EDMUNDO ARTEAGA FERNANDEZ

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

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  • article 0 Citação(ões) na Scopus
    Evaluation of Galectin-3 and Myocardial Fibrosis in Patients with Hypertrophic Cardiomyopathy
    (2019) ANTUNES, Murillo de Oliveira; ARTEAGA-FERNÁNDEZ, Edmundo; FERNANDES, Fabio; SOFFIATTI, Carla David; BUCK, Paula de Cássia; SABINO, Ester Cerdeira; MOREIRA, Carlos Henrique Valente; MADY, Charles
    Abstract Background: Galectin-3 is the designation given to the protein that binds to ß-galactosides, expressed by activated macrophages and described as a cardiac fibrosis mediator. In hypertrophic cardiomyopathy (HCM), myocardial fibrosis is an independent predictor of adverse outcome; however, the association between Galectin-3 and myocardial fibrosis has not been studied in this cardiopathy. Objective: To evaluate the association of Galectin-3 and the presence of myocardial fibrosis in a patient with hypertrophic cardiomyopathy. Methods: Galectin-3 was measured in automated equipment using the Elisa technique in 100 participants divided into two groups: 50 patients with hypertrophic cardiomyopathy and 50 healthy control subjects. All patients with hypertrophic cardiomyopathy underwent magnetic nuclear resonance with the late enhancement technique to investigate myocardial fibrosis. For the statistical analysis, p values < 0.05 were considered statistically significant. Results: Galectin-3 levels were low and did not show significant differences between patients with hypertrophic cardiomyopathy and the control group, 10.3 ± 3.1 ng/dL and 11.3 ± 2.6 ng/dL (p = 0.12) respectively. Myocardial fibrosis was a common finding and was identified in 84% (42/50) of patients with HCM, but no differences were observed between Galectin-3 levels when comparing patients with and without fibrosis, 10.3 ± 2.4 ng/dL and 10.1 ± 2.1 ng/dL (p = 0.59). Conclusion: The results did not show an association between Galectin-3 and myocardial fibrosis in patients with hypertrophic cardiomyopathy, suggesting that non-inflammatory mechanisms of myocardial fibrosis formation and cardiac remodeling are involved in this cardiopathy.
  • article 6 Citação(ões) na Scopus
    Clinical predictors of a positive genetic test in hypertrophic cardiomyopathy in the Brazilian population
    (2014) MARSIGLIA, Julia Daher Carneiro; CREDIDIO, Flavia Laghi; OLIVEIRA, Theo Gremen Mimary de; REIS, Rafael Ferreira; ANTUNES, Murillo de Oliveira; ARAUJO, Aloir Queiroz de; PEDROSA, Rodrigo Pinto; BARBOSA-FERREIRA, Joao Marcos Bemfica; MADY, Charles; KRIEGER, Jose Eduardo; ARTEAGA-FERNANDEZ, Edmundo; PEREIRA, Alexandre Costa
    Background: Hypertrophic cardiomyopathy is a genetic autosomal dominant disease characterized by left ventricular hypertrophy. The molecular diagnosis is important but still expensive. This work aimed to find clinical predictors of a positive genetic test in a Brazilian tertiary centre cohort of index cases with HCM. Methods: In the study were included patients with HCM clinical diagnosis. For genotype x phenotype comparison we have evaluated echocardiographic, electrocardiographic, and nuclear magnetic resonance measures. All patients answered a questionnaire about familial history of HCM and/or sudden death. beta myosin heavy chain, myosin binding protein C, and troponin T genes were sequenced for genetic diagnosis. Results: The variables related to a higher probability of a positive genetic test were familial history of HCM, higher mean heart frequency, presence of NSVT and lower age. Probabilities of having a positive molecular genetic test were calculated from the final multivariate logistic regression model and were used to identify those with a higher probability of a positive molecular diagnosis. Conclusions: We developed an easy and fast screening method that takes into account only clinical data that can help to select the patients with a high probability of positive genetic results from molecular sequencing of Brazilian HCM patients.
  • article 56 Citação(ões) na Scopus
    The amount of late gadolinium enhancement outperforms current guideline-recommended criteria in the identification of patients with hypertrophic cardiomyopathy at risk of sudden cardiac death
    (2019) FREITAS, Pedro; FERREIRA, Antonio Miguel; ARTEAGA-FERNANDEZ, Edmundo; ANTUNES, Murrilo de Oliveira; MESQUITA, Joao; ABECASIS, Joao; MARQUES, Hugo; SARAIVA, Carla; MATOS, Daniel Nascimento; RODRIGUES, Rita; CARDIM, Nuno; MADY, Charles; ROCHITTE, Carlos Eduardo
    Background Identifying the patients with hypertrophic cardiomyopathy (HCM) in whom the risk of sudden cardiac death (SCD) justifies the implantation of a cardioverter-defibrillator (ICD) in primary prevention remains challenging. Different risk stratification and criteria are used by the European and American guidelines in this setting. We sought to evaluate the role of cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) in improving these risk stratification strategies. Methods We conducted a multicentric retrospective analysis of HCM patients who underwent CMR for diagnostic confirmation and/or risk stratification. Eligibility for ICD was assessed according to the HCM Risk-SCD score and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) algorithm. The amount of LGE was quantified (LGE%) and categorized as 0%, 0.1-10%, 10.1-19.9% and >= 20%. The primary endpoint was a composite of SCD, aborted SCD, sustained ventricular tachycardia (VT), or appropriate ICD discharge. Results A total of 493 patients were available for analysis (58% male, median age 46 years). LGE was present in 79% of patients, with a median LGE% of 2.9% (IQR 0.4-8.4%). The concordance between risk assessment by the HCM Risk-SCD, ACCF/AHA and LGE was relatively weak. During a median follow-up of 3.4 years (IQR 1.5-6.8 years), 23 patients experienced an event (12 SCDs, 6 appropriate ICD discharges and 5 sustained VTs). The amount of LGE was the only independent predictor of outcome (adjusted HR: 1.08; 95% CI: 1.04-1.12; p < 0.001) after adjustment for the HCM Risk-SCD and ACCF/AHA criteria. The amount of LGE showed greater discriminative power (C-statistic 0.84; 95% CI: 0.76-0.91) than the ACCF/AHA (C-statistic 0.61; 95% CI: 0.49-0.72; p for comparison < 0.001) and the HCM Risk-SCD (C-statistic 0.68; 95% CI: 0.59-0.78; p for comparison = 0.006). LGE was able to increase the discriminative power of the ACCF/AHA and HCM Risk-SCD criteria, with net reclassification improvements of 0.36 (p = 0.021) and 0.43 (p = 0.011), respectively. Conclusions The amount of LGE seems to outperform the HCM Risk-SCD score and the ACCF/AHA algorithm in the identification of HCM patients at increased risk of SCD and reclassifies a relevant proportion of patients.
  • article 14 Citação(ões) na Scopus
    Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy
    (2013) NERBASS, Flavia B.; PEDROSA, Rodrigo P.; GENTA, Pedro R.; ANTUNES, Murillo O.; ARTEAGA-FERNANDEZ, Edmundo; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo
    OBJECTIVE: Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy. METHODS: Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46 +/- 15 years; body mass index, 26.6 +/- 4.9 kg/m(2)) were included, and obstructive sleep apnea (respiratory disturbance index >= 15 events/h) was present in 37 patients (41%). RESULTS: Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age >= 45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47-13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43-20.12; p = 0.013]. CONCLUSION: Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.
  • article 10 Citação(ões) na Scopus
    Acute Effects of Nasal CPAP in Patients With Hypertrophic Cardiomyopathy
    (2016) NERBASS, Flavia B.; SALEMI, Vera M. C.; PEDROSA, Rodrigo P.; PORTILHO, Natanael de P.; FERREIRA-FILHO, Julio C. A.; MORIYA, Henrique T.; ANTUNES, Murillo O.; ARTEAGA-FERNANDEZ, Edmundo; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo
    BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common genetic disease that may cause left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death. Recent studies have shown a high prevalence of OSA among patients with HCM. Because the hemodynamics in patients with LVOT obstruction are unstable and depend on the loading conditions of the heart, we evaluated the acute effects of CPAP on hemodynamics and cardiac performance in patients with HCM. METHODS: We studied 26 stable patients with HCM divided into nonobstructive HCM (n = 12) and obstructive HCM (n = 14) groups (LVOT gradient pressure lower or higher than 30 mm Hg, respectively). Patients in the supine position while awake were continuously monitored with beat-to-beat BP measurements and electrocardiography. Two-dimensional echocardiography was performed at rest (baseline) and after 20 min of nasal CPAP at 1.5 cm H2O and 10 cm H2O, which was applied in a random order interposed by 10 min without CPAP. RESULTS: BP, cardiac output, stroke volume, heart rate, left ventricular ejection fraction, and LVOT gradient did not change during the study period in either group. CPAP at 10 cm H2O decreased right atrial size and right ventricular relaxation in all patients. It also decreased left atrial volume significantly and decreased right ventricular outflow acceleration time, suggesting an increase in pulmonary artery pressure in patients with obstructive HCM. CONCLUSIONS: The acute application of CPAP is apparently safe in patients with HCM, because CPAP does not lead to hemodynamic compromise. Long-term studies in patients with HCM and sleep apnea and nocturnal CPAP are warranted.
  • bookPart
    Miocardiopatia Hipertrófica
    (2016) HOTTA, Viviane Tiemi; VIEIRA, Marcelo Luiz Campos; ARTEAGA-FERNáNDEZ, Edmundo; MADY, Charles
  • conferenceObject
    Lack of Effect of Simvastatin on Structural Remodeling in Animal Model of Chagas Cardiomyopathy
    (2012) IANNI, Barbara M.; RAMIRES, Felix J. A.; SALEMI, Vera M. C.; FERNANDES, Fabio; OLIVEIRA, Adriana M.; PESSOA, Fernanda G.; FONSECA, Keila C. B.; ARTEAGA, Edmundo; NASTARI, Luciano; MADY, Charles
    Purpose: Chagas cardiomyopathy(CM) is characterized by a large amount of fibrosis and inflamation. As simvastatin (simva) has anti-inflamatory effects, we hypothetized that it could be an important drug in the treatment of patients with CM. The purpose was to evaluate simva in the myocardium remodeling and inflammation in na animal model of CM. Methods: 123 hamsters were divided: C-controls(25), CSimva-controls with simva 10mg/Kg/day(25), Simva1-infected treated from beginning with the same dose of simva(25), Simva2-infected treated after 4 months(24); Infect-untreated(24). Follow-up of 10 months. Interstitial collagen volume fraction (ICVF) RV and LV measured using videomorphometry and picrosirius red stained heart. Metalloproteinase9 (MMP9) was obtained by zymography. Gene expression of TNFalpha, IFNgamma, IL10 by real time PCR and ΔCt. Survival by Kaplan-Meier and log rank. Comparison between groups by Kruskal-Wallis; p≤0.05. Results: Infected animals Simva1=189±133 days Simva2=150±124; Infect=138±123) lived less than controls (C=257±80; CSimva=283±58)(p≤0.05) with no difference among infected. ICVF-RV(%) was greater in infected groups (Simva1=3.88±1.14, Simva2=2.22±0.64; Infect=4.38±0.83) than in controls C=1.12±0.31; CSimva=2.18±0.73)(p≤0.05)with no difference among infected groups. ICVF-LV(%) was greater in infected animals (Simva1=1.83±1.01, Simva2=1.52±0.93; Infect=3.01±0.66) than in controls (C=0.68±0.31; CSimva=0.81±0.28)(p≤0.05) with no difference among infected. MMP9 was higher in infected groups (Simva1=2394±2441, Simva2=5673±4091; Infect=2392±2042) compared to controls (C=954±2332; CSimva=454±1123)(p≤0.05) with no difference among infected. TNFalpha did not have difference among infected groups (Simva1=5.33±3.66, Simva2=4.44±2.17; Infect=6.13±3.24). IFNgamma in infected groups (Simva1=5.47±3.56, Simva2=4.46±2.08; Infect=4.21±2.09) was higher than in controls (C=8.50±2.59; CSimva=6.84±2.53)(p≤0.05) with no difference among infected. IL10 in infected animals (Simva1=9.07±4.62, Simva2=7.76±4.77; Infect=8.11±4.48) did not have difference and the values were greater than controls (C=14.11±4.40; CSimva=12.55±3.90)(p≤0.05). Conclusions: Simva did not attenuate deposition of interstitial collagen, did not change dynamics of collagen degradation, did not decrease inflammation, and did not reduce mortality.
  • article 1 Citação(ões) na Scopus
    Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up
    (2023) ANTUNES, Murillo Oliveira; ARTEAGA-FERNANDEZ, Edmundo; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; MADY, Charles
    Background: Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain. Objective: To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up. Avaliacao Prognostica da Microalternancia da onda T na Cardiomiopatia Hipertrofica em um Seguimento Clinico de 9 anos Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up Oliveira Antunes,1,2 Edmundo Arteaga-Fernandez,1 Nelson Samesima,1 Horacio Gomes Pereira Afonso Yoshikiro Matsumoto,3 Richard L. Verrier,4 Carlos Alberto Pastore,1 Charles Mady1 do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo,1 Sao Paulo, SP - Brasil Universidade Sao Francisco,2 Braganca Paulista, SP - Brasil Group,3 Sao Paulo, SP - Brasil Israel Deaconess Medical Center,4 Boston - EUA
  • article 52 Citação(ões) na Scopus
    Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy
    (2013) SHIOZAKI, Afonso Akio; SENRA, Tiago; ARTEAGA, Edmund; MARTINELLI FILHO, Martino; PITA, Cristiane Guedes; AVILA, Luis Francisco R.; PARGA FILHO, Jose Rodrigues; MADY, Charles; KALIL-FILHO, Roberto; BLUEMKE, David A.; ROCHITTE, Carlos Eduardo
    Background: Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. Objective: The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. Methods: Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. Results: MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 +/- 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 +/- 19.13 g vs 13.57 +/- 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%-88%) and 71% (95% CI, 56%-81%), respectively. Kaplan-Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass >= 18 g than in patients with MF <18 g (P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. Conclusion: The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
  • article 19 Citação(ões) na Scopus
    1st Brazilian Positioning on the Impact of Sleep Disorders on Cardiovascular Diseases of the Brazilian Society of Cardiology
    (2018) DRAGER, Luciano E.; LORENZI-FILHO, Geraldo; CINTRA, Fatima Dumas; PEDROSA, Rodrigo P.; BITTENCOURT, Lia R. A.; POYARES, Dalva; CARVALHO, Carolina Gonzaga; MOURA, Sonia Maria Guimaraes Pereira Togeiro; SANTOS-SILVA, Rogerio; BRUIN, Pedro F. C. de; GEOVANINI, Glaucylara R.; ALBUQUERQUE, Felipe N.; OLIVEIRA, Vvercules Antonio Alves de; MOREIRA, Gustavo A.; UENO, Linda Massako; NERBASS, Flavia Baggio; RONDON, Maria Urbana Pinto Brandao; BARBOSA, Fine Rozaria Ferreira; BERTOLAMI, Adriana; PAOLA, Angelo Amato Vincenzo de; MARQUES, Betania Braga Silva; RIZZI, Camila Futado; NEGRAO, Carlos Eduardo; UCHOA, Carlos Henrique Gomes; MAKI-NUNES, Cristiane; MARTINEZ, Denis; FERNANDEZ, Edmundo Arteaga; MAROJA, Fabrizio U.; ALMEIDA, Fernanda R.; TROMBETTA, Ivani C.; STORTI, Luciana J.; BORTOLOTTO, Luiz Aparecido; MELLO, Marco Tulio de; BORGES, Melania Aparecida; ANDERSEN, Monica Levy; PORTILHO, Natanael de Paula; MACEDO, Paula; ALVES, Rosana; TUFIK, Sergio; FAGONDES, Simone C.; RISSO, Thais Telles