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Preclinical evaluation of the functionality of a polymer-coated sirolimuseluting stent in pigs polymercoated polymer coated
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Perini, Sílvio César

; Jesus, Jeanne Louise Fernandes

; Soares, Alessandro Batista

; Ligabue, Rosane Angélica

; Bodanese, Luiz Carlos

Acta Cirúrgica Brasileira

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2024, Volume 39 elocation e397324

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: To compare the endothelial coverage of different stents in porcine carotid arteries. Research problem: How effective are polyurethane stents (PU) and PU + rapamycin (PU + RAPA) compared to bare-metal stents on endothelial coverage by neointima in pigs after 28 days? Methods: The methodology had two phases for an interventional, experimental, prospective study, with three Moura pigs, 12 weeks old and weighing between 19 and 22.5 kg. In phase I, eight stents were implanted in carotid arteries; three stents coated with PU, three coated with PU + RAPA, and two without coating. After 28 days, phase II was carried out, consisting of euthanasia, removal of the stents, to evaluate the exposed area of the stent struts, and the percentage of endothelialization through optical microscopy and scanning electron microscopy. Results: The eight stents implanted with ultrasound sizing and post-dilation with a larger diameter balloon were analyzed by Doppler ultrasound, intravascular ultrasound, and angiography after 28 days. Conclusions: This study showed complete endothelial coverage by the endoluminal neointima of the stent struts, good integration and coverage with the arterial wall, with no exposed struts showing the presence of intimal hyperplasia (whitish tissue). Purpose arteries problem RAPA baremetal bare metal 2 days Methods interventional experimental 1 225 22 5 22. kg I coating out euthanasia Results postdilation post dilation Conclusions wall whitish tissue. tissue . tissue)

https://doi.org/10.1590/acb397324

Proposed Risk Score in Patients with Aortic Stenosis Submitted to Valve Replacement Surgery
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Gasperi, Ricardo de

; Bodanese, Luiz Carlos

; Guaragna, João Carlos Vieira da Costa

; Wagner, Mario Bernardes

; Albuquerque, Luciano Cabral

Brazilian Journal of Cardiovascular Surgery

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2023, Volume 38 N. 2 Pages 219 - 226

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Due to Brazilian population aging, prevalence of aortic stenosis, and limited number of scores in literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. Methods: This is an observational historical cohort study with analysis of 802 aortic stenosis patients who underwent valve replacement at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, from 1996 to 2018. With the aid of logistic regression, a weighted risk score was constructed based on the magnitude of the coeficients β of the logistic equation. Two performance statistics were obtained: area under the receiver operating characteristic curve and the chi-square (χ2) of Hosmer-Lemeshow goodness-of-fit with Pearson’s correlation coeficient between the observed events and predicted as a model calibration estimate. Results: The risk predictors that composed the score were valve replacement surgery combined with coronary artery bypass grafting, prior renal failure, New York Heart Association class III/IV heart failure, age > 70 years, and ejection fraction < 50%. The receiver operating characteristic curve area was 0.77 (95% confidence interval: 0.72-0.82); regarding the model calibration estimated between observed/predicted mortality, Hosmer-Lemeshow test χ2 = 3,70 (P=0.594) and Pearson’s coeficient r = 0.98 (P<0.001). Conclusion: We propose the creation of a simple score, adapted to the Brazilian reality, with good performance and which can be validated in other institutions. Introduction aging literature disease Methods 80 Lucas Sul 199 2018 regression equation obtained chisquare chi square χ (χ2 HosmerLemeshow Hosmer Lemeshow goodnessoffit goodness fit Pearsons Pearson s estimate Results grafting failure IIIIV III IV 7 years 50 50% 077 0 77 0.7 95% 95 (95 interval 0.720.82 072082 0.72 0.82 72 82 0.72-0.82) observedpredicted mortality 370 3 3,7 P=0.594 P0594 P 594 (P=0.594 098 98 0.9 P<0.001. P0001 P<0.001 . 001 (P<0.001) Conclusion institutions 8 19 201 (χ 5 07 0. 9 (9 720 0.720.8 07208 072 082 0.8 0.72-0.82 37 3, P=0.59 P059 59 (P=0.59 09 P000 P<0.00 00 (P<0.001 1 20 ( 0.720. 0720 08 0.72-0.8 P=0.5 P05 (P=0.5 P00 P<0.0 (P<0.00 2 0.720 0.72-0. P=0. P0 (P=0. P<0. (P<0.0 0.72-0 P=0 (P=0 P<0 (P<0. 0.72- P= (P= P< (P<0 (P (P<

https://doi.org/10.21470/1678-9741-2022-0254

Avaliação Prognóstica da Reserva de Fluxo Fracionada em Diferentes Estratos nos Pacientes com Doença Arterial Coronariana
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Pellegrini, Denise

; Caramori, Paulo R. A.

; Soccol, Ricardo Czarnobai

; Lasevitch, Ricardo

; Agostini, Gustavo Luís

; Dussin, Alice

; Ferreira, Flavio Vinicius Costa

; Wagner, Mario Bernardes

; Bodanese, Luiz Carlos

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 6 elocation e20211051

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

Resumo Fundamento Existem dados limitados sobre a evolução clínica de lesões coronarianas não tratadas de acordo com sua gravidade funcional no mundo real. Objetivo Este estudo teve como objetivo avaliar os resultados clínicos de até 5 anos em pacientes com lesões revascularizadas com reserva de fluxo fracionada (FFR) ≤ 0,8 e em pacientes com lesões não revascularizadas com FFR > 0,8. Métodos A avaliação pelo FFR foi realizada em 218 pacientes seguidos por até 5 anos. Os participantes foram classificados com base na FFR no grupo isquêmico (≤ 0,8, grupo intervenção, n = 55), no grupo FFR normal-baixa (> 0,8-0,9, n = 91) e no grupo FFR normal-alta (> 0,9, n = 72). O desfecho primário foram eventos cardíacos adversos maiores (ECAMs), um composto de morte, infarto do miocárdio e necessidade de nova revascularização. O nível de significância adotado neste estudo foi alfa = 0,05; deste modo, resultados com valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A maioria dos participantes era do sexo masculino (62,8%) com média de idade de 64,1 anos. Diabetes estava presente em 27%. À angiografia coronariana, a gravidade da estenose avaliada foi de 62%, 56,4% e 54,3% nos grupos isquêmico, FFR normal-baixa e FFR normal-alta, respectivamente (p < 0,05). O período médio de acompanhamento foi de 3,5 anos. A incidência ECAM foi de 25,5%, 13,2% e 11,1%, respectivamente (p = 0,037). Não houve diferença na incidência de ECAM entre os grupos FFR normal-baixa e FFR normal-alta (p = NS). Conclusão Pacientes com FFR indicativa de isquemia apresentaram piores desfechos quando comparados aos dos grupos não isquêmicos. Entre os grupos que apresentaram valores de FFR considerados normal-baixo e normal-alto, não houve diferença na incidência de eventos. Há necessidade de estudos de longo prazo e com grande número de pacientes para melhor avaliar os desfechos cardiovasculares em pacientes portadores de estenose coronariana moderada com valores de FFR entre 0,8 e 1,0. real (FFR 08 0 8 0, 21 ( intervenção 55, 55 , 55) normalbaixa normal baixa 0,80,9, 0809 9 0,8-0,9 91 normalalta alta 09 0,9 72. 72 . 72) ECAMs, ECAMs (ECAMs) morte revascularização 005 05 modo 0,0 significativos 62,8% 628 62 (62,8% 641 64 1 64, 27 27% 62% 564 56 4 56,4 543 54 3 54,3 normalalta, alta, 0,05. 0,05) 35 3, 255 25 25,5% 132 13 2 13,2 111 11 11,1% 0,037. 0037 0,037 037 0,037) NS. NS NS) isquêmicos normalbaixo baixo normalalto, normalalto alto, alto normal-alto 10 1,0 80 0,80,9 080 0,8-0, 7 (ECAMs 00 62,8 6 (62,8 56, 54, 25,5 13, 11,1 003 0,03 03 1, 0,80, 0,8-0 62, (62, 25, 11, 0,80 0,8- (62 (6

Abstract Background There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity. Objective To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8. Methods The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant. Results Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups. Conclusion Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0. realworld real world 5year year (FFR 08 0 8 0. nonrevascularized non 21 years ( 55, 55 , 55) lownormal low normal 0.80.9, 0809 9 0.8-0.9 91, 91 91) highnormal high 09 0.9 72. 72 . 72) MACEs, (MACEs) death infarction revascularization 005 05 therefore pvalue p value 0.0 significant 62.8% 628 62 (62.8% 641 64 1 64. 27 27% angiography 564 56 4 56.4 543 54 3 54.3 p<0.05. p005 p<0.05 (p<0.05) followup follow 35 3. 255 25 25.5% 132 13 2 13.2% 111 11 11.1% p=0.037. p0037 p=0.037 037 (p=0.037) groups nonischemia Longterm Long term 10 1.0 80 0.80.9 080 0.8-0. 7 (MACEs 00 62.8 6 (62.8 56. 54. p00 p<0.0 (p<0.05 25.5 13.2 11.1 p003 p=0.03 03 (p=0.037 1. 0.80. 0.8-0 62. (62. p0 p<0. (p<0.0 25. 13. 11. p=0.0 (p=0.03 0.80 0.8- (62 p<0 (p<0. p=0. (p=0.0 (6 p< (p<0 p=0 (p=0. (p< p= (p=0 (p (p=

https://doi.org/10.36660/abc.20211051

Sobrevida em 10 Anos de Pacientes com Insuficiência Cardíaca com FEVE 40-59%: Uma Classificação Fenotípica Viável? 1 4059% 4059 40 59% 59 40-59% Viável 405 4 5 40-59 40-5 40-
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Danzmann, Luiz Claudio

; Bodanese, Luiz Carlos

; Petzold, Aline Petracco

; Tscheika, Anna Paula

; Magedanz, Ellen Hettwer

; Petersen, Lucas Celia

; Belyavskiy, Evgeny

; Chieza, Fernanda Lourega

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 1 elocation e20210772

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

Resumo Os limites da fração de ejeção do ventrículo esquerdo (FEVE) para a insuficiência cardíaca (IC) com FEVE levemente reduzida (ICFElr) têm sido questionados, já que evidências demonstram que alguns medicamentos utilizados para IC com FEVE <40% (ICFEr) demonstram eficácia também em populações com FEVE < 60%. Objetivo do estudo foi comparar a sobrevida total e cardiovascular de pacientes com IC com FEVE 40-59% com paciente com ICFEr e IC com FEVE ≥ 60%. Foram incluídos pacientes com IC descompensada que preencheram os critérios diagnósticos de Framingham na admissão hospitalar entre 2009 e 2011. Os pacientes foram divididos em ICFEr, IC com FEVE 40-59% e IC com FEVE ≥ 60%. O método de Kaplan-Meier foi usado para detectar a sobrevida geral e cardiovascular em 10 anos. A significância estatística foi estabelecida em p <0,05. Foram incluídos 400 pacientes, com idade média de 69 ± 14 anos. A sobrevida cardiovascular nos pacientes com IC e FEVE 40-59% não foi diferente em comparação aos pacientes com ICFEr [Hazard Ratio (HR) ajustado 0,86 – Intervalo de Confiança (IC) 95% 0,61-1,22; Ptrend = NS], mas foi estatisticamente diferente em comparação aos com FEVE ≥ 60% (HR ajustado = 0,64 - IC95% 0,44-0,94; Ptrend = 0,023). Não houve diferença na taxa de sobrevida de 10 anos entre diferentes grupos de FEVE. O grupo de pacientes com IC e FEVE ≥ 60% teve maior sobrevida cardiovascular que os outros grupos. (FEVE (IC ICFElr (ICFElr questionados 40 <40 (ICFEr 60 4059% 4059 59% 59 40-59 200 2011 KaplanMeier Kaplan Meier 1 005 0 05 <0,05 6 Hazard HR 086 86 0,8 95 0,611,22 061122 0,61 1,22 61 22 0,61-1,22 NS, NS , NS] 064 64 0,6 IC95 0,440,94 044094 0,44 0,94 44 94 0,44-0,94 0,023. 0023 0,023 . 023 0,023) 4 <4 405 5 40-5 20 201 00 <0,0 08 8 0, 9 611 0,611,2 06112 061 122 1,2 2 0,61-1,2 06 IC9 440 0,440,9 04409 044 0,4 094 0,9 0,44-0,9 002 0,02 02 40- <0, 0,611, 0611 12 1, 0,61-1, 0,440, 0440 04 09 0,44-0, 0,0 <0 0,611 0,61-1 0,440 0,44-0 0,61- 0,44-

Abstract Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups. (LVEF cutoff cut off HFmrEF (HFmrEF debate 40 (HFrEF 60 4059% 4059 59% 59 40-59 200 201 included 4059%, 59%, KaplanMeier Kaplan Meier tenyear ten year p005 p 0 05 p<0.05 6 1 years adjusted [HR 0.86 086 86 95 [CI 0.611.22, 061122 0.61 1.22, 61 22 0.61-1.22 NS, NS , NS) 0.64 064 64 0.440.94, 044094 0.44 0.94, 44 94 0.44-0.94 0.023. 0023 0.023 . 023 0.023) 10year 10 groups 4 405 5 40-5 20 p00 p<0.0 0.8 08 8 9 611 0.611.22 06112 061 0.6 122 1.22 2 0.61-1.2 06 440 0.440.94 04409 044 0.4 094 0.94 0.44-0.9 002 0.02 02 40- p0 p<0. 0. 0.611.2 0611 12 1.2 0.61-1. 0.440.9 0440 04 09 0.9 0.44-0. 00 0.0 p<0 0.611. 1. 0.61-1 0.440. 0.44-0 p< 0.611 0.61- 0.440 0.44-

https://doi.org/10.36660/abc.20210772

Proposed Risk Score in Patients with Aortic Stenosis Submitted to Valve Replacement Surgery
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Gasperi, Ricardo de

; Bodanese, Luiz Carlos

; Guaragna, João Carlos Vieira da Costa

; Wagner, Mario Bernardes

; Albuquerque, Luciano Cabral

Brazilian Journal of Cardiovascular Surgery

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2023, N. ahead

Abstract: En | Text: En | PDF: En

https://doi.org/10.21470/1678-9741-2022-0254

Risk Score Elaboration for Stroke in Cardiac Surgery
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Magedanz, Ellen Hettwer

; Guaragna, João Carlos Vieira da Costa

; Albuquerque, Luciano Cabral

; Wagner, Mario Bernardes

; Chieza, Fernanda Lourega

; Bueno, Natalia Lamas

; Bodanese, Luiz Carlos

Brazilian Journal of Cardiovascular Surgery

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dec 2021, Volume 36 N. 6 Pages 788 - 795

Abstract: En | Text: En | PDF: En

Abstract Introduction: Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity. The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass. Methods: A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model’s performance was then validated using data from the remainder of the patients (n=1,604). The model’s accuracy was tested using the area under the receiver operating characteristic (ROC) curve. Results: The prevalence of stroke during the postoperative period was 3% (n=149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66 - 0.75). Conclusion: We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.

https://doi.org/10.21470/1678-9741-2020-0331

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis
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Bodanese, Luiz Carlos

; Louzeiro, Gabriel Campos

; Magnus, Gabriela Agne

; Baptista, Ângela Hamann

; Salum, Fernanda Gonçalves

; Mattiello, Rita

International Journal of Cardiovascular Sciences

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nov 2021, Volume 34 N. 5 Pages 121 - 127

Abstract: En | Text: En | PDF: En

Abstract The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I2 = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I2 = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

https://doi.org/10.36660/ijcs.20200055 54 downloads

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021
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Nicolau, José Carlos

; Feitosa Filho, Gilson Soares

; Petriz, João Luiz

; Furtado, Remo Holanda de Mendonça

; Précoma, Dalton Bertolim

; Lemke, Walmor

; Lopes, Renato Delascio

; Timerman, Ari

; Marin Neto, José A.

; Bezerra Neto, Luiz

; Gomes, Bruno Ferraz de Oliveira

; Santos, Eduardo Cavalcanti Lapa

; Piegas, Leopoldo Soares

; Soeiro, Alexandre de Matos

; Negri, Alexandre Jorge de Andrade

; Franci, Andre

; Markman Filho, Brivaldo

; Baccaro, Bruno Mendonça

; Montenegro, Carlos Eduardo Lucena

; Rochitte, Carlos Eduardo

; Barbosa, Carlos José Dornas Gonçalves

; Virgens, Cláudio Marcelo Bittencourt das

; Stefanini, Edson

; Manenti, Euler Roberto Fernandes

; Lima, Felipe Gallego

; Monteiro Júnior, Francisco das Chagas

; Correa Filho, Harry

; Pena, Henrique Patrus Mundim

; Pinto, Ibraim Masciarelli Francisco

; Falcão, João Luiz de Alencar Araripe

; Sena, Joberto Pinheiro

; Peixoto, José Maria

; Souza, Juliana Ascenção de

; Silva, Leonardo Sara da

; Maia, Lilia Nigro

; Ohe, Louis Nakayama

; Baracioli, Luciano Moreira

; Dallan, Luís Alberto de Oliveira

; Dallan, Luis Augusto Palma

; Mattos, Luiz Alberto Piva e

; Bodanese, Luiz Carlos

; Ritt, Luiz Eduardo Fonteles

; Canesin, Manoel Fernandes

; Rivas, Marcelo Bueno da Silva

; Franken, Marcelo

; Magalhães, Marcos José Gomes

; Oliveira Júnior, Múcio Tavares de

; Filgueiras Filho, Nivaldo Menezes

; Dutra, Oscar Pereira

; Coelho, Otávio Rizzi

; Leães, Paulo Ernesto

; Rossi, Paulo Roberto Ferreira

; Soares, Paulo Rogério

; Lemos Neto, Pedro Alves

; Farsky, Pedro Silvio

; Cavalcanti, Rafael Rebêlo C.

; Alves, Renato Jorge

; Kalil, Renato Abdala Karam

; Esporcatte, Roberto

; Marino, Roberto Luiz

; Giraldez, Roberto Rocha Corrêa Veiga

; Meneghelo, Romeu Sérgio

; Lima, Ronaldo de Souza Leão

; Ramos, Rui Fernando

; Falcão, Sandra Nivea dos Reis Saraiva

; Dalçóquio, Talia Falcão

; Lemke, Viviana de Mello Guzzo

; Chalela, William Azem

; Mathias Júnior, Wilson

Arquivos Brasileiros de Cardiologia

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jul 2021, Volume 117 N. 1 Pages 181 - 264

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

https://doi.org/10.36660/abc.20210180 3052 downloads

Risk Score for Prolonged Mechanical Ventilation in Coronary Artery Bypass Grafting
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Dallazen-Sartori, Fernanda

; Albuquerque, Luciano Cabral

; Guaragna, João Carlos Vieira da Costa

; Magedanz, Ellen Hettwer

; Petracco, João Batista

; Bodanese, Rodrigo

; Wagner, Mario Bernardes

; Bodanese, Luiz Carlos

International Journal of Cardiovascular Sciences

Journal Metrics
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jun 2021, Volume 34 N. 3 Pages 264 - 271

Abstract: En | Text: En | PDF: En

Abstract Background Prolonged mechanical ventilation (MV) after cardiac surgery imposes a significant burden on the patient in terms of morbidity and financial hospital costs. Objective To develop a risk score model to predict prolonged MV in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods This was a historical cohort study of 4165 adult patients undergoing CABG between January 1996 and December 2016. MV for periods ≥ 12 hours was considered prolonged. Logistic regression was used to examine the relationship between risk predictors and prolonged MV. The variables were scored according to the odds ratio. To build the risk score, the database was randomly divided into 2 parts: development data set (2/3) with 2746 patients and internal validation data set (1/3) with 1419 patients. The final score was validated in the total database and the model's accuracy was tested by performance statistics. Significance was established at p < 0.05. Results Prolonged MV was observed in 783 (18.8%) patients. Predictors of risk were age ≥ 65 years, urgent/emergency surgery, body mass index ≥ 30 kg/m2, chronic kidney disease, chronic obstructive pulmonary disease, and cardiopulmonary bypass time ≥ 120 minutes. The area under the ROC curve was 0.66 (95% CI, 0.64-0.68; p<0.001), the Hosmer-Lemeshow chi-square test was χ2: 3.38 (p=0.642), and Pearson's correlation was r = 0.99 (p<0.001), indicating the model’s satisfactory ability to predict the occurrence of prolonged MV. Conclusion Selected variables allowed the construction of a simplified risk score for daily practice, which may classify the patients as having low, moderate, high, and very high risk. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

https://doi.org/10.36660/ijcs.20200068 30 downloads

10.

Avaliação do Seguimento de 1 Ano dos Pacientes Incluídos no Registro da Prática Clínica em Pacientes de Alto Risco Cardiovascular (REACT)
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Silva, Pedro Gabriel Melo de Barros e

; Berwanger, Otavio

; Precoma, Dalton Bertolim

; Cavalcante, Margaret Assad

; Vilela-Martin, José Fernando

; Figueiredo, Estêvão Lanna

; Lopes, Renato Delascio

; Bodanese, Luiz Carlos

; Guimarães, Jorge Ilha

; Andrade, Jadelson Pinheiro de

; Paola, Angelo Amato Vincenzo de

; Malachias, Marcus Vinicius Bolivar

; Mattos, Luiz Alberto Piva e

; Bacal, Fernando

; Dutra, Oscar Pereira

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
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jan 2021, Volume 116 N. 1 Pages 108 - 116

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

Resumo Fundamento Na prática clínica, há evidências de falhas na prescrição de terapias baseadas em evidências para pacientes de alto risco cardiovascular. Entretanto, no Brasil, ainda são insuficientes os dados sobre a evolução ao longo de 1 ano desses pacientes. Objetivos Descrição no acompanhamento de 12 meses da utilização de terapias baseadas em evidência e da ocorrência de desfechos cardiovasculares maiores e seus principais preditores em um registro brasileiro multicêntrico de pacientes de alto risco cardiovascular. Métodos Estudo observacional prospectivo que documentou a prática clínica ambulatorial de indivíduos acima de 45 anos e de alto risco cardiovascular tanto em prevenção primária como secundária. Os pacientes foram seguidos por 1 ano e avaliou-se a prescrição de terapias baseadas em evidência e a ocorrência de eventos cardiovasculares maiores (infarto agudo do miocárdio [IAM], acidente vascular cerebral [AVC], parada cardíaca e mortalidade por causa cardiovascular). Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados De julho de 2010 até agosto de 2014, 5.076 indivíduos foram incluídos em 48 centros, sendo 91% dos 4.975 pacientes elegíveis acompanhados em centros de cardiologia e 68,6% em prevenção secundária. Em 1 ano, o uso concomitante de antiplaquetários, estatinas e inibidores da enzima conversora de angiotensina (IECA) reduziu de 28,3% para 24,2% (valor de p < 0,001). A taxa de eventos cardiovasculares maiores foi de 5,46%, e os preditores identificados foram: idade, pacientes em prevenção secundária e nefropatia diabética. Conclusões Neste grande registro nacional de pacientes de alto risco cardiovascular, foram identificados preditores de risco semelhantes aos registros internacionais, porém a adesão da prescrição médica a terapias baseadas em evidência esteve abaixo dos dados da literatura internacional e apresentou piora significativa em 1 ano. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background In clinical practice, there is evidence of failure to prescribe evidence-based therapies for patients at high cardiovascular risk. However, in Brazil, data on 1-year outcomes of these patients remain insufficient. Objectives To describe the use of evidence-based therapies and the occurrence of major cardiovascular outcomes and their major predictors in a 12-month follow-up of a Brazilian multicenter registry of patients at high cardiovascular risk. Methods This prospective observational study documented the outpatient clinical practice of managing patients over 45 years of age and of high cardiovascular risk in both primary and secondary prevention. Patients were followed-up for 1 year, and the prescription of evidence-based therapies and the occurrence of major cardiovascular events (myocardial infarction, stroke, cardiac arrest, and cardiovascular death) were assessed. P-values < 0.05 were considered statistically significant. Results From July 2010 to August 2014, a total of 5076 individuals were enrolled in 48 centers, 91% of the 4975 eligible patients were followed-up in cardiology centers, and 68.6% were in secondary prevention. At 1 year, the concomitant use of antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors reduced from 28.3% to 24.2% (p < 0.001). Major cardiovascular event rate was 5.46%, and the identified predictors were age, patients in secondary prevention, and diabetic nephropathy. Conclusions In this large national registry of patients at high cardiovascular risk, risk predictors similar to those of international registries were identified, but medical prescription adherence to evidence-based therapies was inferior and significantly worsened at 1 year. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

https://doi.org/10.36660/abc.20190885 528 downloads

11.

Sobrevida de Pacientes com Insuficiência Cardíaca Aguda e Fração de Ejeção Intermediária em um País em Desenvolvimento – Estudo de Coorte no Sul do Brasil
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Petersen, Lucas Celia

; Danzmann, Luiz Claudio

; Bartholomay, Eduardo

; Bodanese, Luiz Carlos

; Donay, Brenda Gonçalves

; Magedanz, Ellen Hettwer

; Azevedo, Adriana Vier

; Porciuncula, Gustavo Farias

; Miglioranza, Marcelo Haertel

Arquivos Brasileiros de Cardiologia

Journal Metrics
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jan 2021, Volume 116 N. 1 Pages 14 - 23

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

Resumo Fundamento A insuficiência cardíaca (IC) com fração de ejeção na faixa média ou intermediária (ICFEI) (em inglês, “mid-range ejection fraction) foi recentemente descrita em diretrizes europeia e brasileira recentes sobre o manejo da insuficiência cardíaca (IC). A fração de ejeção (FE) é um parâmetro importante para direcionar terapia e prognóstico. Estudos têm mostrado resultados conflitantes sem dados representativos de países em desenvolvimento. Objetivo Analisar e comparar a taxa de sobrevida em pacientes com ICFEI com pacientes com IC e FE reduzida (ICFEr), e pacientes com IC e FE preservada, e avaliar as características clínicas desses pacientes. Métodos Estudo coorte que incluiu pacientes com IC aguda admitidos no departamento de emergência de um hospital terciário, referência em cardiologia, localizado no sul do Brasil, entre 2009 e 2011. A amostra foi dividida em três grupos de acordo com a FE: reduzida, intermediária e preservada. Curva de Kaplan-Meier foi analisada de acordo com a FE, e uma análise de regressão logística foi realizada. A significância estatística foi estabelecida em p<0,05. Resultados Um total de 380 pacientes foram analisados. A maioria dos pacientes apresentaram ICFEp (515), seguido de ICFEr (32%) e ICFEI (17%). Os pacientes com ICFEI apresentaram características intermediárias em relação à idade, pressão arterial, e diâmetros ventriculares, e a maioria era de etiologia isquêmica. O período mediano de acompanhamento foi de 4 anos. Não se observou diferença na sobrevida geral ou na mortalidade cardiovascular (p=0,03) entre os grupos de FE (FE reduzida: mortalidade de 40,5%; FE intermediária: 39,7%, e FE preservada 26%). A mortalidade hospitalar foi 7,6%. Conclusão Não houve diferença na taxa de sobrevida entre os grupos de FE diferentes. Os pacientes com ICFEI apresentaram maior mortalidade por doenças cardiovasculares em comparação a pacientes com ICFEp. (Arq Bras Cardiol. 2021; 116(1):14-23)

Abstract Background Heart Failure with mid-range Ejection Fraction (HFmEF) was recently described by European and Brazilian guidelines on Heart Failure (HF). The ejection fraction (EF) is an important parameter to guide therapy and prognosis. Studies have shown conflicting results without representative data from developing countries. Objective To analyze and compare survival rate in patients with HFmEF, HF patients with reduced EF (HFrEF), and HF patients with preserved EF (HFpEF), and to evaluate the clinical characteristics of these patients. Methods A cohort study that included adult patients with acute HF admitted through the emergency department to a tertiary hospital, reference in cardiology, in south Brazil from 2009 to 2011. The sample was divided into three groups according to EF: reduced, mid-range and preserved. A Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was done. Statistical significance was established as p < 0.05. Results A total of 380 patients were analyzed. Most patients had HFpEF (51%), followed by patients with HFrEF (32%) and HFmEF (17%). Patients with HFmEF showed intermediate characteristics related to age, blood pressure and ventricular diameters, and most patients were of ischemic etiology. Median follow-up time was 4.0 years. There was no statistical difference in overall survival or cardiovascular mortality (p=.0031) between the EF groups (reduced EF: 40.5% mortality; mid-range EF 39.7% and preserved EF 26%). Hospital mortality was 7.6%. Conclusion There was no difference in overall survival rate between the EF groups. Patients with HFmEF showed higher mortality from cardiovascular diseases in comparison with HFpEF patients. (Arq Bras Cardiol. 2021; 116(1):14-23)

https://doi.org/10.36660/abc.20190427 1094 downloads

12.

Indications of PCSK9 Inhibitors for Patients at High and Very High Cardiovascular Risk
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Behr, Paulo Eduardo Ballvé

; Moriguchi, Emilio Hideyuki

; Castro, Iran

; Bodanese, Luiz Carlos

; Dutra, Oscar Pereira

; Leães, Paulo Ernesto

; Pimentel Filho, Pedro

Arquivos Brasileiros de Cardiologia

Journal Metrics
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jul 2018, Volume 111 N. 1 Pages 104 - 108

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

https://doi.org/10.5935/abc.20180133 5550 downloads

13.

Assessment of the Relationship of Ankle-Brachial Index With Coronary Artery Disease Severity
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Petracco, Andrea Mabilde

; Bodanese, Luiz Carlos

; Porciúncula, Gustavo Farias

; Teixeira, Gabriel Santos

; Pellegrini, Denise de Oliveira

; Danzmann, Luiz Claudio

; Pianta, Ricardo Medeiros

; Petracco, João Batista

International Journal of Cardiovascular Sciences

Journal Metrics
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feb 2018, Volume 31 N. 1 Pages 47 - 55

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

Resumo Fundamento: A Doença Arterial Periférica (DAP) está associada a eventos cardiovasculares, podendo ser diagnosticada e estimada através do Índice Tornozelo-Braquial (ITB). Está bem estabelecido que o ITB é fator agravante na estratificação de risco cardiovascular, mas sua contribuição para definir a gravidade do acometimento arterial coronariano não está bem estabelecida. Objetivos: Estudo testou o valor do ITB com a gravidade da doença aterosclerótica coronariana pelo Escore de Syntax (ES) em pacientes com Síndrome Coronariana Aguda (SCA). Métodos: Estudo prospectivo com medida do ITB de todos os pacientes internados com SCA no Hospital São Lucas da PUCRS, consecutivamente, de maio a setembro de 2016, e comparação de seu valor com o ES e tipos de SCA desses pacientes. As análises foram realizadas considerando-se o nível de confiança de 95% (α = 5%). Resultados: 101 pacientes, com média de idade de 62,6±12,0 anos, 58 (57,4%) masculinos, 74 (82,2%) hipertensos, 33 (45,8%) diabéticos e 46 (45,5%) com infarto agudo do miocárdio com supradesnivelamento do ST (IAMCSST). A gravidade da DAP não teve relação com a gravidade anatômica da doença arterial coronariana (DAC). Encontramos uma associação significativa de ES intermediário com infarto agudo do miocárdio sem supradesnivelamento do ST (IAMSSST) e de ES baixo com angina instável (AI) [OR (IC95%): 1,11 (1,03-1,20); p = 0,004], que se manteve após análise multivariada, ajustada para idade, tabagismo, história familiar de DAC e DAC prévia [OR (IC95%): 1,13 (1,02-1,25); p = 0,019]. Conclusões: Analisando nossos resultados, encontramos que pacientes com ITB < 0,9 não apresentaram associação com maior complexidade determinada pelo ES em pacientes com SCA. Os pacientes com IAMSSST estiveram mais associados com ES intermediário.

Abstract Background: Peripheral Artery Disease (PAD) is associated with cardiovascular events and can be diagnosed and estimated by use of the Ankle-Brachial Index (ABI). ABI is a worsening factor in the stratification of cardiovascular risk, but its contribution to define the severity of coronary artery disease has not been well established. Objectives: To compare the ABI value with the coronary atherosclerotic disease severity by use of the Syntax Score (SS) in patients with Acute Coronary Syndrome (ACS). Methods: This prospective study measured the ABI of all patients with ACS consecutively admitted to the São Lucas Hospital of PUCRS from May to September 2016, and compared the ABI values with the SS and ACS types of those patients. The analyzes were performed considering the 95%confidence interval (a = 5%). Results: This study assessed 101 patients [mean age, 62.6 ± 12.0 years; 58 men (57.4%)], 74 (82.2%) were hypertensive, 33 (45.8%) had diabetes and 46 (45,5%) had ST-elevation acute myocardial infarction (STEMI). The PAD severity was not related to the anatomical severity of the coronary artery disease (CAD). We found a significant association of intermediate SS with non-ST-elevation acute myocardial infarction (NSTEMI), and of low SS with unstable angina (UA) [OR (95% CI): 1.11 (1.03-1.20) (p = 0.004)], which remained after multivariate analysis adjusted to age, smoking, family history of CAD and previous CAD [(OR 95%): 1.13 (1.02-1.25) (p = 0.019)]. Conclusions: Patients with ABI < 0.9 showed no association with higher disease complexity determined by the SS in patients with ACS. Patients with NSTEMI were more associated with an intermediate risk on the SS.

https://doi.org/10.5935/2359-4802.20170094 3247 downloads

14.

Lifestyle Intervention on Metabolic Syndrome and its Impact on Quality of Life: A Randomized Controlled Trial
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Saboya, Patrícia Pozas

; Bodanese, Luiz Carlos

; Zimmermann, Paulo Roberto

; Gustavo, Andreia da Silva

; Macagnan, Fabricio Edler

; Feoli, Ana Pandolfo

; Oliveira, Margareth da Silva

Arquivos Brasileiros de Cardiologia

Journal Metrics
- Sobre o periódico
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jan 2017, Volume 108 N. 1 Pages 60 - 69

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

Resumo Fundamento: Programas de intervenção em estilo de vida podem reduzir a prevalência de síndrome metabólica (SM) e, portanto, diminuir o risco de doença cardíaca, um dos principais problemas de saúde pública da atualidade. Objetivo: Comparar os efeitos de três tipos de abordagem para programas de mudança no estilo de vida visando à redução dos parâmetros metabólicos, assim como identificar seu impacto na qualidade de vida (QV) de indivíduos com SM. Métodos: Estudo randomizado controlado incluindo 72 indivíduos com SM com idade de 30 a 59 anos, que foram randomizados em três grupos de intervenção multidisciplinar [Intervenção Padrão (IP) - grupo controle; Intervenção em Grupo (IG); e Intervenção Individual (II)] por 12 semanas. O desfecho primário foi a mudança nos parâmetros metabólicos, e o secundário, a melhora nas medidas de QV em três momentos: condição basal, aos 3 e aos 9 meses. Resultados: As intervenções IG e II resultaram em uma significativa redução em índice de massa corporal, circunferência abdominal e pressão arterial sistólica, e em melhoras da QV aos 3 meses, embora significativamente associadas com o domínio 'capacidade funcional'. Tais mudanças, entretanto, não permaneceram 6 meses após o final da intervenção. Depressão e ansiedade associaram-se significativamente com pior QV, embora sem efeito na resposta à intervenção. Conclusão: A intervenção multidisciplinar, em especial em grupo, pode ser uma estratégia efetiva e economicamente possível para controlar os parâmetros metabólicos de SM e melhorar a QV quando comparada à IP, mesmo em uma relação de dose-efeito.

Abstract Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.

https://doi.org/10.5935/abc.20160186 4359 downloads

15.

Metabolic syndrome and quality of life: a systematic review
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Saboya, Patrícia Pozas

; Bodanese, Luiz Carlos

; Zimmermann, Paulo Roberto

; Gustavo, Andréia da Silva

; Assumpção, Caroline Melo

; Londero, Fernanda

Revista Latino-Americana de Enfermagem

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2016, Volume 24 elocation e2848

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

RESUMO Objetivos: apresentar as evidências disponíveis atuais para verificar a associação entre síndrome metabólica e qualidade de vida. Métodos: Cochrane Library, EMBASE, Medline e LILACS foram as bases de dados consultadas na identificação de todos os estudos que investigavam a associação entre síndrome metabólica e qualidade de vida. Dois revisores de forma independente e cegados extraíram os dados e, em caso de dúvidas, um outro revisor foi escolhido. Resultados: um total de 30 estudos foram incluídos, considerando os critérios de inclusão e exclusão, os quais envolveram 62.063 pacientes. A maioria dos estudos sugerem que a síndrome metabólica é significativamente associada à piora da qualidade de vida. Alguns, no entanto, demonstram associação apenas em mulheres, ou somente se associadas à depressão ou índice de massa corporal. Entretanto, um estudo não demonstrou tal associação, após ajuste para os fatores confundidores. Conclusão: apesar de dispormos de poucos estudos a respeito da relação entre síndrome metabólica e qualidade de vida, um número crescente de evidências tem demonstrado uma significativa associação entre a síndrome metabólica e o prejuízo na qualidade de vida. Entretanto, é necessário que sejam conduzidos estudos longitudinais com objetivo de confirmar esta associação e, determinar se esta relação é linear ou somente um fator de associação.

ABSTRACT Objectives: to present currently available evidence to verify the association between metabolic syndrome and quality of life. Method: Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. Results: a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. Conclusion: although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.

RESUMEN Objetivo: presentar las evidencias actualmente disponibles para verificar la asociación entre el síndrome metabólico y la calidad de vida. Métodos: se consultaron las bases de datos Cochrane Library, EMBASE, Medline y LILACS para la identificación de todos los estudios que investigaban la asociación entre síndrome metabólico y calidad de vida. Dos revisores de tipo ciego extrajeron los datos y en caso de dudas se eligió un revisor adicional. Resultados: un total de 30 estudios fueron incluidos, llevando en consideración los criterios de inclusión y exclusión, totalizando 62.063 pacientes. La mayoría de los estudios sugieren que el síndrome metabólico esta significativamente asociado al empeoramiento de la calidad de vida. Algunos, sin embargo muestran asociación solamente en mujeres, o sólo asociados a depresión o índice de masa corporal. También un estudio no mostró esta asociación después de ajustar por los factores confundentes. Conclusión: a pesar de tener a disposición pocos estudios en referencia a la relación entre síndrome metabólico y calidad de vida, un número creciente de evidencias ha demostrado una asociación significativa entre síndrome metabólico y perjuicio de la calidad de vida. Sin embargo es necesario que se realicen estudios longitudinales con el objetivo de confirmar esta asociación y determinar si esta relación es linear o solamente un factor de asociación.

https://doi.org/10.1590/1518-8345.1573.2848 13629 downloads

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