MUCIO TAVARES DE OLIVEIRA JUNIOR

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  • article 171 Citação(ões) na Scopus
    Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes The ADvISED Prospective Multicenter Study
    (2018) NAZERIAN, Peiman; MUELLER, Christian; SOEIRO, Alexandre de Matos; LEIDEL, Bernd A.; SALVADEO, Sibilla Anna Teresa; GIACHINO, Francesca; VANNI, Simone; GRIMM, Karin; OLIVEIRA, Mucio Tavares; PIVETTA, Emanuele; LUPIA, Enrico; GRIFONI, Stefano; MORELLO, Fulvio
    BACKGROUND: Acute aortic syndromes (AASs) are rare and severe cardiovascular emergencies with unspecific symptoms. For AASs, both misdiagnosis and overtesting are key concerns, and standardized diagnostic strategies may help physicians to balance these risks. D-dimer (DD) is highly sensitive for AAS but is inadequate as a stand-alone test. Integration of pretest probability assessment with DD testing is feasible, but the safety and efficiency of such a diagnostic strategy are currently unknown. METHODS: In a multicenter prospective observational study involving 6 hospitals in 4 countries from 2014 to 2016, consecutive outpatients were eligible if they had >= 1 of the following: chest/abdominal/back pain, syncope, perfusion deficit, and if AAS was in the differential diagnosis. The tool for pretest probability assessment was the aortic dissection detection risk score (ADD-RS, 0-3) per current guidelines. DD was considered negative (DD-) if < 500 ng/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery, or 14-day follow-up. Outcomes were the failure rate and efficiency of a diagnostic strategy for ruling out AAS in patients with ADD-RS=0/DD-or ADD-RS = 1/DD-. RESULTS: A total of 1850 patients were analyzed. Of these, 438 patients (24%) had ADD-RS=0, 1071 patients (58%) had ADD-RS=1, and 341 patients (18%) had ADD-RS > 1. Two hundred forty-one patients (13%) had AAS: 125 had type A aortic dissection, 53 had type B aortic dissection, 35 had intramural aortic hematoma, 18 had aortic rupture, and 10 had penetrating aortic ulcer. A positive DD test result had an overall sensitivity of 96.7% (95% confidence interval [CI], 93.6-98.6) and a specificity of 64% (95% CI, 61.6-66.4) for the diagnosis of AAS; 8 patients with AAS had DD-. In 294 patients with ADD-RS=0/DD-, 1 case of AAS was observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1.9) and an efficiency of 15.9% (95% CI, 14.3-17.6) for the ADD-RS=0/DD-strategy. In 924 patients with ADD-RS <= 1/DD-, 3 cases of AAS were observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1) and an efficiency of 49.9% (95% CI, 47.7-52.2) for the ADD-RS <= 1/DD-strategy. CONCLUSIONS: Integration of ADD-RS (either ADD-RS=0 or ADD-RS = 1) with DD may be considered to standardize diagnostic rule out of AAS.
  • article 4 Citação(ões) na Scopus
    Effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life among patients with acute heart failure
    (2021) BELKIN, Maria; WUSSLER, Desiree; GUALANDRO, Danielle Menosi; SHRESTHA, Samyut; STREBEL, Ivo; GOUDEV, Assen; MAEDER, Micha T.; WALTER, Joan; FLORES, Dayana; KOZHUHAROV, Nikola; LOPEZ-AYALA, Pedro; DANIER, Isabelle; OLIVEIRA JUNIOR, Mucio Tavares de; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; ERNE, Paul; MUENZEL, Thomas; MUELLER, Christian
    Aims We aimed to assess the long-term effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life (HRQL) among patients with acute heart failure (AHF). Methods and results Health-related quality of life was prospectively assessed by the generic 3-levelled EQ-5D and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) among adult AHF patients enrolled in an international, multicentre, randomised, open-label blinded-end-point trial of a strategy that emphasized early intensive and sustained vasodilation using maximally tolerated doses of established oral and transdermal vasodilators according to systolic blood pressure. Changes in EQ-5D and KCCQ from admission to 180 day follow-up were individually compared between the intensive vasodilatation and the usual care group. Among 666 patients eligible for 180 day follow-up, 284 (43%, median age 79 years, 35% women) and 198 (30%, median age 77 years, 35% women) had completed the EQ-5D and KCCQ at baseline and follow-up, respectively. There was a significant improvement in HRQL as quantified by both, EQ-5D and KCCQ, from hospitalization to 180 day follow-up, with no significant differences in the change of HRQL between both treatment strategies. For instance, 39 (26%) versus 33 (25%) patients had an improvement by at least one level in at least two categories in the EQ-5D. Median increase in KCCQ overall summary score (KCCQ-OSS) was 17.6 (IQR 2.0-42.6) in the intervention group versus 18.5 (IQR 3.9-39.3) in the usual care group (P < 0.001 vs. baseline, P = 0.945 between groups). Conclusions Among patients with AHF, long-term HRQL quantified by EQ-5D and KCCQ improved substantially, with overall no significant differences between a strategy of comprehensive vasodilation versus usual care.
  • article 18 Citação(ões) na Scopus
    Prediction of mortality using quantification of renal function in acute heart failure
    (2015) WEIDMANN, Zoraida Moreno; BREIDTHARDT, Tobias; TWERENBOLD, Raphael; ZUESLI, Christina; NOWAK, Albina; ECKARDSTEIN, Arnold von; ERNE, Paul; RENTSCH, Katharina; OLIVEIRA JR., Mucio T. de; GUALANDRO, Danielle; MAEDER, Micha T.; GIMENEZ, Maria Rubini; PERSHYNA, Kateryna; STALLONE, Fabio; HAAS, Laurent; JAEGER, Cedric; WILDI, Karin; PUELACHER, Christian; HONEGGER, Ursina; WAGENER, Max; WITTMER, Severin; SCHUMACHER, Carmela; KRIVOSHEI, Lian; HILLINGER, Petra; OSSWALD, Stefan; MUELLER, Christian
    Background: Renal function, as quantified by the estimated glomerular filtration rate (eGFR), is a predictor of death in acute heart failure (AHF). It is unknown whether one of the clinically-available serum creatinine-based formulas to calculate eGFR is superior to the others for predicting mortality. Methods and results: We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patients < 70 years, and BIS-1 in patients >= 70 years) in 1104 unselected AHF patients presenting to the emergency department and enrolled in a multicenter study. Two independent cardiologists adjudicated the diagnosis of AHF. The primary endpoint was the accuracy of the five eGFR equations to predict death as quantified by the time-dependent area under the receiver-operating characteristics curve (AUC). The secondary endpoint was the accuracy to predict all-cause readmissions and readmissions due to AHF. In a median follow-up of 374-days (IQR: 221 to 687 days), 445 patients (40.3%) died. eGFR as calculated by all equations was an independent predictor of mortality. The Cockcroft-Gault formula showed the highest prognostic accuracy (AUC 0.70 versus 0.65 for MDRD-4, 0.55 for MDRD-6, and 0.67 for the combined formula CKD-EPI/BIS-1, p < 0.05). These findings were confirmed in patients with varying degrees of renal function and in three vulnerable subgroups: women, patients with severe left ventricular dysfunction, and the elderly. The prognostic accuracy for readmission was poor for all equations, with an AUC around 0.5. Conclusions: Calculating eGFR using the Cockcroft-Gault formula assesses the risk of mortality in patients with AHF more accurately than other commonly used formulas.
  • article 1 Citação(ões) na Scopus
    Comprehensive vasodilatation in women with acute heart failure: Novel insights from the GALACTIC randomized controlled trial
    (2023) WUSSLER, Desiree; BELKIN, Maria; MAEDER, Micha T.; WALTER, Joan; SHRESTHA, Samyut; KUPSKA, Karolina; STIERLI, Michelle; FLORES, Dayana; KOZHUHAROV, Nikola; GUALANDRO, Danielle Menosi; OLIVEIRA JUNIOR, Mucio Tavares de; SABTI, Zaid; NOVEANU, Markus; SOCRATES, Thenral; BAYES-GENIS, Antoni; SIONIS, Alessandro; SIMON, Patrick; MICHOU, Eleni; GUJER, Samuel; GORI, Tommaso; WENZEL, Philip; PFISTER, Otmar; ARENJA, Nisha; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; MUENZEL, Thomas; MUELLER, Christian; GALACTIC Investigators
    Aims Sex-specific differences in acute heart failure (AHF) are both relevant and underappreciated. Therefore, it is crucial to evaluate the risk/benefit ratio and the implementation of novel AHF therapies in women and men separately.Methods and results We performed a pre-defined sex-specific analysis in AHF patients randomized to a strategy of early intensive and sustained vasodilatation versus usual care in an international, multicentre, open-label, blinded endpoint trial. Inclusion criteria were AHF with increased plasma concentrations of natriuretic peptides, systolic blood pressure >= 100 mmHg, and plan for treatment in a general ward. Among 781 eligible patients, 288 (37%) were women. Women were older (median 83 vs. 76 years), had a lower body weight (median 64.5 vs. 77.6 kg) and lower estimated glomerular filtration rate (median 48 vs. 54 ml/min/1.73 m(2)). The primary endpoint, a composite of all-cause mortality or rehospitalization for AHF at 180 days, showed a significant interaction of treatment strategy and sex (p for interaction = 0.03; hazard ratio adjusted for female sex 1.62, 95% confidence interval 1.05-2.50; p = 0.03). The combined endpoint occurred in 53 women (38%) in the intervention group and in 35 (24%) in the usual care group. The implementation of rapid up-titration of renin-angiotensin-aldosterone system (RAAS) inhibitors was less successful in women versus men in the overall cohort and in patients with heart failure with reduced ejection fraction (median discharge % target dose in patients randomized to intervention: 50% in women vs. 75% in men).Conclusion Rapid up-titration of RAAS inhibitors was less successfully implemented in women possibly explaining their higher rate of all-cause mortality and rehospitalization for AHF.
  • article 9 Citação(ões) na Scopus
    Incremental value of B-type natriuretic peptide for early risk prediction of infective endocarditis
    (2014) SICILIANO, Rinaldo Focaccia; GUALANDRO, Danielle Menosi; MUELLER, Christian; SEGURO, Luis Fernando Bernal da Costa; GOLDSTEIN, Priscila Gherardi; STRABELLI, Tania Mara Varejao; ARIAS, Vanessa; ACCORSI, Tarso Augusto Duenhas; GRINBERG, Max; MANSUR, Alfredo Jose; OLIVEIRA JR., Mucio Tavares de
    Background: Early and accurate risk prediction is an unmet clinical need in patients with infective endocarditis (IE). The aim of this study was to determine the value of B-type natriuretic peptide (BNP) levels obtained on admission for the prediction of in-hospital death in IE patients. Methods: Between 2009 and 2011, consecutive patients with IE diagnosed using the revised Duke criteria and admitted to the emergency department were evaluated prospectively. BNP levels were measured on admission. Death during hospitalization was the primary endpoint. Results: Among 104 consecutive patients with IE and with available BNP levels, 34 (32.7%) died in hospital. BNP levels were significantly higher in patients who died as compared to survivors (709.0 pg/ml vs. 177.5 pg/ml, p < 0.001). The accuracy of BNP to predict death as quantified by the area under the receiver operating characteristics curve was 0.826 (95% confidence interval (CI) 0.747-0.905). The value of BNP was additive to that provided by clinical, microbiological, and echocardiography assessment. On multivariate analysis, new heart failure (hazard ratio (HR) 2.02, 95% CI 1.15-3.57, p = 0.015), sepsis (HR 2.10, 95% CI 1.25-3.55, p = 0.005), Staphylococcus aureus endocarditis (HR 2.67, 95% CI 1.60-4.45, p < 0.001), left ventricular ejection fraction <= 55% (HR 1.63, 95% CI 1.00-2.65, p = 0.047), and BNP (HR 1.04, 95% CI 1.02-1.06, p < 0.001) were independent predictors of in-hospital mortality. Conclusion: Among patients with IE, BNP levels obtained on admission provide incremental value for early and accurate risk prediction. (C) 2014 The Authors.
  • article 106 Citação(ões) na Scopus
    Indications and practical approach to non-invasive ventilation in acute heart failure
    (2018) MASIP, Josep; PEACOCK, W. Frank; PRICE, Susanna; CULLEN, Louise; MARTIN-SANCHEZ, F. Javier; SEFEROVIC, Petar; MAISEL, Alan S.; MIRO, Oscar; FILIPPATOS, Gerasimos; VRINTS, Christiaan; CHRIST, Michael; COWIE, Martin; PLATZ, Elke; MCMURRAY, John; DISOMMA, Salvatore; ZEYMER, Uwe; BUENO, Hector; GALE, Chris P.; LETTINO, Maddalena; TAVARES, Mucio; RUSCHITZKA, Frank; MEBAZAA, Alexandre; HARJOLA, Veli-Pekka; MUELLER, Christian
    In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.
  • article 11 Citação(ões) na Scopus
    Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability
    (2019) NAZERIAN, Peiman; PIVETTA, Emanuele; VEGLIA, Simona; CAVIGLI, Edoardo; MUELLER, Christian; SOEIRO, Alexandre de Matos; LEIDEL, Bernd A.; LUPIA, Enrico; RUTIGLIANO, Claudia; WUSSLER, Desiree; GRIFONI, Stefano; MORELLO, Fulvio; CAPRETTI, Elisa; CERINI, Gabriele; PALAZZO, Andrea; TRAUSI, Federica; OTTAVIANI, Maddalena; BARON, Paolo; BIMA, Paolo; FASCIO, Paolo; GARABELLO, Domenica; BOEDDINGHAUS, Jasper; NESTELBERGER, Thomas; SOMMER, Gregor; TWERENBOLD, Raphael; BAUERF, Wolfgang; DAMBERGF, Anneke; PORALLAF, Lukas; TAUPITZI, Matthias; JR, Mucio Tavares de Oliveira
    Objectives Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pretest clinical probability is low. However, the diagnostic impact of CR integration for the rule-in and rule-out of AASs is unknown. Methods We performed a secondary analysis of the ADvISED multicenter study. Emergency department outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD-RS). CR was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME) and other signs. Results In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AASs. ADD-RS/ME and ADD-RS/any CR sign (aCRs) integration were more accurate than ADD-RS alone (area under the curve = 0.8 and 0.78 vs. 0.66, p < 0.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI] = 51.5% to 79.9%) and 82.5% (95% CI = 79.9% to 84.8%) for ADD-RS/ME and 68.8% (95% CI = 53.6% to 80.9%) and 76.5% (95% CI = 73.7% to 79.1%) for ADD-RS/aCRs, respectively. The sensitivity and specificity of CR per se were 54.2% (95% CI = 39.2% to 68.6%) and 92.4% (95% CI = 90.5% to 93.9%) for ME and 60.4% (95% CI = 45.3% to 74.2%) and 85.2% (95% CI = 82.9% to 87.4%) for aCRs. The agreement (kappa) between attending physicians and radiologists for ME was 0.44 (95% CI = 0.35 to 0.54). ADD-RS/ME rule-in (ADD-RS <= 1 and ME-present, or ADD-RS > 1) applied to 204 versus 130 patients with ADD-RS > 1, including 14 with AAS and 60 false-positives (FP). ADD-RS/aCRs rule-in (ADD-RS <= 1 and aCRs-present, or ADD-RS > 1) applied to 264 patients, including 15 with AAS and 119 FP. ADD-RS/ME rule-out (ADD-RS <= 1 and ME-absent) applied to 826 (80.2%) patients, including 16 with AAS (33.3% of cases). ADD-RS/aCRs rule-out (ADD-RS <= 1 and aCRs-absent) applied to 766 patients (74.4%), including 15 with AAS (31.3% of cases). Conclusions CR integration with clinical probability assessment showed modest rule-in efficiency and insufficient sensitivity for conclusive rule-out.
  • article 13 Citação(ões) na Scopus
    Biomarkers for prediction of mortality in left-sided infective endocarditis
    (2020) SICILIANO, Rinaldo F.; GUALANDRO, Danielle M.; BITTENCOURT, Marcio Sommer; PAIXAO, Milena; MARCONDES-BRAGA, Fabiana; SOEIRO, Alexandre de Matos; STRUNZ, Celia; PACANARO, Ana Paula; PUELACHER, Christian; TARASOUTCHI, Flavio; SOMMA, Salvatore Di; CARAMELLI, Bruno; OLIVEIRA JUNIOR, Mucio Tavares de; MANSUR, Alfredo Jose; MUELLER, Christian; BARRETTO, Antonio Carlos Pereira; STRABELLI, Tania Mara Varejao
    Background: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis fator a (TNF-a), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P < 0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P = 0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P = 0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P = 0.018), TNF-alpha (OR 1.8; 95%CI 1.1-2.9; P = 0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P = 0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-alpha 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-alpha 0.554, CRP 0.759). Conclusion: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE. (C) 2020 The Authors.
  • article 0 Citação(ões) na Scopus
    In Reply to Association of Procalcitonin Concentrations with Pathogenic Microorganisms
    (2020) WUSSLER, Desiree; KOZHUHAROV, Nikola; OLIVEIRA, Mucio Tavares; BOSSA, Aline; BREIDTHARDT, Tobias; MUELLER, Christian
  • article 92 Citação(ões) na Scopus
    Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure
    (2019) PLATZ, Elke; JHUND, Pardeep S.; GIRERD, Nicolas; PIVETTA, Emanuele; MCMURRAY, John J. V.; PEACOCK, W. Frank; MASIP, Josep; MARTIN-SANCHEZ, Francisco Javier; MIRO, Oscar; PRICE, Susanna; CULLEN, Louise; MAISEL, Alan S.; VRINTS, Christiaan; COWIE, Martin R.; DISOMMA, Salvatore; BUENO, Hector; MEBAZAA, Alexandre; GUALANDRO, Danielle M.; TAVARES, Mucio; METRA, Marco; COATS, Andrew J. S.; RUSCHITZKA, Frank; SEFEROVIC, Petar M.; MUELLER, Christian
    Lung ultrasound is a useful tool for the assessment of patients with both acute and chronic heart failure, but the use of different image acquisition methods, inconsistent reporting of the technique employed and variable quantification of 'B-lines,' have all made it difficult to compare published reports. We therefore need to ensure that future studies utilizing lung ultrasound in the assessment of heart failure adopt a standardized approach to reporting the quantification of pulmonary congestion. Strategies to improve patient care by use of lung ultrasound in the assessment of heart failure have been difficult to develop. In the present document, key aspects of standardization are discussed, including equipment used, number of chest zones assessed, the method of quantifying B-lines, the presence and timing of additional investigations (e.g. natriuretic peptides and echocardiography) and the impact of therapy. This consensus report includes a checklist to provide standardization in the preparation, review and analysis of manuscripts. This will serve as a guide for investigators and clinicians and enhance the quality and transparency of lung ultrasound research.