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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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- Pulmonary hypertension diagnosed by right heart catheterisation in sickle cell disease(2012) FONSECA, G. H. H.; SOUZA, R.; SALEMI, V. M. C.; JARDIM, C. V. P.; GUALANDRO, S. F. M.Recent studies have recognised the importance of pulmonary hypertension (PH) in sickle cell disease (SCD). The aim of this study was to determine the prevalence and prognostic impact of PH and its features in patients with SCD. 80 patients with SCD underwent baseline clinical evaluation, laboratory testing, 6-min walk tests (6MWTs) and echocardiography. Patients with a peak tricuspid regurgitant jet velocity (TRV) of >= 2.5 m.s(-1) were further evaluated through right heart catheterisation (RHC) to assure the diagnosis of PH. Our study evidenced a 40% prevalence of patients with elevated TRV at echocardiography. RHC (performed in 25 out of 32 patients) confirmed PH in 10% (95% CI 3.4-16.5%) of all patients, with a prevalence of post-capillary PH of 6.25% (95% CI 0.95-11.55%) and pre-capillary PH of 3.75% (95% CI -0.4-7.9%). Patients with PH were older, had worse performance in 6MWTs, and more pronounced anaemia, haemolysis and renal dysfunction. Survival was shorter in patients with PH. Our study reinforced the use of echocardiography as a screening tool for PH in SCD and the mandatory role of RHC for proper diagnosis. Our findings confirmed the prognostic significance of PH in SCD as its association to pronounced haemolytic profile.
- Divulgação do fator de impacto do Jornal Brasileiro de Pneumologia: consolidação de um longo e árduo trabalho(2012) CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes; JARDIM, Carlos Viana Poyares; CARUSO, Pedro
bookPart Schistosomiasis and Pulmonary Hypertension(2012) FERNANDES, Caio Julio Cesar; JARDIM, Carlos; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana Kato; SOUZA, RogerioSchistosomiasis is the third leading parasitic disease in the world. It is present in 74 countries, infecting 200 million people. Each year 280,000 patients die because of the disease. One of its most severe complications is pulmonary arterial hypertension (PAH). Previous studies have shown that 5% of patients with hepatosplenic schistosomiasis develop PAH. It is believed today that the most prevalent cause worldwide of PAH is schistosomiasis. Specifics about schistosomiasis-associated PAH including epidemiological data, mechanisms of the disease, clinical and hemodynamic features, and modalities of treatment will be reviewed in this chapter. Copyright (C) 2012 S. Karger AG, Basel- The Role of Target Therapies in Schistosomiasis-Associated Pulmonary Arterial Hypertension(2012) FERNANDES, Caio J. C. S.; DIAS, Bruno A.; JARDIM, Carlos V. P.; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana K.; SOUZA, Silvia; SUESADA, Milena; BREDA, Ana P.; SOUZA, RogerioBackground: Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) may be one of the most prevalent forms of pulmonary arterial hypertension (PAH) worldwide. However, the clinical and hemodynamical response to specific PAH therapy in Sch-PAH is not known. Methods: We retrospectively analyzed the charts of all patients with Sch-PAH who initiated specific PAH treatment between June 2003 and June 2010 in a single PAH reference center in Sao Paulo, Brazil. Clinical and hemodynamical data were retrospectively collected and evaluated in two periods: baseline and posttreatment. Results: The study population consisted of 12 patients with Sch-PAH. They were treated with phosphodiseterase-5 inhibitors (seven patients), endothelin receptor antagonists (four patients), or combination therapy (one patient). Mean treatment period was 34.9 +/- 15.5 months. Patients with Sch-PAH presented significant improvements in terms of functional class, 6-min walk test distance (439 +/- 85 to 492 +/- 79 m, P = .032), cardiac index (2.66 +/- 0.59 to 3.08 +/- 0.68 L/min/m(2), P = .028), and indexed pulmonary vascular resistance (20.7 +/- 11.6 to 15.9 +/- 9 W/m(2), P = .038) with the introduction of specific PAH treatment. Conclusions: We conclude that specific PAH therapy may be of benefit to patients with Sch-PAH, considering clinical, functional, and hemodynamic parameters. CHEST 2012; 141(4):923-928
- Safety and efficacy of sitaxsentan 50 and 100 mg in patients with pulmonary arterial hypertension(2012) SANDOVAL, Julio; TORBICKI, Adam; SOUZA, Rogerio; RAMIREZ, Alicia; KURZYNA, Marcin; JARDIM, Carlos; DIAZ, Carlos Jerjes-Sanchez; TEAL, Simon A.; HWANG, Lie-Ju; PULIDO, TomasObjective: To assess safety and efficacy of sitaxsentan 50 and 100 mg in patients with pulmonary arterial hypertension (PAH). Background: Sitaxsentan is a highly selective endothelin-A receptor antagonist that was recently withdrawn by the manufacturer because of a pattern of idiosyncratic liver injury. Methods: Before sitaxsentan withdrawal, this 18-week double-blind, placebo-controlled study randomized patients with PAH to receive placebo or sitaxsentan 50 or 100 mg once daily. The primary efficacy endpoint was change from baseline in 6-min walk distance (6MWD) at week 18. Changes in World Health Organization (WHO) functional class and time to clinical worsening (TTCW) were secondary endpoints. The primary efficacy analysis was powered for sitaxsentan 100 mg versus placebo. Results: Of 98 randomized patients, 61% were WHO functional class II at baseline. Improvement from baseline to week 18 in 6MWD occurred with sitaxsentan 100 but not 50 mg; a strong placebo effect was observed. At week 18, WHO functional class was improved or maintained in more patients receiving sitaxsentan 100 mg than placebo (P = 0.038); 0% versus 12% of patients deteriorated, respectively. TTCW was not significantly different for 100-mg sitaxsentan patients than placebo (P = 0.090). Adverse events (AEs) occurring more frequently with sitaxsentan (50 or 100 mg) included headache, peripheral edema, dizziness, nausea, extremity pain, and fatigue; most AEs were of mild or moderate severity. Conclusion: Sitaxsentan 100 mg improved functional class but not 6MWD in PAH patients who were mostly WHO functional class II at baseline. No patient receiving sitaxsentan 100 mg experienced clinical worsening; sitaxsentan was well tolerated.