MARTINO MARTINELLI FILHO
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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- The Six Pillars of Lifestyle Medicine in Managing Noncommunicable Diseases - The Gaps in Current Guidelines(2023) FARIA, Rafaella Rogatto de; SIQUEIRA, Sergio Freitas de; HADDAD, Francisco Aguerre; SILVA, Gustavo Del Monte; SPAGGIARI, Caio Vitale; MARTINELLI FILHO, MartinoBackground: Noncommunicable diseases (NCDs), also known as chronic diseases that are long-lasting, are considered the major cause of death and disability worldwide, and the six pillars of lifestyle medicine (nutrition, exercise, toxic control, stress, sleep, and social connection) play an important role in a holistic management of their prevention and treatment. In addition, medical guidelines are the most accepted documents with recommendations to manage NCDs.Objective: The present study aims to analyze the lack of lifestyle pillars concerning the major Brazilian medical guidelines for NCDs and identify evidence in the literature that could justify their inclusion in the documents.Method: Brazilian guidelines were selected according to the most relevant causes of death in Brazil, given by the Mortality Information System, published by the Brazilian Ministry of Health in 2019. Journals were screened in the PUBMED library according to the disease and non-mentioned pillars of lifestyle.Results: Relevant causes of deaths in Brazil are Acute Myocardial Infarction (AMI), Diabetes Mellitus (DM), and Chronic Obstructive Pulmonary Diseases (COPD). Six guidelines related to these NCDs were identified, and all address aspects of lifestyle, but only one, regarding cardiovascular prevention, highlights all six pillars. Despite this, a literature search involving over 50 articles showed that there is evidence that all the pillars can help control each of these NCDs.Conclusion: Rarely are the six pillars of lifestyle contemplated in Brazilian guidelines for AMI, DM, and COPD. The literature review identified evidence of all lifestyle pillars to offer a holistic approach for the management and prevention of NCDs.
conferenceObject Quality of life and physical capacity after long-term right ventricular pacing in young adults with congenital atrioventricular block(2012) SILVA, K. R.; COSTA, R.; OLIVEIRA JR., R. M.; MARTINELLI FILHO, M.; LACERDA, M. S.; HUANG, A.; ROSSI, M. B.; MATHIAS JR., W.; PIETROBON, R.; STOLF, N. A. G.Background: Although several studies have demonstrated the deleterious consequences of chronic right ventricular (RV) pacing on ventricular function and synchronicity, its effects on health-related quality of life (HRQL) and physical capacity remains uncertain. Objectives: To evaluate the effect of RV pacing on HRQL and physical capacity of children and young adults with congenital complete atrioventricular (AV) block. Methods: Fifty consecutive patients with permanent RV cardiac pacing due to congenital AV block and under clinical follow-up for more than one year were enrolled. Multidimensional HRQL was assessed with the Short Form-36 Health Survey (SF-36) and Child Health Questionnaire (CHQ-PF50). Physical capacity was tested by the 6-minute walk distance test (6MWD). The scores for each domain and the distance performed at the 6MWD test were compared with demographic and clinical characteristics of patients, using the Student’s t-test and Qui-squaretest. Results: Domains presenting lower scores were Vitality (63.0±20.6), Pain(66.5±25.1) and Mental Health (67.3±20.4) in the SF-36 questionnaire; General Health Perceptions (64.0±15.0) and Parental Impact-Emotional (69.0±30.0) in the CHQ-PF50. Female gender (P=0.026), DDD pacing mode (0.008) and normal left ventricular ejection fraction (0.002) were associated with higher quality of life scores. The average distance performed at the 6MWD test was 677,2 meters (454,5 to 852,8). The 6MWD showed significant association with age (P=0.004), normal ventricular function (P= 0.031) and the absence of cardiovascular drugs use (P= 0.018). Conclusions: The results of this analysis indicated that chronic RV pacing did not affect the HRQL and physical capacity of young patients. Female gender, DDD pacing, normal ventricular function and the absence of cardiovascular medications were associated with better HRQL scores and with better results at 6MWD test.conferenceObject Prospective study of thromboembolic events after reoperation in permanent artificial cardiac pacing(2018) ALBERTINI, C. M.; SILVA, K. R.; LEAL FILHO, J. M.; MARTINELLI FILHO, M.; COSTA, R.- Detection of Early Diffuse Myocardial Fibrosis and Inflammation in Chagas Cardiomyopathy with T1 Mapping and Extracellular Volume(2023) MELO, Rodrigo J. L.; ASSUNCAO, Antonildes N.; MORAIS, Thamara C.; NOMURA, Cesar H.; SCANAVACCA, Mauricio I.; MARTINELLI-FILHO, Martino; RAMIRES, Felix J. A.; FERNANDES, Fabio; IANNI, Barbara M.; MADY, Charles; ROCHITTE, Carlos E.Purpose: To evaluate myocardial T1 mapping and extracellular volume (ECV) parameters in different stages of Chagas cardiomyopathy and determine whether they are predictive of disease severity and prognosis.Materials and Methods: Prospectively enrolled participants (July 2013 to September 2016) underwent cine and late gadolinium enhancement (LGE) cardiac MRI and T1 mapping with a precontrast (native) or postcontrast modified Look-Locker sequence. The native T1 and ECV values were measured among subgroups that were based on disease severity (indeterminate, Chagas cardiomyopathy with preserved ejection fraction [CCpEF], Chagas cardiomyopathy with midrange ejection fraction [CCmrEF], and Chagas cardiomyopathy with reduced ejection fraction [CCrEF]). Cox proportional hazards regression and the Akaike information criterion were used to determine predictors of major cardiovascular events (cardioverter defibrillator implant, heart transplant, or death).Results: In 107 participants (90 participants with Chagas disease [mean age & PLUSMN; SD, 55 years & PLUSMN; 11; 49 men] and 17 age-and sex matched control participants), the left ventricular (LV) ejection fraction and the extent of focal and diffuse or interstitial fibrosis were correlated with disease severity. Participants with CCmrEF and participants with CCrEF showed significantly higher global native T1 and ECV values than participants in the indeterminate, CCpEF, and control groups (T1: 1072 msec & PLUSMN; 34 and 1073 msec & PLUSMN; 63 vs 1010 msec & PLUSMN; 41, 1005 msec & PLUSMN; 69, and 999 msec & PLUSMN; 46; ECV: 35.5% & PLUSMN; 3.6 and 35.0% & PLUSMN; 5.4 vs 25.3% & PLUSMN; 3.5, 28.2% & PLUSMN; 4.9, and 25.2% & PLUSMN; 2.2; both P < .001). Remote (LGE-negative areas) native T1 and ECV values were also higher (T1: 1056 msec & PLUSMN; 32 and 1071 msec & PLUSMN; 55 vs 1008 msec & PLUSMN; 41, 989 msec & PLUSMN; 96, and 999 msec & PLUSMN; 46; ECV: 30.2% & PLUSMN; 4.7 and 30.8% & PLUSMN; 7.4 vs 25.1% & PLUSMN; 3.5, 25.1% & PLUSMN; 3.7, and 25.0% & PLUSMN; 2.2; both P < .001). Abnormal remote ECV values (>30%) occurred in 12% of participants in the indeterminate group, which increased with disease severity. Nineteen combined outcomes were observed (median follow-up time: 43 months), and a remote native T1 value greater than 1100 msec was independently predictive of combined outcomes (hazard ratio, 12 [95% CI: 4.1, 34.2]; P < .001).Conclusion: Myocardial native T1 and ECV values were correlated with Chagas disease severity and may serve as markers of myocardial involvement in Chagas cardiomyopathy that precede LGE and LV dysfunction.
- Effectiveness and Safety of Transvenous Removal of Cardiac Pacing and Implantable Cardioverter-defibrillator Leads in the Real Clinical Scenario(2020) COSTA, Roberto; SILVA, Katia Regina da; CREVELARI, Elizabeth Sartori; NASCIMENTO, Wagner Tadeu Jurevicius; NAGUMO, Marcia Mitie; MARTINELLI FILHO, Martino; JATENE, Fabio BiscegliBackground: Transvenous lead extraction (TLE) of cardiac implantable electronic devices (CIED) is an uncommon procedure and requires specialized personnel and adequate facilities. Objectives: To evaluate the effectiveness and safety of the removal of CIED leads and to determine risk factors for surgical complications and mortality in 30 days. Methods: Prospective study with data derived from clinical practice. From January 2014 to April 2020, we included 365 consecutive patients who underwent TLE, regardless of the indication and surgical technique used. The primary outcomes were: success rate of the procedure, combined rate of major complications and intraoperative death. Secondary outcomes were: risk factors for major intraoperative complications and death within 30 days. Univariate and multivariate analysis were used, with a significance level of 5%. Results: Procedure success rate was 96.7%, with 90.1% of complete success and 6.6% of clinical success. Major intraoperative complications occurred in 15 (4.1%) patients. Predictors of major complications were: lead dwelling time >= 7 years (OR = 3.78, p = 0.046) and change in surgical strategy (OR = 5.30, p = 0.023). Functional class III-IV (OR = 6.98, p <0.001), renal failure (OR = 5.75, p = 0.001), CIED infection (OR = 13.30, p <0.001), number of procedures performed (OR = 77.32, p <0.001) and major intraoperative complications (OR = 38.84, p <0.001) were predictors of 30-day mortality. Conclusions: The results of this study, which is the largest prospective registry of consecutive TLE procedures in Latin America, confirm the safety and effectiveness of this procedure in the context of real clinical practice.
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.- Effectiveness of epicardial atrial pacing using a bipolar steroid-eluting endocardial lead with active fixation in an experimental model(2013) BUENO, Savia Christina Pereira; TAMAKI, Wagner Tetsuji; SILVA, Marcelo Fiorelli Alexandrino da; ZAMBOLIM, Cristiane Maciel; SILVA, Katia Regina da; MARTINELLI FILHO, Martino; COSTA, RobertoPURPOSE: To assess the effectiveness of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead implanted on the atrial surface in an experimental model. METHODS: A total of ten Large White adult pigs underwent pacemaker implantation under general anesthesia. Atrial pacing and sensing parameters were obtained at the procedure, immediate postoperative period and on the 7th and the 30th postoperative in unipolar and bipolar configurations. RESULTS: All procedures were successfully performed. There were no perioperative complications and no early deaths. Atrial pacing and sensing parameters for both unipolar and bipolar modes remained stable throughout the study. We observed a progressive increase in atrial thresholds, ranging from 0.49 +/- 0.35 (at implantation) to 1.86 +/- 1.31 volts (30th postoperative day), in unipolar mode. Atrial impedance measurements decreased slightly over time, ranging from 486.80 +/- 126.35 Ohms (at implantation) to 385.0 +/- 80.52 Ohms (30th postoperative day). Atrial sensing measures remained stable from the immediate postoperative period until the end of the study. CONCLUSION: The bipolar active fixation endocardial lead implanted epicardially can provide stable conditions of pacing and sensing parameters throughout the postoperative follow-up.
- Long-Term Follow-Up of Implantable Cardioverter-Defibrillator for Secondary Prevention in Chagas' Heart Disease(2012) MARTINELLI, Martino; SIQUEIRA, Sergio Freitas de; STERNICK, Eduardo Back; RASSI JR., Anis; COSTA, Roberto; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoAssessing the efficacy of implantable cardioverter-defibrillators (ICD) in patients with Chagas' heart disease (ChHD) and identifying the clinical predictors of mortality and ICD shock during long-term follow-up. ChHD is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Although ChHD is a common form of cardiomyopathy in Latin American ICD users, little is known about its efficacy in the treatment of this population. The study cohort included 116 consecutive patients with ChHD and an ICD implanted for secondary prevention. Of the 116 patients, 83 (72%) were men; the mean age was 54 +/- 10.7 years. Several clinical variables were tested in a multivariate Cox model for predicting long-term mortality. The average follow-up was 45 +/- 32 months. New York Heart Association class I-II developed in 83% of patients. The mean left ventricular ejection fraction was 42 +/- 16% at implantation. Of the 116 patients, 58 (50%) had appropriate shocks and 13 (11%) had inappropriate therapy. A total of 31 patients died (7.1% annual mortality rate). New York Heart Association class III (hazard ratio [HR] 3.09, 95% confidence interval 1.37 to 6.96, p = 0.0064) was a predictor of a worse prognosis. The left ventricular ejection fraction (HR 0.972, 95% confidence interval 0.94 to 0.99, p = 0.0442) and low cumulative right ventricular pacing (HR 0.23, 95% confidence interval 0.11 to 0.49, p = 0.0001) were predictors of better survival. The left ventricular diastolic diameter was an independent predictor of appropriate shock (I-ER 1.032, 95% confidence interval 1.004 to 1.060, p = 0.025). In conclusion, in a long-term follow-up, ICD efficacy for secondary sudden cardiac death prevention in patients with ChHD was marked by a favorable annual rate of all-cause mortality (7.1%); 50% of the cohort received appropriate shock therapy. New York Heart Association class III and left ventricular ejection fraction were independent predictors of worse prognosis, and low cumulative right ventricular pacing defined better survival.
- Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures(2020) ALBERTINI, Caio Marcos de Moraes; SILVA, Katia Regina da; LIMA, Marta Fernandes; LEAL FILHO, Joaquim Mauricio da Motta; MARTINELLI FILHO, Martino; COSTA, RobertoBackground Venous obstructions are frequent in patients with transvenous leads, although related clinical findings are rarely reported. After lead replacement or upgrade procedures, these lesions are even more frequent, but there is still no evidence to support this observation. Aim To investigate the incidence and possible risk factors for upper extremity deep venous thrombosis (UEDVT) and pulmonary embolism (PE) after lead replacement or upgrade procedures. Methods Prospective cohort carried out between April 2013 and July 2016. Preoperative evaluation included venous ultrasound and pulmonary angiotomography. Diagnostic exams were repeated postoperatively to detect the study outcomes. Multivariate logistic regression models were used to identify prognostic factors. Results Among the 84 patients included, 44 (52.4%) were female and mean age was 59.3 +/- 15.2 years. Lead malfunctioning (75.0%) was the main surgical procedure indication. Lead removal was performed in 44 (52.4%) cases. The rate of postoperative combined events was 32.6%, with 24 (28.6%) cases of UEDVT and six (7.1%) cases of PE. Clinical manifestations of deep venous thrombosis occurred in 10 (11.9%) patients. Independent prognostic factors for UEDVT were severe collateral circulation in the preoperative venography (odds ratio [OR] 4.7; 95% confidence interval [CI] 1.1-19.8; P = .037) and transvenous lead extraction (OR 27.4; 95% CI 5.8-128.8; P < .0001). Conclusion Reoperations involving previously implanted transvenous leads present high rates of thromboembolic complications. Transvenous lead extraction had a significant impact on the development of UEDVT. These results show the need of further studies to evaluate the role of preventive strategies for this subgroup of patients.