JOSE ANTONIO FRANCHINI RAMIRES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
14 resultados
Resultados de Busca
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- On-pump versus off-pump coronary artery bypass surgery in patients older than 60 years: five-year follow-up of MASS III trial(2014) MELO, Rodrigo Morel Vieira de; HUEB, Whady; REZENDE, Paulo Cury; LIMA, Eduardo Gomes; HUEB, Alexandre Ciappina; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: We aim to evaluate in-hospital events and long-term clinical outcomes in patients over 60 years of age with stable coronary artery disease and preserved left ventricular ejection fraction undergoing off-pump or on-pump coronary artery bypass grafting. Methods: The MASS III was a single-center randomized trial that evaluate 308 patients with stable coronary artery disease and preserved ventricular function assigned for: 155 to off-pump and 153 to on-pump CABG. Of this, 176 (58.3%) patients were 60 years or older at the time of randomization (90 of-pump and 86 on-pump). The primary short-term end point was a composite of myocardial infarction, stroke, and overall mortality occurring within 30 days after surgery or before discharge, whichever was later. The primary long-term end point was death from any cause within 5 years, non-fatal myocardial infarction between 30 days and 5 years, or additional revascularization between 30 days and 5 years. Results: On-pump CABG had a higher incidence of 30-day composite outcome than off-pump CABG (15,1% and 5.6%, respectively; P = 0.036). However, after the multivariate analysis, this association lost statistical significance, P = 0.05. After 5-year follow-up, there were no significant differences between both strategies of CABG in the composite end points 16.7% and 15.1%; Hazard Ratio 1.07; CI 0.41 - 1.82; P = 0.71, for off-pump and on-pump CABG respectively. Conclusions: On-pump and off-pump CABG achieved similar results of combined events at short-term and 5-year follow-up.
conferenceObject Is there a Correlation Between Bleeding Risk Score and Platelet Aggregability?(2014) ARANTES, Flavia B.; FURTADO, Remo H.; BARBOSA, Carlos J.; FRANCI, Andre; MENEZES, Fernando R.; FALCAO, Talia D.; NAKASHIMA, Carlos A.; BARACIOLI, Luciano M.; RAMIRES, Jose A.; NICOLAU, Jose C.- Effects of Cardiac Resynchronization Therapy on Muscle Sympathetic Nerve Activity(2014) KUNIYOSHI, Ricardo R.; MARTINELLI, Martino; NEGRAO, Carlos E.; SIQUEIRA, Sergio F.; RONDON, Maria U. P. B.; TROMBETTA, Ivani C.; KUNIYOSHI, Fatima H. S.; LATERZA, Mateus C.; NISHIOKA, Silvana A. D'Orio; COSTA, Roberto; TAMAKI, Wagner T.; CREVELARI, Elizabeth S.; PEIXOTO, Giselle De Lima; RAMIRES, Jose A. F.; KALIL, RobertoIntroductionMuscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable. ObjectivesIn this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF. MethodsWe assessed 11 HF patients (51 3.4 years; New York Heart Association class III-IV; left ventricular ejection fraction 27.8 2.2%; optimal medical therapy) submitted to CRT. Evaluations were made prior to and 3 months after CRT. MSNA was performed at rest and during moderate static exercise (handgrip). Peak oxygen consumption (VO2) was evaluated by means of cardiopulmonary exercise test. HF patients with advanced NYHA class without CRT and healthy individuals were also studied. ResultsCRT reduced MSNA at rest (48.9 +/- 11.1 bursts/min vs 33.7 +/- 15.3 bursts/min, P < 0.05) and during handgrip exercise (MSNA 62.3 +/- 13.1 bursts/min vs 46.9 +/- 14.3 bursts/min, P < 0.05). Among HF patients submitted to CRT, the peak VO2 increased (12.9 +/- 2.8 mL/kg/min vs 16.5 +/- 3.9 mL/kg/min, P < 0.05) and an inverse correlation between peak VO2 and resting MSNA (r = -0.74, P = 0.01) was observed. ConclusionsIn patients with advanced HF and severe systolic dysfunction: (1) a significant reduction of MSNA (at rest and during handgrip) occurred after CRT, and this behavior was significantly superior to HF patients receiving only medical therapy; (2) MSNA reduction after CRT had an inverse correlation with O-2 consumption outcomes.
- Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?(2014) NICOLAU, Jose Carlos; BARBOSA, Carlos Jose Dornas Goncalves; FRANCI, Andre; BARACIOLI, Luciano Moreira; FRANKEN, Marcelo; LIMA, Felipe Gallego; GIRALDEZ, Roberto Rocha; KALIL FILHO, Roberto; RAMIRES, Jose Antonio Franchini; GIUGLIANO, Robert P.Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.
conferenceObject ACUTE CORONARY SYNDROMES IN THE VERY OLD: THERAPIES AND OUTCOME IN THE LONG-TERM FOLLOW-UP(2014) NICOLAU, Jose C.; FRANCI, Andre; BARBOSA, Carlos; BARACIOLI, Luciano; FURTADO, Remo; GIANNETTI, Natali; GIRALDEZ, Roberto; LIMA, Felipe; FRANKEN, Marcelo; RAMIRES, Jose; KALIL-FILHO, Roberto; FERRAZ, ThiagoconferenceObject Long-term outcomes of patients with coronary artery disease and type 2 diabetes mellitus with chronic kidney disease undergoing surgery, angioplasty, or medical treatment(2014) LIMA, E. G.; HUEB, W.; REZENDE, P. C.; GARZILLO, C. L.; SCUDELER, T. L.; FAVARATO, D.; COSTA, L. M. A.; HUEB, A. C.; RAMIRES, J. A. F.; KALIL FILHO, R.conferenceObject DO PATIENTS WITHOUT SIGNIFICANT CORONARY OBSTRUCTIONS HAVE BETTER OUTCOME IN THE LONG RUN POST-ACUTE MYOCARDIAL INFARCTION?(2014) NICOLAU, Jose C.; FRANKEN, Marcelo; FERRAZ, Thiago; BARACIOLI, Luciano; LIMA, Felipe Gallego; GIRALDEZ, Roberto; FURTADO, Remo; GIANNETTI, Natali; KALIL-FILHO, Roberto; RAMIRES, JoseconferenceObject Mortality impact of previous coronary angioplasty in the long-term follow-up of patients with acute coronary syndromes submitted to coronary artery bypass surgery during the same hospitalization(2014) NICOLAU, J. C.; FRANKEN, M.; FERRAZ, T.; FRANCI, A.; BARBOSA, C. J. D. G.; KALIL FILHO, R.; RAMIRES, J. A. F.; LISBOA, L. A. F.; DALLAN, L. A. O.; JATENE, F. B.- Variação Temporal no Prognóstico e Tratamento da Insuficiência Cardíaca Avançada - Antes e Após 2000(2014) CARLO, Carlos Henrique Del; CARDOSO, Juliano Novaes; OCHIA, Marcelo Eidi; OLIVEIRA JR., Mucio Tavares de; RAMIRES, José Antonio Franchini; PEREIRA-BARRETTO, Antonio CarlosBackground: The treatment of heart failure has evolved in recent decades suggesting that survival is increasing. Objective: To verify whether there has been improvement in the survival of patients with advanced heart failure. Methods: We retrospectively compared the treatment and follow-up data from two cohorts of patients with systolic heart failure admitted for compensation up to 2000 (n = 353) and after 2000 (n = 279). We analyzed in-hospital death, re-hospitalization and death in 1 year of follow-up. We used Mann-Whitney U test and chi-square test for comparison between groups. The predictors of mortality were identified by regression analysis through Cox proportional hazards model and survival analysis by the Kaplan-Meier survival analysis. Results: The patients admitted until 2000 were younger, had lower left ventricular impairment and received a lower proportion of beta-blockers at discharge. The survival of patients hospitalized before 2000 was lower than those hospitalized after 2000 (40.1% vs. 67.4%; p<0.001). The independent predictors of mortality in the regression analysis were: Chagas disease (hazard ratio: 1.9; 95% confidence interval: 1.3-3.0), angiotensin-converting-enzyme inhibitors (hazard ratio: 0.6; 95% confidence interval: 0.4-0.9), beta-blockers (hazard ratio: 0.3; 95% confidence interval: 0.2-0.5), creatinine ≥ 1.4 mg/dL (hazard ratio: 2.0; 95% confidence interval: 1.3-3.0), serum sodium ≤ 135 mEq/L (hazard ratio: 1.8; 95% confidence interval: 1.2-2.7). Conclusions: Patients with advanced heart failure showed a significant improvement in survival and reduction in re-hospitalizations. The neurohormonal blockade, with angiotensin-converting-enzyme inhibitors and beta-blockers, had an important role in increasing survival of these patients with advanced heart failure.
- Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus(2014) TEIXEIRA, Ricardo Alkmim; BORBA, Eduardo F.; PEDROSA, Anisio; NISHIOKA, Silvana; VIANA, Vilma S. T.; RAMIRES, Jose A.; KALIL-FILHO, Roberto; BONFA, Eloisa; MARTINELLI FILHO, MartinoTo perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort. Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 +/- 12.1 years and disease duration was11.4 +/- 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 +/- 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 +/- 6.9 vs. 1.0 +/- 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 +/- 7.99 vs. 3.63 +/- 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008). Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.