CARLOS VIANA POYARES JARDIM
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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- Disfunção ventricular esquerda em pacientes com suspeita de hipertensão arterial pulmonar(2014) GAVILANES, Francisca; ALVES JR., Jose Leonidas; FERNANDES, Caio; PRADA, Luis Felipe Lopes; JARDIM, Carlos Viana Poyares; MORINAGA, Luciana Tamie Kato; DIAS, Bruno Arantes; HOETTE, Susana; SOUZA, RogerioObjective: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). Methods: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism between 2008 and 2013 at our facility. Results: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3% and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). Conclusions: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.
- Schistosomiasis and pulmonary hypertension(2011) DOS, Caio Julio Cesar; FERNANDES, Santos; JARDIM, Carlos Viana Poyares; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana Kato; SOUZA, RogerioExpert Rev. Respir. Med. 5(5), 675-681 (2011) Schistosomiasis is one of the most prevalent chronic infectious diseases in the world. One of its most severe complications, pulmonary hypertension, occurs in up to 5% of patients with hepatosplenic schistosomiasis. The prevalence of schistosomiasis is so overwhelming that schistosomiasis-associated pulmonary hypertension (Sch-PH) may be the most prevalent cause of pulmonary hypertension around the world. Multiple pathways have been described as potential mechanisms of disease in Sch-PH, such as egg embolism, inflammatory disease or pulmonary blood overflow. The possible physiopathological mechanisms will be discussed in this article, as well the disease's clinical course and response to the treatment available.
- Use of medical therapies before pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients with severe hemodynamic impairment(2020) CASTRO, Marcela Araujo; PILOTO, Bruna; FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos; SALIBE FILHO, William; OLEAS, Francisca Gavilanes; ALVES, Jose Leonidas; MORINAGA, Luciana Tamie Kato; HOETTE, Susana; TERRA FILHO, Mario; FREITAS FILHO, Orival; JATENE, Fabio Biscegli; SOUZA, RogerioChronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, characterized by non-resolving fibro-thrombotic obstructions of large pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for the disease, significantly improving survival. Patients with worse hemodynamic profile have worse prognosis after surgery, raising the question of whether the use of medical therapy prior to surgery to optimize hemodynamics could improve outcomes. The aim of this study was to evaluate the role of medical therapy pre-PEA, according to the hemodynamic profile at the diagnosis. We retrospectively analyzed all patients submitted to PEA, from January 2013 to December 2017. Functional, clinical and hemodynamic data were collected to evaluate the main prognostic determinants. Patients were stratified according to the hemodynamic severity and use of targeted therapies prior to surgery. A total of 108 patients were included. Thirty-five patients (32,4%) used targeted therapy pre-PEA. The use of medical therapy delayed the surgical procedure by about 7 months. There was no difference in overall survival between patients that received targeted therapy and those treated only with supportive therapy (87.8% vs 80.3%, respectively, p = 0.426). Nevertheless, when analyzing the group of patients with severe hemodynamic impairment, defined by low cardiac output(< 3.7L/min) at baseline, patients treated with targeted therapies presented a significantly better one-year survival. In higher-risk CTEPH patients, characterized by the presence of low cardiac output, the use of targeted therapies prior to PEA was associated with better outcome, suggesting a potential role for pre-operative use of medical treatment in this particular subgroup.
- Outcomes and prognostic factors of decompensated pulmonary hypertension in the intensive care unit(2021) GARCIA, Marcos Vinicius Fernandes; SOUZA, Rogerio; COSTA, Eduardo Leite Vieira; FERNANDES, Caio Julio Cesar Santos; JARDIM, Carlos Viana Poyares; CARUSO, PedroBackground: Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay. Methods: Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality. Results: 73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU. Conclusions: High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%.
- Quality of life as a prognostic marker in pulmonary arterial hypertension(2014) FERNANDES, Caio J. C. S.; MARTINS, Barbara C. S.; JARDIM, Carlos V. P.; CICONELLI, Rozana M.; MORINAGA, Luciana K.; BREDA, Ana Paula; HOETTE, Susana; SOUZA, RogerioBackground: Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment. Methods: Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months. Results: After treatment, the patients demonstrated an improved 6MWT (414 +/- 124 m vs. 440 +/- 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores. Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58). Conclusions: Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.
bookPart Biomarkers in Pulmonary Arterial Hypertension(2012) SOUZA, Rogerio; HOETTE, Susana; DIAS, Bruno; JARDIM, CarlosTogether with the improvement of pulmonary arterial hypertension (PAH) management arises the need for adequate surrogate markers for treatment decision and follow-up. In this setting, biomarkers play a definitive role. A number of biomarkers addressing specific features of the different pathophysiological mechanisms of PAH, with the ability to describe disease severity and prognosis, have been described. This chapter reviews the characteristics of the different existing biomarkers as the rationale for their integration as the next step for the evaluation of PAH patients. Copyright (C) 2012 S. Karger AG, Basel- Loss of response to calcium channel blockers after long-term follow up in idiopathic pulmonary arterial hypertension(2020) PILOTO, Bruna; FERNANDES, Caio; JARDIM, Carlos; CASTRO, Marcela; SALIBE-FILHO, William; ALVES-JR, Jose Leonidas; MORINAGA, Luciana; SOBRAL-ALVES, Juliana; HOETTE, Susana; TERRA-FILHO, Mario; SOUZA, Rogerio
- New steps for the international consolidation of the Brazilian Journal of Pulmonology(2014) CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes; JARDIM, Carlos Viana Poyares; CARUSO, Pedro; SOUZA, Rogerio
conferenceObject Cavities Lesions In Patients With Chronic Thromboembolic Pulmonary Hypertention(2017) OLIVEIRA, E. P.; FERNANDES, C. C.; OLEAS, F. G.; ALVES JUNIOR, J. L.; ATHANAZIO, R. A.; SALES, R. K. B.; MORAIS, I. O.; SALIBE FILHO, W.; JARDIM, C. V. P.; TERRA FILHO, M.; SOUZA, R.- Immunopathological aspects of schistosomiasis-associated pulmonary arterial hypertension(2014) MAUAD, Thais; POZZAN, Geanette; LANCAS, Tatiana; OVERBEEK, Maria J.; SOUZA, Rogerio; JARDIM, Carlos; DOLHNIKOFF, Marisa; MELLO, George; PIRES-NETO, Ruy Camargo; BERNARDI, Fabiola del Carlo; GRUNBERG, KatrienObjectives: Pulmonary hypertension is a lethal complication of chronic hepatosplenic schistosomiasis. Little is known of the underlying (immuno-)histopathological characteristics of lung vasculopathy. Methods: We characterized vasculopathy and inflammation in lung tissue of 10 patients with Schistosomiasis-associated PH (SCH-PH) in comparison to 22 idiopathic pulmonary arterial hypertension (IPAH) patients and 10 normal controls. SCH-PH cases were younger than controls. Results: Plexiform lesions and/or angiomatoid lesions were found in 10/10 SCH-PH, and 19/22 IPAH patients (chi(2) p = 0.22). Lung granulomas with Schistosoma eggs were found in 2/10 of SCH-PH cases. PAH cases had increased peri-arterial density of CD3+ T cells, chymase+ and tryptase+ mast cells when compared to controls (p <= 0.047). SCH-PH showed increased density of CD4+ cells when compared to controls (p = 0.025), paralleled by an increased density of dendritic CD83+ cells when compared to both controls and IPAH patients (p <= 0.022). Conclusion: Both SCH-PH and IPAH feature plexogenic arteriopathy and increased periarterial T cell and mast cell density. SCH-PH and IPAH differ only with respect to the density of dendritic CD83+ cells. These findings imply ongoing antigenic stimulation in SCH-PH, yet a pattern of pulmonary vasculopathy similar to IPAH, suggestive of a final common pathway in their pathogenesis of PAH.