LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
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conferenceObject Echocardiographic findings of Trypanosoma cruzi seropositive blood donors(2017) SALEMI, V. M. C.; OLIVEIRA, C. D. L.; RIBEIRO, A. L.; MENEZES, M. M.; ANTUNES, A. P.; FERREIRA-FILHO, J. C.; SACHDEV, V.; FERNANDES, F.; NASTARI, L.; IANNI, B. M.; MADY, C.; CARNEIRO-PROIETTI, A. B.; KEATING, S. M.; BUSCH, M. P.; SABINO, E. G.- Electrocardiographic Abnormalities in Trypanosoma cruzi Seropositive and Seronegative Former Blood Donors(2013) RIBEIRO, Antonio L.; SABINO, Ester C.; MARCOLINO, Milena S.; SALEMI, Vera M. C.; IANNI, Barbara M.; FERNANDES, Fabio; NASTARI, Luciano; ANTUNES, Andre; MENEZES, Marcia; OLIVEIRA, Claudia Di Lorenzo; SACHDEV, Vandana; CARRICK, Danielle M.; BUSCH, Michael P.; MURPHY, Eduard L.Background: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. Objectives: To assess the frequency of ECG abnormalities in T. cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. Methods: The study retrospectively enrolled 499 seropositive blood donors in Sao Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF), 0.50%. Results: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159, p<0.0003, and -0.142, p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. Conclusions: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.
conferenceObject Lack of Effect of Simvastatin on Structural Remodeling in Animal Model of Chagas Cardiomyopathy(2012) IANNI, Barbara M.; RAMIRES, Felix J. A.; SALEMI, Vera M. C.; FERNANDES, Fabio; OLIVEIRA, Adriana M.; PESSOA, Fernanda G.; FONSECA, Keila C. B.; ARTEAGA, Edmundo; NASTARI, Luciano; MADY, CharlesPurpose: Chagas cardiomyopathy(CM) is characterized by a large amount of fibrosis and inflamation. As simvastatin (simva) has anti-inflamatory effects, we hypothetized that it could be an important drug in the treatment of patients with CM. The purpose was to evaluate simva in the myocardium remodeling and inflammation in na animal model of CM. Methods: 123 hamsters were divided: C-controls(25), CSimva-controls with simva 10mg/Kg/day(25), Simva1-infected treated from beginning with the same dose of simva(25), Simva2-infected treated after 4 months(24); Infect-untreated(24). Follow-up of 10 months. Interstitial collagen volume fraction (ICVF) RV and LV measured using videomorphometry and picrosirius red stained heart. Metalloproteinase9 (MMP9) was obtained by zymography. Gene expression of TNFalpha, IFNgamma, IL10 by real time PCR and ΔCt. Survival by Kaplan-Meier and log rank. Comparison between groups by Kruskal-Wallis; p≤0.05. Results: Infected animals Simva1=189±133 days Simva2=150±124; Infect=138±123) lived less than controls (C=257±80; CSimva=283±58)(p≤0.05) with no difference among infected. ICVF-RV(%) was greater in infected groups (Simva1=3.88±1.14, Simva2=2.22±0.64; Infect=4.38±0.83) than in controls C=1.12±0.31; CSimva=2.18±0.73)(p≤0.05)with no difference among infected groups. ICVF-LV(%) was greater in infected animals (Simva1=1.83±1.01, Simva2=1.52±0.93; Infect=3.01±0.66) than in controls (C=0.68±0.31; CSimva=0.81±0.28)(p≤0.05) with no difference among infected. MMP9 was higher in infected groups (Simva1=2394±2441, Simva2=5673±4091; Infect=2392±2042) compared to controls (C=954±2332; CSimva=454±1123)(p≤0.05) with no difference among infected. TNFalpha did not have difference among infected groups (Simva1=5.33±3.66, Simva2=4.44±2.17; Infect=6.13±3.24). IFNgamma in infected groups (Simva1=5.47±3.56, Simva2=4.46±2.08; Infect=4.21±2.09) was higher than in controls (C=8.50±2.59; CSimva=6.84±2.53)(p≤0.05) with no difference among infected. IL10 in infected animals (Simva1=9.07±4.62, Simva2=7.76±4.77; Infect=8.11±4.48) did not have difference and the values were greater than controls (C=14.11±4.40; CSimva=12.55±3.90)(p≤0.05). Conclusions: Simva did not attenuate deposition of interstitial collagen, did not change dynamics of collagen degradation, did not decrease inflammation, and did not reduce mortality.article 5 Citação(ões) na Scopus Tratamento de lesão de tronco da artéria coronária esquerda após radioterapia do tórax(2011) SALEMI, Vera Maria Cury; DABARIAN, Andre L.; NASTARI, Luciano; GAMA, Marcus; SOARES JUNIOR, Jose; MADY, CharlesPrevention of late cardiovascular complications after radiation therapy (RT) for treatment of a malignant tumor is challenging. We report the case of a young male patient with Hodgkin's lymphoma treated with RT, who developed ischemic heart disease during follow-up, although he had no cardiovascular risk factors. We conclude that patients undergoing RT who experience chest pain should be fully investigated for coronary artery disease.- Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era(2021) QUEIROZ, Claudio Martins de; CARDOSO, Juliano; RAMIRES, Felix; IANNI, Barbara; HOTTA, Viviane Tiemi; MADY, Charles; BUCK, Paula de Cassia; DIAS, Ricardo Ribeiro; NASTARI, Luciano; FERNANDES, FábioAbstract Background: Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed. Objectives: To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade. Materials and methods: Patients with pericardial effusion classified as small (< 10 mm), moderate (between 10-20 mm), or severe (> 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%. Results: A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001). Conclusions: There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.
- Galectin-3 Associated with Severe Forms and Long-term Mortality in Patients with Chagas Disease(2021) FERNANDES, Fabio; MOREIRA, Carlos Henrique Valente; OLIVEIRA, Lea Campos; SOUZA-BASQUEIRA, Marcela; IANNI, Barbara Maria; LORENZO, Claudia di; RAMIRES, Felix Jose Alvarez; NASTARI, Luciano; CUNHA-NETO, Edecio; RIBEIRO, Antonio L.; LOPES, Renato Delascio; KEATING, Sheila M.; SABINO, Ester Cerdeira; MADY, CharlesBackground: The histopathological characteristics of Chagas disease (ChD) are: presence of myocarditis, destruction of heart fibers, and myocardial fibrosis. Galectin-3 (Gal-3) is a biomarker involved in the mechanism of fibrosis and inflammation that may be useful for risk stratification of individuals with ChD. Objectives We sought to evaluate whether high Gal-3 levels are associated with severe forms of Chagas cardiomyopathy (CC) and whether they are predictive of mortality. Methods We studied anti-T. cruzi positive blood donors (BD): Non-CC-BD (187 BD without CC with normal electrocardiogram [ECG] and left ventricular ejection fraction [LVEF]); CC-Non-Dys-BD (46 BD with CC with abnormal ECG but normal LVEF); and 153 matched serum-negative controls. This cohort was composed of 97 patients with severe CC (CC-Dys). We used Kruskall-Wallis and Spearman's correlation to test hypothesis of associations, assuming a two-tailed p<0.05 as significant. Results The Gal-3 level was 12.3 ng/mL for Non-CC-BD, 12.0 ng/mL for CC-Non-Dys-BD, 13.8 ng/mL for controls, and 15.4 ng/mL for CC-Dys. LVEF<50 was associated with higher Gal-3 levels (p=0.0001). In our linear regression adjusted model, we found association between Gal-3 levels and echocardiogram parameters in T. cruzi-seropositive subjects. In CC-Dys patients, we found a significant association of higher Gal-3 levels (>= 15.3 ng/mL) and subsequent death or heart transplantation in a 5-year follow-up (Hazard ratio - HR 3.11; 95%CI 1.21-8.04; p=0.019). Conclusions In ChD patients, higher Gal-3 levels were significantly associated with severe forms of the disease and more long-term mortality, which means it may be a useful means to identify high-risk patients.
conferenceObject Impairment of parasympathetic and sympathetic nervous systems in different forms of Chagas disease(2013) FERNANDES, F.; BARBOSA-FERREIRA, J. M.; RAMIRES, F. J. A.; GRUPI, C. J.; HACHUL, D. T.; IANNI, B. M.; DABARIAN, A.; NASTARI, L.; BUCK, P. C.; MADY, C.conferenceObject The predictive value of plasma Galectin-3 for cardiac impairment and mortality in patients with Chagas disease(2016) FERNANDES, F.; MOREIRA, C. H.; OLIVEIRA, L. C.; IANNI, B. M.; LORENZO, C. D.; RAMIRES, F. J. A.; NASTARI, L.; RIBEIRO, A. L. P.; CUNHA NETO, E.; SABINO, E. C.; MADY, C.- Detection of Trypanosoma cruzi DNA in blood by PCR is associated with Chagas cardiomyopathy and disease severity(2015) SABINO, E. C.; RIBEIRO, A. L.; LEE, T. H.; OLIVEIRA, C. L.; CARNEIRO-PROIETTI, A. B.; ANTUNES, A. P.; MENEZES, M. M.; IANNI, B. M.; SALEMI, V. M.; NASTARI, L.; FERNANDES, F.; SACHDEV, V.; CARRICK, D. M.; DENG, X.; WRIGHT, D.; GONCALEZ, T. T.; MURPHY, E. L.; CUSTER, B.; BUSCH, M. P.BackgroundThe significance of detection of Trypanosoma cruziDNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruziDNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. MethodsThis is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20mL of blood. All testing was performed on coded samples. ResultsRates of PCR detection of T. cruziDNA were significantly (P=0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. ConclusionTrypanosoma cruziPCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.
- Intramyocardial Adrenergic Activation in Chagasic Cardiomyopathy and Coronary Artery Disease(2011) NASTARI, Luciano; RAMIRES, Felix Jose Alvarez; SALEMI, Vera Maria Cury; IANNI, Barbara Maria; FERNANDES, Fabio; STRUNZ, Celia Maria; ARTEAGA, Edmundo; MADY, CharlesBackground: Myocardial norepinephrine is altered in left ventricular impairment. In patients with Chagas' cardiomyopathy (CC), this issue has not been addressed. Objective: To determine the level of myocardial norepinephrine in patients with CC and compare it in patients with coronary artery disease, and to relate myocardial norepinephrine to left ventricular ejection fraction (WEE). Methods: We studied 39 patients with CC, divided into group 1: 21 individuals with normal LVEF and group 2: 18 individuals with decreased LVEF. Seventeen patients with coronary artery disease were divided into group 3: 12 individuals with normal LVEF and group 4: 5 individuals with decreased LVEF. Two-dimensional echocardiography was used to measure LVEF. Myocardial norepinephrine was determined by high-performance liquid chromatography. Results: Myocardial norepinephrine in CC with and without ventricular dysfunction was 1.3 1.3 and 6.1 +/- 4.2 pg/mu g noncollagen protein, respectively (p<0.0001); in coronary artery disease with and without ventricular dysfunction, it was 3.3 +/- 3.0 and 9.8 +/- 4.2 pg mu g noncollagen protein, respectively (p<0.0001). A positive correlation was found between LVEF and myocardial norepinephrine concentration in the patients with Chagas' cardiomyopathy (p<0.01, r = 0.57) and also in those with coronary artery disease (p<0.01, r=0.69). A significant difference was demonstrated between norepinephrine concentrations in patients with normal WEE (groups 1 and 3; p = 0.0182), hut no difference was found in patients with decreased LVEF (groups 2 and 4; p = 0.1467). Conclusion: In patients with Chagas' cardiomyopathy and normal global ejection fraction there is an early cardiac dolma lion, when compared to coronary artery disease patients. (Arq Bras Cardiol 2011; 96(2): 99-106)