LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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- 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 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.- 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.)
- Response to Letters Regarding Article, ""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.; IANNI, Barbara M.; NASTARI, Luciano; FERNANDES, Fabio; OLIVEIRA, Claudia Di Lorenzo; ANTUNES, Andre P.; MENEZES, Marcia M.; PATAVINO, Giuseppina M.; CAPUANI, Ligia; ALMEIDA-NETO, Cesar de; SACHDEV, Vandana; CARRICK, Danielle M.; WRIGHT, David; KAVOUNIS, Katherine; GONZALEZ, Thelma T.; CUSTER, Brian; BUSCH, Michael P.; MURPHY, Edward L.; CARNEIRO-PROIETTI, Anna-Barbara