FERNANDO BACAL
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
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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- Research Training Program: Duke University and Brazilian Society of Cardiology(2012) PELLANDA, Lucia Campos; CESA, Claudia Ciceri; BELLI, Karlyse Claudino; DAVID, Vinicius Frayze; RODRIGUES, Clarissa Garcia; VISSOCI, Joao Ricardo Nickenig; BACAL, Fernando; KALIL, Renato A. K.; PIETROBON, RicardoBackground: Research coaching program focuses on the development of abilities and scientific reasoning. For health professionals, it may be useful to increase both the number and quality of projects and manuscripts. Objective: To evaluate the initial results and implementation methodology of the Research and Innovation Coaching Program of the Research on Research group of Duke University in the Brazilian Society of Cardiology. Methods: The program works on two bases: training and coaching. Training is done online and addresses contents on research ideas, literature search, scientific writing and statistics. After training, coaching favors the establishment of a collaboration between researchers and centers by means of a network of contacts. The present study describes the implementation and initial results in reference to the years 2011-2012. Results: In 2011, 24 centers received training, which consisted of online meetings, study and practice of the contents addressed. In January 2012, a new format was implemented with the objective of reaching more researchers. In six months, 52 researchers were allocated. In all, 20 manuscripts were published and 49 more were written and await submission and/or publication. Additionally, five research funding proposals have been elaborated. Conclusion: The number of manuscripts and funding proposals achieved the objectives initially proposed. However, the main results of this type of initiative should be measured in the long term, because the consolidation of the national production of high-quality research is a virtuous cycle that feeds itself back and expands over time.
- Position Statement on Diagnosis and Treatment of Cardiac Amyloidosis-2021(2021) V, Marcus Simoes; FERNANDES, Fabio; MARCONDES-BRAGA, Fabiana G.; SCHEINBERG, Philip; CORREIA, Edileide de Barros; ROHDE, Luis Eduardo P.; BACAL, Fernando; ALVES, Silvia Marinho Martins; MANGINI, Sandrigo; BIOLO, Andreia; BECK-DA-SILVA, Luis; SZOR, Roberta Shcolnik; MARQUES JUNIOR, Wilson; OLIVEIRA, Acary Souza Bulle; CRUZ, Marcia Waddington; BUENO, Bruno Vaz Kerges; HAJJAR, Ludhmila Abrahao; ISSA, Aurora Felice Castro; RAMIRES, Felix Jose Alvarez; COELHO FILHO, Otavio Rizzi; SCHMIDT, Andre; PINTO, Ibraim Masciarelli Francisco; ROCHITTE, Carlos Eduardo; VIEIRA, Marcelo Luiz Campos; MESQUITA, Claudio Tinoco; RAMOS, Celso Dario; SOARES-JUNIOR, Jose; ROMANO, Minna Moreira Dias; MATHIAS JUNIOR, Wilson; GARCIA, Marcelo Iorio; MONTERA, Marcelo Westerlund; MELO, Marcelo Dantas Tavares de; SILVA, Sandra Marques E; GARIBALDI, Pedro Manoel Marques; ALENCAR, Aristoteles Comte de; LOPES, Renato Delascio; AVILA, Diane Xavier de; VIANA, Denizar; SARAIVA, Jose Francisco Kerr; CANESIN, Manoel Fernandes; OLIVEIRA, Glaucia Maria Moraes de; MESQUITA, Evandro Tinoco
- Genomic ancestry as a predictor of haemodynamic profile in heart failure(2016) BERNARDEZ-PEREIRA, Sabrina; GIOLI-PEREIRA, Luciana; MARCONDES-BRAGA, Fabiana G.; SANTOS, Paulo Caleb Junior Lima; SPINA, Joceli Mabel Rocha; HORIMOTO, Andrea Roseli Vancan Russo; SANTOS, Hadassa Campos; BACAL, Fernando; FERNANDES, Fabio; MANSUR, Alfredo Jose; PIETROBON, Ricardo; KRIEGER, Jose Eduardo; MESQUITA, Evandro Tinoco; PEREIRA, Alexandre CostaObjective: The aim of this study is to assess the association between genetic ancestry, self-declared race and haemodynamic parameters in patients with chronic heart failure (HF). Methods: Observational, cross-sectional study. Eligible participants were aged between 18 and 80 years; ejection fraction was <= 50%. Patients underwent genetic analysis of ancestry informative markers, echocardiography and impedance cardiography (ICG). Race was determined by self-classification into two groups: white and non-white. Genomic ancestry was estimated using a panel of 101 348 polymorphic markers and three continental reference populations (European, African and Native American). Results: Our study included 362 patients with HF between August 2012 and August 2014. 123 patients with HF declared themselves as white and 234 patients declared themselves as non-white. No statistically significant differences were found regarding the ICG parameters according to self-declared race. The Amerindian ancestry was positively correlated with systolic time ratio (r=0.109, p<0.05). The thoracic fluid content index (r=0.124. p<0.05), E wave peak (r=0.127. p<0.05) and E/e' ratio (r=0.197. p<0.01) were correlated positively with African ancestry. In multiple linear regression, African ancestry remained associated with the E/e0 ratio, even after adjustment to risk factors. Conclusions: The African genetic ancestry was associated with worse parameters of diastolic function; the Amerindian ancestry correlated with a worse pattern of ventricular contractility, while self-declared colour was not helpful to infer haemodynamic profiles in HF.
- Heart Failure Mortality during COVID-19 Pandemic: Insights from a Cohort of Public Hospitals in Brazil(2022) FERNANDES-SILVA, Miguel M.; ADAM, Eduardo Leal; BERNARDEZ-PEREIRA, Sabrina; SILVA, Suzana Alves; PASSAGLIA, Luiz Guilherme; PEREIRA, Kleber Renato Ponzi; GUEDES, Marco Antonio Vieira; SOUZA, Joao David de; PAOLA, Angelo Amato Vincenzo de; RIVERA, Maria Alayde Mendonca; RESENDE, Elmiro Santos; ALBUQUERQUE, Denilson Campos de; BACAL, Fernando; RIBEIRO, Antonio Luiz Pinho; MORGAN, Louise; SMITH, Sidney C.; TANIGUCHI, Fabio Papa
- Update of the Brazilian Guidelines for Valvular Heart Disease-2020(2020) TARASOUTCHI, Flavio; MONTERA, Marcelo Westerlund; RAMOS, Auristela Isabel de Oliveira; SAMPAIO, Roney Orismar; ROSA, Vitor Emer Egypto; ACCORSI, Tarso Augusto Duenhas; SANTIS, Antonio de; FERNANDES, Joao Ricardo Cordeiro; PIRES, Lucas Jose Tachotti; SPINA, Guilherme S.; VIEIRA, Marcelo Luiz Campos; LAVITOLA, Paulo de Lara; AVILA, Walkiria Samuel; PAIXAO, Milena Ribeiro; BIGNOTO, Tiago; TOGNA, Dorival Julio Della; MESQUITA, Evandro Tinoco; ESTEVES, William Antonio de Magalhaes; ATIK, Fernando; COLAFRANCESCHI, Alexandre Siciliano; MOISES, Valdir Ambrosio; KIYOSE, Alberto Takeshi; POMERANTZEFF, Pablo M. A.; LEMOS, Pedro A.; BRITO JUNIOR, Fabio Sandoli de; WEKSLER, Clara; BRANDAO, Carlos Manuel de Almeida; POFFO, Robinson; SIMOES, Ricardo; RASSI, Salvador; LEAES, Paulo Ernesto; MOURILHE-ROCHA, Ricardo; PENA, Jose Luiz Barros; JATENE, Fabio Biscegli; BARBOSA, Marcia de Melo; ABIZAID, Alexandre; RIBEIRO, Henrique Barbosa; BACAL, Fernando; ROCHITTE, Carlos Eduardo; FONSECA, Jose Honorio de Almeida Palma; GHORAYEB, Samira Kaissar Nasr; LOPES, Marcelo Antonio Cartaxo Queiroga; SPINA, Salvador Vicente; PIGNATELLI, Ricardo H.; SARAIVA, Jose Francisco Kerr
conferenceObject Serum B-type natriuretic peptide is more accurate than ascites analyses in the diagnosis of ascites related to heart failure(2013) FARIAS, A. Q.; SILVESTRE, O. M.; BACAL, F.; GARCIA-TSAO, G.; SEGURO, L. F. B. C.; MAZO, D. F. C.; ANDRADE, J. L.; FURTADO, M. S.; CARRILHO, F. J.; D'ALBUQUERQUE, L. A. C.- Effects of Serelaxin in Patients with Acute Heart Failure(2019) METRA, Marco; TEERLINK, John R.; COTTER, Gad; DAVISON, Beth A.; FELKER, G. Michael; FILIPPATOS, Gerasimos; GREENBERG, Barry H.; PANG, Peter S.; PONIKOWSKI, Piotr; VOORS, Adriaan A.; ADAMS, Kirkwood F.; ANKER, Stefan D.; ARIAS-MENDOZA, Alexandra; AVENDANO, Patricio; BACAL, Fernando; BOEHM, Michael; BORTMAN, Guillermo; CLELAND, John G. F.; COHEN-SOLAL, Alain; CRESPO-LEIRO, Maria G.; DOROBANTU, Maria; ECHEVERRIA, Luis E.; FERRARI, Roberto; GOLAND, Sorel; GONCALVESOVA, Eva; GOUDEV, Assen; KOBER, Lars; LEMA-OSORES, Juan; LEVY, Phillip D.; MCDONALD, Kenneth; MANGA, Pravin; MERKELY, Bela; MUELLER, Christian; PIESKE, Burkert; SILVA-CARDOSO, Jose; SPINAR, Jindrich; SQUIRE, Iain; STEPINSKA, Janina; MIEGHEM, Walter Van; LEWINSKI, Dirk von; WIKSTROEM, Gerhard; YILMAZ, Mehmet B.; HAGNER, Nicole; HOLBRO, Thomas; HUA, Tsushung A.; SABARWAL, Shalini V.; SEVERIN, Thomas; SZECSODY, Peter; GIMPELEWICZ, ClaudioBackgroundSerelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. MethodsIn this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 mu g per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. ResultsA total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P=0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P=0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. ConclusionsIn this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778.) In a randomized trial, 6545 patients with acute heart failure were assigned to either serelaxin or placebo in addition to standard care. There were no significant differences between the two groups in the incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days.
- P2Y12 inhibitor monotherapy versus dual antiplatelet therapy in patients with acute coronary syndromes undergoing coronary stenting: rationale and design of the NEOMINDSET Trial(2023) GUIMARES, Patricia O.; FRANKEN, Marcelo; TAVARES, Caio A. M.; SILVEIRA, Fabio S.; ANTUNES, Murillo O.; BERGO, Ricardo R.; JOAQUIM, Rodrigo M.; HIRAI, Jessica C. S.; ANDRADE, Pedro B.; PITTA, Fabio G.; MARIANI JR., Jose; NASCIMENTO, Bruno R.; SILVEIRA, Marcos S.; COSTA, Tiberio A. O.; DALL'ORTO, Frederico T. C.; SERPA, Renato G.; SAMPAIO, Fernanda B. A.; OHE, Louis N.; MANGIONE, Fernanda M.; FURTADO, Remo H. M.; SARMENTO-LEITE, Rogerio; MONFARDINI, Frederico; ASSIS, Silvia R. L.; NICOLAU, Jose C.; SPOSITO, Andrei C.; LOPES, Renato D.; ONUMA, Yoshinobu; VALGIMIGLI, Marco; ANGIOLILLO, Dominick J.; SERRUYS, Patrick W.; BERWANGER, Otavio; BACAL, Fernando; LEMOS, Pedro A.Dual antiplatelet therapy (DAPT) is currently the standard of care after percutaneous coronary interven-tion (PCI). Recent studies suggest that reducing DAPT to 1-3 months followed by an aspirin-free single antiplatelet therapy (SAPT) strategy with a potent P2Y12 inhibitor is safe and associated with less bleeding. However, to date, no randomised trial has tested the impact of initiating SAPT immediately after PCI, par-ticularly in patients with acute coronary syndromes (ACS). NEOMINDSET is a multicentre, randomised, open-label trial with a blinded outcome assessment designed to compare SAPT versus DAPT in 3,400 ACS patients undergoing PCI with the latest-generation drug-eluting stents (DES). After successful PCI and up to 4 days following hospital admission, patients are randomised to receive SAPT with a potent P2Y12 inhibitor (ticagrelor or prasugrel) or DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months. Aspirin is discontinued immediately after randomisation in the SAPT group. The choice between ticagrelor and prasugrel is at the investigator's discretion. The primary hypothesis is that SAPT will be non-inferior to DAPT with respect to the composite endpoint of all-cause mortality, stroke, myocardial infarction or urgent target vessel revascularisation, but superior to DAPT on rates of bleeding defined by Bleeding Academic Research Consortium 2, 3 or 5 criteria. NEOMINDSET is the first study that is specifically designed to test SAPT versus DAPT immediately following PCI with DES in ACS patients. This trial will provide impor-tant insights on the efficacy and safety of withdrawing aspirin in the early phase of ACS. (ClinicalTrials. gov: NCT04360720)
- Heart Transplantation for Chagas Cardiomyopathy(2017) BENATTI, Rodolfo D.; OLIVEIRA, Guilherme H.; BACAL, FernandoChagas cardiomyopathy (CC) is one of the chronic manifestations of Trypanosoma cruzi (T. cruzi) infection and is a major public health disease in Latin America. Since it is a chronic systemic infection, Chagas disease was long considered a potential contraindication for transplantation because of the risk of recurrence with immunosuppression. However, early South American experience in the 1980's established the feasibility of heart transplantation (HT) in patients with Chagas disease. Indeed, the first cardiac transplant for a recipient with CC was performed in 1985 in Brazil. Chagas etiology of heart failure has become the third most common indication for HT in South America. T. cruzi reactivation post-transplant is a common issue that requires prophylactic surveillance but responds well to appropriate therapy. Chagas reactivation has been associated with the potency of the immunosuppressive protocol and occurs more frequently after rejection episodes. Yet, many important questions regarding the management of Chagas HT candidates and recipients remain unanswered. For example, biventricular systolic failure is frequent in end-stage CC, but its impact on the modality of mechanical circulatory bridging has not been described. Also, there is no consensus regarding the most adequate immunosuppressive regimen that balances the risk of graft rejection and disease reactivation. The real efficacy and safety of HT for end-stage CC will only be appreciated when a Latin American transplant registry is established. This review covers the current state of the art of HT for CC.
- Serum B-Type Natriuretic Peptide in the Initial Workup of Patients With New Onset Ascites: A Diagnostic Accuracy Study(2014) FARIAS, Alberto Q.; SILVESTRE, Odilson M.; GARCIA-TSAO, Guadalupe; SEGURO, Luis F. B. da Costa; MAZO, Daniel F. de Campos; BACAL, Fernando; ANDRADE, Jose L.; GONCALVES, Luciana L.; STRUNZ, Celia; RAMOS, Danusa S.; POLLI, Demerson; PUGLIESE, Vincenzo; RODRIGUES, Ana C. T.; FURTADO, Meive S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff 182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. Conclusions: Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF. (Hepatology 2014;59:1043-1051)