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Search Results: 1 - 10 of 682 matches for " Edimar Alcides; "
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Heart transplants for patients with Chagas' heart disease
Bocchi, Edimar Alcides;
Sao Paulo Medical Journal , 1995, DOI: 10.1590/S1516-31801995000200021
Abstract: the role of heart transplants for treating chagas' heart disease is not quite clear. immunosuppression could lead to resurgence of t. cruzi infection with acute or chronic damage to the allograft. there are few publications regarding this issue. thus we reported the follow-up of 18-patients with chagas' heart disease submitted to orthotopic heart transplants from 1985 to 1993 at the heart institute. the patients were in functional class iv or iii, or ii, with sustained ventricular tachycardia episodes. the mean left ventricular ejection fraction was 25 ± 9% and the mean right ventricular ejection was 22 ± 6% (muga). immunosuppression was based on cyclosporin, azathioprine and corticosteroids. for specific post-transplant monitoring of t. cruzi infection, blood tests were performed (examination of blood or leukocyte concentrate, giemsa-stained blood smears, blood culture, xenodiagnosis, mouse inoculation) and tissue biopsy (skin or myocardium). in addition, complement fixation hemagglutination and immunofluorescence assays were performed. t. cruzi parasitemias were detected in 18 circumstances in 13 patients. resurgence of chagas' disease was diagnosed in 11 circumstances in 5 patients. fever, subcutaneous nodules and myocarditis predominated in these episodes. all episodes of parasitemia and chagas' disease resurgence were successfully treated with benzonidazole. all surviving patients had normal cardiac function despite left ventricular function worsening during some myocarditis episodes. neoplasias were important findings and 3 patients developed lymphoproliferative disease, 2 developed karposi's sarcoma and 1 patient developed skin cancer. the survival rates at 4 and 12 months were 83% and 49% respectively. the survival of patients who underwent heart transplants from august 1991 to april 1993 was 100% at 4 months and 75% at 12 months. heart transplants for chagas' heart disease may be associated with episodes of parasitemia and a reoccurrence of episodes of chag
Cardiac transplantation for Chagas' disease
Bacal,Fernando; Bocchi,Edimar Alcides;
Insuficiencia card?-aca , 2008,
Abstract: over the last 20 years the immunosuppression protocols in chagasic heart transplanted patients lived at least three different moments and we testified several changes and discoveries on chagas' disease reactivation, mortality and neoplasias development. the primary phase was important especially because, until that time, chagas' disease was an absolute contraindication for transplantation. the second phase started when immunosuppression protocol adjustment was made, with lower dosage to avoid adverse effects, especially neoplasias. nowadays strategies to change the immunosuppression, especially replacement of mycophenolate mofetil by azathioprine were shown to be effective in reducing chagas' disease reactivation. cardiac transplantation for chagas' disease is a reality. although chagasics have several different implications when submitted to the transplant comparing to others aethiologies, actually these difficulties are well known, so treatments and preventive strategies are also better established.
Application of the principles of evidence-based medicine in programs to assess high-cost procedures and medications
Bocchi Edimar Alcides,Marin Neto José Antonio
Arquivos Brasileiros de Cardiologia , 2001,
Endothelial function in pre-pubertal children at risk of developing cardiomyopathy: a new frontier
Tavares, Aline Cristina;Bocchi, Edimar Alcides;Guimar?es, Guilherme Veiga;
Clinics , 2012, DOI: 10.6061/clinics/2012(03)12
Abstract: although it is known that obesity, diabetes, and kawasaki's disease play important roles in systemic inflammation and in the development of both endothelial dysfunction and cardiomyopathy, there is a lack of data regarding the endothelial function of pre-pubertal children suffering from cardiomyopathy. in this study, we performed a systematic review of the literature on pre-pubertal children at risk of developing cardiomyopathy to assess the endothelial function of pre-pubertal children at risk of developing cardiomyopathy. we searched the published literature indexed in pubmed, bireme and scielo using the keywords 'endothelial', 'children', 'pediatric' and 'infant' and then compiled a systematic review. the end points were age, the pubertal stage, sex differences, the method used for the endothelial evaluation and the endothelial values themselves. no studies on children with cardiomyopathy were found. only 11 papers were selected for our complete analysis, where these included reports on the flow-mediated percentage dilatation, the values of which were 9.80±1.80, 5.90±1.29, 4.50±0.70, and 7.10±1.27 for healthy, obese, diabetic and pre-pubertal children with kawasaki's disease, respectively. there was no significant difference in the dilatation, independent of the endothelium, either among the groups or between the genders for both of the measurements in children; similar results have been found in adolescents and adults. the endothelial function in cardiomyopathic children remains unclear because of the lack of data; nevertheless, the known dysfunctions in children with obesity, type 1 diabetes and kawasaki's disease may influence the severity of the cardiovascular symptoms, the prognosis, and the mortality rate. the results of this study encourage future research into the consequences of endothelial dysfunction in pre-pubertal children.
Reproducibility of the self-controlled six-minute walking test in heart failure patients
Guimar?es, Guilherme Veiga;Carvalho, Vitor Oliveira;Bocchi, Edimar Alcides;
Clinics , 2008, DOI: 10.1590/S1807-59322008000200008
Abstract: introduction: the six-minute walk test (6wt) has been proposed to be a submaximal test, but could actually demand a high level of exercise intensity from the patient, expressed by a respiratory quotient >1.0, following the guideline recommendations. standardizing the 6wt using the borg scale was proposed to make sure that all patients undergo a submaximal walking test. purpose: to test the reproducibility of the six-minute treadmill cardiopulmonary walk test (6cwt) using the borg scale and to make sure that all patients undergo a submaximal test. methods: twenty-three male heart failure patients (50±9 years) were included; these patients had both ischemic (5) and non-ischemic (18) heart failure with a left ventricle ejection fraction of 23±7%, were diagnosed as functional class nyha ii-iii and were undergoing optimized drug therapy. patients were guided to walk at a pace between "relatively easy and slightly tiring" (11 and 13 on borg scale). the 6cwt using the borg scale was performed two times on a treadmill with zero inclination and patient control of speed with an interval of 24 hours. during the sixth minute, we analyzed ventilation (ve, l/min), respiratory quotient, oxygen consumption (vo2, ml/kg/min), ve/vco2 slope, heart rate (hr, bpm), systolic blood pressure (sbp, mmhg), diastolic (dbp, mmhg) blood pressure and distance. results: the intraclass correlation coefficients at the sixth minute were: hr (ri=0.96, p<0.0001), ve (ri=0.84, p<0.0001), sbp (ri=0.72, p=0.001), distance (ri=0.88, p<0.0001), vo2 (ri=0.92, p<0.0001), slopeve/vco2 (ri=0.86, p<0.0001) and rq<1 (ri=0.6, p=0.004). conclusion: using the 6cwt with the borg scale was reproducible, and it seems to be an appropriate method to evaluate the functional capacity of heart failure patients while making sure that they undergo a submaximal walking test.
The relationship between heart rate reserve and oxygen uptake reserve in heart failure patients on optimized and non-optimized beta-blocker therapy
Carvalho, Vitor Oliveira;Guimar?es, Guilherme Veiga;Bocchi, Edimar Alcides;
Clinics , 2008, DOI: 10.1590/S1807-59322008000600003
Abstract: background: the relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients either on non-optimized or off beta-blocker therapy is known to be unreliable. the aim of this study was to evaluate the relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients receiving optimized and non-optimized beta-blocker treatment during a treadmill cardiopulmonary exercise test. methods: a total of 27 sedentary heart failure patients (86% male, 50±12 years) on optimized beta-blocker therapy with a left ventricle ejection fraction of 33±8% and 35 sedentary non-optimized heart failure patients (75% male, 47±10 years) with a left ventricle ejection fraction of 30±10% underwent the treadmill cardiopulmonary exercise test (naughton protocol). resting and peak effort values of both the percentage of oxygen consumption reserve and percentage of heart rate reserve were, by definition, 0 and 100, respectively. results: the heart rate slope for the non-optimized group was derived from the points 0.949±0.088 (0 intercept) and 1.055±0.128 (1 intercept), p<0.0001. the heart rate slope for the optimized group was derived from the points 1.026±0.108 (0 intercept) and 1.012±0.108 (1 intercept), p=0.47. regression linear plots for the heart rate slope for each patient in the non-optimized and optimized groups revealed a slope of 0.986 (almost perfect) for the optimized group, but the regression analysis for the non-optimized group was 0.030 (far from perfect, which occurs at 1). conclusion: the relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in patients on optimized beta-blocker therapy was reliable, but this relationship was unreliable in non-optimized heart failure patients.
Efeitos do carvedilol (bloqueador b1,b2,a1) na insuficiência cardíaca refratária
Bocchi Edimar Alcides,Bacal Fernando,Bellotti Giovanni,Carrara Dirceu
Arquivos Brasileiros de Cardiologia , 1998,
Abstract: OBJETIVO: Os efeitos dos beta-bloqueadores na insuficiência cardíaca (IC) refratária n o têm sido adequadamente estudados. Investigamos os efeitos do carvedilol (bloqueador b1,b2,a1) nos sintomas e na fun o ventricular de portadores de IC refratária. MéTODOS: Foram estudados 21 pacientes, idade média de 56±10 anos, 9 em classe funcional (CF) IV, e 12 em CF III intermitente com IV. A dose inicial de carvedilol foi de 6,25mg e, se tolerada, aumentada progressivamente. A dose média final foi 42±11mg. Os pacientes foram submetidos a avalia es clínicas e eletrocardiográficas seriadas. Realizaram-se, antes e com 196±60 dias de evolu o, ecocardiograma e ventriculografia radioisotópica. RESULTADOS: O medicamento foi tolerado em 16 (76%) pacientes. Um paciente está em fase de titula o em CF II. Com 196±60 dias de evolu o observaram-se 8 pacientes em CF I e 7 em II; redu o da freqüência cardíaca de 96±15 para 67±10bpm (p<0,0001); redu o do diametro diastólico final de ventrículo esquerdo (VE) de 73±13 para 66±12mm (ecocardiograma) (p<0,009); e aumento da fra o de eje o de VE de 0,21±0,06 para 0,34±0,12 (p<0,0003). CONCLUS O: O carvedilol devido aos seus efeitos benéficos na fun o ventricular, remodelamento e CF é, se tolerado, uma potencial alternativa terapêutica no tratamento medicamentoso da IC refratária. Entretanto, estudos adicionais s o necessários para defini o do efeito a longo prazo neste específico subgrupo de pacientes.
Growth hormone for optimization of refractory heart failure treatment
Bocchi Edimar Alcides,Massuda Zyun,Guilherme Guimar?es,Carrara Dirceu
Arquivos Brasileiros de Cardiologia , 1999,
Abstract: It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day) for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 mg/l) and serum IGF-1 levels (from 130 to 300ng/ml) was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA) increased from 13 % to 18 % and to 28 % later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2 to 13.4 and to 16.2ml/kg/min later). The patient was "de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.
Valida??o da vers?o em português do Minnesota Living with Heart Failure Questionnaire
Carvalho, Vitor Oliveira;Guimar?es, Guilherme Veiga;Carrara, Dirceu;Bacal, Fernando;Bocchi, Edimar Alcides;
Arquivos Brasileiros de Cardiologia , 2009, DOI: 10.1590/S0066-782X2009000700008
Abstract: background: the minnesota living with heart failure questionnaire (mlhfq) is an important measurement instrument for assessing the quality of life of heart failure patients. despite being largely used within our context, the questionnaire had not yet been translated and validated into the portuguese language. objective: of this study was to translate and validate the portuguese version of the mlhfq for use in heart failure patients. methods: forty patients with heart failure (30 men, lvef 30±6%, 55% ischemic etiology, classified as nyha i to iii), clinically stable and on optimized drug therapy underwent maximal cardiopulmonary stress testing to assess their physical capacity. right after the test, the mlhfq duly translated into portuguese was administered by the same investigator. the nyha functional classification was provided by the medical team. results: the portuguese version of the mlhfq had the same structure and metrics of the original version. there was no difficulty in the administration of the questionnaire or in the patient's understanding of the questions. the portuguese version of the mlhfq was consistent with peak vo2, duration of the cardiopulmonary test, and nyha functional classification. there was no difference in the score mean for the questionnaire between the group of patients with ischemic etiology and the group with non-ischemic etiology. conclusion: the portuguese version of the mlhfq proposed in this study proved to be valid for heart failure patients, and constitutes a new and important instrument for assessing quality of life.
Exercise and heart failure. Relation of the severity of the disease to the anaerobic threshold and the respiratory compensation point
Guimar?es, Guilherme Veiga;Bellotti, Giovanni;Wajngarten, Mauricio;Teixeira, Luzimar;Ramires, José Franchini;Bocchi, Edimar Alcides;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999001000002
Abstract: objective - to identify, the anaerobic threshold and respiratory compensation point in patients with heart failure. methods - the study comprised 42 men,divided according to the functional class (fc) as follows: group i (gi) - 15 patients in fc i; group ii (gii) - 15 patients in fc ii; and group iii (giii) - 12 patients in fc iii. patients underwent a treadmill cardiopulmonary exercise test, where the expired gases were analyzed. results - the values for the heart rate (in bpm) at the anaerobic threshold were the following: gi, 122±27; gii, 117±17; giii, 114±22. at the respiratory compensation point, the heart rates (in bpm) were as follows: gi, 145±33; gii, 133±14; giii 123±22. the values for the heart rates at the respiratory compensation point in gi and giii showed statistical difference. the values of oxygen consumption (vo2) at the anaerobic threshold were the following (in ml/kg/min): gi, 13.6±3.25; gii, 10.77±1.89; giii, 8.7±1.44 and, at the respiratory compensation point, they were as follows: gi, 19.1±2.2; gii, 14.22±2.63; giii, 10.27±1.85. conclusion - patients with stable functional class i, ii, and iii heart failure reached the anaerobic threshold and the respiratory compensation point at different levels of oxygen consumption and heart rate. the role played by these thresholds in physical activity for this group of patients needs to be better clarified.
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