CAIO DE ASSIS MOURA TAVARES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/65, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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- Contribution of the vectorcardiogram in the differential diagnosis of Brugada electrocardiographic pattern(2022) MADALOSO, Bruna A.; SAMESIMA, Nelson; TOBIAS, Nancy M. M. O.; TAVARES, Caio A. M.; FILHO, Horacio G. Pereira; FACIN, Mirella E.; PASTORE, C. A.Background: The electrocardiogram (ECG) is a powerful tool for differential diagnosis among a group of pathologies with different therapeutic approaches/prognoses, the so-called J-wave syndrome. The vectorcardiogram (VCG) can be used as a complementary method to the ECG in several dubious electrocardiographic alterations. Objective: We carried out a VCG analysis alter conceiving and measuring a novel parameter (JT-distance) that allows diagnosis of the Brugada ECG pattern. Methods: A retrospective cohort study selected ninety-six ECGs with J-point elevation in V-1/V-2, ECG superior leads and VCGs, all performed on the same day. A new VCG measurement by Frank method (IT-distance) was conceived and designed in transverse and right sagittal planes by 3 lines drawn 1) at the final third of the QRS loop, comprehending the J-point; 2) at the initial portion of the T loop; 3) a parallel of the J-point line at the beginning of the T loop. JT measure was determined by the distance between parallels. A validation cohort was established in a new sample of thirty-five patients. Results: JT-distance >= 1.5 mm (tranverse plane) and JT-distance >1.25 mm, in the sagittal plane, differentiated Brugada type-1 from Brugada type-2, early repolarization and others, with 95% sensitivity and 68% specificity. JT-distance <1.5 mm (transverse plane) and JT >1.25 mm (sagittal plane) had 100% sensitivity and 85% specificity for Brugada type-1 diagnosis. A validation cohort showed very similar Cohen's kappa levels (0.65 and 0.77, test and validation cohorts, respectively), with overlapping 95% confidence intervals. Conclusions: The novel vectorcardiogram measurement (JT-distance) presented a new diagnostic criterion to identify Brugada pattern. Nevertheless, prospective studies should be performed by other centers to confirm these findings.
- Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus(2020) GODOY, Lucas C.; TAVARES, Caio A. M.; FARKOUH, Michael E.Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2- or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the post-revascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure. (C) 2019 Canadian Diabetes Association.
- The blood pressure lowering effects of glucagon-like peptide-1 receptor agonists: A mini-review of the mechanisms(2023) RIBEIRO-SILVA, Joao Carlos; TAVARES, Caio A. M.; GIRARDI, Adriana C. C.The incretin hormone glucagon-like peptide 1 (GLP-1) is a key component of the signaling mechanisms promoting glucose homeostasis. Clinical and experimental studies demonstrated that GLP-1 receptor agonists, including GLP-1 itself, have favorable effects on blood pressure and reduce the risk of major cardiovascular events, independently of their effect on glycemic control. GLP-1 receptors are present in the hypo-thalamus and brainstem, the carotid body, the vasculature, and the kidneys. These organs are involved in blood pressure regulation, have their function altered in hypertension, and are positively benefited by the treatment with GLP-1 receptor ag-onists. Here, we discuss the potential mechanisms whereby activation of GLP-1R signaling exerts blood pressure-lowering effects beyond glycemic control.
- Biological Context Linking Hypertension and Higher Risk for COVID-19 Severity(2020) TAVARES, Caio A. M.; BAILEY, Matthew A.; GIRARDI, Adriana C. C.The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents a public health crisis of major proportions. Advanced age, male gender, and the presence of comorbidities have emerged as risk factors for severe illness or death from COVID-19 in observation studies. Hypertension is one of the most common comorbidities in patients with COVID-19. Indeed, hypertension has been shown to be associated with increased risk for mortality, acute respiratory distress syndrome, need for intensive care unit admission, and disease progression in COVID-19 patients. However, up to the present time, the precise mechanisms of how hypertension may lead to the more severe manifestations of disease in patients with COVID-19 remains unknown. This review aims to present the biological plausibility linking hypertension and higher risk for COVID-19 severity. Emphasis is given to the role of the renin-angiotensin system and its inhibitors, given the crucial role that this system plays in both viral transmissibility and the pathophysiology of arterial hypertension. We also describe the importance of the immune system, which is dysregulated in hypertension and SARS-CoV-2 infection, and the potential involvement of the multifunctional enzyme dipeptidyl peptidase 4 (DPP4), that, in addition to the angiotensin-converting enzyme 2 (ACE2), may contribute to the SARS-CoV-2 entrance into target cells. The role of hemodynamic changes in hypertension that might aggravate myocardial injury in the setting of COVID-19, including endothelial dysfunction, arterial stiffness, and left ventricle hypertrophy, are also discussed.
- Ranolazine Injection Into Coronary or Femoral Arteries Exerts Marked, Transient Regional Vasodilation Without Systemic Hypotension in an Intact Porcine Model(2011) NIEMINEN, Tuomo; TAVARES, Caio A. M.; PEGLER, Jose R. M.; BELARDINELLI, Luiz; VERRIER, Richard L.Background-We examined whether intracoronary or intrafemoral administration of ranolazine produces local vasodilation. Methods and Results-Effects of intra-arterial ranolazine on coronary and femoral artery vasodilation and systemic hemodynamic function were studied in anesthetized pigs (n=27). Ranolazine, nitroglycerin, or saline (control) was injected into the left anterior descending (LAD) coronary artery or femoral artery (2-mL bolus in 10 seconds). Pretreatment with prazosin (300 mu g/kg IV) allowed determination of alpha(1)-adrenergic receptor involvement (n=8). Rapid intracoronary administration of ranolazine (0.048 mg/kg) to achieve high local concentrations resulted in 91 +/- 11% increase in LAD coronary artery flow and 39 +/- 7% reduction in coronary vascular resistance (both, P<0.0001). This effect lasted 2-3 minutes without change in heart rate or rate-pressure product. Mean arterial pressure decreased marginally (by 2 +/- 1 mm Hg, P=0.01). Maximum systemic plasma concentration (0.93 +/- 0.29 mu mol/L) remained in subtherapeutic range. Pretreatment with prazosin abolished these effects. Intracoronary nitroglycerin (100 mu g) increased LAD coronary artery flow by 112 +/- 25% (P=0.02), but the effect lasted <2 minutes; mean arterial pressure decreased by 4 +/- 1 mmHg (P=0.01). Intrafemoral injection of ranolazine (0.24 mg/kg, ie, one-tenth of the systemic bolus) resulted in a 70 +/- 19% increase in femoral artery flow (P=0.05) and 26 +/- 5% reduction in femoral artery resistance (P=0.004). At 2 minutes after the injection, the femoral flow remained 16 +/- 9% above the baseline and dilatory effects occurred without tolerance to repeated injections. Conclusions-Intracoronary or intrafemoral ranolazine bolus exerts a marked, 2- to 3-minute dilatory effect that is comparable to nitroglycerin in magnitude but more persistent, attributable primarily to alpha(1)-adrenergic blockade. (Circ Cardiovasc Interv. 2011;4:481-487.)
- Effects of dabigatran versus warfarin on 2-year cognitive outcomes in old patients with atrial fibrillation: results from the GIRAF randomized clinical trial(2022) CARAMELLI, Bruno; YU, Pai Ching; CARDOZO, Francisco A. M.; MAGALHAES, Iuri R.; SPERA, Raphael R.; AMADO, Daniel K.; ESCALANTE-ROJAS, Maria C.; GUALANDRO, Danielle M.; CALDERARO, Daniela; TAVARES, Caio A. M.; BORGES-JUNIOR, Flavio A.; PASTANA, Adriana F.; MATHEUS, Mariana G.; BRUCKI, Sonia M. D.; RODRIGUES, Ana Carolina O.; NITRINI, Ricardo; CARAMELLI, PauloBackground: Observational studies support a role for oral anticoagulation to reduce the risk of dementia in atrial fibrillation patients, but conclusive data are lacking. Since dabigatran offers a more stable anticoagulation, we hypothesized it would reduce cognitive decline when compared to warfarin in old patients with atrial fibrillation. Methods: The GIRAF trial was a 24-month, randomized, parallel-group, controlled, open-label, hypothesis generating trial. The trial was done in six centers including a geriatric care unit, secondary and tertiary care cardiology hospitals in Sao Paulo, Brazil. We included patients aged >= 70 years and CHA2DS2-VASc score > 1. The primary endpoint was the absolute difference in cognitive performance at 2 years. Patients were assigned 1:1 to take dabigatran (110 or 150 mg twice daily) or warfarin, controlled by INR and followed for 24 months. Patients were evaluated at baseline and at 2 years with a comprehensive and thorough cognitive evaluation protocol of tests for different cognitive domains including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam (MMSE), a composite neuropsychological test battery (NTB), and computer-generated tests (CGNT). Results: Between 2014 and 2019, 5523 participants were screened and 200 were assigned to dabigatran (N = 99) or warfarin (N = 101) treatment. After adjustment for age, log of years of education, and raw baseline score, the difference between the mean change from baseline in the dabigatran group minus warfarin group was - 0.12 for MMSE (95% confidence interval [CI] - 0.88 to 0.63; P = 0.75), 0.05 (95% CI - 0.07 to 0.18; P = 0.40) for NTB, - 0.15 (95% CI - 0.30 to 0.01; P = 0.06) for CGNT, and - 0.96 (95% CI - 1.80 to 0.13; P = 0.02) for MoCA, with higher values suggesting less cognitive decline in the warfarin group. Conclusions: For elderly patients with atrial fibrillation, and without cognitive compromise at baseline that did not have stroke and were adequately treated with warfarin (TTR of 70%) or dabigatran for 2 years, there was no statistical difference at 5% significance level in any of the cognitive outcomes after adjusting for multiple comparisons.
- Unraveling the interplay between dipeptidyl peptidase 4 and the renin-angiotensin system in heart failure(2022) ARRUDA-JUNIOR, Daniel F.; SALLES, Thiago A.; MARTINS, Flavia L.; ANTONIO, Ednei L.; TUCCI, Paulo J. F.; GOWDAK, Luis Henrique W.; TAVARES, Caio A. M.; GIRARDI, Adriana C.Aims: Emerging evidence suggests the existence of a crosstalk between dipeptidyl peptidase 4 (DPP4) and the renin-angiotensin system (RAS). Therefore, combined inhibition of DPP4 and RAS may produce similar pharmacological effects rather than being additive. This study tested the hypothesis that combining an inhibitor of DPP4 with an angiotensin II (Ang II) receptor blocker does not provide additional cardioprotection compared to monotherapy in heart failure (HF) rats. Main methods: Male Wistar rats were subjected to left ventricle (LV) radiofrequency ablation or sham operation. Six weeks after surgery, radiofrequency-ablated rats who developed HF were assigned into four groups and received vehicle (water), vildagliptin, valsartan, or both drugs, for four weeks by oral gavage. Key findings: Vildagliptin and valsartan in monotherapy reduced LV hypertrophy, alleviated cardiac interstitial fibrosis, and improved systolic and diastolic function in HF rats, with no additional effect of combination treatment. HF rats displayed higher cardiac and serum DPP4 activity and abundance than sham. Surprisingly, not only vildagliptin but also valsartan in monotherapy downregulated the catalytic function and expression levels of systemic and cardiac DPP4. Moreover, vildagliptin and valsartan alone or in combination comparably upregulate the components of the cardiac ACE2/Ang-(1-7)/MasR while downregulating the ACE/Ang II/AT1R axis. Significance: Vildagliptin or valsartan alone is as effective as combined to treat cardiac dysfunction and remodeling in experimental HF. DPP4 inhibition downregulates classic RAS components, and pharmacological RAS blockade downregulates DPP4 in the heart and serum of HF rats. This interplay between DPP4 and RAS may affect HF progression and pharmacotherapy.
conferenceObject DIAGNOSTIC PERFORMANCE OF ECG CRITERIA FOR LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) SOUZA, Isabela Azevedo Ferreira De; GOMES, Cintia; PADRAO, Eduardo; MIYAWAKI, Isabele; MARQUES, Isabela Reis; MOREIRA, Vittoria; LOYOLA JUNIOR, Jose Eduardo Riceto; SILVA, Caroliny; CARDOSO, Rhanderson; OPRYSKO, Carson; TAVARES, Caio A. M.- P2Y12 inhibitor monotherapy versus dual antiplatelet therapy in patients with acute coronary syndromes undergoing coronary stenting: rationale and design of the NEOMINDSET Trial(2023) GUIMARES, Patricia O.; FRANKEN, Marcelo; TAVARES, Caio A. M.; SILVEIRA, Fabio S.; ANTUNES, Murillo O.; BERGO, Ricardo R.; JOAQUIM, Rodrigo M.; HIRAI, Jessica C. S.; ANDRADE, Pedro B.; PITTA, Fabio G.; MARIANI JR., Jose; NASCIMENTO, Bruno R.; SILVEIRA, Marcos S.; COSTA, Tiberio A. O.; DALL'ORTO, Frederico T. C.; SERPA, Renato G.; SAMPAIO, Fernanda B. A.; OHE, Louis N.; MANGIONE, Fernanda M.; FURTADO, Remo H. M.; SARMENTO-LEITE, Rogerio; MONFARDINI, Frederico; ASSIS, Silvia R. L.; NICOLAU, Jose C.; SPOSITO, Andrei C.; LOPES, Renato D.; ONUMA, Yoshinobu; VALGIMIGLI, Marco; ANGIOLILLO, Dominick J.; SERRUYS, Patrick W.; BERWANGER, Otavio; BACAL, Fernando; LEMOS, Pedro A.Dual antiplatelet therapy (DAPT) is currently the standard of care after percutaneous coronary interven-tion (PCI). Recent studies suggest that reducing DAPT to 1-3 months followed by an aspirin-free single antiplatelet therapy (SAPT) strategy with a potent P2Y12 inhibitor is safe and associated with less bleeding. However, to date, no randomised trial has tested the impact of initiating SAPT immediately after PCI, par-ticularly in patients with acute coronary syndromes (ACS). NEOMINDSET is a multicentre, randomised, open-label trial with a blinded outcome assessment designed to compare SAPT versus DAPT in 3,400 ACS patients undergoing PCI with the latest-generation drug-eluting stents (DES). After successful PCI and up to 4 days following hospital admission, patients are randomised to receive SAPT with a potent P2Y12 inhibitor (ticagrelor or prasugrel) or DAPT (aspirin plus a potent P2Y12 inhibitor) for 12 months. Aspirin is discontinued immediately after randomisation in the SAPT group. The choice between ticagrelor and prasugrel is at the investigator's discretion. The primary hypothesis is that SAPT will be non-inferior to DAPT with respect to the composite endpoint of all-cause mortality, stroke, myocardial infarction or urgent target vessel revascularisation, but superior to DAPT on rates of bleeding defined by Bleeding Academic Research Consortium 2, 3 or 5 criteria. NEOMINDSET is the first study that is specifically designed to test SAPT versus DAPT immediately following PCI with DES in ACS patients. This trial will provide impor-tant insights on the efficacy and safety of withdrawing aspirin in the early phase of ACS. (ClinicalTrials. gov: NCT04360720)
conferenceObject THE ASSOCIATION OF ELECTRICAL LEFT AXIS DEVIATION WITH CARDIAC STRUCTURAL ABNORMALITIES IN PATIENTS WITH ADVANCED AGE: AN OBSERVATIONAL STUDY.(2023) TAVARES, Caio A. M.; SAMESIMA, Nelson; GUIMARAES, Patricia; PADRAO, Eduardo; FACIN, Mirella Esmanhotto; NETO, Felippe Lazar; FERREIRA, Elisa; HAJJAR, Ludhmila; PASTORE, Carlos Alberto