MEIVE SANTOS FURTADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
13 resultados
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- Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension(2016) SANTAREM, Orlando Luis de Andrade; CLEVA, Roberto de; SASAYA, Flavia Megumi; ASSUMPCAO, Marianna Siqueira de; FURTADO, Meive Santos; BARBATO, Alfonso Julio Guedes; HERMAN, PauloObjective The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. Location The University of Sao Paulo Medical School, Brazil; Public Practice. Methods Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15). Results The cardiac output (5.08 +/- 0.91 L/min) and systolic volume (60.1 +/- 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). Conclusions The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.
- Left ventricular diastolic function in patients with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor- a pilot study(2014) NOGUEIRA, Katia Camarano; FURTADO, Meive; FUKUI, Rosa Tsuneshiro; CORREIA, Marcia Regina Silva; SANTOS, Rosa Ferreira dos; ANDRADE, Jose Lazaro; SILVA, Maria Elizabeth Rossi daBackground: Blood glucose control is fundamental albeit not enough to prevent diabetic macrovascular complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors are effective in improving metabolic parameters in patients with type 2 diabetes mellitus (T2DM) but little is known about its cardiovascular effects. We compared the DPP-4 inhibitor sitagliptin with bedtime NPH insulin (NPH) as add-on therapy in patients with T2DM, aiming to ascertain which drug would have additional cardioprotective effects. Methods: Thirty-five T2DM patients inadequately controlled with metformin plus glyburide were randomized to receive sitagliptin (n = 18) or NPH (n = 17) for 24 weeks. Fasting plasma glucose, HbA1c, lipid profile, C-reactive protein, active glucagon-like peptide (aGLP-1) levels, 24-hour ambulatory blood pressure measurement and comprehensive 2-dimensional echocardiogram were determined before and after treatments. Results: Both sitagliptin and NPH therapies decreased HbA1c levels after 24 weeks. Fasting plasma glucose and triglyceride levels decreased in the NPH group whereas only sitagliptin increased aGLP-1 levels. Left ventricular diastolic dysfunction (LVDD) was detected in 58.6% of twenty-nine patients evaluated. Beneficial effects in LVDD were observed in 75% and 11% of patients treated with sitagliptin and NPH, respectively (p = 0.015). Neither therapy changed C-reactive protein or blood pressure. Conclusions: Sitagliptin and bedtime NPH were similarly effective on glucose control. Improvement in LVDD in T2DM patients treated with sitagliptin was suggested, probably related to the increase of aGLP-1 levels. Therefore, DPP-4 inhibitor seems to have cardioprotective effects independent of glucose control and may have a role in the prevention of diabetic cardiomyopathy.
conferenceObject Clinical predictors of primary cardiopathies in liver transplantation candidates(2013) SILVESTRE, O. M.; FARIAS, A. Q.; RAMOS, D. S.; ZITELLI, P. M. Y.; FURTADO, M. S.; ANDRADE, J. L.; XIMENES, R. O.; CARRILHO, F. J.; D'ALBUQUERQUE, L. A. C.; BACAL, F.article 27 Citação(ões) na Scopus Impact of the severity of end-stage liver disease in cardiac structure and function(2013) SILVESTRE, Odilson Marcos; BACAL, Fernando; RAMOS, Danusa de Souza; ANDRADE, Jose L.; FURTADO, Meive; PUGLIESE, Vincenzo; BELLETI, Elisangela; ANDRAUS, Wellington; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto Carneiro; FARIAS, Alberto QueirozBackground. The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Material and methods. 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results. Left-atrial diameter (r = 0.323; IC 95% 0.190-0.455; p < 0.001), left-ventricular diastolic diameter (r = 0.177; IC 95% 0.033-0.320; p = 0.01) and systolic pulmonary artery pressure (r = 0.185; IC 95% 0.036-0.335; p = 0.02) significantly correlated with MELD score. Patients with MELD 16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores < 16 points. Conclusions. Changes in cardiac structure and function correlate with the severity of ESLD.conferenceObject Pulmonary Complications in Right Sided Endocarditis(2013) RODRIGUES, Ana Clara T.; KAY, Fernando U.; OGAWA, Andrea; NISHIYAMA, Katia; ARRUDA, Ana Lucia; LIRA FILHO, Edgar; KOWATSCH, Ingrid; FURTADO, Meive; CERRI, Glovanni G.; ANDRADE, Jose L.- Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study (vol 59, pg 1043. 2014)(2014) FARIAS, Alberto Q.; SILVESTRE, Odilson M.; GARCIA-TSAO, Guadalupe; SEGURO, Luis F. B. da Costa; MAZO, Daniel F. de Campos; BACAL, Fernando; ANDRADE, Jose L.; GONCALVES, Luciana L.; STRUNZ, Celia; RAMOS, Danusa S.; POLLI, Demerson; PUGLIESE, Vincenzo; RODRIGUES, Ana C. T.; FURTADO, Meive S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.
conferenceObject Serum B-type natriuretic peptide is more accurate than ascites analyses in the diagnosis of ascites related to heart failure(2013) FARIAS, A. Q.; SILVESTRE, O. M.; BACAL, F.; GARCIA-TSAO, G.; SEGURO, L. F. B. C.; MAZO, D. F. C.; ANDRADE, J. L.; FURTADO, M. S.; CARRILHO, F. J.; D'ALBUQUERQUE, L. A. C.- Importance of Adequately Performed Valsalva Maneuver to Detect Patent Foramen Ovale during Transesophageal Echocardiography(2013) RODRIGUES, Ana Clara; PICARD, Michael H.; CARBONE, Aime; ARRUDA, Ana Lucia; FLORES, Thais; KLOHN, Juliana; FURTADO, Meive; LIRA-FILHO, Edgar B.; CERRI, Giovanni G.; ANDRADE, Jose L.Background: Transesophageal echocardiography (TEE) plays an important role in evaluating cardioembolic sources of emboli. The identification of a patent foramen ovale (PFO) is reportedly improved with TEE compared with transthoracic echocardiography (TTE), but the Valsalva maneuver during TEE may be difficult or suboptimal. The aim of this study was to assess the efficacy of the Valsalva maneuver for PFO diagnosis using TEE compared with TTE by evaluating patients with ischemic stroke referred for echocardiography. Methods: Only patients able to perform the Valsalva maneuver during TTE were included; efficacy was defined by a 20 cm/sec decrease in transmitral E velocity. A PFO was judged present when microbubbles of agitated intravenous saline were seen in the left chambers within three cycles after right atrial opacification. Results: Of 108 patients (mean age, 55615 years; 61 men), 48 (44%) were judged to have PFOs by TEE and/or TTE. In 36 patients (33% of the total, 75% of those with PFOs), microbubbles were observed both by TEE and TTE, in seven patients only during TTE, and in five patients only during TEE. In patients able to satisfactorily perform the Valsalva maneuver during TEE, 22 PFOs were found, and two shunts (9%) were missed, whereas in patients unable to perform this maneuver, 26 PFOs were observed, with five shunts missed (19%) (P <.05). When a PFO was missed by TTE, either the echocardiographic window was suboptimal or the shunt was small. Conclusions: An adequate Valsalva maneuver is crucial for diagnosis of PFO; most patients with stroke may be screened using TTE with contrast and the Valsalva maneuver, with TEE indicated in case of suboptimal transthoracic images.
- beta-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial(2018) SILVESTRE, Odilson M.; FARIAS, Alberto Q.; RAMOS, Danusa S.; FURTADO, Meive S.; RODRIGUES, Ana C.; XIMENES, Rafael O.; MAZO, Daniel F. de Campos; ZITELLI, Patricia M. Yoshimura; DINIZ, Marcio A.; ANDRADE, Jose L.; STRUNZ, Celia; FRIEDMANN, Antonio A.; LEE, Samuel S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.; BACAL, FernandoBackground Cirrhotic cardiomyopathy is characterized by an attenuated contractile response to stress. Long-term exposure of beta-adrenergic receptors to persistently high levels of catecholamines has been implicated in its pathogenesis. We hypothesized that beta-blockade with metoprolol could reverse the changes in heart function and morphology in cirrhotic cardiomyopathy. Patients and methods In this prospective randomized trial, we included 78 patients aged between 18 and 60 years with abnormal cardiac output response under dobutamine stress echocardiography, without primary cardiac disease or a history of alcohol intake. Patients were assigned randomly to receive metoprolol or placebo for 6 months. The primary endpoint was the improvement in cardiac output response to stress, measured by an increase in the left ventricle stroke volume more than 30%. Results Three (7.3%) patients in the metoprolol group and nine (24.3%) patients in the placebo group showed improved stroke volume (P=0.057). Diastolic dysfunction was found in two (4.8%) patients before and in five (15.6%) patients after therapy in the metoprolol group, and in 10 (27%) patients before and nine (31%) patients after therapy in the placebo group (P=0.67). After treatment, no echocardiography parameter of morphology was significantly different between metoprolol or placebo groups. No significant differences were observed in noradrenaline, plasma renin activity, and troponin levels between groups. Cirrhosis-related clinical events, including hospitalizations and mortality, were not significantly different between the two groups. Six months of therapy with beta-blocker did not ameliorate heart function and morphology in patients with cirrhotic cardiomyopathy.
conferenceObject Impact of the Severity of End-Stage Liver Disease in Cardiac Remodeling(2012) SILVESTRE, O. M.; BACAL, F.; FARIAS, A. Q.; ANDRADE, J. L.; FURTADO, M.; PUGLIESE, V.; ANDRAUS, W.; RAMOS, D. S.; BELLETI, E.; ALBUQUERQUE, L. A. C.; CARRILHO, F. J.Purpose: The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Methods and Materials: 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results: Left-atrial diameter (r=0.323; IC 95% 0.190-0.455; p<0.001), left-ventricular diastolic diameter (r=0.177; IC 95% 0.033-0.320; p=0.01) and systolic pulmonary artery pressure (r=0.185; IC 95% 0.036-0.335; p=0.02) significantly correlated with MELD score. Patients with MELD >16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores <16 points. Conclusions: Changes in cardiac structure and function correlate with the severity of ESLD.