LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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- Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era(2021) 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, FábioAbstract 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.
conferenceObject Impairment of parasympathetic and sympathetic nervous systems in different forms of Chagas disease(2013) FERNANDES, F.; BARBOSA-FERREIRA, J. M.; RAMIRES, F. J. A.; GRUPI, C. J.; HACHUL, D. T.; IANNI, B. M.; DABARIAN, A.; NASTARI, L.; BUCK, P. C.; MADY, C.- Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy(2015) FRAGATA, Claudia da Silva; MATSUMOTO, Afonso Y.; RAMIRES, Felix J. A.; FERNANDES, Fabio; BUCK, Paula de Cassia; SALEMI, Vera Maria C.; NASTARI, Luciano; MADY, Charles; IANNI, Barbara MariaBackground: Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks. Objective: To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions. Methods: 10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. Results: Reservoir function (Total Emptying Fraction: TEF): (p < 0.0001), lower in GIII as compared to CG (p = 0.003), GI (p < 0.001) and GII (p < 0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p < 0.0001) and GII (p = 0.002). There was a negative correlation of E/e'(average) with the reservoir and pump functions (TEF and AEF), and a positive correlation of e'(average) with s' wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions. Conclusion: An impairment of LA functions in Chagas cardiomyopathy was observed.
- Plasma Pro-B-Type Natriuretic Peptide Testing as a Screening Method for Hypertrophic Cardiomyopathy(2012) FERNANDES, Fabio; ARTEAGA-FERNANDEZ, Edmundo; ANTUNES, Murillo de Oliveira; BUCK, Paula; MARSIGLIA, Julia Daher Carneiro; MATSUMOTO, Afonso; NASTARI, Luciano; KRIEGER, Jose Eduardo; PEREIRA, Alexandre Costa; MADY, CharlesBackground: Clinical multistage risk assessment associated with electrocardiogram (ECG) and NT-proBNP may be a feasible strategy to screen hypertrophic cardiomyopathy (HCM). We investigated the effectiveness of a screening based on ECG and NT-proBNP in first-degree relatives of patients with HCM. Methods and Results: A total of 106 first-degree relatives were included. All individuals were evaluated by echocardiography, ECG, NT-proBNP, and molecular screening (available for 65 individuals). From the 106 individuals, 36 (34%) had diagnosis confirmed by echocardiography. Using echocardiography as the gold standard, ECG criteria had a sensitivity of 0.71, 0.42, and 0.52 for the Romhilt-Estes, Sokolow-Lyon, and Cornell criteria, respectively. Mean values of NT-ProBNP were higher in affected as compared with nonaffected relatives (26.1 vs. 1290.5, P < .001). The AUC of NT-proBNP was 0.98. Using a cutoff value of 70 pg/mL, we observed a sensitivity of 0.92 and specificity of 0.96. Using molecular genetics as the gold standard, ECG criteria had a sensitivity of 0.67, 0.37, and 0.42 for the Romhilt-Estes, Sokolow-Lyon, and Cornell criteria, respectively. Using a cutoff value of 70 pg/mL, we observed a sensitivity of 0.83 and specificity of 0.98. Conclusion: Values of NT-proBNP above 70 pg/mL can be used to effectively select high-risk first-degree relatives for HCM screening. (J Cardiac Fail 2012;18:564-568)