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Second-generation biodiesel in Brazil: an analysis of research on animal fats through social and complex networks
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Matos Fernandes, Fábio

; Silva Martins, Luís Oscar

; Santos Marques, Rogério

; Santana Silva, Marcelo

; Gaudêncio Mendonça Freires, Francisco

Journal of technology management & innovation

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dec 2022, Volume 17 N. 4 Pages 28 - 39

Abstract: En | Text: En | PDF: En

Abstract The production of second-generation biodiesel is seen as more sustainable than first-generation biodiesel as it is produced from residues such as animal fats, a by-product of the meat industry. In Brazil, the biodiesel sector has become the main market for animal fats, absorbing around 712 thousand tons in 2018, equivalent to 38% of the fat produced. In order to reach this level, research and development were carried out supported by the Brazilian government through the Brazilian Biodiesel Technology and Innovation Network. The objective of this study is to map the scientific networks formed by Brazilian organizations that have collaborated to solve research problems regarding animal fats for biodiesel production through Social Networks Analysis and The Theory of Complex Networks. An exploratory-descriptive study was conducted in the main collection of Web of Science (WoS). It was observed that research started in 2008 and involved more than 80 institutions. The institutional network formed was of a small-world type, composed of 20 clusters. The research was indexed in 19 knowledge areas, with an emphasis on Chemistry, Energy and Fuels, and Engineering and 70% of them received some type of funding to conduct the research.

Análise Crítica e Limitações do Diagnóstico de Insuficiência Cardíaca com Fração de Ejeção Preservada (ICFEp)
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Hotta, Viviane Tiemi

; Rassi, Daniela do Carmo

; Pena, José Luiz Barros

; Vieira, Marcelo Luiz Campos

; Rodrigues, Ana Clara Tude

; Cardoso, Juliano Novaes

; Ramires, Felix Jose Alvarez

; Nastari, Luciano

; Mady, Charles

; Fernandes, Fábio

Arquivos Brasileiros de Cardiologia

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sep 2022, Volume 119 N. 3 Pages 470 - 479

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Com o aumento da expectativa de vida da população e a maior frequência de fatores de risco como obesidade, hipertensão arterial e diabetes, espera-se um aumento na prevalência de insuficiência cardíaca com fração de ejeção preservada (ICFEp). Entretanto, no momento, o diagnóstico e o tratamento de pacientes com ICFEp permanecem desafiadores. O diagnóstico sindrômico de ICFEp inclui diversas etiologias e doenças com tratamentos específicos, mas que apresentam pontos em comum em relação à apresentação clínica e à avaliação laboratorial no que diz respeito aos biomarcadores como BNP e NT-ProBNP, à avaliação ecocardiográfica do remodelamento cardíaco e às pressões de enchimento diastólico ventricular esquerdo. Extensos ensaios clínicos randomizados envolvendo a terapia nesta síndrome falharam na demonstração de benefícios para o paciente, fazendo-se necessária uma reflexão acerca do diagnóstico, dos mecanismos de morbidade, da taxa de mortalidade e da reversibilidade. Na revisão, serão abordados os conceitos atuais, as controvérsias e, especialmente, os desafios no diagnóstico da ICFEp através de uma análise crítica do escore da European Heart Failure Association.

Abstract With the increase in the population’s life expectancy and the higher frequency of risk factors such as obesity, hypertension and diabetes, an increase in the prevalence of heart failure with preserved ejection fraction (HFpEF) is expected. However, to date, the diagnosis and treatment of patients with HFpEF remain challenging. The syndromic diagnosis of HFpEF includes several etiologies and diseases with specific treatments but has points in common regarding the clinical presentation, laboratory evaluation related to biomarkers, such as BNP and NT-ProBNP, and echocardiographic evaluation of cardiac remodeling and left ventricular diastolic filling pressures. Extensive randomized clinical trials involving the treatment of this condition have failed to demonstrate benefits to the patient, making it necessary to reflect on the diagnosis, mechanisms of morbidity, mortality and reversibility in this syndrome. In this review, the current concepts, controversies and challenges, especially regarding diagnosis, will be addressed, critically analyzing the European Heart Failure Association score for the diagnosis of HFpEF.

https://doi.org/10.36660/abc.20210052

Perfil Clínico, Laboratorial e de Métodos de Imagem na Amiloidose Sistêmica em um Centro de Referência Cardiológico Brasileiro
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Fernandes, Fábio

; Alencar Neto, Aristóteles Comte de

; Bueno, Bruno Vaz Kerges

; Cafezeiro, Caio Rebouças Fonseca

; Rissato, João Henrique

; Szor, Roberta Shcolnik

; Carvalho, Mariana Lombardi Peres de

; Mathias Júnior, Wilson

; Lino, Angelina Maria Martins

; Castelli, Jussara Bianchi

; Souza, Evandro de Oliveira

; Ramires, Félix José Alvarez

; Hotta, Viviane Tiemi

; Soares Júnior, José

; Tavares, Caio de Assis Moura

; Krieger, José Eduardo

; Rochitte, Carlos Eduardo

; Dabarian, André

; Hajjar, Ludhmila Abrahão

; Kalil Filho, Roberto

; Mady, Charles

Arquivos Brasileiros de Cardiologia

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2022, Volume 118 N. 2 Pages 422 - 432

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Amiloidose sistêmica é uma doença com manifestações clínicas diversas. O diagnóstico envolve suspeita clínica, aliada a métodos complementares. Objetivo Descrever o perfil clínico, laboratorial, eletrocardiográfico e de imagem no acometimento cardíaco da amiloidose sistêmica. Métodos Estudo de uma amostra de conveniência, analisando dados clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos, medicina nuclear e ressonância magnética. Considerou-se significância estatística quando p < 0,05. Resultados Avaliaram-se 105 pacientes (com mediana de idade de 66 anos), sendo 62 homens, dos quais 83 indivíduos apresentavam amiloidose por transtirretina (ATTR) e 22 amiloidose por cadeia leve (AL). Na ATTR, 68,7% eram de caráter hereditário (ATTRh) e 31,3% do tipo selvagem (ATTRw). As mutações mais prevalentes foram Val142Ile (45,6%) e Val50Met (40,3%). O tempo de início dos sintomas ao diagnóstico foi 0,54 e 2,15 anos nas formas AL e ATTR (p < 0,001), respectivamente. O acometimento cardíaco foi observado em 77,9% dos ATTR e 90,9% dos AL. Observaram-se alterações de condução atrioventricular em 20% e intraventricular em 27,6% dos pacientes, sendo 33,7 % na ATTR e 4,5% das AL (p = 0,006). A forma ATTRw apresentou mais arritmias atriais que os ATTRh (61,5% x 22,8%; p = 0,001). Ao ecocardiograma a mediana da espessura do septo na ATTRw x ATTRh x AL foi de 15 mm x 12 mm x 11 mm (p = 0,193). Observou-se BNP elevado em 89,5% dos indivíduos (mediana 249 ng/mL, IQR 597,7) e elevação da troponina em 43,2%. Conclusão Foi possível caracterizar, em nosso meio, o acometimento cardíaco na amiloidose sistêmica, em seus diferentes subtipos, através da história clínica e dos métodos diagnósticos descritos.

Abstract Background Systemic amyloidosis is a disease with heterogeneous clinical manifestations. Diagnosis depends on clinical suspicion combined with specific complementary methods. Objective To describe the clinical, laboratory, electrocardiographic, and imaging profile in patients with systemic amyloidosis with cardiac involvement. Methods This study was conducted with a convenience sample, analyzing clinical, laboratory, electrocardiographic, echocardiographic, nuclear medicine, and magnetic resonance data. Statistical significance was set at p < 0.05. Results A total of 105 patients were evaluated (median age of 66 years), 62 of whom were male. Of all patients, 83 had transthyretin (ATTR) amyloidosis, and 22 had light chain (AL) amyloidosis. With respect to ATTR cases, 68.7% were the hereditary form (ATTRh), and 31.3% were wild type (ATTRw). The most prevalent mutations were Val142Ile (45.6%) and Val50Met (40.3%). Time from onset of symptoms to diagnosis was 0.54 and 2.15 years, in the AL and ATTR forms, respectively (p < 0.001). Cardiac involvement was observed in 77.9% of patients with ATTR and in 90.9% of those with AL. Alterations were observed in atrioventricular and intraventricular conduction in 20% and 27.6% of patients, respectively, with 33.7% in ATTR and 4.5% in AL (p = 0.006). In the ATTRw form, there were more atrial arrhythmias than in ATTRh (61.5% versus 22.8%; p = 0.001). On echocardiogram, median septum thickness in ATTRw, ATTRh, and AL was 15 mm, 12 mm, and 11 mm, respectively (p = 0.193). Elevated BNP was observed in 89.5% of patients (median 249, ICR 597.7), and elevated troponin was observed in 43.2%. Conclusion In this setting, it was possible to characterize cardiac involvement in systemic amyloidosis in its different subtypes by means of clinical history and the diagnostic methods described.

https://doi.org/10.36660/abc.20201003

Left ventricular noncompaction highlighted by three-dimensional and speckle tracking echocardiography
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Hotta, Viviane Tiemi

; Martinelli, Luiz Mário Baptista

; Moisés, Valdir Ambrósio

; Mady, Charles

; Fernandes, Fábio

einstein (São Paulo)

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2022, Volume 20 elocation eAI6853

Abstract: En | Text: En | PDF: En

https://doi.org/10.31744/einstein_journal/2022ai6853

Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era
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Queiroz, Claudio Martins de

; Cardoso, Juliano

; Ramires, Felix

; Ianni, Barbara

; Hotta, Viviane Tiemi

; Mady, Charles

; Buck, Paula de Cassia

; Dias, Ricardo Ribeiro

; Nastari, Luciano

; Fernandes, Fábio

International Journal of Cardiovascular Sciences

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nov 2021, Volume 34 N. 5 Pages 24 - 31

Abstract: En | Text: En | PDF: En

Abstract Background: Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed. Objectives: To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade. Materials and methods: Patients with pericardial effusion classified as small (< 10 mm), moderate (between 10-20 mm), or severe (> 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%. Results: A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001). Conclusions: There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.

https://doi.org/10.36660/ijcs.20200247 20 downloads

Importância Diagnóstica e Prognóstica da Capacidade Funcional nas Diversas Formas Evolutivas da Doença De Chagas
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Barbosa-Ferreira, João Marcos

; Mady, Charles

; Fernandes, Fábio

Arquivos Brasileiros de Cardiologia

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nov 2021, Volume 117 N. 5 Pages 942 - 943

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210808 2 downloads

Atualização de Tópicos Emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021
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Marcondes-Braga, Fabiana G.

; Moura, Lídia Ana Zytynski

; Issa, Victor Sarli

; Vieira, Jefferson Luis

; Rohde, Luis Eduardo

; Simões, Marcus Vinícius

; Fernandes-Silva, Miguel Morita

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Albuquerque, Denilson Campos de

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Ramires, Felix José Alvarez

; Bacal, Fernando

; Rossi Neto, João Manoel

; Danzmann, Luiz Claudio

; Montera, Marcelo Westerlund

; Oliveira Junior, Mucio Tavares de

; Clausell, Nadine

; Silvestre, Odilson Marcos

; Bestetti, Reinaldo Bulgarelli

; Bernadez-Pereira, Sabrina

; Freitas Jr, Aguinaldo F.

; Biolo, Andréia

; Barretto, Antonio Carlos Pereira

; Jorge, Antônio José Lagoeiro

; Biselli, Bruno

; Montenegro, Carlos Eduardo Lucena

; Santos Júnior, Edval Gomes dos

; Figueiredo, Estêvão Lanna

; Fernandes, Fábio

; Silveira, Fabio Serra

; Atik, Fernando Antibas

; Brito, Flávio de Souza

; Souza, Germano Emílio Conceição

; Ribeiro, Gustavo Calado de Aguiar

; Villacorta, Humberto

; Souza Neto, João David de

; Goldraich, Livia Adams

; Beck-da-Silva, Luís

; Canesin, Manoel Fernandes

; Bittencourt, Marcelo Imbroinise

; Bonatto, Marcely Gimenes

; Moreira, Maria da Consolação Vieira

; Avila, Mônica Samuel

; Coelho Filho, Otavio Rizzi

; Schwartzmann, Pedro Vellosa

; Mourilhe-Rocha, Ricardo

; Mangini, Sandrigo

; Ferreira, Silvia Moreira Ayub

; Figueiredo Neto, José Albuquerque de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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jun 2021, Volume 116 N. 6 Pages 1174 - 1212

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210367 3168 downloads

Galectina-3 Associada a Formas Graves e Mortalidade em Longo Prazo em Pacientes com Doença de Chagas
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Fernandes, Fábio

; Moreira, Carlos Henrique Valente

; Oliveira, Lea Campos

; Souza-Basqueira, Marcela

; Ianni, Barbara Maria

; Lorenzo, Claudia di

; Ramires, Felix José Alvarez

; Nastari, Luciano

; Cunha-Neto, Edecio

; Ribeiro, Antonio L.

; Lopes, Renato Delascio

; Keating, Sheila M.

; Sabino, Ester Cerdeira

; Mady, Charles

Arquivos Brasileiros de Cardiologia

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feb 2021, Volume 116 N. 2 Pages 248 - 256

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento As características histopatológicas da doença de Chagas (DCC) são: presença de miocardite, destruição das fibras cardíacas e fibrose miocárdica. A Galectina-3 (Gal-3) é um biomarcador envolvido no mecanismo de fibrose e inflamação que pode ser útil para a estratificação de indivíduos com DCC por risco. Objetivos Nosso objetivo foi avaliar se níveis elevados de Gal-3 estão associados a formas graves de cardiomiopatia chagásica (CC) e são preditivos de mortalidade. Métodos Estudamos doadores de sangue (DS) positivos para anti-T. cruzi: não-CC-DS (187 DS sem CC com eletrocardiograma [ECG] e fração de ejeção do ventrículo esquerdo [FEVE] normais); CC-Não-Dis-DS (46 DS com CC e apresentando ECG anormal, mas FEVE normal); e 153 controles negativos correspondentes. Esta amostra foi composta por 97 pacientes com CC grave (CC-Dis). Usamos as correlações de Kruskall-Wallis e Spearman para testar a hipótese de associações, assumindo um p bicaudal <0,05 como significativo. Resultados O nível de Gal-3 foi de 12,3 ng/mL para não-CC-DS, 12,0 ng/mL para CC-Não-Dis-DS, 13,8 ng/mL para controles e 15,4 ng/mL para CC-Dis. FEVE <50 foi associada a níveis mais elevados de Gal-3 (p=0,0001). Em nosso modelo de regressão linear ajustado, encontramos associação entre os níveis de Gal-3 e os parâmetros do ecocardiograma em indivíduos positivos para T. cruzi. Nos pacientes CC-Dis, encontramos uma associação significativa de níveis mais elevados de Gal-3 (≥15,3 ng/mL) e morte ou transplante cardíaco em acompanhamento de cinco anos (Hazard ratio – HR 3,11; IC95% 1,21– 8,04; p=0,019). Conclusões Em pacientes com CC, níveis mais elevados de Gal-3 estiveram significativamente associados a formas graves da doença e maior taxa de mortalidade em longo prazo, o que significa que pode ser um meio efetivo para identificar pacientes de alto risco. (Arq Bras Cardiol. 2021; 116(2):248-256)

Abstract Background The histopathological characteristics of Chagas disease (ChD) are: presence of myocarditis, destruction of heart fibers, and myocardial fibrosis. Galectin-3 (Gal-3) is a biomarker involved in the mechanism of fibrosis and inflammation that may be useful for risk stratification of individuals with ChD. Objectives We sought to evaluate whether high Gal-3 levels are associated with severe forms of Chagas cardiomyopathy (CC) and whether they are predictive of mortality. Methods We studied anti-T. cruzi positive blood donors (BD): Non-CC-BD (187 BD without CC with normal electrocardiogram [ECG] and left ventricular ejection fraction [LVEF]); CC-Non-Dys-BD (46 BD with CC with abnormal ECG but normal LVEF); and 153 matched serum-negative controls. This cohort was composed of 97 patients with severe CC (CC-Dys). We used Kruskall-Wallis and Spearman’s correlation to test hypothesis of associations, assuming a two-tailed p<0.05 as significant. Results The Gal-3 level was 12.3 ng/mL for Non-CC-BD, 12.0 ng/mL for CC-Non-Dys-BD, 13.8 ng/mL for controls, and 15.4 ng/mL for CC-Dys. LVEF<50 was associated with higher Gal-3 levels (p=0.0001). In our linear regression adjusted model, we found association between Gal-3 levels and echocardiogram parameters in T. cruzi-seropositive subjects. In CC-Dys patients, we found a significant association of higher Gal-3 levels (≥15.3 ng/mL) and subsequent death or heart transplantation in a 5-year follow-up (Hazard ratio – HR 3.11; 95%CI 1.21–8.04; p=0.019). Conclusions In ChD patients, higher Gal-3 levels were significantly associated with severe forms of the disease and more long-term mortality, which means it may be a useful means to identify high-risk patients. (Arq Bras Cardiol. 2021; 116(2):248-256)

https://doi.org/10.36660/abc.20190403 575 downloads

Effects of sympathectomy on myocardium remodeling and function
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Jordão, Maurício Rodrigues

; Pessoa, Fernanda G.

; Fonseca, Keila C.B.

; Zanoni, Fernando

; Salemi, Vera M.C.

; Souza, Leandro E.

; Ribeiro, Orlando N.

; Fernandes, Fábio

; Irigoyen, Maria Claudia

; Moreira, Luiz Felipe P.

; Mady, Charles

; Ramires, Felix Jose Alvarez

Clinics

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2021, Volume 76 elocation e1958

Abstract: En | Text: En | PDF: En

OBJECTIVES: To evaluate the effects of sympathectomy on the myocardium in an experimental model. METHODS: The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached. RESULTS: The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09). CONCLUSION: These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.

https://doi.org/10.6061/clinics/2021/e1958 711 downloads

10.

Selenium supplementation prevents DNA damage in ram spermatozoa
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Moya, Carla Fredrichsen

; Piagentini, Marcelo

; Silva, Danilo da Cunha

; Fernandes, Fábio Henrique

; Salvadori, Daisy Maria Fávero

; Oba, Eunice

Ciência Rural

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2021, Volume 51 N. 1 elocation e20200102

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: O presente estudo teve por objetivo avaliar os efeitos da suplementação mineral com diferentes concentrações de selênio (Se) sobre a integridade de DNA espermático de ovinos. Utilizaram-se 30 machos, com 10 meses de idade. Eles foram mantidos em sistema intensivo, sendo alimentados com feno e ração própria para ovinos, divididos em baias (5 m x 3 m), com cochos e água ad libitum. Os ovinos do grupo 1 (G1=controle negativo) receberam suplementação de sal mineral sem a adição de Se, os animais do G2 receberam a mesma mistura mineral, porém com 5 mg de Se (selenito de sódio)/kg mistura mineral, os ovinos do G3 receberam 10 mg Se/kg mistura, os animais do G4 receberam 15 mg Se/kg mistura, os do G5 receberam 20 mg Se/kg mistura. Os ovinos de todos os grupos passaram por um período de adaptação de 14 dias, seguido por um período de tratamento de 56 dias. O sêmen foi colhido por meio de eletroejaculação. A integridade do DNA espermático foi avaliada por meio do teste de cometa. O modelo experimental utilizado foi Quadrado Latino 5 x 5, com cinco grupos e cinco períodos experimentais. A diferença entre as médias foi analisada pelo teste de Tukey, com 5% de nível de significância. O grupo controle (G1) apresentou elevada porcentagem de danos quando comparada aos demais grupos de tratamentos (G2 a G5). Portanto, a suplementação de Se diminui o nível de danos ao DNA espermáticos, sugerindo que o Se pode exercer efeitos protetores sobre o DNA dos espermatozoides de ovinos.

ABSTRACT: In the present study, we aimed to evaluate the effects of different concentrations of selenium (Se) ovine nutritional supplementation on spermatozoa DNA integrity. Thirty male ovines (age: 10 months) were used. They were fed with hay and ram food in an intensive system, which was divided into stalls (5 m long and 3 m wide) with feeding troughs, and had ad libitum access to food and water. Ovines in group 1 (G1, the negative control) received mineral salt supplementation without Se; ovines in G2 received the same mineral salt mixed with 5 mg Se (as sodium selenite)/kg mineral supplement;ovines in G3 received 10 mg Se/kg mineral supplement; ovines in G4 received 15 mg Se/kg mineral supplement; and ovines in G5 received 20 mg Se/kg mineral supplement. Ovines in all groups remained untreated for 14 days, followed by a treatment period of 56 days. Semen samples were obtained by electroejaculation. The DNA damage in semen samples was evaluated using the comet assay. The experimental design was implemented using a 5 × 5 Latin Square, i.e., five treatments and five experimental periods. The mean differences were compared using Tukey’s test at a significance level of 5%. The control group (G1) showed a high percentage of DNA damage compared to the Se-treated groups (G2-G5). Therefore, Se supplementation could decrease the basal level of DNA damage in sperm cells, suggesting that Se might exert protective effects on sperm DNA.

https://doi.org/10.1590/0103-8478cr20200102 693 downloads

11.

Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique?
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Dinato, Fabrício José

; Dias, Ricardo Ribeiro

; Duncan, José Augusto

; Fernandes, Fábio

; Ramirez, Felix José Alvares

; Mady, Charles

; Jatene, Fabio B

Brazilian Journal of Cardiovascular Surgery

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dec 2020, Volume 35 N. 6 Pages 869 - 877

Abstract: En | Text: En | PDF: En

Abstract Introduction: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Methods: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. Results: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). Conclusion: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.

https://doi.org/10.21470/1678-9741-2020-0043 255 downloads

12.

Menor Prevalência e Extensão da Aterosclerose Coronária na Doença de Chagas Crônica por Angiotomografia Coronária
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Cardoso, Savio

; Azevedo Filho, Clerio Francisco de

; Fernandes, Fábio

; Ianni, Barbara

; Torreão, Jorge Andion

; Marques, Mateus Diniz

; Ávila, Luiz Francisco Rodrigues de

; Santos Filho, Raul

; Mady, Charles

; Kalil-Filho, Roberto

; Ramires, José Antônio Franchine

; Bittencourt, Marcio Sommer

; Rochitte, Carlos E.

Arquivos Brasileiros de Cardiologia

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dec 2020, Volume 115 N. 6 Pages 1051 - 1060

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Em regiões endêmicas da doença de Chagas, por muitos anos, existe uma observação empírica recorrente de que a doença arterial coronariana (DAC) é incomum em pacientes com doença de Chagas. Estudos anteriores baseados em análise patológica ou angiografia coronária invasiva apresentam resultados controversos. Objetivo Investigar se a DAC é menos prevalente e menos grave em pacientes com doença de Chagas crônica em comparação a uma população pareada controle, com perfil de risco para DAC similar. Métodos Um total de 86 participantes, 43 pacientes com doença de Chagas crônica consecutivos e 43 indivíduos assintomáticos, sem qualquer história prévia de doença cardíaca ou doença DAC conhecida (grupo controle), foram incluídos no estudo. Pacientes e controles foram pareados quanto sexo, idade e escore de risco de Framingham. Todos os pacientes foram analisados quanto ao escore de cálcio coronário (ECC) e submetidos à angiotomografia coronária usando um tomógrafo de 320 detectores. O nível de significância estatística adotado foi de p < 0,05. Resultados O ECC foi significativamente mais baixo em pacientes com doença de Chagas em comparação aos controles (p<0,05). A presença de placas ateroscleróticas coronárias foi significativamente menos frequente em pacientes com doença de Chagas que nos controles (20,9% versus 41,9%, p=0,037). Após ajuste quanto ao escore de Framingham, o odds ratio para a presença de qualquer calcificação coronária foi de 0,26 (IC95%: 0,07-0,99, p=0,048). O padrão é similar para escore de cálcio coronário (ECC) > 10 (OR: 0,11, IC95%: 0,01-0,87, p=0,04), e para a presença de estenose (OR: 0,06, IC95%: 0,01-0,47, p=0,001). O pareamento por escore de propensão também mostrou um efeito da doença de Chagas no ECC (-21,6 pontos no escore absoluto e 25% menos pacientes com ECC > 10; p=0,015). Conclusões A prevalência e a gravidade da DAC são mais baixas nos pacientes com doença de Chagas crônica em comparação a uma população pareada e perfil de risco para DAC similar. (Arq Bras Cardiol. 2020; 115(6):1051-1060)

Abstract Background In Chagas’ disease endemic regions, there has been for many years a recurrent empirical observation that coronary artery disease (CAD) is uncommon in patients with Chagas’ disease. Previous pathological and invasive coronary angiography studies led to controversial results. Objective We sought to investigate whether CAD is less prevalent and less severe in patients with chronic Chagas’ disease when compared with a matched population with a similar CAD risk profile. Methods A total of 86 participants, 43 consecutive patients with chronic Chagas’ disease and 43 asymptomatic individuals, without any prior history of cardiac disease or known CAD (control group), were included. Patients and controls were matched according to gender, age, and Framingham risk score. All participants underwent coronary calcium scoring and coronary computed tomography angiography on a 320-row detector scanner. Statistical significance level adopted was p < 0.05. Results The coronary artery calcium score (CACS) was significantly lower in patients with Chagas’ disease than in controls (p<0.05). The presence of coronary atherosclerotic plaques was significantly less frequent in patients with Chagas’ disease than in controls (20.9% versus 41.9%, p=0.037). After adjustment for the Framingham score, the odds ratio for the presence of any coronary artery calcium (CAC) in Chagas patients was 0.26 (95%CI: 0.07-0.99, p=0.048). The pattern is similar for CACS > 10 (OR: 0.11, 95%CI: 0.01-0.87, p=0.04) and for the presence of any stenosis (OR: 0.06, 95%CI: 0.01-0.47, p=0.001). Propensity score matching also indicated an effect of Chagas disease on the CACS (-21.6 points in the absolute score and 25% less of patients with CACS >10, p=0.015). Conclusions CAD is less prevalent and less severe in patients with chronic Chagas’ disease when compared with a matched population with a similar CAD risk profile. (Arq Bras Cardiol. 2020; 115(6):1051-1060)

https://doi.org/10.36660/abc.20200342 591 downloads

13.

Afecções Pericárdicas em Pacientes com COVID-19: Uma Possível Causa de Deterioração Hemodinâmica
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Fernandes, Fábio

; Ramires, Felix José Alvarez

; Fernandes, Fábio Danziato

; Simões, Marcus Vinicius

; Mesquita, Evandro Tinoco

; Mady, Charles

Arquivos Brasileiros de Cardiologia

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sep 2020, Volume 115 N. 3 Pages 569 - 573

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20200474 12367 downloads

14.

Galectina-3 em Pacientes com Pericardite Constritiva Crônica
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Fernandes, Fábio

; Melo, Dirceu Thiago Pessoa de

; Ramires, Felix José Alvarez

; Sabino, Ester Cerdeira

; Moreira, Carlos Henrique Valente

; Benvenutti, Luiz Alberto

; Hotta, Viviane Tiemi

; Sayegh, Ana Luiza Carrari

; Souza, Francis Ribeiro de

; Dias, Ricardo Ribeiro

; Mady, Charles

Arquivos Brasileiros de Cardiologia

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apr 2020, Volume 114 N. 4 Pages 683 - 689

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A galectina-3 (Gal-3) é uma molécula pró-inflamatória e pró-fibrótica, envolvida na patogênese da insuficiência cardíaca. O papel da Gal-3 em pacientes com pericardite constritiva crônica (PCC) não está claro. Objetivo O objetivo deste estudo foi avaliar os níveis de Gal-3 em pacientes com PCC e correlacioná-los com parâmetros clínicos, funcionais e histológicos. Métodos Nós avaliamos prospectivamente 25 pacientes sintomáticos com PCC agendados à pericardiectomia e 21 controles sadios. Os pacientes foram submetidos à avaliação clínica, medidas de Gal-3 e peptídeo natriurético do tipo B (BNP), ecocardiografia, ressonância magnética cardíaca e teste cardiopulmonar de exercício (TCPE) no período basal. Seis meses após a pericardiectomia, repetiu-se o TCPE. Um erro alfa < 5% foi considerado estatisticamente significativo, com um intervalo de confiança de 95%. Resultados Foram incluídos 25 pacientes com idade mediana de 45 anos. A etiologia foi principalmente idiopática (n = 19, 76%), e 14 (56%) apresentaram classe funcional New York Heart Association (NYHA) III/IV. Os valores medianos de BNP e Gal-3 foram 143 (89-209) pg/dL e 14,8 (9,7-17,2) ng/mL, respectivamente. Os níveis de Gal-3 não foram estatisticamente maiores nos pacientes com PCC que em controles (p = 0,22). Não foram encontradas correlações significativas da Gal-3 com BNP, medidas ecocardiográficas e de ressonância magnética cardíaca, e achados histológicos. Após a pericardiectomia, encontrou-se uma correlação estatisticamente significativa entre Gal-3 e medidas do TCPE – duração do teste (r = –0,79; p < 0,001) e tempo de exercício (r = –0,79; p < 0,001). Conclusões Pacientes com PCC apresentaram níveis normais de Gal-3, quando comparados aos indivíduos controles. A Gal-3 não se correlacionou com medidas morfológicas e funcionais antes da pericardiectomia. No entanto, associações entre Gal-3 e intolerância ao exercício após pericardiectomia pode sugerir um papel da Gal-3 na predição de prognóstico após a pericardiectomia. (Arq Bras Cardiol. 2020; 114(4):683-689)

Abstract Background Galectin-3 (Gal-3) is a proinflammatory, profibrotic molecule implicated in the pathogenesis of heart failure. The role of Gal-3 in patients with chronic constrictive pericarditis (CCP) is not clear. Objective The aim of this study was to assess plasma Gal-3 in patients with CCP and correlate it with clinical, functional and histologic parameters. Methods We prospectively evaluated 25 symptomatic patients with CCP referred for pericardiectomy and 21 healthy controls. Patients underwent clinical assessment, Gal-3 and B-type natriuretic peptide (BNP) measurements, echocardiography, cardiac magnetic resonance imaging and cardiopulmonary exercise test (CPET) at baseline. Six months after pericardiectomy CPET was repeated. An alpha error < 5% was considered statistically significant, with a confidence interval of 95%. Results Twenty-five patients with a median age of 45 years were included. Etiology was mainly idiopathic (n = 19, 76%); and 14 (56%) patients had NYHA functional class III/IV. Median BNP and Gal-3 were 143 (89-209) pg/dL and 14.8 (9.7-17.2) ng/mL, respectively. Gal-3 levels were not significantly higher in CCP patients than in control (p = 0.22). There were no significant correlations of Gal-3 with BNP, echocardiographic and cardiac magnetic resonance measures and histological findings. After pericardiectomy, it was found a statistically significant correlation between Gal-3 and the CPTE measures test duration (r = –0.79; p < 0.001) and exercise time (r = –0.79; p < 0.001). Conclusions Patients with CCP had normal levels of Gal-3 as compared to the controls. Gal-3 did not correlate with morphological and functional measures before pericardiectomy. However, the associations between Gal-3 and exercise intolerance after pericardiectomy may suggest a role of Gal-3 in prognosis prediction after pericardiectomy. (Arq Bras Cardiol. 2020; 114(4):683-689)

https://doi.org/10.36660/abc.20190152 775 downloads

15.

Cardiac amyloidosis: non-invasive diagnosis
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Hotta, Viviane Tiemi

; Giorgi, Maria Clementina Pinto

; Fernandes, Fábio

; Abduch, Maria Cristina Donadio

; Falcão, Andréa Maria Gomes Marinho

; Mady, Charles

Revista da Associação Médica Brasileira

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mar 2020, Volume 66 N. 3 Pages 345 - 352

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A amiloidose cardíaca é uma doença infiltrativa que exige um alto grau de suspeição clínica para o diagnóstico apropriado. O diagnóstico precoce e a definição do subtipo de amiloidose têm um papel fundamental para a terapêutica e prognóstico desta doença. Nesse contexto, o emprego de biomarcadores cardíacos como as troponinas e NT-proBNT associados à análise por métodos de imagem multimodalidade por técnicas ecocardiográficas atuais como o strain, medicina nuclear e a ressonância magnética cardíaca têm papel crescente em pacientes com amiloidose. Este artigo detalha a utilização dos métodos não invasivos para a avaliação de pacientes com amiloidose cardíaca.

SUMMARY Cardiac amyloidosis is an infiltrative disease which requires a high degree of clinical suspicion for appropriate diagnosis. Early diagnosis and the definition of the type of amyloidosis play a key role in the early treatment and prognosis of this disease. In this context, the use of cardiac biomarkers such as troponins and NT-proBNT associated with analysis by multimodality imaging methods like echocardiographic techniques such as strain, nuclear medicine, and cardiovascular resonance imaging have an increasing role in patients with cardiac amyloidosis. This article details the role of non-invasive diagnostic methods in patients with cardiac amyloidosis.

https://doi.org/10.1590/1806-9282.66.3.345 1322 downloads

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