PAULO ROBERTO CHIZZOLA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 3 Citação(ões) na Scopus
    Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy
    (2018) GOMES, Clara; TERHOCH, Caique Bueno; AYUB-FERREIRA, Silvia Moreira; CONCEICAO-SOUZA, Germano Emilio; SALEMI, Vera Maria Cury; CHIZZOLA, Paulo Roberto; JR, Mucio Tavares Oliveira; LAGE, Silvia Helena Gelas; FRIOES, Fernando; BOCCHI, Edimar Alcides; ISSA, Victor Sarli
    Objectives The prognostic significance of transient use of inotropes has been sufficiently studied in recent heart failure (HF) populations. We hypothesised that risk stratification in these patients could contribute to patient selection for advanced therapies. Methods We analysed a prospective cohort of adult patients admitted with decompensated HF and ejection fraction (left ventricular ejection fraction (LVEF)) less than 50%. We explored the outcomes of patients requiring inotropic therapy during hospital admission and after discharge. Results The study included 737 patients, (64.0% male), with a median age of 58 years (IQR 48-66 years). Main aetiologies were dilated cardiomyopathy in 273 (37.0%) patients, ischaemic heart disease in 195 (26.5%) patients and Chagas disease in 163 (22.1%) patients. Median LVEF was 26 % (IQR 22%-35%). Inotropes were used in 518 (70.3%) patients. In 431 (83.2%) patients, a single inotrope was administered. Inotropic therapy was associated with higher risk of in-hospital death/urgent heart transplant (OR=10.628, 95% CI 5.055 to 22.344, p<0.001). At 180-day follow-up, of the 431 patients discharged home, 39 (9.0%) died, 21 (4.9%) underwent transplantation and 183 (42.4%) were readmitted. Inotropes were not associated with outcome (death, transplant and rehospitalisation) after discharge. Conclusions Inotropic drugs are still widely used in patients with advanced decompensated HF and are associated with a worse in-hospital prognosis. In contrast with previous results, intermittent use of inotropes during hospitalisation did not determine a worse prognosis at 180-day follow-up. These data may add to prognostic evaluation in patients with advanced HF in centres where mechanical circulatory support is not broadly available.
  • article 15 Citação(ões) na Scopus
    Clinical findings and prognosis of patients hospitalized for acute decompensated heart failure: Analysis of the influence of Chagas etiology and ventricular function
    (2018) TERHOCH, Caique Bueno; MOREIRA, Henry Fukuda; AYUB-FERREIRA, Silvia Moreira; CONCEICAO-SOUZA, Germano Emilio; SALEMI, Vera Maria Cury; CHIZZOLA, Paulo Roberto; OLIVEIRA JR., Mucio Tavares; LAGE, Silvia Helena Gelas; BOCCHI, Edimar Alcides; ISSA, Victor Sarli
    Aims Explore the association between clinical findings and prognosis in patients with acute decompensated heart failure (ADHF) and analyze the influence of etiology on clinical presentation and prognosis. Methods and results Prospective cohort of 500 patients admitted with ADHF from Aug/2013-Feb/2016; patients were predominantly male (61.8%), median age was 58 (IQ(25-75%) 47-66 years); etiology was dilated cardiomyopathy in 141 (28.2%), ischemic heart disease in 137 (27.4%), and Chagas heart disease in 113 (22.6%). Patients who died (154 [30.8%]) or underwent heart transplantation (53[10.6%]) were younger (56 years [IQ(25-75%) 45-64 vs 60 years, IQ(25-75%) 4967], P=0.032), more frequently admitted for cardiogenic shock (20.3% vs 6.8%, P<0.001), had longer duration of symptoms (14 days [IQ(25-75%) 4-32.8 vs 7.5 days, IQ(25-75%) 2-31], P=0.004), had signs of congestion (90.8% vs 76.5%, P<0.001) and inadequate perfusion more frequently (45.9% vs 28%, P<0.001), and had lower blood pressure (90 [IQ(25-75%) 80-100 vs 100, IQ(25-75%) 90-120], P<0.001). In a logistic regression model analysis, systolic blood pressure (P<0.001, OR 0.97 [95% CI 10.96-0.98] per mmHg) and jugular distention (P=0.004, OR 1.923 [95% CI 1.232-3.001]) were significant. Chagas patients were more frequently admitted for cardiogenic shock (15%) and syncope/arrhythmia (20.4%). Pulmonary congestion was rare among Chagas patients and blood pressure was lower. The rate of in hospital death or heart transplant was higher among patients with Chagas (50.5%). Conclusions A physical exam may identify patients at higher risk in a contemporaneous population. Our findings support specific therapies targeted at Chagas patients in the setting of ADHF.
  • conferenceObject
    Echocardiography parameters, respiratory eficiency, and quality of life in patients with permanent atrial fibrillation and heart failure: effect of exercise training. A randomized controlled trial
    (2018) ALVES, L. Silva; SALEMI, V. M. C.; ROCON, C.; MELO, M. D. T.; CHIZZOLA, P. R.; AMATO, J. F.; VIEIRA, J. L.; BOCCHI, E. A.; GUIMARAES, G. V.
  • conferenceObject
    Permanent atrial fibrillation in heart failure: impact of exercise training on biomarkers. A randomized controlled trial
    (2018) GUIMARAES, G. V.; ALVES, L. S.; SARA, M. G.; CHIZZOLA, P. R.; CASTRO, R. E.; BOCCHI, E. A.