PAULO ROBERTO CHIZZOLA
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
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- Infectious agents and inflammation in donated hearts and dilated cardiomyopathies related to cardiovascular diseases, Chagas' heart disease, primary and secondary dilated cardiomyopathies(2015) MANGINI, Sandrigo; HIGUCHI, Maria de Lourdes; KAWAKAMI, Joyce Tiyeko; REIS, Marcia Martins; IKEGAMI, Renata Nishiyama; PALOMINO, Suely Aparecida Pinheiro; POMERANTZEFF, Pablo Maria Alberto; FIORELLI, Alfredo Inacio; MARCONDES-BRAGA, Fabiana Goulart; BACAL, Fernando; FERREIRA, Silvia Moreira Ayub; ISSA, Victor Sarli; SOUZA, Germano Emilio Conceicao; CHIZZOLA, Paulo Roberto; BOCCHI, Edimar AlcidesBackground: Clinical and experimental conflicting data have questioned the relationship between infectious agents, inflammation and dilated cardiomyopathy (DCM). Objectives: The aim of this study was to determine the frequency of infectious agents and inflammation in endomyocardial biopsy (EMB) specimens from patients with idiopathic DCM, explanted hearts from different etiologies, including Chagas' disease, compared to donated hearts. Methods: From 2008 to 2011, myocardial samples from 29 heart donors and 55 patients with DCMs from different etiologies were studied (32 idiopathic, 9 chagasic, 6 ischemic and 8 other specific etiologies). Inflammation was investigated by immunohistochemistry and infectious agents by immunohistochemistry, molecular biology, in situ hybridization and electron microscopy. Results: There were no differences regarding the presence of macrophages, expression of HLA class II and ICAM-I in donors and DCM. Inflammation in Chagas' disease was predominant. By immunohistochemistry, in donors, there was a higher expression of antigens of enterovirus and Borrelia, hepatitis B and C in DCMs. By molecular biology, in all groups, the positivity was elevated to microorganisms, including co-infections, with a higher positivity to adenovirus and HHV6 in donors towards DCMs. This study was the first to demonstrate the presence of virus in the heart tissue of chagasic DCM. Conclusions: The presence of inflammation and infectious agents is frequent in donated hearts, in the myocardium of patients with idiopathic DCM, myocardial dysfunction related to cardiovascular diseases, and primary and secondary cardiomyopathies, including Chagas' disease. The role of co-infection in Chagas' heart disease physiopathology deserves to be investigated in future studies.
- Successful Endomyocardial Biopsy Guided by Transthoracic Two-Dimensional Echocardiography(2011) FIORELLI, A. I.; COELHO, G. B.; SANTOS, R. H. B.; OLIVEIRA JR., J. L.; AIELO, V.; BENVENUTI, L.; OLIVEIRA, A. S.; SILVA, M. A. F. Da; CHIZZOLA, P. R.; COSTA, R.; MATHIAS JR., W.; BACAL, F.; BOCCHI, E. A.; STOLF, N. A. G.Introduction. Two-dimensional (2-D) echocardiography is an excellent alternative method to perform endomyocardial biopsies (EB) in special situations, mainly when the patient is in a critical state and cannot go to the catheterization laboratory or when there are contraindications to the use of fluoroscopy as in the pregnancy. Objective. This single-center experience analyzed the last 25 years use of an EB technique guided by echocardiography realized at the bedside on critical patients. Methods. From 1985 to 2010, we performed 76 EB guided by 2-D echocardiography on 59 patients, among whom 38 (64.4%) were critically ill with examinations at the bedside; among 10 (16.9%) subjects, the procedure was carried out simultaneously with fluoroscopy for safety's sake during the learning period. In addition, 8 (13.6%) were unavailable for fluoroscopy, and 3 (5.1%) required a hybrid method due to an intracardiac tumor. Results. The main adverse effects included local pain (n = 4, 5.6%); difficult out successful puncture due to previous biopsies (n = 4, 5.6%); local hematoma without major consequences (n = 3, 4.2%); failed but ultimately successful puncture on the first try due to previous biopsies or (n = 3, 4.2%); obesity and immediate postoperative period with impossibility to pass the bioptome into the right ventricle; however 2 days later the procedure was repeated successfully by echocardiography (n = 1, 1.4%). All myocardial specimens displayed suitable size. There were no undesirable extraction effects on the tricuspid valve tissue. In this series, there was no case of death, hemopericardium, or other major complication as a direct consequence of the biopsy. Conclusion. 2-D echocardiography is a special feature to guide EB is mainly in critically ill patients because it can be performed at the bedside without additional risk or disadvantages of fluoroscopy. The hybrid method associating 2-D echocardiography and fluoroscopy allows the procedure in different situations such as intracardiac tumor cases.
- Immunohistochemical Quantification of Inflammatory Cells in Endomyocardial Biopsy Fragments After Heart Transplantation: A New Potential Method to Improve the Diagnosis of Rejection After Heart Transplantation(2014) BOCCHI, E. A.; TANIGAWA, R. Y.; BRENDAO, S. M. G.; CRUZ, F.; ISSA, V.; AYUB-FERREIRA, S.; CHIZZOLA, P.; SOUZA, G.; FIORELLI, A. I.; BACAL, F.; POMERANTZEFF, P. M. A.; HONORATO, R.; LOURENCO-FILHO, D.; GUIMARAES, G.; BENVENUTI, L. A.Inconsistencies in cardiac rejection grading systems corroborate the concept that the evaluation of inflammatory intensity and myocyte damage seems to be subjective. We studied in 36 patients the potential role of the immunohistochemical (IHC) counting of inflammatory cells in endomyocardial biopsy (EMB) as an objective tool, testing the hypothesis of correlation between the International Society for Heart and Lung Transplantation 2004 rejection and IHC counting of inflammatory cells. We observed a progressive increment in CD68+ cells/mm(2) (P = .000) and CD3+ cells/mm(2) (P = .000) with higher rejection grade. A strong correlation between the grade of cellular rejection and both CD68+ cells/mm(2) and CD3+ cells/mm(2) was obtained (P =.000). One patient with CD3+ and CD68+ cells/mm(2) above the upper limit of the 95% confidence interval for cells/mm(2) found in rejection grade 1R evolved to rejection grade 2R without treatment. In patients with 2R that did not respond to treatment the values of CD68+ or CD3+ cells were higher than the overall median values for rejection grade 2R. For diagnosis of rejection needing treatment, the CD68+ and CD3+ cells/mm(2) areas under the receiver operating characteristic curves were 0.956 and 0.934, respectively. IHC counting of mononuclear inflammatory infiltrate in EMB seems to have additive potential role in evaluation of EMB for the diagnosis and prognosis of rejection episodes.
- NHETS - Estudo de Necrópsias de Pacientes Submetidos a Transplante Cardíaco(2014) VALETTE, Thiago Ninck; AYUB-FERREIRA, Silvia Moreira; BENVENUTI, Luiz Alberto; ISSA, Victor Sarli; BACAL, Fernando; CHIZZOLA, Paulo Roberto; SOUZA, Germano Emilio Conceição; FIORELLI, Alfredo Inácio; SANTOS, Ronaldo Honorato Barros dos; BOCCHI, Edimar AlcidesBackground: Discrepancies between pre and post-mortem diagnoses are reported in the literature, ranging from 4.1 to 49.8 % in cases referred for necropsy, with important impact on patient treatment. Objective: To analyze patients who died after cardiac transplantation and to compare the pre- and post-mortem diagnoses. Methods: Perform a review of medical records and analyze clinical data, comorbidities, immunosuppression regimen, laboratory tests, clinical cause of death and cause of death at the necropsy. Then, the clinical and necroscopic causes of death of each patient were compared. Results: 48 deaths undergoing necropsy were analyzed during 2000-2010; 29 (60.4 %) had concordant clinical and necroscopic diagnoses, 16 (33.3%) had discordant diagnoses and three (6.3%) had unclear diagnoses. Among the discordant ones, 15 (31.3%) had possible impact on survival and one (2.1%) had no impact on survival. The main clinical misdiagnosis was infection, with five cases (26.7 % of discordant), followed by hyperacute rejection, with four cases (20 % of the discordant ones), and pulmonary thromboembolism, with three cases (13.3% of discordant ones). Conclusion: Discrepancies between clinical diagnosis and necroscopic findings are commonly found in cardiac transplantation. New strategies to improve clinical diagnosis should be made, considering the results of the necropsy, to improve the treatment of heart failure by heart transplantation.
conferenceObject Immunohistochemical Counting of Mononuclear Infiltrates in Endomyocardial Biopsy Fragments: A New Method To Improve the Diagnosis of Rejection after Heart Transplantation(2013) BOCCHI, E. A.; BENVENUTTI, L. A.; TANIGAWA, R.; BRANDAO, S.; ISSA, V. S.; AYUB-FERREIRA, S.; CRUZ, F.; POMERANTZEFF, P.; HONORATO, R.; LOURENCO-FILHO, D. D.; FIORELLI, A. I.; CHIZZOLA, P.; SOUZA, G.; BACAL, F.conferenceObject CLINICAL DIAGNOSES AND AUTOPSY FINDINGS AFTER HEART TRANSPLANTATION: DISCREPANCIES AFFECTING MANAGEMENT AND SURVIVAL - NEHTS STUDY (NECROPSY HEART TRANSPLANTATION STUDY)(2012) BOCCHI, Edimar Alcides; VALETTE, Thiago Ninck; AYUB-FERREIRA, Silvia Moreira; ISSA, Victor; BENVENUTI, Luiz Alberto; BACAL, Fernando; FIORELLI, Alfredo Inacio; CHIZZOLA, Paulo; SOUZA, Germano; POMERANTZEFF, Pablo; STOLF, NoedirBackground: Discrepancies between clinical and autopsy diagnosis of causes of death (COD) and its consequences in the management of patients were not evaluated after heart transplantation (HT). Objective: To identify discrepancies between clinical COD and autopsy results. Methods: We studied retrospectively 48 autopsies of HT receptors from 2000 to 2010 (39% of the deaths). We used the Goldman classification to study the discrepancies. Results: 31.3% missed major diagnosis with potential adverse impact on survival and that would have changed management (Class I), 2.1% missed major and minor diagnosis without potential adverse impact on survival and that would have not changed management (Class II and III), 60.4%absolute agreement (Class V), and 6,3% uncertain autopsy diagnosis (Class VI). The main discrepancies between autopsy and clinical COD and missed diagnosis were errors in the diagnosis of causes of transplanted organ dysfunction (40%), acute humoral rejection (20%), cardiac allograft disease (20%), pulmonary embolism (6.7%), disseminated intravascular coagulation (6.7%), and causes of shock (6,7%). Conclusions: This study found significant discrepancies with potential impact on therapy and outcome of HT patients. This reinforces the importance of the postmortem examination in confirming diagnostic accuracy and improving the quality of care of HT patients.