FATIMA DAS DORES DA CRUZ
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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- 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.
conferenceObject Type B natriuretic peptide as a rejection predictor in heart transplantation(2013) CRUZ, F. D. C.; ISSA, V. I.; FERREIRA, S. A.; CONCEICAO, G. E.; BACAL, F.; BOCCHI, E. A.- Hypertonic saline solution for prevention of renal dysfunction in patients with decompensated heart failure(2013) ISSA, Victor S.; ANDRADE, Lucia; AYUB-FERREIRA, Silvia M.; BACAL, Fernando; BRAGANCA, Ana C. de; GUIMARAES, Guilherme V.; MARCONDES-BRAGA, Fabiana G.; CRUZ, Fatima D.; CHIZZOLA, Paulo R.; CONCEICAO-SOUZA, Germano E.; VELASCO, Irineu T.; BOCCHI, Edimar A.Background: Renal dysfunction is associated with increased mortality in patients with decompensated heart failure. However, interventions targeted to prevention in this setting have been disappointing. We investigated the effects of hypertonic saline solution (HSS) for prevention of renal dysfunction in decompensated heart failure. Methods: In a double-blind randomized trial, patients with decompensated heart failure were assigned to receive three-day course of 100 mL HSS (NaCl 7.5%) twice daily or placebo. Primary end point was an increase in serumcreatinine of 0.3 mg/dL or more. Main secondary end point was change in biomarkers of renal function, including serum levels of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin-NGAL and the urinary excretion of aquaporin 2 (AQP(2)), urea transporter (UT-A(1)), and sodium/hydrogen exchanger 3 (NHE3). Results: Twenty-two patients were assigned to HSS and 12 to placebo. Primary end point occurred in two (10%) patients in HSS group and six (50%) in placebo group (relative risk 0.3; 95% CI 0.09-0.98; P=0.01). Relative to baseline, serum creatinine and cystatin C levels were lower in HSS as compared to placebo (P=0.004 and 0.03, respectively). NGAL level was not statistically different between groups, however the urinary expression of AQP2, UT-A1 and NHE3 was significantly higher in HSS than in placebo. Conclusions: HSS administration attenuated heart failure-induced kidney dysfunction as indicated by improvement in both glomerular and tubular defects, a finding with important clinical implications. HSS modulated the expression of tubular proteins involved in regulation of water and electrolyte homeostasis.
conferenceObject Assessment of metabolic profile after conversion from cyclosporine to tacrolimus in heart transplantation(2013) BISELLI, B.; ESCALANTE, J. P.; AVILA, M. S.; NUSSBAUM, A. C. A. Santos; ULHOA, M. B.; AYUB-FERREIRA, S. M.; CHIZZOLA, P. R.; CRUZ, F. D.; BOCCHI, E. A.; BACAL, F.conferenceObject Analysis of survival time and etiologies of base disease in recipients of heart transplants(2013) CRUZ, F. D. C.; NUSSBAUM, A. C. A.; ISSA, V. S.; AYUB, S. F.; CHIZZOLA, P.; CONCEICAO, G. E.; BACAL, F.; BOCCHI, E. A.conferenceObject Cost-effectiveness of long-term disease management program in heart failure: results from the REMADHE trial(2013) BOCCHI, E. A.; CRUZ, F.; BRANDAO, S.; GUIMARAES, G.; BACAL, F.; ISSA, V. S.; CHIZZOLA, P.; SOUZA, G.; FERREIRA, S. M. A.conferenceObject Characteristics of patients in the wait list for heart transplantation at a hospital in Sao Paulo, during the past 19 years(2013) CRUZ, F. D. C.; NUSSBAUM, A. C. A.; FIORELLI, A. I.; BACAL, F.; BOCCHI, E. A.- Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study(2012) CONCEICAO-SOUZA, Germano Emilio; PEGO-FERNANDES, Paulo Manuel; CRUZ, Fatima das Dores; GUIMARAES, Guilherme Veiga; BACAL, Fernando; VIEIRA, Marcelo Luiz Campos; GRUPI, Cesar Jose; GIORGI, Maria Clementina Pinto; CONSOLIM-COLOMBO, Fernanda Marciano; NEGRAO, Carlos Eduardo; RONDON, Maria Urbana P.; MOREIRA, Luiz Felipe Pinho; BOCCHI, Edimar AlcidesTo evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) 40, sinus rhythm, and resting heart rate 65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 6.6 to 33 5.2 (P 0.03); 6 min walking distance improved from 167 35 to 198 47 m (P 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 5 to 15 7 (P 0.06). The remaining analysed variables were unchanged. During 848 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
conferenceObject Survival of patients with Chagas versus non Chagas Cardiomyopathy in a heart failure clinic(2013) CRUZ, F. D. C.; ESCALANTE, J. P.; AYUB, S. F.; ISSA, V. S.; BACAL, F.; BOCCHI, E. A.- Updating of the Brazilian guidelines for chronic heart failure - 2012(2012) BOCCHI, Edimar Alcides; MARCONDES-BRAGA, Fabiana Goulart; BACAL, Fernando; FERRAZ, Almir Sergio; ALBUQUERQUE, Denilson; RODRIGUES, Dirceu de Almeida; MESQUITA, Evandro Tinoco; VILAS-BOAS, Fabio; CRUZ, Fatima; RAMIRES, Felix; VILLACORTA JUNIOR, Humberto; SOUZA NETO, Joao David de; ROSSI NETO, Joao Manoel; MOURA, Lidia Zytynski; BECK-DA-SILVA, Luis; MOREIRA, Luiz Felipe; ROHDE, Luis Eduardo Paim; MONTERA, Marcelo Westerlund; SIMOES, Marcus Vinicius; MOREIRA, Maria da Consolacao; CLAUSELL, Nadine; BESTETTI, Reinaldo; MOURILHE-ROCHA, Ricardo; MANGINI, Sandrigo; RASSI, Salvador; AYUB-FERREIRA, Silvia Moreira; MARTINS, Silvia Marinho; BORDIGNON, Solange; ISSA, Victor Sarli