JOSE JAYME GALVAO DE LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
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conferenceObject Impact of Coronary Atherosclerotic Burden on the Long-Term Prognosis of Patients With Chronic Kidney Disease Undergoing Renal Replacement Therapy(2023) GODINHO, Roger; CAMPOS, Carlos; ABIZAID, Alexandre; LIMA, Jose Jayme de; RIBEIRO, Henrique; LOPES, Neuza; MOTA, Gabriel; SANTOS, Luciano; GOWDAK, Luis; KALIL FILHO, Roberto; RIBEIRO, Expedito- Peripheral Artery Disease Diagnosed by Pulse Palpation as a Predictor of Coronary Artery Disease in Patients with Chronic Kidney Disease(2023) SANTOS, Daniel B. C. Dos; GOWDAK, Luis Henrique W.; DAVID-NETO, Elias; NATANIEL, Felizardo A.; LIMA, Jose J. G. De; BORTOLOTTO, Luiz A.There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.
- Interdialytic Blood Pressure and Risk of Cardiovascular Events and Death in Hemodialysis Patients(2023) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; JR, Jose Otto Reusing; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.IntroductionNormal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients.AimWe explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period.MethodsThis was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP >= 140 mm Hg and/or diastolic BP >= 90 mm Hg. Endpoints were major CV events and all-cause mortality.ResultsDuring a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP >= 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications.ConclusionsInterdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.
- Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery(2016) SANTANA-SANTOS, Eduesley; KAMEI, Felipe Kenji Oshiro; NASCIMENTO, Tarcisia Karoline do; ISMAIL, Anas Abou; PALOMO, Jurema da Silva Herbas; MAGRO, Marcia Cristina da Silva; FERREIRA, Fatima Gil; OLIVEIRA, Larissa Bertacchini de; RODRIGUES, Adriano Rogerio Baldacin; LIMA, Jose Jayme Galvao deBackground. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n = 23) and did not develop (n = 35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6 +/- 8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46 + 16 mL/min) were followed up for 47.8 + 16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI-group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI-patient was started on dialysis. Only 4 patients had an increase in serum creatinine = 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.
- Evaluation of a protocol for coronary artery disease investigation in asymptomatic elderly hemodialysis patients(2018) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Background: Coronary artery disease (CAD) is prevalent in older patients on dialysis, but the prognostic relevance of coronary assessment in asymptomatic subjects remains undefined. We tested the usefulness of a protocol, based on clinical, invasive, and noninvasive coronary assessment, by answering these questions: Could selecting asymptomatic patients for coronary invasive assessment identify those at higher risk of events? Is CAD associated with a worse prognosis? Methods: A retrospective study including 276 asymptomatic patients at least 65 years old on the waiting list, prospectively evaluated for CAD and followed up until death or renal transplantation, were classified into two groups: 1) low-risk patients who did not undergo coronary angiography (n=63) and 2) patients who did undergo angiography (n=213). The latter group was reclassified into patients with significant CAD or normal angiograms/nonsignificant CAD. Results: CAD (>= 70% stenosis) occurred in 124 subjects (58%). The incidence of death by any cause, coronary death, and major cardiovascular (CV) events were similar in patients selected or not for angiography and in those with or without significant CAD. Myocardial revascularization (surgical/percutaneous) was performed in only 21/276 patients (7.6%) and did not result in a reduction in mortality. Conclusion: In older patients on renal replacement therapy, the prevalence of CAD was high, but coronary investigation was not useful as a risk stratification tool and also resulted in a rather small proportion of patients eligible for intervention. Therefore, in the elderly, coronary investigation should not be considered routine in asymptomatic patients.
- Prognostic Value of Serum Uric Acid in Patients on the Waiting List before and after Renal Transplantation(2015) MUELA, Henrique Cotchi Simbo; LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; BORTOLOTTO, Luiz AparecidoBackground. High serumuric acid (UA) is associated with increased cardiovascular (CV) risk in the general population. The impact of UA on CV events and mortality in CKD is unclear. Objective. To assess the relationship between UA and prognosis in hemodialysis (HD) patients before and after renal transplantation (TX). Methods. 1020 HD patients assessed for CV risk and followed from the time of inception until CV event, death, or TX (HD) or date of TX, CV event, death, or return to dialysis (TX). Results. 821 patients remained on HD while 199 underwent TX. High UA (>= 428 mmol/L) was not associated with either composite CV events or mortality in HD patients. In TX patients high UA predicted an increased risk of events (P = 0.03, HR 1.6, and 95% CI 1.03-2.54) but not with death. In the Cox proportional model UA was no longer significantly associated with CV events. Instead, a reduced GFR (<50 mL/min) emerged as the independent risk factor for events (P = 0.02, HR 1.79, and % CI 1.07-3.21). Conclusion. In recipients of TX an increased posttransplant UA is related to higher probability of major CV events but this association probably caused concurrent reduction in GFR.