JOSE JAYME GALVAO DE LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- CARDIAC AND RENAL INVOLVEMENT IN MALIGNANT-ACCELERATED HYPERTENSION: IMPLICATIONS ON LONG-TERM SURVIVAL(2016) BORTOLOTTO, Luiz; GIORGI, Dante; LIMA, Jose
conferenceObject 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. deIntroduction: 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.- 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.
- Diabetes, Cardiovascular Disease, and Cardiovascular Risk in Patients with Chronic Kidney Disease(2021) LIMA, Jose J. G. De; GOWDAK, Luis Henrique W.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Introduction It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD). Aim The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis? Methods A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events. Results The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657). Conclusion In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.
conferenceObject Cardiac and Renal Involvement in Malignant-accelerated Hypertension: Implications on Long-term Survival(2017) BORTOLOTTO, Luiz; LIMA, Jose J. De; GIORGI, DanteconferenceObject Regression of Left Ventricle Hypertrophy and Improvement of Ventricular Dysfunction After Renal Revascularization is Dependent of Blood Pressure Response and Etiology of Renal Artery Stenosis(2018) BORTOLOTTO, Luiz; MACEDO, Thiago A.; KAJITA, Luis J.; MARINO, Julio C.; LIMA, Jose J. DeconferenceObject Increased Blood Pressure Variability and Baroreflex Impairment in Patients With End-stage Renal Disease Undergoing Hemodialysis(2013) SCAPINI, Katia B.; HONG, Valeria C.; FERREIRA, Janaina B.; SOUZA, Silvia B.; FERREIRA, Naomi V.; MORAES, Oscar A.; CONSOLIM-COLOMBO, Fernanda M.; LIMA, Jose J. de; MOSTARDA, Cristiano; IRIGOYEN, Maria C.conferenceObject ARTERIAL STIFFNESS IN PATIENTS WITH STAGE 3 HYPERTENSION IS CORRELATED TO INFLAMMATION AND NOCTURNAL BLOOD PRESSURE(2015) BORTOLOTTO, L.; COSTA-HONG, V.; GIORGI, D. M. A.; LOPES, H. F.; DRAGER, L. F.; CONSOLIM-COLOMBO, F. M.; LIMA, J. J. G. De; KRIEGER, E. M.