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Silva SJD, Rassi S, Pereira ADC. Angiotensin-Converting Enzyme ID Polymorphism in Patients with Heart Failure Secondary to Chagas Disease. Arq Bras Cardiol 2017; 109:307-312. [PMID: 28977050 PMCID: PMC5644210 DOI: 10.5935/abc.20170137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 01/04/2023] Open
Abstract
Background Changes in the angiotensin-converting enzyme (ACE) gene may contribute to the
increase in blood pressure and consequently to the onset of heart failure
(HF). The role of polymorphism is very controversial, and its identification
in patients with HF secondary to Chagas disease in the Brazilian population
is required. Objective To determine ACE polymorphism in patients with HF secondary to Chagas disease
and patients with Chagas disease without systolic dysfunction, and to
evaluate the relationship of the ACE polymorphism with different clinical
variables. Methods This was a comparative clinical study with 193 participants, 103 of them with
HF secondary to Chagas disease and 90 with Chagas disease without systolic
dysfunction. All patients attended the outpatient department of the General
Hospital of the Federal University of Goias general hospital. Alleles I and
D of ACE polymorphism were identified by polymerase chain reaction of the
respective intron 16 fragments in the ACE gene and visualized by
electrophoresis. Results In the group of HF patients, 63% were male, whereas 53.6% of patients with
Chagas disease without systolic dysfunction were female (p = 0,001). The
time from diagnosis varied from 1 to 50 years. Distribution of DD, ID and II
genotypes was similar between the two groups, without statistical
significance (p = 0,692). There was no difference in clinical
characteristics or I/D genotypes between the groups. Age was significantly
different between the groups (p = 0,001), and mean age of patients with HF
was 62.5 years. Conclusion No differences were observed in the distribution of (Insertion/Deletion)
genotype frequencies of ACE polymorphism between the studied groups. The use
of this genetic biomarker was not useful in detecting a possible
relationship between ACE polymorphism and clinical manifestations in HF
secondary to Chagas disease.
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Rassi DDC, Hotta VT, Mota JFS, Dobrianskyj A, Rassi S. Unusual diagnosis of a mass located in the interventricular septum: ectopic thyroid ('Struma cordis'): Struma cordis: an unusual mass in the septum. Eur Heart J Cardiovasc Imaging 2017; 18:717-718. [PMID: 28329168 DOI: 10.1093/ehjci/jex004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Costa SDA, Rassi S, Freitas EMDM, Gutierrez NDS, Boaventura FM, Sampaio LPDC, Silva JBM. Prognostic Factors in Severe Chagasic Heart Failure. Arq Bras Cardiol 2017; 108:246-254. [PMID: 28443956 PMCID: PMC5389874 DOI: 10.5935/abc.20170027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prognostic factors are extensively studied in heart failure; however, their role in severe Chagasic heart failure have not been established. OBJECTIVES To identify the association of clinical and laboratory factors with the prognosis of severe Chagasic heart failure, as well as the association of these factors with mortality and survival in a 7.5-year follow-up. METHODS 60 patients with severe Chagasic heart failure were evaluated regarding the following variables: age, blood pressure, ejection fraction, serum sodium, creatinine, 6-minute walk test, non-sustained ventricular tachycardia, QRS width, indexed left atrial volume, and functional class. RESULTS 53 (88.3%) patients died during follow-up, and 7 (11.7%) remained alive. Cumulative overall survival probability was approximately 11%. Non-sustained ventricular tachycardia (HR = 2.11; 95% CI: 1.04 - 4.31; p<0.05) and indexed left atrial volume ≥ 72 mL/m2 (HR = 3.51; 95% CI: 1.63 - 7.52; p<0.05) were the only variables that remained as independent predictors of mortality. CONCLUSIONS The presence of non-sustained ventricular tachycardia on Holter and indexed left atrial volume > 72 mL/m2 are independent predictors of mortality in severe Chagasic heart failure, with cumulative survival probability of only 11% in 7.5 years.
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Rassi DDC, Vieira MLC, Furtado RG, Turco FDP, Melato LH, Hotta VT, Nunes CGDO, Rassi Jr. L, Rassi S. Dobutamine Stress Echocardiography Safety in Chagas Disease Patients. Arq Bras Cardiol 2017; 108:122-128. [PMID: 28099588 PMCID: PMC5344656 DOI: 10.5935/abc.20170002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/08/2016] [Accepted: 08/31/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. OBJECTIVES: To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. METHODS: Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. RESULTS: Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. CONCLUSION: DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found. FUNDAMENTO: Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas seguro, em pacientes coronarianos não chagásicos. Entretanto, há insegurança na prática clínica de indicá-lo no paciente chagásico, devido ao potencial arritmogênico já intrínseco nesta cardiopatia. OBJETIVOS: Analisar a segurança do EED em uma população de chagásicos com suspeita clínica de coronariopatia. MÉTODOS: Análise retrospectiva de um banco de dados de pacientes encaminhados para a realização do EED entre maio/2012 e fevereiro/2015. Avaliou-se pacientes consecutivos portadores de doença de Chagas e com suspeita de coronariopatia. Confirmou-se a sorologia para doença de Chagas em todos os pacientes. RESULTADOS: A média etária dos 205 pacientes analisados foi de 64 ± 10 anos, sendo a maioria do sexo feminino (65,4%). Nenhum paciente apresentou eventos adversos significativos, como infarto agudo do miocárdio, fibrilação ventricular, assistolia, acidente vascular encefálico, ruptura cardíaca ou morte. Quanto às arritmias, extrassístoles ventriculares frequentes ocorreram em 48% dos pacientes, taquicardia ventricular não sustentada em 7,3%, bigeminismo em 4,4%, taquicardia supraventricular e taquicardia ventricular sustentada em 1% e fibrilação atrial em 0,5%. CONCLUSÃO: O EED mostrou ser um exame seguro nessa população de pacientes chagásicos, onde nenhum desfecho grave foi encontrado.
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Tarasoutchi F, Montera MW, Ramos AIO, Sampaio RO, Rosa VEE, Accorsi TAD, Lopes ASSA, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PL, Bignoto TC, Togna DJD, Mesquita ET, Esteves WAM, Atik FA, Colafranceschi AS, Moisés VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Jr. FS, Clara W, Brandão CMA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MM, Souza Neto JD, Saraiva JFK. ATUALIZAÇÃO DAS DIRETRIZES BRASILEIRAS DE VALVOPATIAS: ABORDAGEM DAS LESÕES ANATOMICAMENTE IMPORTANTES. Arq Bras Cardiol 2017. [DOI: 10.5935/abc.20180007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rassi N, Moraes SMCTD, Alves AG, Cavalheiro DC, Moreira JM, Bellório KB, Abreu FCD, Prata PRM, Teixeira LDS, Rassi S. Comparative study between two recombinant human NPH insulin formulations for the treatment of type 2 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:47-53. [PMID: 26909482 PMCID: PMC10118911 DOI: 10.1590/2359-3997000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the effects of the neutral protamine Hagedorn (NPH) recombinant human insulin formulations Gansulin and Humulin N® on the glycemic control of patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS Prospective, double-blind, randomized, parallel, single-center study of 37 individuals with T2DM treated with NPH insulin formulations. The Tukey-Kramer test for multiple comparisons, the Wilcoxon paired comparison test and the Chi-Square test were used for the statistical analyses. The significance level was set at 5% (p < 0.05). RESULTS The NPH insulin formulations Humulin and Gansulin similarly reduced the HbA1c levels observed at the end of the study compared with the values obtained at the beginning of the study. In the Humulin group, the initial HbA1c value of 7.91% was reduced to 6.56% (p < 0.001), whereas in the Gansulin group, the reduction was from 8.18% to 6.65% (p < 0.001). At the end of the study, there was no significant difference between the levels of glycated hemoglobin (p = 0.2410), fasting plasma glucose (FG; p = 0.9257) and bedtime plasma glucose (BG; p = 0.3906) between the two insulin formulations. There was no nt difference in the number of hypoglycemic events between the two insulin formulations, and no severe hyp episodes were recorded. CONCLUSION This study demonstrated similar glycemic control by NPH insulin Gansulin compared with human insulin Humulin N® in patients with T2DM.
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Furtado RG, Frota DDCR, Silva JBM, Romano MMD, de Almeida OC, Schmidt A, Rassi S. Right ventricular Doppler echocardiographic study of indeterminate form of chagas disease. Arq Bras Cardiol 2015; 104:209-17. [PMID: 25517391 PMCID: PMC4386849 DOI: 10.5935/abc.20140197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/09/2014] [Accepted: 09/16/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with indeterminate form of Chagas disease/cardiac normality (ICD/CN) exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart. OBJECTIVE To assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV) in patients with ICD/CN. METHODS This was a case-control and prevalence study. Using Doppler two-dimensional echocardiography (2D), 92 patients were assessed and divided into two groups: group I (normal, n = 31) and group II (ICD/CN, n = 61). RESULTS The prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%), mobility of the tricuspid annulus (0.0% versus 0.0%), and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016). The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099) and pulsed Doppler (61.3% versus 68%, p = 0.141) and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%), pseudonormal pattern (0.0% versus 0.0%), and restrictive pattern (0.0% versus 0.0%) was not statistically different between groups. CONCLUSION The prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables), suggesting incipient changes in RV systolic function in the ICD/CN group.
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Freitas Jr. AF, Santos RO, Rassi S. Subclinical Ventricular Dysfunction Detected by Speckle-Tracking Two Years after Use of Anthracycline. Arq Bras Cardiol 2015; 105:206. [PMID: 26352183 PMCID: PMC4559134 DOI: 10.5935/abc.20150102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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de Souza ASB, Souza WKSB, Costa SA, Freitas EMDM, Carvalho G, Sá LAB, Rassi S. Incidence of ventricular arrhythmias after stem cell therapy in patients with Chagas cardiomyopathy. Arq Bras Cardiol 2014; 102:489-94. [PMID: 24918914 PMCID: PMC4051452 DOI: 10.5935/abc.20140053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022] Open
Abstract
Background Treatment with stem cells in several cardiomyopathies may be related to the
increase in arrhythmias. Objectives To determine whether intracoronary injection of stem cells in patients with Chagas
cardiomyopathy is associated with increased incidence of ventricular arrhythmias,
compared to the Control Group. Methods A retrospective cohort study that evaluated the medical records of 60 patients who
participated in a previous cross-sectional study. The following data were
collected: age, gender, drugs used and Holter variables that demonstrated the
presence of arrhythmias. Holter was performed in four stages: randomization, 2, 6
and 12 months segments. The Control Group received medical treatment and
intracoronary injection of placebo and the Study Group had drug treatment and
autologous stem cell implant. Results There was no difference between Control Group and Study Group when analyzing the
arrhythmia criteria. In the intra-group analysis, significant difference was found
between the Holter tests of the Study Group for the variable total ventricular
premature beats when compared with baseline, with p = 0.014 between Holter at
randomization and Holter at 2 months, p = 0.004 between Holter at randomization
and Holter at 6 months, and p = 0.014 between Holter at randomization and Holter
at 12 months. The variable non-sustained ventricular tachycardia between Holter at
randomization and Holter at 6 months showed p = 0.036. Conclusion The intracoronary injection of stem cells did not increase the incidence of
ventricular arrhythmias in patients with Chagas cardiomyopathy compared to the
Control Group.
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Noun P, Tarabay A, Aftimos G, Issa I, Korkomaz R, Ghorayeb Z, Rassi S, Fadous Khalifé M. SFCP CO-77 - Augmentation de l’incidence de Ganglioneuroblastome dans les tumeurs de la crête neurale : série de 28 cas. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Freitas AF, Rassi S. Trastuzumab cardiotoxicity in patients with breast cancer. Arq Bras Cardiol 2014; 102:200. [PMID: 24676377 PMCID: PMC3987332 DOI: 10.5935/abc.20140008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/04/2013] [Indexed: 11/20/2022] Open
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Rassi DDC, Vieira MLC, Arruda ALM, Hotta VT, Furtado RG, Rassi DT, Rassi S. Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction. Arq Bras Cardiol 2014; 102:245-52. [PMID: 24553982 PMCID: PMC3987318 DOI: 10.5935/abc.20140003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/16/2013] [Indexed: 01/03/2023] Open
Abstract
Background Echocardiography provides important information on the cardiac evaluation of
patients with heart failure. The identification of echocardiographic parameters in
severe Chagas heart disease would help implement treatment and assess prognosis.
Objective To correlate echocardiographic parameters with the endpoint cardiovascular
mortality in patients with ejection fraction < 35%. Methods Study with retrospective analysis of pre-specified echocardiographic parameters
prospectively collected from 60 patients included in the Multicenter Randomized
Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico
Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The
following parameters were collected: left ventricular systolic and diastolic
diameters and volumes; ejection fraction; left atrial diameter; left atrial
volume; indexed left atrial volume; systolic pulmonary artery pressure; integral
of the aortic flow velocity; myocardial performance index; rate of increase of
left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave
velocities; E wave deceleration time; E/A and E/Em ratios; and mitral
regurgitation. Results In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction
was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction
(HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001)
and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial
volume was an independent predictor in relation to the endpoint, and values >
70.71 mL/m2 were associated with a significant increase in mortality
(log rank p < 0.0001). Conclusion The indexed left atrial volume was the only independent predictor of mortality in
this population of Chagasic patients with severe systolic dysfunction.
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Barros ICM, Freitas EMDM, Rassi S, Carneiro WJ, Rodrigues CR, Honório TCDD, Teixeira LDS, Rodríguez V, Cunha LCD. [Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods]. FARMACIA HOSPITALARIA 2014; 38:38-43. [PMID: 24483858 DOI: 10.7399/fh.2014.38.1.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 06/03/2023] Open
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de Sá LAB, Rassi S, Batista MAL. Is conventional cardiac pacing harmful in patients with normal ventricular function? Arq Bras Cardiol 2013; 101:545-53. [PMID: 24145393 PMCID: PMC4106813 DOI: 10.5935/abc.20130205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Right ventricular pacing may be deleterious in patients with left ventricular dysfunction, but in patients with normal function the impact of this stimulation triggering clinically relevant ventricular dysfunction is not fully established. OBJECTIVES To evaluate the clinical, echocardiographic findings of patients with previously normal left ventricular function underwent implantation of a pacemaker. METHODS Observational, cross-sectional study with 20 patients, who underwent implantation of pacemaker, prospectively followed-up, with the following inclusion criteria: normal left ventricular function defined by echocardiography and ventricular pacing higher than 90%. Were evaluated functional class (FC) (New York Heart Association), 6-minute walk test (6MWT), B-type natriuretic peptide (BNP), echocardiographic assessment (conventional and dyssynchrony parameters), and quality of life questionnaire (QLQ) (SF-36). The assessment was performed at ten days (t1), four months (t2), eight months (t3), 12 months (t4) and 24 months (t5). RESULTS Conventional echocardiographic parameters and dyssynchrony parameters showed statistically significant variation over time. The 6MWT, FC, and BNP showed worsening at the end of two years. QLQ showed initial improvement and worsening at the end of two years. CONCLUSION The implantation of conventional pacemaker was associated with worsening in functional class, worsening in walk test, increased BNP levels, increased duration of QRS, and worsening in some domains of the QLQ at the end of two years. There were no changes in echocardiography measurements (conventional and asynchrony measures).
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Beck-da-Silva L, Piardi D, Soder S, Rohde LE, Pereira-Barretto AC, de Albuquerque D, Bocchi E, Vilas-Boas F, Moura LZ, Montera MW, Rassi S, Clausell N. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol 2013; 168:3439-42. [PMID: 23680589 DOI: 10.1016/j.ijcard.2013.04.181] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 01/31/2013] [Accepted: 04/19/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anemia in heart failure patients and has been associated with increased morbi-mortality. Previous studies have treated anemia in heart failure patients with either erythropoietin alone or combination of erythropoietin and intravenous (i.v.) iron. However, the effect of i.v. or oral (p.o.) iron supplementation alone in heart failure patients with anemia was virtually unknown. AIM To compare, in a double-blind design, the effects of i.v. iron versus p.o. iron in anemic heart failure patients. METHODS IRON-HF study was a multicenter, investigator initiated, randomized, double-blind, placebo controlled trial that enrolled anemic heart failure patients with preserved renal function, low transferrin saturation (TSat) and low-to-moderately elevated ferritin levels. Interventions were Iron Sucrose i.v. 200 mg, once a week, for 5 weeks, ferrous sulfate 200 mg p.o. TID, for 8 weeks, or placebo. Primary endpoint was variation of peak oxygen consumption (peak VO2) assessed by ergospirometry over 3 month follow-up. RESULTS Eighteen patients had full follow-up data. There was an increment of 3.5 ml/kg/min in peak VO2 in the i.v. iron group. There was no increment in peak VO2 in the p.o. iron group. Patients' ferritin and TSat increased significantly in both treated groups. Hemoglobin increased similarly in all groups. CONCLUSION I.v. iron seems to be superior in improving functional capacity of heart failure patients. However, correction of anemia seems to be at least similar between p.o. iron and i.v. iron supplementation.
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Carvalho APPF, Rassi S, Fontana KE, Correa KDS, Feitosa RHF. Influence of creatine supplementation on the functional capacity of patients with heart failure. Arq Bras Cardiol 2012; 99:623-9. [PMID: 22735863 DOI: 10.1590/s0066-782x2012005000056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 02/16/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a complex syndrome characterized by intolerance to exertion and reduced functional capacity. OBJECTIVE To assess the functional capacity of patients with HF and supplemented with creatine. METHODS Prospective, randomized, double-blind study. Thirty-three male patients over the age of 18 years with functional class II to IV HF were randomized into two groups as follows: the experimental group (CRE, n = 17), supplemented with 5 g/day of creatine for six months; and the placebo group (PLA, n = 16), receiving 5 g/day of maltodextrin for that same period. Both groups underwent functional capacity assessment by use of cardiopulmonary exercise test and 6-minute walk test (6MWT) before and after the intervention. The Ancova statistical model and Pearson correlation were used to assess the groups and the treatment. RESULTS Of the variables assessed on the cardiopulmonary exercise test, peak oxygen consumption (peak VO₂), anaerobic threshold (AT), and oxygen pulse (O₂ pulse) showed no significant differences between the groups (P>0.05). On the 6MWT, no significant difference was observed in the covered distance. CONCLUSION Creatine supplementation in patients with HF did not significantly improve functional capacity.
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Ribeiro Dos Santos R, Rassi S, Feitosa G, Grecco OT, Rassi A, da Cunha AB, de Carvalho VB, Guarita-Souza LC, de Oliveira W, Tura BR, Soares MBP, Campos de Carvalho AC. Cell therapy in Chagas cardiomyopathy (Chagas arm of the multicenter randomized trial of cell therapy in cardiopathies study): a multicenter randomized trial. Circulation 2012; 125:2454-61. [PMID: 22523306 DOI: 10.1161/circulationaha.111.067785] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies suggested that transplantation of autologous bone marrow-derived mononuclear cells (BMNCs) improves heart function in chronic chagasic cardiomyopathy. We report the results of the first randomized trial of BMNC therapy in chronic chagasic cardiomyopathy. METHODS AND RESULTS Patients 18 to 75 years of age with chronic chagasic cardiomyopathy, New York Heart Association class II to IV heart failure, left ventricular ejection fraction (LVEF) <35, and optimized therapy were randomized to intracoronary injection of autologous BMNCs or placebo. The primary end point was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5. Between July 2005 and October 2009, 234 patients were enrolled. Two patients abandoned the study and 49 were excluded because of protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had a trimmed mean age of 52.4 years (range, 50.8-54.0 years) and LVEF of 26.1 (range, 25.1-27.1) at baseline. Median number of injected BMNCs was 2.20×10(8) (range, 1.40-3.50×10(8)). Change in LVEF did not differ significantly between treatment groups: trimmed mean change in LVEF at 6 months, 3.0 (1.3-4.8) for BMNCs and 2.5 (0.6-4.5) for placebo (P=0.519); change in LVEF at 12 months, 3.5 (1.5-5.5) for BMNCs and 3.7 (1.5-6.0) for placebo (P=0.850). Left ventricular systolic and diastolic volumes, New York Heart Association functional class, Minnesota quality-of-life questionnaire, brain natriuretic peptide concentrations, and 6-minute walking test did also not differ between groups. CONCLUSION Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with chronic chagasic cardiomyopathy.
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Carvalho G, Rassi S, Bastos JMDDA, Câmara SSP. Asymptomatic coronary artery disease in chagasic patients with heart failure: prevalence and risk factors . Arq Bras Cardiol 2011; 97:408-12. [PMID: 22011801 DOI: 10.1590/s0066-782x2011005000103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 06/01/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concomitant asymptomatic coronary artery disease in patients with Chagas cardiomyopathy in heart failure is controversial in the medical literature, as both diseases are prevalent in some regions of Brazil. OBJECTIVE To determine the prevalence of coronary artery disease (lesions > 50%) in a specific population of patients with Chagas cardiomyopathy in HF functional class III and IV, who had no previous coronary events. METHODS Coronary angiography was performed in 61 consecutive patients with Chagasic cardiomyopathy, in heart failure functional class III and IV, to exclude coronary artery disease. These patients were part of the Cell Therapy Study in Heart Diseases protocol, which required the coronary angiography to be carried out before stem cells were injected. Risk factors for atherosclerosis also analyzed in this population were: age, arterial hypertension, diabetes, dyslipidemia, smoking and overweight. RESULTS mean age was 51.6 + 9.6 years and 65.5% (n = 40) of them were males. The prevalence of coronary disease in this population was 1.6% (1). The prevalence of risk factors were: arterial hypertension 18% (11), smoking 59% (36), diabetes 1.6% (1) and dyslipidemia, 6.5% (4). CONCLUSION The prevalence of asymptomatic coronary artery disease in patients with severe heart failure due to Chagas disease is low and among the risk factors for coronary heart disease, smoking was the most prevalent.
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Rizk H, Rassi S. Foreign body inhalation in the pediatric population: lessons learned from 106 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:169-74. [PMID: 21474416 DOI: 10.1016/j.anorl.2011.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis. PATIENTS AND METHODS Retrospective study of 106 children under the age of 15 years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA). RESULTS Among the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24 hours and 49% were seen later than 72 hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24 hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold. CONCLUSION FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology.
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Nogueira PR, Rassi S, Corrêa KDS. Epidemiological, clinical e therapeutic profile of heart failure in a tertiary hospital. Arq Bras Cardiol 2010; 95:392-8. [PMID: 20949226 DOI: 10.1590/s0066-782x2010005000102] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 10/27/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart failure is a complex syndrome with multiple risk factors involved in its genesis, making its prevention and management difficult to achieve. OBJECTIVE To identify the main etiologies and risk factors in heart failure; to compare clinical and demographic characteristics of patients according to the etiology; analyze whether the treatment is according to that recommended by the Brazilian guidelines. METHODS Retrospective, descriptive and observational study, carried out at Hospital das Clínicas of Universidade Federal de Goiás. The patients were divided in four groups, according to the etiology, for comparison: chagasic cardiomyopathy, hypertensive cardiomyopathy, dilated cardiomyopathy and others, ischemic cardiomyopathy. The Chi-square and Fisher's Exact tests, ANOVA and Kruskal-Wallis tests were used in the analysis of the groups and types of treatment. RESULTS A total of 144 patients' files were analyzed; the patients' mean age was 61 ± 15 years and 54.2% of them were males. Chagasic cardiomyopathy was the main etiology (41%). Arterial hypertension (48.6%), anemia (22.9%), coronary disease (19.4%), dyslipidemia (17.3%) and diabetes (16.6%) were the main risk factors. There was a higher prevalence of female individuals among the hypertensive patients (p=0.044) as well as a higher frequency of pulmonary rales (p < 0.01). Heart rate was lower among chagasic patients (p < 0.001). The most often prescribed medications were diuretics (81.2%), angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (77.7%), beta-blockers (45.8%), spironolactone (35.4%), digitalis (30.5%) and vasodilators (8.3%). CONCLUSION Chagasic cardiomyopathy was the main cause of heart failure. No significant clinical differences were observed among patients from the four etiologic groups.
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Sá LABD, Rassi S, Batista MAL. Efeitos da estimulação ventricular convencional em pacientes com função ventricular normal. Arq Bras Cardiol 2009; 93:167-73. [DOI: 10.1590/s0066-782x2009000800016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 10/24/2008] [Indexed: 11/22/2022] Open
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Assis TR, Viana FP, Rassi S. Study on the major maternal risk factors in hypertensive syndromes. Arq Bras Cardiol 2009; 91:11-7. [PMID: 18660939 DOI: 10.1590/s0066-782x2008001300002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 01/15/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are several risk factors for hypertensive syndromes in pregnancy (HSP), and these can be related to regional and ethnic factors. Studies on this issue are scarce in the State of Goiás. OBJECTIVE To investigate maternal risk factors for HSP. METHODS Case-control study based on the analysis of medical records of parturients from the Maternity Service of Hospital das Clínicas da Universidade Federal de Goiás (HC-UFG) in 2005. Risk factors were analyzed using Logistic Regression Analysis and Fisher's Exact Test. RESULTS In 2005, there were 890 deliveries in the Maternity Service of HC-UFG, and 129 pregnant women were diagnosed with HSP (14.5%). The multivariate analysis identified obesity as a risk factor both for gestational hypertension--GH (OR: 17.636; 95% CI: 2.859 to 108.774) and for preeclampsia superimposed on chronic hypertension--PESCH (OR: 27.307; 95% CI: 4.453 to 167.440). Primiparity was a risk factor for GH (OR: 5.435; 95% CI: 1.923 to 15.385). Age above 30 years was a risk factor for PESCH (OR: 5.218; 95% CI: 1.873 to 14.536) and a protective factor against preeclampsia--PE (OR: 0.035; 95% CI: 0.003 to 0.364). Non-white race was an independent risk for PE (OR: 13.158; 95% CI: 1.672 to 100.000) and previous PE for PESCH (OR: 4.757; 95% CI: 1.261 to 17.938). Of the pregnant women with chronic hypertension (CH), 73.5% developed PESCH (p < 0.001). CONCLUSION The factors identified--obesity, non-white race, previous PE, age above 30 years and CH, were similar to those found in the majority of studies in the literature.
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Bocchi EA, Vilas-Boas F, Moreira MDC, Barretto ACP, Lage S, Albuquerque D, Baima J, Rassi S, Ribeiro JP. Levosimendan in decompensated heart failure patients: efficacy in a Brazilian cohort. Results of the BELIEF study. Arq Bras Cardiol 2009; 90:182-90. [PMID: 18392398 DOI: 10.1590/s0066-782x2008000300008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 11/29/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Levosimendan is a new inodilatory agent that enhances cardiac contractility via Ca(2+) sensitization and induces vasodilation through the activation of KATP/BKCa. OBJECTIVE To study the efficacy and safety of levosimendan in a decompensated heart failure (DHF) Brazilian cohort, and in b-adrenergic agonist resistant patients. METHODS The Brazilian Evaluation of Levosimendan Infusion Efficacy (BELIEF) study was prospective, multicenter, observational and included 182 high-risk DHF patients, all of which received open-label levosimendan. Primary end point was hospital discharge without additional inotropic therapy (responder). Secondary end points were changes in hemodynamics, clinical parameters, and brain natriuretic peptide (BNP). RESULTS Mortality rate was 14.8%, and 139 of 182 patients were responders. In non responders it was 62.8%. Systolic blood pressure was a predictor of response. In b-adrenergic agonist resistant group, 55.8% were responders. Overall, 54 patients experienced at least one adverse event; most of them resolved either spontaneously or after levosimendan dose reduction. A significant improvement in quality of life was verified at 2-6 months of follow-up (p<0.0001). CONCLUSION Our results suggest levosimendan infusion as an alternative therapy in the short term management of DHF patients. HF severity can influence the response to levosimendan treatment. Prospective studies are warranted in a Brazilian cohort including Chagas heart disease.
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Bocchi EA, Braga FGM, Ferreira SMA, Rohde LEP, Oliveira WAD, Almeida DRD, Moreira MDCV, Bestetti RB, Bordignon S, Azevedo C, Tinoco EM, Rocha RM, Issa VS, Ferraz A, Cruz FDD, Guimarães GV, Montera VDSP, Albuquerque DC, Bacal F, Souza GEC, Rossi Neto JM, Clausell NO, Martins SM, Siciliano A, Souza Neto JDD, Moreira LF, Teixeira RA, Moura LZ, Beck-da-Silva L, Rassi S, Azeka E, Horowitz E, Ramires F, Simões MV, Castro RBPD, Salemi VMC, Villacorta Junior H, Vila JH, Simões R, Albanesi F, Montera MW. [III Brazilian Guidelines on Chronic Heart Failure]. Arq Bras Cardiol 2009; 93:3-70. [PMID: 20963312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Beck-da-Silva L, Rohde LE, Pereira-Barretto AC, de Albuquerque D, Bocchi E, Vilas-Boas F, Moura LZ, Montera MW, Rassi S, Clausell N. Rationale and Design of the IRON-HF Study: A Randomized Trial to Assess the Effects of Iron Supplementation in Heart Failure Patients With Anemia. J Card Fail 2007; 13:14-7. [PMID: 17338998 DOI: 10.1016/j.cardfail.2006.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 09/01/2006] [Accepted: 09/28/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anemia is a common finding in heart failure (HF) patients and has been associated with increased morbidity and mortality. It is generally denominated as anemia of chronic disease (ACD), but the association with true ferropenic anemia is common. Many studies have investigated the effects of treating anemia in HF patients with either erythropoietin alone or combination of erythropoietin and intravenous iron. However, the effect of iron supplementation alone in HF patients with ACD, ferropenic anemia, or both is unknown. METHODS AND RESULTS IRON-HF study is a multicenter, investigator initiated, randomized, double-blind, placebo controlled trial that will enroll anemic HF patients with relatively preserved renal function, low transferrin saturation, low iron levels, and low to moderately elevated ferritin levels. Interventions are iron sucrose intravenously 200 mg once per week for 5 weeks, ferrous sulfate 200 mg by mouth 3 times per day for 8 weeks, or placebo. The primary objective is to assess the impact of iron supplementation (intravenously or by mouth) compared with placebo in HF patients with anemia from deficient iron availability. The primary end point is variation of peak oxygen consumption assessed by ergospirometry over 3-month follow-up. Secondary end points include functional class, brain natriuretic peptide levels, quality of life scores, left ventricular ejection fraction, adverse events, HF hospitalization, and death. CONCLUSIONS The results of IRON-HF should help to clarify the potential clinical impact of mild to moderate anemia correction in HF patients.
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