Mestrado Profissional em Ciências Cardiovasculares

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https://dspace.inc.saude.gov.br/handle/123456789/17

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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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    Características antropométricas e metabólicas em obesos com transtorno alimentar
    (HUPE - Hospital Universitário Pedro Ernesto, 2015) Silva, Henyse G. V. da; Magalhães, Vera Cristina; Oliveira, Beatriz A.; Rosa, Juliana S.; Santos, Thaíza T; Moreira, Annie B
    O transtorno de compulsão alimentar periódica (TCAP) é um distúrbio psiquiátrico com alta morbidade, associado à obesidade e ao alto risco cardiovascular. O objetivo deste trabalho foi identificar alterações antropométricas e/ou metabólicas em obesos com TCAP e compará-las àqueles sem TCAP. Estudo transversal realizado no ambulatório do Napta/ UERJ, envolvendo 39 adultos obesos, sem doenças malignas ou consumptivas e medicamentos que interferissem nos re- sultados, sendo 22 com e 17 sem TCAP. As variáveis coletadas foram peso, estatura, perímetro da cintura, pressão arterial; e foram analisadas glicemia, perfil lipídico, dosagem de leptina, adiponectina e insulina, sendo calculado o Índice HOMA IR. Os dados foram expressos como média (desvio-padrão), sendo utilizados os testes: Qui-quadrado e t-Student. O valor de signi- ficância foi 5%. Amostra composta por 82% de mulheres, com elevada prevalência de hipertensão arterial, resistência insu- línica e sedentarismo, sem diferenças entre os grupos com ou sem TCAP. Todos apresentaram o perímetro da cintura acima da recomendação, mais de 60% apresentaram HDL-colesterol baixo e um terço, triglicerídeos elevados. Não houve diferença dos níveis de adiponectina nem de leptina entre obesos com ou sem TCAP, apesar de os valores estarem fora dos limites normais. Obesos, independentemente do diagnóstico de TCAP, têm elevado risco cardiovascular com alta prevalência de hipertensão arterial, dislipidemia, circunferência de cintura alterada e sedentarismo. Além disso, apresentam inflamação crônica de baixo grau com baixos níveis de adiponectina e altos de leptina. Entretanto, apesar de estas afirmativas terem sido confirmadas, não foram identificadas diferenças signifi- cativas entre obesos com o transtorno alimentar.
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    High-intensity interval training or continuous training, combined or not with fasting, in obese or overweight women with cardiometabolic risk factors: study protocol for a randomised clinical trial
    (BMJ Open, 2018) De Lorenzo, Andrea; Moraes, Roger de; Van Bavel, Diogo; Tibirica, Eduardo
    Introduction Physical inactivity and increased caloric intake play important roles in the pathophysiology of obesity. Increasing physical activity and modifying eating behaviours are first-line interventions, frequently hampered by lack of time to exercise and difficulties in coping with different diets. High-intensity interval training (HIIT) may be a time-efficient method compared with moderate-intensity continuous training (CT). Conversely, diets with a fasting component may be more effective than other complex and restrictive diets, as it essentially limits caloric intake to a specified period without major diet composition changes. Therefore, the combination of HIIT and fasting may provide incremental benefits in terms of effectiveness and time efficiency in obese and sedentary populations. The aim of this study is to determine the effect of HIIT versus CT, combined or not with fasting, on microcirculatory function, cardiometabolic parameters, anthropometric indices, cardiorespiratory fitness and quality of life in a population of sedentary overweight or obese women with cardiometabolic risk factors. Methods and analysis Sedentary women aged 30–50 years, with a body mass index ≥25 kg/m2 and cardiometabolic risk factors, will be randomised to HIIT performed in the fasting state, HIIT performed in the fed state, CT in the fasting state or CT in the fed state. Cardiometabolic parameters, anthropometric indices, cardiorespiratory fitness, quality of life and microvascular function (cutaneous capillary density and microvascular reactivity evaluated by laser speckle contrast imaging) will be evaluated before initiation of the interventions and 16 weeks thereafter. Ethics and dissemination The trial complies with the Declaration of Helsinki and has been approved by the local ethics committee (Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil). All patients provide written informed consent before enrolment and randomisation. The study’s results will be disseminated to the healthcare community by publications and presentations at scientific meetings.
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    Impairment of systemic microvascular endothelial and smooth muscle function in individuals with early-onset coronary artery disease: studies with laser speckle contrast imaging
    (Coronary Artery Disease, 2014) Souza, Elaine G.; De Lorenzo, Andrea; Huguenin, Grazielle; Oliveira, Glaucia M.M; Tibiriça, Eduardo
    Objectives: The assessment of systemic microvascular reactivity is currently considered to be critical in the stratification of cardiovascular risk. In the present study, we compared skin microvascular function in individuals with early-onset (premature) coronary artery disease (EOCAD, n= 30) with that of age-matched and sex-matched healthy individuals (n =30). Materials and methods Using laser speckle contrast imaging, cutaneous blood flow was assessed in the forearm at rest and during reactivity tests, including postocclusive reactive hyperemia and the iontophoresis of acetylcholine or sodium nitroprusside with increasing currents of 30, 60, 90, 120, 150, and 180 lA for 10-s intervals spaced 1 min apart. Carotid intima–media thickness was evaluated using an ultrasound system and a 7.5MHz ultrasound transducer. Results: The endothelium-dependent skin microvascular vasodilator responses that were induced by both acetylcholine and postocclusive reactive hyperemia were significantly reduced in patients with EOCAD compared with healthy individuals. The vasodilator responses that were induced by sodium nitroprusside were also significantly reduced in individuals with EOCAD. These systemic microvascular alterations were concurrent with increased carotid intima–media thickness in these patients. Conclusion: Laser speckle contrast imaging identifies endothelial-dependent and endothelial-independent microvascular dysfunction in individuals presenting with EOCAD, and thus could be valuable as an early peripheral marker of atherothrombotic disease.
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    Increased systemic endothelial-dependent microvascular reactivity after ingestion of a high-carbohydrate snack in young, healthy volunteers
    (Microvascular Research, 2020) Peçanha, Daniela; Huguenin, Grazielle Vilas Bôas; Lorenzo, Andrea De; Tibirica, Eduardo
    Objective This study evaluated the acute effect of a high-carbohydrate snack (HCS) on systemic microvascular function of healthy, young volunteers, using laser speckle contrast imaging (LSCI). Methods Cutaneous microvascular blood flow was assessed in the forearm with LSCI coupled to iontophoresis of acetylcholine, using increasing anodal currents, before and after (25 min) the ingestion of a HCS or water (control). Twenty volunteers (10 male) received a single HCS (70 g of carbohydrates) in the fasting state in the morning. Results The area under the curve (AUC) of acetylcholine-induced microvascular vasodilation increased from 17,847 ± 4539 to 20,315 ± 7168 arbitrary perfusion units/s (P = 0.03) after ingestion of a HCS, but was unchanged after the ingestion of water (P = 0.22). Conclusion A single snack consisting on an acute oral load of carbohydrates induced a significant increase of endothelium-dependent microvascular vasodilation in healthy, young subjects.
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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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    Reduced systemic microvascular density and reactivity in individuals with early onset coronary artery disease
    (Microvascular Research, 2015) Tibiriça, Eduardo; Souza, Elaine G; De Lorenzo, Andrea; Oliveira, Glaucia M.M.
    Objective: This study sought to test whether patients with early-onset coronary artery disease (EOCAD, n=30) showed systemic microvascular rarefaction and endothelial dysfunction in comparison to age- and sex-matched healthy controls (CTL, n = 30), as evaluated by skin video-capillaroscopy. Methods: Functional capillary density (FCD)was defined as the number of spontaneously perfused capillaries per square millimeter of skin area and assessed by high-resolution intra-vital color microscopy in the dorsum of the middle phalanx. Capillary recruitment (capillary reserve)was evaluated using post-occlusive reactive hyperemia (PORH) after arm ischemia for 3 min. Results: The mean capillary density at restwas significantly reduced in patientswith EOCADcompared to controls (CTL 95±20 and EOCAD 80±18 capillaries/mm2, P= 0.0040). During PORH, capillary density was also markedly reduced in EOCAD patients (CTL 96 ± 18 and EOCAD 71 ± 20 capillaries/mm2, P b 0.0001). Moreover, the capillary density in EOCAD patients was significantly reduced during PORH (EOCAD at rest 80± 19 and EOCAD during PORH 71 ± 20 capillaries/mm2, P = 0.0073). Conclusions: Patientswith EOCAD presented systemic capillary rarefaction and impaired microvascular endothelial function. Thus, the early detection of these microvascular alterations in young adults at an increased risk of coronary artery disease could be useful as a surrogate marker of subclinical atherosclerosis.
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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