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Roman-Campos D, Marin-Neto JA, Santos-Miranda A, Kong N, D’Avila A, Rassi A. Arrhythmogenic Manifestations of Chagas Disease: Perspectives From the Bench to Bedside. Circ Res 2024; 134:1379-1397. [PMID: 38723031 PMCID: PMC11081486 DOI: 10.1161/circresaha.124.324507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Chagas cardiomyopathy caused by infection with the intracellular parasite Trypanosoma cruzi is the most common and severe expression of human Chagas disease. Heart failure, systemic and pulmonary thromboembolism, arrhythmia, and sudden cardiac death are the principal clinical manifestations of Chagas cardiomyopathy. Ventricular arrhythmias contribute significantly to morbidity and mortality and are the major cause of sudden cardiac death. Significant gaps still exist in the understanding of the pathogenesis mechanisms underlying the arrhythmogenic manifestations of Chagas cardiomyopathy. This article will review the data from experimental studies and translate those findings to draw hypotheses about clinical observations. Human- and animal-based studies at molecular, cellular, tissue, and organ levels suggest 5 main pillars of remodeling caused by the interaction of host and parasite: immunologic, electrical, autonomic, microvascular, and contractile. Integrating these 5 remodeling processes will bring insights into the current knowledge in the field, highlighting some key features for future management of this arrhythmogenic disease.
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Affiliation(s)
- Danilo Roman-Campos
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
| | - José Antonio Marin-Neto
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
| | - Artur Santos-Miranda
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
| | - Nathan Kong
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
| | - André D’Avila
- Departamento de Biofísica, Escola Paulsita de Medicina, Laboratório de Cardiobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil (D.R-C)
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil (J.A.M-N.)
- Departamento de Fisiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil (A.S.-M)
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, GO, Brazil (A.R.J.)
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Gadioli LP, Schmidt A, Maciel BC, Volpe GJ, Simões MV, Marin-Neto JA. Chagas Cardiomyopathy and Myocardial Sympathetic Denervation. Curr Cardiol Rep 2024:10.1007/s11886-024-02057-y. [PMID: 38656586 DOI: 10.1007/s11886-024-02057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic control of the heart in triggering malignant arrhythmia before the appearance of contractile ventricular impairment was reviewed. RECENT FINDINGS Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, 123I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedito Carlos Maciel
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
- Interventional Cardiology Unit, Division of Cardiology, Medical School of Ribeirao Preto, University of Sao Paulo, Campus Universitário, Bairro Monte Alegre, S/N-Ribeirão Preto, Estado de São Paulo, CEP, 14048-900, Brazil.
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3
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, Filho ACLB, Filho AP, Pintya AO, de Figueiredo AB, Simões MV. Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas' cardiomyopathy. J Nucl Cardiol 2022; 29:3166-3176. [PMID: 34981413 DOI: 10.1007/s12350-021-02869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/20/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC. METHODS 18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities. RESULTS In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001). CONCLUSION Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos Henrique Miranda
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Antonio Pazin Filho
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Osvaldo Pintya
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Moreira HT, Volpe GJ, Mesquita GM, Braggion-Santos MF, Pazin-Filho A, Marin-Neto JA, Schmidt A. Association of left ventricular abnormalities with incident cerebrovascular events and sources of thromboembolism in patients with chronic Chagas cardiomyopathy. J Cardiovasc Magn Reson 2022; 24:52. [PMID: 36329520 PMCID: PMC9632087 DOI: 10.1186/s12968-022-00885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although Chagas cardiomyopathy is related to thromboembolic stroke, data on risk factors for cerebrovascular events in Chagas disease is limited. Thus, we assessed the relationship between left ventricular (LV) impairment and cerebrovascular events and sources of thromboembolism in patients with Chagas cardiomyopathy. METHODS This retrospective cohort included patients with chronic Chagas cardiomyopathy who underwent cardiovascular magnetic resonance (CMR). CMR was performed with a 1.5 T scanner to provide LV volumes, mass, ejection fraction (LVEF), and myocardial fibrosis. The primary outcome was a composite of incident ischemic cerebrovascular events (stroke or transient ischemic attack-TIA) and potential thromboembolic sources (atrial fibrillation (AF), atrial flutter, or intracavitary thrombus) during the follow-up. RESULTS A total of 113 patients were included. Median age was 56 years (IQR: 45-67), and 58 (51%) were women. The median LVEF was 53% (IQR: 41-62). LV aneurysms and LV fibrosis were present in 38 (34%) and 76 (67%) individuals, respectively. The median follow-up time was 6.9 years, with 29 events: 11 cerebrovascular events, 16 had AF or atrial flutter, and two had LV apical thrombosis. In the multivariable model, only lower LVEF remained significantly associated with the outcomes (HR: 0.96, 95% CI: 0.93-0.99). Patients with reduced LVEF lower than 40% had a much higher risk of cerebrovascular events and thromboembolic sources (HR: 3.16 95% CI: 1.38-7.25) than those with normal LVEF. The combined incidence rate of the combined events in chronic Chagas cardiomyopathy patients with reduced LVEF was 13.9 new cases per 100 persons-year. CONCLUSIONS LV systolic dysfunction is an independent predictor of adverse cerebrovascular events and potential sources of thromboembolism in patients with chronic Chagas cardiomyopathy.
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Affiliation(s)
- Henrique Turin Moreira
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Gustavo Marques Mesquita
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Maria Fernanda Braggion-Santos
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - Antonio Pazin-Filho
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
| | - André Schmidt
- Division of Cardiology, Department of Internal Medicine, Ribeirão Preto Medical School, Hospital das Clínicas de Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP 14048-900 Brazil
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Tanaka DM, Fabricio CG, Marin-Neto JA, Barros-Filho ACL, Lopes CD, Oliveira LFL, Mejia J, Almeida RR, Batah SS, Nekolla SG, Higuchi ML, Cunha-Neto E, Fabro AT, Romano MM, Simoes MV. Endothelial inflammatory activation is related to myocardial perfusion disturbance in experimental chronic Chagas disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Microvascular myocardial perfusion defect (MPD) is frequent in chronic Chagas cardiomyopathy (CCC) and may be involved in the pathophysiologic process that leads to left ventricular systolic dysfunction (LVSD). However, there is scarcity of studies addressing the histopathological meaning of MPD in CCC and its correlation with endothelial activation.
Purpose
To investigate the correlations between MPD detected in vivo with functional and histopathological changes in the experimental model of CCC in hamsters.
Methods
24 female Sirius hamsters were investigated 8-months after intraperitoneal infection with 3.5x104 trypomastigote forms of Y-strain of T. cruzi. All animals were submitted to rest high-resolution 99mTc-Sestamibi-SPECT myocardial perfusion scintigraphy and echocardiography in vivo. The area of MPD was assessed through the calculation of polar maps by using a dedicated software (MunichHeart®) and a 13-segments model of LV. After euthanasia, we performed a histopathological study of cardiac inflammation and fibrosis and mRNA expression for TNF-α and ICAM, for assessment of inflammation and endothelial activation, respectively.
Results
Most of the animals presented MPD, n=17 (71%), its extension ranging from 1.4 to 30.3% of LV surface. We observed lower values of LVEF in animals with MPD (38.5±11.2%) when compared with animals without MPD 48.4±9.1%, p=0.04) and a trend to higher intensity of myocardial inflammation (estimated by the number of mononuclear cells) in animals with MPD (540.4±153.6 cell/mm2) vs. without MPD (409.6±130.3 cell/mm2), p=0.09. In addition, animals with MPD presented a higher ICAM (0.02±0.01) expression when compared with animals without MPD (0.01±0.01, p=0.02). There was no difference between groups regarding the extent of fibrosis. The results of the regression and correlation analysis showed that individual values of MPD area presented negative correlation with LVEF (R=−0.6, p=0.001), with echocardiographic wall motion score index (WMSi, R=0.5, p=0.007), and with the number of mononuclear cells (R=0.5, p=0.01). Moreover, an analysis based on myocardial segments (n=312), showed that segments with MPD (n=54) in comparison to those without MPD (n=258) presented higher number of mononuclear cells (608±299.9 cell/mm2 and 478.3±201.1 cell/mm, respectively, p<0.0001) and higher WMSi (1.8±0.9 and 1.2±0.4, respectively, p<0.0001.
Conclusions
MPD is a common finding in experimental model of CCC in hamsters and is correlated with inflammation, endothelial inflammatory activation, and systolic ventricular dysfunction. These results suggest that perfusion defects may be an in vivo surrogate marker for inflammation with potential translational implication for monitoring disease activity.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo
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Affiliation(s)
- D M Tanaka
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - C G Fabricio
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - J A Marin-Neto
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | | | - C D Lopes
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - L F L Oliveira
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - J Mejia
- Hospital Israelita Albert Einstein , Sao Paulo , Brazil
| | - R R Almeida
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - S S Batah
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - S G Nekolla
- Technical University of Munich, Department of Nuclear Medicine , Munich , Germany
| | - M L Higuchi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - E Cunha-Neto
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A T Fabro
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - M M Romano
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
| | - M V Simoes
- Medical School of Ribeirao Preto , Ribeirao Preto , Brazil
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7
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Brochet P, Ianni BM, Laugier L, Frade AF, Silva Nunes JP, Teixeira PC, Mady C, Ferreira LRP, Ferré Q, Santos RHB, Kuramoto A, Cabantous S, Steffen S, Stolf AN, Pomerantzeff P, Fiorelli AI, Bocchi EA, Pissetti CW, Saba B, Cândido DDS, Dias FC, Sampaio MF, Gaiotto FA, Marin-Neto JA, Fragata A, Zaniratto RCF, Siqueira S, Peixoto GDL, Rigaud VOC, Bacal F, Buck P, Almeida RR, Lin-Wang HT, Schmidt A, Martinelli M, Hirata MH, Donadi EA, Costa Pereira A, Rodrigues Junior V, Puthier D, Kalil J, Spinelli L, Cunha-Neto E, Chevillard C. Epigenetic regulation of transcription factor binding motifs promotes Th1 response in Chagas disease cardiomyopathy. Front Immunol 2022; 13:958200. [PMID: 36072583 PMCID: PMC9441916 DOI: 10.3389/fimmu.2022.958200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023] Open
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is an endemic parasitic disease of Latin America, affecting 7 million people. Although most patients are asymptomatic, 30% develop complications, including the often-fatal Chronic Chagasic Cardiomyopathy (CCC). Although previous studies have demonstrated some genetic deregulations associated with CCCs, the causes of their deregulations remain poorly described. Based on bulk RNA-seq and whole genome DNA methylation data, we investigated the genetic and epigenetic deregulations present in the moderate and severe stages of CCC. Analysis of heart tissue gene expression profile allowed us to identify 1407 differentially expressed transcripts (DEGs) specific from CCC patients. A tissue DNA methylation analysis done on the same tissue has permitted the identification of 92 regulatory Differentially Methylated Regions (DMR) localized in the promoter of DEGs. An in-depth study of the transcription factors binding sites (TFBS) in the DMRs corroborated the importance of TFBS’s DNA methylation for gene expression in CCC myocardium. TBX21, RUNX3 and EBF1 are the transcription factors whose binding motif appears to be affected by DNA methylation in the largest number of genes. By combining both transcriptomic and methylomic analysis on heart tissue, and methylomic analysis on blood, 4 biological processes affected by severe CCC have been identified, including immune response, ion transport, cardiac muscle processes and nervous system. An additional study on blood methylation of moderate CCC samples put forward the importance of ion transport and nervous system in the development of the disease.
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Affiliation(s)
- Pauline Brochet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Barbara Maria Ianni
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Laurie Laugier
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Amanda Farage Frade
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - João Paulo Silva Nunes
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Priscila Camillo Teixeira
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Charles Mady
- Myocardiopathies and Aortic Diseases Unit, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- RNA Systems Biology Laboratory (RSBL), Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Quentin Ferré
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Ronaldo Honorato Barros Santos
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sandrine Cabantous
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Samuel Steffen
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Antonio Noedir Stolf
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Pablo Pomerantzeff
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alfredo Inacio Fiorelli
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Darlan da Silva Cândido
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Fabrício C. Dias
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Ferraz Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Fabio Antônio Gaiotto
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Ricardo Costa Fernandes Zaniratto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sergio Siqueira
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giselle De Lima Peixoto
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vagner Oliveira-Carvalho Rigaud
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Heart Failure Unit, Heart Institute Instituto do Coração (InCor) School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando Bacal
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Martino Martinelli
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Eduardo Antonio Donadi
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Denis Puthier
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Lionel Spinelli
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Aix Marseille Université, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
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Braggion-Santos MF, Moreira HT, Volpe GJ, Koenigkam-Santos M, Marin-Neto JA, Schmidt A. Electrocardiogram abnormalities in chronic Chagas cardiomyopathy correlate with scar mass and left ventricular dysfunction as assessed by cardiac magnetic resonance imaging. J Electrocardiol 2022; 72:66-71. [PMID: 35344746 DOI: 10.1016/j.jelectrocard.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
Electrocardiographic (ECG) abnormalities are frequently identified in Chronic Chagas cardiomyopathy (CCC) patients and advanced abnormalities are related to a worse prognosis. Cardiac Magnetic Resonance (CMR) can precisely assess ventricular systolic dysfunction and quantify myocardial fibrosis (MF), both identified as prognostic factors. We sought to investigate if ECG abnormalities in CCC patients were associated with more severe myocardial involvement as evaluated by CMR. METHODS CCC patients with 12‑lead ECG and CMR closely obtained were included. ECG analysis evaluated rhythm, presence, and type of intraventricular conduction disturbances (IVCD) and, ventricular premature beats (VPB). CMR short-axis cine and late gadolinium enhancement images were evaluated to obtain left and right ventricular ejection fractions and MF mass, respectively. Statistical significance was set in 5%. RESULTS 194 CCC patients (98 women, 56 ± 14 years) were evaluated, and no IVCD was detected in 71. The most common IVCD was the association of right bundle branch block and left anterior fascicular block (RBBB+LAFB) in 58 patients, followed by isolated RBBB in 34, isolated LAFB in 17, and left bundle branch block (LBBB) in 14 patients. Of patients with no IVCD, 63% had MF and the burden of fibrosis (no IVCD - 7.4 ± 8.6%; RBBB - 6.6 ± 6.5%; p = 1.00), as well as left ventricular ejection fraction (LVEF) (no IVCD - 52 ± 14%; RBBB - 55 ± 10%; p = 1.00) were similar to patients with isolated RBBB. Left conduction system impairment was associated with lower LVEF (LAFB - 39 ± 15%; RBBB+LAFB- 41 ± 15%; and LBBB - 35 ± 15%; p < 0.001) and more MF (RBBB+LAFB - 12.2 ± 10.4%; LBBB - 10.6 ± 7.5%; and LAFB - 12.0 ± 7.0%; p < 0.001). The univariable model showed that the presence of MF was related to RBBB+LAFB (OR 5.0; p = 0.001) and VPB (OR 6.3; p = 0.014). After adjustment for age, gender, and different risk factors in a multivariable model, the same findings were still significantly related to CMR myocardial fibrosis (RBBB+LAFB OR 5.0; p = 0.002 / VPB OR 6.9; p = 0.015). CONCLUSIONS ECG without IVCD does not exclude serious cardiac abnormalities in CCC, and isolated RBBB seems to have a benign course. The presence of VPB and left branch conduction impairment, especially LAFB associated with RBBB, indicate a more severe cardiac involvement.
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Affiliation(s)
- Maria Fernanda Braggion-Santos
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Henrique T Moreira
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Gustavo J Volpe
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Marcel Koenigkam-Santos
- Department of Radiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - André Schmidt
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil.
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9
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Marin-Neto JA, Rassi Jr A. The challenge of risk assessment in the riddle of Chagas heart disease. Mem Inst Oswaldo Cruz 2022; 117:e210172chgsb. [PMID: 35674530 PMCID: PMC9172882 DOI: 10.1590/0074-02760210172chgsb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Anis Rassi Jr
- Diretor Científico do Hospital do Coração Anis Rassi, Brasil
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10
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Silva L, Moreira HT, Oliveira MM, Cintra LSS, Schmidt A, Salgado HC, Fazan Jr R, Tinos R, Rassi Jr A, Marin-Neto JA. Heart rate variability as a biomarker in chronic chagas cardiomyopathy patients with or without concomitant digestive involvement, for prediction of rassi score risk classes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The pathogenesis of Chronic Chagas Cardiomyopathy (CCC) is not yet fully elucidated. However, dysautonomia is one of the factors involved, in addition to being the essential mechanism in the pathogenesis of the Digestive Form of Chagas Disease (DFCD). The prognostic value of dysautonomia remains speculative, and there are no correlative studies of dysautonomia in CCC and DFCD.
Purpose
This study has three aims: a) to investigate in patients with CCC the relationship between cardiac dysautonomia, indirectly studied by heart rate variability (HRV), and the prognostic stratification assessed by the Rassi score; b) to compare the HRV in groups with isolated CCC and with the mixed form, i.e. CCC associated with DFCD; c) to evaluate the power of combining HRV indices to predict the risk class of each patient, using machine learning.
Methods
Thirty-one patients with CCC were classified into three risk groups (low, intermediate and high) according to their Rassi score and had two electrocardiograms (ECG) recorded, i.e. the conventional 12-lead and a single lead, the latter for a period of 10 to 20 minutes. From the single lead ECG, two equally sized RR series were generated and 31 HRV indices were calculated from each. The HRV was then compared between the three risk groups and also regarding the presence or not of concomitant digestive impairment. Taking HRV indices as inputs, four machine learning models were compared in its ability to predict the risk class of each patient. A previous step of attribute selection (sequential feature selection) was applied to identify the most relevant HRV indices for each algorithm.
Results
Comparing the HRV indices in the three risk groups obtained with the Rassi score, the phase entropy is decreased [0.91 (0.90, 0.91) vs 0.87 (0.86, 0.89); p=0.039] and the percentage of inflection points is increased [66.4 (63.5, 71.2) vs 58.2 (53.4, 63.3); p=0.032] in patients in the high-risk group, compared to the low-risk group. Of the 31 patients with CCC, 14 had the mixed form of the disease, i.e. with associated digestive impairment. In the latter, the triangular interpolation of the RR interval histogram decreased significantly [78.1 (62.5, 101.6) vs 121.1 (80.1, 146.5), p=0.046], while the absolute power in the low-frequency band decreased with strong trend to statistical significance [28.5 (17.1, 97.5) vs 86.9 (44.1, 171.7), p=0.06]. The best predictive model for each risk group was obtained with the Support Vector Machine, reaching an overall F1-score of 0.61.
Conclusions
The worst prognosis, indicated by the Rassi score, is associated with increased heart rate fragmentation. The combination of HRV indices enhanced the accuracy of the risk stratification. Compared to CCC the mixed form of Chagas' disease displays a decrease in the components of slow heart rate oscillation, suggesting a higher degree of sympathetic autonomic denervation associated with parasympathetic impairment.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): São Paulo Research Foundation (FAPESP)
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Affiliation(s)
- L Silva
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - H T Moreira
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - M M Oliveira
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - L S S Cintra
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - A Schmidt
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - H C Salgado
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - R Fazan Jr
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - R Tinos
- Ribeirão Preto School of Philosophy, Science and Literature, Ribeirão Preto, Brazil
| | | | - J A Marin-Neto
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
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11
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da Silva Etges APB, Cruz LN, Schlatter R, Neyeloff J, Cardoso RB, Kopittke L, Nunes AA, Neto JA, Nogueira JL, de Assis RM, Tobias JSP, Marin-Neto JA, Moreira LB, Polanczyk CA. Time-driven activity-based costing as a strategy to increase efficiency: An analyses of interventional coronary procedures. Int J Health Plann Manage 2021; 37:189-201. [PMID: 34505319 DOI: 10.1002/hpm.3320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/07/2022] Open
Abstract
Monitoring the costs is one of the key components underlying value-based health care. This study aimed to evaluate the cost-saving opportunities of interventional coronary procedures (ICPs). Data from 90 patients submitted to elective ICP were evaluated in five Brazilian hospitals. Time-driven activity-based costing, that guides the cost estimates using the time consumed and the capacity cost rates per resource as the data input, was used to assess costs and the time spent over the care pathway. Descriptive cost analyses were followed by a labour cost-saving estimate potentially achieved by the redesign of the ICP pathway. The mean cost per patient varied from $807 to $2639. The length of the procedure phase per patient was similar among the hospitals, while the post-procedure phase presented the highest variation in length. The highest direct cost saving opportunities are concentrated in the procedure phase. By comparing the benchmark service with the most expensive one, it was estimated that redesigning physician practices could decrease 51% of the procedure cost. This application is pioneered in Brazil and demonstrates how detailed cost information can contribute to driving health care management to value by identifying cost-saving opportunities.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- The TDABC in Healthcare Consortium, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Nascimento Cruz
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rosane Schlatter
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jeruza Neyeloff
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Bertoglio Cardoso
- Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- The TDABC in Healthcare Consortium, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Kopittke
- Grupo Hospitalar Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - José Alburquerque Neto
- Hospital Universitário Presidente Dutra da Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - José Luiz Nogueira
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renata Melo de Assis
- Hospital Universitário Presidente Dutra da Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | - José Antonio Marin-Neto
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | | | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- The TDABC in Healthcare Consortium, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-graduação em Cardiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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12
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Simões MV, Tanaka DM, Marin-Neto JA. Nuclear Medicine Methods for Assessment of Chronic Chagas Heart Disease. International Journal of Cardiovascular Sciences 2020. [DOI: 10.36660/ijcs.20200153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Farage Frade-Barros A, Ianni BM, Cabantous S, Pissetti CW, Saba B, Lin-Wang HT, Buck P, Marin-Neto JA, Schmidt A, Dias F, Hirata MH, Sampaio M, Fragata A, Pereira AC, Donadi E, Rodrigues V, Kalil J, Chevillard C, Cunha-Neto E. Corrigendum: Polymorphisms in Genes Affecting Interferon-γ Production and Th1 T Cell Differentiation Are Associated With Progression to Chagas Disease Cardiomyopathy. Front Immunol 2020; 11:593759. [PMID: 33013939 PMCID: PMC7511765 DOI: 10.3389/fimmu.2020.593759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Amanda Farage Frade-Barros
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Aix-Marseille Université, INSERM, GIMP UMR_S906, Marseille, France.,Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.,Bioengineering Program, Instituto Tecnológico, Universidade Brasil, São Paulo, Brazil
| | - Barbara Maria Ianni
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | | | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Marcelo Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Bioengineering Program, Instituto Tecnológico, Universidade Brasil, São Paulo, Brazil
| | - Christophe Chevillard
- Aix Marseille Université, INSERM, TAGC Theories and Approaches of Genomic Complexity, UMR_1090, Marseille, France
| | - Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil
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14
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Frade-Barros AF, Ianni BM, Cabantous S, Pissetti CW, Saba B, Lin-Wang HT, Buck P, Marin-Neto JA, Schmidt A, Dias F, Hirata MH, Sampaio M, Fragata A, Pereira AC, Donadi E, Rodrigues V, Kalil J, Chevillard C, Cunha-Neto E. Polymorphisms in Genes Affecting Interferon-γ Production and Th1 T Cell Differentiation Are Associated With Progression to Chagas Disease Cardiomyopathy. Front Immunol 2020; 11:1386. [PMID: 32733459 PMCID: PMC7358543 DOI: 10.3389/fimmu.2020.01386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Chagas disease, caused by the protozoan Trypanosoma cruzi, is endemic in Latin America. Thirty percent of infected individuals develop chronic Chagas cardiomyopathy (CCC), an inflammatory dilated cardiomyopathy that is the most important clinical consequence of T. cruzi infection, while the others remain asymptomatic (ASY). IFN-γ and IFN-γ-producing Th1-type T cells are increased in peripheral blood and CCC myocardium as compared to ASY patients, while the Th1-antagonizing cytokine IL-10 is more expressed in ASY patients. Importantly IFN-γ-producing Th1-type T cells are the most frequent cytokine-producing T cell subset in CCC myocardium, while expression of Th1-antagonizing cytokines IL-10 and IL-4 is unaltered. The control of IFN-γ production by Th1-type T cells may be a key event for progression toward CCC. A genetic component to disease progression was suggested by the familial aggregation of cases and the association of gene polymorphisms with CCC development. We here investigate the role of gene polymorphisms (SNPs) in several genes involved in the control of IFN-γ production and Th1 T cell differentiation in CCC development. Methods: We studied a Brazilian population including 315 CCC cases and 118 ASY subjects. We assessed 35 Tag SNPs designed to represent all the genetic information contained in the IL12B, IL10, IFNG, and IL4 genes. Results: We found 2 IL12 SNPs (rs2546893, rs919766) and a trend of association for a IL10 SNP (rs3024496) to be significantly associated with the ASY group. these associations were confirmed by multivariate analysis and allele tests. The rs919766C, 12rs2546893G, and rs3024496C alleles were associated to an increase risk to CCC development. Conclusions: Our data show that novel polymorphisms affecting IL12B and IL10, but not IFNG or IL4 genes play a role in genetic susceptibility to CCC development. This might indicate that the increased Th1 differentiation and IFN-γ production associated with CCC is genetically controlled.
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Affiliation(s)
- Amanda Farage Frade-Barros
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Aix-Marseille Université, INSERM, GIMP UMR_S906, Marseille, France.,Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.,Bioengineering Program, Instituto Tecnológico, Universidade Brasil, São Paulo, Brazil
| | - Barbara Maria Ianni
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | | | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Marcelo Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Bioengineering Program, Instituto Tecnológico, Universidade Brasil, São Paulo, Brazil
| | - Christophe Chevillard
- Aix Marseille Université, INSERM, TAGC Theories and Approaches of Genomic Complexity, UMR_1090, Marseille, France
| | - Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), São Paulo, Brazil.,Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil
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15
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Ribeiro Cury Pavão ML, Arfelli E, Scorzoni-Filho A, Pavão RB, Pazin-Filho A, Marin-Neto JA, Schmidt A. Electrical Storm in Chagas Cardiomyopathy: Clinical Predictors, Outcome, and Arrhythmic Characteristics in a Prospective Registry. JACC Clin Electrophysiol 2020; 6:1238-1245. [PMID: 33092749 DOI: 10.1016/j.jacep.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study of patients with Chagas heart disease (CHD) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death sought to compare the characteristics of those with or without electrical storm (ES) during long-term follow-up. BACKGROUND ES is a common problem in patients with CHD harboring an ICD, but data on clinical predictors and outcomes are limited. METHODS The authors retrospectively evaluated 110 patients with CHD with a mean follow-up of 1,949 ± 1,271 days. Demographic, clinical, arrhythmia characteristics, ICD treatment, and death data were collected. Descriptive statistics included mean ± SD and Fisher exact tests used for comparisons. A p value <0.05 was considered significant. RESULTS The ES group (n = 57; 43 men; age 62 ± 10 years) and the non-ES group (n = 53; 43 men; age 57 ± 14 years) had similar baseline demographic and clinical parameters, but left ventricular ejection fraction was higher in the ES group (44 ± 14% vs. 37 ± 14%; p = 0.02) and QRS duration was shorter (109 ± 35 ms vs. 134 ± 36 ms; p = 0.0027). Mortality rates were comparable in the 2 groups (odds ratio: 1.2; 95% confidence interval: 0.79 to 1.85; p = 0.44). The ES group presented 116 ES (2.03 ±1.47, 1 to 6). A total of 2,953 (61%) arrhythmic events required ICD therapy. No deaths occurred directly caused by ES, but clinical triggers were reported in 20 patients. CONCLUSIONS ES is frequent in CHD but in itself does not carry a worse prognosis in this study population and was not associated with a more depressed left ventricular systolic function or a longer QRS.
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Affiliation(s)
- Maria Lícia Ribeiro Cury Pavão
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elerson Arfelli
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Adilson Scorzoni-Filho
- Surgical Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rafael Brolio Pavão
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Pazin-Filho
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Cardiology Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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Paulo Chaves de Melo J, Licia Ribeiro Cury Pavão M, Arfelli E, Garcia Leal M, Antonio Marin-Neto J, Schmidt A. Pré-excitação Ventricular como Causa de Disfunção Ventricular Esquerda Parcialmente Reversível com Ablação da via Anômala. J Cardiac Arrhtythmias 2020. [DOI: 10.24207/jca.v32n3.066_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A pré-excitação ventricular é causa rara de cardiomiopatia induzida ou mediada por arritmias. As vias acessórias à direita, especificamente com padrão de bloqueio de ramo esquerdo, podem causar disfunção ventricular pela ativação ventricular anormal resultante da condução anterógrada pela via acessória, por causar dessincronismo atrioventricular, interventricular e intraventricular, com contração assíncrona da parede ventriculare regurgitação mitral. Foi descrita uma paciente assintomática, com eletrocardiograma exibindo pré-excitação ventricular, blo-queio do ramo esquerdo e disfunção ventricular sistólica moderada. Estudo eletrofisiológico demonstrou via acessória de localização anterior e com período refratário anterógrado de 600 ms, realizando-se ablação por radiofrequência com sucesso e significativa melhora da função ventricular.
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Affiliation(s)
| | | | - Elerson Arfelli
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
| | - Marcelo Garcia Leal
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
| | | | - Andre Schmidt
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
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17
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Paulo Chaves de Melo J, Licia Ribeiro Cury Pavão M, Arfelli E, Garcia Leal M, Antonio Marin-Neto J, Schmidt A. Ventricular Pre-excitation Causing Left Ventricular Dysfunction Partially Reverted After Ablation of the Accessory Pathway. J Cardiac Arrhtythmias 2020. [DOI: 10.24207/jca.v32n3.066_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Ventricular pre-excitation is one of the rarest causes of cardiomyopathy induced or mediated by arrhythmia. Right accessory pathways, specifically with left bundle branch block pattern, can cause ventricular dysfunction, since abnormal ventricular activation resulting from anterograde atrioventricular conduction can cause atrioventricular, interventricular, and intraventricular dyssynchrony, with asynchronous contraction of the ventricular wall and mitral regurgitation. An asymptomatic patient, with ventricular pre-excitation with left bundle branch block and moderate ventricular dysfunction at echocardiography, was described. The electrophysiological study demonstrated an accessory route of anterior location and with an anterograde refractory period of 600 ms, successfully performing radiofrequency ablation and substantial improvement of ventricular function.
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Affiliation(s)
| | | | - Elerson Arfelli
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
| | - Marcelo Garcia Leal
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
| | | | - Andre Schmidt
- Universidade de São Paulo – Faculdade de Medicina de Ribeirão Preto – Hospital das Clínicas
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18
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Leite De Barros Filho A, Moreira HT, Santos MK, Schmidt A, Santana RC, Rodrigues AJ, Maciel BC, Marin-Neto JA, Romano MMD. P187 Multimodality in tuberculous constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
CASE PRESENTATION
K.C.P., a 26 y.o. female, presenting dizziness and progressive dyspnea since 9 months ago. Physical examination showed hepatomegaly at 2 centimeters below the right inferior costal border, but without edema, cardiac murmurs or other findings. Electrocardiogram showed atria overload and diffuse ventricular repolarization abnormality. Chest X-ray revealed normal sized cardiac silhouette but with signs of pericardial calcification. Transthoracic echocardiogram revealed: enlargement of both atria, no signs of myocardial left ventricular (LV) hypertrophy; dilated inferior vena cava with minimal respiratory variation; septal bounce; septal e´= 17.20 cm/s, lateral e´= 6.09 cm/s; E/e" septal ratio = 3.9; E deceleration time = 144 ms; thickening and hyper-refringence of the pericardium with calcification adjacent to the lateral and inferior walls of the LV and the free wall of the right ventricle. For evaluation of thickness and extent of pericardial involvement, computed tomography (CT) was performed, showing gross calcifications of the pericardium, mainly in basal and lower portions, without pericardial effusion. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement revealed areas suggestive of active inflammation adjacent to the basal wall of the LV. With this evidence of active inflammatory activity, the patient was treated empirically against the etiologic agent for tuberculosis. Because of progressively severe edema and dyspnea pericardiectomy was warranted providing relief of symptoms. DISCUSSION: The echocardiogram is the initial image exam for diagnosis and monitoring of pericardial conditions. It is a widely available, low-cost method that does not use ionizing radiation and allows a complete morphological and functional evaluation of the heart. However, in up to 20% of cases, pericardial thickening may not be detectable at echocardiography. CT allows a more accurate assessment of pericardial thickening, while CMR allows detection of active inflammatory process. CONCLUSION: A typical and illustrative clinical case of constrictive pericarditis is presented, where the multimodality of cardiac imaging was decisive for the diagnostic and therapeutic delineation.
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Affiliation(s)
- A Leite De Barros Filho
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - H T Moreira
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M K Santos
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - A Schmidt
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - R C Santana
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - A J Rodrigues
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - B C Maciel
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - J A Marin-Neto
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M M D Romano
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
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19
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Barros-Filho ACL, Moreira HT, Martins KSM, Simoes MV, Schmidt A, Maciel BC, Marin-Neto JA, Romano MMD. P1284 The role of three-dimensional echocardiography in the evaluation of geometry and function of the left ventricle in patients with chronic chagas cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
A hallmark of chronic Chagas" cardiomyopathy (CCC) is the early appearance of regional wall motion abnormalities of the left ventricle (LV), especially in the lateral and apical regions. The morphological and functional assessment of LV by two-dimensional (2D) echocardiography, besides depending on geometric assumptions, may not include the most affected segments. The three-dimensional (3D) method offers advantage for the quantification of chamber volumes, but its role in the assessment of patients with CCC is not well established. PURPOSE: The aim of this study is to evaluate the concordance between 3D and 2D methods in the quantification of left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) in patients with CCC. METHODS: 44 patients with CCC were selected. Seven subjects were excluded from the analysis (3 for atrial fibrillation, 1 for frequent ventricular extrasystoles, 3 for inadequate acoustic window), resulting in 37 patients. Subjects were submitted to 2D and 3D transthoracic echocardiography by a single experienced examiner following the recommendations from the chamber quantification guidelines. The concordance between the methods was evaluated using the Lin concordance correlation coefficient (CCI) and the Bland-Altman graph analysis. Descriptive analyses of the percentage of individuals reclassified as to altered or to non altered-LVEDV and LVEF values were performed using normal values of 3D as a reference. RESULTS: Age = 58 ± 12 years, 54% men. LVEF-2D = 47 ± 9% and LVEDV- 2D = 73 ± 18 ml / m². The CCI for the measurements of LVEDV and FEVE by both methods was 0.861 and 0.833, respectively. The mean difference found was 3 mL for LVEDV and 3% for LVEF. The 95% agreement limits found were (-14, 20 ml) for LVEDV and (-5; 11%) for LVEF. When assessed with 2D, 27% of individuals previously classified as having LV enlargement were reclassified as having normal LV volumes using the 3D method. Conversely, regarding LVEF, 16% of individuals considered normal by 2D were reclassified as having reduced LVEF with the 3D method. CONCLUSION: In individuals with CCC measurements of LVEDV and LVEF by 3D and 2D methods show high agreement. However, 3D evaluation allows the reclassification of 27% and 16% of the individuals regarding the presence of LV dilatation and LV systolic dysfunction, respectively.
Abstract P1284 Figure. Bland-Altman plot - LVEF
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Affiliation(s)
- A C L Barros-Filho
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - H T Moreira
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - K S M Martins
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M V Simoes
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - A Schmidt
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - B C Maciel
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - J A Marin-Neto
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M M D Romano
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
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Rassi FM, Minohara L, Rassi A, Correia LCL, Marin-Neto JA, Rassi A, da Silva Menezes A. Systematic Review and Meta-Analysis of Clinical Outcome After Implantable Cardioverter-Defibrillator Therapy in Patients With Chagas Heart Disease. JACC Clin Electrophysiol 2019; 5:1213-1223. [PMID: 31648747 DOI: 10.1016/j.jacep.2019.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The goal of this analysis was to pool data from published studies on outcomes after implantable cardioverter-defibrillator (ICD) therapy in patients with Chagas heart disease (CHD). BACKGROUND CHD is characterized by a high burden of ventricular arrhythmias and an increased risk of sudden cardiac death. The indications for ICD are not well established. METHODS An extensive literature search without language restrictions was performed to identify all studies on ICD therapy in patients with CHD. A random effects model was used to calculate percentages and 95% confidence intervals (CIs). RESULTS Of 397 articles screened, 13 studies (all observational) were included. There were 1,041 patients (mean age at implantation 57 ± 11 years; 64% men), most of whom (92%) received an ICD for secondary prevention. Antiarrhythmic medication consisted of amiodarone (79%) and beta-blockers (44%). Overall, the annual all-cause mortality rate was 9.0% (95% CI: 6.9 to 11.7) in 2.8 ± 1.9 years of follow-up, and the annual sudden cardiac death rate was 2.0% (95% CI: 1.3 to 3.3) in 2.6 ± 1.9 years. In addition, 24.8% (95% CI: 15.7 to 37.0) of patients received 1 or more appropriate interventions (shocks or antitachycardia pacing), 4.7% (95% CI: 3.2 to 6.9) received inappropriate shocks, and 9.1% (95% CI: 5.5 to 14.7) had electric storms annually. CONCLUSIONS In patients with an ICD, annual all-cause mortality rate was 9%. Appropriate ICD interventions and electric storms were frequent, occurring at a rate of 25% and 9% per year, respectively. Inappropriate ICD shocks were not infrequent (5% per year). The benefits and risks of ICD therapy in patients with CHD should be carefully weighed until data from better studies become available.
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Affiliation(s)
- Fabio Mahamed Rassi
- Hospital do Coração Anis Rassi, Goiânia, Brazil; Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil
| | - Lucas Minohara
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, Brazil.
| | | | | | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia, Brazil
| | - Antonio da Silva Menezes
- Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil
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21
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Volpe GJ, Moreira HT, Trad HS, Wu KC, Braggion-Santos MF, Santos MK, Maciel BC, Pazin-Filho A, Marin-Neto JA, Lima JA, Schmidt A. Left Ventricular Scar and Prognosis in Chronic Chagas Cardiomyopathy. J Am Coll Cardiol 2018; 72:2567-2576. [DOI: 10.1016/j.jacc.2018.09.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 01/16/2023]
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Dias JCP, Ramos AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. [Brazilian Consensus on Chagas Disease, 2015]. Epidemiol Serv Saude 2018; 25:7-86. [PMID: 27869914 DOI: 10.5123/s1679-49742016000500002] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.
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Affiliation(s)
| | | | - Eliane Dias Gontijo
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte-MG, Brasil
| | - Alejandro Luquetti
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia-GO, Brasil
| | | | | | - Rosália Morais Torres
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte-MG, Brasil
| | | | | | - Wilson de Oliveira
- Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Recife-PE, Brasil
| | | | | | | | - Antonio Walter Ferreira
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo-SP, Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia-GO, Brasil
| | | | | | - Dalmo Correia
- Universidade Federal do Triângulo Mineiro, Faculdade de Medicina, Uberaba-MG, Brasil
| | - Ana Maria Jansen
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro-RJ, Brasil
| | | | | | | | - Anis Rassi
- Hospital do Coração Anis Rassi, Goiânia-GO, Brasil
| | | | - Fernando Abad-Franch
- Fundação Oswaldo Cruz, Centro de Pesquisas René Rachou, Belo Horizonte-MG, Brasil
| | - Silvana Eloi Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte-MG, Brasil
| | - Egler Chiari
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Belo Horizonte-MG, Brasil
| | | | - Eliane Furtado Moreira
- Secretaria do Estado de Saúde de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte-MG, Brasil
| | | | - Eliane Lages Silva
- Universidade Federal do Triângulo Mineiro, Departamento de Ciências Biológicas, Uberaba-MG, Brasil
| | | | | | - Sergio Salles Xavier
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro-RJ, Brasil
| | | | - Noêmia Barbosa Carvalho
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, São Paulo-SP, Brasil
| | | | | | | | | | - Suelene Mamede Oliveira
- Ministério da Saúde, Empresa Brasileira de Hemoderivados e Biotecnologia, Brasília-DF, Brasil
| | | | - Mayara Maia Lima
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília-DF, Brasil
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Gadioli LP, Miranda CH, Pintya AO, de Figueiredo AB, Schmidt A, Maciel BC, Marin-Neto JA, Simões MV. The severity of ventricular arrhythmia correlates with the extent of myocardial sympathetic denervation, but not with myocardial fibrosis extent in chronic Chagas cardiomyopathy : Chagas disease, denervation and arrhythmia. J Nucl Cardiol 2018; 25:75-83. [PMID: 27381340 DOI: 10.1007/s12350-016-0556-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND To investigate the correlation between the extent of myocardial sympathetic denervation and fibrosis and the presence of degrees of severity of ventricular arrhythmias in chronic Chagas cardiomyopathy (CCC). METHODS Forty-three CCC patients with left ventricular ejection fraction (LVEF) ≥ 35% were divided into three groups: SVT group-presenting Sustained Ventricular Tachycardia (SVT) (n = 15), NSVT group-exhibiting episodes of non-SVT (NSVT) on 24-h Holter monitoring (n = 11), and Control group-exhibiting neither SVT nor episodes of NSVT (n = 17). The patients underwent SPECT imaging for myocardial sympathetic innervation with 123Iodine-MIBG (MIBG) and myocardial perfusion with 99mTc-Sestamibi (MIBI) for the evaluation of regional myocardial fibrosis. RESULTS The summed rest perfusion scores were similar in the three groups. The summed difference score between MIBG and MPI images, which evaluated the extent of denervated but viable myocardium, was significantly higher in SVT group (20.0 ± 8.0) as compared with the control group (2.0 ± 5.0, P < .0001) and with the NSVT group (11.0 ± 8.0, P < .05). CONCLUSIONS The occurrence of ventricular arrhythmias of different degrees of severity correlates quantitatively with the extent of cardiac sympathetic denervation, but not with the extent of fibrosis, suggesting that myocardial sympathetic denervation plays a major role in triggering ventricular arrhythmia in CCC.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos Henrique Miranda
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Osvaldo Pintya
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedito Carlos Maciel
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Simões MV, Romano MMD, Schmidt A, Martins KSM, Marin-Neto JA. Chagas Disease Cardiomyopathy. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Medina TS, Oliveira GG, Silva MC, David BA, Silva GK, Fonseca DM, Sesti-Costa R, Frade AF, Baron MA, Ianni B, Pereira AC, Chevillard C, Cunha-Neto E, Marin-Neto JA, Silva JS. Ebi3 Prevents Trypanosoma cruzi-Induced Myocarditis by Dampening IFN-γ-Driven Inflammation. Front Immunol 2017; 8:1213. [PMID: 29033934 PMCID: PMC5626942 DOI: 10.3389/fimmu.2017.01213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022] Open
Abstract
The identification of anti-inflammatory mediators can reveal important targetable molecules capable of counterbalancing Trypanosoma cruzi-induced myocarditis. Composed of Ebi3 and IL-27p28 subunits, IL-27 is produced by myeloid cells and is able to suppress inflammation by inducing IL-10-producing Tr1 cells, thus emerging as a potential candidate to ameliorate cardiac inflammation induced by T. cruzi. Although IL-27 has been extensively characterized as a suppressive cytokine that prevents liver immunopathogenesis after T. cruzi infection, the mechanisms underlying its effects on T. cruzi-induced myocarditis remain largely unknown. Here, wild-type (WT) and Ebi3-deficient animals were intraperitoneally infected with trypomastigotes of T. cruzi Y strain and used to evaluate the potential anti-inflammatory properties of Ebi3 during T. cruzi infection. The survival rates of mice were daily recorded, the frequency of inflammatory cells was analyzed by flow cytometry and inflammatory mediators were measured by ELISA, real-time PCR and PCR array. We reported that T. cruzi-induced myocarditis was prevented by Ebi3. Stressors mainly recognized by TLR2 and TLR4 receptors on myeloid cells were essential to trigger IL-27p28 production. In addition, Ebi3 regulated IFN-γ-mediated myocarditis by promoting an anti-inflammatory environment through IL-10, which was most likely produced by Tr1 cells rather than classical regulatory T cells (Tregs), in the heart tissue of T. cruzi-infected animals. Furthermore, in vivo IFN-γ blockade ameliorated the host survival without compromising the parasite control in the bloodstream. In humans, IL-27p28 was correlated with cardiac protection during Chagas disease. Patients with mild clinical forms of the disease produced high levels of IL-27p28, whereas lower levels were found in those with severe forms. In addition, polymorphic sites at Ebi3 gene were associated with severe cardiomyopathy in patients with Chagas disease. Collectively, we describe a novel regulatory mechanism where Ebi3 dampens cardiac inflammation by modulating the overproduction of IFN-γ, the bona fide culprit of Chagas disease cardiomyopathy.
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Affiliation(s)
- Tiago Silva Medina
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Cláudia Silva
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bruna Araújo David
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Grace Kelly Silva
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Renata Sesti-Costa
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Amanda Farage Frade
- Medical School/Heart Institute, University of São Paulo, São Paulo, Brazil.,Department of Bioengineering, Brazil University, São Paulo, Brazil
| | | | - Barbara Ianni
- Medical School/Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | | | - Edécio Cunha-Neto
- Medical School/Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | - João Santana Silva
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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26
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Evora PRB, Schmidt A, Arcêncio L, Marin-Neto JA. Speculative Considerations about Some Cardiology Enigmas. Curr Cardiol Rev 2017; 13:217-222. [PMID: 28317490 PMCID: PMC5633716 DOI: 10.2174/1573403x13666170317121721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/03/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Enigmas often lead to hypotheses and speculations. For this reason, especially for the sake of the reader’s motivation, we opted for the plain discussion of some cardiology enigmas. Objective: The present text was aimed to discuss speculatively some cardiology enigmas. Method: Text was freely designed in the context of coronary artery and heart valve diseases. Results: The results were presented as the combination enigma/hypothesis. 1) The absence of arteriosclerosis in intramyocardial coronary arteries/ endothelium-myocardial interaction (crosstalk); 2) The unique and always confirmed superior evolution of the internal thoracic artery as coronary graft/ higher NO basal release 3) The prophylactic left internal thoracic artery graft in mildly-stenosed coronary lesions/need of more accurate functional imaging techniques; 4) The high incidence of perioperative atrial fibrillation in patients with coronary artery disease/atrial ischemia associated to left circumflex coronary lesions; 5) The handling of disease-free saphenous vein grafts at the time of re-operation/biological serendipity with graft vein segments; 6) The possible aortic stenosis protection against coronary artery disease/ endothelium myocardium interaction (crosstalk) improving NO release. Conclusion: The discussed topics associated with their respective speculative hypothesis remain as enigmas, but would become motivations for investigations
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Affiliation(s)
- Paulo Roberto Barbosa Evora
- Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre - CEP: 14049-900 Ribeirão Preto/SP. Brazil
| | - Andre Schmidt
- Department of Surgery and Anatomy (Division of Cardiothoracic Surgery); Department of Medicine (Division of Cardiology); Ribeirão Preto School of Medicine, University of São Paulo, SP. Brazil
| | - Livia Arcêncio
- Department of Surgery and Anatomy (Division of Cardiothoracic Surgery); Department of Medicine (Division of Cardiology); Ribeirão Preto School of Medicine, University of São Paulo, SP. Brazil
| | - José Antonio Marin-Neto
- Department of Surgery and Anatomy (Division of Cardiothoracic Surgery); Department of Medicine (Division of Cardiology); Ribeirão Preto School of Medicine, University of São Paulo, SP. Brazil
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Marchini JFM, Pinto MR, Novaes GC, Badran AV, Pavão RB, Figueiredo GL, Lago IM, Lima-Filho MO, Lemos DC, Tonani M, Antloga CM, Oliveira L, Lorenzi JC, Marin-Neto JA. Decreased platelet responsiveness to clopidogrel correlates with CYP2C19 and PON1 polymorphisms in atherosclerotic patients. ACTA ACUST UNITED AC 2017; 50:e5660. [PMID: 28076455 PMCID: PMC5264542 DOI: 10.1590/1414-431x20165660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
Clopidogrel and aspirin are the most commonly used medications worldwide for dual
antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel
hyporesponsiveness related to gene polymorphisms is a concern. Populations with
higher degrees of genetic admixture may have increased prevalence of clopidogrel
hyporesponsiveness. To assess this, we genotyped CYP2C19,
ABCB1, and PON1 in 187 patients who underwent
percutaneous coronary intervention. Race was self-defined by patients. We also
performed light transmission aggregometry with adenosine diphosphate (ADP) and
arachidonic acid during dual antiplatelet therapy. We found a significant difference
for presence of the CYP2C19*2 polymorphism between white and
non-white patients. Although 7% of patients had platelet resistance to clopidogrel,
this did not correlate with any of the tested genetic polymorphisms. We did not find
platelet resistance to aspirin in this cohort. Multivariate analysis showed that
patients with PON1 and CYP2C19 polymorphisms had
higher light transmission after ADP aggregometry than patients with native alleles.
There was no preponderance of any race in patients with higher light transmission
aggregometry. In brief, PON1 and CYP2C19
polymorphisms were associated with lower clopidogrel responsiveness in this sample.
Despite differences in CYP2C19 polymorphisms across white and
non-white patients, genetic admixture by itself was not able to identify clopidogrel
hyporesponsiveness.
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Affiliation(s)
- J F M Marchini
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M R Pinto
- Departamento de Odontologia, Universidade de Uberaba, Uberaba, MG, Brasil
| | - G C Novaes
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A V Badran
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R B Pavão
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G L Figueiredo
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I M Lago
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M O Lima-Filho
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D C Lemos
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M Tonani
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Antloga
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Oliveira
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J C Lorenzi
- Departamento de Genética, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J A Marin-Neto
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Dias JCP, Ramos Jr. AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, Torres RM, Melo JRDC, Almeida EAD, Oliveira Jr. WD, Silveira AC, Rezende JMD, Pinto FS, Ferreira AW, Rassi A, Fragata Filho AA, Sousa ASD, Correia D, Jansen AM, Andrade GMQ, Britto CFDPDC, Pinto AYDN, Rassi Jr. A, Campos DE, Abad-Franch F, Santos SE, Chiari E, Hasslocher-Moreno AM, Moreira EF, Marques DSDO, Silva EL, Marin-Neto JA, Galvão LMDC, Xavier SS, Valente SADS, Carvalho NB, Cardoso AV, Silva RAE, Costa VMD, Vivaldini SM, Oliveira SM, Valente VDC, Lima MM, Alves RV. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop 2016; 49Suppl 1:3-60. [DOI: 10.1590/0037-8682-0505-2016] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022] Open
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Carlos Pinto Dias J, Novaes Ramos A, Dias Gontijo E, Luquetti A, Aparecida Shikanai-Yasuda M, Rodrigues Coura J, Morais Torres R, Renan da Cunha Melo J, Antonio de Almeida E, de Oliveira Jr W, Carlos Silveira A, Marcondes de Rezende J, Scalabrini Pinto F, Walter Ferreira A, Rassi A, Augusto Fragata Filho A, Silvestre de Sousa A, Correia Filho D, Maria Jansen A, Manzan Queiroz Andrade G, Felícia De Paoli de Carvalho Britto C, Yecê das Neves Pinto A, Rassi Jr A, Elisabeth Campos D, Abad-Franch F, Eloi Santos S, Chiari E, Marcel Hasslocher-Moreno A, Furtado Moreira E, Seila de Oliveira Marques D, Seila de Oliveira Marques D, Lages Silva E, Antonio Marin-Neto J, Maria da Cunha Galvão L, Salles Xavier S, Aldo da Silva Valente S, Barbosa Carvalho N, Viana Cardoso A, Albuquerque e Silva R, Maia da Costa V, Monzani Vivaldini S, Mamede Oliveira S, da Costa Valente V, Maia Lima M, Vieira Alves R. II Consenso Brasileiro em Doença de Chagas, 2015. Epidemiol Serv Saúde 2016. [DOI: 10.5123/s1679-49742016002100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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de Carvalho EEV, Santi GL, Crescêncio JC, de Oliveira LFL, dos Reis DCC, Figueiredo AB, Pintya AO, Lima-Filho MO, Gallo-Júnior L, Marin-Neto JA, Simões MV. Pilot study testing the effect of physical training over the myocardial perfusion and quality of life in patients with primary microvascular angina. J Nucl Cardiol 2015; 22:130-7. [PMID: 25080872 DOI: 10.1007/s12350-014-9949-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/12/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary microvascular angina (PMA) is a common clinical condition associated to negative impact on quality of life (QOL) and reduced physical capacity. This study aimed at evaluating the effects of aerobic physical training (APT) on myocardial perfusion, physical capacity, and QOL in patients with PMA. METHODS We investigated 12 patients (53.8 ± 9.7 years old; 7 women) with PMA, characterized by angina, angiographycally normal coronary arteries, and reversible perfusion defects (RPDs) detected on (99m)Tc-sestamibi-SPECT myocardial perfusion scintigraphy (MPS). At baseline and after 4 month of APT, the patients underwent MPS, cardiopulmonary test, and QOL questionnaire. Stress-rest MPS images were visually analyzed by attributing semi-quantitative scores (0 = normal; 4 = absent uptake), using a 17-segment left ventricular model. Summed stress, rest, and difference scores (SDS) were calculated. RESULTS In comparison to the baseline, in the post-training we observed a significant increase in peak-VO2 (19.4 ± 4.8 and 22.1 ± 6.2 mL·kg(-1)·minute(-1), respectively, P = .01), reduction of SDS (10.1 ± 8.8 and 2.8 ± 4.9, P = .008), and improvement in QOL scores. CONCLUSIONS Physical training in patients with PMA is associated with reduction of myocardial perfusion abnormalities, increasing of physical capacity, and improvement in QOL. The findings of this hypothesis-generating study suggest that APT can be a valid therapeutic option for patients with PMA.
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Affiliation(s)
- Eduardo Elias Vieira de Carvalho
- Cardiology Division, Internal Medicine Department, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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Nicolau JC, Timerman A, Marin-Neto JA, Piegas LS, Barbosa CJDG, Franci A, Avezum A, Carvalho ACC, Markman Filho B, Polanczyk CA, Rochitte CE, Serrano Júnior CV, Precoma DB, Silva Junior DG, Albuquerque DC, Stefanini E, Knobel E, Jatene FB, Feres F, Morcerf FAP, Ganem F, Lima Filho FA, Feitosa Filho GS, Ferreira JFM, Meneghetti JC, Saraiva JFK, Silva LS, Maia LN, Baracioli LM, Lisboa LAF, Dallan LAO, Bodanese LC, Andrade MD, Oliveira Júnior M, Dutra OP, Coelho OR, Leães PE, Albuquerque PF, Lemos P, Kalil R, Costa RVC, Esporcate R, Marino RL, Botellho RV, Meneghelo RS, Sprovieri SR, Timerman S, Mathias Júnior W. [Guidelines of Sociedade Brasileira de Cardiologia for Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction (II Edition, 2007) 2013-2014 Update]. Arq Bras Cardiol 2014; 102:1-61. [PMID: 24862929 DOI: 10.5935/abc.2014s001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Braggion-Santos MF, Volpe GJ, Pazin-Filho A, Maciel BC, Marin-Neto JA, Schmidt A. Sudden cardiac death in Brazil: a community-based autopsy series (2006-2010). Arq Bras Cardiol 2014; 104:120-7. [PMID: 25424162 PMCID: PMC4375655 DOI: 10.5935/abc.20140178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/27/2014] [Indexed: 11/20/2022] Open
Abstract
Background Sudden cardiac death (SCD) is a sudden unexpected event, from a cardiac cause,
that occurs in less than one hour after the symptoms onset, in a person without
any previous condition that would seem fatal or who was seen without any symptoms
24 hours before found dead. Although it is a relatively frequent event, there are
only few reliable data in underdeveloped countries. Objective We aimed to describe the features of SCD in Ribeirão Preto, Brazil (600,000
residents) according to Coroners’ Office autopsy reports. Methods We retrospectively reviewed 4501 autopsy reports between 2006 and 2010, to
identify cases of SCD. Specific cause of death as well as demographic information,
date, location and time of the event, comorbidities and whether cardiopulmonary
resuscitation (CPR) was attempted were collected. Results We identified 899 cases of SCD (20%); the rate was 30/100000 residents per year.
The vast majority of cases of SCD involved a coronary artery disease (CAD) (64%)
and occurred in men (67%), between the 6th and the 7th
decades of life. Most events occurred during the morning in the home setting
(53.3%) and CPR was attempted in almost half of victims (49.7%). The most
prevalent comorbidity was systemic hypertension (57.3%). Chagas’ disease was
present in 49 cases (5.5%). Conclusion The majority of victims of SCD were men, in their sixties and seventies and the
main cause of death was CAD. Chagas’ disease, an important public health problem
in Latin America, was found in about 5.5% of the cases.
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Affiliation(s)
| | - Gustavo Jardim Volpe
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Antonio Pazin-Filho
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Benedito Carlos Maciel
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José Antonio Marin-Neto
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - André Schmidt
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Schwartzmann PV, Carvalho EEV, de Figueiredo AB, Marin-Neto JA, Simões MV. The presence of contractile reserve predicts the left ventricular systolic function improvement after prolonged oral dipyridamole use in patients with non-ischemic dilated cardiomyopathy. Int J Cardiol 2014; 172:622-3. [DOI: 10.1016/j.ijcard.2014.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 11/16/2022]
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Frade AF, Teixeira PC, Ianni BM, Pissetti CW, Saba B, Wang LHT, Kuramoto A, Nogueira LG, Buck P, Dias F, Giniaux H, Llored A, Alves S, Schmidt A, Donadi E, Marin-Neto JA, Hirata M, Sampaio M, Fragata A, Bocchi EA, Stolf AN, Fiorelli AI, Santos RHB, Rodrigues V, Pereira AC, Kalil J, Cunha-Neto E, Chevillard C. Polymorphism in the alpha cardiac muscle actin 1 gene is associated to susceptibility to chronic inflammatory cardiomyopathy. PLoS One 2013; 8:e83446. [PMID: 24367596 PMCID: PMC3868584 DOI: 10.1371/journal.pone.0083446] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
Aims Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in Latin America, and may lead to a life-threatening inflammatory dilated, chronic Chagas cardiomyopathy (CCC). One third of T. cruzi-infected individuals progress to CCC while the others remain asymptomatic (ASY). A possible genetic component to disease progression was suggested by familial aggregation of cases and the association of markers of innate and adaptive immunity genes with CCC development. Since mutations in multiple sarcomeric genes, including alpha-cardiac actin (ACTC1) have been involved in hereditary dilated cardiomyopathy, we investigated the involvement of the ACTC1 gene in CCC pathogenesis. Methods and Results We conducted a proteomic and genetic study on a Brazilian study population. The genetic study was done on a main cohort including 118 seropositive asymptomatic subjects and 315 cases and the replication was done on 36 asymptomatic and 102 CCC cases. ACTC1 protein and mRNA levels were lower in myocardial tissue from patients with end-stage CCC than those found in hearts from organ donors. Genotyping a case-control cohort of CCC and ASY subjects for all informative single nucleotide polymorphism (SNP) in the ACTC1 gene identified rs640249 SNP, located at the 5’ region, as associated to CCC. Associations are borderline after correction for multiple testing. Correlation and haplotype analysis led to the identification of a susceptibility haplotype. Functional assays have shown that the rs640249A/C polymorphism affects the binding of transcriptional factors in the promoter regions of the ACTC1 gene. Confirmation of the detected association on a larger independent replication cohort will be useful. Conclusions Genetic variations at the ACTC1 gene may contribute to progression to chronic Chagas Cardiomyopathy among T. cruzi-infected patients, possibly by modulating transcription factor binding to ACTC1 promoter regions.
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Affiliation(s)
- Amanda Farage Frade
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
- Aix-Marseille Université, Marseille, France
| | - Priscila Camilo Teixeira
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
| | - Barbara Maria Ianni
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Bruno Saba
- Instituto de Cardiologia Dante Pazzanese, São Paulo, São Paulo, Brazil
| | - Lin Hui Tzu Wang
- Instituto de Cardiologia Dante Pazzanese, São Paulo, São Paulo, Brazil
| | - Andréia Kuramoto
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
| | - Luciana Gabriel Nogueira
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Sthefanny Alves
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Andre Schmidt
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mario Hirata
- Instituto de Cardiologia Dante Pazzanese, São Paulo, São Paulo, Brazil
| | - Marcelo Sampaio
- Instituto de Cardiologia Dante Pazzanese, São Paulo, São Paulo, Brazil
| | - Abílio Fragata
- Instituto de Cardiologia Dante Pazzanese, São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Antonio Noedir Stolf
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Alfredo Inacio Fiorelli
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | | | - Virmondes Rodrigues
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology (iii), Instituto Nacional de ciencias e tecnologia, São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
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Frade AF, Pissetti CW, Ianni BM, Saba B, Lin-Wang HT, Nogueira LG, de Melo Borges A, Buck P, Dias F, Baron M, Ferreira LRP, Schmidt A, Marin-Neto JA, Hirata M, Sampaio M, Fragata A, Pereira AC, Donadi E, Kalil J, Rodrigues V, Cunha-Neto E, Chevillard C. Genetic susceptibility to Chagas disease cardiomyopathy: involvement of several genes of the innate immunity and chemokine-dependent migration pathways. BMC Infect Dis 2013; 13:587. [PMID: 24330528 PMCID: PMC3866603 DOI: 10.1186/1471-2334-13-587] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/04/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in Latin America. Thirty percent of infected individuals develop chronic Chagas cardiomyopathy (CCC), an inflammatory dilated cardiomyopathy that is, by far, the most important clinical consequence of T. cruzi infection. The others remain asymptomatic (ASY). A possible genetic component to disease progression was suggested by familial aggregation of cases and the association of markers of innate and adaptive immunity genes with CCC development. Migration of Th1-type T cells play a major role in myocardial damage. METHODS Our genetic analysis focused on CCR5, CCL2 and MAL/TIRAP genes. We used the Tag SNPs based approach, defined to catch all the genetic information from each gene. The study was conducted on a large Brazilian population including 315 CCC cases and 118 ASY subjects. RESULTS The CCL2rs2530797A/A and TIRAPrs8177376A/A were associated to an increase susceptibility whereas the CCR5rs3176763C/C genotype is associated to protection to CCC. These associations were confirmed when we restricted the analysis to severe CCC, characterized by a left ventricular ejection fraction under 40%. CONCLUSIONS Our data show that polymorphisms affecting key molecules involved in several immune parameters (innate immunity signal transduction and T cell/monocyte migration) play a role in genetic susceptibility to CCC development. This also points out to the multigenic character of CCC, each polymorphism imparting a small contribution. The identification of genetic markers for CCC will provide information for pathogenesis as well as therapeutic targets.
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Affiliation(s)
- Amanda Farage Frade
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Aix-Marseille Université, INSERM, GIMP UMR_S906, Faculté de médecine, 27 bd Jean Moulin, Marseille, cedex 05 13385, France
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Barbara Maria Ianni
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Bruno Saba
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Hui Tzu Lin-Wang
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Luciana Gabriel Nogueira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
| | - Ariana de Melo Borges
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Paula Buck
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Monique Baron
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Andre Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Mario Hirata
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Marcelo Sampaio
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Abílio Fragata
- Instituto de Cardiologia Dante Pazzanese (IDPC), Avenida Dante Pazzanese 500 - Ibirapuera, Sâo Paulo, SP 04012-909, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Av. Bandeirantes, 4900 - Monte Alegre 15059-900, Ribeirão Preto, SP, Brazil
| | - Jorge Kalil
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, SP 06504-000, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Universidade Federal do Triângulo Mineiro (UFTM), 40 Frei Paulino, Uberaba, MG 48036-180, Brazil
| | - Edecio Cunha-Neto
- Heart Institute (InCor), University of São Paulo School of Medicine (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44 Bloco 2 9º andar, São Paulo, SP 06504-000, Brazil
- Institute for Investigation in Immunology (iii), INCT, São Paulo, SP, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, SP 06504-000, Brazil
| | - Christophe Chevillard
- Aix-Marseille Université, INSERM, GIMP UMR_S906, Faculté de médecine, 27 bd Jean Moulin, Marseille, cedex 05 13385, France
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Martinelli M, Rassi A, Marin-Neto JA, de Paola AAV, Berwanger O, Scanavacca MI, Kalil R, de Siqueira SF. CHronic use of Amiodarone aGAinSt Implantable cardioverter-defibrillator therapy for primary prevention of death in patients with Chagas cardiomyopathy Study: rationale and design of a randomized clinical trial. Am Heart J 2013; 166:976-982.e4. [PMID: 24268211 DOI: 10.1016/j.ahj.2013.08.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implantable cardioverter defibrillator (ICD) is better than antiarrhythmic drug therapy for the primary and secondary prevention of all-cause mortality and sudden cardiac death in patients with either coronary artery disease or idiopathic dilated cardiomyopathy. This study aims to assess whether the ICD also has this effect for primary prevention in chronic Chagas cardiomyopathy (CCC). METHODS In this randomized (concealed allocation) open-label trial, we aim to enroll up to 1,100 patients with CCC, a Rassi risk score for death prediction of ≥10 points, and at least 1 episode of nonsustained ventricular tachycardia on a 24-hour Holter monitoring. Patients from 28 centers in Brazil will be randomly assigned in a 1:1 ratio to receive an ICD or amiodarone (600 mg/d for 10 days, then 200-400 mg/d until the end of the study). The randomization sequence will be generated by computer, and the members of the committees responsible for end point validation and data analysis will be blinded to study assignment. The primary end point is all-cause death, and enrolment will continue until 256 patients have reached this end point. Key secondary end points include cardiovascular death, sudden cardiac death, hospitalization for heart failure, and quality of life. We expect follow-up to last 3 to 6 years, and data analysis will be done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov number NCT01722942. CONCLUSION CHAGASICS is the first large-scale trial to assess the benefit of ICD therapy for the primary prevention of death in patients with CCC and nonsustained ventricular tachycardia, who have a moderate to high risk of death.
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Affiliation(s)
- Martino Martinelli
- Pacemaker Clinic, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil.
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37
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Gubolino LA, Lopes MACQ, Pedra CAC, Caramori PRA, Mangione JA, Silva SS, Salvadori Junior D, Marin-Neto JA, Castello Junior HJ, Cantarelli MJC, Ferreira MCM, Pimentel Filho WA, Oliveira ADD, Barbosa MR. Diretrizes da Sociedade Brasileira de Cardiologia sobre Qualidade Profissional e Institucional, Centro de Treinamento e Certificação Profissional em Hemodinâmica e Cardiologia Intervencionista (III Edição - 2013). Arq Bras Cardiol 2013. [DOI: 10.5935/abc.2013s013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Marin-Neto JA. Cell therapy in dilated cardiomyopathy: back to the right scientific track? Braz J Med Biol Res 2011; 44:497. [PMID: 21670938 DOI: 10.1590/s0100-879x2011000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/30/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- J A Marin-Neto
- Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de RibeirãoPreto, USP, Av. Bandeirantes 3900, Ribeirão Preto, SP, Brazil.
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Carvalho EEVD, Costa DC, Crescêncio JC, Santi GLD, Papa V, Marques F, Schmidt A, Marin-Neto JA, Simões MV, Gallo Junior L. Heart failure: comparison between six-minute walk test and cardiopulmonary test. Arq Bras Cardiol 2011; 97:59-64. [PMID: 21552646 DOI: 10.1590/s0066-782x2011005000056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 01/11/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic heart failure (HF) is a syndrome characterized by reduced cardiac output in relation to the metabolic needs of the organism, as well as metabolic and neurohormonal axis abnormalities. Symptoms such as fatigue and dyspnoea are notorious and stress tests are widely used to assess functional capacity, prognosis and effectiveness of therapeutic interventions in this syndrome. OBJECTIVE To evaluate the reproducibility of the six-minute walk test (6MW) in patients with HF and correlate the magnitude of the variables reached at peak exercise of the 6MWT with a cardiopulmonary exercise test (CPET). METHODS We studied 16 patients (12 men and 4 women) diagnosed with HF FC I-II (NYHA). The volunteers underwent two 6MWT (6MWT'1 and 6MWT'2) with 30-minute interval between them; then, they underwent a maximum CPET. RESULTS All variables obtained in the two 6MWT' proved to be significant with high correlations: distance walked (DW) (r = 0.93, p < 0.0001), heart rate (HR) (r = 0.89, p < 0.0001), oxygen consumption (VO2) (r = 0.93, p < 0.0001) and scale of perceived exertion (r = 0.85, p < 0.0001). In turn, all variables analyzed in the 6MWT' showed significant and moderate correlations with the variables obtained from the CPET, namely: peak HR (r = 0.66; p = 0.005); VO2 (r = 0.57; p = 0.02) and VO2 in the CPET and DT in the 6MWT'2 (r = 0.70; p = 0.002). CONCLUSION The 6MWT was reproducible in this group of patients with HF (NYHA - I-II) and correlated with the CPET. Therefore, it is a tool for reliable evaluation, and a suitable, safe and low-cost alternative for the prescription of aerobic exercise in patients with HF.
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Affiliation(s)
- Eduardo Elias Vieira de Carvalho
- Departamento de Clínica Médica Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Faculdade de Medicina de Ribeirão Preto, USP, Brazil.
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Abstract
Chagas disease is a chronic, systemic, parasitic infection caused by the protozoan Trypanosoma cruzi, and was discovered in 1909. The disease affects about 8 million people in Latin America, of whom 30-40% either have or will develop cardiomyopathy, digestive megasyndromes, or both. In the past three decades, the control and management of Chagas disease has undergone several improvements. Large-scale vector control programmes and screening of blood donors have reduced disease incidence and prevalence. Although more effective trypanocidal drugs are needed, treatment with benznidazole (or nifurtimox) is reasonably safe and effective, and is now recommended for a widened range of patients. Improved models for risk stratification are available, and certain guided treatments could halt or reverse disease progression. By contrast, some challenges remain: Chagas disease is becoming an emerging health problem in non-endemic areas because of growing population movements; early detection and treatment of asymptomatic individuals are underused; and the potential benefits of novel therapies (eg, implantable cardioverter defibrillators) need assessment in prospective randomised trials.
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Affiliation(s)
- Anis Rassi
- Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil.
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Rassi A, Rassi A, Marin-Neto JA. Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification. Mem Inst Oswaldo Cruz 2010; 104 Suppl 1:152-8. [PMID: 19753470 DOI: 10.1590/s0074-02762009000900021] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 05/26/2009] [Indexed: 10/21/2023] Open
Abstract
Chagas heart disease (CHD) results from infection with the protozoan parasite Trypanosoma cruzi and is the leading cause of infectious myocarditis worldwide. It poses a substantial public health burden due to high morbidity and mortality. CHD is also the most serious and frequent manifestation of chronic Chagas disease and appears in 20-40% of infected individuals between 10-30 years after the original acute infection. In recent decades, numerous clinical and experimental investigations have shown that a low-grade but incessant parasitism, along with an accompanying immunological response [either parasite-driven (most likely) or autoimmune-mediated], plays an important role in producing myocardial damage in CHD. At the same time, primary neuronal damage and microvascular dysfunction have been described as ancillary pathogenic mechanisms. Conduction system disturbances, atrial and ventricular arrhythmias, congestive heart failure, systemic and pulmonary thromboembolism and sudden cardiac death are the most common clinical manifestations of chronic Chagas cardiomyopathy. Management of CHD aims to relieve symptoms, identify markers of unfavourable prognosis and treat those individuals at increased risk of disease progression or death. This article reviews the pathophysiology of myocardial damage, discusses the value of current risk stratification models and proposes an algorithm to guide mortality risk assessment and therapeutic decision-making in patients with CHD.
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Affiliation(s)
- Anis Rassi
- Anis Rassi Hospital, Goiânia, GO, Brasil.
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Miziara A, Marin-Neto JA, Marchini JFM, Figueiredo GL, Pintya AO, Simões MV, Antloga CM. Discinergia ventricular esquerda reversível identificada por potenciação pós-extrassistólica em miocardiopatia chagásica crônica não é causada por hibernação miocárdica. ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s2179-83972009000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Avezum A, Braga J, Santos I, Guimarães HP, Marin-Neto JA, Piegas LS. Cardiovascular disease in South America: current status and opportunities for prevention. Heart 2009; 95:1475-82. [PMID: 19224906 DOI: 10.1136/hrt.2008.156331] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
South America comprises widely different environments consisting of many complex and heterogeneous ethnicities, societies and cultures. During recent decades conspicuous advances in human and societal development have been made. South America now faces three major demographic shifts: population growth; urbanisation (almost 90% of the population live in urban areas) and ageing. Recently, an epidemiological transition has been seen. Urbanisation has brought unfavourable and prominent changes, such as increased smoking rates, stress, lack of physical activity and poor diets (more fat and calories). Consequently, owing to the interaction between environment and genetic susceptibility, the modifications induced by urbanisation have resulted in enhancement of the cardiovascular risk factors and cardiovascular disease (CVD). This situation is responsible for the burden of CVD in South America, requiring effective action towards better detection and control of cardiovascular risk factors aimed at reducing the burden of disease in the region, which tends to be higher and increasingly serious.
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Affiliation(s)
- A Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil.
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Abstract
Congenital heart diseases are one of the most common structural defects present at birth, with an approximate incidence of 8 per 1000 live births. As most countries in South America have a high birth rate, they are a significant public health concern. This paper provides a brief overview of the burden of congenital heart disease in South America, focusing on its local prevalence, facilities for treatment and outcomes after medical, surgical or catheter intervention for the most common diseases.
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Affiliation(s)
- C A C Pedra
- Catheterisation Laboratory for Congenital Heart Disease, Instituto Dante Pazzanese de Cardiologia, Av Dr Dante Pazzanese 500, 14 andar, CEP 04012-180, São Paulo, SP, Brazil.
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Lopes MACQ, Lopes Filho MACQ, Gubolino LA, Mattos LA, Marin-Neto JA. Conflitos éticos e judiciais no emprego dos stents farmacológicos no Brasil: análise das principais controvérsias para incorporação dessa tecnologia nos sistemas de saúde público e privado no país. ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s2179-83972009000100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rassi A, Dias JCP, Marin-Neto JA, Rassi A. Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease. Heart 2008; 95:524-34. [DOI: 10.1136/hrt.2008.159624] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Romano MMD, Pazin-Filho A, Crescêncio JC, Schmidt A, Almeida-Filho OC, Gallo-Júnior L, Marin-Neto JA, Maciel BC. Influence of aging, tidal volume, and respiratory rate on Doppler echocardiographic indices of diastolic function in normal male subjects: a quantitative evaluation. Echocardiography 2008; 25:40-6. [PMID: 18186779 DOI: 10.1111/j.1540-8175.2007.00562.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although the influence of respiration on ventricular filling, as evaluated by Doppler technique, and the evaluation of diastolic velocities of mitral valve annulus (MVA), as measured by Doppler tissue imaging (DTI), can provide valuable information for the study of left ventricular (LV) diastolic function, the concomitant effects of aging, tidal volume (TV), and respiratory rate (RR) on these velocities have not been quantitatively investigated. METHODS We evaluated 12 normal male volunteers (Group I) aged 20-26 years (mean: 22.8) and 8 normal subjects aged 41 to 54 years old (mean: 45.9) (Group II). Using DTI we measured peak early (E(a)) and late (A(a)) velocities of longitudinal axis expansion at lateral and medial MVA. Doppler mitral and tricuspid flow velocities were measured: peak early (E) and late (A) inflow velocity, early (E(i)) and late (A(i)) flow integral, and deceleration time of peak early mitral flow velocity (DT). Respiratory cycles were simultaneously recorded at RR of 9, 12, 15, and 18 cycles/min and TV of 600 and 900 mL during respiration (RESP). RESULTS AND CONCLUSIONS (1) E, A, and A(i) in MV had negligible change during respiration, but E(i) was significantly reduced during inspiration; (2) DT reduced slightly with inspiration, but the change was significant only with TV of 900 mL; (3) an important increase of E in right ventricular flow was observed during inspiration; (4) variations of RR and TV did not significantly influence right and left ventricular inflow in normal subjects, in the conditions of this investigation; (5) a significant increase of E(a) at medial MVA was documented during inspiration only in young subjects; (6) a significant decrease of A(a) at medial MVA was observed during inspiration in both groups of volunteers; (7) RR and TV did not influence MVA velocities in young and adult subjects; (8) a consistent reduction in E(a) and a significant increase in A(a) were observed with increasing age; (9) these changes were more conspicuous and consistent than those documented in ventricular filling when young and middle-age men are compared, suggesting that the DTI is more sensitive to detect changes in diastolic function; and (10) in addition, these data suggest that, for evaluation of diastolic function, in clinical context, it is not necessary to control rigorously RR or TV.
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Affiliation(s)
- Minna Moreira Dias Romano
- Division of Cardiology, Department of Internal Medicine, University Hospital, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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Simões MV, Marin-Neto JA, Maciel BC. Variable regional left ventricular dysfunction in takotsubo cardiomyopathy syndrome. Echocardiography 2008; 24:893; author reply 894. [PMID: 17767545 DOI: 10.1111/j.1540-8175.2007.00548.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pazin-Filho A, Romano MMD, Gomes Furtado R, de Almeida Filho OC, Schmidt A, Marin-Neto JA, Maciel BC. Left Ventricular Global Performance and Diastolic Function in Indeterminate and Cardiac Forms of Chagas’ Disease. J Am Soc Echocardiogr 2007; 20:1338-43. [PMID: 17764903 DOI: 10.1016/j.echo.2007.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Indexed: 10/22/2022]
Abstract
The majority of patients with Chagas' disease remain for 10 to 30 years in the indeterminate form (IF) of this disease. They have no symptoms, serologic positivity, normal electrocardiogram results and heart size, and normal left ventricular global and segmental systolic function on 2-dimensional echocardiography. To investigate whether this group of patients have any impairment of left ventricular global performance (Tei index) and diastolic function, we have studied 43 individuals (age 49 +/- 12 years) including 14 healthy volunteers and 29 patients with Chagas' disease divided as IF (n = 12) and cardiac form (n = 17). Echocardiographic measurements included ejection fraction, Tei index, left atrial volume index, transmitral (peak early transmitral flow velocity, late peak mitral velocity, tissue Doppler, late peak mitral velocity duration) and pulmonary (systolic pulmonary vein velocity, diastolic pulmonary vein velocity, retrograde pulmonary vein velocity, retrograde pulmonary vein velocity duration) flow velocities, and tissue Doppler velocities at lateral mitral annulus (peak early transmitral flow velocity, late peak mitral velocity, systolic pulmonary vein velocity). Although ejection fraction and S' velocity were significantly lower for patients with cardiac form compared with control and IF groups, Tei index was not able to differentiate patients with cardiac conditions from the other groups. Diastolic dysfunction was documented for patients with cardiac form by left atrial volume index, early transmitral peak velocity, early expansion wave by tissue Doppler, late expansion wave by tissue Doppler, and peak early transmitral flow velocity/early expansion wave by tissue Doppler. Patients with the IF of Chagas' disease did not show any abnormality of diastolic function. Thus, when the IF is further characterized on the basis of absence of any echocardiographic marker of regional systolic dysfunction, no impairment of diastolic function can be detected.
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Affiliation(s)
- Antônio Pazin-Filho
- Division of Cardiology, Department of Internal Medicine, University Hospital, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Simões MV, Marin-Neto JA, Romano MMD, OConnell JL, Santi GLD, Maciel BC. Disfunção ventricular esquerda transitória por cardiomiopatia induzida por estresse. Arq Bras Cardiol 2007; 89:e79-83. [DOI: 10.1590/s0066-782x2007001600012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/28/2007] [Indexed: 11/22/2022] Open
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