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
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- 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.
- Erythropoietin reduces collagen deposition after myocardial infarction but does not improve cardiac function(2018) PESSOA, Fernanda Gallinaro; MADY, Charles; FONSECA, Keila Cardoso Barbosa; OLIVEIRA-FONOFF, Adriana Morgan de; SALEMI, Vera Maria Cury; JORDAO, Mauricio Rodrigues; FERNANDES, Fabio; RAMIRES, Felix Jose AlvarezMyocardial remodeling includes inappropriate collagen deposition in the interstitium. Erythropoietin (EPO) may have cardioprotective effects. We aimed to assess the role of EPO on myocardial remodeling during the chronic phase. We studied 60 Wistar rats divided into the following groups: control (CT), control + EPO (CT + EPO), myocardial infarction + EPO (MI + EPO), and myocardial infarction (MI). The interstitial collagen volume fraction (ICVF) was quantified and echocardiography was performed. We quantified asymmetric dimethylarginine and glutathione by ELISA, and used real-time PCR to assess apoptosis and inflammation. Western blotting was used to evaluate inflammatory proteins and tissue inhibitors of metalloproteinases (TIMPs), and TUNEL staining was used to detect apoptosis. For matrix metalloproteinases (MMPs), we performed zymography. Parametric and nonparametric analyses were performed according to normality testing. ICVF was greater in MI groups (p < 0.001) and was attenuated by EPO (p = 0.05). The MMP-2 did not show any difference between groups. The TIMP-1 and TIMP-2 did not have difference between groups. The MI groups had worse fraction shortening (p < 0.001), without EPO protection (p = 0.666). The MI groups had increased left ventricle diastolic dimension (p < 0.001) without EPO attenuation (p = 0.79). EPO did not act on oxidative stress. Apoptosis and inflammation were not modulated by EPO. We concluded that EPO attenuated interstitial collagen accumulation, but did not protect from heart dilation or dysfunction.
- Brazilian Guideline for Chronic and Acute Heart Failure(2018) ROHDE, Luis Eduardo Paim; MONTERA, Marcelo Westerlund; BOCCHI, Edimar Alcides; CLAUSELL, Nadine Oliveira; ALBUQUERQUE, Denilson Campos de; RASSI, Salvador; COLAFRANCESCHI, Alexandre Siciliano; FREITAS JUNIOR, Aguinaldo Figueiredo de; FERRAZ, Almir Sergio; BIOLO, Andreia; BARRETTO, Antonio C. Pereira; RIBEIRO, Antonio Luiz Pinho; POLANCZYK, Carisi Anne; GUALANDRO, Danielle Menosi; ALMEIDA, Dirceu Rodrigues; SILVA, Eneida Rejane Rabelo da; FIGUEIREDO, Estevao Lanna; MESQUITA, Evandro Tinoco; MARCONDES-BRAGA, Fabiana G.; CRUZ, Fatima Das Dores da; RAMIRES, Felix Jose Alvarez; ATIK, Fernando Antibas; BACAL, Fernando; SOUZA, Germano Emilio Conceicao; ALMEIDA JUNIOR, Gustavo Luiz Gouvea de; RIBEIRO, Gustavo Calado de Aguiar; VILLACORTA JUNIOR, Humberto; VIEIRA, Jefferson Luis; SOUZA NETO, Joao David de; ROSSI NETO, Joao Manoel; FIGUEIREDO NETO, Jose Albuquerque de; MOURA, Lidia Ana Zytynsky; GOLDRAICH, Livia Adams; BECK-DA-SILVA, Luis; DANZMANN, Luiz Claudio; CANESIN, Manoel Fernandes; BITTENCOURT, Marcelo Imbroinise; GARCIA, Marcelo Iorio; BONATTO, Marcely Gimenes; SIMOES, Marcus Vinicius; MOREIRA, Maria da Consolacao Vieira; SILVA, Miguel Morita Fernandes da; OLIVERA JUNIOR, Mucio Tavares de; SILVESTRE, Odilson Marcos; SCHWARTZMANN, Pedro Vellosa; BESTETTI, Reinaldo Bulgarelli; ROCHA, Ricardo Mourilhe; SIMOES, Ricardo; PEREIRA, Sabrina Bernardez; MANGINI, Sandrigo; ALVES, Silvia Marinho Martins; FERREIRA, Silvia Moreira Ayub; ISSA, Victor Sarli; BARZILAI, Vitor Salvatore; MARTINS, Wolney de Andrade
conferenceObject Galectin-3 levels are normal in patients with constrictive pericarditis and are associated with exercise intolerance after pericardiectomy(2018) FERNANDES, F.; MELLO, D. T. P.; RAMIRES, F. J. A.; SABINO, E. C.; MOREIRA, C. H. V.; BENVENUTTI, L.; HOTTA, V. T.; SAYEG, A.; DIAS, R. R.; MADY, C.- Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF(2018) MOGENSEN, Ulrik M.; KOBER, Lars; JHUND, Pardeep S.; DESAI, Akshay S.; SENNI, Michele; KRISTENSEN, Soren L.; DUKAT, Andrej; CHEN, Chen-Huan; RAMIRES, Felix; LEFKOWITZ, Martin P.; PRESCOTT, Margaret F.; SHI, Victor C.; ROULEAU, Jean L.; SOLOMON, Scott D.; SWEDBERG, Karl; PACKER, Milton; MCMURRAY, John J. V.Aims Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. Methods and results The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1-Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA >= 8.6 mg/dL) compared with Q1 (< 5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73m(2)), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1= 1.28 [95% confidence intervals (1.09-1.50), P = 0.003], cardiovascular death [1.44 (1.11-1.77), P = 0.001], HF hospitalization [1.37 (1.11-1.70), P = 0.004], and all-cause mortality [1.36 (1.13-1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17-0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. Conclusion Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.
- Post hoc analyses of SHIFT and PARADIGM-HF highlight the importance of chronic Chagas' cardiomyopathy Comment on: ""Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial"" by Bocchi et al.(2018) RAMIRES, Felix J. A.; MARTINEZ, Felipe; GOMEZ, Efrain A.; DEMACQ, Caroline; GIMPELEWICZ, Claudio R.; ROULEAU, Jean L.; SOLOMON, Scott D.; SWEDBERG, Karl; ZILE, Michael R.; PACKER, Milton; MCMURRAY, John J. V.
conferenceObject Effects of exercise training on cardiovascular autonomic modulation and skeletal muscle tissue in chagasic cardiopathy patients and preserved systolic function(2018) SARMENTO, A. S. O.; ANTUNES-CORREA, L. M.; ALVES, M. J. N. N.; BACURAU, A. V. N.; FONSECA, K. C. B.; PESSOA, F. G.; TROMBETTA, I. C.; RONDON, M. U. P. B.; RAMIRES, F. J. A.; BRASILEIRO-SANTOS, M. S.; BRUM, P. C.; MADY, C.; NEGRAO, C. E.; THOMAS, S.; IANNI, B. M.conferenceObject Dysregulation of insulin levels in Chagas heart disease is associated with altered adipocytokine levels(2018) DABARIAN, A.; MADY, C.; FERREIRA, J. M. B.; IANNI, B.; HOTTA, V. T.; RAMIRES, F. J. A.; LOPES, H. F.; FERNANDES, F.