JOSE JAYME GALVAO DE LIMA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Agora exibindo 1 - 10 de 16
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    CORONARY ASSESSMENT IN YOUNG PATIENTS ON HEMODIALYSIS
    (2020) LIMA, Jose De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; DAVID NETO, Elias; BORTOLOTTO, Luiz A.
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    Role of cardiac arrhythmias in sudden cardiac death in renal transplant candidates
    (2014) MARTINELLI FILHO, M.; PEIXOTO, G. L.; SILVA, R. T.; SIQUEIRA, S. F.; LIMA, J. J. G.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.; NISHIOKA, S. A. D.
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    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
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    Cardiac scintigraphy fails to identify patients with single-vessel coronary artery disease and end-stage renal disease: potential impact on cardiovascular morbidity
    (2012) GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; CESAR, Luiz Antonio M.; LIMA, Jose Jayme G. de
    Introduction: Patients (pt) with end-stage renal disease (ESRD) are at increased risk for CAD and major adverse cardiovascular events. Cardiac scintigraphy is regarded as a non-invasive, useful screening tool for risk stratification and to exclude significant CAD in the general population; invasive coronary angiography is usually performed following a positive result in the non-invasive assessment. Objectives: To determine the accuracy of such approach in pt with ESRD being considered as renal transplant candidates. Methods: 482 pt with ESRD (56 ±9 years; 69% men) underwent cardiac scintigraphy (99mTc MIBI-SPECT with dipyridamole) and coronary angiography, regardless of symptoms. Myocardial perfusion scans were categorized as normal or abnormal (fixed and/or transient perfusion defects); significant CAD was defined by luminal stenosis ≥70%. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative (NPV) predictive values were calculated for pt with 1-, 2- or 3-vessel CAD. Kaplan-Meier curves were constructed for the probability of survival free of fatal/non-fatal MACE during a 5-year follow-up based on the results of angiography. Results: 240 pt (50%) had perfusion defects; 237 pt (49%) had significant CAD, of which 89 (38%), 70 (29%), and 78 (33%) had 1-, 2-, and 3-vessel disease, respectively. Figure 1 shows that pt with any degree of significant CAD had a worse-long term prognosis than pt with no CAD. Figure 2 shows that abnormal myocardial scans were more likely to be found in pt with 2- (69%) or 3-vessel CAD (76%), whereas in pt with no CAD, 64% of them had a normal perfusion scan (P<0.0001). However, in pt with 1-vessel CAD, the occurrence of normal and abnormal scans was almost identical (48 vs. 52%). A myocardial perfusion defect yielded a Sen=52%, 69% and 76%, a Spe=28%, 37% and 41%, a PPV=30%, 31% and 39%, and a NPV = 49%, 74% and 77% for the diagnosis of 1-, 2- and 3-vessel CAD, respectively. Conclusion: In pt with ESRD: 1) the prevalence of significant CAD is high, and this imposes a worse long-term prognosis independently of the number of affected vessels; 2) myocardial perfusion assessment by SPECT has a low sensitivity to detect 1-vessel CAD; 3) as a consequence, many pt with 1-vessel CAD could be mistakenly deemed to be free of CAD and, therefore, not treated accordingly, although their long-term prognosis seemed to be no different of that from pt with 2- or 3-vessel disease.
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    Prognostic Value of Serum Uric Acid in Patients on the Waiting List for Renal Transplantation
    (2012) MUELA, H. C. S.; LIMA, J. J. G. De
    Background: High serum uric acid is associated with increased cardiovascular risk in the general population. Although hyperuricemia is common in patients with chronic kidney disease (CKD), the impact of uric acid on mortality and CV events remains unclear. Objective: We assessed the relationship between base-line serum uric acid and the risk of cardiovascular events and all-cause mortality in a group of patients on the waiting list for renal transplantation before and after renal transplantation. Methods: This was a longitudinal observational study conducted in 1020 hemodialysis patients (54±11 years old, 70% Caucasians, 59% males, 40% diabetics, 38% with CVD, median follow-up 26 months) on the waiting list assessed for cardiovascular risk from July 1999 to June 2011. Data collection was terminated either at the end of the study period or in the moment that the patient had a cardiovascular event or expired. Survival curves were compared by Kaplan-Meier method. 199 patients underwent renal transplantation (50±11 years old, 72% Caucasians, 55% males, 34% diabetics, 26% with associated CVD, median follow-up 19 months). Results: High base-line serum uric acid (≥7.2 mg/dL) was not associated with either CV events (myocardial infarction, stroke, heart failure, sudden death, unstable angina, acute arterial syndrome) or with all-cause mortality. Similar results were observed in subgroups of patients with diabetes, elevated C-reactive protein or associated CV disease. For patients who underwent renal transplantation post-transplant base-line uric acid ≥7.2 mg/dL was associated with increased probability of CV events (p=0.03, HR 1.6, 95% CI 1.03-2,54). Conclusion: Elevated serum uric acid was not predictor of cardiovascular events or death in patients on the waiting list for transplant. However, an increased post-transplant base-line uric acid was related to higher probability of CV events.
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    DIABETES AND CARDIOVASCULAR DISEASE ARE EQUALLY STRONG PREDICTORS OF CARDIOVASCULAR EVENTS IN PATIENTS WITH END-STAGE RENAL DISEASE
    (2014) GOWDAK, Luis Henrique Wolff; PAULA, Flavio de; CESAR, Luiz Antonio Machado; LIMA, Jose Jayme G. De
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    Blood pressure level imposes different cardiovascular risk on renal transplant candidates in the presence of previous stroke or myocardial infarction
    (2013) GOWDAK, L. H. W.; PAULA, F. J. De; CESAR, L. A. M.; BORTOLOTTO, L. A.; LIMA, J. J. G. De
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    A NEW RISK-SCORE MODEL TO PREDICT CARDIOVASCULAR EVENTS IN RENAL TRANSPLANT CANDIDATES
    (2012) GOWDAK, Luis Henrique Wolff; PAULA, Flavio J. de; CESAR, Luiz Antonio M.; LIMA, Jose Jayme G. de
    Background Renal transplant candidates (RTC) are at increased risk for cardiovascular events (MACE). We developed a new risk-score model to predict MACE in pt with end-stage renal disease (ESRD). Methods 1,057 RTC (61% men, 53±11 years) were prospectively enrolled. The median follow-up was 16 (1 – 107) months. A logistic regression model was built from three clinically relevant co-variates as defined by the American Society of Transplantation (age, diabetes, and known CVD); the occurrence of the first or new fatal/non-fatal MACE (sudden death, acute myocardial infarction or unstable angina, stroke, peripheral artery disease, or overt heart failure) was regarded as the dependent variable. The logistic regression coefficient B for each variable was multiplied by 10 and rounded to the next whole number, allowing that, for each patient, a correspondent risk-score could be assigned. The receiver-operating-characteristic curve (ROC) was constructed to estimate the accuracy of the new-score. Finally, the prevalence of significant CAD for each risk-score was determined and a linear regression model between risk-score and the probability of MACE was calculated. Results There were 209 events during follow-up. The B coefficients for age, diabetes and CVD were 0.03, 0.62, and 0.89 (all P<.01), respectively. Thus, the risk-score could be calculated by the equation: Risk-Score = (Age * 0.3) + (DM * 6.2) + (CVD * 8.9). The respective area under the curve (ROC) was 0.70 (P=.0001) and the final equation relating the risk-score with the expected probability of the first occurrence of MACE was: Probability of MACE = (Risk-Score *1.45) – 14.2 (R2 = 0.94; P<.0001). As an example, a non-diabetic 40-year old RTC with no evidence of CVD will have an expected probability of suffering a first MACE of 3.2% whereas a 65-year old diabetic pt with peripheral artery disease will have an expected probability of 36.0%. Conclusions We developed and validated a new, simple risk-score to predict the occurrence of the first or new MACE among potential renal transplant recipients. This model should help cardiologists to better identify high-risk RTC, so that a cardiovascular risk reduction program can be aggressively implemented. ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 11:00 a.m.-Noon Session Title: Prevention Abstract Category: 9. Prevention: Clinical Presentation Number: 1181-155
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    Cardiac and Renal Involvement in Malignant-accelerated Hypertension: Implications on Long-term Survival
    (2017) BORTOLOTTO, Luiz; LIMA, Jose J. De; GIORGI, Dante