Artigos e Materiais de Revistas Científicas - LIM/11

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case
(2022) KANHOUCHE, G.; CIVIDANES, F. R.; SAMPAIO, R. O.; SILVA, J. C. A. da; MACHADO, R. D.; WERNECK, M.; ACCORSI, T. A. D.; MORALES, K. R. D. P.; ABIZAID, A. C.; BRITO, F. S. D. Jr.; TARASOUTCHI, F.; PALMA, J. H.; RIBEIRO, H. B.
Coronary obstruction is an uncommon and severe complication after a transcatheter aortic valve replacement (TAVR), that occurs during the procedure in the vast majority of patients. In the present case even in the absence of classic risk factors, an acute coronary syndrome occurred one day after TAVR. Selective angiography revealed a severe left main ostium obstruction by the bulky native leaflet calcification. This is the first case of delayed presentation of coronary obstruction with a transfemoral balloon-expandable valve using the Inovare bioprosthesis (Braile Biomedica, Brazil). In addition, after drug-eluting stent placement in the left main coronary, intravascular ultrasound revealed severe stent underexpansion, so that a second layer of a bare-metal stent and high-pressure balloon post-dilatation was necessary to improve the final result. The patient was discharged after 7 days, and at the 6-month follow-up remained asymptomatic.
Rare association between giant-cell aortitis and giant-cell aortic valvulitis
(2023) LUZURIAGA, G. C. J.; DIAS, R. R.; SANTIAGO, J. A. D.; JUNIOR, V. M.; ISHIKAWA, W. Y.; FERNANDES, F.; AIELLO, V. D.
Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.
Reduced-dose prasugrel monotherapy without aspirin after PCI with the SYNERGY stent in East Asian patients presenting with chronic coronary syndromes or non-ST-elevation acute coronary syndromes: rationale and design of the ASET Japan pilot study
(2023) MASUDA, S.; MURAMATSU, T.; ISHIBASHI, Y.; KOZUMA, K.; TANABE, K.; NAKATANI, S.; KOGAME, N.; NAKAMURA, M.; ASANO, T.; OKAMURA, T.; MIYAZAKI, Y.; TATEISHI, H.; OZAKI, Y.; NAKAZAWA, G.; MORINO, Y.; KATAGIRI, Y.; GARG, S.; HARA, H.; ONO, M.; KAWASHIMA, H.; LEMOS, P. A.; SERRUYS, P. W.; ONUMA, Y.
The Acetyl Salicylic Elimination Trial (ASET) Japan pilot study is a multicentre, single-arm, open-label, proof-of-concept study with a stopping rule based on the occurrence of definite stent thrombosis. This study aims to demonstrate the feasibility and safety of low-dose prasugrel monotherapy following percutaneous coronary intervention (PCI) in Japanese patients presenting with chronic coronary syndromes (CCS) or non-ST-elevation acute coronary syndromes (NSTE-ACS). Four hundred patients with a SYNTAX score <23 requiring PCI due to CCS or NSTE-ACS will be screened and considered eligible for the study. The enrolment is planned in two phases: 1) 200 patients presenting with CCS, followed by 2) 200 patients presenting with NSTE-ACS. After optimal PCI with implantation of a SYNERGY (Boston Scientific) stent, patients will be enrolled and loaded with prasugrel 20 mg, followed by a maintenance dose of prasugrel 3.75 mg once daily without aspirin continued for 3 months in Phase 1 (CCS patients), and for 12 months in Phase 2 (NSTE-ACS patients). After these follow-up periods, prasugrel will be replaced by standard antiplatelet therapy according to local practice. The primary endpoint is a composite of cardiac death, target vessel myocardial infarction, or definite stent thrombosis after the index procedure. The primary bleeding endpoint is any Bleeding Academic Research Consortium type 3 or 5 bleeding occurring within 3 months of the index PCI for CCS patients, or 12 months for NSTE-ACS patients. The ASET Japan study is designed to demonstrate the feasibility and safety of reduced-dose prasugrel monotherapy after PCI in East Asian patients with acute and chronic coronary syndromes.
Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial
(2023) PEREIRA, M. D. P.; LIMA, E. G.; PITTA, F. G.; GOWDAK, L. H. W.; MIOTO, B. M.; CARVALHO, L. N. S.; DARRIEUX, F. C. D. C.; MEJIA, O. A. V.; JATENE, F. B.; SERRANO JR., C. V
Objectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.
The Six Pillars of Lifestyle Medicine in Managing Noncommunicable Diseases - The Gaps in Current Guidelines
(2023) FARIA, Rafaella Rogatto de; SIQUEIRA, Sergio Freitas de; HADDAD, Francisco Aguerre; SILVA, Gustavo Del Monte; SPAGGIARI, Caio Vitale; MARTINELLI FILHO, Martino
Background: Noncommunicable diseases (NCDs), also known as chronic diseases that are long-lasting, are considered the major cause of death and disability worldwide, and the six pillars of lifestyle medicine (nutrition, exercise, toxic control, stress, sleep, and social connection) play an important role in a holistic management of their prevention and treatment. In addition, medical guidelines are the most accepted documents with recommendations to manage NCDs.Objective: The present study aims to analyze the lack of lifestyle pillars concerning the major Brazilian medical guidelines for NCDs and identify evidence in the literature that could justify their inclusion in the documents.Method: Brazilian guidelines were selected according to the most relevant causes of death in Brazil, given by the Mortality Information System, published by the Brazilian Ministry of Health in 2019. Journals were screened in the PUBMED library according to the disease and non-mentioned pillars of lifestyle.Results: Relevant causes of deaths in Brazil are Acute Myocardial Infarction (AMI), Diabetes Mellitus (DM), and Chronic Obstructive Pulmonary Diseases (COPD). Six guidelines related to these NCDs were identified, and all address aspects of lifestyle, but only one, regarding cardiovascular prevention, highlights all six pillars. Despite this, a literature search involving over 50 articles showed that there is evidence that all the pillars can help control each of these NCDs.Conclusion: Rarely are the six pillars of lifestyle contemplated in Brazilian guidelines for AMI, DM, and COPD. The literature review identified evidence of all lifestyle pillars to offer a holistic approach for the management and prevention of NCDs.
Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports
(2023) PIAZ, Matheus Ramos Dal; PIRES, Lucas Tachotti; HERRERA, Jonathan Cayo Urdiales; LABAT, Andre Luis Bezerra; CIVIDANES, Felipe Reale; SPINA, Guilherme Sobreira; PALMA, Jose Honorio; TARASOUTCHI, Flavio
Background Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear.Cases summary A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed.Discussion Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.
Patisiran Treatment in Patients with Transthyretin Cardiac Amyloidosis
(2023) MAURER, Mathew S.; KALE, Parag; FONTANA, Marianna; BERK, John L.; GROGAN, Martha; GUSTAFSSON, Finn; HUNG, Rebecca R.; GOTTLIEB, Robert L.; DAMY, Thibaud; GONZALEZ-DUARTE, Alejandra; SARSWAT, Nitasha; SEKIJIMA, Yoshiki; TAHARA, Nobuhiro; TAYLOR, Mark S.; KUBANEK, Milos; DONAL, Erwan; PALECEK, Tomas; TSUJITA, Kenichi; TANG, W. H. Wilson; YU, Wen-Chung; OBICI, Laura; SIMOES, Marcus; FERNANDES, Fabio; POULSEN, Steen Hvitfeldt; DIEMBERGER, Igor; PERFETTO, Federico; SOLOMON, Scott D.; CARLI, Marcelo Di; BADRI, Prajakta; WHITE, Matthew T.; CHEN, Jihong; YURENEVA, Elena; SWEETSER, Marianne T.; JAY, Patrick Y.; GARG, Pushkal P.; VEST, John; GILLMORE, Julian D.; APOLLO-B Trial Investigators
BackgroundTransthyretin amyloidosis, also called ATTR amyloidosis, is associated with accumulation of ATTR amyloid deposits in the heart and commonly manifests as progressive cardiomyopathy. Patisiran, an RNA interference therapeutic agent, inhibits the production of hepatic transthyretin.MethodsIn this phase 3, double-blind, randomized trial, we assigned patients with hereditary, also known as variant, or wild-type ATTR cardiac amyloidosis, in a 1:1 ratio, to receive patisiran (0.3 mg per kilogram of body weight) or placebo once every 3 weeks for 12 months. A hierarchical procedure was used to test the primary and three secondary end points. The primary end point was the change from baseline in the distance covered on the 6-minute walk test at 12 months. The first secondary end point was the change from baseline to month 12 in the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) score (with higher scores indicating better health status). The second secondary end point was a composite of death from any cause, cardiovascular events, and change from baseline in the 6-minute walk test distance over 12 months. The third secondary end point was a composite of death from any cause, hospitalizations for any cause, and urgent heart failure visits over 12 months.ResultsA total of 360 patients were randomly assigned to receive patisiran (181 patients) or placebo (179 patients). At month 12, the decline in the 6-minute walk distance was lower in the patisiran group than in the placebo group (Hodges-Lehmann estimate of median difference, 14.69 m; 95% confidence interval [CI], 0.69 to 28.69; P=0.02); the KCCQ-OS score increased in the patisiran group and declined in the placebo group (least-squares mean difference, 3.7 points; 95% CI, 0.2 to 7.2; P=0.04). Significant benefits were not observed for the second secondary end point. Infusion-related reactions, arthralgia, and muscle spasms occurred more often among patients in the patisiran group than among those in the placebo group.ConclusionsIn this trial, administration of patisiran over a period of 12 months resulted in preserved functional capacity in patients with ATTR cardiac amyloidosis. (Funded by Alnylam Pharmaceuticals; APOLLO-B ClinicalTrials.gov number, NCT03997383.) This phase 3 trial of patisiran, a small interfering RNA that targets hepatic production of the transthyretin protein, showed efficacy in treating transthyretin-mediated (ATTR) cardiac amyloidosis.
Automated lumen segmentation using multi-frame convolutional neural networks in intravascular ultrasound datasets
(2020) ZIEMER, Paulo G. P.; BULANT, Carlos A.; I, Jose Orlando; TALOU, Gonzalo D. Maso; ALVAREZ, Luis A. Mansilla; BEZERRA, Cristiano Guedes; LEMOS, Pedro A.; GARCIA-GARCIA, Hector M.; BLANCO, Pablo J.
AimsAssessment of minimum lumen areas in intravascular ultrasound (IVUS) pullbacks is time-consuming and demands adequately trained personnel. In this work, we introduce a novel and fully automated pipeline to segment the lumen boundary in IVUS datasets.Methods and resultsFirst, an automated gating is applied to select end-diastolic frames and bypass saw-tooth artefacts. Second, within a machine learning (ML) environment, we automatically segment the lumen boundary using a multi-frame (MF) convolutional neural network (MFCNN). Finally, we use the theory of Gaussian processes (GPs) to regress the final lumen boundary. The dataset consisted of 85 IVUS pullbacks (52 patients). The dataset was partitioned at the pullback-level using 73 pullbacks for training (20 586 frames), 6 pullbacks for validation (1692 frames), and 6 for testing (1692 frames). The degree of overlapping, between the ground truth and ML contours, median (interquartile range, IQR) systematically increased from 0.896 (0.874-0.933) for MF1 to 0.925 (0.911-0.948) for MF11. The median (IQR) of the distance error was also reduced from 3.83 (2.94-4.98)% for MF1 to 3.02 (2.25-3.95)% for MF11-GP. The corresponding median (IQR) in the lumen area error remained between 5.49 (2.50-10.50)% for MF1 and 5.12 (2.15-9.00)% for MF11-GP. The dispersion in the relative distance and area errors consistently decreased as we increased the number of frames, and also when the GP regressor was coupled to the MFCNN output.ConclusionThese results demonstrate that the proposed ML approach is suitable to effectively segment the lumen boundary in IVUS scans, reducing the burden of costly and time-consuming manual delineation.
Quantitative coronary three-dimensional geometry and its association with atherosclerotic disease burden and composition
(2023) PRADO, Guy F. A. F.; BLANCO, Pablo J.; BULANT, Carlos A.; ARES, Gonzalo D.; MARIANI, Jose; CAIXETA, Adriano; ALMEIDA, Breno O.; GARZON, Stefano; PINTON, Fabio A.; BARBATO, Emanuele; RIBICHINI, Flavio L.; TOTH, Gabor G.; MAHFOUD, Felix; WIJNS, William; GARCIA-GARCIA, Hector M.; LEMOS, Pedro A.
BackgroundIsolate features of the coronary anatomy have been associated with the pathophysiology of atherosclerotic disease. Computational methods have been described to allow precise quantification of the complex three-dimensional (3D) coronary geometry. The present study tested whether quantitative parameters that describe the spatial 3D coronary geometry is associated with the extension and composition of the underlying coronary artery disease (CAD). MethodsPatients with CAD scheduled for percutaneous intervention were investigated with coronary computed tomography angiography (CCTA), and invasive coronary angiography, and virtual histology intravascular ultrasound (IVUS-VH). For all target vessels, 3D centerlines were extracted from CCTA images and processed to quantify 23 geometric indexes, grouped into 3 main categories as follows: (i) length-based; (ii) curvature-based, torsion-based, and curvature/torsion-combined; (iii) vessel path-based. The geometric variables were compared with IVUS-VH parameters assessing the extent and composition of coronary atherosclerosis. ResultsA total of 36 coronary patients (99 vessels) comprised the study population. From the 23 geometric indexes, 18 parameters were significantly (p < 0.05) associated with at least 1 IVUS-VH parameter at a univariate analysis. All three main geometric categories provided parameters significantly related with atherosclerosis variables. The 3D geometric indexes were associated with the degree of atherosclerotic extension, as well as with plaque composition. Geometric features remained significantly associated with all IVUS-VH parameters even after multivariate adjustment for clinical characteristics. ConclusionsQuantitative 3D vessel morphology emerges as a relevant factor associated with atherosclerosis in patients with established CAD.
Morphological and functional cardiac alterations in children with congenital Zika syndrome and severe neurological deficits
(2023) BARBOSA, Imara Correia de Queiroz; GOMES, Luizabel de Paula; FEITOSA, Israel Nilton de Almeida; BOTELHO, Luis Fabio Barbosa; BARBOSA, Bruno Robalinho Cavalcanti; BARBOSA, Alex; ARAUJO, Andre Telis de Vilela; MELO, Marcelo Dantas Tavares de; MELO, Adriana Suely de Oliveira; SALEMI, Vera Maria Cury
IntroductionZika virus infection during pregnancy causes fetal microcephaly and brain damage. Congenital Zika syndrome (CZS) is characterized by systemic involvement with diffuse muscle impairment, a high frequency of arthrogryposis, and microphthalmia. Cardiac impairment in CZS has rarely been evaluated. Our study assessed morphology and biventricular cardiac function in children with CZS and advanced neurological dysfunction.Methods This cross-sectional study was conducted on 52 children with CZS (Zika group; ZG) and 25 healthy children (control group; CG) in Paraiba, Brazil. Clinical evaluation, electrocardiogram (EKG), and transthoracic echocardiogram (TTE) were performed on all children. Additionally, troponin I and natriuretic peptide type B (BNP) levels, the degree of cerebral palsy, and neuroimaging findings were assessed in the ZG group.Results The median age of the study population was 5 years in both groups, and 40.4% (ZG) and 60% (CG) were female. The most prevalent electrocardiographic alteration was sinus arrhythmia in both the ZG (n = 9, 17.3%) and CG (n = 4, 16%). The morphological parameters adjusted for Z score were as follows: left ventricular (LV) end-diastolic diameter in ZG: -2.36 [-5.10, 2.63] vs. CG: -1.07 [-3.43, 0.61], p<0.001); ascending aorta (ZG: -0.09 [-2.08, 1.60] vs. CG: 0.43 [-1.47, 2.2], p = 0.021); basal diameter of the right ventricle (RV) (ZG: -2.34 [-4.90, 0.97] vs. CG: -0.96 [-2.21, 0.40], p<0.01); and pulmonary artery dimension (ZG: -2.13 [-5.99, 0.98] vs. CG: -0.24 [-2.53, 0.59], p<0.01). The ejection fractions (%) were 65.7 and 65.6 in the ZG and CG, respectively (p = 0.968). The left atrium volume indices (mL/m2) in the ZG and CG were 13.15 [6.80, 18.00] and 18.80 [5.90, 25.30] (p<0.01), respectively, and the right atrium volume indices (mL/m2) were 10.10 [4.90, 15.30] and 15.80 [4.10, 24.80] (p<0.01). The functional findings adjusted for Z score were as follows: lateral systolic excursion of the mitral annular plane (MAPSE) (ZG: 0.36 [-2.79, 4.71] vs. CG: 1.79 [-0.93, 4.5], p = 0.001); tricuspid annular plane systolic excursion (TAPSE) (ZG: -2.43 [-5.47, 5.09] vs. CG: 0.07 [-1.98, 3.64], p<0.001); and the S' of the RV (ZG: 1.20 [3.35, 2.90] vs. CG: -0.20 [-2.15, 1.50], p = 0.0121). No differences in biventricular strain measurements were observed between the groups. Troponin I and BNP levels were normal in in the ZG. Grade V cerebral palsy and subcortical calcification were found in 88.6% and 97.22% of children in the ZG group, respectively.Conclusion A reduction in cardiac dimensions and functional changes were found in CZS patients, based on the TAPSE, S' of the RV, and MAPSE, suggesting the importance of cardiac evaluation and follow-up in this group of patients.
Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol
(2021) SCHWARTZ, Gregory G.; SZAREK, Michael; BITTNER, Vera A.; DIAZ, Rafael; GOODMAN, Shaun G.; JUKEMA, J. Wouter; LANDMESSER, Ulf; LOPEZ-JARAMILLO, Patricio; MANVELIAN, Garen; PORDY, Robert; SCEMAMA, Michel; SINNAEVE, Peter R.; WHITE, Harvey D.; STEG, Ph Gabriel
BACKGROUND Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains >= 70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3-74.0 mg/dL); in 14,573 patients (77.0%), both determinations were >= 70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2-111.0 mg/dL). RESULTS In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [CI]: 0.52-0.90) and 1.11 (95% CI: 0.83-1.49), with treatment-lipoprotein(a) interaction on MACE (P-interaction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or <= 13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with P-interaction = 0.43. CONCLUSIONS In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402) (C) 2021 The Authors.
The impact of data quality monitoring of a multicenter prospective registry of cardiac implantable electronic devices
(2023) SAUCEDO, Sarah Caroline Martins; SILVA, Katia Regina; SILVA, Laisa de Arruda; CRIVELARI, Jessica Moretto; COSTA, Roberto
Data quality monitoring plays a crucial role in multicenter prospective registries. By maintaining high data accuracy, completeness, and consistency, researchers can improve the overall quality and reliability of the registry data, enabling meaningful conclusions and supporting evidencebased decisions. The purpose of the present study was to evaluate data quality metrics (completeness, accuracy, and temporal plausibility) of a Multicenter Registry of Cardiac Implantable Electronic Devices (CIEDs) and to perform a direct data audit of a random sample of records to assess the agreement levels with the source documents. The CIED Registry was a prospective, multicenter, real-world observational study carried out from January 2020 to December 2022 in five designated centers across Sao Paulo, Brazil. We assessed the data quality of the CIED Registry by using two distinct approaches: center dot Dynamic data monitoring using features of the REDCap (Research Electronic Data Capture) software, including data reports and data quality rules center dot Direct data audit in which information from a random sample of 10 % of cases from the coordinating center was compared with original source documents Our findings suggest that the methodological approach applied to the CIED Registry resulted in high data completeness, accuracy, temporal plausibility, and excellent agreement levels with the source documents.
Value-based health care in heart failure: Quality of life and cost analysis
(2023) GHISLENI, Eduarda Chiesa; ASTOLFI, Vit oria Rech; ZIMMERMANN, Larissa; LIRA, Camila Nogueira Leandro; NASCIMENTO, Eduarda Faria do; ETGES, Ana Paula Beck da Silva; MARCONDES-BRAGA, Fabiana G.; BACAL, Fernando; DANZMANN, Luiz Claudio; POLANCZYK, Carisi Anne; BIOLO, Andreia
Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept.Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex.Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 +/- 238 for NYHA I patients, US$ 296 +/- 399 for NYHA II and US$ 667 +/- 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05).Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classifi-cation increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reim-bursement strategies based on value.
Neurovascular and hemodynamic responses to mental stress and exercise in severe COVID-19 survivors
(2023) FARIA, Diego; MOLL-BERNARDES, Renata; TESTA, Laura; MONIZ, Camila M. V.; RODRIGUES, Erika C.; MOTA, Jose M.; SOUZA, Francis R.; ALVES, Maria Janieire N. N.; ONO, Bruna E.; IZAIAS, Joao E.; SALES, Artur O.; RODRIGUES, Thais S.; SALEMI, Vera M. C.; JORDAO, Camila P.; ANGELIS, Katia De; CRAIGHEAD, Daniel H.; ROSSMAN, Matthew J.; BORTOLOTTO, Luiz A.; CONSOLIM-COLOMBO, Fernanda M.; IRIGOYEN, Maria C. C.; SEALS, Douglas R.; NEGRAO, Carlos E.; SALES, Allan R. K.
Previous studies show that COVID-19 survivors have elevated muscle sympathetic nerve activity (MSNA), endothelial dysfunction, and aortic stiffening. However, the neurovascular responses to mental stress and exercise are still unexplored. We hypothesized that COVID-19 survivors, compared with age-and body mass index (BMI)-matched control subjects, exhibit abnormal neurovascular responses to mental stress and physical exercise. Fifteen severe COVID-19 survivors (aged: 49 +/- 2 yr, BMI: 30 +/- 1 kg/m(2)) and 15 well-matched control subjects (aged: 46 +/- 3 yr, BMI: 29 +/- 1 kg/m(2)) were studied. MSNA (microneurography), forearm blood flow (FBF), and forearm vascular conductance (FVC, venous occlusion plethysmography), mean arterial pressure (MAP, Finometer), and heart rate (HR, ECG) were measured during a 3-min mental stress (Stroop Color-Word Test) and during a 3-min isometric handgrip exercise (30% of maximal voluntary contraction). During mental stress, MSNA (frequency and incidence) responses were higher in COVID-19 survivors than in controls (P < 0.001), and FBF and FVC responses were attenuated (P < 0.05). MAP was similar between the groups (P > 0.05). In contrast, the MSNA (frequency and incidence) and FBF and FVC responses to handgrip exercise were similar between the groups (P > 0.05). MAP was lower in COVID-19 survivors (P < 0.05). COVID-19 survivors exhibit an exaggerated MSNA and blunted vasodilatory response to mental challenge compared with healthy adults. However, the neurovascular response to handgrip exercise is preserved in COVID-19 survivors. Overall, the abnormal neurovascular control in response to mental stress suggests that COVID-19 survivors may have an increased risk to cardiovascular events during mental challenge.
The impact of obesity in hospitalized patients with COVID-19: a retrospective cohort study
(2024) CARRA, Fabio Alfano; MELO, Maria Edna de; STUMPF, Matheo A. M.; CERCATO, Cintia; FERNANDES, Ariana E.; MANCINI, Marcio C.; HIROTA, Adriana; KANASIRO, Alberto Kendy; CRESCENZI, Alessandra; FERNANDES, Amanda Coelho; MIETHKE-MORAIS, Anna; BELLINTANI, Arthur Petrillo; CANASIRO, Artur Ribeiro; CARNEIRO, Barbara Vieira; ZANBON, Beatriz Keiko; PINHEIRO, Bernardo; BATISTA, Senna Nogueira; NICOLAO, Bianca Ruiz; BESEN, Bruno Adler Maccagnan Pinheiro; BISELLI, Bruno; MACEDO, Bruno Rocha De; TOLEDO, Caio Machado Gomes De; CARVALHO, Carlos Roberto Ribeiro De; MOL, Caroline Gomes; STIPANICH, Cassio; BUENO, Caue Gasparotto; GARZILLO, Cibele; TANAKA, Clarice; FORTE, Daniel Neves; JOELSONS, Daniel; ROBIRA, Daniele; COSTA, Eduardo Leite Vieira; SILVA JUNIOR, Elson Mendes Da; REGALIO, Fabiane Aliotti; SEGURA, Gabriela Cardoso; LOURO, Giulia Sefrin; MARCELINO, Gustavo Brasil; HO, Yeh-Li; FERREIRA, Isabela Argollo; GOIS, Jeison Oliveira; SILVA-JR, Joao Manoel Da; JUNIOR, Jose Otto Reusing; RIBEIRO, Julia Fray; FERREIRA, Juliana Carvalho; GALLETI, Karine Vusberg; SILVA, Katia Regina; ISENSEE, Larissa Padrao; OLIVEIRA, Larissa Santos; TANIGUCHI, Leandro Utino; LETAIF, Leila Suemi; LIMA, Ligia Trombetta; PARK, Lucas Yongsoo; NETTO, Lucas Chaves; NOBREGA, Luciana Cassimiro; HADDAD, Luciana Bertocco Paiva; HAJJAR, Ludhmila Abrahao; MALBOUISSON, Luiz Marcelo Sa; PANDOLFI, Manuela Cristina Adsuara; PARK, Marcelo; CARMONA, Maria Jose Carvalho; ANDRADE, Maria Castilho Prandini H.; SANTOS, Mariana Moreira; BATELOCHE, Matheus Pereira; SUIAMA, Mayra Akimi; OLIVEIRA, Mayron Faria de; SOUSA, Mayson Laercio; GARCIA, Michelle Louvaes; HUEMER, Natassja; MENDES, Pedro Vitale; LINS, Paulo Ricardo Gessolo; SANTOS, Pedro Gaspar Dos; MOREIRA, Pedro Ferreira Paiva; GUAZZELLI, Renata Mello; REIS, Renato Batista Dos; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta Muriel Longo; PEDRO, Rodolpho Augusto Moura; KONDO, Rodrigo; RACHED, Samia Zahi; FONSECA, Sergio Roberto Silveira Da; BORGES, Thais Sousa; FERREIRA, Thalissa; JUNIOR, Vilson Cobello; SALES, Vivian Vieira Tenorio; FERREIRA, Willaby Serafim Cassa
Background Obesity is believed to be a risk factor for COVID-19 and unfavorable outcomes, although data on this remains to be better elucidated.Objective To evaluate the impact of obesity on the endpoints of patients hospitalized due to SARS-CoV-2.Methods This retrospective cohort study evaluated patients hospitalized at a tertiary hospital (Hospital das Cl & iacute;nicas da Faculdade de Medicina da USP) from March to December 2020. Only patients positive for COVID-19 (real-time PCR or serology) were included. Data were collected from medical records and included clinical and demographic information, weight and height, SAPS-3 score, comorbidities, and patient-centered outcomes (mortality, and need for mechanical ventilation, renal replacement therapy, or vasoactive drugs). Patients were divided into categories according to their BMI (underweight, eutrophic, overweight and obesity) for comparison porpoise.Results A total of 2547 patients were included. The mean age was 60.3 years, 56.2% were men, 65.2% were white and the mean BMI was 28.1 kg/m(2). SAPS-3 score was a risk factor for all patient-centered outcomes (HR 1.032 for mortality, OR 1.03 for dialysis, OR 1.07 for vasoactive drug use, and OR 1.08 for intubation, p < 0.05). Male sex increased the risk of death (HR 1.175, p = 0.027) and dialysis (OR 1.64, p < 0.001), and underweight was protective for vasoactive drug use (OR 0.45, p = 0.027) and intubation (OR 0.31, p < 0.003).Conclusion Obesity itself was not an independent factor for worse patient-centered outcomes. Critical clinical state (indirectly evaluated by SAPS-3) appears to be the most important variable related to hard outcomes in patients infected with COVID-19.
Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure
(2023) FILIPPINI, Filippe Barcellos; RIBEIRO, Henrique Barbosa; BOCCHI, Edimar; BACAL, Fernando; MARCONDES-BRAGA, Fabiana G.; AVILA, Monica S.; STURMER, Janine Daiana; MARCHI, Mauricio Felippi de Sa; KANHOUCHE, Gabriel; FERNANDO, Antonio; CASSAR, Renata; JR, Fabio Sandoli de Brito; ABIZAID, Alexandre A.
Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
A review of cost-effectiveness analysis: From theory to clinical practice
(2023) BRANDAO, Sara Michelly Goncalves; ROCCA, Hans-Peter Brunner-La; LIMA, Antonio Carlos Pedroso de; BOCCHI, Edimar Alcides
Cost-effectiveness analysis has long been practiced; registries date back to the United States of America War Department in 1886. In addition, everyone does intuitive cost-effectiveness analyses in their daily lives. In routine medical care, health economic assessment becomes increasingly important due to progressively limited resources, rising demands, population increases, and continuous therapeutic innovations. The health economic assessment must analyze the outcomes and costs of actions and technologies as objectively as possible to guarantee efficient assessment of novel interventions for Public Health Policy. In other words, it is necessary to determine how much society or patients are willing to or able to pay for novel interventions compared with existing alternatives, given the available resources. In addition, increased cost may displace other health care services already provided in case of fixed budget health care systems. To conduct such analyses, researchers must use standard methodologies and interpretations in light of regional characteristics according to social and economic determinants as well as clinical practice. Such an approach may be essential for transforming the current healthcare system to a value-based model. In this narrative review, concepts of the importance of and some approaches to health economic evaluation in clinical practice will be discussed.
Abnormal release of cardiac biomarkers in the presence of myocardial oedema evaluated by cardiac magnetic resonance after uncomplicated revascularization procedures
(2023) RIBAS, Fernando Faglioni; HUEB, Whady; REZENDE, Paulo Cury; ROCHITTE, Carlos Eduardo; NOMURA, Cesar Higa; VILLA, Alexandre Volney; MORAIS, Thamara Carvalho; LIMA, Eduardo Gomes; BOROS, Gustavo Andre Boeing; RIBEIRO, Matheus de Oliveira Laterza; LINHARES-FILHO, Jaime Paula Pessoa; DALLAZEN, Anderson Roberto; SILVA, Rafael Rocha Mol; RAMIRES, Jose Antonio Franchini; KALIL-FILHO, Roberto
Aims To analyse the association of myocardial oedema (ME), observed as high T2 signal intensity (HT2) in cardiac magnetic resonance imaging, with the release of cardiac biomarkers, ventricular ejection, and clinical outcomes after revascularization. Methods and results Patients with stable coronary artery disease with the indication for revascularization were included. Biomarker levels [troponin I (cTnI) and creatine kinase MB (CK-MB)] and T2-weighted and late gadolinium enhancement (LGE) images were obtained before and after the percutaneous or surgical revascularization procedures. The association of HT2 with the levels of biomarkers, with and without LGE, evolution of left ventricular ejection fraction (LVEF), and 5-year clinical outcomes were assessed. A total of 196 patients were divided into 2 groups: Group 1 (HT2, 40) and Group 2 (no HT2, 156). Both peak cTnI (8.9 and 1.6 ng/mL) and peak CK-MB values (44.7 and 12.1 ng/mL) were significantly higher in Group 1. Based on the presence of new LGE, patients were stratified into Groups A (no HT2/LGE, 149), B (HT2, 9), C (LGE, 7), and D (both HT2/LGE, 31). The peak cTnI and CK-MB values were 1.5 and 12.0, 5.4 and 44.7, 5.0 and 18.3, and 9.8 and 42.8 ng/mL in Groups A, B, C, and D, respectively, and were significantly different. The average LVEF decreased by 4.4% in Group 1 and increased by 2.2% in Group 2 (P = 0.057). Conclusion ME after revascularization procedures was associated with increased release of cardiac necrosis biomarkers, and a trend towards a difference in LVEF, indicating a role of ME in cardiac injury after interventions.
Effects of exercise on platelet reactivity after myocardial infarction: a randomized clinical trial
(2023) DALCOQUIO, Talia Falcao; SANTOS, Mayara Alves dos; ALVES, Leandro Silva; ARANTES, Flavia Bittar Brito; FERREIRA-SANTOS, Larissa; RONDON, Maria Urbana Pinto Brandao; FURTADO, Remo Holanda M.; FERRARI, Aline Gehlen; RIZZO, Paulo Roberto Genestreti; SALSOSO, Rocio; FRANCI, Andre; BARACIOLI, Luciano Moreira; ALVES, Maria Janieire de Nazare Nunes; NEGRAO, Carlos Eduardo; NICOLAU, Jose Carlos
Exercise training (ET) can lower platelet reactivity in patients with cardiovascular risk factors. However, the effects of ET on platelet reactivity in higher-risk patients is unknown. The aim of this study was to evaluate the effects of ET on platelet reactivity in patients with recent myocardial infarction (MI). Ninety patients were randomly assigned 1 month post-MI to the intervention (patients submitted to a supervised ET program) or control group. All patients were on dual antiplatelet therapy (DAPT). Platelet reactivity by VerifyNow-P2Y(12) (measured by P2Y(12) reaction units - PRU5) test was determined at baseline and at the end of 14 +/- 2 weeks of follow-up at rest (primary endpoint), and multiplate electrode aggregometry (MEA) adenosine diphosphate (ADP) and aspirin (ASPI) tests were performed immediately before and after the maximal cardiopulmonary exercise test (CPET) at the same time points (secondary endpoints). Sixty-five patients (mean age 58.9 +/- 10 years; 73.8% men; 60% ST elevation MI) completed follow-up (control group, n = 31; intervention group, n = 34). At the end of the follow-up, the mean platelet reactivity was 172.8 +/- 68.9 PRU5 and 166.9 +/- 65.1 PRU5 for the control and intervention groups, respectively (p = .72). Platelet reactivity was significantly increased after the CPET compared to rest at the beginning and at the end of the 14-week follow-up (among the intervention groups) by the MEA-ADP and MEA-ASPI tests (p < .01 for all analyses). In post-MI patients on DAPT, 14 weeks of supervised ET did not reduce platelet reactivity.

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