FRANCISCO AKIRA MALTA CARDOZO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Autor: GUALANDRO, Danielle M. ×

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  • article 24 Citação(ões) na Scopus
    Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery
    (2023) PUELACHER, Christian; GUALANDRO, Danielle M.; GLARNER, Noemi; BUSE, Giovanna Lurati; LAMPART, Andreas; BOLLIGER, Daniel; STEINER, Luzius A.; GROSSENBACHER, Mario; BURRI-WINKLER, Katrin; GERHARD, Hatice; KAPPOS, Elisabeth A.; CLERC, Olivier; BINER, Laura; ZIVZIVADZE, Zaza; KINDLER, Christoph; HAMMERER-LERCHER, Angelika; FILIPOVIC, Miodrag; CLAUSS, Martin; GURKE, Lorenz; WOLFF, Thomas; MUJAGIC, Edin; BILICI, Murat; CARDOZO, Francisco A.; OSSWALD, Stefan; CARAMELLI, Bruno; MUELLER, Christian
    Aims Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed.Methods and results Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into 'extra-cardiac' if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and 'cardiac', further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45-98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis.Conclusion At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments.Study registration.
  • article 30 Citação(ões) na Scopus
    Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery
    (2018) GUALANDRO, Danielle M.; PUELACHER, Christian; LURATIBUSE, Giovanna; LAMPART, Andreas; STRUNZ, Celia; CARDOZO, Francisco A.; YU, Pai C.; JAFFE, Allan S.; BARAC, Sanela; BOCK, Lukas; BADERTSCHER, Patrick; LAVALLAZ, Jeanne du Fay de; MARBOT, Stella; SAZGARY, Lorraine; BOLLIGER, Daniel; RENTSCH, Katharina; TWERENBOLD, Raphael; HAMMERER-LERCHER, Angelika; MELO, Edielle S.; CALDERARO, Daniela; DUARTE, Alberto J. S.; LUCCIA, Nelson de; CARAMELLI, Bruno; MUELLER, Christian
    Background: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P=.012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
  • conferenceObject
    Dabigatran versus Warfarin on Cognitive Outcomes in Nonvalvular Atrial Fibrillation: Results of the GIRAF Trial
    (2021) CARAMELLI, Bruno; YU, Pai C.; CARDOZO, Francisco A.; MAGALHAES, Iuri R.; FEITOSA, Raul R.; SPERA, Raphael; AMADO, Daniel; ROJAS, Maria Carmen Escalante; GUALANDRO, Danielle M.; CALDERARO, Daniela; TAVARES, Caio de Assis Moura A.; BORG-ES-JUNIOR, Flavio A.; PASTANA, Adriana F.; MATHEUS, Mariana G. Gomes; BRUCKI, Sonia M.; RODRIGUES, Ana C.; NITRINI, Ricardo M.; CARAMELLI, Paulo
  • article 11 Citação(ões) na Scopus
    Effects of dabigatran versus warfarin on 2-year cognitive outcomes in old patients with atrial fibrillation: results from the GIRAF randomized clinical trial
    (2022) CARAMELLI, Bruno; YU, Pai Ching; CARDOZO, Francisco A. M.; MAGALHAES, Iuri R.; SPERA, Raphael R.; AMADO, Daniel K.; ESCALANTE-ROJAS, Maria C.; GUALANDRO, Danielle M.; CALDERARO, Daniela; TAVARES, Caio A. M.; BORGES-JUNIOR, Flavio A.; PASTANA, Adriana F.; MATHEUS, Mariana G.; BRUCKI, Sonia M. D.; RODRIGUES, Ana Carolina O.; NITRINI, Ricardo; CARAMELLI, Paulo
    Background: Observational studies support a role for oral anticoagulation to reduce the risk of dementia in atrial fibrillation patients, but conclusive data are lacking. Since dabigatran offers a more stable anticoagulation, we hypothesized it would reduce cognitive decline when compared to warfarin in old patients with atrial fibrillation. Methods: The GIRAF trial was a 24-month, randomized, parallel-group, controlled, open-label, hypothesis generating trial. The trial was done in six centers including a geriatric care unit, secondary and tertiary care cardiology hospitals in Sao Paulo, Brazil. We included patients aged >= 70 years and CHA2DS2-VASc score > 1. The primary endpoint was the absolute difference in cognitive performance at 2 years. Patients were assigned 1:1 to take dabigatran (110 or 150 mg twice daily) or warfarin, controlled by INR and followed for 24 months. Patients were evaluated at baseline and at 2 years with a comprehensive and thorough cognitive evaluation protocol of tests for different cognitive domains including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam (MMSE), a composite neuropsychological test battery (NTB), and computer-generated tests (CGNT). Results: Between 2014 and 2019, 5523 participants were screened and 200 were assigned to dabigatran (N = 99) or warfarin (N = 101) treatment. After adjustment for age, log of years of education, and raw baseline score, the difference between the mean change from baseline in the dabigatran group minus warfarin group was - 0.12 for MMSE (95% confidence interval [CI] - 0.88 to 0.63; P = 0.75), 0.05 (95% CI - 0.07 to 0.18; P = 0.40) for NTB, - 0.15 (95% CI - 0.30 to 0.01; P = 0.06) for CGNT, and - 0.96 (95% CI - 1.80 to 0.13; P = 0.02) for MoCA, with higher values suggesting less cognitive decline in the warfarin group. Conclusions: For elderly patients with atrial fibrillation, and without cognitive compromise at baseline that did not have stroke and were adequately treated with warfarin (TTR of 70%) or dabigatran for 2 years, there was no statistical difference at 5% significance level in any of the cognitive outcomes after adjusting for multiple comparisons.
  • article 0 Citação(ões) na Scopus
    Cardiovascular imaging following perioperative myocardial infarction/injury
    (2022) ARSLANI, Ketina; GUALANDRO, Danielle M.; PUELACHER, Christian; BUSE, Giovanna Lurati; LAMPART, Andreas; BOLLIGER, Daniel; SCHULTHESS, David; GLARNER, Noemi; HIDVEGI, Reka; KINDLER, Christoph; BLUM, Steffen; CARDOZO, Francisco A. M.; CARAMELLI, Bruno; GUERKE, Lorenz; WOLFF, Thomas; MUJAGIC, Edin; SCHAEREN, Stefan; RIKLI, Daniel; CAMPOS, Carlos A.; FAHRNI, Gregor; KAUFMANN, Beat A.; HAAF, Philip; ZELLWEGER, Michael J.; KAISER, Christoph; OSSWALD, Stefan; STEINER, Luzius A.; MUELLER, Christian
    Patients developing perioperative myocardial infarction/injury (PMI) have a high mortality. PMI work-up and therapy remain poorly defined. This prospective multicenter study included highrisk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program. The frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction (T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/cardiologist, who determined selection/timing of cardiovascular imaging. T1M1 was considered with the presence of a new wall motion abnormality within 30 days in transthoracic echocardiography (TTE), a new scar or ischemia within 90 days in myocardial perfusion imaging (MPI), and Ambrose-Type II or complex lesions within 7 days of PMI in coronary angiography (CA). In patients with PMI, 21% (268/1269) underwent at least one cardiac imaging modality. TTE was used in 13% (163/1269), MPI in 3% (37/1269), and CA in 5% (68/1269). Cardiology consultation was associated with higher use of cardiovascular imaging (27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and 63% of CA. Most patients with PMI did not undergo any cardiovascular imaging within their PMI work-up. If performed, MPI and CA showed high yield for signs indicative of T1MI.
  • conferenceObject
    Dabigatran versus Warfarin on Cognitive Outcomes in Nonvalvular Atrial Fibrillation: Results of the GIRAF Trial
    (2021) CARAMELLI, Bruno; YU, Pai C.; CARDOZO, Francisco A.; MAGALHAES, Iuri R.; FEITOSA, Raul R.; SPERA, Raphael; AMADO, Daniel; ROJAS, Maria Carmen Escalante; GUALANDRO, Danielle M.; CALDERARO, Daniela; TAVARES, Caio de Assis Moura A.; BORGES-JUNIOR, Flavio A.; PASTANA, Adriana F.; MATHEUS, Mariana G. Gomes; BRUCKI, Sonia M.; RODRIGUES, Ana C.; NITRINI, Ricardo M.; CARAMELLI, Paulo
  • article 24 Citação(ões) na Scopus
    Prediction of major cardiac events after vascular surgery
    (2017) GUALANDRO, Danielle M.; PUELACHER, Christian; LURATIBUSE, Giovanna; LLOBET, Gisela B.; YU, Pai C.; CARDOZO, Francisco A.; GLARNER, Noemi; ZIMMERLI, Andres; ESPINOLA, Jaqueline; CORBIERE, Sydney; CALDERARO, Daniela; MARQUES, Andre C.; CASELLA, Ivan B.; LUCCIA, Nelson de; OLIVEIRA, Mucio T.; LAMPART, Andreas; BOLLIGER, Daniel; STEINER, Luzius; SEEBERGER, Manfred; KINDLER, Christoph; OSSWALD, Stefan; GURKE, Lorenz; CARAMELLI, Bruno; MUELLER, Christian
    Objective: Predicting cardiac events is essential to provide patients with the best medical care and to assess the riskbenefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy. Methods: The study prospectively enrolled 954 consecutive patients undergoing arterial vascular surgery, and the Lee and VSG scores were calculated. Receiver operating characteristic curves for each cardiac risk score were constructed and the areas under the curve (AUCs) compared. Two logistic regression models were done to determine new variables related to the occurrence of major cardiac events (myocardial infarction, heart failure, arrhythmias, and cardiac arrest). Results: Cardiac events occurred in 120 (12.6%) patients. Both scores underestimated the rate of cardiac events across all risk strata. The VSG score had AUC of 0.63 (95% confidence interval [CI], 0.58-0.68), which was higher than the AUC of the Lee score (0.58; 95% CI, 0.52-0.63; P =.03). Addition of preoperative anemia significantly improved the accuracy of the Lee score to an AUC of 0.61 (95% CI, 0.58-0.67; P =.002) but not that of the VSG score. Conclusions: The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.
  • article 17 Citação(ões) na Scopus
    Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I
    (2021) GUALANDRO, Danielle M.; PUELACHER, Christian; BUSE, Giovanna Lurati; GLARNER, Noemi; CARDOZO, Francisco A.; VOGT, Ronja; HIDVEGI, Reka; STRUNZ, Celia; BOLLIGER, Daniel; GUECKEL, Johanna; YU, Pai C.; LIFFERT, Marcel; ARSLANI, Ketina; PREPOUDIS, Alexandra; CALDERARO, Daniela; HAMMERER-LERCHER, Angelika; LAMPART, Andreas; STEINER, Luzius A.; SCHAEREN, Stefan; KINDLER, Christoph; GUERKE, Lorenz; OSSWALD, Stefan; DEVEREAUX, P. J.; CARAMELLI, Bruno; MUELLER, Christian; MARBOT, Stella; STREBEL, Ivo; GENINI, Alessandro; RENTSCH, Katharina; BOEDDINGHAUS, Jasper; NESTELBERGER, Thomas; WILD, Karin; ZIMMERMANN, Tobias; DUARTE, Alberto J. S.; BUSER, Andreas; LUCCIA, Nelson de; KOECHLIN, Luca; WUSSLER, Desiree; WALTER, Joan; WIDMER, Velina; FREESE, Michael; LOPEZ-AYALA, Pedro; TWERENBOLD, Raphael; BADERTSCHER, Patrick; SEEBERGER, Esther; WOLFF, Thomas; MUJAGIC, Edin; MEHRKENS, Arne; DINORT, Julia; FAHRNI, Gregor; JEGER, Raban; KAISER, Christoph; MATHEUS, Mariana; PASTANA, Adriana F.
    Background Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. Methods We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Results Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8-10%), including PMIInfarct 2.6% (95% CI 2.0-3.2) and PMIInjury 6.1% (95% CI 5.3-6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14-16%), PMIInfarct 3.7% (95% CI 3.0-4.4) and PMIInjury 11.3% (95% CI 10.2-12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1-6.0], and aHR 2.8 [95% CI 1.4-5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2-3.3], and aHR 1.8 [95% CI 1.2-2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. Conclusions Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality. [GRAPHICS] .