Artigos Mestrado CC

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    Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT)
    (Circulation, 2011) ACT Investigators; Tura, Bernardo R; Santos Junior, Bráulio dos; Cramer, Helena
    Background: It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury. Methods and results: We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P=0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P=0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment. Conclusions: In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography. Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT00736866.
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    Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery
    (Revista Brasileira de Cirurgia Cardiovascular, 2012) Rocha, Antônio Sergio C. da; Pittella, Felipe; De Lorenzo, Andrea; Barzan, Valmir; Colafranceschi, Alexandre Siciliano; Brito, José Oscar R.; Mattos, Marco Antonio de; Silva, Paulo Roberto Dutra da
    Objetivo: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM) isolada com circulação extracorpórea em pacientes com idade ³ 70 anos em comparação àqueles com < 70 anos. Métodos: Pacientes submetidos consecutivamente à CRVM isolada. Os pacientes foram agrupados em G1 (idade³ 70 anos) e G2 (idade < 70 anos). Os desfechos analisados foram letalidade hospitalar, infarto agudo miocárdio (IAM), acidente vascular encefálico (AVE), reoperação para revisão de hemostasia (RRH), necessidade de balão intra-aórtico (BIA), complicações respiratórias, insuficiência renal aguda (IRA), mediastinite, sepse, fibrilação atrial (FA) e bloqueio atrioventricular total (BAVT). Resultados: Foram estudados 1033 pacientes, 257 (24,8%) do G1 e 776 (75,2%) do G2. A letalidade hospitalar foi significantemente maior no G1 quando comparado ao G2 (8,9% vs. 3,6%, P=0,001), enquanto a incidência de IAM foi semelhante (5,8% vs. 5,5%; P=0,87). Maior número de pacientes do G1 necessitou de RRH (12,1% vs. 6,1%; P=0,003). Da mesma forma, no G1 houve maior incidência de complicações respiratórias (21,4% vs. 9,1%; P<0,001), mediastinite (5,1% vs. 1,9%; P=0,013), AVE (3,9% vs. 1,3%; P=0,016), IRA (7,8% vs. 1,3%, P<0,001), sepse (3,9% vs. 1,9%; P=0,003), fibrilação atrial (15,6% vs. 9,8%; P=0,016) e BAVT (3,5% vs. 1,2%; P=0,023) do que o G2. Não houve diferença significante na necessidade de BIA. Na análise regressão logística multivariada “forward stepwise”, a idade ³ 70 anos foi fator preditivo independente para maior.
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    The association of selenium status with thyroid hormones and anthropometric values in dyslipidemic patients
    (Nutrición Hospitalaria, 2015) Carvalho, Roberta F; Rosa, Glorimar; Huguenin, Grazielle VB; Luiz, Ronir R; Moreira, Annie SB; Oliveira, Glaucia MM
    Background: Selenium (Se) is an essential micronu- trient that performs physiological functions in the meta- bolism of thyroid hormone and may have an association with anthropometric variables relevant to cardiovascu- lar disease. Aim: To study the associations between Se status, thyroid hormones and anthropometric variables in dyslipidemic patients.Methods: Eighty-three patients were assessed in a cross-sectional study. Blood samples were analyzed for Se and thyroid hormones. Anthropo- metric measurements were taken, and dietary Se intake was investigated. Results: Mean plasma Se concentrations were low in the patients, at 88.7 ± 16.7 μg/L. Patients with plasma Se ≥ 95 μg/L were found to have a higher body mass index (BMI) (30.74 ± 4.31 vs 27.68 ± 5.63 kg/m2 , P = 0.02) and waist-to-height ratio (0.65 ± 0.05 vs 0.59 ± 0.07, P = 0.003) when compared to those with concentrations between 80 and 94 μg/L. Se intake associated positively with T3 L/T4 L ratio (r = 0.273; P= 0.03), BMI (r= 0.257, P= 0.04) and WC (r= 0.299, P= 0.02). Conclusion: The patients with the highest normal plasma Se concentrations were found to have increases in the anthropometric variables we in- vestigated. There is a need for further study in order to elucidate these findings. Furthermore, we found a positi- ve association between Se intake and the most metaboli- cally active form of the thyroid hormones.
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    Budget Impact of Cryoablation Versus Radiofrequency Ablation of Atrial Fibrillation in the Brazilian Public Healthcare System
    (Value in Health Regional Issues, 2019) Paço, Patricia; Tura, Bernardo; Santos, Marisa; Amparo, Pedro; De Lorenzo, Andrea
    Background: Cryoablation is a new technology for ablation of atrial fibrillation (AF), effective and safe when compared with standard radiofrequency (RF) ablation. Nevertheless, the economic impact of its incorporation is unknown, especially considering the public health system of a developing country. This study analyzed the budget impact of cryoablation incorporation for treatment of paroxysmal AF in the Brazilian public health system. Methods: The budget impact was calculated as the cost difference between the current scenario (RF ablation guided by electroanatomic mapping) and the new scenario (cryoablation). The cost of each intervention was obtained by multiplying the price of a single procedure by the number of candidates for it. Other technologies (RF ablation guided by intracardiac echocardiography or with a nonirrigated catheter) were considered in a sensitivity analysis. Results: The budget impact showed savings of $43 097 096.84 with cryoablation. In the sensitivity analysis, cryoablation resulted in cost savings compared with RF ablation guided by intracardiac echocardiography, whereas in comparison to RF ablation with the nonirrigated catheter, cryoablation was more expensive. A market share assessment, performed using an incorporation rate of 3% per year, indicated savings of approximately $800 000 per 5 years. Conclusions: Cryoablation of AF resulted in cost savings compared with the current scenario (RF ablation guided by electroanatomic mapping). When alternative technologies were considered, cryoablation was more expensive than RF ablation with a nonirrigated catheter, but it also resulted in savings compared with RF ablation guided by intracardiac echocardiography. Overall, cryoablation of AF may reduce expenditures in the Brazilian public health system.
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    Exercise training improves microvascular function in patients with Chagas heart disease: Data from the PEACH study
    (Microvascular Research, 2021) Borges, Juliana Pereira; Mendes, Fernanda de Souza Nogueira Sardinha; Rangel, Marcus Vinícius Dos Santos; Lopes, Gabriella de Oliveira; Silva, Gilberto Marcelo Sperandio da; Mazzoli-Rocha, Flavia; Saraiva, Roberto Magalhães; Sousa, Andrea Silvestre de; Tibirica, Eduardo; Mediano, Mauro Felippe Felix
    Background: Chagas heart disease (CHD) impairs the systemic microvascular function. We investigated the effects of exercise training on cutaneous microvascular function among patients with CHD. Methods: Patients from the PEACH study were randomly assigned to a supervised exercise training 3 times/week for 6 months (Trained; n = 10) or a control group (Untrained; n = 8). Both groups underwent evaluation of microvascular function before, and at 3- and 6-months of follow-up. Cutaneous vascular conductance (CVC) was assessed in the skin of the forearm using laser speckle contrast imaging coupled with iontophoresis of acetylcholine (ACh), sodium nitroprusside (SNP) and during post-occlusive reactive hyperemia (PORH). Results: At 3-months of follow-up, no difference was detected between groups in CVC responses to ACh (p = 0.50), SNP (p = 0.26) and HRPO (p = 0.65). However, at 6-months of follow-up, trained vs. untrained patients improved CVC induced by SNP-iontophoresis (0.19 ± 0.10 vs. 0.14 ± 0.15 APU.mmHg-1; p = 0.05) and PORH (0.63 ± 0.15 vs. 0.48 ± 0.18 APU.mmHg-1; p = 0.05). CVC response to ACh-iontophoresis was similar between groups (0.19 ± 0.11 vs. 0.22 ± 0.17 APU.mmHg-1; p = 0.38). Conclusion: Exercise training performed during 6 months improved the cutaneous microvascular function of CHD patients. Further studies evaluating the mechanism involved in this response are warranted.
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    Microvascular Function and Endothelial Progenitor Cells in Patients with Severe Hypercholesterolemia and the Familial Hypercholesterolemia Phenotype
    (Cardiology, 2017) De Lorenzo, Andrea; Moreira, Annie S B; Muccillo, Fabiana B; Assad, Marcelo; Tibiriçá, Eduardo V
    Objective: To evaluate endothelial progenitor cells (EPCs) and systemic microvascular function in patients with severe hypercholesterolemia, comparing patients with the definite familial hypercholesterolemia (FH) phenotype (DFH) or probable/possible FH phenotype (PFH). There is a large spectrum of atherosclerotic disease between these two clinical phenotypes of FH, and to acquire further knowledge of the pathophysiology of vascular disease in both is desirable. Methods: Subjects with severe hypercholesterolemia, defined as low-density lipoprotein cholesterol (LDL-C) >190 mg/dL, were classified as DFH or PFH and underwent measurement of the number of EPCs by flow cytometry and evaluation of cutaneous microvascular reactivity using a laser speckle contrast-imaging system with iontophoresis of acethylcholine (ACh) or sodium nitroprusside. EPCs were defined as CD45- or CD45low, CD34+CD133+CD309+ cells. Categorical variables were compared using Fisher test and continuous variables with Student t test or Mann-Whitney test, and a value of p < 0.05 was considered statistically significant. Results: Patients with DFH had higher LDL-C than those with PFH. There was no difference in the median number of EPCs between patients with DFH or PFH, but there was a significant reduction of endothelial-dependent, ACh-induced vasodilatation in the former. Conclusion: Patients with DFH have impaired microvascular endothelial-dependent vasodilatation compared to those with PFH, indicating more severe vascular disease in the former.
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    Outcomes of patients with left main coronary artery disease undergoing medical or surgical treatment: a propensity- matched analysis
    (Coronary Artery Disease, 2011) De Lorenzo, Andrea; Tura, Bernardo; Bassan, Fernando; Pittella, Felipe; Rocha, Antonio Sergio C
    Objective: To evaluate the outcomes of patients with significant (≥ 50%) left main coronary artery disease (LMCAD) undergoing medical treatment (MT) or coronary artery bypass grafting surgery (CABG). Methods: A total of 181 patients with significant LMCAD were followed for 4 ± 2 years. MT was done when patients refused CABG or because of either thin native vessels or high clinical risk. Events were defined as all-cause death, myocardial infarction, percutaneous coronary intervention, or subsequent CABG. Logistic regression analysis was used to identify independent predictors of death. A propensity score was created to compare outcomes of patients from the two treatment groups. Results: CABG was performed in 78.5% of the patients. Overall, there were no significant differences in the incidences of death or other events between treatment groups. In patients with normal left ventricular (LV) function (ejection fraction, ≥ 45%), there were no significant differences in event rates with MT or CABG (death, 7.7 vs. 12.1%; myocardial infarction, 0 vs. 1.9%; percutaneous coronary intervention, 3.8 vs. 5.6%). For patients with LV dysfunction, death was more frequent with MT than with CABG (53.8 vs. 22.9%, P<0.001), whereas the incidence of other events was not statistically different. Age and LV dysfunction, but not treatment type, were independent predictors of death. When comparing propensity-matched patients from both treatment groups, there was also no difference in survival. Conclusion: Patients with 50% or more LMCAD and LV dysfunction had increased survival with CABG. However, outcomes of patients with 50% or more LMCAD and normal LV function were not significantly different with either MT or CABG.
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    Systemic microvascular endothelial dysfunction and disease severity in COVID-19 patients: Evaluation by laser Doppler perfusion monitoring and cytokine/chemokine analysis
    (Microvascular Research, 2021) Sabioni, Leticia; De Lorenzo, Andrea; Lamas, Cristiane C.; Muccillo, Fabiana B.; Castro-Faria-Neto, Hugo C; Estato, Vanessa; Tibirica, Eduardo
    Background Microvascular dysfunction, serum cytokines and chemokines may play important roles in pathophysiology of coronavirus disease 2019 (COVID-19), especially in severe cases. Methods Patients with COVID-19 underwent non-invasive evaluation of systemic endothelium-dependent microvascular reactivity - using laser Doppler perfusion monitoring in the skin of the forearm - coupled to local thermal hyperemia. Maximal microvascular vasodilatation (44 °C thermal plateau phase) was used as endpoint. A multiplex biometric immunoassay was used to assess a panel of 48 serum cytokines and chemokines. Severe COVID-19 (S-COVID) was defined according to WHO criteria, while all other cases of COVID-19 were considered mild to moderate (M-COVID). A group of healthy individuals who tested negative for SARS-CoV-2 served as a control group and was also evaluated with LDPM. Results Thirty-two patients with COVID-19 (25% S-COVID) and 14 controls were included. Basal microvascular flow was similar between M-COVID and controls (P = 0.69) but was higher in S-COVID than in controls (P = 0.005) and M-COVID patients (P = 0.01). The peak microvascular vasodilator response was markedly decreased in both patient groups (M-COVID, P = 0.001; S-COVID, P < 0.0001) compared to the healthy group. The percent increases in microvascular flow were markedly reduced in both patient groups (M-COVID, P < 0.0001; S-COVID, P < 0.0001) compared to controls. Patients with S-COVID had markedly higher concentrations of dissimilar proinflammatory cytokines and chemokines, compared to patients with M-COVID. Conclusions In patients with COVID-19, especially with S-COVID, endothelium-dependent microvascular vasodilator responses are reduced, while serum cytokines and chemokines involved in the regulation of vascular function and inflammation are increased. pt
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    The Association Between Physical Performance and Health-Related Quality of Life Based on the EQ-5D-3L Questionnaire in Patients With Chagas Disease
    (Value in Health Regional Issues, 2021) Lins, Wylisson Marcelo Almeida; Tura, Bernardo Rangel; Kasal, Daniel Arhur
    Objectives: Chagas disease (CD) is a chronic disease to millions worldwide, and many patients develop heart disease. In addition, they are part of an aging population. These characteristics can be associated with a reduction in physical performance and health-related quality of life (HRQoL). This study evaluated HRQoL, and the relationship between physical performance and HRQoL in patients with chronic CD. Methods: We used the 3-level version of EuroQol 5-dimensional questionnaire (EQ-5D-3L), with the visual analog scale (VAS). Physical performance was measured with 30-s chair-stand test (30sCST) and timed up and go test (TUGT). Results: Sixty-three patients were evaluated. The majority were women (68.2%) aged 67.7 ± 9.7 years. Overall EQ-5D-3L utility index was 0.65 ± 0.28, and VAS score was 68.4 ± 25.1. Most patients with intermediate and high performance in 30sCST referred no problems in the domains "mobility," "usual activities," and "pain/feeling ill" (P < .001, P = .01, and P = .025, respectively). In a similar way, most patients with intermediate and high performance in TUGT referred no problems in "mobility" (P < .0001) and "usual activities" (P = .001). Higher performance in both tests was associated with higher overall EQ-5D-3L utility and VAS scores. HRQoL measured by EQ-5D-3L was associated with physical status in a cohort of patients with chronic CD. The results underscore the contribution of physical performance, measured by 2 inexpensive and safe physical tests, to HRQoL in these patients. Conclusion: Strategies aiming the improvement of HRQoL in patients with CD may focus on mobility skills and force. Future studies evaluating interventions in physical performance should be a priority in these patients.