REMO HOLANDA DE MENDONCA FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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conferenceObject Is there a Correlation Between Bleeding Risk Score and Platelet Aggregability?(2014) ARANTES, Flavia B.; FURTADO, Remo H.; BARBOSA, Carlos J.; FRANCI, Andre; MENEZES, Fernando R.; FALCAO, Talia D.; NAKASHIMA, Carlos A.; BARACIOLI, Luciano M.; RAMIRES, Jose A.; NICOLAU, Jose C.conferenceObject Adenosine Plasmatic Concentration in Coronary Artery Disease Patients With and Without Chronic Kidney Disease(2019) FRANCI, Andre; BARBOSA, Carlos; DALCOQUIO, Talia; SALSOSO, Rocio; FURTADO, Remo H.; STRUNZ, Celia; GENESTRETI, Paulo; LIMA, Viviane; SCANAVINI, Marco; FERRARI, Aline G.; BARACIOLI, Luciano; NICOLAU, Jose C.- Effect of Dapagliflozin on Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus Insights From the DECLARE-TIMI 58 Trial(2020) ZELNIKER, Thomas A.; BONACA, Marc P.; FURTADO, Remo H. M.; MOSENZON, Ofri; KUDER, Julia F.; MURPHY, Sabina A.; BHATT, Deepak L.; LEITER, Lawrence A.; MCGUIRE, Darren K.; WILDING, John P. H.; BUDAJ, Andrzej; KISS, Robert G.; PADILLA, Francisco; GAUSE-NILSSON, Ingrid; LANGKILDE, Anna Maria; RAZ, Itamar; SABATINE, Marc S.; WIVIOTT, Stephen D.Background: Atrial fibrillation (AF) and atrial flutter (AFL) are associated with both diabetes mellitus and its related comorbidities, including hypertension, obesity, and heart failure (HF). SGLT2 (sodium-glucose cotransporter 2) inhibitors have been shown to lower blood pressure, reduce weight, have salutary effects on left ventricular remodeling, and reduce hospitalization for HF and cardiovascular death in patients with type 2 diabetes mellitus. We therefore investigated whether SGLT2 inhibitors could also reduce the risk of AF/AFL. Methods: DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58) studied the efficacy and safety of the SGLT2 inhibitor dapagliflozin versus placebo in 17 160 patients with type 2 diabetes mellitus and either multiple risk factors for atherosclerotic cardiovascular disease (n=10 186) or known atherosclerotic cardiovascular disease (n=6974). We explored the effect of dapagliflozin on the first and total number of AF/AFL events in patients with (n=1116) and without prevalent AF/AFL using Cox and negative binomial models, respectively. AF/AFL events were identified by search of the safety database using MedDRA preferred terms (""atrial fibrillation,"" ""atrial flutter""). Results: Dapagliflozin reduced the risk of AF/AFL events by 19% (264 versus 325 events; 7.8 versus 9.6 events per 1000 patient-years; hazard ratio [HR], 0.81 [95% CI, 0.68-0.95]; P=0.009). The reduction in AF/AFL events was consistent regardless of presence or absence of a history of AF/AFL at baseline (previous AF/AFL: HR, 0.79 [95% CI, 0.58-1.09]; no AF/AFL: HR, 0.81 [95% CI, 0.67-0.98]; P for interaction 0.89). Similarly, presence of atherosclerotic cardiovascular disease (HR, 0.83 [95% CI, 0.66-1.04]) versus multiple risk factors (HR, 0.78 [95% CI, 0.62-0.99]; P for interaction 0.72) or a history of HF (HF: HR, 0.78 [95% CI, 0.55-1.11]; No HF: HR, 0.81 [95% CI, 0.68-0.97]; P for interaction 0.88) did not modify the reduction in AF/AFL events observed with dapagliflozin. Moreover, there was no effect modification by sex, history of ischemic stroke, glycated hemoglobin A(1c), body mass index, blood pressure, or estimated glomerular filtration rate (all P for interaction >0.20). Dapagliflozin also reduced the total number (first and recurrent) of AF/AFL events (337 versus 432; incidence rate ratio, 0.77 [95% CI, 0.64-0.92]; P=0.005). Conclusions: Dapagliflozin decreased the incidence of reported episodes of AF/AFL adverse events in high-risk patients with type 2 diabetes mellitus. This effect was consistent regardless of the patient's previous history of AF, atherosclerotic cardiovascular disease, or HF. Registration: URL: ; Unique identifier: NCT01730534.
- Dapagliflozin and Cardiac, Kidney, and Limb Outcomes in Patients With and Without Peripheral Artery Disease in DECLARE-TIMI 58(2020) BONACA, Marc P.; WIVIOTT, Stephen D.; ZELNIKER, Thomas A.; MOSENZON, Ofri; BHATT, Deepak L.; LEITER, Lawrence A.; MCGUIRE, Darren K.; GOODRICH, Erica L.; FURTADO, Remo Holanda De Mendonca; WILDING, John P. H.; CAHN, Avivit; GAUSE-NILSSON, Ingrid A. M.; JOHANSON, Per; FREDRIKSSON, Martin; JOHANSSON, Peter A.; LANGKILDE, Anna Maria; RAZ, Itamar; SABATINE, Marc S.BACKGROUND: Patients with peripheral artery disease (PAD) are at heightened risk of cardiovascular complications. The sodium-glucose cotransporter 2 inhibitor dapagliflozin reduces the risk for hospitalization for heart failure (HHF) and kidney events in patients with type 2 diabetes mellitus. An increased risk of amputation has been observed with canagliflozin in 1 previous trial. We examined cardiovascular and kidney efficacy and the risk of limb-related events in patients with and without PAD in an exploratory analysis. METHODS: A total of 17 160 patients with type 2 diabetes mellitus, including 1025 (6%) with PAD, were randomized. Key efficacy outcomes were MACE (cardiovascular [CV] death, myocardial infarction, stroke), CV death/HHF, and progression of kidney disease. Amputations, peripheral revascularization, and limb ischemic adverse events were site-reported and categorized by a blinded reviewer. RESULTS: Patients in the placebo arm with PAD versus those without tended to have higher adjusted risk of CV death, myocardial infarction, or stroke (adjusted hazard ratio [HR], 1.23 [95% CI, 0.97-1.56],P=0.094) and significantly higher adjusted risk of CV death/HHF (adjusted HR, 1.60 [95% CI, 1.21-2.12],P=0.0010) and progression of kidney disease (adjusted HR, 1.51 [95% CI, 1.13 - 2.03],P=0.0058), and limb adverse events (adjusted HR, 8.37,P<0.001). The relative risk reductions with dapagliflozin for CV death/HHF (HR, 0.86, PAD; HR, 0.82, no-PAD;P-interaction=0.79) and progression of kidney disease (HR, 0.78, PAD; HR, 0.76, no-PAD;P-interaction=0.84) were consistent regardless of PAD. There were 560 patients who had at least 1 limb ischemic event, 454 patients with at least 1 peripheral revascularization, and 236 patients with at least 1 amputation, with a total of 407 amputations reported. Overall, there were no significant differences in any limb outcome with dapagliflozin versus placebo including limb ischemic adverse events (HR, 1.07 [95% CI, 0.90-1.26]) and amputation (HR, 1.09 [95% CI, 0.84-1.40]), with no significant interactions by a history of PAD versus not (P-interactions=0.30 and 0.093, respectively). CONCLUSIONS: Patients with versus without PAD are at a higher risk of CV death of CV death, HHF, and kidney outcomes, and have a consistent benefits for CV death/HHF and progression of kidney disease with dapagliflozin. Patients with PAD had a higher risk of limb events, with no consistent pattern of incremental risk observed with dapagliflozin.
conferenceObject Impact of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes and Reduced Left Ventricular Ejection Fraction(2019) SALSOSO, Rocio; GENESTRETI, Paulo; FRANCI, Andre; DALCOQUIO, Talia; NAKASHIMA, Carlos A.; SCANAVINI, Marco; FERRARI, Aline G.; FURTADO, Remo H.; LIMA, Felipe G.; GIRALDEZ, Roberto R.; BARACIOLI, Luciano; NICOLAU, Jose C.conferenceObject HDL Dysfunction in Patients With Coronary Artery Disease and Previous Ischemic Cerebrovascular Event(2016) BARBOSA, Carlos J.; MARANHAO, Raul C.; BARREIROS, Renata S.; FRANCI, Andre; FURTADO, Remo H.; ARANTES, Flavia B.; FREITAS, Fatima R. Sousa e; RAMIRES, Jos A.; KALIL-FILHO, Roberto; NICOLAU, Jose C.- Increased bodyweight and inadequate response to aspirin in individuals with coronary artery disease(2019) FURTADO, Remo H. M.; GIUGLIANO, Robert P.; DALCOQUIO, Talia F.; ARANTES, Flavia B. B.; BARBOSA, Carlos J. D. G.; GENESTRETI, Paulo R. R.; FRANCI, Andre; MENEZES, Fernando R.; NAKASHIMA, Carlos A. K.; SCANAVINI FILHO, Marco A.; FERRARI, Aline G.; SALSOSO, Rocio; BARACIOLI, Luciano M.; NICOLAU, Jose C.Recent reports have suggested that aspirin effect might be influenced by bodyweight, with decreased efficacy in heavier individuals. We investigated the influence of bodyweight on aspirin pharmacodynamics in two independent datasets of patients taking non-enteric coated aspirin 100mg QD for coronary artery disease (CAD). In the first dataset, 368 patients had their platelet aggregation assessed using VerifyNow Aspirin and measured in Aspirin Reaction Units (ARU). In the second dataset, 70 patients had serum thromboxane B2 (TXB2) dosage assessed by an ELISA assay and measured in pg/mL. Platelet aggregation was independently associated with bodyweight, with 8.41 (95% CI 1.86-14.97; adjusted p-value=0.012) increase in ARU for every 10kg. Furthermore, the rate of non-response to aspirin (defined as ARU550) was significantly associated with increased bodyweight (adjusted p-value=0.007), with OR=1.23 (95% CI 1.06-1.42) for every 10kg. Similar results were found considering body mass index (in kg/m(2)), with 15.5 (95% CI 5.0 to 25.9; adjusted p-value=0.004) increase in ARU for every 10kg and non-response OR=1.43 (95% CI 1.13 to 1.81, adjusted p-value=0.003) for every 5kg/m(2). Moreover, serum TXB2 was higher in patients weighting more than 70kg (222.6 +/- 62.9 versus 194.9 +/- 61.9pg/mL; adjusted p-value=0.018). In two different datasets of patients with CAD on non-enteric coated aspirin 100mg QD, increased bodyweight was independently associated with impaired response to aspirin.
- Randomized, Placebo-Controlled Phase 2b Study to Evaluate the Safety and Efficacy of Recombinant Human Lecithin Cholesterol Acyltransferase in Acute ST-Segment-Elevation Myocardial Infarction: Results of REAL-TIMI 63B(2022) BONACA, Marc P.; MORROW, David A.; BERGMARK, Brian A.; BERG, David D.; LIMA, Joao A. C.; HOFFMANN, Udo; KATO, Yoko; LU, Michael T.; KUDER, Julia; MURPHY, Sabina A.; SPINAR, Jindrich; OPHUIS, Ton Oude; KISS, Robert G.; LOPEZ-SENDON, Jose; AVERKOV, Oleg; WHEATCROFT, Stephen B.; KUBICA, Jacek; NICOLAU, Jose Carlos; FURTADO, Remo H. M.; ABUHATZIRA, Liron; HIRSHBERG, Boaz; OMAR, Sami A.; VAVERE, Andrea L.; CHANG, Yi-Ting; GEORGE, Richard T.; SABATINE, Marc S.BACKGROUND: High-density lipoprotein plays a key role in reverse cholesterol transport. In addition, high-density lipoprotein particles may be cardioprotective and reduce infarct size in the setting of myocardial injury. Lecithin-cholesterol acyltransferase is a rate-limiting enzyme in reverse cholesterol transport. MEDI6012 is a recombinant human lecithincholesterol acyltransferase that increases high-density lipoprotein cholesterol. Administration of lecithin-cholesterol acyltransferase has the potential to reduce infarct size and regress coronary plaque in acute ST-segment-elevation myocardial infarction. METHODS: REAL-TIMI 63B (A Randomized, Placebo-controlled Phase 2b Study to Evaluate the Safety and Efficacy of MED16012 in Acute ST Elevation Myocardial Infarction) was a phase 2B multinational, placebo-controlled, randomized trial. Patients with ST-segment-elevation myocardial infarction within 6 hours of symptom onset and planned for percutaneous intervention were randomly assigned 2:1 to MEDI6012 (2- or 6-dose regimen) or placebo and followed for 12 weeks. The primary outcome was infarct size as a percentage of left ventricular mass by cardiac MRI at 10 to 12 weeks, with the primary analysis in patients with TIMI Flow Grade 0 to 1 before percutaneous intervention who received at least 2 doses of MEDI6012. The secondary outcome was change in noncalcified plaque volume on coronary computed tomographic angiography from baseline to 10 to 12 weeks with the primary analysis in patients who received all 6 doses of MEDI6012. RESULTS: A total of 593 patients were randomly assigned. Patients were a median of 62 years old, 77.9% male, and 95.8% statin naive. Median time from symptom onset to randomization was 146 (interquartile range [IQR], 103-221) minutes and from hospitalization to randomization was 12.7 (IQR, 6.6-24.0) minutes, and the first dose of drug was administered a median of 8 (IQR, 3-13) minutes before percutaneous intervention. The index myocardial infarction was anterior in 69.6% and TIMI Flow Grade 0 to 1 in 65.1% of patients. At 12 weeks, infarct size did not differ between treatment groups (MED16012: 9.71%, IQR 4.79-16.38; placebo: 10.48%, [IQR, 4.92-16.61], 1-sided P=0.79. There was also no difference in noncalcified plaque volume (geometric mean ratio, 0.96 [95% CI, NA-1.10], 1-sided P=0.30). There was no significant difference in treatment emergent serious adverse events. CONCLUSIONS: Administration of MEDI6012 in patients with acute ST-segment-elevation myocardial infarction did not result in a significant reduction in infarct size or noncalcified plaque volume at 12 weeks. MEDI6012 was well tolerated with no excess in overall serious adverse events.
conferenceObject Long-Term Mortality After Acute Coronary Syndromes Among Patients with Normal, Mid-Range or Low Ejection Fraction(2021) FURTADO, Remo; JULIASZ, Marcela G.; CHIU, Felipe Y.; BASTOS, Livia B.; DALCOQUIO, Talia F.; LIMA, Felipe G.; ROSA, Renato; CAPORRINO, Cesar A.; BERTOLIN, Adriadne; SOFFIATTI, Carla; RIBEIRO, Andre S.; ANDRADE, Maria C.; GIRALDEZ, Roberto; BARACIOLI, Luciano; NICOLAU, Jose C.conferenceObject Effect of Exercise-based Cardiac Rehabilitation After Acute Myocardial Infarction on HDL Function: A Randomized Clinical Trial(2019) DALCOQUIO, Talia F.; FREITAS, Fatima; ARANTES, Flavia B.; FERREIRA-SANTOS, Larissa; ALVES, Leandro; SANTOS, Mayara; RONDON, Maria Urbana P.; ALVES, Maria-janieire N.; FURTADO, Remo H.; NEGRAO, Carlos E.; MARANHAO, Raul C.; NICOLAU, Jose C.