LUCIANO NASTARI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
2 resultados
Resultados de Busca
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- 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.
- 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.