GUILHERME VEIGA GUIMARAES

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Departamento de Cardio-Pneumologia, Faculdade de Medicina
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

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Autor e Coautores FMUSP-HC Normalizados: FERNANDO BACAL ×

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  • article 49 Citação(ões) na Scopus
    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.
  • article 10 Citação(ões) na Scopus
    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 Veiga
    Purpose 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.
  • conferenceObject
    Exercise Training Improves Chronotropic Incompetence but not Heart Rate Recovery to Exercise in Heart Transplant Patients
    (2015) CIOLAC, Emmanuel Gomes; CASTRO, Rafael E.; BACAL, Fernando; BOCCHI, Edimar A.; GUIMARAES, Guilherme V.
  • article 16 Citação(ões) na Scopus
    Physical Exercise and MicroRNAs: New Frontiers in Heart Failure
    (2012) FERNANDES-SILVA, Miguel Morita; CARVALHO, Vagner Oliveira; GUIMARAES, Guilherme Veiga; BACAL, Fernando; BOCCHI, Edimar Alcides
    Although the impact of exercise on survival of patients with heart failure has been recently questioned, exercise training improves quality of life, functional capacity, inflammation, endothelial and autonomic function. In recent years, interest has increased regarding a group of small non-protein coding RNAs called microRNAs. Studies have shown that the expression of these molecules changes in several pathological conditions, such as myocardial infarction, myocardial ischemia and heart failure, and when clinical improvement occurs, they seem to normalize. With the potential for practical applicability, markers that may be useful in diagnostic and prognostic assessment of heart failure have been identified, such as miR-423-5p. In addition, results of experimental studies have indicated that there are potential therapeutic effects of microRNAs. MicroRNAs are involved in the regulation of gene expression during fetal development and in adult individuals, increasing or decreasing in the heart in response to physiological stress, injury or hemodynamic overload. Thus, the study of the behavior of these molecules in physical exercise has brought important information about the effects of this therapeutic modality and represents a new era in the understanding of heart failure. This review aims to integrate the evidence on microRNAs in heart failure with greater relevance in the study of physical exercise.
  • article 29 Citação(ões) na Scopus
    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
    AGE-RELATED MAXIMUM HEART RATE AMONG ISCHEMIC AND NON-ISCHEMIC HEART FAILURE PATIENTS RECEIVING BETA-BLOCKADE THERAPY
    (2012) SILVA, Miguel Morita; GUIMARAES, Guilherme; ROQUE, Jean M.; TEIXEIRA NETO, Iran S.; BACAL, Fernando; BOCCHI, Edimar
    Background At the setting of evaluation of functional capacity, heart failure (HF) patients must be evaluated under optimised clinical therapy, including beta-adrenergic blockade (BB). Predicted maximum heart rate (HRmax) based on 220 – age is widespread used, but it is not applicable to patients receiving BB therapy. Few studies suggest other equations which estimate HRmax in patients receiving BB therapy with and without heart failure. However, these studies do not consider the etiology in HF. The purpose of this study was to determine an equation to predict HRmax in patients with ischemic and non ischemic HF who are receiving BB therapy. Methods We included patients with heart failure who were being considered for heart transplantation and underwent treadmill cardiopulmonary exercise testing between 1999 and 2010, using Naughton protocol. All patients were taking BB at maximum tolerated dose at the discretion of the treating physician. We excluded patients with pacemaker and/or implantable defibrillator, ejection fraction greater than 0.50 or peak respiratory exchange ratio (RER) less than 1.00 and chagas disease. We used linear regression to develop the equation that predict HR max, based on age in ischemic and non-ischemic patients. Results We analysed 278 patients, age 47±10, ischemic (n=75) and non-ischemic (n=203). The left ventricle ejection fraction was 30.8±9.4 and 28.6±8.2% (p = 0.04), peak VO2 was 16.9±4.7 and 16.9±5.2 ml/kg/min (p = NS) and the HRmax was 130.8±23.3 and 125.3±25.3 bpm (p = 0.051) in ischemic and non-ischemic respectively. We have found the equation HRmax = 168 − 0.76 × age for ischemic and HRmax = 134 − 0.18 × age for non-ischemic HF patients. Conclusion Our results suggest that equations to estimate HR max should consider the etiology in heart failure patients. ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m. Session Title: Does the Exercise ECG Have a Role in 2012? Abstract Category: 25. Diagnostic Testing: ECG Exercise Presentation Number: 1155-455
  • article 25 Citação(ões) na Scopus
    Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients
    (2015) PASCOALINO, Lucas Nobilo; CIOLAC, Emmanuel Gomes; TAVARES, Aline Cristina; CASTRO, Rafael Ertner; AYUB-FERREIRA, Silvia Moreira; BACAL, Fernando; ISSA, Victor Sarli; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme Veiga
    BACKGROUND: Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients. METHODS: 40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at similar to 70% of maximum oxygen uptake (Vo(2MAX)) RESULTS: The ET group had reduced 24-hour (4.0 +/- 1.4 mm Hg, p < 0.01) and daytime (4.8 +/- 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 +/- 1.4 mm Hg, p < 0.001) daytime (7.5 +/- 1.6 mm Hg, p < 0.001) and nighttime (5.9 +/- 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo(2MAX) (9.7% +/- 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention. CONCLUSIONS: The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggesfs that endurance ET may be a tool to counteract hypertension in this high-risk population.
  • 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.
  • article 22 Citação(ões) na Scopus
    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 Alcides
    To 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
    Treadmill versus cycle ergometer cardiopulmonary exercise testing in patients with chronic heart failure in the beta-blocker era
    (2013) MORITA, M.; BACAL, F.; CASTRO, R. E.; CRUZ, L.; BELLI, J. F. C.; ROQUE, J.; TEIXEIRA-NETO, I. S.; CHIZZOLA, P.; BOCCHI, E. A.; GUIMARAES, G. V.