LILIANE KOPEL
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
Resultados de Busca
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- Cerebral blood flow changes during intermittent acute hypoxia in patients with heart failure(2018) MANSUR, Antonio P.; ALVARENGA, Glaura Souza; KOPEL, Liliane; GUTIERREZ, Marco Antonio; CONSOLIM-COLOMBO, Fernanda Marciano; HAJJAR, Ludhmila Abrahao; LAGE, Silvia GelasObjective: Heart failure (HF) is associated with intermittent hypoxia, and the effects of this hypoxia on the cardiovascular system are not well understood. This study was performed to compare the effects of acute hypoxia (10% oxygen) between patients with and without HF. Methods: Fourteen patients with chronic HF and 17 matched control subjects were enrolled. Carotid artery changes were examined during the first period of hypoxia, and brachial artery changes were examined during the second period of hypoxia. Data were collected at baseline and after 2 and 4 minutes of hypoxia. Norepinephrine, epinephrine, dopamine, and renin were measured at baseline and after 4 minutes hypoxia. Results: The carotid blood flow, carotid systolic diameter, and carotid diastolic diameter increased and the carotid resistance decreased in patients with HF. Hypoxia did not change the carotid compliance, distensibility, brachial artery blood flow and diameter, or concentrations of sympathomimetic amines in patients with HF, but hypoxia increased the norepinephrine level in the control group. Hypoxia increased minute ventilation and decreased the oxygen saturation and end-tidal carbon dioxide concentration in both groups. Conclusion: Hypoxia-induced changes in the carotid artery suggest an intensification of compensatory mechanisms for preservation of cerebral blood flow in patients with HF.
- Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry(2016) BEZERRA, Cristiano Guedes; ADAM, Eduardo Leal; BAPTISTA, Mariana Lins; CIAMBELLI, Giuliano Serafino; KOPEL, Liliane; BERNOCHE, Claudia; LOPES, Leonardo Nicolau Geisler Daud; MACATRAO-COSTA, Milena Frota; FALCAO, Breno de Alencar Araripe; LAGE, Silvia GelasBackground: The use of aortic counterpulsation therapy in advanced heart failure is controversial. Objectives: To evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP) and its impact on 30-day mortality in patients with heart failure. Methods: Historical prospective, unicentric study to evaluate all patients treated with IABP betwen August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation). We analyzed changes in oxygen central venous saturation (ScvO(2)), arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and diferences in subgroups were evaluated by the Log-rank test. Results: A total of 223 patients (mean age 49 +/- 14 years) were included. Mean left ventricle ejection fraction was 24 +/- 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008). Conclusion: After 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.
- Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial(2016) BASTOS, Jaime Freitas; FERRI, Mauricio; LIMA, José Jayme Galvão de; KOPEL, Liliane; LAGE, Silvia GelásOBJECTIVES: Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach. METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate. RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups. CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.
- Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019(2019) BERNOCHE, Claudia; TIMERMAN, Sergio; POLASTRI, Thatiane Facholi; GIANNETTI, Natali Schiavo; SIQUEIRA, Adailson Wagner da Silva; PISCOPO, Agnaldo; SOEIRO, Alexandre de Matos; REIS, Amelia Gorete Afonso da Costa; TANAKA, Ana Cristina Sayuri; THOMAZ, Ana Maria; QUILICI, Ana Paula; CATARINO, Andrei Hilario; RIBEIRO, Anna Christina de Lima; BARRETO, Antonio Carlos Pereira; AZEVEDO FILHO, Antonio Fernando Barros de; PAZIN FILHO, Antonio; TIMERMAN, Ari; SCARPA, Bruna Romanelli; TIMERMAN, Bruno; TAVARES, Caio de Assis Moura; MARTINS, Cantidio Soares Lemos; SERRANO JUNIOR, Carlos Vicente; MALAQUE, Ceila Maria Sant'Ana; PISANI, Cristiano Faria; BATISTA, Daniel Valente; LEANDRO, Daniela Luana Fernandes; SZPILMAN, David; GONCALVES, Diego Manoel; PAIVA, Edison Ferreira de; OSAWA, Eduardo Atsushi; LIMA, Eduardo Gomes; ADAM, Eduardo Leal; PEIXOTO, Elaine; EVARISTO, Eli Faria; AZEKA, Estela; SILVA, Fabio Bruno da; WEN, Fan Hui; FERREIRA, Fatima Gil; LIMA, Felipe Gallego; FERNANDES, Felipe Lourenco; GANEM, Fernando; GALAS, Filomena Regina Barbosa Gomes; TARASOUTCHI, Flavio; SOUZA, Germano Emilio Conceicao; FEITOSA FILHO, Gilson Soares; FORONDA, Gustavo; GUIMARAES, Helio Penna; ABUD, Isabela Cristina Kirnew; LEITE, Ivanhoe Stuart Lima; LINHARES FILHO, Jaime Paula Pessoa; MORAES JUNIOR, Joao Batista de Moura Xavier; FALCAO, Joao Luiz Alencar de Araripe; RAMIRES, Jose Antonio Franchini; CAVALINI, Jose Fernando; SARAIVA, Jose Francisco Kerr; ABRAO, Karen Cristine; PINTO, Lecio Figueira; BIANCHI, Leonardo Luis Torres; LOPES, Leonardo Nicolau Geisler Daud; PIEGAS, Leopoldo Soares; KOPEL, Liliane; GODOY, Lucas Colombo; TOBASE, Lucia; HAJJAR, Ludhmila Abrahao; DALLAN, Luis Augusto Palma; CANEO, Luiz Fernando; CARDOSO, Luiz Francisco; CANESIN, Manoel Fernandes; PARK, Marcelo; RABELO, Marcia Maria Noya; MALACHIAS, Marcus Vinicius Bolivar; GONCALVES, Maria Aparecida Batistao; ALMEIDA, Maria Fernanda Branco de; SOUZA, Maria Francilene Silva; FAVARATO, Maria Helena Sampaio; CARRION, Maria Julia Machline; GONZALEZ, Maria Margarita; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MACATRAO-COSTA, Milena Frota; SHIMODA, Monica Satsuki; OLIVEIRA-JUNIOR, Mucio Tavares de; IKARI, Nana Miura; DUTRA, Oscar Pereira; BERWANGER, Otavio; PINHEIRO, Patricia Ana Paiva Correa; REIS, Patricia Feitosa Frota dos; CELLIA, Pedro Henrique Moraes; SANTOS FILHO, Raul Dias dos; GIANOTTO-OLIVEIRA, Renan; KALIL FILHO, Roberto; GUINSBURG, Ruth; MANAGINI, Sandrigo; LAGE, Silvia Helena Gelas; YEU, So Pei; FRANCHI, Sonia Meiken; SHIMODA-SAKANO, Tania; ACCORSI, Tarso Duenhas; LEAL, Tatiana de Carvalho Andreucci; GUIMARAES, Vanessa; SALLAI, Vanessa Santos; AVILA, Walkiria Samuel; SAKO, Yara Kimiko