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1. Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024

Author

Fabio Fernandes, Marcus V. Simões, Edileide de Barros Correia, Fabiana Goulart Marcondes-Braga, Otavio Rizzi Coelho-Filho, Cláudio Tinoco Mesquita, Wilson Mathias Junior, Murillo de Oliveira Antunes, Edmundo Arteaga-Fernández, Carlos Eduardo Rochitte, Felix José Alvarez Ramires, Silvia Marinho Martins Alves, Marcelo Westerlund Montera, Renato Delascio Lopes, Mucio Tavares de Oliveira Junior, Fernando Luis Scolari, Walkiria Samuel Avila, Manoel Fernandes Canesin, Edimar Alcides Bocchi, Fernando Bacal, Lidia Zytynski Moura, Eduardo Benchimol Saad, Mauricio Ibrahim Scanavacca, Bruno Pereira Valdigem, Manuel Nicolas Cano, Alexandre Antonio Cunha Abizaid, Henrique Barbosa Ribeiro, Pedro Alves Lemos Neto, Gustavo Calado de Aguiar Ribeiro, Fabio Biscegli Jatene, Ricardo Ribeiro Dias, Luis Beck-da-Silva, Luis Eduardo Paim Rohde, Marcelo Imbroinise Bittencourt, Alexandre da Costa Pereira, José Eduardo Krieger, Humberto Villacorta Junior, Wolney de Andrade Martins, José Albuquerque de Figueiredo Neto, Juliano Novaes Cardoso, Carlos Alberto Pastore, Ieda Biscegli Jatene, Ana Cristina Sayuri Tanaka, Viviane Tiemi Hotta, Minna Moreira Dias Romano, Denilson Campos de Albuquerque, Ricardo Mourilhe-Rocha, Ludhmila Abrahão Hajjar, Fabio Sandoli de Brito Junior, Bruno Caramelli, Daniela Calderaro, Pedro Silvio Farsky, Alexandre Siciliano Colafranceschi, Ibraim Masciarelli Francisco Pinto, Marcelo Luiz Campos Vieira, Luiz Claudio Danzmann, Silvio Henrique Barberato, Charles Mady, Martino Martinelli Filho, Ana Flavia Malheiros Torbey, Pedro Vellosa Schwartzmann, Ariane Vieira Scarlatelli Macedo, Silvia Moreira Ayub Ferreira, Andre Schmidt, Marcelo Dantas Tavares de Melo, Moysés Oliveira Lima Filho, Andrei C. Sposito, Flávio de Souza Brito, Andreia Biolo, Vagner Madrini Junior, Stephanie Itala Rizk, and Evandro Tinoco Mesquita

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2024
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2. Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

Author

Gláucia Maria Moraes de Oliveira, Maria Cristina Costa de Almeida, Daniela do Carmo Rassi, Érika Olivier Vilela Bragança, Lidia Zytynski Moura, Magaly Arrais, Milena dos Santos Barros Campos, Viviana Guzzo Lemke, Walkiria Samuel Avila, Alexandre Jorge Gomes de Lucena, André Luiz Cerqueira de Almeida, Andréa Araujo Brandão, Andrea Dumsch de Aragon Ferreira, Andreia Biolo, Ariane Vieira Scarlatelli Macedo, Breno de Alencar Araripe Falcão, Carisi Anne Polanczyk, Carla Janice Baister Lantieri, Celi Marques-Santos, Claudia Maria Vilas Freire, Denise Pellegrini, Elizabeth Regina Giunco Alexandre, Fabiana Goulart Marcondes Braga, Fabiana Michelle Feitosa de Oliveira, Fatima Dumas Cintra, Isabela Bispo Santos da Silva Costa, José Sérgio Nascimento Silva, Lara Terra F. Carreira, Lucelia Batista Neves Cunha Magalhães, Luciana Diniz Nagem Janot de Matos, Marcelo Heitor Vieira Assad, Marcia M. Barbosa, Marconi Gomes da Silva, Maria Alayde Mendonça Rivera, Maria Cristina de Oliveira Izar, Maria Elizabeth Navegantes Caetano Costa, Maria Sanali Moura de Oliveira Paiva, Marildes Luiza de Castro, Marly Uellendahl, Mucio Tavares de Oliveira Junior, Olga Ferreira de Souza, Ricardo Alves da Costa, Ricardo Quental Coutinho, Sheyla Cristina Tonheiro Ferro da Silva, Sílvia Marinho Martins, Simone Cristina Soares Brandão, Susimeire Buglia, Tatiana Maia Jorge de Ulhôa Barbosa, Thais Aguiar do Nascimento, Thais Vieira, Valquíria Pelisser Campagnucci, and Antonio Carlos Palandri Chagas

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2023
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3. Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022

Author

Glaucia Maria Moraes de Oliveira, Maria Cristina Costa de Almeida, Celi Marques-Santos, Maria Elizabeth Navegantes Caetano Costa, Regina Coeli Marques de Carvalho, Cláudia Maria Vilas Freire, Lucelia Batista Neves Cunha Magalhães, Ludhmila Abrahão Hajjar, Maria Alayde Mendonça Rivera, Marildes Luiza de Castro, Walkiria Samuel Avila, Alexandre Jorge Gomes de Lucena, Andréa Araujo Brandão, Ariane Vieira Scarlatelli Macedo, Carla Janice Baister Lantieri, Carisi Anne Polanczyk, Carlos Japhet da Matta Albuquerque, Daniel Born, Eduardo Belisário Falcheto, Érika Olivier Vilela Bragança, Fabiana Goulart Marcondes Braga, Fernanda M. Consolim Colombo, Ieda Biscegli Jatene, Isabela Bispo Santos da Silva Costa, Ivan Romero Rivera, Jaqueline Ribeiro Scholz, José Xavier de Melo Filho, Magaly Arrais dos Santos, Maria Cristina de Oliveira Izar, Maria Fátima Azevedo, Maria Sanali Moura, Milena dos Santos Barros Campos, Olga Ferreira de Souza, Orlando Otávio de Medeiros, Sheyla Cristina Tonheiro Ferro da Silva, Stéphanie Itala Rizk, Thais de Carvalho Vieira Rodrigues, Thaís Rocha Salim, and Viviana de Mello Guzzo Lemke

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2022
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4. Diretriz Brasileira de Cardio-oncologia – 2020

Author

Ludhmila Abrahão Hajjar, Isabela Bispo Santos da Silva da Costa, Marcelo Antônio Cartaxo Queiroga Lopes, Paulo Marcelo Gehm Hoff, Maria Del Pilar Estevez Diz, Silvia Moulin Ribeiro Fonseca, Cristina Salvadori Bittar, Marília Harumi Higuchi dos Santos Rehder, Stephanie Itala Rizk, Dirceu Rodrigues Almeida, Gustavo dos Santos Fernandes, Luís Beck-da-Silva, Carlos Augusto Homem de Magalhães Campos, Marcelo Westerlund Montera, Sílvia Marinho Martins Alves, Júlia Tizue Fukushima, Maria Verônica Câmara dos Santos, Carlos Eduardo Negrão, Thiago Liguori Feliciano da Silva, Silvia Moreira Ayub Ferreira, Marcus Vinicius Bolivar Malachias, Maria da Consolação Vieira Moreira, Manuel Maria Ramos Valente Neto, Veronica Cristina Quiroga Fonseca, Maria Carolina Feres de Almeida Soeiro, Juliana Barbosa Sobral Alves, Carolina Maria Pinto Domingues Carvalho Silva, João Sbano, Ricardo Pavanello, Ibraim Masciarelli F. Pinto, Antônio Felipe Simão, Marianna Deway Andrade Dracoulakis, Ana Oliveira Hoff, Bruna Morhy Borges Leal Assunção, Yana Novis, Laura Testa, Aristóteles Comte de Alencar Filho, Cecília Beatriz Bittencourt Viana Cruz, Juliana Pereira, Diego Ribeiro Garcia, Cesar Higa Nomura, Carlos Eduardo Rochitte, Ariane Vieira Scarlatelli Macedo, Patricia Tavares Felipe Marcatti, Wilson Mathias Junior, Evanius Garcia Wiermann, Renata do Val, Helano Freitas, Anelisa Coutinho, Clarissa Maria de Cerqueira Mathias, Fernando Meton de Alencar Camara Vieira, André Deeke Sasse, Vanderson Rocha, José Antônio Franchini Ramires, and Roberto Kalil Filho

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2020
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6. Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Author

Márcio Vinícius Lins de Barros, Ariane Vieira Scarlatelli Macedo, Sebastian Imre Sarvari, Monica Hermont Faleiros, Patricia Tavares Felipe, Jose Luiz Padilha Silva, and Thor Edvardsen

Subjects
Ventricular Dysfunction, Left, Drug Therapy, Cardiotoxicity, Breast Neoplasms, Anthracyclines, Trastuzumab, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background: Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied. Objective: To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy. Methods: Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time. Results: Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p < 0,05), LV systolic dimension (1.34 [CI 95%: 1.01; 1.79], p < 0,05) and global longitudinal strain by speckle tracking (1.48 [CI 95%: 1.02; 2.12], p < 0,05) were strongly associated with cardiotoxicity. Conclusion: In the present study, we showed that LVWMA, in addition to global longitudinal strains, were strong predictors of cardiotoxicity and could be useful in the risk stratification of these patients.

Published
2018
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9. Antiplatelet Therapy in Breast Cancer Patients Using Hormonal Therapy: Myths, Evidence and Potentialities – Systematic Review

Author

Andréa de Melo Leite, Ariane Vieira Scarlatelli Macedo, Antonio José Lagoeiro Jorge, and Wolney de Andrade Martins

Subjects
Neoplasias da Mama/tratamento farmacológico, Indicadores de Morbimortalidade, Aspirina, Tamoxifeno, Cloridrato de Raloxifeno, Doenças Cardiovasculares/prevenção & controle, Moduladores Seletivos do Receptor Estrogênio, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Breast cancer is the most frequently diagnosed tumor in women worldwide, with a significant impact on morbidity and mortality. Chemotherapy and hormone therapy have significantly reduced mortality; however, the adverse effects are significant. Aspirin has been incorporated into clinical practice for over 100 years at a low cost, making it particularly attractive as a potential agent in breast cancer prevention and as an adjunct treatment to endocrine therapy in the prophylaxis of cardiovascular complications. The objective of this study was to evaluate the role of aspirin in reducing the incidence of breast cancer and to evaluate the impact of its use on morbidity and mortality and reduction of cardiovascular events as adjuvant therapy during breast cancer treatment with selective estrogen receptor modulators. A systematic review was performed using the PRISMA methodology and PICO criteria, based on the MEDLINE, EMBASE and LILACS databases. The original articles of clinical trials, cohort, case-control studies and meta-analyses published from January 1998 to June 2017, were considered. Most studies showed an association between the use of selective estrogen receptor modulators and the increase in thromboembolic events. The studies suggest a protective effect of aspirin for cardiovascular events during its concomitant use with selective estrogen receptor modulators and in the prevention of breast cancer. This systematic review suggests that aspirin therapy combines the benefit of protection against cardiovascular events with the potential reduction in breast cancer risk, and that the evaluation of the benefits of the interaction of endocrine therapy with aspirin should be further investigated.

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10. Brazilian Society of Cardiology - The Women’s Letter

Author

Glaucia Maria Moraes de Oliveira, Fátima Elizabeth Fonseca de Oliveira Negri, Nadine Oliveira Clausell, Maria da Consolação V. Moreira, Olga Ferreira de Souza, Ariane Vieira Scarlatelli Macedo, Barbara Campos Abreu Marino, Carisi Anne Polanczyk, Carla Janice Baister Lantieri, Celi Marques-Santos, Cláudia Maria Vilas Freire, Deborah Christina Nercolini, Fatima Cristina Monteiro Pedroti, Imara Correia de Queiroz Barbosa, Magaly Arrais dos Santos, Maria Christiane Valéria Braga Braile, Maria Sanali Moura de Oliveira Paiva, Marianna Deway Andrade Dracoulakis, Narriane Chaves Holanda, Patricia Toscano Rocha Rolim, Roberta Tavares Barreto Teixeira, Sandra Mattos, Sheyla Cristina Tonheiro Ferro da Silva, Simone Cristina Soares Brandão, Viviana de Mello Guzzo Lemke, and Marcelo Antônio Cartaxo Queiroga Lopes

Subjects
Women, Medicine/ trends, Demography, Cardiovascular Diseases/prevention and control, Societies, Medical, Management Quality Circles, Risk Factors, Prevalence, Education, Medical, Diseases of the circulatory (Cardiovascular) system, RC666-701
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11. Eficácia do dexrazoxano na prevenção de cardiotoxicidade em pacientes com câncer de mama expostos à quimioterapia com antraciclina, associado ou não ao trastuzumabe: revisão sistemática e metanálise

Author

Ariane Vieira Scarlatelli Macedo, Antônio Luiz Pinho Ribeiro, Angêlica Nogueira Rodrigues, Bruno Ramos Nascimento, and Andreia Cristina Melo

Subjects
Antraciclinas, Dexrazoxano, Câncer de mama, Cardioprotecão, Insuficiência Cardíaca, Antraciclina/uso terapêutico, Quimioterapia, Cardiotoxicidade, Trastuzumab, Neoplasias da Mama
Abstract

Antecedentes: As antraciclinas configuram entre os agentes mais eficazes no tratamento do câncer de mama, mas seu uso é limitado por uma cardiotoxicidade dose-dependente. Estudos clínicos sugerem que o dexrazoxano poderia contribuir para a redução da toxicidade, mas não está claro se o efeito é mantido durante o tratamento adjuvante seguido por trastuzumabe. O dexrazoxano é frequentemente utilizado no contexto do câncer de mama metastático, quando são necessárias doses cumulativas mais elevadas de antraciclina, mas é frequentemente omitido quando a antraciclina é utilizada na terapia adjuvante. O objetivo deste estudo é conduzir revisão sistemática e metanálise de estudos que avaliaram a eficácia do dexrazoxano como cardioprotetor em pacientes com câncer de mama, em todos os estágios que receberam quimioterapia baseada em antraciclina, seguida ou não de trastuzumabe. Métodos: Foram realizadas revisão sistemática e metanálise. A revisão foi registrada no banco de dados PROSPERO (CRD42017077462). Realizou-se revisão sistemática de artigos relevantes publicados entre 1990 e agosto de 2017 no Cochrane Central Register de Ensaios Controlados, Google Scholar, MEDLINE/Pubmed, LILACS, Web of Science, referências de artigos e procedimentos da ASCO. Os estudos que avaliaram insuficiência cardíaca congestiva ou evento cardíaco (alterações da função cardíaca sem sintomas cardíacos ou hospitalização por motivos cardíacos) foram incluídos como desfechos primários. Desfechos secundários foram potenciais efeitos adversos de dexrazoxano na resposta oncológica (sobrevida completa ou parcial, global e livre de progressão). Dois revisores realizaram independentemente a seleção dos estudos, a avaliação do risco de viés e a extração de dados. A metanálise foi feita usando o modelo de efeito aleatório para estimativa do efeito do tratamento. Foram avaliados viés de publicação, análise de sensibilidade e heterogeneidade, além de análises de subgrupo e metarregressão. Resultados: Nove estudos foram identificados, incluindo 1.545 pacientes. Dexrazoxano reduziu a incidência de insuficiência cardíaca (RR 0,182, IC 95%: 0,080-0,413, p < 0,0001) e eventos cardíacos (RR 0,262, IC 95%: 0,169-0,407, p < 0,0001), sem impacto na taxa de resposta (RR 0,897, IC 95%: 0,780-1,032, p=0,129), sobrevida geral (RR 1,008, IC 95%: 0,86-1,17, p=0,91) e sobrevida livre de progressão ( RR 0,97, IC 95%: 0,75-1,25, p=0,81). Realizamos análises de subgrupos de estudos que utilizaram trastuzumabe após antraciclina e estudos com exposição prévia à antraciclina. Em ambas as análises, o benefício geral do dexrazoxano foi mantido. A metarregressão, utilizando como modelo a dose média de antraciclinas nos estudos e a idade dos estudos, não demonstrou correlação significativa entre as covariáveis e o efeito global do dexrazoxano na redução de eventos cardíacos. Conclusões: Em pacientes com câncer de mama, o uso de dexrazoxano retardou e reduziu a toxicidade cardíaca induzida pela antraciclina, com ou sem trastuzumabe. O uso associado de dexrazoxano não interferiu na eficácia antitumoral das antraciclinas. Esses achados podem ter implicações significativas para a prática clínica. Background: Anthracyclines continue to rank among the most effective agents in breast cancer (BC) treatment, but its use is limited by a dose-dependent cardiotoxicity. Clinical studies have suggested that dexrazoxane could reduce this toxicity, however it is unclear whether the effect is maintained during an adjuvant treatment followed by trastuzumab. Dexrazoxane is frequently used in the metastatic setting, when higher anthracycline cumulative doses are needed, but is often omitted in adjuvancy. We aimed to analyse whether dexrazoxane is cardioprotective in all BC stages in patients receiving anthracycline-based chemotherapy followed or not by trastuzumab. Methods: We performed a systematic review and meta-analysis. The review was registreded in PROSPERO database (CRD42017077462). We searched data from 1990 to August 2017 in Cochrane Central Register of Controlled Trials, Google Scholar, MEDLINE/Pubmed, LILACS, Web of Science, articles references and ASCO proceedings. Studies assessing congestive heart failure or cardiac event (cardiac function alterations without cardiac symptoms or hospitalization for cardiac reasons) as primary endpoints were included. Secondary outcomes were potential adverse effects of dexrazoxane on oncologic response (complete or partial, overall and progression free survivals). Two reviewers independently performed the studies selection, risk of bias assessment and data extraction. Meta-analysis was done using random effect model for estimation of treatment effect. Heterogeneity was assessed by visual inspection of forest plots and by Q test. Results: Nine studies were identified, including 1545 patients. Dexrazoxane reduced heart failure incidence (RR 0.182, CI 95%: 0.080-0.413, p < 0.0001) and cardiac events (RR 0.262, CI 95%:0.169-0.407, p < 0.0001) without impact on response rate or survival. In a subgroup analysis of studies using trastuzumab after anthracycline, the overall benefit and safety of dexrazoxane was maintained. Conclusions: dexrazoxane delayed and reduced anthracycline induced cardiac toxicity, with or without trastuzumab. Its use did not interfere with the anthracycline antitumoral efficacy. These findings may have significant implications for clinical practice.

Published
2018

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