ANDRE LUIZ DRESLER HOVNANIAN
Projetos de Pesquisa
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LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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- Schistosomiasis and pulmonary hypertension(2011) DOS, Caio Julio Cesar; FERNANDES, Santos; JARDIM, Carlos Viana Poyares; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana Kato; SOUZA, RogerioExpert Rev. Respir. Med. 5(5), 675-681 (2011) Schistosomiasis is one of the most prevalent chronic infectious diseases in the world. One of its most severe complications, pulmonary hypertension, occurs in up to 5% of patients with hepatosplenic schistosomiasis. The prevalence of schistosomiasis is so overwhelming that schistosomiasis-associated pulmonary hypertension (Sch-PH) may be the most prevalent cause of pulmonary hypertension around the world. Multiple pathways have been described as potential mechanisms of disease in Sch-PH, such as egg embolism, inflammatory disease or pulmonary blood overflow. The possible physiopathological mechanisms will be discussed in this article, as well the disease's clinical course and response to the treatment available.
- The epidemiology of acute respiratory failure in hospitalized patients: A Brazilian prospective cohort study(2011) FRANCA, Suelene Aires; TOUFEN JUNIOR, Carlos; HOVNANIAN, Andre Luiz D.; ALBUQUERQUE, Andre Luis P.; BORGES, Eduardo R.; PIZZO, Vladimir R. P.; CARVALHO, Carlos Roberto RibeiroPurpose: The purpose of this study was to assess risk factors associated with the development of acute respiratory failure (ARF) and death in a general intensive care unit (ICU). Materials and Methods: Adults who were hospitalized at 12 surgical and nonsurgical ICUs were prospectively followed up. Multivariable analyses were realized to determine the risk factors for ARF and point out the prognostic factors for mortality in these patients. Results: A total of 1732 patients were evaluated, with an ARF prevalence of 57%. Of the 889 patients who were admitted without ARF, 141 (16%) developed this syndrome in the ICU. The independent risk factors for developing ARF were 64 years of age or older, longer time between hospital and ICU admission, unscheduled surgical or clinical reason for ICU admission, and severity of illness. Of the 984 patients with ARF, 475 (48%) died during the ICU stay. Independent prognostic factors for death were age older than 64 years, time between hospital and ICU admission of more than 4 days, history of hematologic malignancy or AIDS, the development of ARF in ICU, acute lung injury, and severity of illness. Conclusions: Acute respiratory failure represents a large percentage of all ICU patients, and the high mortality is related to some preventable factors such as the time to ICU admission.
bookPart Tromboembolismo pulmonar(2014) HOVNANIAN, André Luiz DreslerbookPart Schistosomiasis and Pulmonary Hypertension(2012) FERNANDES, Caio Julio Cesar; JARDIM, Carlos; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana Kato; SOUZA, RogerioSchistosomiasis is the third leading parasitic disease in the world. It is present in 74 countries, infecting 200 million people. Each year 280,000 patients die because of the disease. One of its most severe complications is pulmonary arterial hypertension (PAH). Previous studies have shown that 5% of patients with hepatosplenic schistosomiasis develop PAH. It is believed today that the most prevalent cause worldwide of PAH is schistosomiasis. Specifics about schistosomiasis-associated PAH including epidemiological data, mechanisms of the disease, clinical and hemodynamic features, and modalities of treatment will be reviewed in this chapter. Copyright (C) 2012 S. Karger AG, BaselconferenceObject Incident pulmonary arterial hypertension in a Brazilian reference center: Results of a four-year registry(2013) ALVES- JR., Jose Leonidas; GAVILANES, Francisca; JARDIM, Carlos; FERNANDES, Caio; KATO, Luciana; HOETTE, Susana; DIAS, Bruno; HOVNANIAN, Andre; SOUZA, RogerioconferenceObject The role of right heart catheterization prior to initiation of PAH specific therapy(2013) GAVILANES, Francisca; ALVES- JR., Jose Leonidas; FERNANDES, Caio; JARDIM, Carlos; KATO, Luciana; HOETTE, Susana; HOVNANIAN, Andre; DIAS, Bruno; SOUZA, Rogerio- The Role of Target Therapies in Schistosomiasis-Associated Pulmonary Arterial Hypertension(2012) FERNANDES, Caio J. C. S.; DIAS, Bruno A.; JARDIM, Carlos V. P.; HOVNANIAN, Andre; HOETTE, Susana; MORINAGA, Luciana K.; SOUZA, Silvia; SUESADA, Milena; BREDA, Ana P.; SOUZA, RogerioBackground: Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) may be one of the most prevalent forms of pulmonary arterial hypertension (PAH) worldwide. However, the clinical and hemodynamical response to specific PAH therapy in Sch-PAH is not known. Methods: We retrospectively analyzed the charts of all patients with Sch-PAH who initiated specific PAH treatment between June 2003 and June 2010 in a single PAH reference center in Sao Paulo, Brazil. Clinical and hemodynamical data were retrospectively collected and evaluated in two periods: baseline and posttreatment. Results: The study population consisted of 12 patients with Sch-PAH. They were treated with phosphodiseterase-5 inhibitors (seven patients), endothelin receptor antagonists (four patients), or combination therapy (one patient). Mean treatment period was 34.9 +/- 15.5 months. Patients with Sch-PAH presented significant improvements in terms of functional class, 6-min walk test distance (439 +/- 85 to 492 +/- 79 m, P = .032), cardiac index (2.66 +/- 0.59 to 3.08 +/- 0.68 L/min/m(2), P = .028), and indexed pulmonary vascular resistance (20.7 +/- 11.6 to 15.9 +/- 9 W/m(2), P = .038) with the introduction of specific PAH treatment. Conclusions: We conclude that specific PAH therapy may be of benefit to patients with Sch-PAH, considering clinical, functional, and hemodynamic parameters. CHEST 2012; 141(4):923-928
- Electrical impedance tomography in pulmonary arterial hypertension(2021) HOVNANIAN, Andre L. D.; V, Eduardo L. Costa; HOETTE, Susana; FERNANDES, Caio J. C. S.; JARDIM, Carlos V. P.; DIAS, Bruno A.; MORINAGA, Luciana T. K.; AMATO, Marcelo B. P.; SOUZA, RogerioThe characterization of pulmonary arterial hypertension (PAH) relies mainly on right heart catheterization (RHC). Electrical impedance tomography (EIT) provides a non-invasive estimation of lung perfusion that could complement the hemodynamic information from RHC. To assess the association between impedance variation of lung perfusion (Delta Z(Q)) and hemodynamic profile, severity, and prognosis, suspected of PAH or worsening PAH patients were submitted simultaneously to RHC and EIT. Measurements of Delta Z(Q) were obtained. Based on the results of the RHC, 35 patients composed the PAH group, and eight patients, the normopressoric (NP) group. PAH patients showed a significantly reduced Delta Z(Q) compared to the NP group. There was a significant correlation between Delta Z(Q) and hemodynamic parameters, particularly with stroke volume (SV) (r = 0.76; P < 0.001). At 60 months, 15 patients died (43%) and 1 received lung transplantation; at baseline they had worse hemodynamics, and reduced Delta Z(Q) when compared to survivors. Patients with low Delta Z(Q) (<= 154.6%.Kg) presented significantly worse survival (P = 0.033). Delta Z(Q) is associated with hemodynamic status of PAH patients, with disease severity and survival, demonstrating EIT as a promising tool for monitoring patients with pulmonary vascular disease.
bookPart Hipertensão arterial pulmonar(2014) HOVNANIAN, André Luiz Dresler; JARDIM, Carlos; SOUZA, Rogérioarticle 3 Citação(ões) na Scopus The role of imaging techniques in the assessment of pulmonary circulation(2011) HOVNANIAN, Andre; MENEZES, Eduardo; HOETTE, Susana; JARDIM, Carlos; JASINOWODOLINSKI, Dany; SOUZA, RogerioKnowledge of the structure and function of pulmonary circulation has evolved considerably in the last few decades. The use of non-invasive imaging techniques to assess the anatomy and function of the pulmonary vessels and heart has taken on added importance with the recent advent of novel therapies. Imaging findings not only constitute a diagnostic tool but have also proven to be essential for prognosis and treatment follow-up. This article reviews the myriad of imaging methods currently available for the assessment of pulmonary circulation, from the simple chest X-ray to techniques that are more complex and promising, such as electrical impedance tomography.