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
167 resultados
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conferenceObject The impact of the rapid use of beta-blockers on ventricular remodeling and mortality in end-stage heart failure (the FAST study)(2012) MELO, Domingos B.; BARRETTO, Antonio P.; OCHIAI, Marcelo; CARDOSO, Juliano; OLIVEIRA, Aristea; MELO, Fernando; MORGADO, Paulo; UCHIDA, Augusto; RAMIRES, Jose F.Introduction: The therapy with beta blockers (BB) is fundamental in the treatment of heart failure(HF). However, even though the data documents the benefits of BB, the optimizing of the dosage of this medication during hospitalization has yet to be tested. Objectives: Our objective was to evaluate the safety and effectivity of the rapid usage of BB on patients (pcts) hospitalized for advanced HF. Methods: Ninety-two pcts were studied with advanced HF(NYHA IV) and fraction of ejection (EF) of the left ventricule (LV) 45% were hospitalized for compensation and accompanied after release. The average age was 62.25 years of age with 59 being males. The ptcs were divided into two groups: 46 for treatment (GT) and 46 control (GC). During hospitalization, they were placed randomly for BB rapid usage with an increase of dosage every two days (GT), or every 15 days (GC). The principal result was the occurrence of re-hospitalization or death for various different causes.Utilizing: t from Student, Mann-Whitney, Qui-square, Fisher calculation. Kaplan-Meiyer for survival, with comparison using the test of Log-rank and the “hazard ratio” or the reason of the risks calculated with the Cox model. Results: With the GT group, there was a significant reduction of the diameter of the systolic of the LV in 3 months and 1 year (p<0,001), and remained unaltered among GCs (P=0,337).The final diastolic diameter of the LV presented a significant reduction. (p=0,036) for the GTs, and the GCs did not show any sig. reduction (p=0,250). There was a sig. increase of the LVEF with the GTs (p<0,001) in 3 months, but did not occur with the GCs (P=0,151). The distance covered in the running test of 6 minutes increased sig.(P<0,001) with the GT in relation to the GC. The GT presented the probability of being free of any sig. future hospitalization_greater than the GT (p=0,045). The possibility of survival for the GT was sig. greater than the GC during the period of evaluation (P=0,002) (HR and CI at 95%). Conclusion: Beta blockers rapid optimization dosages during hospitalization of end-stage HF patients is safe and promotes a better ventricular remodeling and lower mortality rate than that observed with a usual treatment schedule.- Role of Trimetazidine in Ischemic Preconditioning in Patients With Symptomatic Coronary Artery Disease(2015) COSTA, Leandro M. A.; REZENDE, Paulo C.; GARCIA, Rosa M. R.; UCHIDA, Augusto H.; SEGURO, Luis Fernando B. C.; SCUDELER, Thiago L.; BOCCHI, Edimar A.; KRIEGER, Jose E.; HUEB, Whady; RAMIRES, Jose Antonio F.; KALIL FILHO, RobertoIschemic preconditioning (IP) is a powerful cardioprotective cellular mechanism that has been related to the warm-up phenomenon or walk-through angina, and has been documented through the use of sequential exercise tests (ETs). It is known that several drugs, for example, cromokalim, pinacidil, adenosine, and nicorandil, can interfere with the cellular pathways of IP. The purpose of this article is to report the effect of the anti-ischemic agent trimetazidine (TMZ) on IP in symptomatic coronary artery disease (CAD) patients.We conducted a prospective study evaluating IP by the analysis of ischemic parameters in 2 sequential ETs. In phase I, without TMZ, patients underwent ET1 and ET2 with a 30-minute interval between them. In phase II, after 1 week of TMZ 35mg twice daily, all patients underwent 2 consecutive ETs (ET3 and ET4). IP was considered present when the time to 1.0-mm segment ST on electrocardiogram deviation (T-1.0mm) and rate pressure product (RPP) were greater in the second of 2 tests. The improvement in T-1.0mm and RPP were compared in the 2 phases: without TMZ and after 1-week TMZ to assess the action of such drug in myocardial protective mechanisms. ETs were analyzed by 2 independent cardiologists.From 135 CAD patients screened, 96 met inclusion criteria and 62 completed the study protocol. Forty patients manifested IP by demonstrating an improvement in T-1.0mm in ET2 compared with ET1, without the use of any drugs (phase I). In phase II, after 1-week TMZ, 26 patients (65%) did not show any incremental result in ischemic parameters in ET4 compared with ET3. Furthermore, of these patients, 8 (20%) had IP blockage.In this study, TMZ did not add any benefit to IP in patients with stable symptomatic CAD.
conferenceObject Comparison between off-pump and on-pump coronary artery bypass grafting in patients with severe lesions at the circumflex artery territory: 5-year follow-up of the MASS III trial(2013) MELO, R. M. V.; HUEB, W.; REZENDE, P. C.; GARZILLO, C. L.; LIMA, E. G.; OIKAWA, F. T. C.; COSTA, L. M. A.; HUEB, T. O.; RAMIRES, J. A. F.; KALIL FILHO, R.- Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: Effect of age in the Medicine, Angioplasty, or Surgery Study II trial(2013) REZENDE, Paulo Cury; HUEB, Whady; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; HUEB, Alexandre Ciappina; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoObjective: With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options. Methods: Patients were separated according to age: 65 years or more (n = 200) and less than 65 years (n = 411). All patients were followed for 10 years. The rates of overall mortality, acute myocardial infarction, and new revascularizations were analyzed. Results: Of 200 patients aged 65 years or more, 68 were randomized to medical therapy, 68 were randomized to percutaneous coronary intervention, and 64 were randomized to coronary artery bypass grafting. At 10 years, overall survival was 63% (medical therapy), 69% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .93). The survival free of combined events was 43% (medical therapy), 38% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .007). The survival free of myocardial infarction was 82% (medical therapy), 77% (percutaneous coronary intervention), and 90%(coronary artery bypass grafting) (P = .17), and survival free of new revascularizations was 59% (medical therapy), 58% (percutaneous coronary intervention), and 91% (coronary artery bypass grafting) (P = .0003). When the 2 age groups were compared, survival free of myocardial infarction for patients treated by percutaneous coronary intervention was 77% (older patients) and 92% (younger patients) (P = .004). Conclusions: In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.
conferenceObject The Release of Cardiac Necrosis Biomarkers in Patients Without Myocardial Infarction After On-Pump Surgical Revascularization. A Study of Cardiac Magnetic Resonance Imaging(2016) OIKAWA, Fernando T.; HUEB, Whady; COSTA, Leandro M.; MELO, Rodrigo M. Vieira de; REZENDE, Paulo C.; GARZILLO, Cibele L.; LIMA, Eduardo G.; NOMURA, Cesar H.; VILLA, Alexandre V.; HUEB, Alexandre C.; RAMIRES, Jose A.; KALIL FILHO, RobertoconferenceObject EFFECT OF MYOCARDIAL ISCHEMIA IN DIABETIC AND NON-DIABETIC PATIENTS: LONG-TERM FOLLOW-UP OF MASS REGISTRY(2020) CARVALHO, Felipe Pereira Camara de; HUEB, Whady; LIMA, Eduardo Gomes; LINHARES FILHO, Jaime; RIBEIRO, Matheus; MARTINS, Eduardo; BATISTA, Daniel Valente; GARZILLO, Cibele; BOROS, Gustavo Andre Boeing; REZENDE, Paulo; RIBAS, Fernando Faglioni; SERRANO, Carlos; RAMIRES, Jose; KALIL-FILHO, Roberto- Long-Term Follow-Up of Implantable Cardioverter-Defibrillator for Secondary Prevention in Chagas' Heart Disease(2012) MARTINELLI, Martino; SIQUEIRA, Sergio Freitas de; STERNICK, Eduardo Back; RASSI JR., Anis; COSTA, Roberto; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoAssessing the efficacy of implantable cardioverter-defibrillators (ICD) in patients with Chagas' heart disease (ChHD) and identifying the clinical predictors of mortality and ICD shock during long-term follow-up. ChHD is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Although ChHD is a common form of cardiomyopathy in Latin American ICD users, little is known about its efficacy in the treatment of this population. The study cohort included 116 consecutive patients with ChHD and an ICD implanted for secondary prevention. Of the 116 patients, 83 (72%) were men; the mean age was 54 +/- 10.7 years. Several clinical variables were tested in a multivariate Cox model for predicting long-term mortality. The average follow-up was 45 +/- 32 months. New York Heart Association class I-II developed in 83% of patients. The mean left ventricular ejection fraction was 42 +/- 16% at implantation. Of the 116 patients, 58 (50%) had appropriate shocks and 13 (11%) had inappropriate therapy. A total of 31 patients died (7.1% annual mortality rate). New York Heart Association class III (hazard ratio [HR] 3.09, 95% confidence interval 1.37 to 6.96, p = 0.0064) was a predictor of a worse prognosis. The left ventricular ejection fraction (HR 0.972, 95% confidence interval 0.94 to 0.99, p = 0.0442) and low cumulative right ventricular pacing (HR 0.23, 95% confidence interval 0.11 to 0.49, p = 0.0001) were predictors of better survival. The left ventricular diastolic diameter was an independent predictor of appropriate shock (I-ER 1.032, 95% confidence interval 1.004 to 1.060, p = 0.025). In conclusion, in a long-term follow-up, ICD efficacy for secondary sudden cardiac death prevention in patients with ChHD was marked by a favorable annual rate of all-cause mortality (7.1%); 50% of the cohort received appropriate shock therapy. New York Heart Association class III and left ventricular ejection fraction were independent predictors of worse prognosis, and low cumulative right ventricular pacing defined better survival.
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.bookPart Medicações utilizadas no tratamento de arritmias na emergência(2015) NEVES, Carolina Frezzatti de Andrade; PAULA, Leonardo Jorge Cordeiro de; RAMIRES, José Antônio FranchiniconferenceObject Application of SYNTAX score I, II and residual SYNTAX as predictors of long-term clinical outcomes after coronary artery bypass grafting(2019) MARTINS, E. B.; HUEB, W.; LIMA, E. G.; REZENDE, P. C.; GARZILLO, C. L.; CARVALHO, G. F.; CARVALHO, F. P. C.; LINHARES FILHO, J. P. P.; BATISTA, D. V.; SILVA, R. R.; BOROS, G. A. B.; AZEVEDO, D. F. C.; SERRANO JUNIOR, C. V.; RAMIRES, J. A. F.; KALIL FILHO, R.