VICTOR SARLI ISSA

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LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina

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Revista / Livro: Journal of the American College of Cardiology ×

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    CARVEDILOL FOR PREVENTION OF CHEMOTHERAPY-INDUCED CARDIOTOXICITY: FINAL RESULTS OF THE PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED CECCY TRIAL
    (2020) AYUB-FERREIRA, Silvia M.; AVILA, Monica; BRANDAO, Sara; CRUZ, Fatima D.; WANDERLEY JR., Mauro; RIGAUD, Vagner O. C.; HAJJAR, Ludhmila; KALIL-FILHO, Roberto; CRUZ, Cecilia B. V.; ALVES, Marco Stephan; GUIMARAES, Guilherme V.; ABDUCH, Maria; ISSA, Victor S.; SANTOS, Marilia; BITTENCOURT, Marcio; BOCCHI, Edimar Alcides
  • article 138 Citação(ões) na Scopus
    Chronic Chagas Heart Disease Management From Etiology to Cardiomyopathy Treatment
    (2017) BOCCHI, Edimar Alcides; BESTETTI, Reinaldo Bulgarelli; SCANAVACCA, Mauricio Ibrahim; NETO, Edecio Cunha; ISSA, Victor Sarli
    Trypanosoma cruzi (T. cruzi) infection is endemic in Latin America and is becoming a worldwide health burden. It may lead to heterogeneous phenotypes. Early diagnosis of T. cruzi infection is crucial. Several biomarkers have been reported in Chagas heart disease (ChHD), but most are nonspecific for T. cruzi infection. Prognosis of ChHD patients is worse compared with other etiologies, with sudden cardiac death as an important mode of death. Most ChHD patients display diffuse myocarditis with fibrosis and hypertrophy. The remodeling process seems to be associated with etiopathogenic mechanisms and neurohormonal activation. Pharmacological treatment and antiarrhythmic therapy for ChHD is mostly based on results for other etiologies. Heart transplantation is an established, valuable therapeutic option in refractory ChHD. Implantable cardioverter-defibrillators are indicated for prevention of secondary sudden cardiac death. Specific etiological treatments should be revisited and reserved for select patients. Understanding and management of ChHD need improvement, including development of randomized trials. (C) 2017 by the American College of Cardiology Foundation.
  • article 343 Citação(ões) na Scopus
    Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity
    (2018) AVILA, Monica Samuel; AYUB-FERREIRA, Silvia Moreira; WANDERLEY JR., Mauro Rogerio de Barros; CRUZ, Fatima das Dores; BRANDAO, Sara Michelly Goncalves; RIGAUD, Vagner Oliveira Carvalho; HIGUCHI-DOS-SANTOS, Marilia Harumi; HAJJAR, Ludhmila Abrahao; KALIL FILHO, Roberto; HOFF, Paulo Marcelo; SAHADE, Marina; FERRARI, Marcela S. M.; COSTA, Romulo Leopoldo de Paula; MANO, Max Senna; CRUZ, Cecilia Beatriz Bittencourt Viana; ABDUCH, Maria Cristina; ALVES, Marco Stephan Lofrano; GUIMARAES, Guilherme Veiga; ISSA, Victor Sarli; BITTENCOURT, Marcio Sommer; BOCCHI, Edimar Alcides
    BACKGROUND Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with beta-blockers remains controversial. OBJECTIVES This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m(2)) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a >= 10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 +/- 3.64 mm to 45.2 +/- 3.2 mm vs. 44.9 +/- 3.6 mm to 46.4 +/- 4.0 mm; p = 0.057). CONCLUSIONS In this largest clinical trial of beta-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction.(Carvedilol Effect in Preventing Chemotherap-Induced Cardiotoxicity [CECCy] NCTO1724450)(C) 2018 by the American College of Cardiology Foundation.
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    CLINICAL DIAGNOSES AND AUTOPSY FINDINGS AFTER HEART TRANSPLANTATION: DISCREPANCIES AFFECTING MANAGEMENT AND SURVIVAL - NEHTS STUDY (NECROPSY HEART TRANSPLANTATION STUDY)
    (2012) BOCCHI, Edimar Alcides; VALETTE, Thiago Ninck; AYUB-FERREIRA, Silvia Moreira; ISSA, Victor; BENVENUTI, Luiz Alberto; BACAL, Fernando; FIORELLI, Alfredo Inacio; CHIZZOLA, Paulo; SOUZA, Germano; POMERANTZEFF, Pablo; STOLF, Noedir
    Background: Discrepancies between clinical and autopsy diagnosis of causes of death (COD) and its consequences in the management of patients were not evaluated after heart transplantation (HT). Objective: To identify discrepancies between clinical COD and autopsy results. Methods: We studied retrospectively 48 autopsies of HT receptors from 2000 to 2010 (39% of the deaths). We used the Goldman classification to study the discrepancies. Results: 31.3% missed major diagnosis with potential adverse impact on survival and that would have changed management (Class I), 2.1% missed major and minor diagnosis without potential adverse impact on survival and that would have not changed management (Class II and III), 60.4%absolute agreement (Class V), and 6,3% uncertain autopsy diagnosis (Class VI). The main discrepancies between autopsy and clinical COD and missed diagnosis were errors in the diagnosis of causes of transplanted organ dysfunction (40%), acute humoral rejection (20%), cardiac allograft disease (20%), pulmonary embolism (6.7%), disseminated intravascular coagulation (6.7%), and causes of shock (6,7%). Conclusions: This study found significant discrepancies with potential impact on therapy and outcome of HT patients. This reinforces the importance of the postmortem examination in confirming diagnostic accuracy and improving the quality of care of HT patients.