GUILHERME SOBREIRA SPINA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
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bookPart Surto agudo de febre reumática(2015) PEDREIRA, Fábio Américo; SPINA, Guilherme Sobreiraarticle 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 Prognostic Significance of Elevated Troponin I After Valve Heart Surgery(2015) ARAGAO, Roberto C.; SAMPAIO, Roney O.; BITTENCOURT, Marcio S.; LOPES, Antonio S.; ACCORSI, Tarso A.; ROSA, Vitor E.; FERNANDES, Joao R.; SPINA, Guilherme S.; NAJJAR, Ludhmila A.; TARASOUTCHI, FlaviobookPart Febre reumática(2015) SPINA, Guilherme Sobreira; ACCORSI, Tarso Augusto DuenhasbookPart Surto agudo de febre reumática(2015) PEDREIRA, Fábio Américo; SPINA, Guilherme Sobreira- EuroSCORE Models in a Cohort of Patients with Valvular Heart Disease and a High Prevalence of Rheumatic Fever Submitted to Surgical Procedures(2015) CASALINO, Ricardo; TARASOUTCHI, Flavio; SPINA, Guilherme; KATZ, Marcelo; BACELAR, Antonio; SAMPAIO, Roney; RANZANI, Otavio T.; POMERANTZEFF, Pablo M.; GRINBERG, MaxObjectives Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery. Methods Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC) curve analysis. Results The mean age was 56 +/- 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery). Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70-0.81) for the additive EuroSCORE, 0.76 (95% CI 0.70-0.81) for the logistic EuroSCORE and 0.81 (95% CI 0.76-0.86) for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II. Conclusions In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.