EDIMAR ALCIDES BOCCHI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
117 resultados
Resultados de Busca
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- Polymorphism in the Alpha Cardiac Muscle Actin 1 Gene Is Associated to Susceptibility to Chronic Inflammatory Cardiomyopathy(2013) FRADE, Amanda Farage; TEIXEIRA, Priscila Camilo; IANNI, Barbara Maria; PISSETTI, Cristina Wide; SABA, Bruno; WANG, Lin Hui Tzu; KURAMOTO, Andreia; NOGUEIRA, Luciana Gabriel; BUCK, Paula; DIAS, Fabricio; GINIAUX, Helene; LLORED, Agnes; ALVES, Sthefanny; SCHMIDT, Andre; DONADI, Eduardo; MARIN-NETO, Jose Antonio; HIRATA, Mario; SAMPAIO, Marcelo; FRAGATA, Abilio; BOCCHI, Edimar Alcides; STOLF, Antonio Noedir; FIORELLI, Alfredo Inacio; SANTOS, Ronaldo Honorato Barros; RODRIGUES, Virmondes; PEREIRA, Alexandre Costa; KALIL, Jorge; CUNHA-NETO, Edecio; CHEVILLARD, ChristopheAims: Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in Latin America, and may lead to a life-threatening inflammatory dilated, chronic Chagas cardiomyopathy (CCC). One third of T. cruzi-infected individuals progress to CCC while the others remain asymptomatic (ASY). A possible genetic component to disease progression was suggested by familial aggregation of cases and the association of markers of innate and adaptive immunity genes with CCC development. Since mutations in multiple sarcomeric genes, including alpha-cardiac actin (ACTC1) have been involved in hereditary dilated cardiomyopathy, we investigated the involvement of the ACTC1 gene in CCC pathogenesis. Methods and Results: We conducted a proteomic and genetic study on a Brazilian study population. The genetic study was done on a main cohort including 118 seropositive asymptomatic subjects and 315 cases and the replication was done on 36 asymptomatic and 102 CCC cases. ACTC1 protein and mRNA levels were lower in myocardial tissue from patients with end-stage CCC than those found in hearts from organ donors. Genotyping a case-control cohort of CCC and ASY subjects for all informative single nucleotide polymorphism (SNP) in the ACTC1 gene identified rs640249 SNP, located at the 5' region, as associated to CCC. Associations are borderline after correction for multiple testing. Correlation and haplotype analysis led to the identification of a susceptibility haplotype. Functional assays have shown that the rs640249A/C polymorphism affects the binding of transcriptional factors in the promoter regions of the ACTC1 gene. Confirmation of the detected association on a larger independent replication cohort will be useful. Conclusions: Genetic variations at the ACTC1 gene may contribute to progression to chronic Chagas Cardiomyopathy among T. cruzi-infected patients, possibly by modulating transcription factor binding to ACTC1 promoter regions.
- Role of Trimetazidine in Ischemic Preconditioning in Patients With Symptomatic Coronary Artery Disease(2015) COSTA, Leandro M. A.; REZENDE, Paulo C.; GARCIA, Rosa M. R.; UCHIDA, Augusto H.; SEGURO, Luis Fernando B. C.; SCUDELER, Thiago L.; BOCCHI, Edimar A.; KRIEGER, Jose E.; HUEB, Whady; RAMIRES, Jose Antonio F.; KALIL FILHO, RobertoIschemic preconditioning (IP) is a powerful cardioprotective cellular mechanism that has been related to the warm-up phenomenon or walk-through angina, and has been documented through the use of sequential exercise tests (ETs). It is known that several drugs, for example, cromokalim, pinacidil, adenosine, and nicorandil, can interfere with the cellular pathways of IP. The purpose of this article is to report the effect of the anti-ischemic agent trimetazidine (TMZ) on IP in symptomatic coronary artery disease (CAD) patients.We conducted a prospective study evaluating IP by the analysis of ischemic parameters in 2 sequential ETs. In phase I, without TMZ, patients underwent ET1 and ET2 with a 30-minute interval between them. In phase II, after 1 week of TMZ 35mg twice daily, all patients underwent 2 consecutive ETs (ET3 and ET4). IP was considered present when the time to 1.0-mm segment ST on electrocardiogram deviation (T-1.0mm) and rate pressure product (RPP) were greater in the second of 2 tests. The improvement in T-1.0mm and RPP were compared in the 2 phases: without TMZ and after 1-week TMZ to assess the action of such drug in myocardial protective mechanisms. ETs were analyzed by 2 independent cardiologists.From 135 CAD patients screened, 96 met inclusion criteria and 62 completed the study protocol. Forty patients manifested IP by demonstrating an improvement in T-1.0mm in ET2 compared with ET1, without the use of any drugs (phase I). In phase II, after 1-week TMZ, 26 patients (65%) did not show any incremental result in ischemic parameters in ET4 compared with ET3. Furthermore, of these patients, 8 (20%) had IP blockage.In this study, TMZ did not add any benefit to IP in patients with stable symptomatic CAD.
- Brazilian Society of Cardiology Guideline on Myocarditis-2022(2022) MONTERA, Marcelo Westerlund; MARCONDES-BRAGA, Fabiana G.; SIMOES, Marcus Vinicius; MOURA, Lidia Ana Zytynski; FERNANDES, Fabio; MANGINE, Sandrigo; OLIVEIRA JUNIOR, Amarino Carvalho de; SOUZA, Aurea Lucia Alves de Azevedo Grippa de; IANNI, Barbara Maria; ROCHITTE, Carlos Eduardo; MESQUITA, Claudio Tinoco; AZEVEDO FILHO, Clerio F. de; FREITAS, Dhayn Cassi de Almeida; MELO, Dirceu Thiago Pessoa de; BOCCHI, Edimar Alcides; HOROWITZ, Estela Suzana Kleiman; MESQUITA, Evandro Tinoco; OLIVEIRA, Guilherme H.; VILLACORTA, Humberto; ROSSI NETO, Joao Manoel; BARBOSA, Joao Marcos Bemfica; FIGUEIREDO NETO, Jose Albuquerque de; LUIZ, Louise Freire; HAJJAR, Ludhmila Abrahao; BECK-DA-SILVA, Luis; CAMPOS, Luiz Antonio de Almeida; DANZMANN, Luiz Claudio; BITTENCOURT, Marcelo Imbroise; GARCIA, Marcelo Iorio; AVILA, Monica Samuel; CLAUSELL, Nadine Oliveira; JR, Nilson Araujo de Oliveira; SILVESTRE, Odilson Marcos; SOUZA, Olga Ferreira de; MOURILHE-ROCHA, Ricardo; KALIL FILHO, Roberto; AL-KINDI, Sadeer G.; RASSI, Salvador; ALVES, Silvia Marinho Martins; FERREIRA, Silvia Moreira Ayub; RIZK, Stephanie Itala; MATTOS, Tiago Azevedo Costa; BARZILAI, Vitor; MARTINS, Wolney de Andrade; SCHULTHEISS, Heinz-Peter
article BRAZILIAN DIRECTOR OF CARDIO-ONCOLOGY OF THE BRAZILIAN CARDIOLOGY SOCIETY ACHIEVEMENT(2011) KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao; BACAL, Fernando; HOFF, Paulo Marcelo Gehm; DIZ, Maria Del Pilar Estevez; GALAS, Filomena Regina Barbosa Gomes; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; NAKAMURA, Rosana Ely; TRIELLI, Thalia Rodrigues; BITTAR, Cristina Salvadori; SANTOS, Marilia Harumi dos; GALDEANO, Flavia Gomes; AULER JUNIOR, Jose Otavio da Costa; SILVESTRINI, Anderson Arantes; ALENCAR, Aristoteles; MOTA, Augusto Cesar de Andrade; GUSMAO, Cid Abreu Buarque de; ALMEIDA, Dirceu Rodrigues; SIMOES, Claudia Marques; BOCCHI, Edimar Alcides; LIMA, Enaldo Melo de; FERNANDES, Fabio; SILVEIRA, Fabio Serra; VILAS-BOAS, Fabio; SILVA NETO, Luis Beck da; ROHDE, Luis Eduardo Paim; MONTERA, Marcelo Westerlund; BARBOSA, Marcia; MANO, Max Senna; RIECHELMANN, Rachel Simoes; ARAI, Roberto Jun; MARTINS, Silvia M.; FERREIRA, Silvia Moreira Ayub; SANTOS, Veronica- 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.
- Prescribing and Regulating Exercise with RPE after Heart Transplant: A Pilot Study(2015) CIOLAC, Emmanuel Gomes; CASTRO, Rafael Ertner; GREVE, Julia Maria D'Andrea; BACAL, Fernando; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme VeigaPurpose The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. Methods Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 2.5 yr) age 46.7 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. Results No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. Conclusion Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.
- Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study(2013) GUIMARAES, Guilherme V.; CRUZ, Lais G. B.; TAVARES, Aline C.; DOREA, Egidio L.; FERNANDES-SILVA, Miguel M.; BOCCHI, Edimar A.High blood pressure (BP) increases the risk of cardiovascular diseases, and its control is a clinical challenge. Regular exercise lowers BP in patients with mild-to-moderate hypertension. No data are available on the effects of heated water-based exercise in hypertensive patients. Our objective was to evaluate the effects of heated water-based exercise on BP in patients with resistant hypertension. We tested the effects of 60-min heated water-based exercise training three times per week in 16 patients with resistant hypertension (age 55 +/- 6 years). The protocol included walking and callisthenic exercises. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM) before and after a 2-week exercise program in a heated pool. Systolic office BP was reduced from 162 to 144 mmHg (P<0.004) after heated-water training. After the heated-water exercise training during 24-h ABPM, systolic BP decreased from 135 to 123 mmHg (P=0.02), diastolic BP decreased from 83 to 74 mmHg (P=0.001), daytime systolic BP decreased from 141 to 125 mmHg (P=0.02), diastolic BP decreased from 87 to 77 mmHg (P=0.009), night-time systolic BP decreased from 128 to 118 mmHg (P=0.06), and diastolic BP decreased from 77 to 69 mmHg (P=0.01). In addition, BP cardiovascular load was reduced significantly during the 24-h daytime and night-time period after the heated water-based exercise. Heated water-based exercise reduced office BP and 24-h daytime and night-time ABPM levels. These effects suggest that heated water-based exercise may have a potential as a new therapeutic approach to resistant hypertensive patients.
- Effects of the exercise training on skeletal muscle oxygen consumption in heart failure patients with reduced ejection fraction(2021) GUIMARAES, Guilherme Veiga; RIBEIRO, Fernando; CASTRO, Rafael Ertner; ROQUE, Jean Marcelo; MACHADO, Alexander Douglas Teixeira; ANTUNES-CORREA, Ligia M.; FERREIRA, Silvia Ayub; BOCCHI, Edimar AlcidesAims: Skeletal muscle dysfunction is a systemic consequence of heart failure (HF) that correlates with functional capacity. However, the impairment within the skeletal muscle is not well established. We investigated the effect of exercise training on peripheral muscular performance and oxygenation in HF patients. Methods and results: HF patients with ejection fraction <= 40% were randomized 2:1 to exercise training or control for 12 weeks. Muscle tissue oxygen was measured noninvasively by near-infrared spectroscopy (NIPS) during rest and a symptom-limited cardiopulmonary exercise test (CPET) before and after intervention. Measurements included skeletal muscle oxygenated hemoglobin concentration, deoxygenated hemoglobin concentration, total hemoglobin concentration, VO2 peak, VE/VCO2 slope, and heart rate. Muscle sympathetic nerve activity by microneurography, and muscle blood flow by plethysmography were also assessed at rest pre and post 12 weeks. Twenty-four participants (47.5 +/- 7.4 years, 58% men, 75% no ischemic) were allocated to exercise training (ET, n = 16) or control (CG, n = 8). At baseline, no differences between groups were found. Exercise improved VO2 peak, slope VE/VCO2, and heart rate. After the intervention, significant improvements at rest were seen in the ET group in muscle sympathetic nerve activity and muscle blood flow. Concomitantly, a significant decreased in Oxy-Hb (from 29.4 +/- 20.4 to 15.7 +/- 9.0 mu mol, p = 0.01), Deoxi-Hb (from 16.3 +/- 8.2 to 12.2 +/- 6.0 mu mol, p = 0.003) and HbT (from 45.7 +/- 27.6 to 27.7 +/- 13.4 mu mol, p = 0.008) was detected at peak exercise after training. No changes were observed in the control group. Conclusion: Exercise training improves skeletal muscle function and functional capacity in HF patients with reduced ejection fraction. This improvement was associated with increased oxygenation of the peripheral muscles, increased muscle blood flow, and decreased sympathetic nerve activity.
- Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials(2023) RAVANI, Lis Victoria; GEWEHR, Douglas Mesadri; CALOMENI, Pedro; GAUZA, Mateus de Miranda; PEREIRA, Jussara; CARDOSO, Rhanderson; RIBEIRO, Henrique Barbosa; BOCCHI, EdimarSacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the associaangiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;205:259-268)
- Baseline characteristics of patients with heart failure with preserved ejection fraction in the EMPEROR-Preserved trial(2020) ANKER, Stefan D.; BUTLER, Javed; FILIPPATOS, Gerasimos; KHAN, Muhammad Shahzeb; FERREIRA, Joao Pedro; BOCCHI, Edimar; BOHM, Michael; ROCCA, Hans Pieter Brunner-La; CHOI, Dong-Ju; CHOPRA, Vijay; CHUQUIURE, Eduardo; GIANNETTI, Nadia; GOMEZ-MESA, Juan Esteban; JANSSENS, Stefan; JANUZZI, James L.; GONZALEZ-JUANATEY, Jose R.; MERKELY, Bela; NICHOLLS, Stephen J.; V, Sergio Perrone; PINA, Ileana L.; PONIKOWSKI, Piotr; SENNI, Michele; SERONDE, Marie-France; SIM, David; SPINAR, Jindrich; SQUIRE, Iain; TADDEI, Stefano; TSUTSUI, Hiroyuki; VERMA, Subodh; VINEREANU, Dragos; ZHANG, Jian; JAMAL, Waheed; SCHNAIDT, Sven; SCHNEE, Janet M.; BRUECKMANN, Martina; POCOCK, Stuart J.; ZANNAD, Faiez; PACKER, MiltonAims EMPEROR-Preserved is an ongoing trial evaluating the effect of empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). This report describes the baseline characteristics of the EMPEROR-Preserved cohort and compares them with patients enrolled in prior HFpEF trials. Methods and results EMPEROR-Preserved is a phase III randomized, international, double-blind, parallel-group, placebo-controlled trial in which 5988 symptomatic HFpEF patients [left ventricular ejection fraction (LVEF) >40%] with and without type 2 diabetes mellitus (T2DM) have been enrolled. Patients were required to have elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations (i.e. >300 pg/mL in patients without and >900 pg/mL in patients with atrial fibrillation) along with evidence of structural changes in the heart or documented history of heart failure hospitalization. Among patients enrolled from various regions (45% Europe, 11% Asia, 25% Latin America, 12% North America), the mean age was 72 +/- 9 years, 45% were women. Almost all patients had New York Heart Association class II or III symptoms (99.6%), and 23% had prior heart failure hospitalization within 12 months. Thirty-three percent of the patients had baseline LVEF of 41-50%. The mean LVEF (54 +/- 9%) was slightly lower while the median NT-proBNP [974 (499-1731) pg/mL] was higher compared with previous HFpEF trials. Presence of comorbidities such as diabetes (49%) and chronic kidney disease (50%) were common. The majority of the patients were on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (80%) and beta-blockers (86%), and 37% of patients were on mineralocorticoid receptor antagonists. Conclusion When compared with prior trials in HFpEF, the EMPEROR-Preserved cohort has a somewhat higher burden of comorbidities, lower LVEF, higher median NT-proBNP and greater use of mineralocorticoid receptor antagonists at baseline. Results of the EMPEROR-Preserved trial will be available in 2021.