FRANCISCO AKIRA MALTA CARDOZO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
11 resultados
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conferenceObject Incidence and outcome of perioperative myocardial injury after noncardiac surgeries diagnosed by different high sensitivity troponin assays(2018) GUALANDRO, D. M.; PUELACHER, C.; CARAMELLI, B.; LURATIBUSE, G.; CARDOZO, F. A.; CALDERARO, D.; YU, P. C.; SAZGARY, L.; HIDVEGI, R.; STRUNZ, C.; BOLLIGER, D.; OSSWALD, S.; MUELLER, C.conferenceObject Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes(2022) GUALANDRO, D. M.; PUELACHER, C.; CHEW, M. S.; ANDERSSON, H.; BUSE, G. Lurati; GLARNER, N.; MUELLER, D.; CARDOZO, F. A. M.; BURRI, K.; MORK, C.; WUSSLER, D.; BOLLIGER, D.; OSSWALD, S.; CARAMELLI, B.; MUELLER, C.- 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, ChristianAims 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.
- 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, ChristianBackground: 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 Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery(2017) GUALANDRO, D. M.; PUELACHER, C.; LURATI-BUSE, G.; STRUNZ, C.; CARDOZO, F. A.; YU, P. C.; JAFFE, A.; TWERENBOLD, R.; HAMMERER-LERCHER, A.; MELO, E. S.; CALDERARO, D.; DUARTE, A. J. S.; LUCCIA, N.; CARAMELLI, B.; MUELLER, C.- Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes(2023) GUALANDRO, Danielle M. M.; PUELACHER, Christian; CHEW, Michelle S. S.; ANDERSSON, Henrik; BUSE, Giovanna Lurati; GLARNER, Noemi; MUELLER, Daria; CARDOZO, Francisco A. M.; BURRI-WINKLER, Katrin; MORK, Constantin; WUSSLER, Desiree; SHRESTHA, Samyut; HEIDELBERGER, Isabelle; FALT, Mikael; HIDVEGI, Reka; BOLLIGER, Daniel; LAMPART, Andreas; STEINER, Luzius A. A.; SCHAREN, Stefan; KINDLER, Christoph; GURKE, Lorenz; RIKLI, Daniel; LARDINOIS, Didier; OSSWALD, Stefan; BUSER, Andreas; CARAMELLI, Bruno; MUELLER, ChristianAims Primary acute heart failure (AHF) is a common cause of hospitalization. AHF may also develop postoperatively (pAHF). The aim of this study was to assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.Methods and results A total of 9164 consecutive high-risk patients undergoing 11 262 non-cardiac inpatient surgeries were prospectively included. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, were determined. The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2-2.8%); 51% of pAHF occurred in patients without known heart failure (de novo pAHF), and 49% in patients with chronic heart failure. Among patients with chronic heart failure, 10% developed pAHF, and among patients without a history of heart failure, 1.5% developed pAHF. Chronic heart failure, diabetes, urgent/emergent surgery, atrial fibrillation, cardiac troponin elevations above the 99th percentile, chronic obstructive pulmonary disease, anaemia, peripheral artery disease, coronary artery disease, and age, were independent predictors of pAHF in the logistic regression model. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p < 0.001) and AHF readmission (15% vs. 2%, p < 0.001) within 1 year than patients without pAHF. After Cox regression analysis, pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3-2.2]; p < 0.001) and AHF readmission (aHR 2.3 [95% CI 1.5-3.7]; p < 0.001). Findings were confirmed in an external validation cohort using a prospective multicentre cohort of 1250 patients (incidence of pAHF 2.4% [95% CI 1.6-3.3%]).Conclusions Postoperative AHF frequently developed following non-cardiac surgery, being de novo in half of cases, and associated with a very high mortality.
conferenceObject Long term outcomes in different aetiologies of perioperative myocardial infarction/injury after noncardiac surgery(2022) PUELACHER, C.; GUALANDRO, D.; GLAMOR, N.; BUSE, G. Lurati; LAMPART, A.; BOLLIGER, D.; GROSSENBACHER, M.; STEINER, L.; BURRI, K.; BINER, L.; CARAMELLI, B.; CARDOZO, F. A.; OSSWALD, S.; MUELLER, C.- 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, ChristianObjective: 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.
conferenceObject Risk stratification of perioperative myocardial infarction/injury following noncardiac surgery in high risk patients(2022) PUELACHER, C.; GUALANDRO, D.; GLARNER, N.; BUSE, G. Lurati; LAMPART, A.; BOLLIGER, D.; STEINER, L.; GERHARD, H.; CLERC, O.; KINDLER, C.; CARDOZO, F. A.; CARAMELLI, B.; OSSWALD, S.; MUELLER, C.conferenceObject Direct comparison of the accuracy of preoperative high-sensitivity cardiac troponin T to predict mortality, acute heart failure and perioperative myocardial infarction/injury after non-cardiac surgery(2020) GUALANDRO, D.; PUELACHER, C.; LIFFERT, M.; ARSLANI, K.; MEISTER, R.; GLARNER, N.; LURATIBUSE, G.; CARDOZO, F. A.; BOLLIGER, D.; STEINER, L.; CARAMELLI, B.; OSSWALD, S.; MUELLER, C.