MARCELO VILLACA LIMA
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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.conferenceObject 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.