BRUNO MAHLER MIOTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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- A prospective study of patients with refractory angina: outcomes and the role of high-sensitivity troponin T(2017) POPPI, Nilson T.; GOWDAK, Luis H. W.; DOURADO, Luciana O. C.; ADAM, Eduardo L.; LEITE, Thiago N. P.; MIOTO, Bruno M.; KRIEGER, Jose E.; CESAR, Luiz A. M.; PEREIRA, Alexandre C.BackgroundThe predictors of cardiovascular events in patients with chronic refractory angina are limited. High-sensitivity cardiac troponin T (hs-cTnT) assays are biomarkers that may be used to determine the prognosis of patients with stable coronary artery disease. HypothesisHs-cTnT is a predictor of death and nonfatal myocardial infarction (MI) in patients with refractory angina. MethodsWe prospectively enrolled 117 consecutive patients in this study. A heart team ruled out myocardial revascularization feasibility after assessing recent coronary angiograms; evidence of myocardial ischemia served as an inclusion criterion. Optimal medical therapy was encouraged via outpatient visits every 6 months; plasma hs-cTnT levels were determined at baseline. The primary endpoint was the composite incidence of death and nonfatal MI. ResultsDuring a median follow-up period of 28.0 months (interquartile range, 18.0-47.5 months), an estimated 28.0-month cumulative event rate of 13.4% was determined via the Kaplan-Meier method. Univariate predictors of the composite endpoint were hs-cTnT levels and LV dysfunction. Following a multivariate analysis, only hs-cTnT was independently associated with the events in question, either as a continuous variable (hazard ratio per unit increase in the natural logarithm: 2.83, 95% confidence interval: 1.62-4.92, P < 0.001) or as a categorical variable (hazard ratio for concentrations above the 99th percentile: 5.14, 95% confidence interval: 2.05-12.91, P < 0.001). ConclusionsIn patients with chronic refractory angina, plasma concentration of hs-cTnT is the strongest predictor of death and nonfatal MI. Notably, none of the outcomes in question occurred in patients with baseline plasma levels <5.0 ng/L.
- How and when to revascularize patients with chronic coronary syndrome(2020) CESAR, Luiz Antonio Machado; MIOTO, Bruno Mahler
- Paper-filtered coffee increases cholesterol and inflammation biomarkers independent of roasting degree: A clinical trial(2013) CORREA, Telma A. F.; ROGERO, Marcelo M.; MIOTO, Bruno M.; TARASOUTCHI, Daniela; TUDA, Vera L.; CESAR, Luiz A. M.; TORRES, Elizabeth A. F. S.Objective: The aim of this study was to compare the effects of medium light roast (MLR) and medium roast (MR) paper-filtered coffee on cardiovascular risk factors in healthy volunteers. Methods: This randomized crossover trial compared the effects of consuming three or four cups (150 mL) of MLR or MR coffee per day for 4 wk in 20 healthy volunteers. Plasma lipids, lipoprotein(a) (Lp[a]), total homocysteine, and endothelial dysfunction-related inflammation biomarkers, serum glycemic biomarkers, and blood pressure were measured at baseline and after each intervention. Results: Both roasts increased plasma total cholesterol, low-density lipoprotein-cholesterol, and soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations (10%, 12%, and 18% for MLR; 12%, 14%, and 14% for MR, respectively) (P < 0.05). MR also increased high-density lipoportein-cholesterol concentration by 7% (P = 0.003). Plasma fibrinogen concentration increased 8% after MR intake (P = 0.01), and soluble E-selectin increased 12% after MLR intake (P = 0.02). No changes were observed for Lp(a), total homocysteine, glycemic biomarkers, and blood pressure. Conclusion: Moderate paper-filtered coffee consumption may have an undesirable effect on plasma cholesterol and inflammation biomarkers in healthy individuals regardless of its antioxidant content.
- Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention study(2022) MEJIA, Omar Asdrubal Vilca; BORGOMONI, Gabrielle Barbosa; DALLAN, Luis Roberto Palma; MIOTO, Bruno Mahler; ACCORSI, Tarso Augusto Duenhas; LIMA, Eduardo Gomes; SOEIRO, Alexandre de Matos; LIMA, Felipe Gallego; BRANDAO, Carlos Manuel de Almeida; POMERANTZEFF, Pablo Maria Alberto; DALLAN, Luis Alberto Oliveira; LISBOA, Luiz Augusto FerreiraBackground: The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America.Methods: Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics.Results: The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times.Conclusion: The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
conferenceObject Effect of coffee consumption on blood pressure and exercise tolerance(2012) MIOTO, B. M.; MORETTI, M. A.; TARASOUTCHI, D.; DIAS, K. M.; AMATO, R. V.; MASSAROPPE, L.; VIANNA, C. B.; CESAR, L. A. MachadoPurpose: Coffee is the most abundantly consumed stimulant worldwide. However, its cardiovascular safely remains controversial. Some studies suggest coffee consumption acutely can determine a slight blood pressure raise and improve exercise tolerance. AIM: We evaluated blood pressure and exercise tolerance before and after daily chronic coffee consumption in a group of healthy volunteers and in patients with coronary artery disease. Methods: We did a prospective random crossed-over trial to evaluate two different types of roasted coffee. All individuals were oriented by the same nutritionist and put on 3 weeks washout for caffeine beverages and foods. Then they were randomly assigned to start drinking filtered coffee first in one style-roasted coffee and then crossed-over to the other style. Ground coffee beans, provided for four weeks each, were medium-dark (MD) and dark (D) roasts. After 4 weeks there were cross-over with a total of 8 weeks of drinking coffee. All individuals were taught the amount of coffee to brew each time. They get instructions to drink 450 to 600ml every single day. In the baseline and after each period of drinking they were submitted to treadmill test and ambulatory blood pressure monitoring (24-h ABPM). We did analyze average systolic blood pressure (SBP) and diastolic blood pressure (DBP) from 24-h ABPM, total exercise time(TExercise)and double product (DP) from treadmill test. Variable means were evaluated by the analysis of variance for repeated measures. Results: We evaluated 80 subjects (26 with coronary artery disease and 54 healthy volunteers) with 53.4±13.5 years old, 35 men and 45 women (see table). Conclusions: Both roast raised total exercise time capacity, without an increase in double product. Medium dark roasted coffee consumption, but not dark, promoted a slight blood pressure elevation. These findings suggest that there are substances other than caffeine that raises blood pressure and is degraded by roasting.- Training Non-Cardiologists Could Improve the Treatment Results of ST Elevation Myocardial Infarction (Aug, 10.36660/abc.20200180, 2021)(2021) MIOTO, Bruno Mahler; FERREIRA, Joao Fernando Monteiro; FARSKY, Pedro Silvio; OLIVEIRA, Naide Aparecida de
bookPart Causas não ateroscleróticas de angina(2022) MORENO, Cristian Paul Delgado; MIOTO, Bruno MahlerconferenceObject Coronary flow reserve but not ischemia is a strong predictor of mortality in 551 outpatients referred for stress myocardial perfusion by Rubidium-82 PET imaging(2019) POPPI, N. Tavares; SOARES JUNIOR, J.; MENEGHETTI, J. C.; MIOTO, B. Mahler; GIORGI, M. C. P.; IZAKI, M.; CESAR, L. A. Machado- Medium Light and Medium Roast Paper-Filtered Coffee Increased Antioxidant Capacity in Healthy Volunteers: Results of a Randomized Trial(2012) CORREA, Telma Angelina Faraldo; MONTEIRO, Marcela Piedade; MENDES, Thaise Maria Nogueira; OLIVEIRA, Daniela Moura de; ROGERO, Marcelo Macedo; BENITES, Cibelem Iribarrem; VINAGRE, Carmen Guilherme Christiano de Matos; MIOTO, Bruno Mahler; TARASOUTCHI, Daniela; TUDA, Vera Lucia; CESAR, Luiz Antonio Machado; TORRES, Elizabeth Aparecida Ferraz da SilvaWe compared the effects of medium light roast (MLR) and medium roast (MR) paper-filtered coffee on antioxidant capacity and lipid peroxidation in healthy volunteers. In a randomized crossover study, 20 volunteers consumed 482 +/- 61 ml/day of MLR or MR for four weeks. Plasma total antioxidant status (TAS), oxygen radical absorbance capacity (ORAC), oxidized LDL and 8-epi-prostaglandin F2 alpha, erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activity were measured at baseline and after the interventions. MLR had higher chlorogenic acids-(CGA; 334 mg/150 mL) and less caffeine (231 mg/150 ml) than MR had (210 and 244 mg/150 ml, respectively). MLR also had fewer Maillard reaction products (MRP) than MR had. Compared with baseline, subjects had an increase of 21 and 26 % in TAS, 13 and 13 % in CAT, 52 and 75 % in SOD, and 62 and 49 % in GPx after MLR and MR consumption (P < 0.001), respectively. ORAC increased after MLR (P = 0.004). No significant alteration in lipid peroxidation biomarkers was observed. Both coffees had antioxidant effects. Although MLR contained more CGA, there were similar antioxidant effects between the treatments. MRP may have contributed as an antioxidant. These effects may be important in protecting biological systems and reducing the risk of diseases related to oxidative stress.
- Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial(2023) PEREIRA, M. D. P.; LIMA, E. G.; PITTA, F. G.; GOWDAK, L. H. W.; MIOTO, B. M.; CARVALHO, L. N. S.; DARRIEUX, F. C. D. C.; MEJIA, O. A. V.; JATENE, F. B.; SERRANO JR., C. VObjectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.