MILENA RIBEIRO PAIXAO
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- 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.
conferenceObject 18F-FDG PET/CT Findings vs. Histology of Surgically Resected Cardiac Valves in Patients With Infective Endocarditis.(2018) CAMARGO, Raphael A.; CASTELLI, Jussara B.; BITTENCOURT, Marcio S.; AYABE, Daniel; PAIXAO, Milena R.; FELICIO, Marilia F.; SOEIRO, Alexandre M.; GONCALVES, Luis Fernando T.; V, Tania Strabelli; SOARES JR., Jose; BUCHPIGUEL, Carlos A.; MANSUR, Alfredo J.; TARASOUTCHI, Flavio; OLIVEIRA JR., Mucio T.; MENEGHETTI, Claudio; GUALANDRO, Daniele M.; POCEBON, Lucas; BLANKSTEIN, Ron; ALAVI, Abass; SICILIANO, Rinaldo F.- The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis(2024) ALMEIDA, Bianca Leal de; STRABELLI, Tania Mara Varejao; BITTENCOURT, Marcio Sommer; OLIVEIRA, Vitor Falcao de; GUALANDRO, Danielle Menosi; MANSUR, Alfredo Jose; TARASOUCHI, Flavio; POCEBON, Lucas; PAIXAO, Milena; GOLDEMBERG, Flora; SALOMAO, Reinaldo; SICILIANO, Rinaldo FocacciaBackground: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. Methods: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as ""possible"" or ""definite"" endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. Results: The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522-0.681) and SOFA score 0.679 (CI95% 0.602-0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA >= 2 showed ROC curves of 0.627 (CI95% 0.563-0.690) and 0.775 (CI95% 0.594-0.956), respectively. Conclusions: qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient's death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.
bookPart Infecções de ferida operatória em cirurgias cardiovasculares(2018) PAIXãO, Milena Ribeiro; SICILIANO, Rinaldo FocacciabookPart Infecções de ferida operatória em cirurgias cardiovasculares(2015) PAIXãO, Milena Ribeiro; SICILIANO, Rinaldo FocacciabookPart Endocardite infecciosa(2018) SICILIANO, Rinaldo Focaccia; PAIXãO, Milena Ribeiro; GOLDSTEIN, Priscila Gherardi- Biomarkers for prediction of mortality in left-sided infective endocarditis(2020) SICILIANO, Rinaldo F.; GUALANDRO, Danielle M.; BITTENCOURT, Marcio Sommer; PAIXAO, Milena; MARCONDES-BRAGA, Fabiana; SOEIRO, Alexandre de Matos; STRUNZ, Celia; PACANARO, Ana Paula; PUELACHER, Christian; TARASOUTCHI, Flavio; SOMMA, Salvatore Di; CARAMELLI, Bruno; OLIVEIRA JUNIOR, Mucio Tavares de; MANSUR, Alfredo Jose; MUELLER, Christian; BARRETTO, Antonio Carlos Pereira; STRABELLI, Tania Mara VarejaoBackground: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis fator a (TNF-a), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P < 0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P = 0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P = 0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P = 0.018), TNF-alpha (OR 1.8; 95%CI 1.1-2.9; P = 0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P = 0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-alpha 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-alpha 0.554, CRP 0.759). Conclusion: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE. (C) 2020 The Authors.
bookPart Infecções de ferida operatória em cirurgias cardio(2018) PAIXãO, Milena Ribeiro; SICILIANO, Rinaldo FocacciabookPart Endocardite infecciosa(2018) SICILIANO, Rinaldo Focaccia; PAIXãO, Milena Ribeiro; GOLDSTEIN, Priscila Gherardi- The Role of F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Left-sided Endocarditis: Native vs Prosthetic Valves Endocarditis(2020) CAMARGO, Raphael Abegao de; BITENCOURT, Marcio Sommer; MENEGHETTI, Jose Claudio; JR, Jose Soares; GONCALVES, Luis Fernando Tonello; BUCHPIGUEL, Carlos Alberto; PAIXAO, Milena Ribeiro; FELICIO, Marilia Francesconi; SOEIRO, Alexandre de Matos; STRABELLI, Tania Mara Varejao; MANSUR, Alfredo Jose; TARASOUTCHI, Flavio; JR, Mucio Tavares de Oliveira; CASTELLI, Jussara Bianchi; GUALANDRO, Danielle Menosi; POCEBON, Lucas Zoboli; BLANKSTEIN, Ron; ALAVI, Abass; MOORE, John Edmund; MILLAR, Beverley Cherie; SICILIANO, Rinaldo FocacciaBackground: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of F-18-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). Methods: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. F-18-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and F-18-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. Results: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of F-18-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal F-18-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as ""possible"" to ""definite"" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only. Conclusions: Use of F-18-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of F-18-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.