CAROLINA MARIA PINTO DOMINGUES DE CARVALHO E SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
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- Brazilian Cardio-oncology Guideline-2020(2020) HAJJAR, Ludhmila Abrahao; COSTA, Isabela Bispo Santos da Silva da; LOPES, Marcelo Antonio Cartaxo Queiroga; HOFF, Paulo Marcelo Gehm; DIZ, Maria Del Pilar Estevez; FONSECA, Silvia Moulin Ribeiro; BITTAR, Cristina Salvadori; REHDER, Marilia Harumi Higuchi dos Santos; RIZK, Stephanie Itala; ALMEIDA, Dirceu Rodrigues; FERNANDES, Gustavo S. Santos; BECK-DA-SILVA, Luis; CAMPOS, Carlos Augusto Homem de Magalhaes; MONTERA, Marcelo Westerlund; ALVES, Silvia Marinho Martins; FUKUSHIMA, Julia Tizue; SANTOS, Maria Veronica Camara dos; NEGRAO, Carlos Eduardo; SILVA, Thiago Liguori Feliciano da; FERREIRA, Silvia Moreira Ayub; MALACHIAS, Marcus Vinicius Bolivar; MOREIRA, Maria da Consolacao Vieira; VALENTE NETO, Manuel Maria Ramos; FONSECA, Veronica Cristina Quiroga; SOEIRO, Maria da Carolina Feres de Almeida; ALVES, Juliana Barbosa Sobral; SILVA, Carolina Maria Pinto Domingues Carvalho; SBANO, Joao; PAVANELLO, Ricardo; PINTO, Ibraim Masciarelli F.; SIMAO, Antonio Felipe; DRACOULAKIS, Marianna Deway Andrade; HOFF, Ana Oliveira; ASSUNCAO, Bruna Morhy Borges Leal; NOVIS, Yana; TESTA, Laura; ALENCAR FILHO, Aristoteles Comte de; CRUZ, Cecilia Beatriz Bittencourt Viana; PEREIRA, Juliana; GARCIA, Diego Ribeiro; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; MACEDO, Ariane Vieira Scarlatelli; MARCATTI, Patricia Tavares Felipe; MATHIAS JUNIOR, Wilson; WIERMANN, Evanius Garcia; VAL, Renata do; FREITAS, Helano; COUTINHO, Anelisa; MATHIAS, Clarissa Maria de Cerqueira; VIEIRA, Fernando Meton de Alencar Camara; SASSE, Andre Deeke; ROCHA, Vanderson; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
- High tumour burden, delayed diagnosis and history of cardiovascular disease may be associated with carcinoid heart disease(2018) ALVES, Carolina; MESQUITA, Marcella; SILVA, Carolina; SOEIRO, Maria; HAJJAR, Ludhmila; RIECHELMANN, Rachel P.Background: Patients with carcinoid syndrome (CS) may present carcinoid heart disease (CHD) but prognostic factors are not entirely understood. Patients and Methods: Retrospective study of patients with metastatic neuroendocrine tumours (NETs) and CS and/or abnormal 24-hour-urinary 5-hydroxiindolacetic acid. CHD was defined as moderate to severe tricuspid or pulmonary regurgitation in the echocardiogram. Results: The frequency of CHD among 42 patients was 38% (95% confidence interval [CI]: 23%-54%). CHD was associated with higher volume of liver metastases (odds ratio [OR] 13.86, 95% CI: 2.57-74.68, p = 0.002). Time from CS symptoms to NET diagnosis was borderline significant (p = 0.08). When CHD was defined as at least mild tricuspide regurgitation, the frequency of CHD was 45% and it was associated with cardiovascular comorbidities (OR: 6.58, 95% CI: 1.09; 39.78, p = 0.040). Conclusion: CHD was frequent among patients with CS, significantly associated with high liver tumour burden, and likely linked to the history of cardiovascular disease and longer time of CS.
conferenceObject High hepatic tumor burden and cardiovascular comorbidities linked to carcinoid heart disease(2017) MESQUITA, M. C.; SILVA, C. A. C.; SILVA, C. M. P. D. C.; SOEIRO, M. C. Feres Almeida; HAJJAR, L. A.; HOFF, P. M. Gehm; RIECHELMANN, R. S. P.- Reaching Across the Aisle: Cardio-Oncology Advocacy and Program Building(2021) SADLER, Diego; ARNOLD, Anita; HERRMANN, Joerg; DANIELE, Andres; SILVA, Carolina Maria Pinto Domingues Carvalho; GHOSH, Arjun K.; SZMIT, Sebastian; KHAN, Roohi Ismail; RAEZ, Luis; BLAES, Anne; BROWN, Sherry-AnnPurpose of ReviewThis study aims to assess the current state of cardio-oncology in reference to advocacy efforts, access to care, and perspective of stakeholders in their ability to provide patient care as well as development of ""across the aisle"" synergy among cardiologists and oncologists and academic and non-academic centers in various worldwide locations.Recent FindingsDuring the last decade, there has been a significant and diverse growth in cardio-oncology. We reviewed the experience from cardiologists and oncologists across different healthcare systems, the global trends, the role of collaborative networks, and the importance of advocacy efforts.SummaryCardio-oncology will continue to grow, but there is an unmet need to increase awareness, improve education, and expand access to care to larger segments of the cancer population in order to have a more significant impact on their health. The growing collaboration through professional societies and collaborative networks provides an opportunity to advance the cardiovascular care of cancer patients to meet the projected needs in a growing and more diverse population.
- Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials(2018) PUTZU, Alessandro; SILVA, Carolina Maria Pinto Domingues de Carvalho e; ALMEIDA, Juliano Pinheiro de; BELLETTI, Alessandro; CASSINA, Tiziano; LANDONI, Giovanni; HAJJAR, Ludhmila AbrahaoBackground: The effects of perioperative statin therapy on clinical outcome after cardiac or non-cardiac surgery are controversial. We aimed to assess the association between perioperative statin therapy and postoperative outcome. Methods: Electronic databases were searched up to May 1, 2018, for randomized controlled trials of perioperative statin therapy versus placebo or no treatment in adult cardiac or non-cardiac surgery. Postoperative outcomes were: myocardial infarction, stroke, acute kidney injury (AKI), and mortality. We calculated risk ratio (RR) or odds ratio (OR) and 95% confidence interval (CI) using fixed-effects meta-analyses. We performed meta-regression and subgroup analyses to assess the possible influence of statin therapy regimen on clinical outcomes and trial sequential analysis to evaluate the risk of random errors and futility. Results: We included data from 35 RCTs involving 8200 patients. Perioperative statin therapy was associated with lower incidence of postoperative myocardial infarction in non-cardiac surgery (OR = 0.44 [95% CI 0.30-0.64], p < 0.0001), but not in cardiac surgery (OR = 0.93 [95% CI 0.70-1.24], p = 0.61) (psubgroup = 0.002). Higher incidence of AKI was present in cardiac surgery patients receiving perioperative statins (RR = 1.15 [95% CI 1.00-1.31], p = 0.05), nonetheless not in non-cardiac surgery (RR = 1.52 [95% CI 0.71-3.26], p = 0.28) (psubgroup = 0.47). No difference in postoperative stroke and mortality was present in either cardiac or non-cardiac surgery. However, low risk of bias trials performed in cardiac surgery showed a higher mortality with statins versus placebo (OR = 3.71 [95% CI 1.03-13.34], p = 0.04). Subgroup and meta-regression analyses failed to find possible relationships between length of statin regimens and clinical outcomes. Trial sequential analysis suggested no firm conclusions on the topic. Conclusions: Perioperative statins appear to be protective against postoperative myocardial infarction in non-cardiac surgery and associated with higher AKI in cardiac surgery. Possible positive or even negative effects on mortality could not be excluded and merits further investigations. Currently, no randomized evidence supports the systematic administration of statins in surgical patients.
- Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report(2020) FIGUEIREDO, Clara Salles; COSTA, Isabela Bispo Santos da Silva; BITTAR, Cristina Salvadori; PAIVA, Antonio Fernando Lins de; LIMA, Ivanhoe Stuart; DIVINO, Paulo Henrique do Amor; SILVA, Carolina Maria P. D. de C.; FONSECA, Silvia Moulin Ribeiro; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoThymomas are usually tumors with a good prognosis but with potential to invade nearby structures. We report a case of a 56-year-old woman previously diagnosed with an invasive thymoma that came to the emergence room with symptoms of acute coronary syndrome. After a coronary computed tomography angiography, it was seen that the tumor was invading the myocardial and it was irrigated by the left circumflex coronary and its branches. Considering her poor prognosis, it was decided not to make further interventions. This case highlights a unique and rare case of an unresectable thymoma that was invading the myocardium and it was irrigated by the left circumflex coronary and its branches, causing typical angina due to compromised coronary blood flow by the mass causing ischemia.
- Recommendations for the management of cardiovascular risk in patients with chronic myeloid leukemia on tyrosine kinase inhibitors: risk assessment, stratification, treatment and monitoring(2021) SEGURO, Fernanda Salles; SILVA, Carolina Maria Pinto Domingues Carvalho; MOURA, Carla Maria Boquimpani de; CONCHON, Monika; FOGLIATTO, Laura; FUNKE, Vaneuza Araujo Moreira; ABDO, Andre; MACEDO, Ariane Vieira Scarlatelli; SANTOS, Marilia Harumi Higushi dos; SARAIVA, Jose Francisco KerrThis manuscript summarizes the results of the consensus meeting composed of hematol-ogists and cardiologists to establish recommendations for the prevention and follow-up of cardiovascular (CV) risk in patients with chronic myeloid leukemia (CML) treated with BCR-ABL tyrosine kinase inhibitors (TKIs) from the point of view of clinical practice and from the perspective of hematology consultation. In the first medical appointment, the CV risk factors should be identified to perform the baseline risk stratification, based on the Brazilian Guideline of Dyslipidemia and Atheroscle-rosis Prevention Update (risk levels: very high, high, intermediate and low). Once stratified, the treatment of the CV risk factors should be administered. If the patient presents risk factors, such as hypertension, diabetes, renal disease, smoking and hyperc- holesterolemia, the evaluation and initial treatment may be done by the hematologist, being an option the request for evaluation by a specialist. If the patient has a history of previous CV disease, we recommend referral to a specialist. As the CV risk score is dynamic and the control of risk factors can reduce the patient risk, this expert consensus recommends that the re-evaluation of the CV risk after the baseline should be performed at 3 months, 6 months and 12 months. After this period, it should be done annually and, for specific patients, at the clinician's discretion. The evaluation of the baseline CV risk and the safe administration of a TKI allow the patient to benefit from the maximum treatment, avoiding unwanted effects. (C) 2020 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.
- Takotsubo syndrome: an overview of pathophysiology, diagnosis and treatment with emphasis on cancer patients(2019) COSTA, Isabela Bispo Santos da Silva; FIGUEIREDO, Clara Salles; FONSECA, Silvia Moulin Ribeiro; BITTAR, Cristina Salvadori; SILVA, Carolina Maria Domingues de Carvalho; RIZK, Stephanie Itala; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoTakotsubo syndrome is a disease of great clinical importance that remains underdiagnosed. It is a form of acute heart failure characterized by a transient wall motion abnormality of the left ventricular apex typically triggered by emotional or physical stress. Takotsubo syndrome is commonly associated with cancer and results in poor outcomes. Therefore, early recognition and prompt therapy are essential to improve prognosis. The aim of this manuscript is to review the consequences of the association between cancer and Takotsubo to summarize the available evidence to guide physicians to improve the management of these patients.
- A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery(2015) NAKAMURA, Rosana Ely; VINCENT, Jean-Louis; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; FRANCO, Rafael Alves; PARK, Clarice Lee; OSAWA, Eduardo Atsushi; SILVA, Carolina Maria Pinto; AULER JR., Jose Otavio Costa; LANDONI, Giovanni; GALAS, Filomena Regina Barbosa Gomes; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoObjective: The aim of this study was to compare outcomes in patients undergoing cardiac surgery who are aged 60 years or more or less than 60 years after implementation of a restrictive or a liberal transfusion strategy. Methods: This is a substudy of the Transfusion Requirements After Cardiac Surgery (TRACS) randomized controlled trial. In this subgroup analysis, we separated patients into those aged 60 years or more (elderly) and those aged less than 60 years randomized to a restrictive or a liberal strategy of red blood cell transfusion. The primary outcome was a composite defined as a combination of 30-day all-cause mortality and severe morbidity. Results: Of the 502 patients included in the Transfusion Requirements After Cardiac Surgery study, 260 (51.8%) were aged 60 years or more and 242 (48.2%) were aged less than 60 years and were included in this study. The primary end point occurred in 11.9% of patients in the liberal strategy group and 16.8% of patients in the restrictive strategy group (P = .254) for those aged 60 years or more and in 6.8% of patients in the liberal strategy group and 5.6% of patients in the restrictive strategy group for those aged less than 60 years (P = .714). However, in the older patients, cardiogenic shock was more frequent in patients in the restrictive transfusion group (12.8% vs 5.2%, P = .031). Thirty-day mortality, acute respiratory distress syndrome, and acute renal injury were similar in the restrictive and liberal transfusion groups in both age groups. Conclusions: Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy may result in an increased rate of cardiogenic shock in elderly patients undergoing cardiac surgery compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients.
- Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo(2020) COSTA, Isabela B. S. da S.; BITTAR, Cristina S.; FONSECA, Silvia M. R.; SILVA, Carolina M. P. D. e; REHDER, Marilia H. H. dos Santos; RIZK, Stephanie I.; CRUZ, Cecilia B. B. V.; FIGUEIREDO, Clara S.; ANDRADE, Fernanda T. de A.; BARBERINO, Ludmila de A.; COSTA, Fernanda A. de S.; MACHADO, Letticya P.; GONZALEZ, Thalita B.; ALMEIDA, Marcel P. C.; FUKUSHIMA, Julia T.; KALIL FILHO, Roberto; HAJJAR, Ludhmila AbrahaoBackgroundIn recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes.MethodsA retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity).ResultsFrom a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p <0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p <0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p <0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p <0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p =0.650]).ConclusionThe number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.