MUCIO TAVARES DE OLIVEIRA JUNIOR
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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject The journey of patients with Chagas cardiomyopathy during episodes of descompensated heart failure(2018) ISSA, V. S.; GOMES, C.; TERHOCH, C. B.; MOREIRA, H. F.; PAES, T. M.; PADUA, V. P.; LAGE, S. G.; OLIVEIRA, M. T.; BOCCHI, E. A.- Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy(2018) GOMES, Clara; TERHOCH, Caique Bueno; AYUB-FERREIRA, Silvia Moreira; CONCEICAO-SOUZA, Germano Emilio; SALEMI, Vera Maria Cury; CHIZZOLA, Paulo Roberto; JR, Mucio Tavares Oliveira; LAGE, Silvia Helena Gelas; FRIOES, Fernando; BOCCHI, Edimar Alcides; ISSA, Victor SarliObjectives The prognostic significance of transient use of inotropes has been sufficiently studied in recent heart failure (HF) populations. We hypothesised that risk stratification in these patients could contribute to patient selection for advanced therapies. Methods We analysed a prospective cohort of adult patients admitted with decompensated HF and ejection fraction (left ventricular ejection fraction (LVEF)) less than 50%. We explored the outcomes of patients requiring inotropic therapy during hospital admission and after discharge. Results The study included 737 patients, (64.0% male), with a median age of 58 years (IQR 48-66 years). Main aetiologies were dilated cardiomyopathy in 273 (37.0%) patients, ischaemic heart disease in 195 (26.5%) patients and Chagas disease in 163 (22.1%) patients. Median LVEF was 26 % (IQR 22%-35%). Inotropes were used in 518 (70.3%) patients. In 431 (83.2%) patients, a single inotrope was administered. Inotropic therapy was associated with higher risk of in-hospital death/urgent heart transplant (OR=10.628, 95% CI 5.055 to 22.344, p<0.001). At 180-day follow-up, of the 431 patients discharged home, 39 (9.0%) died, 21 (4.9%) underwent transplantation and 183 (42.4%) were readmitted. Inotropes were not associated with outcome (death, transplant and rehospitalisation) after discharge. Conclusions Inotropic drugs are still widely used in patients with advanced decompensated HF and are associated with a worse in-hospital prognosis. In contrast with previous results, intermittent use of inotropes during hospitalisation did not determine a worse prognosis at 180-day follow-up. These data may add to prognostic evaluation in patients with advanced HF in centres where mechanical circulatory support is not broadly available.
- Upper vena cava syndrome secondary to giant atrial myxoma(2018) LONGATTO, Flavia Contreira; SANTOS, Thamires Suellen Alves Pereira; SOARES, Marilia Joaquina de Medeiros; NEGRISOLI, Juliana; LEAL, Tatiana de Carvalho Andreucci Torres; BISELLI, Bruno; OLIVEIRA JR., Mucio Tavares; SOEIRO, Alexandre de MatosCardiac myxoma is a benign neoplasm, which corresponds to the most common primary heart tumour, responsible for about 50% of the cases. In general, 75-80% of myxomas are located in the left atrium, 18% in the right atrium, and more rarely in the ventricles or multicentric. Right atrial myxoma, in particular, can obstruct the tricuspid valve, causing symptoms of right heart failure, peripheral oedema, hepatic congestion, and syncope. Systemic embolization occurs in 30% of cases, by either tumour fragmentation or total tumour detachment. In the present report, we present a case of a symptomatic patient, who showed a large right intra-atrial lesion, with consequent superior vena cava syndrome, and then underwent surgical resection at admission.
- 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, FulvioBACKGROUND: 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.
bookPart Abordagem de dor torácica na emergência(2018) SOEIRO, Alexandre de Matos; REIS, Patrícia Feitosa Frota dos; MATTOS, Fernando Ramos de; PEDROTTI, Carlos Henrique Sartorato; JúNIOR, Múcio Tavares de OliveirabookPart Abordagem de dor torácica na emergência(2018) SOEIRO, Alexandre de Matos; REIS, Patricia Feitosa Frota dos; MATTOS, Fernando Ramos de; PEDROTTI, Carlos Henrique Sartorato; OLIVEIRA JR., Múcio Tavares debookPart Manejo e desmame de inotrópicos(2018) GUALANDRO, Danielle Menosi; SEGURO, Luis Fernando Bernal da Costa; OLIVEIRA JR., Múcio Tavares deconferenceObject 18F-FDG PET/CT Findings vs. Histology of Surgically Resected Cardiac Valves in Patients With Infective Endocarditis.(2018) CAMARGO, Raphael A.; CASTELLI, Jussara B.; BITTENCOURT, Marcio S.; AYABE, Daniel; PAIXAO, Milena R.; FELICIO, Marilia F.; SOEIRO, Alexandre M.; GONCALVES, Luis Fernando T.; V, Tania Strabelli; SOARES JR., Jose; BUCHPIGUEL, Carlos A.; MANSUR, Alfredo J.; TARASOUTCHI, Flavio; OLIVEIRA JR., Mucio T.; MENEGHETTI, Claudio; GUALANDRO, Daniele M.; POCEBON, Lucas; BLANKSTEIN, Ron; ALAVI, Abass; SICILIANO, Rinaldo F.bookPart Insuficiência cardíaca sistólica descompensada(2018) FERNANDES, Felipe Lourenço; AZEVEDO FILHO, Antônio Fernando Barros de; LIMA, Pedro Yuri Paiva; JúNIOR, Múcio Tavares de OliveiraconferenceObject Training, Simulation and Validation of Therapeutic Hypothermia as an Adjuvant Treatment in St Segment Elevation Myocardial Infarction(2018) DALLAN, Luis Augusto; RIBEIRO, Marcelo; GIANNETTI, Natali; ROCHITTE, Carlos; NOMURA, Cesar H.; HAJJAR, Ludhmila A.; BERNOCHE, Claudia Y.; LAGE, Silvia G.; NICOLAU, Jose Carlos; OLIVEIRA, Mucio T.; POLASTRI, Thatiane F.; RIBEIRO, Expedito E.; KALIL FILHO, Roberto; LEMOS NETO, Pedro A.; TIMERMAN, Sergio