NOEDIR ANTONIO GROPPO STOLF
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Quality of life and physical capacity after long-term right ventricular pacing in young adults with congenital atrioventricular block(2012) SILVA, K. R.; COSTA, R.; OLIVEIRA JR., R. M.; MARTINELLI FILHO, M.; LACERDA, M. S.; HUANG, A.; ROSSI, M. B.; MATHIAS JR., W.; PIETROBON, R.; STOLF, N. A. G.Background: Although several studies have demonstrated the deleterious consequences of chronic right ventricular (RV) pacing on ventricular function and synchronicity, its effects on health-related quality of life (HRQL) and physical capacity remains uncertain. Objectives: To evaluate the effect of RV pacing on HRQL and physical capacity of children and young adults with congenital complete atrioventricular (AV) block. Methods: Fifty consecutive patients with permanent RV cardiac pacing due to congenital AV block and under clinical follow-up for more than one year were enrolled. Multidimensional HRQL was assessed with the Short Form-36 Health Survey (SF-36) and Child Health Questionnaire (CHQ-PF50). Physical capacity was tested by the 6-minute walk distance test (6MWD). The scores for each domain and the distance performed at the 6MWD test were compared with demographic and clinical characteristics of patients, using the Student’s t-test and Qui-squaretest. Results: Domains presenting lower scores were Vitality (63.0±20.6), Pain(66.5±25.1) and Mental Health (67.3±20.4) in the SF-36 questionnaire; General Health Perceptions (64.0±15.0) and Parental Impact-Emotional (69.0±30.0) in the CHQ-PF50. Female gender (P=0.026), DDD pacing mode (0.008) and normal left ventricular ejection fraction (0.002) were associated with higher quality of life scores. The average distance performed at the 6MWD test was 677,2 meters (454,5 to 852,8). The 6MWD showed significant association with age (P=0.004), normal ventricular function (P= 0.031) and the absence of cardiovascular drugs use (P= 0.018). Conclusions: The results of this analysis indicated that chronic RV pacing did not affect the HRQL and physical capacity of young patients. Female gender, DDD pacing, normal ventricular function and the absence of cardiovascular medications were associated with better HRQL scores and with better results at 6MWD test.conferenceObject Comparative Study between Cavopulmonary Anastomosis Associated with Left Ventricular Assist Device Support and Biventricular Circulatory Assistance in Acute Biventricular Failure(2012) SANTOS, L. A. S.; MOREIRA, L. F. P.; BENICIO, A.; CESTARI, I.; MATTOS JR., E.; STOLF, N. G.Purpose: Right ventricular failure during left ventricular assist device (LVAD) support can result in severe hemodynamic compromise with high mortality. This study investigated the acute effects of cavopulmonary anastomosis on LVAD performance and right ventricular myocardial compromise in comparison with biventricular circulatory support, in a model of severe biventricular failure. Methods and Materials: LVAD support was performed by means of centrifugal pump implantation in 21 anesthetized pigs (20-30 kg) with biventricular failure obtained by ventricular fibrillation induction. Animals were randomized to be submitted to modified cavopulmonary anastomosis, to biventricular circulatory support or to control group. They were maintained under circulatory support and hemodynamic monitoring for 3h. Venous lactate and cytokines serum levels were also determined. Endocardium samples of the ventricles were collected and analyzed by electronic microscopy. Results: Ventricular fibrillation was responsible for acute LVAD performance impairment after 180 min in the control group. Cavopulmonary anastomosis resulted in non-significant improvement of LVAD pump flow in relation to control group (+55±14 ml/kg/min, p=0.072), while animals under biventricular support maintained higher LVAD flow performance (+93±17 ml/kg/min, p=0.012). Mean arterial pressure remained constant only in biventricular group (p<0.001), which also presented significant decrease of right atrial and ventricular pressures. Similar increases in lactate and cytokines levels were observed in the three groups. Ultrastructural analysis documented the presence of higher levels of myocardial mitochondrial swelling in control group (p=0.018). Conclusions: Concomitant use of cavopulmonary anastomosis during LVAD support in a pig model of severe biventricular failure resulted in non-significant improvement of hemodynamic performance and it did not effectively replace the use of biventricular support.conferenceObject Computed Tomography Evaluation of Adamkiewicz Artery in Patients With and Without Aortic Disease(2016) AMATO, Alexandre C. M.; PARGA FILHO, Jose R.; STOLF, Noedir A. G.conferenceObject PERFORMANCE OF LEFT VENTRICULAR EJECTION FRACTION ON PATIENTS WITH STABLE MULTIVESSEL CORONARY DISEASE SUBMITTED TO MEDICINE, ANGIOPLASTY OR SURGERY: 10 YEARS FOLLOW-UPFROM MASS II TRIAL(2012) GARZILLO, Cibele L.; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; FAVARATO, Desiderio; SOARES, Paulo; HUEB, Alexandre Ciappina; STOLF, Noedir A. G.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are assumed as effective therapeutic options for the protection of the ischemic myocardium. However, it is not established if those procedures are effective for left ventricular ejection fraction (LVEF) preservation. In this setting, we evaluated the evolution of LVEF in patients with stable multivessel coronary disease, submitted to CABG, PCI or medical treatment (MT) alone, after ten years of follow-up. Methods Echocardiography was performed on patients participants of MASS II trial, previously to randomization for CABG, PCI or MT, and after 10 years. LVEF was measured by the biplane method (Simpson), when regional wall-motion abnormalities were present, or by the Teichholz method. Results After a follow-up of 10.32 (±1.43) years, 350 patients had LVEF reassessed: 108 patients on MT, 111 on CABG and 131 on PCI group. Main baseline characteristics and the occurrence of AMI were similar among the three groups. There was no difference of LVEF either at the beginning (0.61 + 0.07, 0.61 + 0.08 e 0.61 + 0.09 respectively for PCI, CABG and MT, p=0.675) and the end of follow up (0.56 + 0.11, 0.55 + 0.11 e 0.55 + 0.12 respectively for PCI, CABG and MT, p=0.675). The impact of other variables over LVEF evolution, such as gender, age, diabetes and arterial pattern, were also analyzed, and no relevance was demonstrated. However, the presence of previous AMI (OR 2.50, 95% CI 1.40-4.45; p= 0.0007) and the occurrence of AMI during follow up (OR 2.73, 95% IC 1.25-5.92; p=0.005) were associated with an increased risk of developing LVEF < 45%. Also, AMI during follow-up was responsible for a greater reduction of LVEF (reduction delta of 18.29 ± 21.22% and 6.63 ± 18.91%, respectively for patients with and without AMI, p=0.001). Conclusion Thus, compared with PCI or CABG patients, patients in the medical group with unprotected coronary artery disease by mechanical revascularization without adverse cardiac events showed no differences in the left ventricular function after 10 years of follow up. Moreover, whatever of interventional therapeutic strategies applied, the left ventricular function remained unchanged in absence of MACE. ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m. Session Title: Fresh CABG: Good for SIHD? Abstract Category: 3. Chronic CAD/Stable Ischemic Heart Disease: Therapy Presentation Number: 1208-410conferenceObject Evolution of left ventricular ejection fraction in patients with multivessel coronary heart disease submitted to 3 therapeutic strategies: 10 years follow-up(2012) GARZILLO, C. L.; HUEB, W.; LIMA, E. G.; REZENDE, P. C.; FAVARATO, D.; SOARES, P. R.; HUEB, A. C.; STOLF, N. A. G.; RAMIRES, J. A. F.; KALIL FILHO, R.Background: Coronary artery bypassgraft (CABG) and percutaneous coronary intervention (PCI) are assumed aseffective therapeutic options for the protection of the ischemic myocardium. However, it is not established if those procedures are mandatory for leftventricular ejection fraction (LVEF) preservation. In this setting, weevaluated the evolution of LVEF in patients with chronic multivessel coronary- heart disease, submitted to CABG, PCI or medical treatment (MT) alone, after afollow-up of ten years. Methods: Echocardiography wasperformed on patients participants of MASS II trial, previously to randomizationfor CABG, PCI or MT, and after 10 years. LVEF was measured by the biplanemethod (Simpson) preferably, but on obligatory basiswhen regional wall-motion abnormalities were present, or alternatively by the Teichholz method. Results: After afollow-up of 10,32 (±1.43)years, 350 patients had LVEF reassessed: 108 patientson MT, 111 on CABG and 131 on PCI group. Main baseline characteristics and theoccurrence of AMI were similar among the three groups. There was no difference of LVEF either at the beginning (0,61 + 0,07, 0,61 + 0,08 e 0,61 +0,09 respectively for PCI, CABG and MT, p=0,675) and the end of follow up (0,56+ 0,11, 0,55 + 0,11 e 0,55 + 0,12 respectively for PCI,CABG and MT, p=0,675). The impact ofother variables over LVEF evolution, such as gender, age, diabetes and arterial pattern, were also analyzed, and no relevance was demonstrated. However, the presence of previous AMI (OR 2.50, 95% CI 1.40- 4.45; p= 0.0007) and theoccurrence of AMI during follow up (OR 2.73, 95% IC 1.25-5.92; p=0,005) were associated with an increased risk of developing LVEF < 45%. Also, AMIduring follow-up was responsible for a greater reduction of LVEF (reductiondelta of 18,29 ± 21,22% and 6,63 ± 18,91%, respectively for patients with andwithout AMI, p=0.001). Conclusion: In this study, the evolution of ventricular function on patients of MT-group, with unprotected coronary heart disease, was similar to those withme-chanical revascularization, either by PCI or CABG. Besides, irrespective ofthe therapeutic strategy applied, the occurrence of AMI was responsible for agreater decrease of LVEF.conferenceObject Expression of SMAD proteins, intracellular effectors of TGF-beta signalling, in non-Marfan patients with thoracic aortic aneurysms and dissections(2012) GUTIERREZ, P. S.; APARECIDA-SILVA, R.; BORGES, L. F.; MOREIRA, L. F. P.; DIAS, R. R.; KALIL, J.; STOLF, N. A. G.Introduction a role for TGF-beta (TGFb) in thoracic aortic aneurysms and dissections (TAAD) has been evidenced by many studies. For example, around 5% of TAAD patients present Marfan's syndrome (MFS), in which there is a defect in fibrillin, that regulates TGFb signalling. Nevertheless, most TAAD patients have no known syndrome, but rather systemic arterial hypertension (SAH); other alterations in TGFb pathway might be involved in those cases. In this study, we analysed the expression of SMAD proteins, a family of intracellular effectors of TGFb signalling, in TAAD patients without MFS. Since aortic dissections occur always at the external half of the medial layer, we compared both halves. Patients and methods Five micrometre-thick sections of ascending aorta samples obtained at surgery were submitted to immunoperoxidase reactions to detect SMAD-2, -3, -4, and -7. The positive and total cells were counted in each half of the medial layer in the aortas from 10 patients with ascending aorta aneurysms, 10 with aortic dissections (all without MFS, most with SAH), 8 control cases (patients submitted to coronary artery bypass surgery) with SAH, and 9 control cases without SAH. The positive/ total cell ratios in each half of the media were compared by two-way repeated measure ANOVA after ranking transformation (since the distribution was not normal), and Bonferroni t-test as post-hoc test both in all these 4 groups and considering the cases as only two groups (patients with TAAD versus controls). Significance was established in p < or = 0.05. Results No significant difference was detected between halves for any SMAD. No difference was also found considering separately the 4 groups; however, when analyzing TAAD as a whole (table), the expression of SMAD 4 was significantly increased in comparison with controls (p=0.02). Conclusion an increase in SMAD 4 protein, one of the intracellular effectors of TGFb, may be related to TAAD. TAAD Controls p SMAD 2 0.84 0.86 0.61 SMAD 3 0.62 0.63 0.72 SMAD 4 0.95 0.87 0.02 SMAD 7 0.95 0.95 0.61 Abstract P410 figure Medians for SMAD proteins positive cell/total cell ratio at the medial layer of thoracic aortas with aneurysms or dissections (TAAD) and controlsconferenceObject CLINICAL DIAGNOSES AND AUTOPSY FINDINGS AFTER HEART TRANSPLANTATION: DISCREPANCIES AFFECTING MANAGEMENT AND SURVIVAL - NEHTS STUDY (NECROPSY HEART TRANSPLANTATION STUDY)(2012) BOCCHI, Edimar Alcides; VALETTE, Thiago Ninck; AYUB-FERREIRA, Silvia Moreira; ISSA, Victor; BENVENUTI, Luiz Alberto; BACAL, Fernando; FIORELLI, Alfredo Inacio; CHIZZOLA, Paulo; SOUZA, Germano; POMERANTZEFF, Pablo; STOLF, NoedirBackground: Discrepancies between clinical and autopsy diagnosis of causes of death (COD) and its consequences in the management of patients were not evaluated after heart transplantation (HT). Objective: To identify discrepancies between clinical COD and autopsy results. Methods: We studied retrospectively 48 autopsies of HT receptors from 2000 to 2010 (39% of the deaths). We used the Goldman classification to study the discrepancies. Results: 31.3% missed major diagnosis with potential adverse impact on survival and that would have changed management (Class I), 2.1% missed major and minor diagnosis without potential adverse impact on survival and that would have not changed management (Class II and III), 60.4%absolute agreement (Class V), and 6,3% uncertain autopsy diagnosis (Class VI). The main discrepancies between autopsy and clinical COD and missed diagnosis were errors in the diagnosis of causes of transplanted organ dysfunction (40%), acute humoral rejection (20%), cardiac allograft disease (20%), pulmonary embolism (6.7%), disseminated intravascular coagulation (6.7%), and causes of shock (6,7%). Conclusions: This study found significant discrepancies with potential impact on therapy and outcome of HT patients. This reinforces the importance of the postmortem examination in confirming diagnostic accuracy and improving the quality of care of HT patients.