MUCIO TAVARES DE OLIVEIRA JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
47 resultados
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Agora exibindo 1 - 10 de 47
- 3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY(2017) GUALANDRO, D. M.; YU, P. C.; CARAMELLI, B.; MARQUES, A. C.; CALDERARO, D.; FORNARI, L. S.; PINHO, C.; FEITOSA, A. C. R.; POLANCZYK, C. A.; ROCHITTE, C. E.; JARDIM, C.; VIEIRA, C. L. Z.; NAKAMURA, D. Y. M.; IEZZI, D.; SCHREEN, D.; ADAM, Eduardo L.; D'AMICO, E. A.; LIMA, M. Q.; BURDMANN, E. A.; PACHON, E. I. M.; BRAGA, F. G. M.; MACHADO, F. S.; PAULA, F. J.; CARMO, G. A. L.; FEITOSA-FILHO, G. S.; PRADO, G. F.; LOPES, H. F.; FERNANDES, J. R. C.; LIMA, J. J. G.; SACILOTTO, L.; DRAGER, L. F.; VACANTI, L. J.; ROHDE, L. E. P.; PRADA, L. F. L.; GOWDAK, L. H. W.; VIEIRA, M. L. C.; MONACHINI, M. C.; MACATRAO-COSTA, M. F.; PAIXAO, M. R.; OLIVEIRA JR., M. T.; CURY, P.; VILLACA, P. R.; FARSKY, P. S.; SICILIANO, R. F.; HEINISCH, R. H.; SOUZA, R.; GUALANDRO, S. F. M.; ACCORSI, T. A. D.; MATHIAS JR., W.
- 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 SarliObjectives 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.
- Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes The ADvISED Prospective Multicenter Study(2018) NAZERIAN, Peiman; MUELLER, Christian; SOEIRO, Alexandre de Matos; LEIDEL, Bernd A.; SALVADEO, Sibilla Anna Teresa; GIACHINO, Francesca; VANNI, Simone; GRIMM, Karin; OLIVEIRA, Mucio Tavares; PIVETTA, Emanuele; LUPIA, Enrico; GRIFONI, Stefano; MORELLO, FulvioBACKGROUND: Acute aortic syndromes (AASs) are rare and severe cardiovascular emergencies with unspecific symptoms. For AASs, both misdiagnosis and overtesting are key concerns, and standardized diagnostic strategies may help physicians to balance these risks. D-dimer (DD) is highly sensitive for AAS but is inadequate as a stand-alone test. Integration of pretest probability assessment with DD testing is feasible, but the safety and efficiency of such a diagnostic strategy are currently unknown. METHODS: In a multicenter prospective observational study involving 6 hospitals in 4 countries from 2014 to 2016, consecutive outpatients were eligible if they had >= 1 of the following: chest/abdominal/back pain, syncope, perfusion deficit, and if AAS was in the differential diagnosis. The tool for pretest probability assessment was the aortic dissection detection risk score (ADD-RS, 0-3) per current guidelines. DD was considered negative (DD-) if < 500 ng/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery, or 14-day follow-up. Outcomes were the failure rate and efficiency of a diagnostic strategy for ruling out AAS in patients with ADD-RS=0/DD-or ADD-RS = 1/DD-. RESULTS: A total of 1850 patients were analyzed. Of these, 438 patients (24%) had ADD-RS=0, 1071 patients (58%) had ADD-RS=1, and 341 patients (18%) had ADD-RS > 1. Two hundred forty-one patients (13%) had AAS: 125 had type A aortic dissection, 53 had type B aortic dissection, 35 had intramural aortic hematoma, 18 had aortic rupture, and 10 had penetrating aortic ulcer. A positive DD test result had an overall sensitivity of 96.7% (95% confidence interval [CI], 93.6-98.6) and a specificity of 64% (95% CI, 61.6-66.4) for the diagnosis of AAS; 8 patients with AAS had DD-. In 294 patients with ADD-RS=0/DD-, 1 case of AAS was observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1.9) and an efficiency of 15.9% (95% CI, 14.3-17.6) for the ADD-RS=0/DD-strategy. In 924 patients with ADD-RS <= 1/DD-, 3 cases of AAS were observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1) and an efficiency of 49.9% (95% CI, 47.7-52.2) for the ADD-RS <= 1/DD-strategy. CONCLUSIONS: Integration of ADD-RS (either ADD-RS=0 or ADD-RS = 1) with DD may be considered to standardize diagnostic rule out of AAS.
- Effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life among patients with acute heart failure(2021) BELKIN, Maria; WUSSLER, Desiree; GUALANDRO, Danielle Menosi; SHRESTHA, Samyut; STREBEL, Ivo; GOUDEV, Assen; MAEDER, Micha T.; WALTER, Joan; FLORES, Dayana; KOZHUHAROV, Nikola; LOPEZ-AYALA, Pedro; DANIER, Isabelle; OLIVEIRA JUNIOR, Mucio Tavares de; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; ERNE, Paul; MUENZEL, Thomas; MUELLER, ChristianAims We aimed to assess the long-term effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life (HRQL) among patients with acute heart failure (AHF). Methods and results Health-related quality of life was prospectively assessed by the generic 3-levelled EQ-5D and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) among adult AHF patients enrolled in an international, multicentre, randomised, open-label blinded-end-point trial of a strategy that emphasized early intensive and sustained vasodilation using maximally tolerated doses of established oral and transdermal vasodilators according to systolic blood pressure. Changes in EQ-5D and KCCQ from admission to 180 day follow-up were individually compared between the intensive vasodilatation and the usual care group. Among 666 patients eligible for 180 day follow-up, 284 (43%, median age 79 years, 35% women) and 198 (30%, median age 77 years, 35% women) had completed the EQ-5D and KCCQ at baseline and follow-up, respectively. There was a significant improvement in HRQL as quantified by both, EQ-5D and KCCQ, from hospitalization to 180 day follow-up, with no significant differences in the change of HRQL between both treatment strategies. For instance, 39 (26%) versus 33 (25%) patients had an improvement by at least one level in at least two categories in the EQ-5D. Median increase in KCCQ overall summary score (KCCQ-OSS) was 17.6 (IQR 2.0-42.6) in the intervention group versus 18.5 (IQR 3.9-39.3) in the usual care group (P < 0.001 vs. baseline, P = 0.945 between groups). Conclusions Among patients with AHF, long-term HRQL quantified by EQ-5D and KCCQ improved substantially, with overall no significant differences between a strategy of comprehensive vasodilation versus usual care.
- Prediction of mortality using quantification of renal function in acute heart failure(2015) WEIDMANN, Zoraida Moreno; BREIDTHARDT, Tobias; TWERENBOLD, Raphael; ZUESLI, Christina; NOWAK, Albina; ECKARDSTEIN, Arnold von; ERNE, Paul; RENTSCH, Katharina; OLIVEIRA JR., Mucio T. de; GUALANDRO, Danielle; MAEDER, Micha T.; GIMENEZ, Maria Rubini; PERSHYNA, Kateryna; STALLONE, Fabio; HAAS, Laurent; JAEGER, Cedric; WILDI, Karin; PUELACHER, Christian; HONEGGER, Ursina; WAGENER, Max; WITTMER, Severin; SCHUMACHER, Carmela; KRIVOSHEI, Lian; HILLINGER, Petra; OSSWALD, Stefan; MUELLER, ChristianBackground: Renal function, as quantified by the estimated glomerular filtration rate (eGFR), is a predictor of death in acute heart failure (AHF). It is unknown whether one of the clinically-available serum creatinine-based formulas to calculate eGFR is superior to the others for predicting mortality. Methods and results: We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patients < 70 years, and BIS-1 in patients >= 70 years) in 1104 unselected AHF patients presenting to the emergency department and enrolled in a multicenter study. Two independent cardiologists adjudicated the diagnosis of AHF. The primary endpoint was the accuracy of the five eGFR equations to predict death as quantified by the time-dependent area under the receiver-operating characteristics curve (AUC). The secondary endpoint was the accuracy to predict all-cause readmissions and readmissions due to AHF. In a median follow-up of 374-days (IQR: 221 to 687 days), 445 patients (40.3%) died. eGFR as calculated by all equations was an independent predictor of mortality. The Cockcroft-Gault formula showed the highest prognostic accuracy (AUC 0.70 versus 0.65 for MDRD-4, 0.55 for MDRD-6, and 0.67 for the combined formula CKD-EPI/BIS-1, p < 0.05). These findings were confirmed in patients with varying degrees of renal function and in three vulnerable subgroups: women, patients with severe left ventricular dysfunction, and the elderly. The prognostic accuracy for readmission was poor for all equations, with an AUC around 0.5. Conclusions: Calculating eGFR using the Cockcroft-Gault formula assesses the risk of mortality in patients with AHF more accurately than other commonly used formulas.
- Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial(2014) OCHIAI, Marcelo E.; BRANCALHAO, Euler C. O.; PUIG, Raphael S. N.; VIEIRA, Kelly R. N.; CARDOSO, Juliano N.; OLIVEIRA- JR., Mucio Tavares de; BARRETTO, Antonio C. P.OBJECTIVE: We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure. METHODS: We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction,<0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov:NCT01857999. RESULTS: We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg. min, indexed systemic vascular resistance 1918.0 dynes. sec/cm(5).m(2), cardiac index 2.8 L/min.m(2), and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, 49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements. CONCLUSION: Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.
- Comprehensive vasodilatation in women with acute heart failure: Novel insights from the GALACTIC randomized controlled trial(2023) WUSSLER, Desiree; BELKIN, Maria; MAEDER, Micha T.; WALTER, Joan; SHRESTHA, Samyut; KUPSKA, Karolina; STIERLI, Michelle; FLORES, Dayana; KOZHUHAROV, Nikola; GUALANDRO, Danielle Menosi; OLIVEIRA JUNIOR, Mucio Tavares de; SABTI, Zaid; NOVEANU, Markus; SOCRATES, Thenral; BAYES-GENIS, Antoni; SIONIS, Alessandro; SIMON, Patrick; MICHOU, Eleni; GUJER, Samuel; GORI, Tommaso; WENZEL, Philip; PFISTER, Otmar; ARENJA, Nisha; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; MUENZEL, Thomas; MUELLER, Christian; GALACTIC InvestigatorsAims Sex-specific differences in acute heart failure (AHF) are both relevant and underappreciated. Therefore, it is crucial to evaluate the risk/benefit ratio and the implementation of novel AHF therapies in women and men separately.Methods and results We performed a pre-defined sex-specific analysis in AHF patients randomized to a strategy of early intensive and sustained vasodilatation versus usual care in an international, multicentre, open-label, blinded endpoint trial. Inclusion criteria were AHF with increased plasma concentrations of natriuretic peptides, systolic blood pressure >= 100 mmHg, and plan for treatment in a general ward. Among 781 eligible patients, 288 (37%) were women. Women were older (median 83 vs. 76 years), had a lower body weight (median 64.5 vs. 77.6 kg) and lower estimated glomerular filtration rate (median 48 vs. 54 ml/min/1.73 m(2)). The primary endpoint, a composite of all-cause mortality or rehospitalization for AHF at 180 days, showed a significant interaction of treatment strategy and sex (p for interaction = 0.03; hazard ratio adjusted for female sex 1.62, 95% confidence interval 1.05-2.50; p = 0.03). The combined endpoint occurred in 53 women (38%) in the intervention group and in 35 (24%) in the usual care group. The implementation of rapid up-titration of renin-angiotensin-aldosterone system (RAAS) inhibitors was less successful in women versus men in the overall cohort and in patients with heart failure with reduced ejection fraction (median discharge % target dose in patients randomized to intervention: 50% in women vs. 75% in men).Conclusion Rapid up-titration of RAAS inhibitors was less successfully implemented in women possibly explaining their higher rate of all-cause mortality and rehospitalization for AHF.
- Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer(2022) DALLAN, Luis Augusto Palma; DAE, Michael; GIANNETTI, Natali Schiavo; POLASTRI, Tathiane Facholi; LIMA, Marian Keiko Frossard; ROCHITTE, Carlos Eduardo; HAJJAR, Ludhmila Abrahao; MARTIN, Claudia Yanet Bernoche San; LIMA, Felipe Gallego; NICOLAU, Jose Carlos; JR, Mucio Tavares de Oliveira; DALLAN, Luis Alberto Oliveira; SILVA, Expedito Eustaquio Ribeiro da; FILHO, Roberto Kalil; ABIZAID, Alexandre; LEMOS NETO, Pedro Alves; TIMERMAN, SergioBackground: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETU and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. Methods and results: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEN s starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus (R) Endovascular System (loll Circulation Inc (TM), San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewanning during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 +/- 1.0 degrees C or PCI-only. A total of 35 patients underwent FM (85.7% [30/35] in 90 +/- 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). Conclusions: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEM.
- Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus(2014) SOEIRO, Alexandre de Matos; SOEIRO, Maria Carolina Feres de Almeida; OLIVEIRA JR., Mucio Tavares de; SERRANO JR., Carlos VienteObjective: Due to the chronic inflammation associated with systemic lupus erythematosus (SLE), patients develop premature atherosclerosis and the disease is a risk factor for acute myocardial infarction. The best interventional treatment for acute coronary syndrome (ACS) in these patients is unclear. The objective of this study is to describe the baseline characteristics, clinical manifestations, treatment and in-hospital outcome of patients with SLE and ACS. Methods: Eleven SLE patients with ACS were analyzed retrospectively between 2004 and 2011. The following data were obtained: age, gender, clinical and electrocardiographic characteristics, Killip class, risk factors for ACS, myocardial necrosis markers (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), drugs used during hospital stay, treatment (medical, percutaneous or surgical) and in-hospital outcome. The statistical analysis is presented in percentages and absolute values. Results: Ten of the patients (91%) were women. The median age was 47 years. Typical precordial pain was present in 91%. Around 73% had positive erythrocyte sedimentation rate. The vessel most often affected was the anterior descending artery, in 73%. One patient underwent coronary artery bypass grafting, seven underwent percutaneous coronary intervention with bare-metal stents and three were treated medically. In-hospital mortality was 18%. Conclusions: Despite the small number of patients, our findings were similar to those in the literature, showing coronary artery disease in young people with SLE due to premature atherosclerosis and a high mortality rate.
article Telecardiology guideline in Patient Care with Acute Coronary Syndrome and Other Respiratory Diseases(2015) OLIVEIRA JUNIOR, Mucio Tavares de; CANESIN, Manoel Fernandes; MARCOLINO, Milena Soriano; RIBEIRO, Antonio Luiz Pinho; CARVALHO, Antonio Carlos de Camargo; REDDY, Shankar; SANTOS, Adson Roberto Franca dos; FERNANDES, Alfredo Manoel da Silva; AMARAL, Amaury Zatorre; REZENDE, Ana Carolina de; NECHAR JUNIOR, Antonio; NASCIMENTO, Bruno Ramos do; PASTORE, Carlos Alberto; WEN, Chao Lung; GUALANDRO, Danielle Menosi; NAPOLI, Domingos Guilherme; FRANCA, Francisco Faustino A. C.; FEITOSA-FILHO, Gilson Soares; SAAD, Jamil Abdalla; PILLI, Jeanne; PAULA, Leonardo Jorge Cordeiro de; LODI-JUNQUEIRA, Lucas; CESAR, Luis Antonio Machado; BODANESE, Luiz Carlos; GUTIERREZ, Marco Antonio; ALKMIM, Maria Beatriz Moreira; NUNES, Mauricio Batista; MEDEIROS, Orlando Otavio de; MORENO, Ramon Alfredo; GUNDIM, Rosangela Simoes; MONTENEGRO, Sergio Tavares; NAZIMA, Willyan Issamu