MONICA SAMUEL AVILA GRINBERG
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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- Survival of Heart Transplant Patients with Chagas' Disease Under Different Antiproliferative Immunosuppressive Regimens(2023) FURQUIM, Silas Ramos; GALBIATI, Luana Campoli; AVILA, Monica S.; MARCONDES-BRAGA, Fabiana G.; FUKUSHIMA, Julia; MANGINI, Sandrigo; SEGURO, Luis Fernando Bernal da Costa; CAMPOS, Iascara Wozniak de; STRABELLI, Tania Mara Varejao; BARONE, Fernanda; PAULO, Audrey Rose da Silveira Amancio de; OHE, Luciana Akutsu; GALANTE, Mariana Cappelletti; GAIOTTO, Fabio Antonio; BACAL, FernandoBackground: Chagas' disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas' disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown.Objectives: To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival.Methods: Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (""Change"" group). A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates.Conclusions: This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.
- Renin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysis(2023) AVILA, Monica Samuel; SIQUEIRA, Suellen Rodrigues Rangel; WALDECK, Lucas; AYUB-FERREIRA, Silvia Moreira; TAKX, Richard; BITTENCOURT, Marcio Sommer; BOCCHI, Edimar AlcidesBackground: The evidence supporting the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and beta-blockers for the prevention of anthracycline-induced cardiomyopathy is controversial. Objective: We performed a meta-analysis to assess the effectiveness of these drugs in preventing cardiotoxicity. Methods: The meta-analysis included prospective, randomized studies in adults receiving anthracycline chemotherapy and compared the use of RAAS inhibitors or beta-blockers versus placebo with a follow-up of 6 to 18 months. The primary outcome was change in left ventricular ejection fraction (LVEF) during chemotherapy. Secondary outcomes were the incidence of heart failure, all-cause mortality, and changes in end-diastolic measurement. Heterogeneity was assessed by stratification and meta-regression. A significance level of p < 0.05 was adopted. Results: The search resulted in 17 studies, totaling 1,530 patients. The variation (delta) in LVEF was evaluated in 14 studies. Neurohormonal therapy was associated with a lower delta in pre- versus post-therapy LVEF (weighted mean difference 4.42 [95% confidence interval2.3 to 6.6]) and higher final LVEF (p < 0.001). Treatment resulted in a lower incidence of heart failure (risk ratio 0.45 [95% confidence interval0.3 to 0.7]). There was no effect on mortality (p = 0.3). For analysis of LVEF, substantial heterogeneity was documented, which was not explained by the variables explored in the study. Conclusion: The use of RAAS inhibitors and beta-blockers to prevent anthracycline-induced cardiotoxicity was associated with less pronounced reduction in LVEF, higher final LVEF, and lower incidence of heart failure. No changes in mortalitywere observed. (CRD PROSPERO 42019133615)
conferenceObject Breath acetone changes in advanced heart failure patients on inotropes(2023) COSTA-DAN, D. M.; BACAL, F.; LIRA, C. N. L.; FURLAN, D. A. G.; SILVA, B. G.; RINCO, R. S.; SOIERO, A. M.; LEAL, T. C. A. T.; AVILA, M. S.; BISELLI, B.; BOCCHI, E. A.; SOARES, P. R.; OLIVEIRA JUNIOR, M. T.; GUTZ, I. G. R.; MARCONDES-BRAGA, F. G.conferenceObject Necropsy findings in heart transplant recipients with and without primary graft dysfunction: a retrospective study(2023) BELFORT, D. S. P.; MANGINI, S.; AVILA, M. S.; MARCONDES-BRAGA, F. G.; CAMPOS, I. W.; SEGURO, L. F. B. C.; BACAL, F.; GUTIERREZ, P. S.conferenceObject The Role of High-Sensitive Troponin in Identifying Patients with Cardiac Allograft Rejection(2023) SCUSSEL, A. A.; MARCONDES-BRAGA, F. G.; ESPINOZA, C.; MARCHI, D. De; AVILA, M.; DUQUE, A. P.; PAULO, A. R. de; MANGINI, S.; CAMPOS, I. W. de; SEGURO, L. F.; GAIOTTO, F. A.; BACAL, F.- Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure(2023) FILIPPINI, Filippe Barcellos; RIBEIRO, Henrique Barbosa; BOCCHI, Edimar; BACAL, Fernando; MARCONDES-BRAGA, Fabiana G.; AVILA, Monica S.; STURMER, Janine Daiana; MARCHI, Mauricio Felippi de Sa; KANHOUCHE, Gabriel; FERNANDO, Antonio; CASSAR, Renata; JR, Fabio Sandoli de Brito; ABIZAID, Alexandre A.Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
- Neurochagas in post-heart transplant: clinical and epidemiological analysis of this entity based on a series of cases(2024) ROMERO, Cristhian Espinoza; MARCHI, Daniel Catto De; MARCONDES-BRAGA, Fabiana G.; MANGINI, Sandrigo; AVILA, Monica Samuel; BACAL, Fernando