ALEXANDRE DE MATOS SOEIRO

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

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  • conferenceObject
    Suspected Acute Coronary Syndrome With Normal Coronary Arteries: The Value of Cardiac Magnetic Resonance in Changes of Treatment
    (2015) SOEIRO, Alexandre M.; NAKAMURA, Debora Y.; LEAL, Tatiana C.; BOSSA, Aline S.; SOEIRO, Maria C.; SERRANO JR., Carlos V.; OLIVEIRA JR., Mocio T.
  • conferenceObject
    Breath acetone changes in advanced heart failure patients on inotropes
    (2023) COSTA-DAN, D. M.; BACAL, F.; LIRA, C. N. L.; FURLAN, D. A. G.; SILVA, B. G.; RINCO, R. S.; SOIERO, A. M.; LEAL, T. C. A. T.; AVILA, M. S.; BISELLI, B.; BOCCHI, E. A.; SOARES, P. R.; OLIVEIRA JUNIOR, M. T.; GUTZ, I. G. R.; MARCONDES-BRAGA, F. G.
  • article 41 Citação(ões) na Scopus
    Nitazoxanide superiority to placebo to treat moderate COVID-19-A Pilot prove of concept randomized double-blind clinical trial
    (2021) BLUM, Vinicius Fontanesi; CIMERMAN, Sergio; HUNTER, James R.; TIERNO, Paulo; LACERDA, Acioly; SOEIRO, Alexandre; CARDOSO, Florentino; BELLEI, Nancy Cristina; MARICATO, Juliana; MANTOVANI, Nathalia; VASSAO, Marcella; DIAS, Danilo; GALINSKAS, Juliana; JANINI, Luis Mario Ramos; SANTOS-OLIVEIRA, Joanna Reis; DA-CRUZ, Alda Maria; DIAZ, Ricardo Sobhie
    Background: The absence of specific antivirals to treat COVID-19 leads to the repositioning of candidates' drugs. Nitazoxanide (NTZ) has a broad antiviral effect. Methods: This was a randomized, double-blind pilot clinical trial comparing NTZ 600 mg BID versus Placebo for seven days among 50 individuals (25 each arm) with SARS-COV-2 RT-PCR+ (PCR) that were hospitalized with mild respiratory insufficiency from May 20th, 2020, to September 21st, 2020 (ClinicalTrials.gov NCT04348409). Clinical and virologic endpoints and inflammatory biomarkers were evaluated. A five-point scale for disease severity (SSD) was used. Findings: Two patients died in the NTZ arm compared to 6 in the placebo arm (p = 0.564). NTZ was superior to placebo when considering SSD (p < 0001), the mean time for hospital discharge (6.6 vs. 14 days, p = 0.021), and negative PCR at day 21 (p = 0.035), whereas the placebo group presented more adverse events (p = 0.04). Among adverse events likely related to the study drug, 14 were detected in the NTZ group and 22 in placebo (p = 0.24). Among the 30 adverse events unlikely related, 21 occurred in the placebo group (p = 0.04). A decrease from baseline was higher in the NTZ group for D-Dimer (p = 0.001), US-RCP (p < 0.002), TNF (p < 0.038), IL-6 (p < 0.001), IL-8 (p = 0.014), HLA DR. on CD4(+) T lymphocytes (p < 0.05), CD38 in CD4(+) and CD8(+) T (both p < 0.05), and CD38 and HLA-DR. on CD4(+) (p < 0.01) Interpretation: Compared to placebo in clinical and virologic outcomes and improvement of inflammatory out-comes, the superiority of NTZ warrants further investigation of this drug for moderate COVID-19 in larger clinical trials. A higher incidence of adverse events in the placebo arm might be attributed to COVID-19 related symptoms. (C) 2021 The Authors.
  • article 0 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus
    Nitazoxanide superiority to placebo to treat moderate COVID-19 - A Pilot prove of concept randomized double-blind clinical trial (vol 37, 100981, 2021)
    (2021) BLUM, Vinicius Fontanesi; CIMERMAN, Sergio; HUNTER, James R.; TIERNO, Paulo; LACERDA, Acioly; SOEIRO, Alexandre; CARDOSO, Florentino; BELLEI, Nancy Cristina; MARICATO, Juliana; MANTOVANI, Nathalia; VASSAO, Marcella; DIAS, Danilo; GALINSKAS, Juliana; JANINI, Luis Mario Ramos; SANTOS-OLIVEIRA, Joanna Reis; DA-CRUZ, Alda Maria; DIAZ, Ricardo Sobhie
  • article 0 Citação(ões) na Scopus
    The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis
    (2023) SOEIRO, Alexandre M.; BOSSA, Aline S.; CESAR, Maria C.; LEAL, Tatiana C. A. T.; GARCIA, Guilherme; FONSECA, Rafael A.; NAKAMURA, Debora; GUIMARAES, Patricia O.; SOEIRO, Maria C. F. A.; JR, Carlos V. Serrano; SOARES, Paulo R.; MUELLER, Christian; MEBAZAA, Alexandre; FERNANDES, Fabio; NOMURA, Cesar H.; ROCHITTE, Carlos E.; JR, Mucio T. de Oliveira
    IntroductionThe role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methodsThis was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. ResultsThe mean follow-up was 18.7 & PLUSMN; 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. ConclusionMeasurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
  • conferenceObject
    Early Biomarkers to Predict a Worse Outcome After Acute Myocardial Infarction: Circulating Infectious Extracellular Vesicles From Archaea and M. Pneumoniae Are Present and Correlated to Cytokines IL-6 and IL-10
    (2022) MORENO, Camila R.; SOEIRO, Alexandre M.; SATO, Maria N.; PEREIRA, Jaqueline J.; IKEGAMI, Renata N.; KAWAKAMI, Joyce T.; REIS, Marcia M.; OLIVEIRA, Luanda M.; HIGUCHI, Maria Lourdes
  • article 2 Citação(ões) na Scopus
    Morphomolecular Characterization of Serum Nanovesicles From Microbiomes Differentiates Stable and Infarcted Atherosclerotic Patients
    (2021) MORENO, Camila Rodrigues; RAMIRES, Jose Antonio Franchini; LOTUFO, Paulo Andrade; SOEIRO, Alexandre Matos; OLIVEIRA, Luanda Mara da Silva; IKEGAMI, Renata Nishiyama; KAWAKAMI, Joyce Tiyeko; PEREIRA, Jaqueline de Jesus; REIS, Marcia Martins; HIGUCHI, Maria de Lourdes
    Microbial communities are considered decisive for maintaining a healthy situation or for determining diseases. Acute myocardial infarction (AMI) is an important complication of atherosclerosis caused by the rupture of atheroma plaques containing proinflammatory cytokines, reactive oxygen species, oxidized low-density lipoproteins (oxLDL), damaged proteins, lipids, and DNA, a microenvironment compatible with a pathogenic microbial community. Previously, we found that archaeal DNA-positive infectious microvesicles (iMVs) were detected in vulnerable plaques and in the sera of Chagas disease patients with heart failure. Now, we characterize and quantify the levels of serum microbiome extracellular vesicles through their size and content using morphomolecular techniques to differentiate clinical outcomes in coronary artery disease (CAD). We detected increased numbers of large iMVs (0.8-1.34 nm) with highly negative surface charge that were positive for archaeal DNA, Mycoplasma pneumoniae antigens and MMP9 in the sera of severe AMI patients, strongly favoring our hypothesis that pathogenic archaea may play a role in the worst outcomes of atherosclerosis. The highest numbers of EVs <100 nm (exosomes) and MVs from 100 to 200 nm in the stable atherosclerotic and control healthy groups compared with the AMI groups were indicative that these EVs are protective, entrapping and degrading infectious antigens and active MMP9 and protect against the development of plaque rupture. Conclusion: A microbiome with pathogenic archaea is associated with high numbers of serum iMVs in AMI with the worst prognosis. This pioneering work demonstrates that the morphomolecular characterization and quantification of iEVs in serum may constitute a promising serum prognostic biomarker in CAD.
  • article 1 Citação(ões) na Scopus
    The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction
    (2023) CHIANG, Hsu Po; AGUIAR, Miguel O. D.; TAVARES, Bruno G.; ROSA, Vitor E. E.; GOMES, Sergio Barros; OLIVEIRA, Mucio T.; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; SBANO, Joao C.; ROCHITTE, Carlos E.; FILHO, Roberto Kalil; RAMIRES, Jose A. F.; PORTER, Thomas R.; MATHIAS, Wilson; TSUTSUI, Jeane M.
    Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous micro -bubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. Methods: One hundred patients (59 +/- 10 years; 34% women) were randomized to receive either high mechan-ical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were clas-sified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS).Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incre-mentally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% +/- 7.3% in the therapy group versus 19.6% +/- 7.2% in the control group, P = .005; at 1 month, 25.3% +/- 6.3% in the ther-apy group versus 21.5% +/- 8.3% in the control group, P = .020; and at 6 months, 26.2% +/- 8.7% in the therapy group versus 21.6% +/- 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006).Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodel-ing. (J Am Soc Echocardiogr 2023;36:504-13.)
  • article 0 Citação(ões) na Scopus
    Tocilizumab in SARS-COVID19 following postoperative laparoscopic transhiatal esophagectomy for the adenocarcinoma of esophagogastric tumor: A case report
    (2021) TAKEDA, Flavio Roberto; MUNIZ, Renan Rosetti; FONSECA, Silvia Moulin Ribeiro; SOEIRO, Alexandre de Matos; ABREU, Barbara Seffair de Castro de; LITVOC, Marcelo Nobrega
    Introduction and importance: Esophagectomy for esophageal cancer is one of the most challenging surgical procedures, with high rates of morbidity, especially from respiratory complications. SARS-COVID19 represents a health threat nowadays. Peri-operative SARS-COVID19 infection after esophagectomy might negatively affect the postoperative outcomes. The use of tocilizumab as an alternative to reduce the inflammatory response in SARS-COVID19 is an option that has not been described in the literature after esophagectomy. Case presentation: A SARS-COVID19-vaccinated (CORONAVAC) 73-year-old man with pulmonary emphysema, coronary artery disease, previous asymptomatic pulmonary embolism, and adenocarcinoma of the esophagogastric junction tumor was submitted to laparoscopic transhiatal esophagectomy (ypT2N0M0) after perioperative neoadjuvant chemotherapy. He was also infected with SARS-COVID19, confirmed by PCR test at the 14th postoperative day. During follow-up, mild hypoxemia persisted without evidence of infection except for SARS-COVID19, and a high-flow cannula was required to maintain oxygenation. Tocilizumab was administered following high parameters of a high-flow cannula, and invasive mechanical ventilation was avoided. Discussion: Besides of the risk of secondary infection, after administration of tocilizumab, the parameters of oxygen supplementation were systematically reduced, and he stayed in the ICU for seven days. He was discharged from the ward six days later. He developed late cervical anastomotic leakage, which was treated with conservative therapy. Conclusion: Although the patient had high-risk comorbidities, esophagectomy, and SARS-COVID19 infection, the use of tocilizumab was safe and improved the pulmonary recovery.