MARCELO EIDI OCHIAI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject The impact of the rapid use of beta-blockers on ventricular remodeling and mortality in end-stage heart failure (the FAST study)(2012) MELO, Domingos B.; BARRETTO, Antonio P.; OCHIAI, Marcelo; CARDOSO, Juliano; OLIVEIRA, Aristea; MELO, Fernando; MORGADO, Paulo; UCHIDA, Augusto; RAMIRES, Jose F.Introduction: The therapy with beta blockers (BB) is fundamental in the treatment of heart failure(HF). However, even though the data documents the benefits of BB, the optimizing of the dosage of this medication during hospitalization has yet to be tested. Objectives: Our objective was to evaluate the safety and effectivity of the rapid usage of BB on patients (pcts) hospitalized for advanced HF. Methods: Ninety-two pcts were studied with advanced HF(NYHA IV) and fraction of ejection (EF) of the left ventricule (LV) 45% were hospitalized for compensation and accompanied after release. The average age was 62.25 years of age with 59 being males. The ptcs were divided into two groups: 46 for treatment (GT) and 46 control (GC). During hospitalization, they were placed randomly for BB rapid usage with an increase of dosage every two days (GT), or every 15 days (GC). The principal result was the occurrence of re-hospitalization or death for various different causes.Utilizing: t from Student, Mann-Whitney, Qui-square, Fisher calculation. Kaplan-Meiyer for survival, with comparison using the test of Log-rank and the “hazard ratio” or the reason of the risks calculated with the Cox model. Results: With the GT group, there was a significant reduction of the diameter of the systolic of the LV in 3 months and 1 year (p<0,001), and remained unaltered among GCs (P=0,337).The final diastolic diameter of the LV presented a significant reduction. (p=0,036) for the GTs, and the GCs did not show any sig. reduction (p=0,250). There was a sig. increase of the LVEF with the GTs (p<0,001) in 3 months, but did not occur with the GCs (P=0,151). The distance covered in the running test of 6 minutes increased sig.(P<0,001) with the GT in relation to the GC. The GT presented the probability of being free of any sig. future hospitalization_greater than the GT (p=0,045). The possibility of survival for the GT was sig. greater than the GC during the period of evaluation (P=0,002) (HR and CI at 95%). Conclusion: Beta blockers rapid optimization dosages during hospitalization of end-stage HF patients is safe and promotes a better ventricular remodeling and lower mortality rate than that observed with a usual treatment schedule.- Haemodynamic effects of aliskiren in decompensated severe heart failure(2012) BRANCALHAO, Euler O.; OCHIAI, Marcelo E.; CARDOSO, Juliano N.; VIEIRA, Kelly R.; PUIG, Raphael N.; LIMA, Marcelo V.; BARRETTO, Antonio P.Aim: The renin-angiotensin-aldosterone system (RAAS) has dual pathways to angiotensin II production; therefore, multiple blockages may be useful in heart failure. In this study, we evaluated the short-term haemodynamic effects of aliskiren, a direct renin inhibitor, in patients with decompensated severe heart failure who were also taking angiotensin-converting enzyme ( ACE) inhibitors. Materials and methods: A total of 16 patients (14 men, two women, mean age: 60.3 years) were enrolled in the study. The inclusion criteria included hospitalisation due to decompensated heart failure, ACE inhibitor use, and an ejection fraction < 40% (mean: 21.9 +/- 6.7%). The exclusion criteria were: creatinine > 2.0 mg/dl, cardiac pacemaker, serum K+ > 5.5 mEq/l, and systolic blood pressure < 70 mmHg. Patients either received 150 mg/d aliskiren for 7 days (aliskiren group, n = 10) or did not receive aliskiren (control group, n = 6). Primary end points were systemic vascular resistance and cardiac index values. Repeated-measures analysis of variance (ANOVA) was used to assess variables before and after intervention. A two-sided p-value < 0.05 was considered statistically significant. Results: Compared to pre-intervention levels, systemic vascular resistance was reduced by 20.4% in aliskiren patients, but it increased by 2.9% in control patients (p = 0.038). The cardiac index was not significantly increased by 19.0% in aliskiren patients, but decreased by 8.4% in control patients (p = 0.127). No differences in the pulmonary capillary or systolic blood pressure values were observed between the groups. Conclusion: Aliskiren use reduced systemic vascular resistance in patients with decompensated heart failure taking ACE inhibitors.
conferenceObject Prognosis in advanced heart failure is related to betablocker doses(2013) BARRETTO, A. C. Pereira; MELO, D. S. B.; CARLO, C. H. Del; CARDOSO, J. N.; OCHIA, M. E.; MORGADO, P. C.; MUNHOZ, R. T.- The use of peripherally inserted central catheter reduced the incidence of phlebitis in heart failure patients: A randomized trial(2023) SILVA, Eunice Vieira Cavalcante; OCHIAI, Marcelo Eidi; VIEIRA, Kelly Regina Novaes; BARRETTO, Antonio Carlos PereiraBackground: During decompensated heart failure, the use of intravenous inotropes can be necessary. With peripheral venous access, prolonged inotrope infusion can cause phlebitis. However, traditional central venous catheters have possible complications. Peripherally inserted central catheters (PICCs) may be an alternative to traditional catheters. Aim: Our objective was to compare the incidence of phlebitis between patients with PICC and those with peripheral venous access catheter indwelling. Methods: In a randomized clinical trial, the patients were randomized to PICC and control groups, with 40 patients in each group. The inclusion criteria were hospitalized patients with advanced heart failure, ejection fraction of <0.45, and platelet count of >50,000/mm(3) and current use of continuous intravenous infusion of dobutamine. The patients were randomly assigned to receive a PICC or keep their peripheral venous access. The primary end point was the occurrence of phlebitis. Results: The PICC and control groups included 40 patients each. The median age was 61.5 years; ejection fraction, 0.24; and dobutamine dose, 7.73 mu g/(kg min). Phlebitis occurred in 1 patient (2.5%) in the PICC group and in 38 patients (95.0%) in the control group, with an odds ratio of 0.10% (95% confidence interval: 0.01%-1.60%, p < 0.001). Conclusion: In conclusion, in severe heart failure patients who received intravenous dobutamine, PICC use reduced the incidence of phlebitis when compared to patients with peripheral venous access. Therefore, the PICC use should considered over peripheral venous access for prolonged intravenous therapy in heart failure patients.
- Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial(2014) OCHIAI, Marcelo E.; BRANCALHAO, Euler C. O.; PUIG, Raphael S. N.; VIEIRA, Kelly R. N.; CARDOSO, Juliano N.; OLIVEIRA- JR., Mucio Tavares de; BARRETTO, Antonio C. P.OBJECTIVE: We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure. METHODS: We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction,<0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov:NCT01857999. RESULTS: We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg. min, indexed systemic vascular resistance 1918.0 dynes. sec/cm(5).m(2), cardiac index 2.8 L/min.m(2), and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, 49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements. CONCLUSION: Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.
- Diuretic titration based on weight change in decompensated congestive heart failure: A randomized trial(2013) CARDOSO, J. N.; OCHIAI, M. E.; OLIVEIRA, M. T.; REIS, C. M.; CURIATI, M.; VIEIRA, K. R.; BARRETTO, A. C. P.
conferenceObject Non-Invasive Hemodynamic Measurements for Acute Decompensated Heart Failure(2012) OCHIAI, Marcelo E.; LIMA, Marcelo V.; BRANCALHAO, Euler O.; PUIG, Raphael S.; VIERA, Kelly N.; CARDOSO, Juliano N.; BARRETTO, Antonio R.Background: Hemodynamic invasive monitoring has been proved without benefit in management of decompesated heart failure. However non-invasive hemodynamic modelflow method has not been assessed in management of decompesated severe heart failure. The objective of this study was to compare the non-invasive modelflow method of hemodynamic monitoring with the thermodilution pulmonary artery catheter method in hospitalized patients by decompensated severe heart failure. Methods: Hospitalized patients for acute decompensated heart failure were included. The patients had ejection fraction < 0.45, in use of inotropes for low cardiac output and underwent to invasive pulmonary artery catheterization to hemodynamic measurement. Simultaneously non-invasive modelflow method hemodynamic (Nexfin™, Bmeye) was done for each patient. For same patient hemodynamic measurements in different day were considered separate. The data were analyzed by Bland-Altman agreement method and correlation Pearson or Spearman method. P < 0.05 was significant. Results: Twenty eight patients were included and 47 simultaneous hemodynamic measurements were done. For cardiac index, the correlation coefficient was 0.281 (P=0.05) and for indexed systemic vascular resistance was 0.104 (P=0.48). the Bland-Altman plot show the agreement between the methods. Conclusion: In decompensated severe heart failure with current use of inotropes non-invasive hemodynamic modelflow method measurement was in agreement with invasive measurement. The non-invasive modelflow method could be useful for heart failure management.- Variação Temporal no Prognóstico e Tratamento da Insuficiência Cardíaca Avançada - Antes e Após 2000(2014) CARLO, Carlos Henrique Del; CARDOSO, Juliano Novaes; OCHIA, Marcelo Eidi; OLIVEIRA JR., Mucio Tavares de; RAMIRES, José Antonio Franchini; PEREIRA-BARRETTO, Antonio CarlosBackground: The treatment of heart failure has evolved in recent decades suggesting that survival is increasing. Objective: To verify whether there has been improvement in the survival of patients with advanced heart failure. Methods: We retrospectively compared the treatment and follow-up data from two cohorts of patients with systolic heart failure admitted for compensation up to 2000 (n = 353) and after 2000 (n = 279). We analyzed in-hospital death, re-hospitalization and death in 1 year of follow-up. We used Mann-Whitney U test and chi-square test for comparison between groups. The predictors of mortality were identified by regression analysis through Cox proportional hazards model and survival analysis by the Kaplan-Meier survival analysis. Results: The patients admitted until 2000 were younger, had lower left ventricular impairment and received a lower proportion of beta-blockers at discharge. The survival of patients hospitalized before 2000 was lower than those hospitalized after 2000 (40.1% vs. 67.4%; p<0.001). The independent predictors of mortality in the regression analysis were: Chagas disease (hazard ratio: 1.9; 95% confidence interval: 1.3-3.0), angiotensin-converting-enzyme inhibitors (hazard ratio: 0.6; 95% confidence interval: 0.4-0.9), beta-blockers (hazard ratio: 0.3; 95% confidence interval: 0.2-0.5), creatinine ≥ 1.4 mg/dL (hazard ratio: 2.0; 95% confidence interval: 1.3-3.0), serum sodium ≤ 135 mEq/L (hazard ratio: 1.8; 95% confidence interval: 1.2-2.7). Conclusions: Patients with advanced heart failure showed a significant improvement in survival and reduction in re-hospitalizations. The neurohormonal blockade, with angiotensin-converting-enzyme inhibitors and beta-blockers, had an important role in increasing survival of these patients with advanced heart failure.
article 1 Citação(ões) na Scopus Thermal Vasodilation Using a Portable Infrared Thermal Blanket in Decompensated Heart Failure(2014) VILLACA, Marcelo; OCHIAI, Marcelo E.; VIEIRA, Kelly N.; SCIPIONI, Airton; CARDOSO, Juliano N.; MUNHOZ, Robinson T.; MORGADO, Paulo C.; BARRETTO, Antonio C. P.Adjunctive and non-pharmacological therapies, such as heat, for the treatment of heart failure patients have been proposed. Positive results have been obtained in clinically stable patients, but no studies of the use of thermal therapy in patients with decompensated heart failure (DRIP) have been reported. An open randomized clinical trial was designed in patients with DRIP and controls. We studied 38 patients with a mean age of 56.9 years. A total of 86.8% were men, and 71% had nonischemic myocardiopathy. All participants were using dobutamine, and the median brain natriuretic peptide (BNP) level was 1396 pg/mL. An infrared thermal blanket heated the patients, who were divided into 2 groups: group T (thermal therapy) and group C (control). Group T underwent vasodilation using the thermal blanket at 50 C for 40 minutes in addition to drug treatment. The cardiac index increased by 24.1% (P = 0.009), and systemic vascular resistance decreased by 16.0% in group T (P < 0.024) after thermal therapy. Heat as a vasodilator increased the cardiac index and lowered systemic vascular resistance in DHF patients. These data suggest thermal therapy as a therapeutic approach for the adjuvant treatment of DHF patients.conferenceObject Use of non-invasive continuous hemodynamic monitoring in decompensated heart failure(2013) LIMA, M. Villaca; OCHIAI, M. E.; CARDOSO, J. N.; VIEIRA, K. R.; CARDOSO, M. N.; BRANCALHAO, E. C. O.; BARRETTO, A. C. P.