MARCELO VILLACA LIMA
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- 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 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.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.- Papel dos níveis de BNP no prognóstico da insuficiência cardíaca avançada descompensada(2013) PEREIRA-BARRETTO, Antonio Carlos; CARLO, Carlos Henrique Del; CARDOSO, Juliano Novaes; OCHIAI, Marcelo Eid; LIMA, Marcelo Villaca; CURIATI, Milena Cardoso; SCIPIONI, Airton Roberto; RAMIRES, Jose Antonio FranchiniBackground: Heart failure (HF) is a condition with poor outcome, especially in advanced cases. Determination of B-type natriuretic peptide (BNP) levels is useful in the diagnosis of cardiac decompensation and has also been proving useful in the prognostic evaluation. Objectives: To verify whether BNP levels are able to identify patients with a poorer outcome and whether it is an independent prognostic factor considering age, gender, cardiac and renal functions, as well as the cause of heart disease. Methods: 189 patients in functional class III/IV advanced HF were studied. All had systolic dysfunction and had their BNP levels determined during hospitalization. Variables related to mortality were studied using univariate and multivariate analyses. Results: BNP levels were higher in patients who died in the first year of follow-up (1,861.9 versus 1,408.1 pg/dL; p = 0.044) and in chagasic patients (1,985 versus 1,452 pg/mL; p = 0.001); the latter had a higher mortality rate in the first year of follow-up (56% versus 35%; p = 0.010). The ROC curve analysis showed that the BNP level of 1,400 pg/mL was the best predictor of events; high levels were associated with lower LVEF (0.23 versus 0.28; p = 0.002) and more severe degree of renal dysfunction (mean urea 92 versus 74.5 mg/dL; p = 0.002). Conclusion: In advanced HF, high BNP levels identified patients at higher risk of a poorer outcome. Chagasic patients showed higher BNP levels than those with heart diseases of other causes, and have poorer prognosis (Arq Bras Cardiol. 2013; 100(3): 281-287).
article 6 Citação(ões) na Scopus Constrictive Pericarditis with Extensive Calcification(2011) LIMA, Marcelo Villaca; CARDOSO, Juliano Novaes; CARDOSO, Cristina Martins dos Reis; BRANCALHAO, Euler Cristovan Ochiai; LIMACO, Renan Prado; BARRETTO, Antonio Carlos PereiraconferenceObject 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(2012) OCHIAI, Marcelo E.; BRANCALHAO, Euler O.; PUIG, Raphael S.; VIERA, Kelly N.; LIMA, Marcelo V.; CARDOSO, Juliano N.; BARRETTO, Antonio P.Objectives: The dual blockage of renin-angiotensin-aldosterone system could be useful for end-stage inotrope-dependent patients. The objective of this study was to evaluate the effects of angiotensin receptor blocker add-on therapy in low cardiac output in decompensated heart failure. Methods: We selected patients hospitalized for decompensated heart failure with low cardiac output and dobutamine dependence, ejection fraction < 0.45, spontaneous breathing and receiving angiotensin-converting enzyme (ACE) inhibitor. They were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide (BNP) measurements at baseline and on the seventh day of intervention. Results: We studied 10 patients in losartan group and 11 patients in placebo group, the main characteristics were 52.7 years old, ejection fraction of 21.3%, dobutamine infusion of 8.5mcg/kg.min, indexed systemic vascular resistance of 1918.0 dynes.sec/cm5.m2, cardiac index of 2.8 L/min.m2, and BNP of 1,403 pg/mL. After 7 days of intervention, there was a reduction of 37.4% in BNP levels in the losartan group, compared with an increase of 11.9% in the placebo group (mean difference, -49.1%; 95% CI: -88.1 to -9.8%, P = 0.018). No significant difference was found in hemodynamic measurements. Conclusions: Short-term add-on therapy with losartan reduced BNP levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.- Continuous Noninvasive Hemodynamic Monitoring in Decompensated Heart Failure(2012) LIMA, Marcelo Villaca; OCHIAI, Marcelo Eidi; VIEIRA, Kelly Novaes; CARDOSO, Juliano Novaes; BRANCALHAO, Euler Cristovan; PUIG, Raphael; BARRETTO, Antonio Carlos PereiraBackground: The clinical and hemodynamic assessment at the bedside and the use of pulmonary artery catheter for the estimation of hemodynamic data have been used in decompensated heart failure. However, there are no data on the use of continuous noninvasive hemodynamic monitoring. Objective: To compare the data obtained through noninvasive hemodynamic monitoring with invasive ones in patients with decompensated heart failure and refractory to treatment. Methods: The non-invasive hemodynamic measurements were obtained through continuous monitoring of systemic blood pressure by the pulse wave model (Modelflow) and compared with measurements obtained by the passage of a pulmonary artery catheter, simultaneously. Results: A total of 56 measurements were performed in 14 patients studied on different days and time periods. The correlation index between systolic blood pressure measurements was r = 0.26 (95% CI = 0.00 to 0.49, p = 0.0492) and diastolic ones, r = 0.50 (95% CI = 0.27 to 0.67, p < 0.0001). The correlation was r = 0.55 (95% CI = 0.34 to 0.71, p < 0.0001) for cardiac index and r = 0.32 (95% CI = 0.06 to 0 53, p = 0.0178) for systemic vascular resistance. Conclusion: There was a correlation between the hemodynamic measurements when compared to noninvasive pulmonary artery catheter measurements. The continuous noninvasive hemodynamic monitoring may be useful for hospitalized patients with decompensated heart failure. (Arq Bras Cardiol 2012;99(3):843-847)
- Predictors of low cardiac output in decompensated severe heart failure(2011) OCHIAI, Marcelo Eidi; CARDOSO, Juliano Novaes; VIEIRA, Kelly Regina Novaes; LIMA, Marcelo Villaca; BRANCALHAO, Euler Cristovan Ochiai; BARRETTO, Antonio Carlos PereiraOBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical-hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical-hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant. RESULTS: The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047). CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.
- Mortality rates are going down in clinical use of inotropics. Temporal trends for prognosis in acute decompensated heart failure (1992/1999-2005/2006)(2014) CARDOSO, Juliano N.; GROSSI, Andre; CARLO, Carlos H. Del; REIS, Cristina Martins dos; CURIATI, Milena; OCHIAI, Marcelo E.; LIMA, Marcelo V.; SCIPIONI, Airton R.; PEREIRA-BARRETTO, Antonio C.; KALIL FILHO, Roberto