LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- 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.
- 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)
bookPart Cardiomiopatia dilatada(2016) NASTARI, Luciano; RAMIRES, Felix José Alvarez- Ten-Year Incidence of Chagas Cardiomyopathy Among Asymptomatic Trypanosoma cruzi-Seropositive Former Blood Donors(2013) SABINO, Ester C.; RIBEIRO, Antonio L.; SALEMI, Vera M. C.; OLIVEIRA, Claudia Di Lorenzo; ANTUNES, Andre P.; MENEZES, Marcia M.; IANNI, Barbara M.; NASTARI, Luciano; FERNANDES, Fabio; PATAVINO, Giuseppina M.; SACHDEV, Vandana; CAPUANI, Ligia; ALMEIDA-NETO, Cesar de; CARRICK, Danielle M.; WRIGHT, David; KAVOUNIS, Katherine; GONCALEZ, Thelma T.; CARNEIRO-PROIETTI, Anna Barbara; CUSTER, Brian; BUSCH, Michael P.; MURPHY, Edward L.Background-Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-infected persons. Methods and Results-We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi-seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of Sao Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S-3 heart sound. Conclusions-There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi-seropositive blood donors, although disease was mild at diagnosis. (Circulation. 2013;127:1105-1115.)
- Critical Analysis and Limitations of the Diagnosis of Heart Failure with Preserved Ejection Fraction (HFpEF)(2022) HOTTA, Viviane Tiemi; RASSI, Daniela do Carmo; PENA, Jose Luiz Barros; VIEIRA, Marcelo Luiz Campos; RODRIGUES, Ana Clara Tude; CARDOSO, Juliano Novaes; RAMIRES, Felix Jose Alvarez; NASTARI, Luciano; MADY, Charles; FERNANDES, FabioWith the increase in the population's life expectancy and the higher frequency of risk factors such as obesity, hypertension and diabetes, an increase in the prevalence of heart failure with preserved ejection fraction (HFpEF) is expected. However, to date, the diagnosis and treatment of patients with HFpEF remain challenging. The syndromic diagnosis of HFpEF includes several etiologies and diseases with specific treatments but has points in common regarding the clinical presentation, laboratory evaluation related to biomarkers, such as BNP and NT-ProBNP, and echocardiographic evaluation of cardiac remodeling and left ventricular diastolic filling pressures. Extensive randomized clinical trials involving the treatment of this condition have failed to demonstrate benefits to the patient, making it necessary to reflect on the diagnosis, mechanisms of morbidity, mortality and reversibility in this syndrome. In this review, the current concepts, controversies and challenges, especially regarding diagnosis, will be addressed, critically analyzing the European Heart Failure Association score for the diagnosis of HFpEF.
- Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy(2015) FRAGATA, Claudia da Silva; MATSUMOTO, Afonso Y.; RAMIRES, Felix J. A.; FERNANDES, Fabio; BUCK, Paula de Cassia; SALEMI, Vera Maria C.; NASTARI, Luciano; MADY, Charles; IANNI, Barbara MariaBackground: Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks. Objective: To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions. Methods: 10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. Results: Reservoir function (Total Emptying Fraction: TEF): (p < 0.0001), lower in GIII as compared to CG (p = 0.003), GI (p < 0.001) and GII (p < 0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p < 0.0001) and GII (p = 0.002). There was a negative correlation of E/e'(average) with the reservoir and pump functions (TEF and AEF), and a positive correlation of e'(average) with s' wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions. Conclusion: An impairment of LA functions in Chagas cardiomyopathy was observed.