CHARLES MADY
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
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 - Líder
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 - Líder
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
conferenceObject Echocardiographic findings of Trypanosoma cruzi seropositive blood donors(2017) SALEMI, V. M. C.; OLIVEIRA, C. D. L.; RIBEIRO, A. L.; MENEZES, M. M.; ANTUNES, A. P.; FERREIRA-FILHO, J. C.; SACHDEV, V.; FERNANDES, F.; NASTARI, L.; IANNI, B. M.; MADY, C.; CARNEIRO-PROIETTI, A. B.; KEATING, S. M.; BUSCH, M. P.; SABINO, E. G.- Chagas' heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance(2016) ASSUNCAO JR., Antonildes N.; JEROSCH-HEROLD, Michael; MELO, Rodrigo L.; MAURICIO, Alejandra V.; ROCHA, Liliane; TORREAO, Jorge A.; FERNANDES, Fabio; IANNI, Barbara M.; MADY, Charles; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.Background: Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas' heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR). Methods and results: Retrospectively, 62 seropositive Chagas' heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003). Conclusions: We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas' heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas' disease.
conferenceObject Sleep Apnea Worsens Muscle Vasoconstriction During Central and Peripheral Chemoreceptors Stimulation in Patients with Systolic Heart Failure(2016) LOBO, Denise M. L.; TREVIZAN, Patricia F.; TOSCHI-DIAS, Edgar; OLIVEIRA, Patricia A.; PIVETA, Rafael B.; MADY, Charles; BOCCHI, Edimar A.; ALMEIDA, Dirceu R.; LORENZI-FILHO, Gerald; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos E.conferenceObject Exercise Training Restores Muscle Mechano and Metaboreflex Sensitivity in Heart Failure Patients(2013) ANTUNES-CORREA, Ligia M.; NOBRE, Thais S.; GROEHS, Raphaela V.; ALVES, Maria Janieire N. N.; RONDON, Maria Urbana P. B.; MADY, Charles; ALMEIDA, Dirceu R.; OLIVEIRA, Patricia; LIMA, Marta F.; MATHIAS, Wilson; BRUM, Patricia C.; ROSSONI, Luciana V.; OLIVEIRA, Edilamar M.; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos EduardoIncreased sympathetic muscle mechanoreflex sensitivity and attenuated sympathetic muscle metaboreflex sensitivity have been described in heart failure (HF) patients. We tested the hypothesis that exercise training (ET) would improve sympathetic mechano and metaboreflex sensitivity in HF patients. 24 consecutive, randomized, HF patients, Functional Class II-III NYHA, EF≤40% were divided into two groups: Exercise-trained (n=12, 55±2 years) and untrained (n=12, 54±2 years). 10 normal controls (NC) were also studied. Muscle sympathetic nerve activity (MSNA) was directly recorded from the peroneal nerve. Mechanoreceptors were activated by passive exercise. Metaboreceptors were activated by post-exercise circulatory arrest. ET consisted of three 60-minutes exercise sessions per week for 4 months. ET significantly reduced MSNA in HF patients (34 vs. 40 bursts/min, P<0.05). ET significantly reduced MSNA responses to passive exercise ({Delta} = 2 vs. 5 bursts/min, P<0.05) and increased MNSA responses during post-exercise circulatory arrest ({Delta} = 5 vs. –1 bursts/min, P<0.0 5). These changes were so dramatic that the difference between HF patients and NC were no longer observed. No changes in untrained HF patients were found. In conclusion, ET restores sympathetic muscle mechano and metaboreflex sensitivity in HF patients, which may contribute to the reduction in MSNA and clinical outcomes in these patients.- Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up(2023) ANTUNES, Murillo Oliveira; ARTEAGA-FERNANDEZ, Edmundo; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; MADY, CharlesBackground: Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain. Objective: To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up. Avaliacao Prognostica da Microalternancia da onda T na Cardiomiopatia Hipertrofica em um Seguimento Clinico de 9 anos Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up Oliveira Antunes,1,2 Edmundo Arteaga-Fernandez,1 Nelson Samesima,1 Horacio Gomes Pereira Afonso Yoshikiro Matsumoto,3 Richard L. Verrier,4 Carlos Alberto Pastore,1 Charles Mady1 do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo,1 Sao Paulo, SP - Brasil Universidade Sao Francisco,2 Braganca Paulista, SP - Brasil Group,3 Sao Paulo, SP - Brasil Israel Deaconess Medical Center,4 Boston - EUA
- Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy(2013) SHIOZAKI, Afonso Akio; SENRA, Tiago; ARTEAGA, Edmund; MARTINELLI FILHO, Martino; PITA, Cristiane Guedes; AVILA, Luis Francisco R.; PARGA FILHO, Jose Rodrigues; MADY, Charles; KALIL-FILHO, Roberto; BLUEMKE, David A.; ROCHITTE, Carlos EduardoBackground: Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. Objective: The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. Methods: Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. Results: MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 +/- 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 +/- 19.13 g vs 13.57 +/- 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%-88%) and 71% (95% CI, 56%-81%), respectively. Kaplan-Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass >= 18 g than in patients with MF <18 g (P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. Conclusion: The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
- Subclinical Regional Left Ventricular Dysfunction in Obese Patients With and Without Hypertension or Hypertrophy(2011) SANTOS, Jose L. F.; SALEMI, Vera M. C.; PICARD, Michael H.; MADY, Charles; COELHO, Otavio R.We investigated the impact of obesity on the abnormalities of systolic and diastolic regional left ventricular (LV) function in patients with or without hypertension or hypertrophy, and without heart failure. We studied 120 individuals divided into 6 groups of 20 patients (42 +/- 6 years, 60 females) using standard and pulsed-wave tissue Doppler imaging (TDI) echocardiography, and heterogeneity index (HI): nonobese (I: no hypertension, no hypertrophy, control group; II: hypertension, no hypertrophy; III: hypertension and hypertrophy) and obese (IV: no hypertension, no hypertrophy; V: hypertension, no hypertrophy; VI: hypertension and hypertrophy). The criterion for obesity was BMI >= 30 kg/m(2), for hypertension was blood pressure >= 140/90 mm Hg, for hypertrophy in nonobese was LV mass/body surface area (BSA) >134 g/m(2) (men) and >110 mg/m(2) (women), and in obese was LV mass/height((2.7)) >50 (men) and >40 (women). Obese groups had normal LV ejection fraction compared with nonobese groups, but decreased longitudinal and radial systolic myocardial peak velocities (S'), and early diastolic myocardial peak velocity (E'). Also, a great variability of E' and late diastolic myocardial peak velocity (A') from the longitudinal basal region was observed in obese groups (E' basal nonobese: 11 +/- 7 vs. obese 19 +/- 11, P < 0.001, A' basal nonobese: 7 +/- 4 vs. obese 11 +/- 7, P < 0.001). Our findings were more evident when comparing groups IV with V and VI, with the latter having concentric hypertrophy and obvious segmental systolic and diastolic dysfunctions. Subclinical myocardial alterations and increased variability of the velocities were observed in obese groups, especially with hypertension and hypertrophy, reflecting impaired regional LV relaxation, segmental atrial, and systolic dysfunctions.
- Lower Prevalence and Severity of Coronary Atherosclerosis in Chronic Chagas' Disease by Coronary Computed Tomography Angiography(2020) CARDOSO, Savio; AZEVEDO FILHO, Clerio Francisco de; FERNANDES, Fabio; IANNI, Barbara; TORREAO, Jorge Andion; MARQUES, Mateus Diniz; AVILA, Luiz Francisco Rodrigues de; SANTOS FILHO, Raul; MADY, Charles; KALIL-FILHO, Roberto; RAMIRES, Jose Antonio Franchine; BITTENCOURT, Marcio Sommer; ROCHITTE, Carlos E.Background: In Chagas' disease endemic regions, there has been for many years a recurrent empirical observation that coronary artery disease (CAD) is uncommon in patients with Chagas' disease. Previous pathological and invasive coronary angiography studies led to controversial results. Objective: We sought to investigate whether CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile. Methods: A total of 86 participants, 43 consecutive patients with chronic Chagas' disease and 43 asymptomatic individuals, without any prior history of cardiac disease or known CAD (control group), were included. Patients and controls were matched according to gender, age, and Framingham risk score. All participants underwent coronary calcium scoring and coronary computed tomography angiography on a 320-row detector scanner. Statistical significance level adopted was p < 0.05. Results: The coronary artery calcium score (CACS) was significantly lower in patients with Chagas' disease than in controls (p<0.05). The presence of coronary atherosclerotic plaques was significantly less frequent in patients with Chagas' disease than in controls (20.9% versus 41.9%, p=0.037). After adjustment for the Framingham score, the odds ratio for the presence of any coronary artery calcium (CAC) in Chagas patients was 0.26 (95%CI: 0.07-0.99, p=0.048). The pattern is similar for CACS > 10 (OR: 0.11, 95%CI: 0.01-0.87, p=0.04) and for the presence of any stenosis (OR: 0.06, 95%CI: 0.01-0.47, p=0.001). Propensity score matching also indicated an effect of Chagas disease on the CACS (-21.6 points in the absolute score and 25% less of patients with CACS >10, p=0.015). Conclusions: CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile.
- Galectin-3 Associated with Severe Forms and Long-term Mortality in Patients with Chagas Disease(2021) FERNANDES, Fabio; MOREIRA, Carlos Henrique Valente; OLIVEIRA, Lea Campos; SOUZA-BASQUEIRA, Marcela; IANNI, Barbara Maria; LORENZO, Claudia di; RAMIRES, Felix Jose Alvarez; NASTARI, Luciano; CUNHA-NETO, Edecio; RIBEIRO, Antonio L.; LOPES, Renato Delascio; KEATING, Sheila M.; SABINO, Ester Cerdeira; MADY, CharlesBackground: The histopathological characteristics of Chagas disease (ChD) are: presence of myocarditis, destruction of heart fibers, and myocardial fibrosis. Galectin-3 (Gal-3) is a biomarker involved in the mechanism of fibrosis and inflammation that may be useful for risk stratification of individuals with ChD. Objectives We sought to evaluate whether high Gal-3 levels are associated with severe forms of Chagas cardiomyopathy (CC) and whether they are predictive of mortality. Methods We studied anti-T. cruzi positive blood donors (BD): Non-CC-BD (187 BD without CC with normal electrocardiogram [ECG] and left ventricular ejection fraction [LVEF]); CC-Non-Dys-BD (46 BD with CC with abnormal ECG but normal LVEF); and 153 matched serum-negative controls. This cohort was composed of 97 patients with severe CC (CC-Dys). We used Kruskall-Wallis and Spearman's correlation to test hypothesis of associations, assuming a two-tailed p<0.05 as significant. Results The Gal-3 level was 12.3 ng/mL for Non-CC-BD, 12.0 ng/mL for CC-Non-Dys-BD, 13.8 ng/mL for controls, and 15.4 ng/mL for CC-Dys. LVEF<50 was associated with higher Gal-3 levels (p=0.0001). In our linear regression adjusted model, we found association between Gal-3 levels and echocardiogram parameters in T. cruzi-seropositive subjects. In CC-Dys patients, we found a significant association of higher Gal-3 levels (>= 15.3 ng/mL) and subsequent death or heart transplantation in a 5-year follow-up (Hazard ratio - HR 3.11; 95%CI 1.21-8.04; p=0.019). Conclusions In ChD patients, higher Gal-3 levels were significantly associated with severe forms of the disease and more long-term mortality, which means it may be a useful means to identify high-risk patients.
- Late Gadolinium Enhancement Magnetic Resonance Imaging in the Diagnosis and Prognosis of Endomyocardial Fibrosis Patients(2011) SALEMI, Vera M. C.; ROCHITTE, Carlos E.; SHIOZAKI, Afonso A.; ANDRADE, Joalbo M.; PARGA, Jose R.; AVILA, Luiz F. de; BENVENUTI, Luiz A.; CESTARI, Ismar N.; PICARD, Michael H.; KIM, Raymond J.; MADY, CharlesBackground-Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (EMF). Echocardiography is a first-line and the standard technique for the diagnosis of this disease. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) allows FT characterization, its role in the diagnosis and prognosis of EMF has not been investigated. Methods and Results-Thirty-six patients (29 women; age, 54 +/- 12 years) with EMF diagnosis after clinical evaluation and comprehensive 2-dimensional Doppler echocardiography underwent cine-CMR for assessing ventricular volumes, ejection fraction and mass, and LGE-CMR for FT characterization and quantification. Indexed FT volume (FT/body surface area) was calculated after planimetry of the 8 to 12 slices obtained in the short-axis view at end-diastole (mL/m(2)). Surgical resection of FT was performed in 16 patients. In all patients, areas of LGE were confined to the endocardium, frequently as a continuous streak from the inflow tract extending to the apex, where it was usually most prominent. There was a relation between increased FT/body surface area and worse New York Heart Association functional class and with increased probability of surgery (P<0.05). The histopathologic examination of resected FT showed typical features of EMF with extensive endocardial fibrous thickening, proliferation of small vessels, and scarce inflammatory infiltrate. In multivariate analysis, the patients with FT/body surface area >19 mL/m(2) had an increased mortality rate, with a relative risk of 10.8. Conclusions-Our study provides evidence that LGE-CMR is useful in the diagnosis and prognosis of EMF through quantification of the typical pattern of FT deposition. (Circ Cardiovasc Imaging. 2011;4:304-311.)