontan Circulation
    (Pediatric Cardiology, 2024) Innocenzi, Adriana; Rangel, Isabela; Póvoa‐Corrêa, Mariana; Parente, Daniella Braz; Perez, Renata; Rodrigues, Rosana Souza; Fukuyama, Lúcia Tomoko; Barroso, Julia Machado; Oliveira Neto, Jaime Araújo; Sousa, Andréa Silvestre de; Luiz, Ronir Raggio; Barbosa, Rosa Célia Pimentel; Camargo, Gabriel Cordeiro; Moll‐Bernardes, Renata
    The abnormal hemodynamics in Fontan circulation due to persistently increased systemic venous pressure results in hepatic venous congestion and Fontan-associated liver disease. Combined assessment of cardiac and liver fbrosis and cardiac remodeling using multiparametric MRI in this context have not been fully explored. To evaluate cardiac and liver fbrosis and cardiac remodeling using multiparametric MRI in patients who have undergone Fontan procedures. Thirty-eight patients and 23 controls underwent cardiac and liver MRI examinations in a 3.0-T scanner. Mann–Whitney, Fisher exact test, and Spearman’s correlation were applied to evaluate myocardial volumes, function, native cardiac and liver T1 mapping, ECVs and liver stifness. The mean native cardiac T1 value (p=0.018), cardiac ECV (p<0.001), liver native T1 (p<0.001), liver ECV (p<0.001), and liver stifness (p<0.001) were higher in patients than controls. The indexed end-diastolic volume (EDVi) correlated with the myocardial ECV (r=0.356; p=0.033), native liver T1 (r=0.571; p<0.001), and with liver stif- ness (r=0.391; p=0.015). In addition, liver stifness correlated with liver ECV (r=0.361; p=0.031) and native liver T1 (r=0.458; p=0.004). An association between cardiac remodeling and cardiac and liver fbrosis were found in this population. The usefulness of MRI to follow cardiac and liver involvement in these patients is critical to improve treatment strategies and to prevent the need for combined liver and heart transplantation.
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    AORTIC DISSECTION WITH A BICUSPID AORTIC VALVE RESULTING IN ST-ELEVATION MYOCARDIAL INFARCTION
    (Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Soares, Amanda Marinho; Reis, Leonardo; Brandão, Luiza Fonseca; Dantas, Carlos; Nishijuka, Fabio Akio
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    PULSATILE MASS IN THE THORAX CAUSED BY SYPHILITIC AORTITIS
    (Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Pereira, Nelson Bonifacio; Reis, Leonardo; Brito, Izadora Bighetti; Brandão, Luiza Fonseca; Dantas, Carlos; Bech, Gregory; Lynch, Rafaela; Nishijuka, Fabio Akio
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    AORTIC DISSECTION DIAGNOSED DURING TREATMENT OF HYDATIDIFORM MOLE: A CASE REPORT
    (Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Deorsola, Breno; Leal, Stella; Brito, Izadora Bighetti; Velloso, Nathalia; Stockler, Márcia Olivares; Nishijuka, Fabio Akio
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    Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions
    (Catheterization and Cardiovascular Interventions, 2024) Filho, Evandro M.; Araujo, Gustavo N.; Machado, Guilherme P.; Padilla, Lucio; Paula, João E. T. de; Botelho, Antonio C.; Campos, Carlos M.; Quesada, Franklin L. H.; Alcantara, Marco; Santiago, Ricardo; Santos, Félix D. de los; Oliveira, Marcos D.; Ribeiro, Marcelo H.; Perez, Luiz; Pinto, Mauro E.; Côrtes, Leandro A.; Piccaro, Pedro; Brilakis, Emmanouil S.; Quadros, Alexandre S.
    Background: Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. Aim: Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all‐cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. Results: From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J‐CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78–2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41–2.41, p = 0.986), in‐hospital death (OR: 1.39, 95% CI: 0.54–3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52–2.19, p = 0.850) were similar in both groups. Conclusion: In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
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    Fontan Associated Liver Disease (FALD) - When Should We Consider Combined Heart-lung Transplant
    (Journal of Cardiac Failure, 2024) MONTEIRO, THAISSA SANTOS; ZORZ, MARIANA; JUSTINIANO, MARINA; PAES, LUIZA; INNOCENZI, ADRIANA; SILVA, RENATA MATTOS; PEREIRA, NELSON BONIFACIO; NISHIJUKA, FABIO
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    Diretriz Brasileira de Ergometria em População Adulta – 2024
    (Arquivos Brasileiros de Cardiologia, 2024) Carvalho, Tales de; Freitas, Odilon Gariglio Alvarenga de; Chalela, William Azem; Hossri, Carlos Alberto Cordeiro; Milani, Mauricio; Buglia, Susimeire; Precoma, Dalton Bertolim; Falcão, Andréa Maria Gomes Marinho; Mastrocola, Luiz Eduardo; Castro, Iran; Albuquerque, Pedro Ferreira de; Coutinho, Ricardo Quental; Brito, Fabio Sandoli de; Alves, Josmar de Castro; Serra, Salvador Manoel; Santos, Mauro Augusto dos; Colombo, Clea Simone Sabino de Souza; Stein, Ricardo; Herdy, Artur Haddad; Silveira, Anderson Donelli da; Castro, Claudia Lucia Barros de; Silva, Miguel Morita Fernandes da; Meneghello, Romeu Sergio; Ritt, Luiz Eduardo Fonteles; Malafaia, Felipe Lopes; Pena, José Luiz Barros; Almeida, Antônio Eduardo Monteiro de; Vieira, Marcelo Luiz Campos; Júnior, Arnaldo Laffitte Stier
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    Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study
    (British Journal of Sports Medicine, 2024) Ferrari, Filipe; Silveira, Anderson D da; Ziegelmann, Patrícia K; Aleixo, Haroldo; Dilda, Guilherme D; Emed, Luiz G M; Magalhães, Flávia C O; Cardoso, Fernando B; Silva, Henrique C da; Guerra, Felipe E F; Soares, Luciano G; Bassan, Fernando; Braga, Fabrício; Herdy, Artur H; Froelicher, Victor; Stein, Ricardo; B-Pro Foot ECG Collaborators
    Objectives To evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players. Methods The ’B-Pro Foot ECG’ is a multicentre observational study conducted in 82 Brazilian professional clubs. It analysed 6125 players aged 15–35 years (2496 white, 2004 mixed-race and 1625 black individuals) who underwent cardiovascular screening from 2002 to 2023. All ECGs were reviewed by two experienced cardiologists in the athlete’s care. Those with abnormal findings underwent further investigations, including a transthoracic echocardiogram (TTE). Cardiac magnetic resonance (CMR) was subsequently performed based on TTE findings or clinical suspicion. Results In total, 180 (3%) players had abnormal ECGs and 176 (98%) showed normal TTE results. Athletes aged 26–35 years had a higher prevalence of abnormal ECGs than younger athletes (15–25 years). Black players had a higher prevalence of T-wave inversion (TWI) in the inferior leads than white players (2.6% vs 1.4%; p=0.005), as well as in V5 (2.9%) and V6 (2.1%) compared with white (1.2% and 1.0%; p<0.001) and mixed-race (1.5% and 1.2%; p<0.05) players, respectively. TTE parameters were similar across ethnicities. However, four out of 75 players with inferolateral TWI showed abnormal TTEs and CMR findings consistent with cardiomyopathies. CMR also showed cardiomyopathies or myocarditis in four players with inferolateral TWI and normal TTEs. In total, nine (0.1%) athletes were diagnosed with cardiac diseases and were followed for 40±30 months, with no cardiac events documented. Conclusion This study found a 3% prevalence of abnormal ECGs in male Brazilian football players. Inferolateral TWI was associated with cardiac pathologies confirmed by CMR, even in athletes with a normal TTE.
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    Chronic Dissection Of The Ascending Aorta Leading To Heart Failure
    (Journal of the American College of Cardiology, 2024) MONTEIRO, THAISSA; ZORZI, MARIANA; JUSTINIANO, MARINA; PAES, LUIZA DE MOARES PIRES; VIANNA, DIEGO SARTY; NISHIJUKA, FABIO
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    TACHYCARDIOMYOPATHY AND ATRIAL FIBRILLATION IN A PATIENT WITH TOTAL SITUS INVERSUS
    (Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Gutterres, Diogo Barros; Lynch, Rafaela; Carreiro, Ana Clara; Corvisier, Maurício; Nishijuka, Fabio Akio