SILVIA HELENA GELAS LAGE PASQUALUCCI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/22 - Laboratório de Patolologia Cardiovascular, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/22 - Laboratório de Patolologia Cardiovascular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Clinical outcomes of patients with decompensated heart failure(2016) MORAES, L. R.; GOMEZ, L. M.; TERHOCH, C. B.; MOREIRA, H. F.; AYUB-FERREIRA, S. M.; LAGE, S. G.; OLIVEIRA, M. T.; ISSA, V. S. Victor Sarli; BOCCHI, E. A.bookPart Choque séptico em paciente com cardiopatia(2016) BERNOCHE, Claudia Yanet San Martin; LAGE, Silvia H. G.; YEU, So Pei- Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry(2016) BEZERRA, Cristiano Guedes; ADAM, Eduardo Leal; BAPTISTA, Mariana Lins; CIAMBELLI, Giuliano Serafino; KOPEL, Liliane; BERNOCHE, Claudia; LOPES, Leonardo Nicolau Geisler Daud; MACATRAO-COSTA, Milena Frota; FALCAO, Breno de Alencar Araripe; LAGE, Silvia GelasBackground: The use of aortic counterpulsation therapy in advanced heart failure is controversial. Objectives: To evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP) and its impact on 30-day mortality in patients with heart failure. Methods: Historical prospective, unicentric study to evaluate all patients treated with IABP betwen August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation). We analyzed changes in oxygen central venous saturation (ScvO(2)), arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and diferences in subgroups were evaluated by the Log-rank test. Results: A total of 223 patients (mean age 49 +/- 14 years) were included. Mean left ventricle ejection fraction was 24 +/- 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001) and use of nitroprusside (33.6% vs. 47.5%, p < 0.001), and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001) and use of vasopressors (36.3% vs. 25.6%, p = 0.003) after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008). Conclusion: After 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.
bookPart Dissecção aguda de aorta(2016) SAROUTE, Ally Nader Roquetti; BERNOCHE, Claudia Yanet San Martin; LAGE, Silvia Helena GelasconferenceObject Clinical presentation and prognosis of patients with Chagas' cardiomyopathy during episodes of acute decompensated heart failure(2016) MADRONERO, L. M. Lina Marcela Gomez; MORAES, L. R.; TERHOCH, C. B.; MOREIRA, H. F.; AYUB-FERREIRA, S. M.; OLIVEIRA, M. T.; LAGE, S. G.; ISSA, V. S.; BOCCHI, E. A.- Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial(2016) BASTOS, Jaime Freitas; FERRI, Mauricio; LIMA, José Jayme Galvão de; KOPEL, Liliane; LAGE, Silvia GelásOBJECTIVES: Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach. METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate. RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups. CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.
bookPart Drogas vasoativas(2016) ABUD, Isabela Cristina Kirnew; LOPES, Leonardo Nicolau Geisler Daud; LAGE, Silvia H. G.conferenceObject Model for end-stage liver disease excluding normalized ratio (MELD-XI) score as a measure of hepato-renal dysfunction in patients with decompensated heart failure(2016) MADRONERO, L. M. Gomez; MORAES, L. R.; TERHOCH, C. B.; MOREIRA, H. F.; AYUB-FERREIRA, S. M.; OLIVEIRA, M. T.; LAGE, S. G.; ISSA, V. S.; BOCCHI, E. A.- Effect Of Soccer Training Program On Health Parameters In Prepubertal Obese Boys.(2016) SANTOS, Claudia Renata Pinto dos; LEME, Renata Barco; SANTOS, Fernando Miranda; SANTOS-SILVA, Paulo Roberto; FRANCO, Ruth Rocha; ARAUJO, Alessandra T. Miranda; SECCHI, Leonardo L. Barretti; ROMANO, Angela; LAGE, Silvia; DAMIANI, Durval; GREVE, Julia Maria D'Andrea
bookPart Edema agudo dos pulmões(2016) PARK, Marcelo; LAGE, Silvia Gelás