DESIDERIO FAVARATO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
9 resultados
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conferenceObject ON-PUMP VERSUS OFF-PUMP CORONARY ARTERY BYPASS SURGERY IN PATIENTS WITH ADVANCED AGE: FIVE-YEAR FOLLOW-UP OF MASS III TRIAL(2013) MELO, Rodrigo M. V.; HUEB, Whady; OIKAWA, Fernando T. C.; COSTA, Leandro; SERRANO, Carlos; GARZILLO, Cibele; REZENDE, Paulo; LIMA, Eduardo; FAVARATO, Desiderio; HUEB, Alexandre; RAMIRES, Jose; KALIL-FILHO, RobertoBackground: Advanced age is associated with increased mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG), which may be a consequence of cardiopulmonary bypass. We aim to evaluate cardiac events and long-term clinical outcome in patients with advanced age and stable coronary artery disease (CAD) undergoing off-pump (OPCAB) and on-pump (ONCAB) CABG. Methods: The MASS III was a single-center randomized trial that evaluate 308 patients with stable CAD and preserved ventricular function assigned for: 155 to off-pump and 153 to on-pump CABG. Of this, 176 (58.3%) patients had 60 years or older at the time of randomization (90 of-pump and 86 on-pump). Primary composite end points were death, myocardial infarction, further revascularization, or stroke. Results: The two randomized groups were well-matched for baseline demographic, clinical, and angiographic characteristics. The mean age was 67.2 (±5.0) years. In hospital analysis ONCAB patients had a higher incidence of postoperative stroke or myocardial infarction: 13 (15.1%) vs 5 (5.6%); p=0.036. After 5-year follow-up, there were no significant differences between both strategies of CABG in the composite end points 29.1% vs 27.8%; (Hazard Ratio 1.07; CI 0.62 – 1.87; p=0.8) for ONCAB and OPCAB respectively. Conclusion: In this advanced age population, off-pump surgery did not add benefit in clinical outcome at 5-year follow-up.conferenceObject CHARACTERIZATION, TREATMENT AND OUTCOMES OF PATIENTS WITH STABLE ISCHEMIC HEART DISEASE IN A TERTIARY-CARE CENTER IN BRAZIL(2020) MOREIRA, Eduardo; GARZILLO, Cibele; AYRES, Sandra; FAVARATO, Desiderio; PITTA, Fabio; LIMA, Eduardo Gomes; HUEB, Whady; SERRANO, CarlosconferenceObject LIPID TRANSFER TO HIGH DENSITY LIPOPROTEINS IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT CORONARY ARTERY DISEASE(2012) SPRANDEL, Marilia C. O.; HUEB, Whady; CASELLA-FILHO, Antonio; SEGRE, Alexandre; REZENDE, Paulo Cury; CARVALHO, Ana L. O.; FAVARATO, Desiderio; MARANHAO, Raul C.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground In type 2 diabetes mellitus (DM2), HDL-cholesterol is diminished and it is important to understand the functional and metabolic changes existing in HDL in DM2 patients that may predispose to coronary artery disease (CAD). Lipid transfers between HDL and the other lipoproteins, mediated by cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP), are crucial steps in HDL formation and role in reverse cholesterol transfer. Objective Investigate whether development of CAD in DM2 patients are associated with alterations in lipid transfers to HDL and in content of free cholesterol in the plasma. Methods 78 patients with DM2 and CAD (DM2-CAD) and 78 with DM2 without CAD, as diagnosed by cineangiography, were studied. They were of both genders, aged 40-80 yrs. Plasma was incubated for 1h at 37oC with a donor nanoemulsion labeled with 3H -cholesteryl-esters and14C -phospholipids or with 14C-free-cholesterol and 3H -triglycerides. Radioactive lipids transferred from the donor nanoemulsion to HDL were measured in the supernatant after chemical precipitation of non-HDL fractions and the nanoemulsion. Results are % of the total radioactivity of each lipid in HDL. Results In DM2-CAD, LDL-cholesterol and triglycerides were higher than in DM2; HDL-cholesterol was lower. Compared to DM2, DM2-CAD showed diminished transfer to HDL of free-cholesterol (DM2-CAD=4.23±0.24; DM2= 5.66±0.14, p<0.0001) and of triglycerides (1.65±0.13 vs 3.08±0.11, p<0.0001), whereas cholesteryl-ester transfer was increased (3.67±0.16 vs 2.25±0.13, p<0.0001); phospholipid transfer was equal (15.37±0.60 vs15.18±0.20, p=0.76). CETP concentration was equal, while plasma free-cholesterol was higher in DM2-CAD (DM2-CAD=36.9±0.9; DM2=33.1±0.7, p=0.003).HDL particle diameter was equal in both groups. Conclusion The reduction of free-cholesterol transfer to HDL may hinder cholesterol esterification and reverse cholesterol transport. Alterations in triglyceride and cholesteryl-ester transfer may affect lipoprotein stability. Those disturbances in HDL metabolism may facilitate CAD development in DM2. ACC Oral Contributions McCormick Place South, S100c Sunday, March 25, 2012, 9:04 a.m.-9:17 a.m. Session Title: Prevention: Focus on Lipids Abstract Category: 9. Prevention: Clinical Presentation Number: 911-8conferenceObject PERFORMANCE OF LEFT VENTRICULAR EJECTION FRACTION ON PATIENTS WITH STABLE MULTIVESSEL CORONARY DISEASE SUBMITTED TO MEDICINE, ANGIOPLASTY OR SURGERY: 10 YEARS FOLLOW-UPFROM MASS II TRIAL(2012) GARZILLO, Cibele L.; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; FAVARATO, Desiderio; SOARES, Paulo; HUEB, Alexandre Ciappina; STOLF, Noedir A. G.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are assumed as effective therapeutic options for the protection of the ischemic myocardium. However, it is not established if those procedures are effective for left ventricular ejection fraction (LVEF) preservation. In this setting, we evaluated the evolution of LVEF in patients with stable multivessel coronary disease, submitted to CABG, PCI or medical treatment (MT) alone, after ten years of follow-up. Methods Echocardiography was performed on patients participants of MASS II trial, previously to randomization for CABG, PCI or MT, and after 10 years. LVEF was measured by the biplane method (Simpson), when regional wall-motion abnormalities were present, or by the Teichholz method. Results After a follow-up of 10.32 (±1.43) years, 350 patients had LVEF reassessed: 108 patients on MT, 111 on CABG and 131 on PCI group. Main baseline characteristics and the occurrence of AMI were similar among the three groups. There was no difference of LVEF either at the beginning (0.61 + 0.07, 0.61 + 0.08 e 0.61 + 0.09 respectively for PCI, CABG and MT, p=0.675) and the end of follow up (0.56 + 0.11, 0.55 + 0.11 e 0.55 + 0.12 respectively for PCI, CABG and MT, p=0.675). The impact of other variables over LVEF evolution, such as gender, age, diabetes and arterial pattern, were also analyzed, and no relevance was demonstrated. However, the presence of previous AMI (OR 2.50, 95% CI 1.40-4.45; p= 0.0007) and the occurrence of AMI during follow up (OR 2.73, 95% IC 1.25-5.92; p=0.005) were associated with an increased risk of developing LVEF < 45%. Also, AMI during follow-up was responsible for a greater reduction of LVEF (reduction delta of 18.29 ± 21.22% and 6.63 ± 18.91%, respectively for patients with and without AMI, p=0.001). Conclusion Thus, compared with PCI or CABG patients, patients in the medical group with unprotected coronary artery disease by mechanical revascularization without adverse cardiac events showed no differences in the left ventricular function after 10 years of follow up. Moreover, whatever of interventional therapeutic strategies applied, the left ventricular function remained unchanged in absence of MACE. ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m. Session Title: Fresh CABG: Good for SIHD? Abstract Category: 3. Chronic CAD/Stable Ischemic Heart Disease: Therapy Presentation Number: 1208-410conferenceObject CORONARY ARTERY BYPASS GRAFT SURGERY OUTCOMES IN PATIENTS WITH AND WITHOUTCOVID-19 DURING THE PANDEMIC FIRST WAVE(2023) MATUCK, Bruna Scarpa; PINESI, Henrique; MARTINS, Eduardo; GARZILLO, Cibele Larrosa; LOTTENBERG, Marcos Pita; LIMA, Joao A. C.; SEGRE, Alexandre; FAVARATO, Desiderio; LIMA, Eduardo Gomes; RACHED, Fabiana Hanna; PITTA, Fabio Grunspun; LISBOA, Luiz Augusto; JATENE, Fabio Biscegli; KALIL-FILHO, Roberto; SERRANO JR., Carlos V.- VARIABILITY IN GLYCATED HEMOGLOBIN VALUES AND CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES AND MULTIVESSEL CORONARY ARTERY DISEASE(2019) REZENDE, Paulo; HUEB, Whady; HLATKY, Mark; GARCIA, Rosa; GARZILLO, Cibele; SCUDELER, Thiago; BOROS, Gustavo Andre Boeing; RIBAS, Fernando Faglioni; DALLAZEN, Anderson Roberto; FAVARATO, Desiderio; RAMIRES, Jose; KALIL-FILHO, Roberto
conferenceObject RED WINE REMODELS GUT MICROBIOTA INDEPENDENTLY OF TRIMETHYLAMINE N-OXIDE LEVELS(2022) HAAS, Elisa; SAAD, Mario J.; SANTOS, Andrey; VITULO, Nicola; LEMOS JR., Wilson; MARTINS, Aline; PICOSSI, Carolina R.; FAVARATO, Desiderio; LIBBY, Peter; LAURINDO, Francisco; LUZ, Protasio Lemos DaconferenceObject THE TRIGLYCERIDE/HDL RATIO REMAINS AS AN INDEPENDENT PLASMA LIPID MARKER OF MAJOR CARDIOVASCULAR EVENTS IN DIABETIC PATIENTS 10-YEAR FOLLOW-UP FROM THE MEDICINE ANGIOPLASTY OR SURGERY STUDY II (MASS II) TRIAL(2012) CASELLA-FILHO, Antonio; HUEB, Whady; JONKE, Vivian; SANTOS, Raul; FAVARATO, Desiderio; LIMA, Eduardo; SEGRE, Alexandre; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; CHACRA, Ana P. M.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground: The second Medical, Angioplasty, or Surgery Study (MASS II) compared the long-term effects of medical treatment (MT), angioplasty (PCI), or surgical strategies (CABG) among patients with stable angina symptoms of multivessel coronary artery disease (CAD) and preserved ventricular function who were appropriate candidates for all 3 therapies. Plasma lipids are important risk factors for cardiovascular events in CAD patients, especially in diabetics. We showed previously that the TG/HDL ratio was the only parameter independently associated with major cardiovascular events (MACE; overall death, myocardial infarction, and unstable angina that required myocardial revascularization) in patients after the 10-year follow up of stable CAD patients in the MASS II. In this analysis we evaluated the association of plasma lipids with MACE in diabetic patients after a 10-year follow-up of the MASS II. Methods: The data of 200 patients of the MASS II, 100 diabetics and 100 non diabetics, were analyzed for risk factors and plasma lipids levels. The levels of fasting plasma lipids were determined at baseline and 6 months after randomization. It was instituted in all study patient groups the same lipid therapy. Concentrations of total cholesterol, HDL, non-HDL and LDL-cholesterol as well as LDL/HDL, and TG/HDL ratios were divided according to distribution quartiles. The association of plasma lipids at baseline and at 6 months with MACE was determined by Cox regression models. Results: The patients were followed up for an average of 11.4 years. In the subgroup of diabetic patients, after adjustment for confounders, older age (> 65 years old), randomized treatment for CAD (CABG vs. MT) and the TG/HDL ratio determined at 6 months were independently associated with MACE. There was no association between MACE and other plasma lipids. Conclusions: The TG/HDL remains as a lipid parameter independently associated with MACE in diabetic patients after the 10-year follow up of stable CAD patients in the MASS II.conferenceObject HIGH SENSITIVITY CARDIAC TROPONIN I AS A DIAGNOSTIC TOOL FOR THE PRESENCE OF CORONARY ARTERY DISEASE IN STABLE DIABETIC PATIENTS(2014) SEGRE, Alexandre; HUEB, Whady; SPRANDEL, Marilia O.; CASELLA-FILHO, Antonio; FAVARATO, Desiderio; STRUNZ, Celia; VENTURA, Laura; CARVALHO, Ana; MARANHAO, Raul C.; RAMIRES, Jose; KALIL-FILHO, Roberto