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
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- 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.
- 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.
- 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.
- Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease(2020) ALVES, Silvia Marinho Martins; ALVARADO-ARNES, Lucia Elena; CAVALCANTI, Maria da Gloria Aureliano de Melo; CARRAZZONE, Cristina de Fatima Velloso; PACHECO, Antonio Guilherme Fonseca; SARTESCHI, Camila; MORAES, Milton Ozorio; OLIVEIRA JUNIOR, Wilson Alves de; MEDEIROS, Carolina de Araujo; PESSOA, Fernanda Gallinaro; MADY, Charles; LANNES-VIEIRA, Joseli; RAMIRES, Felix Jose AlvarezIntroduction: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. Methods: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. Results: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). Conclusions: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
- Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC-HF baseline characteristics and comparison with contemporary clinical trials(2020) 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.Aims The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is being tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial. Here we describe the baseline characteristics of participants in GALACTIC-HF and how these compare with other contemporary trials. Methods and results Adults with established HFrEF, New York Heart Association (NYHA) functional class >= II, ejection fraction <= 35%, elevated natriuretic peptides and either current hospitalization for heart failure or history of hospitalization/emergency department visit for heart failure within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic-guided dosing: 25, 37.5, or 50 mg bid). A total of 8256 patients [male (79%), non-white (22%), mean age 65 years] were enrolled with a mean ejection fraction 27%, ischaemic aetiology in 54%, NYHA class II 53% and III/IV 47%, and median N-terminal pro-B-type natriuretic peptide 1971 pg/mL. Heart failure therapies at baseline were among the most effectively employed in contemporary heart failure trials. GALACTIC-HF randomized patients representative of recent heart failure registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure <100 mmHg (n = 1127), estimated glomerular filtration rate <30 mL/min/1.73 m(2) (n = 528), and treated with sacubitril/valsartan at baseline (n = 1594). Conclusions GALACTIC-HF enrolled a well-treated, high-risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation.
- The effect of beta-blockade on myocardial remodelling in Chagas' cardiomyopathy(2012) PIMENTEL, Walace de Souza; RAMIRES, Felix Jose Alvarez; IANNI, Barbara Maria; SALEMI, Vera Maria Cury; BILATE, Angelina Morand Bianchi; CUNHA-NETO, Edecio; OLIVEIRA, Adriana Morgan de; FERNANDES, Fabio; MADY, CharlesOBJECTIVE: Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model. METHODS: We studied Trypanosoma cruzi infection in 55 Syrian hamsters that were divided into three groups: control (15), infected (20), and infected + carvedilol (20). Animals underwent echocardiography, electrocardiography, and morphometry for collagen evaluation in ventricles stained with picrosirius red. RESULTS: The left ventricular diastolic diameter did not change between groups, although it was slightly larger in infected groups, as was left ventricular systolic diameter. Fractional shortening also did not change between groups, although it was slightly lower in infected groups. Collagen accumulation in the interstitial myocardial space was significantly higher in infected groups and was not attenuated by carvedilol. The same response was observed in the perivascular space. The survival curve showed significantly better survival in the control group compared with the infected groups; but no benefit of carvedilol was observed during the study. However, in the acute phase (up to 100 days of infection), carvedilol did reduce mortality. CONCLUSION: Carvedilol did not attenuate cardiac remodeling or mortality in this model of Chagas' cardiomyopathy. The treatment did improve survival in the acute phase of the disease.
- A putative placebo analysis of the effects of LCZ696 on clinical outcomes in heart failure(2015) MCMURRAY, John; PACKER, Milton; DESAI, Akshay; GONG, Jianjian; GREENLAW, Nicola; LEFKOWITZ, Martin; RIZKALA, Adel; SHI, Victor; ROULEAU, Jean; SOLOMON, Scott; SWEDBERG, Karl; ZILE, Michael R.; ANDERSEN, Karl; ARANGO, Juan Luis; ARNOLD, Malcolm; BELOHLAVEK, Jan; BOEHM, Michael; BOYTSOV, Sergey; BURGESS, Lesley; CABRERA, Walter; CHEN, Chen-Huan; ERGLIS, Andrejs; FU, Michael; GOMEZ, Efrain; GONZALEZ, Angel; HAGEGE, Albert-Alain; KATOVA, Tzvetana; KIATCHOOSAKUN, Songsak; KIM, Kee-Sik; BAYRAM, Edmundo; MARTINEZ, Felipe; MERKELY, Bela; MENDOZA, Ivan; MOSTERD, Arend; NEGRUSZ-KAWECKA, Marta; PEUHKURINEN, Keijo; RAMIRES, Felix; REFSGAARD, Jens; SENNI, Michele; SIBULO JR., Antonio S.; SILVA-CARDOSO, Jose; SQUIRE, Iain; STARLING, Randall C.; VINEREANU, Dragos; TEERLINK, John R.; WONG, RaymondAims Although active-controlled trials with reninangiotensin inhibitors are ethically mandated in heart failure with reduced ejection fraction, clinicians and regulators often want to know how the experimental therapy would perform compared with placebo. The angiotensin receptor-neprilysin inhibitor LCZ696 was compared with enalapril in PARADIGM-HF. We made indirect comparisons of the effects of LCZ696 with putative placebos. Methods and results We used the treatment-arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) as the reference trial for comparison of an ACE inhibitor to placebo and the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity-Alternative trial (CHARM-Alternative) as the reference trial for comparison of an ARB to placebo. The hazard ratio of LCZ696 vs. a putative placebo was estimated through the product of the hazard ratio of LCZ696 vs. enalapril (active-control) and that of the historical active-control (enalapril or candesartan) vs. placebo. For the primary composite outcome of cardiovascular death or heart failure hospitalization in PARADIGM-HF, the relative risk reduction with LCZ696 vs. a putative placebo from SOLVD-T was 43% (95%CI 3450%; P < 0.0001) with similarly large effects on cardiovascular death (34%, 2144%; P < 0.0001) and heart failure hospitalization (49%, 3958%; P < 0.0001). For all-cause mortality, the reduction compared with a putative placebo was 28% (95%CI 1539%; P < 0.0001). Putative placebo analyses based on CHARM-Alternative gave relative risk reductions of 39% (95%CI 2748%; P < 0.0001) for the composite outcome of cardiovascular death or heart failure hospitalization, 32% (95%CI 1645%; P < 0.0001) for cardiovascular death, 46% (3356%; P < 0.0001) for heart failure hospitalization, and 26% (95%CI 1139%; P < 0.0001) for all-cause mortality. Conclusion These indirect comparisons of LCZ696 with a putative placebo show that the strategy of combined angiotensin receptor blockade and neprilysin inhibition led to striking reductions in cardiovascular and all-cause mortality, as well as heart failure hospitalization. These benefits were obtained even though LCZ696 was added to comprehensive background beta-blocker and mineralocorticoid receptor antagonist therapy.
- Angiotensin Receptor Neprilysin Inhibition Compared With Enalapril on the Risk of Clinical Progression in Surviving Patients With Heart Failure(2015) PACKER, Milton; MCMURRAY, John J. V.; DESAI, Akshay S.; GONG, Jianjian; LEFKOWITZ, Martin P.; RIZKALA, Adel R.; ROULEAU, Jean L.; SHI, Victor C.; SOLOMON, Scott D.; SWEDBERG, Karl; ZILE, Michael; ANDERSEN, Karl; ARANGO, Juan Luis; ARNOLD, J. Malcolm; BELOHLAVEK, Jan; BOEHM, Michael; BOYTSOV, Sergey; BURGESS, Lesley J.; CABRERA, Walter; CALVO, Carlos; CHEN, Chen-Huan; DUKAT, Andrej; DUARTE, Yan Carlos; ERGLIS, Andrejs; FU, Michael; GOMEZ, Efrain; GONZALEZ-MEDINA, Angel; HAGEGE, Albert A.; HUANG, Jun; KATOVA, Tzvetana; KIATCHOOSAKUN, Songsak; KIM, Kee-Sik; KOZAN, Oemer; LLAMAS, Edmundo Bayram; MARTINEZ, Felipe; MERKELY, Bela; MENDOZA, Ivan; MOSTERD, Arend; NEGRUSZ-KAWECKA, Marta; PEUHKURINEN, Keijo; RAMIRES, Felix J. A.; REFSGAARD, Jens; ROSENTHAL, Arvo; SENNI, Michele; JR, Antonio S. Sibulo; SILVA-CARDOSO, Jose; SQUIRE, Iain B.; STARLING, Randall C.; TEERLINK, John R.; VANHAECKE, Johan; VINEREANU, Dragos; WONG, Raymond Ching-ChiewBackground-Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. Methods and Results-We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensin-converting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-B-type natriuretic peptide and troponin) versus enalapril. Conclusions-Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition.
- Comparing LCZ696 With Enalapril According to Baseline Risk Using the MAGGIC and EMPHASIS-HF Risk Scores(2015) SIMPSON, Joanne; JHUND, Pardeep S.; CARDOSO, Jose Silva; MARTINEZ, Felipe; MOSTERD, Arend; RAMIRES, Felix; RIZKALA, Adel R.; SENNI, Michele; SQUIRE, Iain; GONG, Jianjian; LEFKOWITZ, Martin P.; SHI, Victor C.; DESAI, Akshay S.; ROULEAU, Jean L.; SWEDBERG, Karl; ZILE, Michael R.; MCMURRAY, John J. V.; PACKER, Milton; SOLOMON, Scott D.BACKGROUND Although most patients in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial had mild symptoms, there is a poor correlation between reported functional limitation and prognosis in heart failure. OBJECTIVES The aim of this study was to examine the spectrum of risk in PARADIGM-HF and the effect of LCZ696 across that spectrum. METHODS This study analyzed rates of the primary composite outcome of cardiovascular death or heart failure hospitalization, its components, and all-cause mortality using the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) risk scores to categorizepatients. The authors determined whether risk, on the basis of these scores, modified the treatment effect of LCZ696. RESULTS The complete MAGGIC risk score was available for 8,375 of the 8,399 patients in PARADIGM-HF. The median MAGGIC score was 20 (IQR: 16 to 24). An increase of 1 point was associated with a 6% increased risk for the primary endpoint (p < 0.001) and a 7% increased risk for cardiovascular death (p < 0.001). The benefit of LCZ696 over enalapril for the primary endpoint was similar across the spectrum of risk (p = 0.159). Treating 100 patients for 2 years with LCZ696 instead of enalapril led to 7 fewer patients in the highest quintile of risk experiencing primary outcomes, compared with 3 in the lowest quintile. Analyses using the EMPHASIS-HF risk score gave similar findings. CONCLUSIONS Although most PARADIGM-HF patients had mild symptoms, many were at high risk for adverse outcomes and obtained a large absolute benefit from LCZ696, compared with enalapril, over a relatively short treatment period. LCZ696's benefit was consistent across the spectrum of risk. (PARADIGM-HF trial [Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure]; NCT01035255) (C) 2015 by the American College of Cardiology Foundation.
- Emerging Topics in Heart Failure: New Era of Pharmacological Treatment(2020) MARCONDES-BRAGA, Fabiana G.; RAMIRES, Felix J. A.; FIGUEIREDO, Estevao Lanna; FIGUEIREDO, Jose Albuquerque; BECK-DA-SILVA, Luis; RASSI, Salvador