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
34 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 34
- 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.
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
- 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.
- The use of new anticoagulants in CTEPH(2017) GAVILANES, Francisca; ALVES JR., Jose Leonnidas; FERNANDES, Caio J. C.; PRADA, Luis F. L.; SALIBE FILHO, William; TERRA FILHO, Mario; JARDIM, Carlos; SOUZA, Rogerio
- Pulmonary artery enlargement in schistosomiasis associated pulmonary arterial hypertension(2015) HOETTE, Susana; FIGUEIREDO, Claudia; DIAS, Bruno; ALVES- JR., Jose Leonidas; GAVILANES, Francisca; PRADA, Luis Felipe; JASINOWODOLINSKI, Dany; MORINAGA, Luciana Tamie Kato; JARDIM, Carlos; FERNANDES, Caio Julio Cesar; SOUZA, RogerioBackground: Schistosomiasis associated pulmonary arterial hypertension (Sch-PAH) might represent the most prevalent form of PAH worldwide. In Sch-PAH, the presence of aneurismal dilation of the pulmonary artery has been described, although it is still a matter of debate whether on average the pulmonary artery is more enlarged in Sc-PAH than IPAH. Methods: We retrospectively evaluated patients with IPAH (n = 25) and Sch-PAH (n = 22) who underwent computed tomography pulmonary angiogram and right heart catheterization. Results: Sch-PAH patients were older and presented less severe hemodynamic profiles. Main pulmonary artery diameter (MPAD) was greater in Sch-PAH than IPAH (4.5 +/- 1.8 vs 3.7 +/- 1.1 cm, p = 0.018). For the same level of mean pulmonary artery pressure, the MPAD in Sch-PAH was 0.89 cm larger than in IPAH (Covariance model p = 0.02). Conclusion: This study demonstrated that pulmonary artery enlargement is more pronounced in Sch-PAH than IPAH, independently of mean pulmonary artery pressure level, suggesting that this is more likely a feature of Sch-PAH.
- Loss of response to calcium channel blockers after long-term follow-up treatment in patients with idiopathic pulmonary arterial hypertension(2023) PILOTO, Bruna; FERNANDES, Caio Julio Cesar dos Santos; JARDIM, Carlos; CASTRO, Marcela; ALVES- JR., Jose Leonidas; SOUZA, RogerioIdiopathic pulmonary arterial hypertension (PAH) patients with a positive response to acute vasodilator challenge and a clinical response to calcium channel blockers (CCBs) for at least one year are traditionally designated true responders. Nevertheless, little is known about a sustained response to CCBs over longer periods of time. We evaluated the loss of response to CCBs after long-term treatment in a cohort of idiopathic PAH patients previously classified as being true responders. Our data suggest that idiopathic PAH patients can lose clinical response to CCBs even after one year of clinical stability, reinforcing the need for constant multidimensional reevaluation to assess the need for targeted PAH therapies and to classify these patients correctly.
- Update on the Treatment of Pulmonary Arterial Hypertension(2021) FERNANDES, Caio J.; CALDERARO, Daniela; ASSAD, Ana Paula Luppino; SALIBE-FILHO, William; KATO-MORINAGA, Luciana Tamie; HOETTE, Susana; PILOTO, Bruna; CASTRO, Marcela Araujo; LISBOA, Roberta Pontes; SILVA, Taysa Antonia Felix da; MARTINS, Murillo de Araujo; ALVES-JR, Jose L.; JARDIM, Carlos; TERRA-FILHO, Mario; SOUZA, Rogerio deIn the last decades, important advances have been made in the treatment of pulmonary arterial hypertension (PAH), a severe, progressive, incurable, and potentially fatal disease. For an adequate therapy, correct hemodynamic diagnosis and etiology classification are fundamental. Many etiologies - rheumatic disease, portal hypertension, congenital heart diseases, schistosomiasis - require specific measures, in addition to drug therapy for PAH. The specific therapy for PAH is based on medications that act on three pathophysiological pathways - prostacyclin, endothelin, and nitric oxide pathways. These drugs have multiple presentations (oral, intravenous, subcutaneous, and inhaled) and have changed the history of PAH. This review presents an overview of drug therapy strategies and different forms and peculiarities of PAH.
- Prognostic value of predicted 6MWD in PAH(2015) GAVILANES, Francisca; ALVES- JR., Jose Leonidas; PRADA, Luis Felipe; FERNANDES, Caio; VITORIO, Patricia; MORINAGA, Luciana; HOETTE, Susana; JARDIM, Carlos; SOUZA, Rogerio
- Biomarkers and Prognostic Indicators in Pulmonary Arterial Hypertension(2015) JARDIM, Carlos; SOUZA, RogerioOur understanding of the pathophysiology of pulmonary arterial hypertension (PAH) has increased substantially in the past decades. More accurate diagnosis and increased options for treatment have given researchers the opportunity to better explore the response to medical therapy and prognosis. As a result, the use of biomarkers and prognostic indicators for this devastating disease has been widely investigated. Biomarkers and prognostic indicators have also been more frequently incorporated into the design of new clinical trials. This approach has helped the pulmonary hypertension (PH) community step forward in the search for effective treatments for PAH. However, no single biomarker has shown significant superiority in predicting prognosis or patient response and an integrative approach is necessary to understand which combination of markers should be used in each of the clinical scenarios that characterize the management of PAH.