LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Echocardiographic findings of Trypanosoma cruzi seropositive blood donors(2017) SALEMI, V. M. C.; OLIVEIRA, C. D. L.; RIBEIRO, A. L.; MENEZES, M. M.; ANTUNES, A. P.; FERREIRA-FILHO, J. C.; SACHDEV, V.; FERNANDES, F.; NASTARI, L.; IANNI, B. M.; MADY, C.; CARNEIRO-PROIETTI, A. B.; KEATING, S. M.; BUSCH, M. P.; SABINO, E. G.- Electrocardiographic Abnormalities in Trypanosoma cruzi Seropositive and Seronegative Former Blood Donors(2013) RIBEIRO, Antonio L.; SABINO, Ester C.; MARCOLINO, Milena S.; SALEMI, Vera M. C.; IANNI, Barbara M.; FERNANDES, Fabio; NASTARI, Luciano; ANTUNES, Andre; MENEZES, Marcia; OLIVEIRA, Claudia Di Lorenzo; SACHDEV, Vandana; CARRICK, Danielle M.; BUSCH, Michael P.; MURPHY, Eduard L.Background: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. Objectives: To assess the frequency of ECG abnormalities in T. cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. Methods: The study retrospectively enrolled 499 seropositive blood donors in Sao Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF), 0.50%. Results: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159, p<0.0003, and -0.142, p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. Conclusions: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.
- Galectin-3 Associated with Severe Forms and Long-term Mortality in Patients with Chagas Disease(2021) FERNANDES, Fabio; MOREIRA, Carlos Henrique Valente; OLIVEIRA, Lea Campos; SOUZA-BASQUEIRA, Marcela; IANNI, Barbara Maria; LORENZO, Claudia di; RAMIRES, Felix Jose Alvarez; NASTARI, Luciano; CUNHA-NETO, Edecio; RIBEIRO, Antonio L.; LOPES, Renato Delascio; KEATING, Sheila M.; SABINO, Ester Cerdeira; MADY, CharlesBackground: 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.
- Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity(2015) SABINO, E. C.; RIBEIRO, A. L.; LEE, T. H.; OLIVEIRA, C. L.; CARNEIRO-PROIETTI, A. B.; ANTUNES, A. P.; MENEZES, M. M.; IANNI, B. M.; SALEMI, V. M.; NASTARI, L.; FERNANDES, F.; SACHDEV, V.; CARRICK, D. M.; DENG, X.; WRIGHT, D.; GONCALEZ, T. T.; MURPHY, E. L.; CUSTER, B.; BUSCH, M. P.BackgroundThe significance of detection of Trypanosoma cruziDNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruziDNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. MethodsThis is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20mL of blood. All testing was performed on coded samples. ResultsRates of PCR detection of T. cruziDNA were significantly (P=0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. ConclusionTrypanosoma cruziPCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
conferenceObject TEN-YEAR INCIDENCE OF CHAGAS CARDIOMYOPATHY AMONG ASYMPTOMATIC T. CRUZI SEROPOSITIVE, FORMER BLOOD DONORS(2012) MURPHY, E. L.; SABINO, E.; RIBEIRO, A.; SALEMI, V; ANTUNES, A.; MENEZES, M.; IANNI, B.; NASTARI, L.; FERNANDEZ, F.; PATAVINO, G.; SACHDEV, V; CAPUANI, L.; ALMEIDA NETO, C. De; OLIVEIRA, C. Di Lorenzo; CARRICK, D.; WRIGHT, D.; CUSTER, B.; BUSCH, M. P.; MURPHY, E. L.- Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic Trypanosoma cruzi-Seropositive Former Blood Donors(2013) SABINO, Ester C.; RIBEIRO, Antonio L.; SALEMI, Vera M. C.; OLIVEIRA, Claudia Di Lorenzo; ANTUNES, Andre P.; MENEZES, Marcia M.; IANNI, Barbara M.; NASTARI, Luciano; FERNANDES, Fabio; PATAVINO, Giuseppina M.; SACHDEV, Vandana; CAPUANI, Ligia; ALMEIDA-NETO, Cesar de; CARRICK, Danielle M.; WRIGHT, David; KAVOUNIS, Katherine; GONCALEZ, Thelma T.; CARNEIRO-PROIETTI, Anna Barbara; CUSTER, Brian; BUSCH, Michael P.; MURPHY, Edward L.Background-Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-infected persons. Methods and Results-We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi-seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of Sao Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S-3 heart sound. Conclusions-There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi-seropositive blood donors, although disease was mild at diagnosis. (Circulation. 2013;127:1105-1115.)
- Response to Letters Regarding Article, ""Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic, Trypanosoma cruzi-Seropositive Former Blood Donors""(2013) SABINO, Ester C.; RIBEIRO, Antonio L.; SALEMI, Vera M. C.; IANNI, Barbara M.; NASTARI, Luciano; FERNANDES, Fabio; OLIVEIRA, Claudia Di Lorenzo; ANTUNES, Andre P.; MENEZES, Marcia M.; PATAVINO, Giuseppina M.; CAPUANI, Ligia; ALMEIDA-NETO, Cesar de; SACHDEV, Vandana; CARRICK, Danielle M.; WRIGHT, David; KAVOUNIS, Katherine; GONZALEZ, Thelma T.; CUSTER, Brian; BUSCH, Michael P.; MURPHY, Edward L.; CARNEIRO-PROIETTI, Anna-Barbara