FABIANA GOULART MARCONDES BRAGA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Vaccine-Induced Coronay Antibodie-Mediated Rejection and Thrombosis in a Heart Transplant Pacient: A Case Report(2022) BARROSO, N. D.; GALBIATI, L. C.; ARAGAO, C.; FERNANDEZ, M. P.; AVILA, M. S.; SEGURO, L. F.; MARCONDES-BRAGA, F. G.; MANGINI, S.; CAMPOS, I. W.; OLIVEIRA, J. Junior de; FURQUIM, S.; PIERI, R.; GAIOTTO, F.; BACAL, F.conferenceObject Prevalence of Cognitive Impairment in Heart Transplant Waiting-List Patients in a Developing Country(2020) OLIVEIRA, F. M. de; IKEDA, E. T.; AVILA, M.; WOZNIAK, I.; SEGURO, L.; SANTOS, M.; FELTRIM, M.; BARONE, F.; ISSA, V.; LAGE, S.; BACAL, F.; BOCCHI, E.; GAIOTTO, F.; NOMURA, C.; MARCONDES-BRAGA, F.; MANGINI, S.- Mode of Death on Chagas Heart Disease: Comparison with Other Etiologies. A Subanalysis of the REMADHE Prospective Trial(2013) AYUB-FERREIRA, Silvia M.; MANGINI, Sandrigo; ISSA, Victor S.; CRUZ, Fatima D.; BACAL, Fernando; GUIMARAES, Guilherme V.; CHIZZOLA, Paulo R.; CONCEICAO-SOUZA, Germano E.; MARCONDES-BRAGA, Fabiana G.; BOCCHI, Edimar A.Background: Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy. Methods and results: We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34-5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04-1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97-0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47-6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01-1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34-0.94; p = 0.014) were independently associated with sudden death mortality. Conclusions: In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death.
bookPart Infecções gastrointestinais no paciente Transplantado(2015) MOURA, Ewandro Luiz Rey; BRAGA, Fabiana Goulart Marcondes- Hypertonic saline solution for prevention of renal dysfunction in patients with decompensated heart failure(2013) ISSA, Victor S.; ANDRADE, Lucia; AYUB-FERREIRA, Silvia M.; BACAL, Fernando; BRAGANCA, Ana C. de; GUIMARAES, Guilherme V.; MARCONDES-BRAGA, Fabiana G.; CRUZ, Fatima D.; CHIZZOLA, Paulo R.; CONCEICAO-SOUZA, Germano E.; VELASCO, Irineu T.; BOCCHI, Edimar A.Background: Renal dysfunction is associated with increased mortality in patients with decompensated heart failure. However, interventions targeted to prevention in this setting have been disappointing. We investigated the effects of hypertonic saline solution (HSS) for prevention of renal dysfunction in decompensated heart failure. Methods: In a double-blind randomized trial, patients with decompensated heart failure were assigned to receive three-day course of 100 mL HSS (NaCl 7.5%) twice daily or placebo. Primary end point was an increase in serumcreatinine of 0.3 mg/dL or more. Main secondary end point was change in biomarkers of renal function, including serum levels of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin-NGAL and the urinary excretion of aquaporin 2 (AQP(2)), urea transporter (UT-A(1)), and sodium/hydrogen exchanger 3 (NHE3). Results: Twenty-two patients were assigned to HSS and 12 to placebo. Primary end point occurred in two (10%) patients in HSS group and six (50%) in placebo group (relative risk 0.3; 95% CI 0.09-0.98; P=0.01). Relative to baseline, serum creatinine and cystatin C levels were lower in HSS as compared to placebo (P=0.004 and 0.03, respectively). NGAL level was not statistically different between groups, however the urinary expression of AQP2, UT-A1 and NHE3 was significantly higher in HSS than in placebo. Conclusions: HSS administration attenuated heart failure-induced kidney dysfunction as indicated by improvement in both glomerular and tubular defects, a finding with important clinical implications. HSS modulated the expression of tubular proteins involved in regulation of water and electrolyte homeostasis.
conferenceObject Anatomopathological Consequences of the Change in the Clinical-Demographic Profile of Chagasic Patients Who Are Candidates for Heart Transplantation in Recent Years(2022) ARAGAO, C. A.; CAMPOS, I. W.; DUARTE, N.; FURQUIM, S.; GALBIATI, L. C.; PEREZ, M.; PIERI, R.; GRINBERG, M. S. Avila; SEGURO, L. F.; MARCONDES-BRAGA, F. G.; MANGINI, S.; STRABELLI, T. M.; GAIOTTO, F. A.; BACAL, F.- Value-based health care in heart failure: Quality of life and cost analysis(2023) GHISLENI, Eduarda Chiesa; ASTOLFI, Vit oria Rech; ZIMMERMANN, Larissa; LIRA, Camila Nogueira Leandro; NASCIMENTO, Eduarda Faria do; ETGES, Ana Paula Beck da Silva; MARCONDES-BRAGA, Fabiana G.; BACAL, Fernando; DANZMANN, Luiz Claudio; POLANCZYK, Carisi Anne; BIOLO, AndreiaObjectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept.Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex.Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 +/- 238 for NYHA I patients, US$ 296 +/- 399 for NYHA II and US$ 667 +/- 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05).Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classifi-cation increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reim-bursement strategies based on value.
conferenceObject Venous Thromboembolism as an Initial Manifestation of COVID-19 in a Heart Transplant Patient(2021) DANTAS, R. C. Tourinho; LIRA, M.; BELFORT, D.; ARAGAO, C.; MURAD, C.; AVILA, M.; SEGURO, L.; MANGINI, S.; CAMPOS, I.; MARCONDES-BRAGA, F.; BACAL, F.conferenceObject Bone Metabolism Impairment in Heart Transplant: Results from a Prospective Cohort Study(2019) SEGURO, Luis; PEREIRA, Rosa; SEGURO, Luciana; CAPARBO, Valeria; AVILA, Monica; MANGINI, Sandrigo; CAMPOS, Iascara; GAIOTTO, Fabio; MARCONDES-BRAGA, Fabiana; BACAL, FernandoconferenceObject Early Antibody-Mediated Rejection in Non-Pre-Sensitized Heart Transplant Recipient(2021) LIRA, M. S.; BELFORT, D. Sa Pereira; DANTAS, R. Cavalcanti Tourinho; ARAGAO, C. Aurelio Santos; AVILA, M. Samuel; SEGURO, L.; MANGINI, S.; CAMPOS, I. Wozniak; MARCONDES-BRAGA, F.; BACAL, F.