ALEXANDRE DE MATOS SOEIRO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study
    (2019) NAKASHIMA, C. A. K.; DALLAN, L. A. O.; LISBOA, L. A. F.; HAJJAR, L. A.; SOEIRO, A. M.; SILVA, B. A.; COSTA, M. S. S.; DORNAS, C. J. C. B.; DALCOQUIO, T. F.; FURTADO, R. H. M.; BARACIOLI, L. M.; FUKUSHIMA, J. T.; GURBEL, P. A.; GIUGLIANO, R. P.; NICOLAU, J. C.
  • article 3 Citação(ões) na Scopus
    Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?
    (2019) SOEIRO, Alexandre de Matos; CASALE, Guilherme; LOPES, Maria Antonieta Albanez Albuquerque de Medeiros; GODOY, Lucas Colombo; BOSSA, Aline Siqueira; BISELLI, Bruno; LEAL, Tatiana de Carvalho Andreucci Torres; SOEIRO, Maria Carolina Feres de Almeida; SERRANO JR., Carlos V; OLIVEIRA JR., Múcio Tavares
    Abstract Background: There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel.
  • conferenceObject
    ACUTE PULMONAR EDEMA AND VENTRICULAR DYSFUNCTION DUE ADRENERGIC MYOCARDITIS ASSOCIATED TO PHEOCHROMOCYTOMA
    (2019) BORTOLOTTO, Luiz Aparecido; BORTOLOTTO, Alexandre L.; CASTRO, Rafael; SOUSA, Maria T. S.; SOEIRO, Alexandre; PEREIRA, Adelaide
  • article 34 Citação(ões) na Scopus
    Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes
    (2019) NAZERIAN, Peiman; MUELLER, Christian; VANNI, Simone; SOEIRO, Alexandre de Matos; LEIDEL, Bernd A.; CERINI, Gabriele; LUPIA, Enrico; PALAZZO, Andrea; GRIFONI, Stefano; MORELLO, Fulvio
    Aims The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation. Methods and results This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS <= 1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P<0.001), including 29 with AAS. ADD-RS <= 1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%). Conclusion FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.
  • article 0 Citação(ões) na Scopus
  • article 11 Citação(ões) na Scopus
    Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability
    (2019) NAZERIAN, Peiman; PIVETTA, Emanuele; VEGLIA, Simona; CAVIGLI, Edoardo; MUELLER, Christian; SOEIRO, Alexandre de Matos; LEIDEL, Bernd A.; LUPIA, Enrico; RUTIGLIANO, Claudia; WUSSLER, Desiree; GRIFONI, Stefano; MORELLO, Fulvio; CAPRETTI, Elisa; CERINI, Gabriele; PALAZZO, Andrea; TRAUSI, Federica; OTTAVIANI, Maddalena; BARON, Paolo; BIMA, Paolo; FASCIO, Paolo; GARABELLO, Domenica; BOEDDINGHAUS, Jasper; NESTELBERGER, Thomas; SOMMER, Gregor; TWERENBOLD, Raphael; BAUERF, Wolfgang; DAMBERGF, Anneke; PORALLAF, Lukas; TAUPITZI, Matthias; JR, Mucio Tavares de Oliveira
    Objectives Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pretest clinical probability is low. However, the diagnostic impact of CR integration for the rule-in and rule-out of AASs is unknown. Methods We performed a secondary analysis of the ADvISED multicenter study. Emergency department outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD-RS). CR was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME) and other signs. Results In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AASs. ADD-RS/ME and ADD-RS/any CR sign (aCRs) integration were more accurate than ADD-RS alone (area under the curve = 0.8 and 0.78 vs. 0.66, p < 0.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI] = 51.5% to 79.9%) and 82.5% (95% CI = 79.9% to 84.8%) for ADD-RS/ME and 68.8% (95% CI = 53.6% to 80.9%) and 76.5% (95% CI = 73.7% to 79.1%) for ADD-RS/aCRs, respectively. The sensitivity and specificity of CR per se were 54.2% (95% CI = 39.2% to 68.6%) and 92.4% (95% CI = 90.5% to 93.9%) for ME and 60.4% (95% CI = 45.3% to 74.2%) and 85.2% (95% CI = 82.9% to 87.4%) for aCRs. The agreement (kappa) between attending physicians and radiologists for ME was 0.44 (95% CI = 0.35 to 0.54). ADD-RS/ME rule-in (ADD-RS <= 1 and ME-present, or ADD-RS > 1) applied to 204 versus 130 patients with ADD-RS > 1, including 14 with AAS and 60 false-positives (FP). ADD-RS/aCRs rule-in (ADD-RS <= 1 and aCRs-present, or ADD-RS > 1) applied to 264 patients, including 15 with AAS and 119 FP. ADD-RS/ME rule-out (ADD-RS <= 1 and ME-absent) applied to 826 (80.2%) patients, including 16 with AAS (33.3% of cases). ADD-RS/aCRs rule-out (ADD-RS <= 1 and aCRs-absent) applied to 766 patients (74.4%), including 15 with AAS (31.3% of cases). Conclusions CR integration with clinical probability assessment showed modest rule-in efficiency and insufficient sensitivity for conclusive rule-out.
  • article 65 Citação(ões) na Scopus
    Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
    (2019) JR, Wilson Mathias; TSUTSUI, Jeane M.; TAVARES, Bruno G.; FAVA, Agostina M.; AGUIAR, Miguel O. D.; BORGES, Bruno C.; JR, Mucio T. Oliveira; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; CHIANG, Hsu Po; SBANO, Joao C. N.; MORAD, Abdulrahman; GOLDSWEIG, Andrew; ROCHITTE, Carlos E.; LOPES, Bernardo B. C.; RAMIREZ, Jose A. F.; KALIL FILHO, Roberto; PORTER, Thomas R.
    BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 +/- 22 g high MI/PCI vs. 40 +/- 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 +/- 11% vs. 43 +/- 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF <= 30%) was reducedin the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (C) 2019 by the American College of Cardiology Foundation.
  • conferenceObject
    Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction
    (2019) AGUIAR, Miguel O.; TSUTSUI, Jeane; TAVARES, Bruno G.; LOPES, Bernardo B. C.; NICOLAU, Jose; CHIANG, Hsu Po; PORTER, Thomas; BORGES, Bruno Carter C.; SOEIRO, Alexandre; OLIVEIRA JR., Mucio T.; ROCHITTE, Carlos; RAMIRES, Jose A. F.; KALIL, Roberto; MATHIAS, Wilson
  • article 87 Citação(ões) na Scopus
    Effect of a Strategy of Comprehensive Vasodilation vs Usual Care on Mortality and Heart Failure Rehospitalization Among Patients With Acute Heart Failure The GALACTIC Randomized Clinical Trial
    (2019) KOZHUHAROV, Nikola; GOUDEV, Assen; FLORES, Dayana; MAEDER, Micha T.; WALTER, Joan; SHRESTHA, Samyut; GUALANDRO, Danielle Menosi; OLIVEIRA JUNIOR, Mucio Tavares de; SABTI, Zaid; MUELLER, Beat; NOVEANU, Markus; SOCRATES, Thenral; ZILLER, Ronny; BAYES-GENIS, Antoni; SIONIS, Alessandro; SIMON, Patrick; MICHOU, Eleni; GUJER, Samuel; GORI, Tommaso; WENZEL, Philip; PFISTER, Otmar; CONEN, David; KAPOS, Ioannis; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; MUENZEL, Thomas; ERNE, Paul; MUELLER, Christian; DIMOV, Bojidar; HARTWIGER, Sabine; HERR, Natascha; ISENRICH, Rahel; MOSIMANN, Tamina; TWERENBOLD, Raphael; BOEDDINGHAUS, Jasper; NESTELBERGER, Thomas; PUELACHER, Christian; FREESE, Michael; VOGELE, Janine; MEISSNER, Kathrin; MARTIN, Jasmin; STREBEL, Ivo; WUSSLER, Desiree; SCHUMACHER, Carmela; OSSWALD, Stefan; VOGT, Fabian; HILTI, Jonas; SCHWARZ, Jonas; FITZE, Brigitte; HARTWIGER, Sabine; ARENJA, Nisha; GLATZ, Bettina; RENTSCH, Katharina; BOSSA, Aline; JALLAD, Sergio; SOEIRO, Alexandre; JANSEN, Thomas; GEBEL, Gabriele; BOSSARD, Matthias; CHRIST, Michael
    IMPORTANCE Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). OBJECTIVE To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100mmHg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. INTERVENTIONS Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. MAIN OUTCOMES AND MEASURES The primary end pointwas a composite of all-cause mortality or rehospitalization for AHF at 180 days. RESULTS Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P =.59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). CONCLUSIONS AND RELEVANCE Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.
  • article 30 Citação(ões) na Scopus
    Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019
    (2019) BERNOCHE, Claudia; TIMERMAN, Sergio; POLASTRI, Thatiane Facholi; GIANNETTI, Natali Schiavo; SIQUEIRA, Adailson Wagner da Silva; PISCOPO, Agnaldo; SOEIRO, Alexandre de Matos; REIS, Amelia Gorete Afonso da Costa; TANAKA, Ana Cristina Sayuri; THOMAZ, Ana Maria; QUILICI, Ana Paula; CATARINO, Andrei Hilario; RIBEIRO, Anna Christina de Lima; BARRETO, Antonio Carlos Pereira; AZEVEDO FILHO, Antonio Fernando Barros de; PAZIN FILHO, Antonio; TIMERMAN, Ari; SCARPA, Bruna Romanelli; TIMERMAN, Bruno; TAVARES, Caio de Assis Moura; MARTINS, Cantidio Soares Lemos; SERRANO JUNIOR, Carlos Vicente; MALAQUE, Ceila Maria Sant'Ana; PISANI, Cristiano Faria; BATISTA, Daniel Valente; LEANDRO, Daniela Luana Fernandes; SZPILMAN, David; GONCALVES, Diego Manoel; PAIVA, Edison Ferreira de; OSAWA, Eduardo Atsushi; LIMA, Eduardo Gomes; ADAM, Eduardo Leal; PEIXOTO, Elaine; EVARISTO, Eli Faria; AZEKA, Estela; SILVA, Fabio Bruno da; WEN, Fan Hui; FERREIRA, Fatima Gil; LIMA, Felipe Gallego; FERNANDES, Felipe Lourenco; GANEM, Fernando; GALAS, Filomena Regina Barbosa Gomes; TARASOUTCHI, Flavio; SOUZA, Germano Emilio Conceicao; FEITOSA FILHO, Gilson Soares; FORONDA, Gustavo; GUIMARAES, Helio Penna; ABUD, Isabela Cristina Kirnew; LEITE, Ivanhoe Stuart Lima; LINHARES FILHO, Jaime Paula Pessoa; MORAES JUNIOR, Joao Batista de Moura Xavier; FALCAO, Joao Luiz Alencar de Araripe; RAMIRES, Jose Antonio Franchini; CAVALINI, Jose Fernando; SARAIVA, Jose Francisco Kerr; ABRAO, Karen Cristine; PINTO, Lecio Figueira; BIANCHI, Leonardo Luis Torres; LOPES, Leonardo Nicolau Geisler Daud; PIEGAS, Leopoldo Soares; KOPEL, Liliane; GODOY, Lucas Colombo; TOBASE, Lucia; HAJJAR, Ludhmila Abrahao; DALLAN, Luis Augusto Palma; CANEO, Luiz Fernando; CARDOSO, Luiz Francisco; CANESIN, Manoel Fernandes; PARK, Marcelo; RABELO, Marcia Maria Noya; MALACHIAS, Marcus Vinicius Bolivar; GONCALVES, Maria Aparecida Batistao; ALMEIDA, Maria Fernanda Branco de; SOUZA, Maria Francilene Silva; FAVARATO, Maria Helena Sampaio; CARRION, Maria Julia Machline; GONZALEZ, Maria Margarita; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MACATRAO-COSTA, Milena Frota; SHIMODA, Monica Satsuki; OLIVEIRA-JUNIOR, Mucio Tavares de; IKARI, Nana Miura; DUTRA, Oscar Pereira; BERWANGER, Otavio; PINHEIRO, Patricia Ana Paiva Correa; REIS, Patricia Feitosa Frota dos; CELLIA, Pedro Henrique Moraes; SANTOS FILHO, Raul Dias dos; GIANOTTO-OLIVEIRA, Renan; KALIL FILHO, Roberto; GUINSBURG, Ruth; MANAGINI, Sandrigo; LAGE, Silvia Helena Gelas; YEU, So Pei; FRANCHI, Sonia Meiken; SHIMODA-SAKANO, Tania; ACCORSI, Tarso Duenhas; LEAL, Tatiana de Carvalho Andreucci; GUIMARAES, Vanessa; SALLAI, Vanessa Santos; AVILA, Walkiria Samuel; SAKO, Yara Kimiko