SILVANA ANGELINA D'ORIO NISHIOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Role of cardiac arrhythmias in sudden cardiac death in renal transplant candidates(2014) MARTINELLI FILHO, M.; PEIXOTO, G. L.; SILVA, R. T.; SIQUEIRA, S. F.; LIMA, J. J. G.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.; NISHIOKA, S. A. D.- Effects of Cardiac Resynchronization Therapy on Muscle Sympathetic Nerve Activity(2014) KUNIYOSHI, Ricardo R.; MARTINELLI, Martino; NEGRAO, Carlos E.; SIQUEIRA, Sergio F.; RONDON, Maria U. P. B.; TROMBETTA, Ivani C.; KUNIYOSHI, Fatima H. S.; LATERZA, Mateus C.; NISHIOKA, Silvana A. D'Orio; COSTA, Roberto; TAMAKI, Wagner T.; CREVELARI, Elizabeth S.; PEIXOTO, Giselle De Lima; RAMIRES, Jose A. F.; KALIL, RobertoIntroductionMuscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable. ObjectivesIn this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF. MethodsWe assessed 11 HF patients (51 3.4 years; New York Heart Association class III-IV; left ventricular ejection fraction 27.8 2.2%; optimal medical therapy) submitted to CRT. Evaluations were made prior to and 3 months after CRT. MSNA was performed at rest and during moderate static exercise (handgrip). Peak oxygen consumption (VO2) was evaluated by means of cardiopulmonary exercise test. HF patients with advanced NYHA class without CRT and healthy individuals were also studied. ResultsCRT reduced MSNA at rest (48.9 +/- 11.1 bursts/min vs 33.7 +/- 15.3 bursts/min, P < 0.05) and during handgrip exercise (MSNA 62.3 +/- 13.1 bursts/min vs 46.9 +/- 14.3 bursts/min, P < 0.05). Among HF patients submitted to CRT, the peak VO2 increased (12.9 +/- 2.8 mL/kg/min vs 16.5 +/- 3.9 mL/kg/min, P < 0.05) and an inverse correlation between peak VO2 and resting MSNA (r = -0.74, P = 0.01) was observed. ConclusionsIn patients with advanced HF and severe systolic dysfunction: (1) a significant reduction of MSNA (at rest and during handgrip) occurred after CRT, and this behavior was significantly superior to HF patients receiving only medical therapy; (2) MSNA reduction after CRT had an inverse correlation with O-2 consumption outcomes.
conferenceObject Role of impedance cardiography in predicting clinical near-term outcomes of patients with cardiac resynchronization therapy(2014) MARTINELLI FILHO, MMartino; PEIXOTO, G. L.; SIQUEIRA, S. F.; LENSI, M. M.; TRINDADE, R. H. L.; NISHIOKA, S. A. D.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.conferenceObject Chagas cardiomyopathy patients with pacemaker: predictors of left ventricular remodeling(2014) PEIXOTO, G.; MADIA, R. O.; SIQUEIRA, S. F.; LENSI, M. M.; TEIXEIRA, R. A.; NISHIOKA, S. A. D.; PEDROSA, A. A. A.; SACCAB, M. G. M.; COSTA, R.; MARTINELLI, M.- Diretriz Brasileira de Dispositivos Cardiacos Eletronicos Implantaveis-2023(2023) TEIXEIRA, Ricardo Alkmim; FAGUNDES, Alexsandro Alves; JR, Jose Mario Baggio; OLIVEIRA, Julio Cesar de; MEDEIROS, Paulo de Tarso Jorge; VALDIGEM, Bruno Pereira; TENO, Luiz Antonio Castilho; SILVA, Rodrigo Tavares; MELO, Celso Salgado de; ELIAS NETO, Jorge; JR, Antonio Vitor Moraes; PEDROSA, Anisio Alexandre Andrade; PORTO, Fernando Mello; JR, Helio Lima de Brito; SOUZA, Thiago Goncalves Schroder e; MATEOS, Jose Carlos Pachon; MORAES, Luis Gustavo Belo de; FORNO, Alexander Romeno Janner Dal; D'AVILA, Andre Luiz Buchele; CAVACO, Diogo Alberto de Magalhaes; KUNIYOSHI, Ricardo Ryoshim; PIMENTEL, Mauricio; CAMANHO, Luiz Eduardo Montenegro; SAAD, Eduardo Benchimol; ZIMERMAN, Leandro Ioschpe; OLIVEIRA, Eduardo Bartholomay; SCANAVACCA, Mauricio Ibrahim; MARTINELLI FILHO, Martino; LIMA, Carlos Eduardo Batista de; PEIXOTO, Giselle de Lima; DARRIEUX, Francisco Carlos da Costa; DUARTE, Jussara de Oliveira Pinheiro; GALVAO FILHO, Silas dos Santos; COSTA, Eduardo Rodrigues Bento; MATEO, Enrique Indalecio Pachon; MELO, Sissy Lara De; RODRIGUES, Thiago da Rocha; ROCHA, Eduardo Arrais; HACHUL, Denise Tessariol; LORGA FILHO, Adalberto Menezes; NISHIOKA, Silvana Angelina D'Orio; GADELHA, Eduardo Barreto; COSTA, Roberto; ANDRADE, Veridiana Silva de; TORRES, Gustavo Gomes; OLIVEIRA NETO, Nestor Rodrigues de; LUCCHESE, Fernando Antonio; MURAD, Henrique; WANDERLEY NETO, Jose; BROFMAN, Paulo Roberto Slud; ALMEIDA, Rui M. S.; LEAL, Joao Carlos Ferreira
conferenceObject Risk Factors for Sudden Death in Chagas Cardiomyopathy(2015) PEIXOTO, Giselle L.; SIQUEIRA, Sergio; NISHIOKA, Silvana; PEDROSA, Anisio; TEIXEIRA, Ricardo; COSTA, Roberto; MARTINELLI, MartinoconferenceObject Pacinchagas-crt: A Cohort Study of Cardiac Resynchronization Therapy in Patients With Chronic Chagas Cardiomyopathy(2015) MARTINELLI, Martino; PEIXOTO, Giselle L.; SIQUEIRA, Sergio; SANTOS, Johnny; MARTINS, Sergio; NISHIOKA, Silvana; PEDROSA, Anisio; TEIXEIRA, Ricardo; COSTA, Roberto- Predictors of death in chronic Chagas cardiomyopathy patients with pacemaker(2018) PEIXOTO, Giselle de Lima; MARTINELLI FILHO, Martino; SIQUEIRA, Sergio Freitas de; NISHIOKA, Silvana Angelina D'Orio; PEDROSA, Anisio Alexandre Andrade; TEIXEIRA, Ricardo Alkmim; COSTA, Roberto; KALIL FILHO, Roberto; RAMIRES, Jose Antonio FranchiniBackground: Chronic Chagas cardiomyopathy (CCC) is the most serious and frequent manifestation of Chagas disease. Conduction abnormalities and bradycardia requiring pacemaker are common. The aim of this study was to determine the rate and predictors of death in CCC patients with pacemaker. Methods: In this single-center prospective cohort study we assessed the outcome of 396 CCC patients with pacemaker, followed-up for at least 24 months. All patients underwent a clinical and device assessment, 12-lead electrocardiography and echocardiography. Results: During the median follow-up of 1.9 years (Interquartile range 1.6-2.4), there were 65 (16.4%) deaths, yielding an annual mortality rate of 8.6%. The major cause was sudden death (33.8%), followed by heart failure (HF), 32.3%. All the investigated variables were examined as potential predictors of death. The final multivariate logistic regression model included five independent variables: advanced HF functional class (OR [odds ratio] 6.71; 95% confidence interval [95% CI] 1.95-23.2; P = 0.003), renal disease (OR 5.71; 95% CI 1.80-18.0; P = 0.003), QRS >= 150 ms (OR 2.80; 95% CI 1.08-7.27; P = 0.034), left atrial enlargement (OR 2.75; 95% CI 1.09-6.95; P = 0.032) and left ventricular ejection fraction = 43% (OR 2.31; 95% CI 1.07-4.97; P = 0.032). Themodel had good discrimination, confirmed by bootstrap validation (optimism-adjusted c-statistic of 0.78) and the calibration curve showed a proper calibration (slope = 0.972). Conclusions: CCC patients with pacemaker have a high annual mortality rate despite that the pacemaker related variables were not predictors of death. The independent predictors of death can help us to identify the poor prognosis patients.
- A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy(2018) MARTINELLI FILHO, Martino; PEIXOTO, Giselle de Lima; SIQUEIRA, Rgio Freitas de; MARTINS, Sergio Augusto Mezzalira; NISHIOKA, Silvana Angelina D'orio; PEDROSA, Anisio Alexandre Andrade; TEIXEIRA, Ricardo Alkmim; SANTOS, Johnny Xavier dos; COSTA, Roberto; KALIL FILHO, Roberto; RAMIRES, Jose Antonio FranchiniAims Cardiac resynchronization therapy (CRT) is an established procedure for patients with heart failure. However, trials evaluating its efficacy did not include patients with chronic Chagas cardiomyopathy (CCC). We aimed to assess the role of CRT in a cohort of patients with CCC. Methods and results This retrospective study compared the outcomes of CCC patients who underwent CRT with those of dilated (DCM) and ischaemic cardiomyopathies (ICM). The primary endpoint was all-cause mortality and the secondary endpoints were the rate of non-advanced New York Heart Association (NYHA) class 12 months after CRT and echocardiographic changes evaluated at least 6 months after CRT. There were 115 patients in the CCC group, 177 with DCM, and 134 with ICM. The annual mortality rates were 25.4%, 10.4%, and 11.3%, respectively (P < 0.001). Multivariate analysis adjusted for potential confounders showed that the CCC group had a two-fold [hazard ratio 2.34 (1.47-3.71), P < 0.001] higher risk of death compared to the DCM group. The rate of non-advanced NYHA class 12 months after CRT was significantly higher in non-CCC groups than in the CCC group (DCM 74.0% vs. ICM 73.9% vs. 56.5%, P < 0.001). Chronic Chagas cardiomyopathy and ICM patients had no improvement in the echocardiographic evaluation, but patients in the DCM group had an increase in left ventricular ejection fraction and a decrease in left ventricular end-diastolic diameter. Conclusion This study showed that CCC patients submitted to CRT have worse prognosis compared to patients with DCM and ICM who undergo CRT. Studies comparing CCC patients with and without CRT are warranted.
conferenceObject Left ventricular remodeling behavior of patients with Chagas cardiomyopathy and pacemaker in a long-term follow-up(2014) PEIXOTO, G.; MARTINELLI, M.; SIQUEIRA, S. F.; MADIA, R. O.; LENSI, M. M.; NISHIOKA, S. A. D.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.