LUIS FERNANDO BERNAL DA COSTA SEGURO
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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conferenceObject Vaccine-Induced Coronay Antibodie-Mediated Rejection and Thrombosis in a Heart Transplant Pacient: A Case Report(2022) BARROSO, N. D.; GALBIATI, L. C.; ARAGAO, C.; FERNANDEZ, M. P.; AVILA, M. S.; SEGURO, L. F.; MARCONDES-BRAGA, F. G.; MANGINI, S.; CAMPOS, I. W.; OLIVEIRA, J. Junior de; FURQUIM, S.; PIERI, R.; GAIOTTO, F.; BACAL, F.- 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.
conferenceObject Prevalence of Cognitive Impairment in Heart Transplant Waiting-List Patients in a Developing Country(2020) OLIVEIRA, F. M. de; IKEDA, E. T.; AVILA, M.; WOZNIAK, I.; SEGURO, L.; SANTOS, M.; FELTRIM, M.; BARONE, F.; ISSA, V.; LAGE, S.; BACAL, F.; BOCCHI, E.; GAIOTTO, F.; NOMURA, C.; MARCONDES-BRAGA, F.; MANGINI, S.- Profile of Heart Transplant Recipients in a Brazilian Center: Comparison With International Registry(2014) SEGURO, L. F.; BRAGA, F. G. Marcondes; AVILA, M. S.; MANGINI, S.; BISELLI, B.; FRANCO, G. P.; LIMA, C. G.; SANTOS, R. H.; LOURENCO FILHO, D. D.; GAIOTTO, F. A.; BACAL, F.
conferenceObject Anatomopathological Consequences of the Change in the Clinical-Demographic Profile of Chagasic Patients Who Are Candidates for Heart Transplantation in Recent Years(2022) ARAGAO, C. A.; CAMPOS, I. W.; DUARTE, N.; FURQUIM, S.; GALBIATI, L. C.; PEREZ, M.; PIERI, R.; GRINBERG, M. S. Avila; SEGURO, L. F.; MARCONDES-BRAGA, F. G.; MANGINI, S.; STRABELLI, T. M.; GAIOTTO, F. A.; BACAL, F.- Frofile of Donor Hearts in Brazil(2014) MELO, J. L.; PAULO, A. R.; SOUZA, J. A.; OHE, L. A.; BARBOSA, M. B.; AVILA, M. S.; MARCONDES-BRAGA, E. G.; SEGURO, L. B.; MANGINI, S.; SANTOS, R. H.; LOURENCO FILHO, D. D.; GAIOTTO, F. A.; KAWABE, L. T.; BACAL, F.
conferenceObject Venous Thromboembolism as an Initial Manifestation of COVID-19 in a Heart Transplant Patient(2021) DANTAS, R. C. Tourinho; LIRA, M.; BELFORT, D.; ARAGAO, C.; MURAD, C.; AVILA, M.; SEGURO, L.; MANGINI, S.; CAMPOS, I.; MARCONDES-BRAGA, F.; BACAL, F.conferenceObject Bone Metabolism Impairment in Heart Transplant: Results from a Prospective Cohort Study(2019) SEGURO, Luis; PEREIRA, Rosa; SEGURO, Luciana; CAPARBO, Valeria; AVILA, Monica; MANGINI, Sandrigo; CAMPOS, Iascara; GAIOTTO, Fabio; MARCONDES-BRAGA, Fabiana; BACAL, Fernando- 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.
conferenceObject Early Antibody-Mediated Rejection in Non-Pre-Sensitized Heart Transplant Recipient(2021) LIRA, M. S.; BELFORT, D. Sa Pereira; DANTAS, R. Cavalcanti Tourinho; ARAGAO, C. Aurelio Santos; AVILA, M. Samuel; SEGURO, L.; MANGINI, S.; CAMPOS, I. Wozniak; MARCONDES-BRAGA, F.; BACAL, F.