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Bisol RV, Clausell N, Vieira JL, Bacal F, Lopes RD, Goldraich LA. Advanced Heart Failure and Transplant Cardiology as a New Subspecialty in Latin America: Challenges and Opportunities Based on a Brazilian Survey Study. J Card Fail 2024; 30:520-522. [PMID: 38266869 DOI: 10.1016/j.cardfail.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Rafaela Vebber Bisol
- Caxias do Sul University, Caxias do Sul, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nadine Clausell
- Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Heart Transplant Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jefferson L Vieira
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor), Hospital das Clínicas - Faculdade de Medicina, São Paulo, Brazil
| | | | - Livia Adams Goldraich
- Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Heart Transplant Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Bernardes DDS, Santos MS, Mantovani VM, Almeida Neto OPD, Goldraich LA, Clausell N, Rabelo-Silva ER. Use of the ADHERE Risk Model as a Predictor of Risk of in-Hospital Worsening Heart Failure in a Cohort. Arq Bras Cardiol 2023; 120:e20220584. [PMID: 37672471 PMCID: PMC10519228 DOI: 10.36660/abc.20220584] [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: 08/30/2022] [Revised: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF. OBJECTIVE To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients. METHODS This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant. RESULTS A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%. CONCLUSIONS In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not.
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Affiliation(s)
- Daniela de Souza Bernardes
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Marina Scherer Santos
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | - Omar Pereira de Almeida Neto
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Departamento de Enfermagem, Universidade Federal de Uberlândia, Uberlândia, MG - Brasil
| | - Livia Adams Goldraich
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Nadine Clausell
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
| | - Eneida Rejane Rabelo-Silva
- Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
- Divisão de Cardiologia, Grupo de Insuficiência Cardíaca e Transplante Cardíaco, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brasil
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do Nascimento DM, Machado KC, Bock PM, Saffi MAL, Goldraich LA, Silveira AD, Clausell N, Schaan BD. Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial. BMC Cardiovasc Disord 2023; 23:381. [PMID: 37516830 PMCID: PMC10386700 DOI: 10.1186/s12872-023-03404-7] [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: 12/12/2022] [Accepted: 07/17/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Functional training may be an effective non-pharmacological therapy for heart failure (HF). This study aimed to compare the effects of functional training with strength training on peak VO2 and quality of life in individuals with HF. METHODS A randomized, parallel-design and examiner-blinded controlled clinical trial with concealed allocation, intention-to-treat and per-protocol analyses. Twenty-seven participants with chronic HF were randomly allocated to functional or strength training group, to perform a 12-week physical training, three times per week, totalizing 36 sessions. Primary outcomes were the difference on peak VO2 and quality of life assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire, respectively. Secondary outcomes included functionality assessed by the Duke Activity Status Index and gait speed test, peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively, endothelial function by brachial artery flow-mediated dilation, and lean body mass by arm muscle circumference. RESULTS Participants were aged 60 ± 7 years, with left ventricular ejection fraction 29 ± 8.5%. The functional and strength training groups showed the following results, respectively: peak VO2 increased by 1.4 ± 3.2 (16.9 ± 2.9 to 18.6 ± 4.8 mL.kg-1.min-1; p time = 0.011) and 1.5 ± 2.5 mL.kg-1.min-1 (16.8 ± 4.0 to 18.6 ± 5.5 mL.kg-1.min-1; p time = 0.011), and quality of life score decreased by 14 ± 15 (25.8 ± 14.8 to 10.3 ± 7.8 points; p time = 0.001) and 12 ± 28 points (33.8 ± 23.8 to 19.0 ± 15.1 points; p time = 0.001), but no difference was observed between groups (peak VO2: p interaction = 0.921 and quality of life: p interaction = 0.921). The functional and strength training increased the activity status index by 6.5 ± 12 and 5.2 ± 13 points (p time = 0.001), respectively, and gait speed by 0.2 ± 0.3 m/s (p time = 0.002) in both groups. CONCLUSIONS Functional and strength training are equally effective in improving peak VO2, quality of life, and functionality in individuals with HF. These findings suggest that functional training may be a promising and innovative exercise-based strategy to treat HF. TRIAL REGISTRATION NCT03321682. Registered date: 26/10/2017.
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Affiliation(s)
| | - Karina Costa Machado
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia Martins Bock
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Clinical Research Center, National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil
- Faculdades Integradas de Taquara, Taquara, RS, Brazil
| | | | | | | | - Nadine Clausell
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Beatriz D Schaan
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Clinical Research Center, National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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5
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Einsfeld L, Goldraich LA, Matte B, Clausell N, Valle FH. Pancreatitis as a Potential Trigger for Severe Accelerated Cardiac Allograft Vasculopathy Early Post Heart Transplant: A Case Report. Transplant Proc 2022; 54:2797-2799. [DOI: 10.1016/j.transproceed.2022.09.027] [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] [Received: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
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Scolari FL, Trott G, Schneider D, Goldraich LA, Frederico Tonietto T, Moura LZ, Bertoldi EG, Rover MM, Wolf JM, Souza DD, Clausell N, Polanczyk CA, Rohde LE, Rosa RG, Wainstein RV. Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve. Int J Artif Organs 2022; 45:292-300. [PMID: 35075937 DOI: 10.1177/03913988211070841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil. METHODS Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers' learning curve. The cohort was divided into two periods: from April 2017 to July 2018 (n = 24), and from August 2018 to December 2020 (n = 25). RESULTS The study enrolled 49 patients [age 59 (43-63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases. CONCLUSIONS Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.
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Affiliation(s)
- Fernando Luís Scolari
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Geraldine Trott
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniel Schneider
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Livia Adams Goldraich
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tulio Frederico Tonietto
- Division of Critical Care Medicine, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lídia Zytynski Moura
- Transplant Division, Cardiology Department, Irmandade Hospital da Santa Casa de Misericórdia de Curitiba, Curitiba, Parana, Brazil
| | | | - Marciane Maria Rover
- Heart Failure and Transplant Division, Instituto de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jonas Michel Wolf
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Denise de Souza
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nadine Clausell
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carisi Anne Polanczyk
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luis Eduardo Rohde
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Regis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Vugman Wainstein
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Einsfeld L, Hastenteufel LCT, Taber D, Clausell N, Goldraich LA. Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action. J Clin Pharm Ther 2021; 47:588-591. [PMID: 34841539 DOI: 10.1111/jcpt.13577] [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: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Clinical pharmacists' involvement in the care of solid organ transplant recipients has been discussed worldwide given its potential to improve clinical outcomes. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programmes nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centres in Brazil and compared them with accredited programmes in the United States. METHODS An electronic questionnaire was distributed to all 40 heart and lung transplant centres registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. Survey findings were compared to previously published data from accredited U.S. centres. RESULTS AND DISCUSSION From 22 centre respondents, ten (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translated into 158 (37.6%) transplant recipients without any direct pharmaceutical care. In centres with pharmacists (n = 12), none had a full-time professional dedicated to their heart and/or lung programmes. When compared to U.S. centres, there was a significantly lower insertion of clinical pharmacist activities among Brazilian centres. WHAT IS NEW AND CONCLUSION Our findings point to an unmet need related to clinical pharmacy activity within thoracic transplant programmes, especially in a developing country, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.
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Affiliation(s)
- Lídia Einsfeld
- Division of Clinical Pharmacy, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - David Taber
- Division of Transplant Surgery, Ralph H Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Nadine Clausell
- Division of Cardiology, Graduate Studies in Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Livia Adams Goldraich
- Division of Cardiology, Graduate Studies in Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Nazario RDA, Goldraich LA, Hastenteufel LCT, Santos ABS, Carrion L, Clausell N. Donor-recipient predicted heart mass ratio and right ventricular-pulmonary arterial coupling in heart transplant. Eur J Cardiothorac Surg 2021; 59:847-854. [PMID: 33860318 DOI: 10.1093/ejcts/ezaa391] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Right ventricular-pulmonary arterial (RV-PA) coupling interactions are largely unexplored in heart transplant patients. The outcome of this study was RV-PA coupling at 7 and 30 days after heart transplant and its association with donor-recipient size matching. METHODS Clinical, echocardiographic and haemodynamic data from a retrospective cohort of heart transplant recipients and respective donors were reviewed. Coupling between RV-PA was examined by assessing the RV fractional area change and pulmonary artery systolic pressure ratio. Donor-recipient size matching was assessed by the predicted heart mass (PHM) ratio, and groups with a PHM ratio <1 and ≥1 were compared. RESULTS Forty-four heart transplant recipients were included in this study (50 years, 57% male sex). Postoperative RV-PA coupling improved from 7 to 30 days (RV fractional area change/pulmonary artery systolic pressure 0.9 ± 0.3 vs 1.2 ± 0.3; P < 0.001). A positive association was found between an adequate PHM ratio and improvement of RV fractional area change/pulmonary artery systolic pressure at 30 days, independent of graft ischaemic time and pre-existent pulmonary hypertension (B coefficient 0.54; 95% confidence interval 0.11-0.97; P = 0.016; adjusted R2 = 0.24). CONCLUSIONS These findings highlight the role of PHM as a metric to help donor selection and suggest its impact in RV-PA coupling interactions post-heart transplant.
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Affiliation(s)
- Raffaela de Almeida Nazario
- Division of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Graduate Studies Program on Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Livia Adams Goldraich
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Angela B S Santos
- Graduate Studies Program on Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana Carrion
- Division of Cardiology, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nadine Clausell
- Graduate Studies Program on Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Marcondes-Braga FG, Moura LAZ, Issa VS, Vieira JL, Rohde LE, Simões MV, Fernandes-Silva MM, Rassi S, Alves SMM, de Albuquerque DC, de Almeida DR, Bocchi EA, Ramires FJA, Bacal F, Rossi JM, Danzmann LC, Montera MW, de Oliveira MT, Clausell N, Silvestre OM, Bestetti RB, Bernadez-Pereira S, Freitas AF, Biolo A, Barretto ACP, Jorge AJL, Biselli B, Montenegro CEL, dos Santos EG, Figueiredo EL, Fernandes F, Silveira FS, Atik FA, Brito FDS, Souza GEC, Ribeiro GCDA, Villacorta H, de Souza JD, Goldraich LA, Beck-da-Silva L, Canesin MF, Bittencourt MI, Bonatto MG, Moreira MDCV, Avila MS, Coelho OR, Schwartzmann PV, Mourilhe-Rocha R, Mangini S, Ferreira SMA, de Figueiredo JA, Mesquita ET. Emerging Topics Update of the Brazilian Heart Failure Guideline - 2021. Arq Bras Cardiol 2021; 116:1174-1212. [PMID: 34133608 PMCID: PMC8288520 DOI: 10.36660/abc.20210367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fabiana G. Marcondes-Braga
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Lídia Ana Zytynski Moura
- Pontifícia Universidade Católica de CuritibaCuritibaPRBrasilPontifícia Universidade Católica de Curitiba, Curitiba, PR – Brasil.
| | - Victor Sarli Issa
- Universidade da AntuérpiaBélgicaUniversidade da Antuérpia, – Bélgica
| | - Jefferson Luis Vieira
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Luis Eduardo Rohde
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Marcus Vinícius Simões
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoSão PauloSPBrasilFaculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP – Brasil.
| | - Miguel Morita Fernandes-Silva
- Universidade Federal do ParanáCuritibaPRBrasilUniversidade Federal do Paraná (UFPR), Curitiba, PR – Brasil.
- Quanta Diagnóstico por ImagemCuritibaPRBrasilQuanta Diagnóstico por Imagem, Curitiba, PR – Brasil.
| | - Salvador Rassi
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Silvia Marinho Martins Alves
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Denilson Campos de Albuquerque
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Dirceu Rodrigues de Almeida
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brasil.
| | - Edimar Alcides Bocchi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Felix José Alvarez Ramires
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil.
| | - Fernando Bacal
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - João Manoel Rossi
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil.
| | - Luiz Claudio Danzmann
- Universidade Luterana do BrasilCanoasRSBrasilUniversidade Luterana do Brasil, Canoas, RS – Brasil.
- Hospital São Lucas da PUC-RSPorto AlegreRSBrasilHospital São Lucas da PUC-RS, Porto Alegre, RS – Brasil.
| | | | - Mucio Tavares de Oliveira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Nadine Clausell
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Odilson Marcos Silvestre
- Universidade Federal do AcreRio BrancoACBrasilUniversidade Federal do Acre, Rio Branco, AC – Brasil.
| | - Reinaldo Bulgarelli Bestetti
- Universidade de Ribeirão PretoDepartamento de MedicinaRibeirão PretoSPBrasilDepartamento de Medicina da Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP – Brasil.
| | | | - Aguinaldo F. Freitas
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilHospital das Clínicas da Universidade Federal de Goiás (UFGO), Goiânia, GO – Brasil.
| | - Andréia Biolo
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Antonio Carlos Pereira Barretto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Antônio José Lagoeiro Jorge
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - Bruno Biselli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Carlos Eduardo Lucena Montenegro
- Pronto Socorro Cardiológico de PernambucoRecifePEBrasilPronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE – Brasil.
- Universidade de PernambucoRecifePEBrasilUniversidade de Pernambuco (UPE), Recife, PE – Brasil.
| | - Edval Gomes dos Santos
- Universidade Estadual de Feira de SantanaFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana, Feira de Santana, BA – Brasil.
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil.
| | - Estêvão Lanna Figueiredo
- Instituto OrizontiBelo HorizonteMGBrasilInstituto Orizonti, Belo Horizonte, MG – Brasil.
- Hospital Vera CruzBelo HorizonteMGBrasilHospital Vera Cruz, Belo Horizonte, MG – Brasil.
| | - Fábio Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Fabio Serra Silveira
- Fundação Beneficência Hospital de CirurgiaAracajuSEBrasilFundação Beneficência Hospital de Cirurgia (FBHC-Ebserh), Aracaju, SE – Brasil.
- Centro de Pesquisa Clínica do CoraçãoAracajuSEBrasilCentro de Pesquisa Clínica do Coração, Aracaju, SE – Brasil.
| | - Fernando Antibas Atik
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília (UnB), Brasília, DF – Brasil.
| | - Flávio de Souza Brito
- Universidade Estadual Paulista Júlio de Mesquita FilhoSão PauloSPBrasilUniversidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São Paulo, SP – Brasil.
| | - Germano Emílio Conceição Souza
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil.
- Hospital Regional de São José dos CamposSão PauloSPBrasilHospital Regional de São José dos Campos, São Paulo, SP – Brasil.
| | - Gustavo Calado de Aguiar Ribeiro
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas (PUCC), Campinas, SP – Brasil.
| | - Humberto Villacorta
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
| | - João David de Souza
- Hospital do Coração de MessejanaFortalezaCEBrasilHospital do Coração de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE – Brasil.
| | - Livia Adams Goldraich
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
| | - Luís Beck-da-Silva
- Hospital de Clínicas de Porto AlegrePorto AlegeRSBrasilHospital de Clínicas de Porto Alegre, Porto Alege, RS – Brasil.
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brasil.
| | - Manoel Fernandes Canesin
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrasilHospital Universitário da Universidade Estadual de Londrina, Londrina, PR – Brasil.
| | - Marcelo Imbroinise Bittencourt
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
- Hospital Universitário Pedro ErnestoRio de JaneiroRJBrasilHospital Universitário Pedro Ernesto, Rio de Janeiro, RJ – Brasil.
| | - Marcely Gimenes Bonatto
- Hospital Santa Casa de Misericórdia de CuritibaCuritibaPRBrasilHospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR – Brasil.
| | | | - Mônica Samuel Avila
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Otavio Rizzi Coelho
- Universidade Estadual de CampinasFaculdade de Ciências MédicasCampinasSPBrasilFaculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP – Brasil.
| | - Pedro Vellosa Schwartzmann
- Hospital Unimed Ribeirão PretoRibeirão PretoSPBrasilHospital Unimed Ribeirão Preto, Ribeirão Preto, SP – Brasil.
- Centro Avançado de PesquisaEnsino e Diagnóstico (CAPED)Ribeirão PretoSPBrasilCentro Avançado de Pesquisa, Ensino e Diagnóstico (CAPED), Ribeirão Preto, SP – Brasil.
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil.
| | - Sandrigo Mangini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | - Silvia Moreira Ayub Ferreira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP – Brasil.
| | | | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilFaculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ – Brasil.
- Treinamento Edson de Godoy Bueno / UHGCentro de EnsinoRio de JaneiroRJBrasilCentro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ – Brasil.
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10
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Goldraich LA, Silvestre OM, Gomes E, Biselli B, Montera MW. Emerging Topics in Heart Failure: COVID-19 and Heart Failure. Arq Bras Cardiol 2020; 115:942-944. [PMID: 33295461 PMCID: PMC8452204 DOI: 10.36660/abc.20201081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Edval Gomes
- Universidade Estadual de Feira de Santana, Feira de Santana, BA - Brasil
| | - Bruno Biselli
- Instituto do Coração da Universidade de São Paulo, São Paulo, SP - Brasil
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11
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do Nascimento DM, Machado KC, Bock PM, Saffi MAL, Goldraich LA, Silveira AD, Clausell N, Schaan BD. Cardiopulmonary exercise capacity and quality of life of patients with heart failure undergoing a functional training program: study protocol for a randomized clinical trial. BMC Cardiovasc Disord 2020; 20:200. [PMID: 32334527 PMCID: PMC7183632 DOI: 10.1186/s12872-020-01481-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Exercise intolerance is a common finding in heart failure that generates a vicious cycle in which the individual starts to limit his activities even more due to progressive fatigue. Regular physical exercise can increase the cardiopulmonary exercise capacity of these individuals. A new approach to physical exercise, known as functional training, could improve the oxygen consumption and quality of life of patients with heart failure; however, there is no information about the effect of this modality of exercise in this patient population. This randomized trial will compare the effects of 36 sessions of functional training versus strength training in heart failure patients. METHODS This randomized parallel-design examiner-blinded clinical trial includes individuals of both sexes aged ≥40 years receiving regular follow-up at a single academic hospital. Subjects will be randomly allocated to an intervention group (for 12-week functional training) or an active comparator group (for 12-week strength training). The primary outcomes will be the difference from baseline to the 3-month time point in peak oxygen consumption on cardiopulmonary exercise testing and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Secondary outcome measures will include functionality assessed by the Duke Activity Status Index and gait speed test; peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively; endothelial function by brachial artery flow-mediated dilation; lean body mass by arm muscle circumference; and participant adherence to the exercise programs classified as a percentage of the prescribed exercise dose. DISCUSSION The functional training program aims to improve the functional capacity of the individual using exercises that relate to his specific physical activity transferring gains effectively to one's daily life. In this context, we believe that that functional training can increase the cardiopulmonary exercise capacity and quality of life of patients with heart failure. The trial has been recruiting patients since October 2017. TRIAL REGISTRATION NCT03321682. Registered on October 26, 2017.
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Affiliation(s)
| | - Karina Costa Machado
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Patrícia Martins Bock
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Hospital de Clínicas de Porto Alegre, Clinical Research Center, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil.,Faculdades Integradas de Taquara, Taquara, RS, Brazil
| | | | | | | | - Nadine Clausell
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Beatriz D Schaan
- Exercise Pathophysiology Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil, Hospital de Clínicas de Porto Alegre, Clinical Research Center, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil.,Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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12
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Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DCD, Rassi S, Colafranceschi AS, Freitas AFD, Ferraz AS, Biolo A, Barretto ACP, Ribeiro ALP, Polanczyk CA, Gualandro DM, Almeida DR, Silva ERRD, Figueiredo EL, Mesquita ET, Marcondes-Braga FG, Cruz FDDD, Ramires FJA, Atik FA, Bacal F, Souza GEC, Almeida GLGD, Ribeiro GCDA, Villacorta H, Vieira JL, Souza JDD, Rossi JM, Figueiredo JAD, Moura LAZ, Goldraich LA, Beck-da-Silva L, Danzmann LC, Canesin MF, Bittencourt MI, Garcia MI, Bonatto MG, Simões MV, Moreira MDCV, Silva MMFD, Olivera MTD, Silvestre OM, Schwartzmann PV, Bestetti RB, Rocha RM, Simões R, Pereira SB, Mangini S, Alves SMM, Ferreira SMA, Issa VS, Barzilai VS, Martins WDA. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol 2019; 111:436-539. [PMID: 30379264 DOI: 10.5935/abc.20180190] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Antonio C. Pereira Barretto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Danielle Menosi Gualandro
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | - Estêvão Lanna Figueiredo
- Hospital Lifecenter, Belo Horizonte, MG - Brasil.,Hospital Vera Cruz, Belo Horizonte, MG - Brasil
| | | | - Fabiana G. Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fátima das Dores da Cruz
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Felix José 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
| | - Germano Emilio Conceição Souza
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Regional de São José dos Campos, São José dos Campos, SP - Brasil
| | | | | | | | | | - João David de Souza
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - Brasil
| | | | | | | | | | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Luiz Claudio Danzmann
- Universidade Luterana do Brasil, Canoas, RS - Brasil.,Hospital da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Maria da Consolação Vieira Moreira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Mucio Tavares de Olivera
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Pedro Vellosa Schwartzmann
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil.,Hospital Unimed Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | | | | | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Sandrigo Mangini
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Silvia Moreira Ayub Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Victor Sarli Issa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Wolney de Andrade Martins
- Universidade Federal Fluminense, Niterói, RJ - Brasil.,Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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13
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Alvarez JS, Goldraich LA, Nunes AH, Zandavalli MCB, Zandavalli RB, Belli KC, Rocha NSD, Fleck MPDA, Clausell N. Association between Spirituality and Adherence to Management in Outpatients with Heart Failure. Arq Bras Cardiol 2016; 106:491-501. [PMID: 27192385 PMCID: PMC4940148 DOI: 10.5935/abc.20160076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 11/25/2015] [Accepted: 02/19/2016] [Indexed: 12/23/2022] Open
Abstract
Background Spirituality may influence how patients cope with their illness. Objectives We assessed whether spirituality may influence adherence to management of
outpatients with heart failure. Methods Cross sectional study enrolling consecutive ambulatory heart failure patients
in whom adherence to multidisciplinary treatment was evaluated. Patients
were assessed for quality of life, depression, religiosity and spirituality
utilizing validated questionnaires. Correlations between adherence and
psychosocial variables of interest were obtained. Logistic regression models
explored independent predictors of adherence. Results One hundred and thirty patients (age 60 ± 13 years; 67% male) were
interviewed. Adequate adherence score was observed in 38.5% of the patients.
Neither depression nor religiosity was correlated to adherence, when
assessed separately. Interestingly, spirituality, when assessed by both
total score sum (r = 0.26; p = 0.003) and by all specific domains, was
positively correlated to adherence. Finally, the combination of
spirituality, religiosity and personal beliefs was an independent predictor
of adherence when adjusted for demographics, clinical characteristics and
psychosocial instruments. Conclusion Spirituality, religiosity and personal beliefs were the only variables
consistently associated with compliance to medication in a cohort of
outpatients with heart failure. Our data suggest that adequately addressing
these aspects on patient’s care may lead to an improvement in adherence
patterns in the complex heart failure management.
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Affiliation(s)
- Juglans Souto Alvarez
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Livia Adams Goldraich
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Neusa Sica da Rocha
- Division of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Pio de Almeida Fleck
- Division of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nadine Clausell
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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14
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Goldraich LA, Stehlik J, Kucheryavaya AY, Edwards LB, Ross HJ. Retransplant and Medical Therapy for Cardiac Allograft Vasculopathy: International Society for Heart and Lung Transplantation Registry Analysis. Am J Transplant 2016; 16:301-9. [PMID: 26274617 DOI: 10.1111/ajt.13418] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 01/28/2015] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 01/25/2023]
Abstract
Cardiac retransplantation for heart transplant recipients with advanced cardiac allograft vasculopathy (CAV) remains controversial. The International Society for Heart and Lung Transplantation Registry was used to examine survival in adult heart recipients with CAV who were retransplanted (ReTx) or managed medically (MM). Recipients transplanted between 1995 and 2010 who developed CAV and were either retransplanted within 2 years of CAV diagnosis (ReTx) or alive at ≥2 years after CAV diagnosis, managed medically (MM), without retransplant, constituted the study groups. Donor, recipient, transplant characteristics and long-term survival were compared. The population included 65 patients in ReTx and 4530 in MM. During a median follow-up of 4 years, there were 24 deaths in ReTx, and 1466 in MM. Survival was comparable at 9 years (55% in ReTx and 51% in MM; p = 0.88). Subgroup comparison suggested survival benefit for retransplant versus MM in patients who developed systolic graft dysfunction. Adjusted predictors for 2-year mortality were diagnosis of CAV in the early era and longer time since CAV diagnosis following primary transplant. Retransplant was not an independent predictor in the model. Challenges associated with retransplantation as well as improved CAV treatment options support the current consensus recommendation limiting retransplant to highly selected patients with CAV.
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Affiliation(s)
- L A Goldraich
- Cardiac Transplant Program, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
| | - J Stehlik
- University of Utah School of Medicine, Salt Lake City, UT
| | - A Y Kucheryavaya
- International Society for Heart and Lung Transplantation and United Network for Organ Sharing, Richmond, VA
| | - L B Edwards
- International Society for Heart and Lung Transplantation and United Network for Organ Sharing, Richmond, VA
| | - H J Ross
- Cardiac Transplant Program, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
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