VERA MARIA CURY SALEMI
Projetos de Pesquisa
Unidades Organizacionais
LIM/65, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
15 resultados
Resultados de Busca
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- Insights into the Classification of Cardiomyopathies: Past, Present, and Future Directions(2021) SALEMI, Vera Maria Cury; MOHTY, Dania; ALTAVILA, Sonia Lages Lustosa de; MELO, Marcelo Dantas Tavares de; KALIL FILHO, Roberto; BOCCHI, Edimar Alcides
- Smoking accelerates renal cystic disease and worsens cardiac phenotype in Pkd1-deficient mice(2021) SOUSA, Marciana V.; AMARAL, Andressa G.; FREITAS, Jessica A.; MURATA, Gilson M.; WATANABE, Elieser H.; BALBO, Bruno E.; TAVARES, Marcelo D.; HORTEGAL, Renato A.; ROCON, Camila; SOUZA, Leandro E.; IRIGOYEN, Maria C.; SALEMI, Vera M.; ONUCHIC, Luiz F.Smoking has been associated with renal disease progression in ADPKD but the underlying deleterious mechanisms and whether it specifically worsens the cardiac phenotype remain unknown. To investigate these matters, Pkd1-deficient cystic mice and noncystic littermates were exposed to smoking from conception to 18 weeks of age and, along with nonexposed controls, were analyzed at 13-18 weeks. Renal cystic index and cyst-lining cell proliferation were higher in cystic mice exposed to smoking than nonexposed cystic animals. Smoking increased serum urea nitrogen in cystic and noncystic mice and independently enhanced tubular cell proliferation and apoptosis. Smoking also increased renal fibrosis, however this effect was much higher in cystic than in noncystic animals. Pkd1 deficiency and smoking showed independent and additive effects on reducing renal levels of glutathione. Systolic function and several cardiac structural parameters were also negatively affected by smoking and the Pkd1-deficient status, following independent and additive patterns. Smoking did not increase, however, cardiac apoptosis or fibrosis in cystic and noncystic mice. Notably, smoking promoted a much higher reduction in body weight in Pkd1-deficient than in noncystic animals. Our findings show that smoking aggravated the renal and cardiac phenotypes of Pkd1-deficient cystic mice, suggesting that similar effects may occur in human ADPKD.
- THE INFLUENCE OF ISCHEMIC PRECONDITIONING ON NEUROMUSCULAR PERFORMANCE(2021) SANTANA, Vinicius Jose de; DEANGELO, Carlos Eduardo de Oliveira; SALEMI, Vera Maria Cury; MIRANDA, Douglas PinheiroIntroduction: Ischemic preconditioning (IPC) has been described in the literature as a resource capable of improving physical performance. Objective: The purpose of this randomized double-blind study was to evaluate the influence of IPC on the neuromuscular performance of trained individuals. Methods: Twenty-four (24) resistance training participants (6 of them women) with a mean age of 25.8 +/- 4.6 years were selected and divided into two groups: the upper limb group (ULG) composed of 12 individuals (4 women) and the lower limb group (LLG) composed of 12 individuals (2 women). The maximum repetitions test was applied in the bench press for the ULG and in the 45 degrees leg press for the LLG, with 50% of the one-repetition maximum under control, placebo and IPC conditions, at a random interval of 72 hours between tests. The IPC was applied four hours before the tests by means of an analog sphygmomanometer cuff inflated to 220 mmHg on the arm for the ULG and on the thigh for LLG, with three cycles of five minutes each of ischemia and reperfusion, alternating between the right and left sides. For the placebo, the cuff was inflated to 40 mmHg without causing ischemia. The significance level for the Wilcoxon test was p <0.017, due to the Bonferroni correction. The effect size (ES) was also analyzed. Results: With IPC, the ULG performed 34.8 +/- 4.8 repetitions, representing an improvement of 11.29% (IPC vs. control, ES = 0.68 and p = 0.002) and the LLG performed 40.5 +/- 15.7 repetitions, representing an improvement of 37.47% (IPC vs. control, ES = 0.84 and p = 0.002). No significant improvements were observed for the placebo in either group. Conclusion: Our data showed that IPC positively influenced neuromuscular performance of both the upper and lower limbs.
- Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil(2021) NORMANDO, Paulo Garcia; ARAUJO-FILHO, Jose De Arimateia; FONSECA, Gabriela de Alcantara; RODRIGUES, Rodrigo Elton Ferreira; OLIVEIRA, Victor Agripino; HAJJAR, Ludhmila Abrahao; ALMEIDA, Andre Luiz Cerqueira; BOCCHI, Edimar Alcides; SALEMI, Vera Maria Cury; MELO, MarceloBackground: In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated. Objectives: To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System. Methods: Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05. Results: Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively). Conclusions: During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario.
- Worsening of heart failure by coronavirus disease 2019 is associated with high mortality(2021) BOCCHI, Edimar Alcides; LIMA, Ivna Girard Cunha Vieira; BISELLI, Bruno; SALEMI, Vera Maria Cury; FERREIRA, Silvia Moreira Ayub; CHIZZOLA, Paulo Roberto; MUNHOZ, Robinson Tadeu; PESSOA, Ranna Santos; CARDOSO, Francisco Akira Malta; BELLO, Mariana Vieira de Oliveira; HAJJAR, Ludhmila Abrahao; GOMES, Brenno RizerioAims Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. Methods and results We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) mu g/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. Conclusion Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.
- Effects of sympathectomy on myocardium remodeling and function(2021) JORDAO, Mauricio Rodrigues; PESSOA, Fernanda G.; FONSECA, Keila C. B.; ZANONI, Fernando; SALEMI, Vera M. C.; SOUZA, Leandro E.; RIBEIRO, Orlando N.; FERNANDES, Fabio; IRIGOYEN, Maria Claudia; MOREIRA, Luiz Felipe P.; MADY, Charles; RAMIRES, Felix Jose AlvarezOBJECTIVES: To evaluate the effects of sympathectomy on the myocardium in an experimental model. METHODS: The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached. RESULTS: The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09). CONCLUSION: These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.
- Incidence and Predictors of Progression to Chagas Cardiomyopathy: Long-Term Follow-Up of Trypanosoma cruzi-Seropositive Individuals(2021) NUNES, Maria Carmo P.; BUSS, Lewis F.; SILVA, Jose Luiz P.; MARTINS, Larissa Natany A.; OLIVEIRA, Claudia Di Lorenzo; CARDOSO, Clareci Silva; BRITO, Bruno Oliveira de Figueiredo; FERREIRA, Ariela Mota; OLIVEIRA, Lea Campos; BIERRENBACH, Ana Luiza; FERNANDES, Fabio; BUSCH, Michael P.; HOTTA, Viviane Tiemi; MARTINELLI, Luiz Mario Baptista; SOEIRO, Maria Carolina F. Almeida; BRENTEGANI, Adriana; SALEMI, Vera M. C.; MENEZES, Marcia M.; RIBEIRO, Antonio Luiz P.; SABINO, Ester CerdeiraBackground: There are few contemporary cohorts of Trypanosoma cruzi-seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi-seropositive blood donors. T. cruzi-seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008-2010) and at follow-up (2018-2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration 120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using inverse probability weights for selection. Results: We enrolled 499 T. cruzi-seropositive donors (age 4810 years, 52% male), 488 T. cruzi-seronegative donors (age 49 +/- 10 years, 49% male), and 101 patients with established Chagas cardiomyopathy (age 48 +/- 8 years, 59% male). The mortality in patients with established cardiomyopathy was 80.9 deaths/1000 person-years (py) (54/101, 53%) and 15.1 deaths/1000 py (17/114, 15%) in T. cruzi-seropositive donors with cardiomyopathy at baseline. Among T. cruzi-seropositive donors without cardiomyopathy at baseline, mortality was 3.7 events/1000 py (15/385, 4%), which was no different from T. cruzi-seronegative donors with 3.6 deaths/1000 py (17/488, 3%). The incidence of cardiomyopathy in T. cruzi-seropositive donors was 13.8 (95% CI, 9.5-19.6) events/1000 py (32/262, 12%) compared with 4.6 (95% CI, 2.3-8.3) events/1000 py (11/277, 4%) in seronegative controls, with an absolute incidence difference associated with T. cruzi seropositivity of 9.2 (95% CI, 3.6-15.0) events/1000 py. T. cruzi antibody level at baseline was associated with development of cardiomyopathy (adjusted odds ratio, 1.4 [95% CI, 1.1-1.8]). Conclusions: We present a comprehensive description of the natural history of T. cruzi seropositivity in a contemporary patient population. The results highlight the central importance of anti-T. cruzi antibody titer as a marker of Chagas disease activity and risk of progression.
- Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology-2021(2021) MELO, Marcelo Dantas Tavares de; PAIVA, Marcelo Goulart; SANTOS, Maria Veronica Camara; ROCHITTE, Carlos Eduardo; MOREIRA, Valeria de Melo; SALEH, Mohamed Hassan; BRANDAO, Simone Cristina Soares; GALLAFRIO, Claudia Cosentino; GOLDWASSER, Daniel; GRIPP, Eliza de Almeida; PIVETA, Rafael Bonafim; SILVA, Tonnison Oliveira; SANTO, Thais Harada Campos Espirito; FERREIRA, Waldinai Pereira; SALEMI, Vera Maria Cury; CAUDURO, Sanderson A.; BARBERATO, Silvio Henrique; LOPES, Heloisa M. Christovam; PENA, Jose Luiz Barros; RACHED, Heron Rhydan Saad; MIGLIORANZA, Marcelo Haertel; PINHEIRO, Aurelio Carvalho; VRANDECIC, Barbara Athayde Linhares Martins; CRUZ, Cecilia Beatriz Bittencourt Viana; NOMURA, Cesar Higa; CERBINO, Fernanda Mello Erthal; COSTA, Isabela Bispo Santos da Silva; COELHO FILHO, Otavio Rizzi; CARNEIRO, Adriano Camargo de Castro; BURGOS, Ursula Maria Moreira Costa; FERNANDES, Juliano Lara; UELLENDAHL, Marly; CALADO, Eveline Barros; SENRA, Tiago; ASSUNCAO, Bruna Leal; FREIRE, Claudia Maria Vilas; MARTINS, Cristiane Nunes; SAWAMURA, Karen Saori Shiraishi; BRITO, Marcio Miranda; JARDIM, Maria Fernanda Silva; BERNARDES, Renata Junqueira Moll; DIOGENES, Tereza Cristina; VIEIRA, Lucas de Oliveira; MESQUITA, Claudio Tinoco; LOPES, Rafael Willain; SEGUNDO NETO, Elry Medeiros Vieira; RIGO, Leticia; MARIN, Valeska Leite Siqueira; SANTOS, Marcelo Jose; GROSSMAN, Gabriel Blacher; QUAGLIATO, Priscila Cestari; ALCANTARA, Monica Luiza de; TEODORO, Jose Aldo Ribeiro; ALBRICKER, Ana Cristina Lopes; BARROS, Fanilda Souto; AMARAL, Salomon Israel do; PORTO, Carmen Lucia Lascasas; BARROS, Marcio Vinicius Lins; SANTOS, Simone Nascimento Dos; CANTISANO, Armando Luis; PETISCO, Ana Claudia Gomes Pereira; BARBOSA, Jose Eduardo Martins; VELOSO, Orlando Carlos Gloria; SPINA, Salvador; PIGNATELLI, Ricardo; HAJJAR, Ludhmilla Abrahao; KALIL FILHO, Roberto; LOPES, Marcelo Antonio Cartaxo Queiroga; VIEIRA, Marcelo Luiz Campos; ALMEIDA, Andre Luiz Cerqueira
- Diagnostic Accuracy of Dobutamine Stress Echocardiography for Detection of Cardiac Allograft Vasculopathy in Orthotopic Heart Transplant Patients(2021) MAHMOODURRAHMAN, Mohammed; MAREK, Josef; JUHARDEEN, Hamzah Ruxshan; OTAIBI, Talal Al; SALEMI, Vera Maria Cury; ECHAHIDI, Najmeddine; BURAIKI, Jehad Al; FADEL, Bahaa M.; MOHTY, DaniaObjective: Cardiac allograft vasculopathy is one of the leading causes of late graft failure and subsequent death in orthotopic heart transplant. Although invasive coronary angiography is the gold standard modality for detection of cardiac allograft vasculopathy, dobutamine stress echocardiography has been recently frequently used as an alternative. Our aim was to evaluate the diagnostic performance of dobutamine stress echocardiography for detection of cardiac allograft vasculopathy in transplant patients. Methods: A retrospective analysis was conducted using a total of 150 dobutamine stress echocardiographic exams that were performed on 99 patients in our institution, with paired coronary angiogram and no acute rejection, within a median of 538 [interquartile range 371-816] days. Sensitivity and specificity of dobutamine echocardiography to detect allograft vasculopathy was evaluated. Allograft vasculopathy was defined as Grade 1 or higher based on ISHLT criteria. A positive dobutamine stress echo result was defined by new or worsening wall motion abnormality. Results: Median age of the population at transplant was 34 [interquartile range 22-46] years; 76 (77%) patients were male. Allograft vasculopathy was present in 31 (20.6%) out of 150 coronary angiograms. Only 7 (4.6%) of that number were positive on dobutamine stress echocardiography. Sensitivity and specificity for allograft vasculopathy detection was 3% and 94%, respectively. Out of 7 false positive dobutamine stress echocardiograms, two were in patients with myocardial bridging. Two patients with mild acute rejection had both negative dobutamine stress echo. Conclusions: Overall, positivity of dobutamine stress echocardiography in patients after heart transplant is low. It has high specificity, but very low sensitivity for detection of cardiac allograft vasculopathy. Dobutamine stress echocardiography should only be cautiously used as an alternative to coronary angiography.
- Association between right heart dimensions and muscle performance and cardiorespiratory capacity in strength and endurance athletes(2021) MIRANDA, Douglas P.; ALVES, Wilson Eduardo F. M.; LOPES, Heloisa H. M. C.; SANTANA, Vinicius J.; BOCCHI, Edimar A.; SALEMI, Vera Maria C.Our purpose was to investigate the association between right heart dimensions and muscle performance and cardiorespiratory capacity in athletes. We selected 90 men with a mean age of 33.0 +/- 8.0 years: strength group (SG), 30 bodybuilders; endurance group (EG), 30 endurance athletes; and control group (CG), 30 healthy non-athletes. Comprehensive echocardiography and radionuclide angiography allowed the cardiac evaluation. VO(2)peak was assessed by cardiopulmonary testing, muscle strength by the one-repetition maximum test (1RM) and the relative strength (RS), and muscle endurance by the maximum repetitions test (MR) with 50% of 1RM. In SG was observed an association between right ventricle (RV) basal diameter and RS bench press (R-2 = .188 beta = 0.486 P = .017) and between right atrium (RA) area and MR leg press (R-2 = .257 beta = 0.143 P = .004). In EG was observed an association between RV basal diameter and VO(2)peak (R-2 = .299 beta = 0.026 P = .002) and between RA area and VO(2)peak (R-2 = .417 beta = 0.092 P <= .001). In conclusion, our data suggest that there is an association between right heart dimensions and muscle performance and cardiorespiratory capacity; moreover, muscle strength seems important for understanding cardiac adaptations to training.