FELIX JOSE ALVAREZ RAMIRES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
83 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 83
conferenceObject Impact of sympathectomy upon myocardium(2019) PESSOA, F. Fernanda; JORDAO, M. R.; FONSECA, K. C. B.; ZANONI, F.; SALEMI, V. M. C.; RIBEIRO, O. N.; SOUZA, L. E.; FERNANDES, F.; IRIGOYEN, M. C.; MOREIRA, L. F. P.; MADY, C.; RAMIRES, F. J. A.conferenceObject Effects of sympathectomy on myocardium(2014) JORDAO, M.; RAMIRES, F.; PESSOA, F.; FONSECA, K.; ZANONI, F.; SOUZA, L.; SALEMI, V.; MADY, C.- Detection of Early Diffuse Myocardial Fibrosis and Inflammation in Chagas Cardiomyopathy with T1 Mapping and Extracellular Volume(2023) MELO, Rodrigo J. L.; ASSUNCAO, Antonildes N.; MORAIS, Thamara C.; NOMURA, Cesar H.; SCANAVACCA, Mauricio I.; MARTINELLI-FILHO, Martino; RAMIRES, Felix J. A.; FERNANDES, Fabio; IANNI, Barbara M.; MADY, Charles; ROCHITTE, Carlos E.Purpose: To evaluate myocardial T1 mapping and extracellular volume (ECV) parameters in different stages of Chagas cardiomyopathy and determine whether they are predictive of disease severity and prognosis.Materials and Methods: Prospectively enrolled participants (July 2013 to September 2016) underwent cine and late gadolinium enhancement (LGE) cardiac MRI and T1 mapping with a precontrast (native) or postcontrast modified Look-Locker sequence. The native T1 and ECV values were measured among subgroups that were based on disease severity (indeterminate, Chagas cardiomyopathy with preserved ejection fraction [CCpEF], Chagas cardiomyopathy with midrange ejection fraction [CCmrEF], and Chagas cardiomyopathy with reduced ejection fraction [CCrEF]). Cox proportional hazards regression and the Akaike information criterion were used to determine predictors of major cardiovascular events (cardioverter defibrillator implant, heart transplant, or death).Results: In 107 participants (90 participants with Chagas disease [mean age & PLUSMN; SD, 55 years & PLUSMN; 11; 49 men] and 17 age-and sex matched control participants), the left ventricular (LV) ejection fraction and the extent of focal and diffuse or interstitial fibrosis were correlated with disease severity. Participants with CCmrEF and participants with CCrEF showed significantly higher global native T1 and ECV values than participants in the indeterminate, CCpEF, and control groups (T1: 1072 msec & PLUSMN; 34 and 1073 msec & PLUSMN; 63 vs 1010 msec & PLUSMN; 41, 1005 msec & PLUSMN; 69, and 999 msec & PLUSMN; 46; ECV: 35.5% & PLUSMN; 3.6 and 35.0% & PLUSMN; 5.4 vs 25.3% & PLUSMN; 3.5, 28.2% & PLUSMN; 4.9, and 25.2% & PLUSMN; 2.2; both P < .001). Remote (LGE-negative areas) native T1 and ECV values were also higher (T1: 1056 msec & PLUSMN; 32 and 1071 msec & PLUSMN; 55 vs 1008 msec & PLUSMN; 41, 989 msec & PLUSMN; 96, and 999 msec & PLUSMN; 46; ECV: 30.2% & PLUSMN; 4.7 and 30.8% & PLUSMN; 7.4 vs 25.1% & PLUSMN; 3.5, 25.1% & PLUSMN; 3.7, and 25.0% & PLUSMN; 2.2; both P < .001). Abnormal remote ECV values (>30%) occurred in 12% of participants in the indeterminate group, which increased with disease severity. Nineteen combined outcomes were observed (median follow-up time: 43 months), and a remote native T1 value greater than 1100 msec was independently predictive of combined outcomes (hazard ratio, 12 [95% CI: 4.1, 34.2]; P < .001).Conclusion: Myocardial native T1 and ECV values were correlated with Chagas disease severity and may serve as markers of myocardial involvement in Chagas cardiomyopathy that precede LGE and LV dysfunction.
bookPart Miocardite(2013) RAMIRES, Felix José Alvarez; PIMENTEL, Walace de Souza; FERNANDES, Fábio- Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy(2017) SHEN, Li; RAMIRES, Felix; MARTINEZ, Felipe; BODANESE, Luiz Carlos; ECHEVERRIA, Luis Eduardo; GOMEZ, Efrain A.; ABRAHAM, William T.; DICKSTEIN, Kenneth; KOBER, Lars; PACKER, Milton; ROULEAU, Jean L.; SOLOMON, Scott D.; SWEDBERG, Karl; ZILE, Michael R.; JHUND, Pardeep S.; GIMPELEWICZ, Claudio R.; MCMURRAY, John J. V.BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies. METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P= 0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P= 0.002). The rates of allcause mortality were also higher. CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies.
- Artéria coronária direita anômala com origem na artéria pulmonar e pericardite constritiva: uma associação inusitada(2013) SILVESTRE, Odilson Marcos; ADAM, Eduardo Leal; MELO, Dirceu Thiago Pessoa de; DIAS, Ricardo Ribeiro; RAMIRES, Felix J. A.; MADY, CharlesThe association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis.
conferenceObject Effect of the angiotensin receptor neprilysin inhibitor LCZ696 compared with enalapril according to systolic blood pressure in PARADIGM-HF(2015) BOHM, M.; REFSGAARD, J.; RAMIRES, F. J. A.; ROULEAU, J. L.; SOLOMON, S. D.; SWEDBERG, K.; ZILE, M.; SHI, V. C.; PACKER, M.; MCMURRAY, J. J. V.- The value of B-type natriuretic peptide as a predictor of mortality in patients with constrictive pericarditis undergoing pericardiectomy(2016) MELO, Dirceu Thiago Pessoa de; MADY, Charles; RAMIRES, Felix Jose Alvarez; DIAS, Ricardo Ribeiro; GUALANDRO, Danielle Menosi; CARAMELLI, Bruno; KALIL FILHO, Roberto; FERNANDES, Fabio
- Was the Enalapril Dose Too Low in the PARADIGM-HF Trial?(2018) BERNARDEZ-PEREIRA, Sabrina; RAMIRES, Felix Jose Alvares; MELO, Rachel Figueiredo Tavares de; PEREIRA-BARRETTO, Antonio CarlosHeart failure (HF) is a common clinical syndrome associated with significant morbidity and mortality, and there remains a clear need for innovative therapies that can modify disease progression. Sacubitril/valsartan (LCZ696) is a novel complex that combines simultaneous neprilysin inhibition and angiotensin II receptor blockade, that has demonstrated significant cardiovascular death or HF hospitalization reduction in the Prospective Comparison of Angiotensin Receptor/Neprilysin Inhibitor (ARNI) With Angiotensin-Converting Enzyme (ACE) Inhibitors to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial when compared with evidence-based doses of the gold standard ACE inhibitor enalapril. In this comprehensive review, the authors discuss historical trials that have investigated clinical outcomes utilizing variable dosing levels of ACE inhibitors or angiotensin receptor blockers in patients with HF with reduced ejection fraction. A critical analysis of the highlighted studies is proposed in the context of current HF management guidelines and HF clinical practice. In conclusion, based on current evidence, it is unclear whether a maximum recommended enalapril dose would promote improved patient outcomes compared with an intermediate dose. However, no prospective study to date comparing ACE inhibitor doses has documented that higher doses result in significant mortality reduction, although the data suggest that there may be a decrease in HF hospitalizations when compared with lower doses.
- Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC-HF baseline characteristics and comparison with contemporary clinical trials (vol 11, pg 2160, 2020)(2022) TEERLINK, John R.; DIAZ, Rafael; FELKER, G. Michael; MCMURRAY, John J. V.; METRA, Marco; SOLOMON, Scott D.; ADAMS, Kirkwood F.; ANAND, Inder; ARIAS-MENDOZA, Alexandra; BIERING-SORENSEN, Tor; BOHM, Michael; BONDERMAN, Diana; CLELAND, John G. F.; CORBALAN, Ramon; CRESPO-LEIRO, Maria G.; DAHLSTROM, Ulf; CORREA, Luis E. Echeverria; FANG, James C.; FILIPPATOS, Gerasimos; FONSECA, Candida; GONCALVESOVA, Eva; GOUDEV, Assen R.; HOWLETT, Jonathan G.; LANFEAR, David E.; LUND, Mayanna; MACDONALD, Peter; MAREEV, Vyacheslav; MOMOMURA, Shin-ichi; O'MEARA, Eileen; PARKHOMENKO, Alexander; PONIKOWSKI, Piotr; RAMIRES, Felix J. A.; SERPYTIS, Pranas; SLIWA, Karen; SPINAR, Jindrich; SUTER, Thomas M.; TOMCSANYI, Janos; VANDEKERCKHOVE, Hans; VINEREANU, Dragos; VOORS, Adriaan A.; YILMAZ, Mehmet B.; ZANNAD, Faiez; SHARPSTEN, Lucie; LEGG, Jason C.; ABBASI, Siddique A.; VARIN, Claire; MALIK, Fady I.; KURTZ, Christopher E.