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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conferenceObject Vaccine-Induced Coronay Antibodie-Mediated Rejection and Thrombosis in a Heart Transplant Pacient: A Case Report(2022) BARROSO, N. D.; GALBIATI, L. C.; ARAGAO, C.; FERNANDEZ, M. P.; AVILA, M. S.; SEGURO, L. F.; MARCONDES-BRAGA, F. G.; MANGINI, S.; CAMPOS, I. W.; OLIVEIRA, J. Junior de; FURQUIM, S.; PIERI, R.; GAIOTTO, F.; BACAL, F.bookPart Rejeição aguda de transplante cardíaco(2015) AVILA, Mônica Samuel; BACAL, FernandoconferenceObject Prevalence of Cognitive Impairment in Heart Transplant Waiting-List Patients in a Developing Country(2020) OLIVEIRA, F. M. de; IKEDA, E. T.; AVILA, M.; WOZNIAK, I.; SEGURO, L.; SANTOS, M.; FELTRIM, M.; BARONE, F.; ISSA, V.; LAGE, S.; BACAL, F.; BOCCHI, E.; GAIOTTO, F.; NOMURA, C.; MARCONDES-BRAGA, F.; MANGINI, S.- Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial(2013) AYUB-FERREIRA, Silvia M.; MANGINI, Sandrigo; ISSA, Victor S.; CRUZ, Fatima D.; BACAL, Fernando; GUIMARAES, Guilherme V.; CHIZZOLA, Paulo R.; CONCEICAO-SOUZA, Germano E.; MARCONDES-BRAGA, Fabiana G.; BOCCHI, Edimar A.Background: Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy. Methods and results: We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34-5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04-1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97-0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47-6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01-1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34-0.94; p = 0.014) were independently associated with sudden death mortality. Conclusions: In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death.
- Prescribing and Regulating Exercise with RPE after Heart Transplant: A Pilot Study(2015) CIOLAC, Emmanuel Gomes; CASTRO, Rafael Ertner; GREVE, Julia Maria D'Andrea; BACAL, Fernando; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme VeigaPurpose The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. Methods Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 2.5 yr) age 46.7 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. Results No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. Conclusion Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.
conferenceObject Type B natriuretic peptide as a rejection predictor in heart transplantation(2013) CRUZ, F. D. C.; ISSA, V. I.; FERREIRA, S. A.; CONCEICAO, G. E.; BACAL, F.; BOCCHI, E. A.conferenceObject A New Allocation System for Priorization in Heart Transplantation in the State of Sao Paulo - Brazil: Its Impact on Patients in ECMO(2022) STEFFEN, Samuel P.; GAIOTTO, Fabio A.; GASPAR, Shyrline F.; SANTOS, Ronaldo Honorato B.; FILHO, Domingos D. L.; BACAL, Fernando; JATENE, Fabio B.- Exercise Training Improves Chronotropic Incompetence but not Heart Rate Recovery to Exercise in Heart Transplant Patients(2015) CIOLAC, Emmanuel Gomes; CASTRO, Rafael E.; BACAL, Fernando; BOCCHI, Edimar A.; GUIMARAES, Guilherme V.
conferenceObject Current status of heart failure specialists in a Latin American country: challenges and opportunities(2021) BISOL, R. V.; CLAUSELL, N.; BACAL, F.; VIEIRA, J. L.; GOLDRAICH, L. A.- Hypertonic saline solution for prevention of renal dysfunction in patients with decompensated heart failure(2013) ISSA, Victor S.; ANDRADE, Lucia; AYUB-FERREIRA, Silvia M.; BACAL, Fernando; BRAGANCA, Ana C. de; GUIMARAES, Guilherme V.; MARCONDES-BRAGA, Fabiana G.; CRUZ, Fatima D.; CHIZZOLA, Paulo R.; CONCEICAO-SOUZA, Germano E.; VELASCO, Irineu T.; BOCCHI, Edimar A.Background: Renal dysfunction is associated with increased mortality in patients with decompensated heart failure. However, interventions targeted to prevention in this setting have been disappointing. We investigated the effects of hypertonic saline solution (HSS) for prevention of renal dysfunction in decompensated heart failure. Methods: In a double-blind randomized trial, patients with decompensated heart failure were assigned to receive three-day course of 100 mL HSS (NaCl 7.5%) twice daily or placebo. Primary end point was an increase in serumcreatinine of 0.3 mg/dL or more. Main secondary end point was change in biomarkers of renal function, including serum levels of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin-NGAL and the urinary excretion of aquaporin 2 (AQP(2)), urea transporter (UT-A(1)), and sodium/hydrogen exchanger 3 (NHE3). Results: Twenty-two patients were assigned to HSS and 12 to placebo. Primary end point occurred in two (10%) patients in HSS group and six (50%) in placebo group (relative risk 0.3; 95% CI 0.09-0.98; P=0.01). Relative to baseline, serum creatinine and cystatin C levels were lower in HSS as compared to placebo (P=0.004 and 0.03, respectively). NGAL level was not statistically different between groups, however the urinary expression of AQP2, UT-A1 and NHE3 was significantly higher in HSS than in placebo. Conclusions: HSS administration attenuated heart failure-induced kidney dysfunction as indicated by improvement in both glomerular and tubular defects, a finding with important clinical implications. HSS modulated the expression of tubular proteins involved in regulation of water and electrolyte homeostasis.