GUILHERME SOBREIRA SPINA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
24 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 24
article 17 Citação(ões) na Scopus Natriuretic Peptides and Long-Term Mortality in Patients with Severe Aortic Stenosis(2012) KATZ, Marcelo; TARASOUTCHI, Flavio; PESARO, Antonio Eduardo Pereira; LOPES, Renato D.; SPINA, Guilherme Sobreira; VIEIRA, Marcelo Luiz Campos; GRINBERG, MaxBackground and aim of the study: The natriuretic peptides, brain natriuretic peptide (BNP) and its N-terminal prohormone (NT-proBNP), can be used as diagnostic and prognostic markers for aortic stenosis (AS). However, the association between BNP, NT-proBNP, and long-term clinical outcomes in patients with severe AS remains uncertain. Methods: A total of 64 patients with severe AS was prospectively enrolled into the study, and underwent clinical and echocardiographic assessments at baseline. Blood samples were drawn for plasma BNP and NT-proBNP analyses. The primary outcome was death from any cause, through a six-year follow up period. Cox proportional hazards modeling was used to examine the association between natriuretic peptides and long-term mortality, adjusting for important clinical factors. Results: During a mean period of 1,520 681 days, 51 patients (80%) were submitted to aortic valve replacement, and 13 patients (20%) were medically managed without surgical interventions. Mortality rates were 13.7% in the surgical group and 62% in the medically managed group (p <0.001). Patients with higher plasma BNP (>135 pg/ml) and NT-proBNP (>1,150 pg/ml) levels at baseline had a greater risk of long-term mortality (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.1; HR 4.3, 95% CI 1.4-13.5, respectively). After adjusting for important covariates, both BNP and NT-proBNP remained independently associated with long-term mortality (HR 2.9, 95%CI 1.5-5.7; HR 1.8, 95%CI 1.1-3.1, respectively). Conclusion: In patients with severe AS, plasma BNP and NT-proBNP levels were associated with long-term mortality. The use of these biomarkers to guide treatment might represent an interesting approach that deserves further evaluation. The Journal of Heart Valve Disease 2012;21:331-336- Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery(2011) FERNANDES, Juliano L.; SAMPAIO, Roney O.; BRANDAO, Carlos M.; ACCORSI, Tarso Augusto D.; CARDOSO, Luiz F.; SPINA, Guilherme S.; TARASOUTCHI, Flavio; POMERANTZEFF, Pablo; AULER JR., Jose O.; GRINBERG, MaxPulmonary hypertension represents an important cause of morbidity and mortality in patients with mitral stenosis who undergo cardiac surgery, especially in the postoperative period. The aim of this study was to test the hypothesis that inhaled nitric oxide (iNO) would improve the hemodynamic effects and short-term clinical outcomes of patients with mitral stenosis and severe pulmonary hypertension who undergo cardiac surgery in a randomized, controlled study. Twenty-nine patients (4 men, 25 women; mean age 46 2 years) were randomly allocated to receive iNO (n = 14) or oxygen (n = 15) for 48 hours immediately after surgery. Hemodynamic data, the use of vasoactive drugs, duration of stay, and short-term complications were assessed. No differences in baseline characteristics were observed between the groups. After 24 and 48 hours, patients receiving iNO had a significantly greater increase in cardiac index compared to patients receiving oxygen (p < 0.0001). Pulmonary vascular resistance was also more significantly reduced in patients receiving iNO versus oxygen (-117 dyne/s/cm(5), 95% confidence interval 34 to 200, vs 40 dyne/s/cm5, 95% confidence interval 34 to 100, p = 0.005) at 48 hours. Patients in the iNO group used fewer systemic vasoactive drugs.(mean 2.1 +/- 0.14 vs 2.6 +/- 0.16, p = 0.046) and had a shorter intensive care unit stay (median 2 days, interquartile range 0.25, vs median 3 days, interquartile range 7, p = 0.02). In conclusion, iNO immediately after surgery in patients with mitral stenosis and severe pulmonary hypertension improves hemodynamics and may have short-term clinical benefits.
conferenceObject PRIMARY TRICUSPID REGURGITATION AND PATENT FORAMEN OVALE: A RARE CAUSE OF HYPOXEMIA(2023) CARVALHO, Leticia Neves Solon; FERREIRA, Jose Carlos Lucena De Aguiar; NASCIMENTO, Andre Luiz Kummer Hora; POPP, Vinicius Oro; SPINA, Guilherme S.; CALDERARO, Daniela; TARASOUTCHI, Flavio- Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease(2021) LOPES, Mariana Pezzute; ROSA, Vitor Emer Egypto; PALMA, Jose Honorio; VIEIRA, Marcelo Luiz Campos; FERNANDES, Joao Ricardo Cordeiro; SANTIS, Antonio de; SPINA, Guilherme Sobreira; FONSECA, Rafael de Jesus; MARCHI, Mauricio F. de Sa; ABIZAID, Alexandre; BRITO, Fabio Sandoli de; TARASOUTCHI, Flavio; SAMPAIO, Roney Orismar; RIBEIRO, Henrique BarbosaBackground: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median followup of 20.7 [5.1-30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30 day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
conferenceObject Short- and Long-term Outcomes After Surgical Aortic Valve Replacement in Patients With Classical Low-flow, Low-gradient Aortic Stenosis(2019) ROSA, Vitor E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E.; SANTIS, Antonio S. De; FERNANDES, Joao Ricardo C.; SPINA, Guilherme S.; VIEIRA, Marcelo L.; POMERANTZEFF, Pablo M.; ROCHITTE, Carlos E.; MATHIAS JR., Wilson; TARASOUTCHI, FlavioconferenceObject Predictors of Mortality in Prosthetic Valve Endocarditis(2016) SANTIS, Antonio S.; SPINA, Guilherme; ROSA, Vitor; ACCORSI, Tarso; FERNANDES, Joao Ricardo; SAMPAIO, Roney; PIRES, Lucas; PAIXAO, Milena; TARASOUTCHI, FlavioconferenceObject EuroSCORE II, BNP, C-Reactive Protein, Creatinine and Delayed Myocardial Enhancement Imaging are Predictors of 1-Year Mortality in Patients with Low-Flow and Low-Gradient True Severe Aortic Stenosis with Low Ejection Fraction(2016) ROSA, Vitor E.; SAMPAIO, Roney O.; PAIXAO, Milena R.; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A.; SANTIS, Antonio S. de; SPINA, Guilherme S.; VIEIRA, Marcelo L.; MORAIS, Thamara C.; BELLO, Juliana H.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; BRANDAO, Carlos Manuel A.; TARASOUTCHI, Flavioarticle 7 Citação(ões) na Scopus Heart Transplant in Patients with Predominantly Rheumatic Valvular Heart Disease(2015) ROSA, Vitor E. E.; LOPES, Antonio S. S. A.; ACCORSI, Tarso A. D.; FERNANDES, Joao Ricardo C.; SPINA, Guilherme S.; SAMPAIO, Roney O.; BACAL, Fernando; TARASOUTCHI, FlavioBackground and aim of the study: International records indicate that only 2.6% of patients with heart transplants have valvular heart disease. The study aim was to evaluate the epidemiological and clinical profile of patients with valvular heart disease undergoing heart transplantation. Methods: Between 1985 and 2013, a total of 569 heart transplants was performed at the authors' institution. Twenty patients (13 men, seven women; mean age 39.5 +/- 15.2 years) underwent heart transplant due to structural (primary) valvular disease. Analyses were made of the patients' clinical profile, laboratory data, echocardiographic and histopathological data, and mortality and rejection. Results: Of the patients, 18 (90%) had a rheumatic etiology, with 85% having undergone previous valve surgery (45% had one or more operations), and 95% with a normal functioning valve prosthesis at the time of transplantation. Atrial fibrillation was present in seven patients (35%), while nine (45%) were in NYHA functional class IV and eight (40%) in class III. The indication for cardiac transplantation was refractory heart failure in seven patients (35%) and persistent NYHA class III/IV in ten (50%). The mean left ventricular ejection fraction (LVEF) was 26.6 +/- 7.9%. The one-year mortality was 20%. Histological examination of the recipients' hearts showed five (27.7%) to have reactivated rheumatic myocarditis without prior diagnosis at the time of transplantation. Univariate analysis showed that age, gender, LVEF, rheumatic activity and rejection were not associated with mortality at one year. Conclusion: Among the present patient cohort, rheumatic heart disease was the leading cause of heart transplantation, and a significant proportion of these patients had reactivated myocarditis diagnosed in the histological analyses. Thus, it appears valid to investigate the existence of rheumatic activity, especially in valvular cardiomyopathy with severe systolic dysfunction before transplantation.conferenceObject Correlation between Topographic Distribution of Aortic Valve Calcium and Hemodynamic Repercussion in Aortic Stenosis(2013) SANTIS, Antonio S. de; TARASOUTCHI, Flavio; SPINA, Guilherme; ROSA, Vitor; ACCORSI, Tarso; FERNANDES, Joao; NOMURA, Cesar; VIEIRA, Marcelo; SAMPAIO, Roney; GRINBERG, Max- 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
- «
- 1 (current)
- 2
- 3
- »