JOSE JAYME GALVAO DE LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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conferenceObject Impact of Coronary Atherosclerotic Burden on the Long-Term Prognosis of Patients With Chronic Kidney Disease Undergoing Renal Replacement Therapy(2023) GODINHO, Roger; CAMPOS, Carlos; ABIZAID, Alexandre; LIMA, Jose Jayme de; RIBEIRO, Henrique; LOPES, Neuza; MOTA, Gabriel; SANTOS, Luciano; GOWDAK, Luis; KALIL FILHO, Roberto; RIBEIRO, Expedito- Peripheral Artery Disease Diagnosed by Pulse Palpation as a Predictor of Coronary Artery Disease in Patients with Chronic Kidney Disease(2023) SANTOS, Daniel B. C. Dos; GOWDAK, Luis Henrique W.; DAVID-NETO, Elias; NATANIEL, Felizardo A.; LIMA, Jose J. G. De; BORTOLOTTO, Luiz A.There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.
- Interdialytic Blood Pressure and Risk of Cardiovascular Events and Death in Hemodialysis Patients(2023) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; JR, Jose Otto Reusing; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.IntroductionNormal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients.AimWe explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period.MethodsThis was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP >= 140 mm Hg and/or diastolic BP >= 90 mm Hg. Endpoints were major CV events and all-cause mortality.ResultsDuring a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP >= 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications.ConclusionsInterdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.