PAULO CESAR MORGADO
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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.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.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 Impact of genetic polymorphisms in end-stage heart failure prognosis after rapid up titration of beta-blockers(2013) MELO, D. M.; BARRETTO, A. C. P. B.; OLIVEIRA, A. I. O.; CARDOSO, J. N. C.; MELO, F. S. A. M.; OCHIAI, M. E. O.; MORGADO, P. C. M.; RAMIREZ, J. A. F. R.