JOSE JAYME GALVAO DE LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
Resultados de Busca
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conferenceObject 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.- Cardiovascular assessment of patients with advanced kidney disease - Reply(2012) GOWDAK, Luis Henrique W.; LIMA, Jose Jayme G. De
- Coronary events in obese hemodialysis patients before and after renal transplantation(2015) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.We examined the impact of obesity (BMI 30 kg/m(2), n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 +/- 9.2 vs. 54.2 +/- 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 +/- 52 vs. 169 +/- 47), and triglycerides (219 +/- 167 vs. 144 +/- 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 +/- 56 vs. 172 +/- 48), and triglycerides (237 +/- 190 vs. 149 +/- 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.
- Early cardiovascular events and cardiovascular death after renal transplantation: role of pretransplant risk factors(2021) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Background The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of cardiovascular (CV) events and death during the first 12 months after transplantation. Methods Based on the data collected prospectively during pretransplant workups, a retrospective study was conducted including 665 patients followed up until death or completing 12 months posttransplantation. Endpoints were the composite incidence of CV events and death. Results The prevalence of diabetes, LV hypertrophy, and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease. CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age >= 50 years (HR 2.292; CI% 1.093-4.806), angina (HR 1.969; CI% 1.039-3.732), and altered myocardial scan (HR 1.905, CI% 1.059-3.428). Altered myocardial scan (HR 2.822, 95% CI 1.095-6.660) was also one of the independent predictor of CV death. Conclusion The incidence of CV events and death were predicted by variables associated with myocardial ischemia, a potentially modifiable risk factor. Patients with pretransplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after kidney transplantation.
conferenceObject Prognostic Value of Serum Uric Acid in Patients on the Waiting List for Renal Transplantation(2012) MUELA, H. C. S.; LIMA, J. J. G. DeBackground: 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.- Unexplained sudden death in patients on the waiting list for renal transplantation(2011) LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; ARANTES, Rodolfo Leite; CESAR, Luiz Antonio Machado; RAMIRES, Jose Antonio Franchini; KRIEGER, Eduardo M.Background. The incidence of unexplained sudden death (SD) and the factors involved in its occurrence in patients with chronic kidney disease are not well known. Methods. We investigated the incidence and the role of co-morbidities in unexplained SD in 1139 haemodialysis patients on the renal transplant waiting list. Results. Forty-four patients died from SD of undetermined causes (20% of all deaths; 3.9 deaths/1000 patients per year), while 178 died from other causes and 917 survived. SD patients were older and likely to have diabetes, hypertension, past/present cardiovascular disease, higher left ventricular mass index, and lower ejection fraction. Multivariate analysis showed that cardiovascular disease of any type was the only independent predictor of SD (P = 0.0001, HR = 2.13, 95% CI 1.46-3.22). Alterations closely associated with ischaemic heart disease like angina, previous myocardial infarction and altered myocardial scan were not independent predictors of SD. The incidence of unexplained SD in these haemodialysis patients is high and probably a consequence of pre-existing cardiovascular disease. Conclusions. Factors influencing SD in dialysis patients are not substantially different from factors in the general population. The role played by ischaemic heart disease in this context needs further evaluation.
- Cardiovascular risk reduction with periodontal treatment in patients on the waiting list for renal transplantation(2019) SANTOS-PAUL, Marcela A.; NEVES, Ricardo Simoes; GOWDAK, Luis Henrique W.; PAULA, Flayio J. de; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.; RAMIRES, Jose Antonio F.; LIMA, Jose Jayme G. DeBackground Cardiovascular mortality is increased in chronic kidney disease, a condition with a high prevalence of periodontal disease. Whether periodontitis treatment improves prognosis is unknown. Methods The effect of periodontal treatment on the incidence of cardiovascular events and death in 206 waitlist hemodialysis subjects was compared with that in 203 historical controls who did not undergo treatment. Patients were followed up for 24 months or until death or transplantation. Results The prevalence of moderate/severe periodontitis was 74%. Coronary artery disease correlated with the severity of periodontal disease (P = .02). Survival free of cardiovascular events (94% vs 83%, log-rank 0.009), coronary events (97% vs 89%, log-rank = 0.009), and cardiovascular death (96% vs 87%, log-rank = 0.037) was higher in the evaluated group. Death by any cause did not differ between groups. Multivariate analysis showed that treatment was associated with reduction in cardiovascular events (HR 0.43; 95% CI 0.22-0.87), coronary events (HR 0.31; 95% CI 0.12-0.83), and cardiovascular deaths (HR 0.43; 95% CI 0.19-0.98). Conclusion Periodontal treatment reduced the 24-month incidence of cardiovascular events and cardiovascular death, suggesting that periodontal treatment may improve cardiovascular outcomes. We suggest that periodontal screening and eventual treatment may be considered in patients with advanced renal disease.
- The role of myocardial scintigraphy in the assessment of cardiovascular risk in patients with end-stage chronic kidney disease on the waiting list for renal transplantation(2012) LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; RAMIRES, Jose Antonio Franchini; BORTOLOTTO, Luiz A.The usefulness of stress myocardial perfusion scintigraphy for cardiovascular (CV) risk stratification in chronic kidney disease remains controversial. We tested the hypothesis that different clinical risk profiles influence the test. We assessed the prognostic value of myocardial scintigraphy in 892 consecutive renal transplant candidates classified into four risk groups: very high (aged epsilon 50 years, diabetes and CV disease), high (two factors), intermediate (one factor) and low (no factor). The incidence of CV events and death was 20 and 18, respectively (median follow-up 22 months). Altered stress testing was associated with an increased probability of cardiovascular events only in intermediate-risk (one risk factor) patients [30.3 versus 10, hazard ratio (HR) 2.37, confidence interval (CI) 1.693.33, P 0.0001]. Low-risk patients did well regardless of scan results. In patients with two or three risk factors, an altered stress test did not add to the already increased CV risk. Myocardial scintigraphy was related to overall mortality only in intermediate-risk patients (HR 2.8, CI 1.55.1, P 0.007). CV risk stratification based on myocardial stress testing is useful only in patients with just one risk factor. Screening may avoid unnecessary testing in 60 of patients, help stratifying for risk of events and provide an explanation for the inconsistent performance of myocardial scintigraphy.
- Which patients are more likely to benefit from renal transplantation?(2012) LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; CESAR, Luiz Antonio Machado; RAMIRES, Jose Antonio Franchini; BORTOLOTTO, Luiz A.Background: We evaluated whether the advantages conferred by renal transplantation encompass all individuals or whether they favor more specific groups of patients. Methods: One thousand and fifty-eight patients on the transplant waiting list and 270 receiving renal transplant were studied. End points were the composite incidence of CV events and death. Patients were followed up from date of placement on the list until transplantation, CV event, or death (dialysis patients), or from the date of transplantation, CV event, return to dialysis, or death (transplant patients). Results: Younger patients with no comorbidities had a lower incidence of CV events and death independently of the treatment modality (log-rank = 0.0001). Renal transplantation was associated with better prognosis only in high-risk patients (p = 0.003). Conclusions: Age and comorbidities influenced the prevalence of CV complications and death independently of the treatment modality. A positive effect of renal transplantation was documented only in high-risk patients. These findings suggest that age and comorbidities should be considered indication for early transplantation even considering that, as a group, such patients have a shorter survival compared with low-risk individuals.
- Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients: Analysis from the KiHeart Cohort(2016) LIMA, Jose J. G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Background. The value of coronary artery disease (CAD) assessment and coronary intervention in the prognosis of patients who undergo renal transplantation is controversial. We investigated whether pretransplant identification of patients with CAD is helpful for defining prognosis and whether preemptive coronary intervention reduces the incidence of cardiovascular events and death after engraftment. Methods. We analyzed the impact of coronary assessment by clinical stratification and coronary angiography and of coronary intervention on prognosis in 535 chronic kidney disease patients on the transplantation waiting list who underwent renal transplantation. Results. Patients with 70% or greater narrowing experienced more coronary events than patients with less significant lesions (P = 0.01) and subjects at low risk (P = 0.001). Coronary assessment did not discriminate between the risk of death in patients with or without significant CAD, and the independent predictors of death were age (hazards ratio, 1.04; 95% confidence interval, 1.01-1.06, P = 0.001) and diabetes (hazards ratio, 1.63; 95% confidence interval, 1.11-2.39, P = 0.01). No difference occurred in events and mortality between patients treated medically or by intervention, but the severity of CAD was higher in the latter. Conclusions. Coronary assessment identified patients at increased risk of posttransplant coronary events and was also useful to define a low-risk population that may be safely transplanted without in-depth cardiovascular evaluation. However, it did not differentiate between the risk of death in patients with and those without significant CAD. Survival was similar in patients undergoing either medical or interventional treatment for CAD.