134 results on '"Sandrigo, Mangini"'
Search Results
2. Sobrevida de Pacientes Transplantados Cardíacos com Doença de Chagas Sob Diferentes Regimes de Imunossupressores Antiproliferativos
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Silas Ramos Furquim, Luana Campoli Galbiati, Monica S. Avila, Fabiana G. Marcondes-Braga, Julia Fukushima, Sandrigo Mangini, Luis Fernando Bernal da Costa Seguro, Iascara Wozniak de Campos, Tania Mara Varejão Strabelli, Fernanda Barone, Audrey Rose da Silveira Amancio de Paulo, Luciana Akutsu Ohe, Mariana Cappelletti Galante, Fabio Antonio Gaiotto, and Fernando Bacal
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Sobrevida ,Transplante de Coração ,Doença de Chagas ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Resumo Fundamento A Doença de Chagas (DC) é uma causa importante de transplante cardíaco (TC). O principal obstáculo é a reativação da DC (RDC), normalmente associada a altas doses de imunossupressores. Estudos anteriores sugeriram uma associação do micofenolato de mofetila com aumento na RDC. No entanto, preditores de mortalidade são desconhecidos. Objetivos Identificar os fatores de risco de mortalidade em pacientes com DC após o TC e o impacto do regime antiproliferativo sobre a sobrevida. Métodos Estudo retrospectivo com pacientes chagásicos submetidos ao TC entre janeiro de 2004 e setembro de 2020, em protocolo de imunossupressão que priorizava o uso de azatioprina e sua mudança para micofenolato de mofetila em caso de rejeição. Realizamos regressão univariada para identificar preditores de mortalidade e comparamos sobrevida, rejeição, e evidência RDC entre os pacientes que usavam azatioprina, micofenolato de mofetila, e aqueles que mudaram de azatioprina para micofenolato (grupo “Mudança”) após a alta. Um valor de p
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- 2023
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3. Trombose de Aorta e Artéria Renal como Manifestação Clínica Inicial da COVID-19 em um Receptor de Transplante Cardíaco
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Deborah de Sá Pereira Belfort, Fabiana G. Marcondes-Braga, Sandrigo Mangini, Caio Rebouças Fonseca Cafezeiro, Diógenes Amauri Gonçalves Furlan, and Fernando Bacal
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COVID-19 ,Tromboembolia ,Transplante de Coração ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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4. A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
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Antonio de Santis, Guilherme Moratti Gilberto, Sandrigo Mangini, Adalberto Batalha Megale, Fabio Antonio Gaiotto, Ricardo Mingarini Terra, and Rodrigo Gobbo Garcia
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Infective endocarditis ,Heart transplantation ,Pericardium ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. Case presentation We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. Conclusions Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.
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- 2020
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5. Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients
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Fabiana G. Marcondes‐Braga, Luciana Gioli‐Pereira, Sabrina Bernardez‐Pereira, Guilherme L. Batista, Sandrigo Mangini, Victor S. Issa, Fabio Fernandes, Edimar A. Bocchi, Silvia M. Ayub‐Ferreira, Alfredo J. Mansur, Ivano G.R. Gutz, Jose E. Krieger, Alexandre C. Pereira, and Fernando Bacal
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Heart failure ,Exhaled breath acetone ,Biomarker ,Prognosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Exhaled breath acetone (EBA) has been described as a new biomarker of heart failure (HF) diagnosis. EBA concentration increases according to severity of HF and is associated with poor prognosis, especially in acute decompensated HF. However, there are no data on chronic HF patients. The aim is to evaluate the role of EBA for predicting cardiac and overall mortality in chronic HF patients. Methods and results In GENIUS‐HF cohort, chronic patients were enrolled between August 2012 and December 2014. All patients had left ventricular ejection fraction ≤ 50%, and the diagnosis was established according to Framingham criteria. After consent, patients were submitted to clinical evaluation and exhaled breath collection. EBA identification and quantitative determination were done by spectrophotometry. The clinical characteristics associated with acetone were identified. All participants were followed for 18 months to assess cardiac and overall mortality. Around 700 participants were enrolled in the current analysis. Patients were 55.4 ± 12.2 years old, 67.6% male patients, and 81% New York Heart Association I/II with left ventricular ejection fraction of 32 ± 8.6%. EBA median concentration was 0.6 (0.3–1.2) ug/L. Acetone levels increased with the number of symptoms of HF and were associated with right HF signs/symptoms and liver biochemical changes. EBA at highest quartile (EBA > 1.2ug/L) was associated with a significantly worse prognosis (log rank test, P 1.20ug/L was an independent predictor of cardiac (P = 0.011) and overall (P = 0.010) mortality in our population. Conclusions This study shows that EBA levels reflect clinical HF features, especially right HF signs/symptoms. EBA is an independent predictor of cardiac and overall mortality in chronic HF patients.
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- 2020
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6. C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant
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Débora Cestari Bacal, Miguel Morita Fernandes-Silva, Sandrigo Mangini, Marcia Santos de Jesus, and Fernando Bacal
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Biomarkers ,Heart Transplant ,Inflammation ,Ventricular Remodeling ,Medicine (General) ,R5-920 - Abstract
OBJECTIVES: Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function. METHODS: We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis. RESULTS: We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, p
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- 2021
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7. Distinct Microbial Communities in Dilated Cardiomyopathy Explanted Hearts Are Associated With Different Myocardial Rejection Outcomes
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Jaqueline de Jesus Pereira, Renata Nishiyama Ikegami, Joyce Tiyeko Kawakami, Shérrira Menezes Garavelo, Marcia Martins Reis, Suely Aparecida Pinheiro Palomino, Sandrigo Mangini, Camila Rodrigues Moreno, Samar Freschi de Barros, Aline Rodrigues Souza, and Maria de Lourdes Higuchi
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cardiomyopathy ,infectious agents ,transplantation ,myocardial ,rejection ,Microbiology ,QR1-502 - Abstract
BackgroundIdiopathic dilated cardiomyopathy (IDCM) myocardial inflammation may be associated with external triggering factors such as infectious agents. Here, we searched if moderate/severe heart transplantation rejection is related to the presence of myocardial inflammation in IDCM explanted hearts, associated with microbial communities.MethodReceptor myocardial samples from 18 explanted hearts were separated into groups according to post-transplant outcome: persistent moderate rejection (PMR; n = 6), moderate rejection (MR; n = 7) that regressed after pulse therapy, and no rejection (NR; n = 5)/light intensity rejection. Inflammation was quantified through immunohistochemistry (IHC), and infectious agents were evaluated by IHC, molecular biology, in situ hybridization technique, and transmission electron microscopy (TEM).ResultsNR presented lower numbers of macrophages, as well as B cells (p = 0.0001), and higher HLA class II expression (p ≤ 0.0001). PMR and MR showed higher levels of Mycoplasma pneumoniae (p = 0.003) and hepatitis B core (p = 0.0009) antigens. NR presented higher levels of parvovirus B19 (PVB19) and human herpes virus 6 (HHV6) and a positive correlation between Borrelia burgdorferi (Bb) and enterovirus genes. Molecular biology demonstrated the presence of M. pneumoniae, Bb, HHV6, and PVB19 genes in all studied groups. TEM revealed structures compatible with the cited microorganisms.ConclusionsThis initial study investigating on infectious agents and inflammation in the IDCM explanted hearts showed that the association between M. pneumoniae and hepatitis B core was associated with a worse outcome after HT, represented by MR and PMR, suggesting that different IDCM microbial communities may be contributing to post-transplant myocardial rejection.
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- 2021
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8. Parasitic persistence in left atrium remnants of chronic chagasic patients submitted to bicaval heart transplantation
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Luiz A. Benvenuti, Sandrigo Mangini, Fabio A. Gaiotto, and Fernando Bacal
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Transplantation ,Infectious Diseases - Published
- 2023
9. SARS-CoV-2 Infection and CMV Dissemination in Transplant Recipients as a Treatment for Chagas Cardiomyopathy: A Case Report
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Sarah Cristina Gozzi-Silva, Gil Benard, Ricardo Wesley Alberca, Tatiana Mina Yendo, Franciane Mouradian Emidio Teixeira, Luana de Mendonça Oliveira, Danielle Rosa Beserra, Anna Julia Pietrobon, Emily Araujo de Oliveira, Anna Cláudia Calvielli Castelo Branco, Milena Mary de Souza Andrade, Iara Grigoletto Fernandes, Nátalli Zanete Pereira, Yasmim Álefe Leuzzi Ramos, Julia Cataldo Lima, Bruna Provenci, Sandrigo Mangini, Alberto José da Silva Duarte, and Maria Notomi Sato
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SARS-CoV-2 ,COVID-19 ,heart transplant ,CMV ,Chagas disease ,infection ,Medicine - Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has infected over 90 million people worldwide, therefore it is considered a pandemic. SARS-CoV-2 infection can lead to severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and/or organ failure. Individuals receiving a heart transplantation (HT) may be at higher risk of adverse outcomes attributable to COVID-19 due to immunosuppressives, as well as concomitant infections that may also influence the prognoses. Herein, we describe the first report of two cases of HT recipients with concomitant infections by SARS-CoV-2, Trypanosoma cruzi, and cytomegalovirus (CMV) dissemination, from the first day of hospitalization due to COVID-19 in the intensive care unit (ICU) until the death of the patients.
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- 2021
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10. A modified heterotopic heart transplant technique to bridge patients with 'fixed' pulmonary hypertension: A case report
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Fabio Antonio Gaiotto, Fernando Bacal, Samuel Padovan Steffen, Fabiana Goulart Marcondes-Braga, Luis Fenando Bernal da Costa Seguro, Sandrigo Mangini, Iascara Wozniak de Campos, Mônica Samuel Avila, Roberto Kalil Filho, and Fabio Biscegli Jatene
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
11. Cognitive Frailty and Depressive Symptoms in Heart Transplant Candidates: Rational and Study Design
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France Matos de Oliveira, Erika Tiemi Ikeda, Luis Fernando Bernal da Costa Seguro, Mônica Samuel Avila, Iascara Wozniak de Campos, Marcus Vinicius B. Santos, Maria Ignez Zanetti Feltrim, Silvia Helena Gelas Lage, Edimar Alcides Bocchi, Victor Sarli Issa, Miguel Morita Fernandes-Silva, Fábio Antônio Gaiotto, Fernando Bacal, Fabiana Goulart Marcondes-Braga, and Sandrigo Mangini
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- 2022
12. Transplantation for Chagas Heart Disease: a Comprehensive Review
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Fábio Antônio Gaiotto, I.W. Campos, Carlos Aurélio dos Santos Aragão, Luis Fernando Bernal da Costa Seguro, Fabiana G. Marcondes-Braga, Tania Mara Varejão Strabelli, Mônica Samuel Avila, Fernando Bacal, Sandrigo Mangini, and C.M. Murad
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Heart transplantation ,Chagas disease ,Transplantation ,medicine.medical_specialty ,Hepatology ,Heart disease ,business.industry ,medicine.medical_treatment ,Immunology ,Cardiomyopathy ,Immunosuppression ,medicine.disease ,Gastroenterology ,Nephrology ,Internal medicine ,Heart failure ,Medicine ,Surgery ,business ,Contraindication - Abstract
Chagas cardiomyopathy (CC) has a worse prognosis than other forms of cardiomyopathy and up to 10% of patients may progress to end-stage heart failure. In this article, we have performed a comprehensive literature review of heart transplantation (HT) for CC, including results after HT, management of immunosuppression, and Chagas disease (CD) reactivation. CD used to be considered a contraindication to HT due to the risks of disease reactivation with immunosuppression. Nonetheless, multiple reports have consistently demonstrated the feasibility and safety of HT for refractory CC. CD reactivation must be routinely screened in the first-year post-transplant, and in recent years, polymerase chain reactions (PCR)-based techniques have been used more often. HT is now considered the best treatment for end-stage Chagas heart disease. In addition, studies of immunosuppressive medications have shown that these patients require a lesser degree of immunosuppression, mainly to balance reactivation risks.
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- 2021
13. Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Associated with Advanced Heart Failure: An Outdated Strategy?
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Ciro Mancilha Murad and Sandrigo Mangini
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- 2022
14. Trombose de Aorta e Artéria Renal como Manifestação Clínica Inicial da COVID-19 em um Receptor de Transplante Cardíaco
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Fernando Bacal, Diógenes Amauri Gonçalves Furlan, Sandrigo Mangini, Caio Rebouças Fonseca Cafezeiro, Fabiana G. Marcondes-Braga, and Deborah de Sá Pereira Belfort
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Clinical manifestation ,Heart transplant recipient ,law.invention ,Transplante de Coração ,Renal Artery ,law ,Internal medicine ,Thromboembolism ,medicine ,Research Letter ,Tromboembolia ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Myocardial infarction ,Carta Científica ,Stroke ,business.industry ,SARS-CoV-2 ,Incidence (epidemiology) ,COVID-19 ,Thrombosis ,medicine.disease ,Intensive care unit ,RC666-701 ,Cardiology ,Heart Transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction The novel coronavirus infection emerged in Wuhan, China, in the end of 2019 and is now a pandemic. The relation between COVID-19 and thrombotic events is well established, even for patients under prophylactic anticoagulation. Although venous and arterial thromboembolic events have been described, usually stroke and acute myocardial infarction (AMI),, there are few reports of arterial thrombosis in unusual sites. Almost all reports of thrombotic events are of intensive care unit (ICU) patients, and the incidence of thromboembolism in [...]
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- 2021
15. Registry of Transthyretin Amyloidosis in the State of São Paulo (REACT-SP)
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Fabio Fernandes, Caio Cafezeiro, Renata Margarida do Val, Alexandra Patrícia Zilli Vieira, Wilson Marques, Edileide Barros Correia, Alzira Alves Siqueira Carvalho, Antonio Carlos Palandrini Chagas, Acary Souza Bulle Oliveira, Paulo Victor Sgobi de Souza, Wladimir Bocca Vieira de Resende Pinto, Ariane Vieira Scarlatelli Macedo, Murillo Oliveira Antunes, Pedro Vellosa Schwartzmann, Sandrigo Mangini, and Marcus Vinicius Simões
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- 2021
16. First Combined Heart-Liver Transplant in Amyloidosis Due to Transthyretin Mutation in Brazil: Impact of the Liver on Reducing anti-HLA Antibodies
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Sandrigo Mangini, Bianca de Cássia Sabbion, Robinson Poffo, Sérgio Paiva Meira, Márcio Dias de Almeida, and Fernando Bacal
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- 2021
17. A Practical Approach to Differential Diagnosis of Cardiomyopathies with Infiltrative Phenotypes
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Ligia Lopes Balsalobre Trevizan and Sandrigo Mangini
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- 2021
18. Insuficiência cardíaca descompensada
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Sandrigo Mangini, Philippe Vieira Pires, Fabiana Goulart Marcondes Braga, and Fernando Bacal
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Insuficiência cardíaca ,Prognóstico ,Medicine - Abstract
A insuficiência cardíaca apresenta elevada incidência e prevalência em todo mundo. Os custos com internação por insuficiência cardíaca descompensada chegam a aproximadamente 60% do custo total do tratamento da insuficiência cardíaca, e a mortalidade durante a internação varia conforme a população estudada, podendo chegar a 10%. Em pacientes com insuficiência cardíaca descompensada, os achados de história e exame físico são de grande valor por fornecerem, além do diagnóstico da síndrome, o tempo de início dos sintomas, as informações sobre etiologia, as causas de descompensação e o prognóstico. O objetivo inicial do tratamento da insuficiência cardíaca descompensada é a melhora hemodinâmica e sintomática. Além disso, outros alvos devem ser buscados, incluindo preservação e/ou melhora da função renal, prevenção de lesão miocárdica, modulação da ativação neuro-hormonal e/ou inflamatória, e manejo de comorbidades que podem causar ou contribuir para progressão da síndrome. Com base nos perfis clínico-hemodinâmicos, é possível estabelecer um racional para o tratamento da insuficiência cardíaca descompensada, individualizando o procedimento a ser instituído e objetivando redução de tempo de internação e de mortalidade.
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- 2013
19. I Diretriz brasileira de miocardites e pericardites
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Marcelo Westerlund Montera, Evandro Tinoco Mesquita, Alexandre Siciliano Colafranceschi, Amarino Carvalho de Oliveira Jr., Arnaldo Rabischoffsky, Barbara Maria Ianni, Carlos Eduardo Rochitte, Charles Mady, Claudio Tinoco Mesquita, Clerio Francisco Azevedo, Edimar Alcides Bocchi, Eduardo Benchimol Saad, Fabiana Goulart Marcondes Braga, Fábio Fernandes, Felix José Alvarez Ramires, Fernando Bacal, Gilson Soares Feitosa, Hélio Roque Figueira, João David de Souza Neto, Lídia Ana Zytynski Moura, Luiz Antônio de Almeida Campos, Marcelo Imbroinise Bittencourt, Márcia de Melo Barbosa, Maria da Consolação Vieira Moreira, Maria de Lourdes Higuchi, Pedro Schwartzmann, Ricardo Mourilhe Rocha, Sabrina Bernardez Pereira, Sandrigo Mangini, Silvia Marinho Martins, Solange Bordignon, and Vitor Agueda Salles
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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20. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up.
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Fabiana G Marcondes-Braga, Guilherme L Batista, Ivano G R Gutz, Paulo H N Saldiva, Sandrigo Mangini, Victor S Issa, Silvia M Ayub-Ferreira, Edimar A Bocchi, Alexandre Costa Pereira, and Fernando Bacal
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Medicine ,Science - Abstract
The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis.To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF).After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months.The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56-6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels.High EBA levels could be associated to poor prognosis in HFrEF patients.
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- 2016
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21. Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients
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Ivano Gebhardt Rolf Gutz, Fernando Bacal, Alfredo José Mansur, Sandrigo Mangini, Luciana Gioli-Pereira, José Eduardo Krieger, Silvia Moreira Ayub-Ferreira, Fabiana G. Marcondes-Braga, Sabrina Bernardez-Pereira, Edimar Alcides Bocchi, Victor Sarli Issa, Guilherme Lopes Batista, Fábio Fernandes, and Alexandre C. Pereira
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Adult ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Acetone ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Original Research Article ,030212 general & internal medicine ,education ,Aged ,Heart Failure ,education.field_of_study ,Framingham Risk Score ,Ejection fraction ,business.industry ,Stroke Volume ,Biomarker ,Middle Aged ,Prognosis ,medicine.disease ,Log-rank test ,Quartile ,lcsh:RC666-701 ,Exhalation ,Heart failure ,Cohort ,Cardiology ,Biomarker (medicine) ,Female ,Exhaled breath acetone ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Exhaled breath acetone (EBA) has been described as a new biomarker of heart failure (HF) diagnosis. EBA concentration increases according to severity of HF and is associated with poor prognosis, especially in acute decompensated HF. However, there are no data on chronic HF patients. The aim is to evaluate the role of EBA for predicting cardiac and overall mortality in chronic HF patients. Methods and results In GENIUS‐HF cohort, chronic patients were enrolled between August 2012 and December 2014. All patients had left ventricular ejection fraction ≤ 50%, and the diagnosis was established according to Framingham criteria. After consent, patients were submitted to clinical evaluation and exhaled breath collection. EBA identification and quantitative determination were done by spectrophotometry. The clinical characteristics associated with acetone were identified. All participants were followed for 18 months to assess cardiac and overall mortality. Around 700 participants were enrolled in the current analysis. Patients were 55.4 ± 12.2 years old, 67.6% male patients, and 81% New York Heart Association I/II with left ventricular ejection fraction of 32 ± 8.6%. EBA median concentration was 0.6 (0.3–1.2) ug/L. Acetone levels increased with the number of symptoms of HF and were associated with right HF signs/symptoms and liver biochemical changes. EBA at highest quartile (EBA > 1.2ug/L) was associated with a significantly worse prognosis (log rank test, P 1.20ug/L was an independent predictor of cardiac (P = 0.011) and overall (P = 0.010) mortality in our population. Conclusions This study shows that EBA levels reflect clinical HF features, especially right HF signs/symptoms. EBA is an independent predictor of cardiac and overall mortality in chronic HF patients.
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- 2020
22. ASSISTÊNCIA CIRCULATÓRIA MECÂNICA
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Paulo Manuel Pêgo-Fernandes, Sandrigo Mangini, and Silvia Moreira Ayub-Ferreira
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2020
23. Bone Metabolism Impairment in Heart Transplant: Results From a Prospective Cohort Study
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Fernando Bacal, Sandrigo Mangini, Mônica Samuel Avila, Luciana Parente Costa Seguro, Fábio Antônio Gaiotto, Luis Fernando Bernal da Costa Seguro, I.W. Campos, Rosa Maria Rodrigues Pereira, Fabiana G. Marcondes-Braga, and Valeria F. Caparbo
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Population ,Osteoporosis ,Urology ,030230 surgery ,Bone resorption ,vitamin D deficiency ,Bone remodeling ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Risk Factors ,medicine ,Vitamin D and neurology ,Humans ,Prospective Studies ,Vitamin D ,education ,Bone mineral ,Transplantation ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Dietary Supplements ,Heart Transplantation ,Spinal Fractures ,Calcium ,Female ,030211 gastroenterology & hepatology ,Cortical bone ,Bone Remodeling ,business ,Biomarkers ,Osteoporotic Fractures - Abstract
BACKGROUND Data on the prevention of fractures after heart transplant (HTx) are controversial in the literature. Understanding the effects of HTx on bone may guide appropriate treatments in this high-risk population. METHODS Seventy adult HTx patients were followed for 12 months. Clinical and laboratory parameters, bone mineral density, microarchitecture, and vertebral fractures were assessed at baseline (after intensive care unit discharge) and at 6 and 12 months. Patients received recommendations regarding calcium intake and vitamin D supplementation after HTx. RESULTS At baseline, 27% of patients had osteoporosis, associated with the length of hospitalization before HTx (P = 0.001). Bone mineral density decreased in the first 6 months, with partial recovery later. Bone microarchitecture deteriorated, mainly in the trabecular bone in the first 6 months and cortical bone in the subsequent 6 months. At baseline, 92.9% of patients had vitamin D levels
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- 2020
24. Sildenafil vs. Nitroprussiato de Sódio durante Teste de Reatividade Pulmonar pré-transplante cardíaco
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Aguinaldo Figueiredo Freitas Jr, Fernando Bacal, José de Lima Oliveira Júnior, Alfredo Inácio Fiorelli, Ronaldo Honorato Santos, Luiz Felipe Pinho Moreira, Christiano Pereira Silva, Sandrigo Mangini, Jeane Mike Tsutsui, and Edimar Alcides Bocchi
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Hipertensão pulmonar ,Sildenafil ,Nitroprussiato de Sódio ,Doppler Tecidual ,Transplante Cardíaco ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: A hipertensão pulmonar é associada ao pior prognóstico no pós-transplante cardíaco. O teste de reatividade pulmonar com Nitroprussiato de Sódio (NPS) está associado a elevados índices de hipotensão arterial sistêmica, disfunção ventricular do enxerto transplantado e elevadas taxas de desqualificação para o transplante. OBJETIVO: Neste estudo, objetivou-se comparar os efeitos do Sildenafil (SIL) e NPS sobre variáveis hemodinâmicas, neuro-hormonais e ecocardiográficas durante teste de reatividade pulmonar. MÉTODOS: Os pacientes foram submetidos, simultaneamente, ao cateterismo cardíaco direito, ao ecocardiograma e à dosagem de BNP e gasometria venosa, antes e após administração de NPS (1 - 2 µg/Kg/min) ou SIL (100 mg, dose única). RESULTADOS: Ambos reduziram a hipertensão pulmonar, porém o nitrato promoveu hipotensão sistêmica significativa (Pressão Arterial Média - PAM: 85,2 vs. 69,8 mmHg, p < 0,001). Ambos reduziram as dimensões cardíacas e melhoraram a função cardíaca esquerda (NPS: 23,5 vs. 24,8 %, p = 0,02; SIL: 23,8 vs. 26 %, p < 0,001) e direita (SIL: 6,57 ± 2,08 vs. 8,11 ± 1,81 cm/s, p = 0,002; NPS: 6,64 ± 1,51 vs. 7,72 ± 1,44 cm/s, p = 0,003), medidas pela fração de ejeção ventricular esquerda e Doppler tecidual, respectivamente. O SIL, ao contrário do NPS, apresentou melhora no índice de saturação venosa de oxigênio, medido pela gasometria venosa. CONCLUSÃO: Sildenafil e NPS são vasodilatadores que reduzem, de forma significativa, a hipertensão pulmonar e a geometria cardíaca, além de melhorar a função biventricular. O NPS, ao contrário do SIL, esteve associado a hipotensão arterial sistêmica e piora da saturação venosa de oxigênio.
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- 2012
25. Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011
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Marcelo Westerlund Montera, Sabrina Bernardez Pereira, Alexandre Siciliano Colafranceschi, Dirceu Rodrigues de Almeida, Evandro Mesquita Tinoco, Ricardo Mourilhe Rocha, Lídia Ana Zytynski Moura, Álvaro Réa-Neto, Sandrigo Mangini, Fabiana Goulart Marcondes Braga, Denilson Campos Albuquerque, Edson Stefanini, Eduardo Benchimol Saad, and Fábio Vilas-Boas
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Insuficência cardíaca ,diagnóstico ,prognóstico ,edema pulmonar ,baixo débito cardíaco ,choque cardiogênico ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Nos últimos dois anos, observamos diversas modificações na abordagem diagnóstica e terapêutica dos pacientes com Insuficiência Cardíaca aguda (IC aguda), o que nos motivou quanto à necessidade da realização de um sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda de 2009. Na avaliação diagnóstica, o fluxograma diagnóstico foi simplificado e foi fortalecido o papel da avaliação clínica e ecocardiograma. Na avaliação clínico-hemodinâmica admissional, o ecocardiograma hemodinâmico ganhou destaque no auxilio da definição dessa condição no paciente com IC aguda na sala de emergência. Na avaliação prognóstica, os biomarcadores tiveram seu papel mais bem estabelecido, e a síndrome cardiorrenal teve seus critérios e valor prognóstico mais bem definidos. Os fluxogramas de abordagem terapêutica foram revistos, tornando-se mais simples e objetivos. Dentre os avanços na terapêutica medicamentosa destacam-se a segurança e a importância da manutenção ou introdução dos betabloqueadores na terapêutica admissional. A anticoagulação, de acordo com as novas evidências, ganha um espectro maior de indicações. O edema agudo de pulmão tem bem estabelecido os seus modelos hemodinâmicos de apresentação com suas distintas formas de abordagens terapêuticas, com novos níveis de indicação e evidência. No tratamento cirúrgico da IC aguda, a revascularização miocárdica, a abordagem das lesões mecânicas e o transplante cardíaco foram revistos e atualizados. Este sumário de atualização fortalece a II Diretriz Brasileira de Insuficiência Cardíaca Aguda por mantê-la atualizada e rejuvenescida. Todos os clínicos cardiologistas que lidam com pacientes com IC aguda encontrarão na diretriz e em seu sumário de atualização importantes instrumentos no auxílio da prática clínica para o melhor diagnóstico e tratamento de seus pacientes.
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- 2012
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26. C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant
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Marcia Santos de Jesus, Débora Cestari Bacal, Fernando Bacal, Miguel Morita Fernandes-Silva, and Sandrigo Mangini
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musculoskeletal diseases ,Graft Rejection ,Male ,medicine.medical_specialty ,Medicine (General) ,Acute cellular rejection ,Single Center ,Endomyocardial biopsy ,Left ventricular mass ,Ventricular Dysfunction, Left ,R5-920 ,Internal medicine ,Medicine ,Humans ,In patient ,Major complication ,C-reactive protein level ,Inflammation ,Ventricular Remodeling ,business.industry ,General Medicine ,Gold standard (test) ,Troponin ,C-Reactive Protein ,Cardiology ,Heart Transplant ,Heart Transplantation ,Female ,Original Article ,business ,Biomarkers - Abstract
OBJECTIVES: Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function. METHODS: We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis. RESULTS: We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, p
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- 2021
27. Redução da prevalência de apneia central em pacientes com insuficiência cardíaca sob uso de betabloqueador Reducción de la prevalencia de apnea central en pacientes con insuficiencia cardiaca bajo uso de betabloqueante Reduction of central sleep apnea in heart failure patients with beta-blockers therapy
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Christiano Pereira Silva, Geraldo Lorenzi-Filho, Bianca Marcondes, Gilmar Osmundo Junior, Sandrigo Mangini, Aguinaldo Figueiredo Freitas Junior, Phillipe Vieira Pires, Edimar Alcides Bocchi, and Fernando Bacal
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Síndromes de la apnea del sueño ,insuficiencia cardiaca ,betaantagonistas adrenergicos ,Síndromes da apneia do sono ,insuficiência cardíaca ,beta-antagonistas adrenérgicos ,Sleep apnea syndromes ,heart failure ,adrenergic beta-antagonists ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: As apneias do sono são doenças frequentes em portadores de insuficiência cardíaca (IC). Estimativas da era pré-betabloqueador (BB) apontam para uma prevalência de 45% de apneias centrais nestes pacientes. OBJETIVO: Avaliar a influência dos BB na prevalência das apneias centrais e sua interferência na qualidade do sono e de vida de portadores de IC. MÉTODOS: 65 pacientes portadores de IC foram submetidos a polissonografia diagnóstica.Os resultados da polissonografia foram avaliados de acordo com o uso ou não de BB. No dia do exame os pacientes responderam ao questionário de Minessota para qualidade de vida com IC. Após 6 e 12 meses da data da polissonografia, houve contato telefônico com todos os pacientes, para a repetição do questionário de Minessota. RESULTADOS: A prevalência de apneia do sono (IAH > 15/h) foi de 46,1% na população total, porém a apneia central foi identificada em apenas 18,4% dos pacientes. O uso de BB, em análise multivariada, foi o único preditor de ocorrência de menor índice de apneia e hipopneia (IAH) central (p=0,002), maior saturação (p=0,02) e menor dessaturação média de oxigênio (p=0,03). Além disso, o uso de BB foi preditor de melhor qualidade de vida após 6 e 12 meses (p=0,002 e 0,001 respectivamente) e de menor número de hospitalizações nestes períodos (p=0,001 e p=0,05 respectivamente). CONCLUSÃO: O uso de BB reduziu a incidência de apneia central na população total, se compararmos com os dados da literatura. Além disto, os BB melhoraram parâmetros da qualidade do sono e de vida de portadores de IC.FUNDAMENTO: Las apneas del sueño son enfermedades frecuentes en portadores de insuficiencia cardiaca (IC). Una estimación de la era pre betabloqueante (BB) señala hacia una prevalencia del 45% de apneas centrales en estos pacientes. OBJETIVO: Evaluar la influencia de los BB en la prevalencia de las apneas centrales y su interferencia en la calidad del sueño y de vida de portadores de IC. MÉTODOS: 65 pacientes portadores de IC fueron sometidos a polisonografía diagnóstica. Los resultados de la polisonografía se evaluaron según el empleo o no de BB. El día del examen, los pacientes contestaron el cuestionario de Minnesota para la calidad de vida con IC. Tras 6 y 12 meses de la fecha de la polisonografía, hubo contacto telefónico con todos los pacientes, para la repetición del cuestionario de Minnesota. RESULTADOS: La prevalencia de apnea del sueño (IAH > 15/h) fue de un 46,1% en la población total, además de la apnea central se identificó en solamente un 18,4% de los pacientes. El empleo de BB, en análisis multivariado, fue el único predictor de ocurrencia de menor índice de apnea e hipopnea (IAH) central (p=0,002), mayor saturación (p=0,02) y menor desaturación promedio de oxígeno (p=0,03). Además de ello, el empleo de BB fue predictor de mejor calidad de vida tras 6 y 12 meses (p=0,002 y 0,001 respectivamente) y de menor número de hospitalizaciones en estos períodos (p=0,001 y p=0,05 respectivamente). CONCLUSIÓN: El empleo de BB reduzco la incidencia de apnea central en la población total, si lo comparamos con los datos de la literatura. Además de esto, los BB mejoran parámetros de la calidad del sueño y de vida de portadores de IC.BACKGROUND: Sleep apneas are frequent in patients with heart failure (HF). Estimate of the pre-beta blocker age (BB) point out to 45% of central apneas in these patients. OBJECTIVE: Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS: 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minessota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minessota questionnaire. RESULTS: The prevalence of sleep apnea (IAH > 15/h) hit 46.1% in the total population, however, central sleep apnea was identified in 18.4% of patients. The use of BB, in a multivariate analysis, was the only predictor of a minor index of central apnea and hypopnea (IAH) (p=0.002), greater saturation (p=0.02) and smaller average desaturation of oxygen (p=0.03). Additionally, the use of BB could predict a better quality of life after 6 and 12 months (p=0.002 and 0.001 respectively) and a smaller number admissions in these periods (p=0.001 and p=0.05 respectively). CONCLUSION: The use BB reduced the rate of central sleep apnea in total population, if we compare to literature data. Additionally, the BB improved parameters of quality of sleep and life of patients with heart failure.
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- 2010
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28. Impacto do sildenafil sublingual na hipertensão pulmonar de pacientes com insuficiência cardíaca Impacto del sildenafil sublingual en la hipertensión pulmonar de pacientes con insuficiencia cardiaca Impact of sublingual sildenafil on pulmonary hypertension in patients with heart failure
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Aguinaldo Figueiredo de Freitas Jr., Fernando Bacal, José de Lima Oliveira Jr., Ronaldo Honorato Barros Santos, Luiz Felipe Pinho Moreira, Christiano Pereira Silva, Sandrigo Mangini, Rodrigo Moreno Dias Carneiro, Alfredo Inácio Fiorelli, and Edimar Alcides Bocchi
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Vasodilatadores ,hipertensión pulmonar ,insuficiencia cardiaca ,hipertensão pulmonar ,insuficiência cardíaca ,Vasodilatator agents ,hypertension, pulmonary ,heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: A hipertensão pulmonar (HP) é fator de mau prognóstico no pós-operatório de transplante cardíaco (TC) e, desta forma, o estudo do grau de reversibilidade a vasodilatadores é obrigatório durante avaliação pré-operatória. OBJETIVO: Avaliar os efeitos hemodinâmicos pulmonares e sistêmicos do sildenafil como droga vasodilatadora durante o teste de reversibilidade da HP em candidatos a transplante cardíaco. MÉTODOS: Pacientes em fila para TC foram submetidos à medida de variáveis hemodinâmicas sistêmicas e pulmonares antes e após a administração de 100mg dose única e sublingual de sildenafil, durante cateterização cardíaca direita. RESULTADOS: Quatorze pacientes (idade: 47±12 anos, 71,4% homens) com insuficiência cardíaca avançada, Fração de Ejeção (FE) 25 ± 7%, Classe Funcional (CF- NYHA) CF III - 6 e CF IV - 8, foram avaliados neste estudo. A administração aguda de sildenafil mostrou ser eficaz na redução das pressões sistólica (62,4 ± 12,1 vs. 51,5 ± 9,6 mmHg, IC=95%, pFUNDAMENTO: La hipertensión pulmonar (HP) se muestra factor de mal pronóstico en el postoperatorio de transplante cardiaco (TC) y, de esta forma, el estudio del grado de reversibilidad a vasodilatadores se vuelve obligatorio durante evaluación preoperatoria. OBJETIVO: Evaluar los efectos hemodinámicos pulmonares y sistémicos del Sildenafil como droga vasodilatadora durante la prueba de reversibilidad de la HP en candidatos a transplante cardiaco. MÉTODOS: Pacientes en fila para TC fueron sometidos a la medición de variables hemodinámicas sistémicas y pulmonares, antes y luego de la administración de 100mg en dosificación única y sublingual de Sildenafil, durante cateterización cardiaca derecha. RESULTADOS: Se evaluaron en este estudio a 14 pacientes (edad: 47±12 años, el 71,4% varones) con insuficiencia cardiaca avanzada, fracción de eyección (FE) 25 ± 7%, clase funcional (CF-NYHA) CF III - 6 y CF IV - 8. La administración aguda de Sildenafil se mostró eficaz en la reducción de las presiones sistólica (62,4 ± 12,1 vs 51,5 ± 9,6 mmHg, IC=95%, pBACKGROUND: Pulmonary hypertension (PH) is a factor of poor prognosis in the postoperative period of heart transplant (HT) and thus, the study of the degree of reversibility to vasodilators is mandatory during the preoperative assessment. OBJECTIVE: To evaluate the pulmonary and systemic hemodynamic effects of sildenafil as a vasodilator during the PH reversibility test in patients that are candidates to HT. METHODS: Patients awaiting HT were submitted to the measurement of systemic and pulmonary hemodynamic variables before and after the administration of a single sublingual dose of 100 mg of sildenafil during right heart catheterization. RESULTS: Fourteen patients (age: 47±12 years, 71.4% men) with advanced heart failure Ejection Fraction (EF) 25 ± 7%, Functional Class (FC - NYHA) FC III - 6 and FC IV - 8, were evaluated in this study. The acute administration of sildenafil showed to be effective in decreasing the systolic (62.4 ± 12.1 vs 51.5 ± 9.6 mmHg, CI=95%, p
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- 2009
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29. Insuficiência cardíaca descompensada na unidade de emergência de hospital especializado em cardiologia Decompensated heart failure in the emergency department of a cardiology hospital
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Sandrigo Mangini, Fábio Serra Silveira, Christiano Pereira Silva, Petherson Suzano Grativvol, Luís Fernando Bernal da Costa Seguro, Sílvia Moreira Ayub Ferreira, Amílcar Oshiro Mocelin, Luiz Francisco Cardoso, Fernando Bacal, and Edimar Alcides Bocchi
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Insuficiência cardíaca descompensada ,unidade de emergência ,Decompensated heart failure ,emergency unit ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: Estudos nacionais em insuficiência cardíaca descompensada (ICD) são fundamentais para o entendimento dessa afecção em nosso meio. OBJETIVO: Determinar as características dos pacientes com ICD em uma unidade de emergência. MÉTODOS: Examinamos prospectivamente 212 pacientes com o diagnóstico de insuficiência cardíaca descompensada, os quais foram admitidos em uma unidade de emergência (UE) de hospital especializado em cardiologia. Estudaram-se variáveis clínicas, apresentação e causas de descompensação. Em 100 pacientes, foram analisados exames complementares, prescrição de drogas vasoativas, tempo de internação e letalidade. RESULTADOS: Entre os pesquisados houve predomínio de homens (56%) e a etiologia isquêmica foi a mais freqüente (29,7%), apesar da elevada freqüência de valvares (15%) e chagásicos (14,7%). A forma de apresentação e a causa de descompensação mais comuns foram, respectivamente, congestão (80,7%) e má adesão/medicação inadequada (43,4%). Na subanálise dos 100 pacientes, a disfunção sistólica foi a mais freqüente (55%), uso de drogas vasoativas ocorreu em 20% e a letalidade foi de 10%. Análise comparativa entre os pacientes que receberam alta e faleceram durante a internação ratificou alguns critérios de mau prognóstico: pressão arterial sistólica reduzida, baixo débito associado à congestão, necessidade de droga vasoativa, fração de ejeção do ventrículo esquerdo reduzida, diâmetro diastólico do ventrículo esquerdo (DDVE) aumentado e hiponatremia. CONCLUSÃO: Este trabalho apresenta dados sobre o perfil da população com insuficiência cardíaca descompensada atendida na unidade de emergência de um hospital especializado em cardiologia da região sudeste do Brasil. Na avaliação inicial destes pacientes dados clínico-hemodinâmicos e de exames complementares fornecem subsídios para estratificação de risco, auxiliando na decisão de internação e estratégias terapêuticas mais avançadas.BACKGROUND: National studies on decompensated heart failure (DHF) are key to the understanding of this condition in our midst. OBJECTIVE: To determine the characteristics of DHF patients in an emergency department. METHODS: A total of 212 patients diagnosed with decompensated heart failure who had been admitted to an emergency department (EU) of a cardiology hospital were prospectively evaluated. Clinical variables, form of presentation and causes of decompensation were studied. In 100 patients, ancillary tests, prescription of vasoactive drugs, length of hospital stay and mortality were also analyzed. RESULTS: There was a predominance of the male gender (56%) and the most frequent etiology was ischemia (29,7%) despite high frequency of valvular (15%) and chagasic (14,7%) etiologies. The most common form of presentation and cause of decompensation were congestion (80.7%) and poor compliance/inadequate medication (43.4%), respectively. In the subanalysis of the 100 patients, systolic dysfunction was the most common cause of decompensation (55%); use of vasoactive drugs occurred in 20%, and mortality was 10%. The comparative analysis between the patients who were discharged and those who died during hospitalization confirmed some criteria of poor prognosis: reduced systolic blood pressure, low cardiac output associated with congestion, need for vasoactive drugs, reduced left ventricular ejection fraction, increased left ventricular diastolic diameter (LVDD) and hyponatremia. CONCLUSION: This study presents information about the profile of decompensated heart failure patients attended on the emergency unit of a brazilian southeast cardiology hospital. Clinical, hemodynamical and ancillary data may provide information for risk assessment in the initial evaluation helping the decision on hospitalization and advanced strategic therapies.
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- 2008
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30. Solução salina hipertônica para prevenção de insuficiência renal em pacientes com insuficiência cardíaca descompensada e hiponatremia Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure
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Victor Sarli Issa, Fernando Bacal, Sandrigo Mangini, Rodrigo Moreno Dias Carneiro, Cristiano Humberto Naves de Freitas Azevedo, Paulo Roberto Chizzola, Silvia Moreira Ayub Ferreira, and Edimar Alcides Bocchi
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Soluções hipertônicas ,baixo débito cardíaco ,insuficiência renal ,hiponatremia ,Hypertonic solutions ,heart failure ,renal insufficiency ,hyponatremia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: Hiponatremia e fenômenos congestivos indicam mau prognóstico na insuficiência cardíaca descompensada. A ocorrência de insuficiência renal está associada a aumento do risco de morte. OBJETIVO: Avaliar a segurança e a eficácia da solução hipertônica em pacientes com insuficiência cardíaca descompensada para prevenção de insuficiência renal. MÉTODOS: Participaram do estudo pacientes com insuficiência cardíaca descompensada, congestão e hiponatremia. Além do tratamento padrão, os pacientes receberam solução salina hipertônica, e foram submetidos a avaliação tanto clínica como laboratorial. RESULTADOS: Foram incluídos 9 pacientes. A média das idades dos pacientes foi de 55 + 14,2 anos, sendo 5 (55,5%) do sexo masculino e 4 (44,5%), do feminino. Todos apresentavam classe funcional III-IV da New York Heart Association (NYHA), e 5 (55,5%) recebiam dobutamina. Todos apresentaram creatinina inicial acima de 1,4 mg/dl. A tonicidade média da solução foi de 4,39% + 0,018% (2,5% a 7,5%) e a duração do tratamento foi de 4,9 dias + 4,1 dias (1 dia a 15 dias). Não houve efeitos adversos graves; em nenhum caso houve piora clínica ou distúrbios neurológicos; hipocalemia ocorreu em 4 (44,5%) casos. A comparação das variáveis pré- e pós-tratamento demonstrou queda da uréia (105 mg/dl + 74,8 mg/dl vs. 88 mg/dl + 79,4 mg/dl; p = 0,03) e aumento do volume urinário (1.183 ml/dia vs. 1.778 ml/dia; p = 0,03); houve tendência a redução da creatinina (2,0 mg/dl + 0,8 mg/dl vs. 1,7 mg/dl + 1,0 mg/dl; p = 0,08). Apesar da elevação do valor do sódio (131 mEq/l + 2,8 mEq/l vs. 134 mEq/l + 4,9 mEq/l) e da redução do peso (69,5 kg + 18,6 kg vs. 68,2 kg + 17,1 kg), não houve diferença estatisticamente significante. CONCLUSÃO: O uso de solução salina hipertônica em pacientes com insuficiência cardíaca descompensada pode ser método terapêutico seguro e potencialmente relacionado a melhora clínica e de prevenção da insuficiência renal.BACKGROUND: Hyponatremia and congestive phenomena indicate a bad prognosis in decompensated heart failure. The occurrence of renal failure is associated to an increased death risk. OBJECTIVE: To evaluate the safety and efficacy of the hypertonic saline solution in patients with decompensated heart failure for renal failure prevention. METHODS: Patients with decompensated heart failure, congestion and hyponatremia participated in the study. In addition to the standard treatment, the patients received hypertonic saline solution and were submitted to clinical as well as laboratory assessment. RESULTS: Nine patients were enrolled in the study. Mean age was 55 + 14.2 years, being 5 male (55.5%) and 4 (44.5%) female patients. All of them presented functional class III-IV of the New York Heart Association (NYHA), and 5 (55.5%) received dobutamine. All of them presented initial creatinine > 1.4 mg/dl. The mean tonicity of the solution was 4.39% + 0.018% (2.5% to 7.5%) and the duration of treatment was 4.9 days + 4.1 days (1-15 days). There were no severe adverse effects; none of the patients presented clinical worsening or neurologic disorders; hypokalemia occurred in 4 cases (44.5%). The comparison of the variables before and after treatment showed a decrease in urea (105 mg/dl + 74.8 mg/dl vs. 88 mg/dl + 79.4 mg/dl; p = 0.03) and increase in the urinary volume (1,183 ml/day vs. 1,778 ml/day; p = 0.03); there was no tendency to creatinine decrease (2.0 mg/dl + 0.8 mg/dl vs. 1.7 mg/dl + 1.0 mg/dl; p = 0.08). Despite the elevation in sodium levels (131 mEq/l + 2.8 mEq/l vs. 134 mEq/l + 4.9 mEq/l) and weight decrease (69.5 kg + 18.6 kg vs. 68.2 kg + 17.1 kg), there was no statistically significant difference. CONCLUSION: The use of hypertonic saline solution in patients with decompensated heart failure can be a safe therapeutic method and potentially related to clinical improvement and renal failure prevention.
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- 2007
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31. Perfil do tratamento da insuficiência cardíaca na era dos betabloqueadores Heart failure treatment profile at the beta blockers era
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Christiano Pereira Silva, Fernando Bacal, Philippe Vieira Pires, Sandrigo Mangini, Victor Sarli Issa, Silvia Ferreira Ayub Moreira, Paulo Roberto Chizzola, Germano Emílio Conceição Souza, Guilherme Veiga Guimarães, and Edimar Alcides Bocchi
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Baixo débito cardíaco ,insuficiência cardíaca ,ambulatório hospitalar ,sistema resina-angiotensina ,Cardiac output ,low heart failure ,outpatient clinic hospital ,renin- angiotensin system ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVOS: A inibição dos sistemas renina-angiotensina-aldosterona (SRAA) e sistema nervoso autônomo simpático aumentou a perspectiva de sobrevida desses pacientes, além de permitir substancial melhora na qualidade de vida. O objetivo deste trabalho foi avaliar a realidade do tratamento aplicado e seu impacto sobre a doença em pacientes acompanhados em um ambulatório especializado em insuficiência cardíaca(IC). MÉTODOS: Foram estudados 96 pacientes acompanhados no ambulatório de Insuficiência Cardíaca e Transplante do Instituto do Coração, do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Os dados foram coletados durante a consulta ambulatorial a partir de prontuário médico e exame clínico. A escolha dos pacientes foi aleatória. RESULTADOS: A maior parte dos pacientes encontrava-se em classe funcional II (42,3%) e em estágio C de evolução (94,9%). A prescrição médica para os pacientes foi bastante próxima do preconizado pelas diretrizes. Aproximadamente 95% recebem inibidores do SRAA (inibidor de ECA - enalapril e captopril - ou antagonista dos receptores de angiotensina-losartan), enquanto 85% dos pacientes recebem, além desses, agentes betabloqueadores (carvedilol). A dose média prescrita também se aproxima das utilizadas nos grandes estudos, e atinge mais de 60% da dose máxima de cada medicação. Os dados hemodinâmicos encontrados mostram pacientes estáveis, apesar da intensidade da disfunção e do remodelamento ventricular destes. CONCLUSÃO: Pacientes portadores de IC acompanhados por equipe médica especializada têm prescrição médica mais próxima do preconizado. Esses pacientes, embora com características marcadas de gravidade da doença, conseguem estabilidade hemodinâmica e clínica com a otimização terapêutica adequada.OBJECTIVES: The inhibition of the rennin-angiotensin-aldosterone system (RAAS) and sympathetic autonomous nervous system has increased the perspective of survival in these patients, as well as allowing the improvement of the quality of life. The aim of this study was to evaluate the reality of the treatment employed and its impact on the disease in patients followed at a specialized heart failure (HF) outpatient clinic. METHODS: A sample of 96 patients followed at the HF and Transplant Outpatient Clinic of Heart Institute of the University of São Paulo School of Medicine (InCor -HCFMUSP) were evaluated. The data were collected during the ambulatory consultation from the medical files and through physical examination. Patients were randomly selected for the study. RESULTS: Most of the patients were Functional Class II (42.3%) and evolution stage C (94.9%). The medical prescription given to the patients was quite similar to the one recommended by the directives. Approximately 95% of them received RAAS inhibitors (ACE inhibitor - enalapril and captopril - or angiotensin receptor antagonist - losartan), whereas 85% of the patients additionally received beta blockers (carvedilol). The mean dose prescribed was also similar to the one used in large studies and reached more than 60% of the maximum dose for each medication. The hemodynamic data show that patients were stable, despite the intensity of the dysfunction and ventricular remodeling observed in these patients. CONCLUSION: Patients with HF followed by a specialized medical team receive a medical prescription that is closer to the recommended one. These patients, despite the marked characteristics of disease severity, achieve hemodynamic and clinical stability with an adequate therapeutic optimization.
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- 2007
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32. Emerging Topics Update of the Brazilian Heart Failure Guideline - 2021
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Fabiana G, Marcondes-Braga, Lídia Ana Zytynski, Moura, Victor Sarli, Issa, Jefferson Luis, Vieira, Luis Eduardo, Rohde, Marcus Vinícius, Simões, Miguel Morita, Fernandes-Silva, Salvador, Rassi, Silvia Marinho Martins, Alves, Denilson Campos de, Albuquerque, Dirceu Rodrigues de, Almeida, Edimar Alcides, Bocchi, Felix José Alvarez, Ramires, Fernando, Bacal, João Manoel, Rossi Neto, Luiz Claudio, Danzmann, Marcelo Westerlund, Montera, Mucio Tavares de, Oliveira Junior, Nadine, Clausell, Odilson Marcos, Silvestre, Reinaldo Bulgarelli, Bestetti, Sabrina, Bernadez-Pereira, Aguinaldo F, Freitas, Andréia, Biolo, Antonio Carlos Pereira, Barretto, Antônio José Lagoeiro, Jorge, Bruno, Biselli, Carlos Eduardo Lucena, Montenegro, Edval Gomes Dos, Santos Júnior, Estêvão Lanna, Figueiredo, Fábio, Fernandes, Fabio Serra, Silveira, Fernando Antibas, Atik, Flávio de Souza, Brito, Germano Emílio Conceição, Souza, Gustavo Calado de Aguiar, Ribeiro, Humberto, Villacorta, João David de, Souza Neto, Livia Adams, Goldraich, Luís, Beck-da-Silva, Manoel Fernandes, Canesin, Marcelo Imbroinise, Bittencourt, Marcely Gimenes, Bonatto, Maria da Consolação Vieira, Moreira, Mônica Samuel, Avila, Otavio Rizzi, Coelho Filho, Pedro Vellosa, Schwartzmann, Ricardo, Mourilhe-Rocha, Sandrigo, Mangini, Silvia Moreira Ayub, Ferreira, José Albuquerque de, Figueiredo Neto, and Evandro Tinoco, Mesquita
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Heart Failure ,Humans ,American Heart Association ,Atualização ,Brazil ,Update - Published
- 2021
33. Caso 06/2004 - Morte súbita em muher de 69 anos no terceiro dia de pós-opertório de cirurgia de revascularização miocárdica realizada na fase aguda de infarto do miocádio: Instituto do Coração (InCor) HC-FMUSP
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Felipe Kumamoto, Sandrigo Mangini, and Vera Demarchi Aiello
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2004
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34. Epipericardial fat necrosis as cause of chest pain in patient after heart transplantation
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Sandrigo Mangini, Fernando Bacal, Mariana Pezzute Lopes, Caio Tavares Silva, I.W. Campos, Mônica Samuel Avila, Luis Fernando Bernal da Costa Seguro, Fábio Antônio Gaiotto, Caio Rebouças Fonseca Cafezeiro, and Fabiana G. Marcondes-Braga
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Heart transplantation ,Transplantation ,Acute coronary syndrome ,medicine.medical_specialty ,Heart disease ,business.industry ,medicine.medical_treatment ,030230 surgery ,medicine.disease ,Chest pain ,Pulmonary embolism ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Etiology ,Immunology and Allergy ,Pharmacology (medical) ,Fat necrosis ,Radiology ,medicine.symptom ,business - Abstract
Epipericardial fat necrosis is an uncommon clinical condition of unknown etiology. It typically presents as acute pleuritic chest pain and should be differentiated from acute pulmonary embolism and acute coronary syndrome. This condition is diagnosed by characteristic chest computed tomography findings of an ovoid mediastinal fatty lesion with intrinsic and surrounding soft-tissue stranding. Treatment of epipericardial fat necrosis includes the administration of anti-inflammatory agents, and symptoms usually resolve within a few days after treatment initiation. This disease entity has rarely been reported since it was first described in 1957. Most current knowledge of epipericardial fat necrosis is based on case reports that describe this condition in previously healthy individuals. We present the case of a 39-year-old woman with a history of heart transplant, who presented with chest pain secondary to epipericardial fat necrosis. Serial computed tomography revealed lesion resolution after appropriate treatment.
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- 2020
35. AVALIAÇÃO DE UMA COORTE DE TRANSPLANTE CARDÍACO POR ESCORE RELACIONADO AO DOADOR A
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I.W. Campos, Sandrigo Mangini, Fabiana Goulart Marcondes Braga, Marina Hoff de Lima Tonin, Luis Fernando Bernal da Costa Seguro, Fernando Bacal, Jaqueline Melo, Fernanda Barone, Audrey de Paula, Mônica Samuel Avila, Laura Leite da Escóssia Marinho, Marcely Gimenes Bonatto, and Ana Maria Peixoto Cardoso Duque
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2019
36. An 18-year-old male with dyspnea and pulmonary arterial hypertension
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Maria Aparecida Barne Teixeira, Sandrigo Mangini, and Vera Demarchi Aiello
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2001
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37. Characteristics and Outcomes of Heart Transplant Recipients With Coronavirus-19 Disease in a High-volume Transplant Center
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Maria Tereza Sampaio de Sousa Lira, Sandrigo Mangini, Mariana Vieira de Oliveira Bello, Mônica Samuel Avila, Rinaldo Focaccia Siciliano, Fábio Antônio Gaiotto, Tânia Mara Varejão Strabelli, Fabiana G. Marcondes-Braga, I.W. Campos, Fernando Bacal, Luis Fernando Bernal da Costa Seguro, C.M. Murad, Fernanda Barone Alves Santos, Rafael C T Dantas, Carlos Aurélio dos Santos Aragão, and Deborah de Sá Pereira Belfort
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Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Disease ,030230 surgery ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Mild disease ,Coronavirus ,Cause of death ,Immunosuppression Therapy ,Transplantation ,Cardiac allograft ,business.industry ,SARS-CoV-2 ,Absolute lymphocyte count ,COVID-19 ,Middle Aged ,Transplant Recipients ,Hospitalization ,Heart Transplantation ,030211 gastroenterology & hepatology ,business - Abstract
BACKGROUND: Heart transplant (HT) recipients may be at higher risk of acquiring SARS-CoV-2 infection and developing critical illness. The aim of this study is to describe characteristics and outcomes of HT recipients infected by SARS-COV-2, from a high-volume transplant center. METHODS: We have described data of all adult HT recipients with confirmed COVID-19 by RT-PCR in nasopharyngeal samples from April 5th,2020 to January 5th, 2021. Outcomes and follow-up were recorded until February 5th, 2021. RESULTS: Forty patients were included. Twenty-four patients (60%) were men; the median age was 53 (40-60) years old; median HT time was 34 months and median follow-up time 162 days. The majority needed hospitalization (83%). Immunosuppressive therapy was reduced/withdrawn in the majority of patients, except from steroids, which were maintained. Seventeen patients (42.5%) were classified as having severe disease according to the ordinal scale developed by the WHO Committee. They tended to have lower absolute lymphocyte count (p
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- 2021
38. Usefulness of PCR for Trypanosoma cruzi DNA in blood and endomyocardial biopsies for detection of Chagas disease reactivation after heart transplantation: A comparative study
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Alessandra Roggério, Luiz Alberto Benvenuti, Anna S. Nishiya, Sandrigo Mangini, Vera Lúcia Teixeira de Freitas, and Tânia Mara Varejão Strabelli
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Chagas disease ,medicine.medical_specialty ,Biopsy ,Trypanosoma cruzi ,medicine.medical_treatment ,030230 surgery ,Polymerase Chain Reaction ,Gastroenterology ,Endomyocardial biopsy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,mental disorders ,medicine ,Humans ,Chagas Disease ,Heart transplantation ,Transplantation ,biology ,business.industry ,DNA ,biology.organism_classification ,medicine.disease ,Trypanosoma cruzi DNA ,Infectious Diseases ,Heart Transplantation ,030211 gastroenterology & hepatology ,business ,Endocardium - Abstract
Background Chagas disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease with proliferation and dissemination of Trypanosoma cruzi parasites. Serial blood PCR testing is consensually recommended for CDR monitoring, but there is uncertainty about the incremental value in performing the molecular tests in endomyocardial biopsies (EMB). Methods We compared qualitative and quantitative results of PCR for T. cruzi DNA in 62 pairs of blood and EMB collected with a maximum time interval of 7 days, from 34 heart-transplanted, chagasic patients. Results Blood PCR resulted positive in 39/62 (62.9%) samples, with PL ranging from 0.14 to 1,610.73 (median: 3.31). PCR resulted positive in 8/60 (13.3%) EMB, with PL ranging from 2.82 to 1,670.55 (median: 65.63). All blood samples which tested negative presented a paired EMB which also tested negative. However, 31/39 (79.5%) blood samples which tested positive presented a paired EMB which tested negative. There was poor agreement between blood and EMB PCR (kappa=0.153). CDR affecting the myocardium (myo-CDR) was diagnosed in three occasions. PCR resulted positive in both blood and EMB at the time of myo-CDR, with PL ranging from 0.61 to 1,610.73 in blood and 13.8 to 1,670.55 in EMB. Conclusions Negative PCR for T. cruzi in blood rules out myo-CDR, with no value of testing EMB. Positive PCR in blood with high PL is diagnostic for myo-CDR. If PCR in blood results positive with low PL, testing EMB is useful: negative PCR turns unlikely, and positive PCR reinforces greatly the possibility of myo-CDR.
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- 2021
39. SARS-CoV-2 Infection and CMV Dissemination in Transplant Recipients as a Treatment for Chagas Cardiomyopathy: A Case Report
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Luana de Mendonça Oliveira, Sarah Cristina Gozzi-Silva, Julia Cataldo Lima, Yasmim Álefe Leuzzi Ramos, Danielle Rosa Beserra, Emily Araujo de Oliveira, Maria Notomi Sato, Tatiana Mina Yendo, Franciane Mouradian Emidio Teixeira, Anna Cláudia Calvielli Castelo Branco, Alberto José da Silva Duarte, Milena Mary de Souza Andrade, Nátalli Zanete Pereira, Bruna Provenci, Sandrigo Mangini, Iara Grigoletto Fernandes, Ricardo Wesley Alberca, Gil Benard, and Anna Julia Pietrobon
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0301 basic medicine ,Chagas disease ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,lcsh:Medicine ,severity ,Case Report ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Chagas Cardiomyopathy ,Medicine ,heart transplant ,General Immunology and Microbiology ,business.industry ,SARS-CoV-2 ,lcsh:R ,Public Health, Environmental and Occupational Health ,CMV ,virus diseases ,COVID-19 ,medicine.disease ,Virology ,infection ,030104 developmental biology ,Infectious Diseases ,business - Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has infected over 90 million people worldwide, therefore it is considered a pandemic. SARS-CoV-2 infection can lead to severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and/or organ failure. Individuals receiving a heart transplantation (HT) may be at higher risk of adverse outcomes attributable to COVID-19 due to immunosuppressives, as well as concomitant infections that may also influence the prognoses. Herein, we describe the first report of two cases of HT recipients with concomitant infections by SARS-CoV-2, Trypanosoma cruzi, and cytomegalovirus (CMV) dissemination, from the first day of hospitalization due to COVID-19 in the intensive care unit (ICU) until the death of the patients.
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- 2021
40. Tópicos Emergentes em Insuficiência Cardíaca: Novos Paradigmas na Amiloidose Cardíaca
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Otavio Rizzi Coelho Filho, Fábio Fernandes, Silvia Marinho Martins Alves, Marcus Vinicius Simões, and Sandrigo Mangini
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Doenca cardiovascular ,medicine.medical_specialty ,Miocardiopatia Restritiva ,Insuficiência Cardíaca ,030204 cardiovascular system & hematology ,Amiloidose ,03 medical and health sciences ,0302 clinical medicine ,Doença Cardiovascular ,Internal medicine ,Cardiovascular Disease ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Cardiovascular Imaging ,Heart Failure ,biology ,business.industry ,Amyloidosis ,Imagem Cardiovascular ,Stroke volume ,medicine.disease ,Transthyretin ,Cardiac amyloidosis ,RC666-701 ,biology.protein ,Cardiology ,Restrictive Cardiomyopathy ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction - Abstract
Resumo Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos. Abstract Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.
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- 2020
41. Abstract 17484: Prevalence, Prognosis and Predictors of Neurological Complications After Heart Transplantation
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Sandrigo Mangini, Ligia Trevizan, Daniela Harsanyi, Fernando Bacal, and Camila Caraviello
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Heart transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Transplantation ,Physiology (medical) ,Internal medicine ,Heart failure ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Introduction: Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its benefits, this therapy still involves complications. Among them, neurological complications may impact significantly patient’s morbidity and mortality. The aim of this study is to identify the prevalence, prognosis and predictors of neurological complications after HT. Methods: Data from all patients who underwent orthotopic HT between 2007 and 2017 in a single center were collected and analyzed. Neurological complications were defined as seizures, ischemic and hemorrhagic stroke. Univariate and multivariate analysis were performed to identify significant predictors and ROC curves were generated to determine cutoff values that could influence the presence of neurological complications. Results: We assessed 132 patients from 15-76 years of age, mean age of 51.8 (73.5% men), who were mainly in INTERMACS profile 3 (78.8%). Cardiomyopathy etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated (24.4%) and other etiologies (22.2%). Neurological events before transplant were present in 16.7%. Neurological complications after HT occurred in 17.4% of patients (8.7% ischemic stroke, 60.9% hemorrhagic stroke and 30.4% seizures), mainly in the first 10 postoperative days (71.4%) and were not related to a higher mortality risk (p=0.159). In the multivariate analysis, pre-transplant adrenaline use (p-value=0.044; 95% CI of 1.07-179.25, OR 13.84) and the difference between mean systolic blood pressure before HT and on the 3rd postoperative day (p-value=0.011; 95% CI of 1.38-11.56, OR 3.99) were independent predictors of neurological complications. A cutoff value higher than 32 mmHg (between mean systolic blood pressure before HT and on the 3rd postoperative day) increased the risk of neurological complications (64.3% sensitivity, 63% specificity; AUROC 0.652). Conclusion: In this single center study, prevalence of neurological complications was high, however had no impact on prognosis. Pre-transplant adrenaline use and systolic blood pressure elevation in the 3rd postoperative day in comparison to the pre-transplant period were predictors of neurological complications.
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- 2020
42. Mode of death on Chagas heart disease: comparison with other etiologies. a subanalysis of the REMADHE prospective trial.
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Silvia M Ayub-Ferreira, Sandrigo Mangini, Victor S Issa, Fátima D Cruz, Fernando Bacal, Guilherme V Guimarães, Paulo R Chizzola, Germano E Conceição-Souza, Fabiana G Marcondes-Braga, and Edimar A Bocchi
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
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.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
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- 2013
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43. Emerging Topics in Heart Failure: New Paradigms in Cardiac Amyloidosis
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Marcus Vinicius, Simões, Silvia Marinho Martins, Alves, Fabio, Fernandes, Otávio Rizzi, Coelho Filho, and Sandrigo, Mangini
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Heart Failure ,Humans ,Prealbumin ,Stroke Volume ,Amyloidosis ,Aged - Abstract
Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos.
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- 2020
44. A medical epopee: recurrent fungal endocarditis, heart transplantation and chylopericardium
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Ricardo Mingarini Terra, Adalberto Batalha Megale, Guilherme Moratti Gilberto, Fábio Antônio Gaiotto, Sandrigo Mangini, Rodrigo Gobbo Garcia, and Antonio de Santis
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,030204 cardiovascular system & hematology ,Heart transplantation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,medicine ,Endocarditis ,business.industry ,Mitral valve replacement ,medicine.disease ,Cardiac surgery ,Surgery ,lcsh:RC666-701 ,Infective endocarditis ,Chylopericardium ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Pericardium - Abstract
Background Candida prosthetic endocarditis is associated with high mortality rates and valve replacement surgery, together with antifungal treatment, play a major role in eradicating the fungal infection. Valve reoperations in these scenarios may be relatively common due to the high infection relapse rates and, in some cases, heart transplantation may be an imposing therapy for infection resolution and for the heart failure related to the myocardial reoperation injury. Among the many postoperative complications related to heart transplantation, chylopericardium is a rare but challenging example. Case presentation We report the case of a 55-year-old man who was admitted to our hospital with a 1-month history of progressive dyspnea and fatigue. His past medical history included four open-heart surgeries for aortic and mitral valve replacement due to recurrent Candida parapsilosis infective endocarditis. Transthoracic echocardiogram showed a markedly reduced left ventricular systolic function and normofunctioning bioprosthetic valves. An inotropic dependency condition led to heart transplantation surgery. In the early postoperative period, a persistent chylous fluid started to drain from the pericardial tube, compatible with the diagnosis of chylopericardium. The lack of clinical response to total parenteral nutrition and intravenous infusion of octreotide imposed the need of interventional radiology with diagnostic lymphography through cisterna chyli puncture and thoracic duct catheterization, confirming the presence of a lymphatic fistula. A successful treatment outcome was achieved with percutaneous thoracic duct embolization using coils and n-butyl-cyanoacrilate glue, possibiliting hospital discharge. Conclusions Fungal endocarditis requires combined treatment (surgical and antimicrobial) for eradication. Valve replacement, while necessary, may lead to severe ventricular deterioration and heart transplantation may be the only viable therapeutic solution. Among the several postoperative complications of heart transplantation, chylopericardium is an uncommon and defiant example. Advances in interventional radiology like the percutaneous embolization allow a less invasive and highly efficient approach for this complication.
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- 2020
45. Sequential measurement of Trypanosoma cruzi parasitic load in endomyocardial biopsies for early detection and follow‐up of Chagas disease reactivation after heart transplantation
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José Eduardo Levi, Anna S. Nishiya, Luiz Alberto Benvenuti, Sandrigo Mangini, and Alessandra Roggério
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Pulmonary and Respiratory Medicine ,Adult ,Chagas Cardiomyopathy ,Graft Rejection ,Male ,Chagas disease ,medicine.medical_specialty ,Biopsy ,Trypanosoma cruzi ,medicine.medical_treatment ,Early detection ,Gastroenterology ,Parasite Load ,law.invention ,law ,Internal medicine ,medicine ,Humans ,Polymerase chain reaction ,Aged ,Retrospective Studies ,Parasitic load ,Heart transplantation ,Transplantation ,medicine.diagnostic_test ,biology ,business.industry ,Histological Techniques ,DNA, Protozoan ,Middle Aged ,biology.organism_classification ,medicine.disease ,Early Diagnosis ,Infectious Diseases ,Benznidazole ,Heart Transplantation ,Surgery ,Female ,Histopathology ,Cardiology and Cardiovascular Medicine ,business ,After treatment ,medicine.drug ,Endocardium - Abstract
Purpose To evaluate the parasitic load of the protozoan Trypanosoma cruzi (etiologic agent of Chagas disease) in sequential endomyocardial biopsies (EMB) of heart-transplanted, chagasic patients who presented reactivation of the disease affecting the allograft. Methods Chagas disease reactivation was diagnosed in 13 patients (aged 25 to 66 years, 8 males) through histopathological detection of T. cruzi parasites in EMB. All patients were successfully treated with oral benznidazole (5mg/kg/day for 60 days). Besides the thirteen EMB that presented morphologically detectable parasites and allowed the diagnosis of reactivation, we examined retrospectively 44 EMB obtained 9 to 168 days prior to reactivation and 43 EMB obtained 8 to 249 days after the diagnosis of reactivation and initiation of treatment. Serial sections of the paraffin-embedded EMB were submitted to a real-time PCR-based assay targeting a 166 base-pairs sequence from satellite T. cruzi DNA. The parasitic load of the EMB was normalized by means of the quantification of the albumin gene. Results Chagas disease reactivation occurred from 64 to 237 days after transplantation (median: 114 days). The parasitic load of the EMB at the time of reactivation ranged from 22.80 to 190,000/106 cells (median: 1,555). In 6 patients none of the EMB obtained prior to reactivation amplified T. cruzi DNA. On the other hand, 10 EMB from 7 patients, obtained 9 to 105 days before reactivation (median: 26 days), showed parasitic load ranging from 8.25 to 625/106 cells (median: 167.55). In all but one of these patients the parasitic load increased sharply at the time of reactivation. After initiation of treatment, all patients showed negative PCR for T. cruzi DNA or a sharply reduction of the parasitic load in the following EMB. One patient presented a new episode of reactivation 178 days after the initial one, with histopathological detection of parasites in the endomyocardial biopsy; at this time the parasitic load of the biopsy raised again, reaching 2,490/106 cells. Conclusion Sequential measurement of T. cruzi parasitic load in EMB is useful for monitoring Chagas disease reactivation after heart transplantation. Its progressive increase suggests imminent reactivation and its decrease after treatment indicates favorable evolution for cure.
- Published
- 2019
46. Prevalence, Prognosis and Predictors of Neurological Complications after Heart Transplantation
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Sandrigo Mangini, Fernando Bacal, C. Caraviello, D. Harsanyi, and L.L.B Trevizan
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Pulmonary and Respiratory Medicine ,Heart transplantation ,Transplantation ,medicine.medical_specialty ,Ischemic cardiomyopathy ,business.industry ,medicine.medical_treatment ,medicine.disease ,Single Center ,Blood pressure ,Internal medicine ,Heart failure ,Idiopathic dilated cardiomyopathy ,medicine ,Etiology ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Purpose Heart transplantation (HT) is the gold-standard treatment for end-stage heart failure. In spite of its innumerous benefits, it still involves complications. Among them, neurological complications significantly impact patient's morbidity and mortality. The aim of this study is to determine the prevalence, prognosis and predictors of neurological events after HT. Methods Between January 2007-December 2017, data from all patients who underwent orthotopic HT in this single center were collected and analyzed considering seizures, ischemic and hemorrhagic stroke as neurological complications. Univariate and multivariate analysis were performed to determine significant predictors; ROC curves were generated to establish blood pressure cutoffs that influence the presence of neurological events. Mortality between groups was evaluated through Kaplan Meier curves and Log Rank test. Results We assessed 132 patients from 15-76 years of age (mean 51.8), 73.5% men, mainly in INTERMACS profile 3 (78.8%). Etiologies included Chagas disease (26.7%), ischemic cardiomyopathy (26.7%), idiopathic dilated cardiomyopathy (24.4%) and other (22.2%). Neurological events before transplant occurred in 16.7%. The prevalence of neurological complications after HT was 17.4% (8.7% ischemic stroke, 60.9% hemorrhagic stroke, 30.4% seizures), and occurred mainly in the first 10 postoperative days (71.4%). In the multivariate analysis, the difference between systolic blood pressure (SBP) before HT and on the 3rd postoperative day was an independent predictor of neurological events (p-value 0.018; 95% CI of 1.007-1.080 OR 1.043). A cut off value of SBP gradient>31,9mmHg (64.3% sensitivity,63% specificity;AUROC 0.652) significantly increased the risk of neurological complications (p=0.006, 95%CI 1.576-14.692 OR 4.811). Presence of neurological events was related to a longer hospital stay (38.6 days for patients with events, 29.1 days for patients without, p=0.019). However, up to the first-year post-transplant, neurological complications did not impact mortality risk (p=0.191). Conclusion In this single center study, prevalence of neurological complications was high, however without impact on mortality. Systolic blood pressure elevation in the 3rd postoperative day in comparison to the pre transplant period was a significant predictor of neurological complications.
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- 2021
47. II Diretriz Brasileira de Transplante Cardíaco
- Author
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Fernando Bacal, João David de Souza Neto, Alfredo Inácio Fiorelli, Juan Mejia, Fabiana Goulart Marcondes-Braga, Sandrigo Mangini, José de Lima Oliveira Jr, Dirceu Rodrigues de Almeida, Estela Azeka, Jarbas Jakson Dinkhuysen, Maria da Consolação Vieira Moreira, João Manoel Rossi Neto, Reinaldo Bulgarelli Bestetti, Juliana Rolim Fernandes, Fátima das Dores Cruz, Lucinei Paz Ferreira, Helenice Moreira da Costa, Ana Augusta Maria Pereira, Nicolas Panajotopoulos, Luiz Alberto Benvenuti, Lídia Zytynski Moura, Glauber Gean Vasconcelos, João Nelson Rodrigues Branco, Claudio Leo Gelape, Ricardo Barreira Uchoa, Silvia Moreira Ayub-Ferreira, Luis Fernando Aranha Camargo, Alexandre Siciliano Colafranceschi, Solange Bordignon, Reginaldo Cipullo, Estela Suzana Kleiman Horowitz, Klébia Castelo Branco, Marcelo Jatene, Sergio Lopes Veiga, Cesar Augusto Guimarães Marcelino, Guaracy Fernandes Teixeira Filho, José Henrique Vila, and Marcelo Westerlund Montera
- Subjects
Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2010
- Full Text
- View/download PDF
48. Pneumonia por Influenza A(H1N1) em paciente imunossuprimido após transplante cardíaco Neumonía por Influenza A (H1N1) en paciente inmunosuprimido tras transplante cardiaco Influenza A (H1N1) pneumonia in an immunossupressed patient after heart transplantation
- Author
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Fernando Bacal, Luis Fernando Seguro, Tania Ogawa, Sandrigo Mangini, Alfredo Fiorelli, and Edimar Bocchi
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Influenza virus A (H1N1) ,transplante de corazón ,inmunosupresión ,neumonía ,Influenza vírus A (H1N1) ,transplante de coração ,imunossupressão ,pneumonia ,Influenzavirus A (H1N1) ,heart transplantation ,immunosuppression ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
O papel da resposta imunológica durante a infecção pelo vírus Influenza H1N1 não está totalmente estabelecido, mas acredita-se que atue de forma decisiva no agravamento do quadro e no aparecimento da síndrome de desconforto respiratório agudo. O papel de terapias imunomoduladoras no controle de infecções virais também não é consensual e faltam dados de literatura para se definir as indicações de seu uso. Neste relato de caso, apresentamos, segundo nosso conhecimento, pela primeira vez, o relato de um paciente transplantado cardíaco que apresentou infecção pelo vírus H1N1 e evoluiu de forma favorável, trazendo um questionamento sobre o real papel da terapia imunossupressora como fator de risco para a forma grave da doença.El rol de la respuesta inmunológica durante la infección por el virus Influenza H1N1 no está totalmente establecido, sino que se cree que él actúe de forma decisiva en el agravamiento del cuadro y en el surgimiento del síndrome de distrés respiratorio agudo. El papel de terapias inmunomoduladoras en el control de infecciones virales también no es consensual y nos faltan datos de la literatura para definirse las indicaciones de su utilización. En este caso clínico presentamos, según nuestro conocimiento, por primera vez, el relato de un paciente transplantado cardiaco que presentó infección por el virus H1N1 y evolucionó de forma favorable, y aprovechamos para poner en cuestión el real papel de la terapia inmunosupresora como factor de riesgo para la forma severa de la enfermedad.The role of the immune response during Influenza H1N1 virus infection is not yet fully established, but it is believed that it decisively participates in the severity of the disease as well as in the development of acute respiratory distress syndrome. The role of immunomodulating therapies in the control of viral infections is not a consensus either, and data from the literature defining the indications for their use are lacking. The present report is, to our knowledge, the first on a heart transplant patient who developed H1N1 virus infection and had a favorable outcome, thus generating discussion on the real role of immunosuppressive therapy as a risk factor for the severe form of the disease.
- Published
- 2009
- Full Text
- View/download PDF
49. Prevalence of Cognitive Impairment in Heart Transplant Waiting-List Patients in a Developing Country
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M. Feltrim, E A Bocchi, Fernando Bacal, Cesar Higa Nomura, Mônica Samuel Avila, Sandrigo Mangini, I. Wozniak, E.T. Ikeda, Luis Fernando Bernal da Costa Seguro, Fábio Antônio Gaiotto, Fabrício Manoel Oliveira, Fabiana G. Marcondes-Braga, S.H. Lage, Malu Mateus Santos, V.S. Issa, and F. Barone
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Pulmonary and Respiratory Medicine ,Transplantation ,education.field_of_study ,Pediatrics ,medicine.medical_specialty ,Heart disease ,business.industry ,Population ,Beck Depression Inventory ,Montreal Cognitive Assessment ,Wechsler Adult Intelligence Scale ,Transplant Waiting List ,medicine.disease ,Mood ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,education ,Depression (differential diagnoses) - Abstract
Purpose Cognitive impairment and mood deviation often occurs in patients with heart failure. Frailty and sarcopenia have been widely studied in patients with heart disease, but cognitive frailty has been little explored. High complexity of patients referred for heart transplantation connected with socioeconomic characteristics in a developing country underlines the importance to investigate cognitive and mood conditions in this population. The purpose of the study is to evaluate the prevalence of cognitive impairment and depression symptoms in patients with heart failure in waiting list for heart transplantation. Methods Cognition was assessed with the Montreal Cognitive Assessment (MoCA) and Wechsler Abbreviated Scale of Intelligence (WASI). Tables 1 and 2 show the domains evaluated by these tests and the established frailty criteria. Depression symptoms was assessed with Beck Depression Inventory (BDI). Patients included in waiting-list from Nov/2018 to May/2020 in our institution had its cognitive assessment in four weeks. Results 57 patients were evaluated; 77% were male; 49.9 was the average age; Chagas disease was the main etiology (38%), followed by dilated cardiomyopathy (28%) and ischemic cardiomyopathy (8%). 8.5 was the average of school years; 55% belong to social class “E” according to monthly family income and 28% reported history of mental health treatment or psychotropic use. Considering scales described above, 35% had mild symptons for depression; 89% denoted frailty on the brief cognitive screening test (MoCA) and 80% in the global intelligence scale (WASI), with emphasis on lower scores on non-verbal tasks over verbal tasks. Conclusion In our cohort, the prevalence of cognitive frailty in patients in heart transplant waiting list was alarming. Socioeconomic conditions seem to be a crucial issue in worse performance of candidates reflecting specific features and challenges regarding heart transplantation in a developing country.
- Published
- 2020
50. Calcificação Miocárdica Extensa em Paciente após Transplante Cardíaco
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Fernando Bacal, Sasha B. C. P. Duarte, Marcelo L. Montemor, Sandrigo Mangini, and Mônica Samuel Avila
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business.industry ,Medicine ,Nuclear medicine ,business - Published
- 2019
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