33 results on '"Farsky PS"'
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2. 3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY
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Gualandro, DM, primary, Yu, PC, additional, Caramelli, B, additional, Marques, AC, additional, Calderaro, D, additional, Fornari, LS, additional, Pinho, C, additional, Feitosa, ACR, additional, Polanczyk, CA, additional, Rochitte, CE, additional, Jardim, C, additional, Vieira, CLZ, additional, Nakamura, DYM, additional, Iezzi, D, additional, Schreen, D, additional, Eduardo L., Adam, additional, D'Amico, EA, additional, Lima, Q, additional, Burdmann, EA, additional, Pachón, EIM, additional, Braga, FGM, additional, Machado, FS, additional, Paula, FJ, additional, Carmo, GAL, additional, Feitosa-Filho, GS, additional, Prado, GF, additional, Lopes, HF, additional, Fernandes, JRC, additional, Lima, JJG, additional, Sacilotto, L, additional, Drager, LF, additional, Vacanti, LJ, additional, Rohde, LEP, additional, Prada, LFL, additional, Gowdak, LHW, additional, Vieira, MLC, additional, Monachini, MC, additional, Macatrão-Costa, MF, additional, Paixão, MR, additional, Oliveira Jr., MT, additional, Cury, P, additional, Villaça, PR, additional, Farsky, PS, additional, Siciliano, RF, additional, Heinisch, RH, additional, Souza, R, additional, Gualandro, SFM, additional, Accorsi, TAD, additional, and Mathias Jr., W, additional
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- 2017
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3. PCV3 - Budget Impact Analysis Of Adopting Evolocumab In The Brazilian Private Healthcare System For Patients With Uncontrolled LDL-C And High Cardiovascular Risk
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dos Santos, RF, Alves, FP, Urbich, M, Villa, G, and Farsky, PS
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- 2017
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4. Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024.
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Gualandro DM, Fornari LS, Caramelli B, Abizaid AAC, Gomes BR, Tavares CAM, Fernandes CJCDS, Polanczyk CA, Jardim C, Vieira CLZ, Pinho C, Calderaro D, Schreen D, Marcondes-Braga FG, Souza F, Cardozo FAM, Tarasoutchi F, Carmo GAL, Kanhouche G, Lima JJG, Bichuette LD, Sacilotto L, Drager LF, Vacanti LJ, Gowdak LHW, Vieira MLC, Martins MLFM, Lima MSM, Lottenberg MP, Aliberti MJR, Marchi MFS, Paixão MR, Oliveira Junior MT, Yu PC, Cury PR, Farsky PS, Pessoa RS, Siciliano RF, Accorsi TAD, Correia VM, and Mathias Junior W
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- 2024
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5. GPCRs overexpression and impaired fMLP-induced functions in neutrophils from chronic kidney disease patients.
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Scharf P, Sandri S, Rizzetto F, Xavier LF, Grosso D, Correia-Silva RD, Farsky PS, Gil CD, and Farsky SHP
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- Humans, Male, Female, Middle Aged, Aged, N-Formylmethionine Leucyl-Phenylalanine pharmacology, Receptors, G-Protein-Coupled metabolism, Reactive Oxygen Species metabolism, Receptors, Lipoxin metabolism, Receptors, CXCR4 metabolism, Neutrophils immunology, Neutrophils metabolism, Receptors, Formyl Peptide metabolism, Renal Insufficiency, Chronic metabolism, Renal Insufficiency, Chronic immunology
- Abstract
Introduction: G-protein coupled receptors (GPCRs) expressed on neutrophils regulate their mobilization from the bone marrow into the blood, their half-live in the circulation, and their pro- and anti-inflammatory activities during inflammation. Chronic kidney disease (CKD) is associated with systemic inflammatory responses, and neutrophilia is a hallmark of CKD onset and progression. Nonetheless, the role of neutrophils in CKD is currently unclear., Methods: Blood and renal tissue were collected from non-dialysis CKD (grade 3 - 5) patients to evaluate GPCR neutrophil expressions and functions in CKD development., Results: CKD patients presented a higher blood neutrophil-to-lymphocyte ratio (NLR), which was inversely correlated with the glomerular filtration rate (eGFR). A higher frequency of neutrophils expressing the senescent GPCR receptor (CXCR4) and activation markers (CD18
+ CD11b+ CD62L+ ) was detected in CKD patients. Moreover, CKD neutrophils expressed higher amounts of GPCR formyl peptide receptors (FPR) 1 and 2, known as neutrophil pro- and anti-inflammatory receptors, respectively. Cytoskeletal organization, migration, and production of reactive oxygen species (ROS) by CKD neutrophils were impaired in response to the FPR1 agonist (fMLP), despite the higher expression of FPR1. In addition, CKD neutrophils presented enhanced intracellular, but reduced membrane expression of the protein Annexin A1 (AnxA1), and an impaired ability to secrete it into the extracellular compartment. Secreted and phosphorylated AnxA1 is a recognized ligand of FPR2, pivotal in anti-inflammatory and efferocytosis effects. CKD renal tissue presented a low number of neutrophils, which were AnxA1+ ., Conclusion: Together, these data highlight that CKD neutrophils overexpress GPCRs, which may contribute to an unbalanced aging process in the circulation, migration into inflamed tissues, and efferocytosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Scharf, Sandri, Rizzetto, Xavier, Grosso, Correia-Silva, Farsky, Gil and Farsky.)- Published
- 2024
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6. Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy - 2024.
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Fernandes F, Simões MV, Correia EB, Marcondes-Braga FG, Coelho-Filho OR, Mesquita CT, Mathias Junior W, Antunes MO, Arteaga-Fernández E, Rochitte CE, Ramires FJA, Alves SMM, Montera MW, Lopes RD, Oliveira Junior MT, Scolari FL, Avila WS, Canesin MF, Bocchi EA, Bacal F, Moura LZ, Saad EB, Scanavacca MI, Valdigem BP, Cano MN, Abizaid AAC, Ribeiro HB, Lemos Neto PA, Ribeiro GCA, Jatene FB, Dias RR, Beck-da-Silva L, Rohde LEP, Bittencourt MI, Pereira ADC, Krieger JE, Villacorta Junior H, Martins WA, Figueiredo Neto JA, Cardoso JN, Pastore CA, Jatene IB, Tanaka ACS, Hotta VT, Romano MMD, Albuquerque DC, Mourilhe-Rocha R, Hajjar LA, Brito Junior FS, Caramelli B, Calderaro D, Farsky PS, Colafranceschi AS, Pinto IMF, Vieira MLC, Danzmann LC, Barberato SH, Mady C, Martinelli Filho M, Torbey AFM, Schwartzmann PV, Macedo AVS, Ferreira SMA, Schmidt A, Melo MDT, Lima Filho MO, Sposito AC, Brito FS, Biolo A, Madrini Junior V, Rizk SI, and Mesquita ET
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- Humans, Cardiomyopathy, Hypertrophic therapy, Cardiomyopathy, Hypertrophic diagnosis
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- 2024
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7. Importance of the Internal Thoracic Artery as the Source of Collateral Circulation in CABG Patients with Leriche Syndrome.
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Farsky PS, Sena MDB, Rabelato JT, Petisco ACGP, and Arnoni RT
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- Humans, Male, Middle Aged, Collateral Circulation physiology, Mammary Arteries physiopathology, Mammary Arteries transplantation, Coronary Artery Bypass adverse effects, Leriche Syndrome physiopathology, Leriche Syndrome diagnostic imaging, Leriche Syndrome surgery
- Abstract
In coronary artery bypass grafting (CABG) the use of the internal thoracic artery (ITA), is a Class I indication for the left anterior descending (LAD) artery. Atherosclerosis is a systemic disease, and peripheral arterial disease (PAD) is an important complicator of CABG, present in about one-third of the patients with coronary disease. In Leriche Syndrome, ITA can be the source of collateral circulation for arteries below the level of occlusion. Its inadvertent use can lead to serious ischemic complications in the dependent territories.
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- 2024
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8. Change of Strategy in Coronary Artery Bypass Graft Surgery Waiting List during the COVID-19 Pandemic: One-Year Follow-Up.
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Pereira FJSS, Menezes MP, Naranjo GCS, Delamain JHH, Costa JR, Issa M, Amato VL, Feres F, and Farsky PS
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- Humans, Follow-Up Studies, Pandemics prevention & control, Coronary Artery Bypass, Waiting Lists, COVID-19
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- 2023
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9. Optimal medical therapy with or without surgical revascularization and long-term outcomes in ischemic cardiomyopathy.
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Farsky PS, White J, Al-Khalidi HR, Sueta CA, Rouleau JL, Panza JA, Velazquez EJ, and O'Connor CM
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- Humans, Stroke Volume, Ventricular Function, Left, Treatment Outcome, Coronary Artery Disease surgery, Myocardial Ischemia complications, Myocardial Ischemia therapy, Heart Failure surgery, Cardiomyopathies drug therapy, Cardiomyopathies complications, Ventricular Dysfunction, Left
- Abstract
Objectives: Optimal medical therapy in patients with heart failure and coronary artery disease is associated with improved outcomes. However, whether this association is influenced by the performance of coronary artery bypass grafting is less well established. Thus, the aim of this study was to determine the possible relationship between coronary artery bypass grafting and optimal medical therapy and its effect on the outcomes of patients with ischemic cardiomyopathy., Methods: The Surgical Treatment for Ischemic Heart Failure trial randomized 1212 patients with coronary artery disease and left ventricular ejection fraction 35% or less to coronary artery bypass grafting with medical therapy or medical therapy alone with a median follow-up over 9.8 years. For the purpose of this study, optimal medical therapy was collected at baseline and 4 months, and defined as the combination of 4 drugs: angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, statin, and 1 antiplatelet drug., Results: At baseline and 4 months, 58.7% and 73.3% of patients were receiving optimal medical therapy, respectively. These patients had no differences in important parameters such as left ventricular ejection fraction and left ventricular volumes. In a multivariable Cox model, optimal medical therapy at baseline was associated with a lower all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = .001). When landmarked at 4 months, optimal medical therapy was also associated with a lower all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.62-0.99; P = .04). There was no interaction between the benefit of optimal medical therapy and treatment allocation., Conclusions: Optimal medical therapy was associated with improved long-term survival and lower cardiovascular mortality in patients with ischemic cardiomyopathy and should be strongly recommended., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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10. Renal function and coronary bypass surgery in patients with ischemic heart failure.
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Doenst T, Haddad H, Stebbins A, Hill JA, Velazquez EJ, Lee KL, Rouleau JL, Sopko G, Farsky PS, and Al-Khalidi HR
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- Aged, Cardiovascular Agents adverse effects, Female, Heart Failure diagnostic imaging, Heart Failure mortality, Heart Failure physiopathology, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia mortality, Myocardial Ischemia physiopathology, Prospective Studies, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic mortality, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Cardiovascular Agents therapeutic use, Coronary Artery Bypass adverse effects, Coronary Artery Bypass mortality, Glomerular Filtration Rate, Heart Failure drug therapy, Kidney physiopathology, Myocardial Ischemia surgery, Renal Insufficiency, Chronic physiopathology
- Abstract
Objective: Chronic kidney disease is a known risk factor in cardiovascular disease, but its influence on treatment effect of bypass surgery remains unclear. We assessed the influence of chronic kidney disease on 10-year mortality and cardiovascular outcomes in patients with ischemic heart failure treated with medical therapy (medical treatment) with or without coronary artery bypass grafting., Methods: We calculated the baseline estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula, chronic kidney disease stages 1-5) from 1209 patients randomized to medical treatment or coronary artery bypass grafting in the Surgical Treatment for IsChemic Heart failure trial and assessed its effect on outcome., Results: In the overall Surgical Treatment for IsChemic Heart failure cohort, patients with chronic kidney disease stages 3 to 5 were older than those with stages 1 and 2 (66-71 years vs 54-59 years) and had more comorbidities. Multivariable modeling revealed an inverse association between estimated glomerular filtration rate and risk of death, cardiovascular death, or cardiovascular rehospitalization (all P < .001, but not for stroke, P = .697). Baseline characteristics of the 2 treatment arms were equal for each chronic kidney disease stage. There were significant improvements in death or cardiovascular rehospitalization with coronary artery bypass grafting (stage 1: hazard ratio, 0.71; confidence interval, 0.53-0.96, P = .02; stage 2: hazard ratio, 0.71; confidence interval, 0.59-0.84, P < .0001; stage 3: hazard ratio, 0.76; confidence interval, 0.53-0.96, P = .03). These data were inconclusive in stages 4 and 5 for insufficient patient numbers (N = 28). There was no significant interaction of estimated glomerular filtration rate with the treatment effect of coronary artery bypass grafting (P = .25 for death and P = .54 for death or cardiovascular rehospitalization)., Conclusions: Chronic kidney disease is an independent risk factor for mortality in patients with ischemic heart failure with or without coronary artery bypass grafting. However, mild to moderate chronic kidney disease does not appear to influence long-term treatment effects of coronary artery bypass grafting., (Copyright © 2020 The American Association for Thoracic Surgery. All rights reserved.)
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- 2022
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11. Training Non-Cardiologists Could Improve the Treatment Results of ST Elevation Myocardial Infarction.
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Cesar LAM, Mansur AP, Ramos RF, Magalhães C, Ferreira JFM, Mioto BM, Oliveira NA, Farsky PS, Amaral AZ, and Moreno ACC
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- Brazil epidemiology, Electrocardiography, Hospital Mortality, Humans, Emergency Medical Services, Myocardial Infarction therapy, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction therapy
- Abstract
Background: According to the World Health Organization, emerging countries will have an enormous growth in the number of heart attacks and related deaths. The main medical issue in Brazil is mortality caused by acute ST elevation myocardial infarction (STEMI). The Society of Cardiology in the State of São Paulo has never trained non-cardiologists as emergency personnel. Patients usually seek help from emergency departments instead of calling for an ambulance., Objectives: We aimed at reducing in-hospital death rates from acute myocardial infarction by training emergency personnel in the city of Sao Paulo., Methods: We used a training program for the personnel of five hospitals with >100 patients admitted with STEMI per year, and at least 15% in-hospital STEMI-associated mortality rate. We performed internet training, biannual-quarterly symposia for up to 400 participants, informative folders and handouts. Statistical analysis used the two proportion comparison test with p <0.05., Results: Nearly 200 physicians and 350 nurses attended at least one training from May 2010 to December 2013. Initially, many emergency physicians could not recognize an acute myocardial infarction on the electrocardiogram, but tele-electrocardiography is used in some emergency departments to determine the diagnosis. The death rate in the five hospitals decreased from 25.6%, in 2009, to 18.2%, in 2010 (p=0.005). After the entire period of training, the STEMI-associated death rate in all public hospitals of São Paulo decreased from 14.31%, in 2009, to 11.25%, in 2014 (p<0.0001)., Conclusion: Even simple training programs for emergency personnel can greatly reduce acute myocardial infarction death rates in undeveloped countries.
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- 2021
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12. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021.
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFO, Santos ECL, Piegas LS, Soeiro AM, Negri AJA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLAA, Sena JP, Peixoto JM, Souza JA, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LAO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MT, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VMG, Chalela WA, and Mathias Júnior W
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- Angina, Unstable diagnosis, Angina, Unstable therapy, Brazil, Electrocardiography, Humans, Cardiology, Myocardial Infarction therapy
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- 2021
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13. Coronary Artery Bypass Surgery in Patients With COVID-19: What Have We Learned?
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Farsky PS, Feriani D, Valente BBP, Andrade MAG, Amato VL, Carvalho L, Ibanes AS, Godoy LF, Arnoni RT, and Abboud CS
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- Adult, Aged, COVID-19 mortality, COVID-19 prevention & control, COVID-19 transmission, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Female, Hospital Mortality, Humans, Infection Control, Male, Middle Aged, Postoperative Complications mortality, Risk Assessment, Risk Factors, Time Factors, Time-to-Treatment, Treatment Outcome, COVID-19 diagnosis, Coronary Artery Bypass adverse effects, Coronary Artery Bypass mortality, Coronary Artery Disease surgery
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- 2021
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14. Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial.
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Lopes RD, Alexander KP, Stevens SR, Reynolds HR, Stone GW, Piña IL, Rockhold FW, Elghamaz A, Lopez-Sendon JL, Farsky PS, Chernyavskiy AM, Diaz A, Phaneuf D, De Belder MA, Ma YT, Guzman LA, Khouri M, Sionis A, Hausenloy DJ, Doerr R, Selvanayagam JB, Maggioni AP, Hochman JS, and Maron DJ
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- Aged, Disease-Free Survival, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Survival Rate, Heart Failure mortality, Heart Failure physiopathology, Heart Failure therapy, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Myocardial Infarction therapy, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Ventricular Dysfunction, Left therapy
- Abstract
Background: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is ≥35% but <45% is unknown., Methods: Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) ≥35%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF/LVD at baseline versus those without HF/LVD. Median follow-up was 3.2 years., Results: There were 398 (7.7%) participants with HF/LVD at baseline, of whom 177 had HF/LVEF >45%, 28 HF/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF/LVD, participants with HF/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, -12.1% [95% CI, -22.6 to -1.6%]), whereas those without HF/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, -1.6% [95% CI, -3.8% to 0.7%]; P interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy-associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF., Conclusions: ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
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- 2020
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15. Dysregulation of microRNAs and target genes networks in human abdominal aortic aneurysm tissues.
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Araujo NNF, Lin-Wang HT, Germano JF, Farsky PS, Feldman A, Rossi FH, Izukawa NM, Higuchi ML, Savioli Neto F, Hirata MH, and Bertolami MC
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- Adult, Aged, Aortic Aneurysm, Abdominal pathology, Cohort Studies, Female, Humans, Male, Middle Aged, Reverse Transcriptase Polymerase Chain Reaction, Signal Transduction genetics, Aortic Aneurysm, Abdominal genetics, Gene Expression Profiling methods, Gene Expression Regulation, Gene Regulatory Networks, MicroRNAs genetics
- Abstract
Background: Abdominal aortic aneurysm (AAA) is a pathological enlargement of infrarenal aorta close to the aortic bifurcation, and it is an important cause of mortality in the elderly. Therefore, the biomarker identification for early diagnosis is of great interest for clinical benefit. It is known that microRNAs (miRNAs) have important roles via target genes regulation in many diseases. This study aimed to identify miRNAs and their target genes involved in the pathogenesis of AAA., Methods: Tissue samples were obtained from patients who underwent AAA surgery and from organ donors (control group). Quantitative PCR Array was applied to assess 84 genes and 384 miRNAs aiming to identify differentially expressed targets (AAA n = 6, control n = 6), followed by validation in a new cohort (AAA n = 18, control n = 6) by regular qPCR. The functional interaction between validated miRNAs and target genes was performed by the Ingenuity Pathway Analysis (IPA) software., Results: The screening cohort assessed by PCR array identified 10 genes and 59 miRNAs differentially expressed (≥2-fold change, p<0.05). Among these, IPA identified 5 genes and 9 miRNAs with paired interaction. ALOX5, PTGIS, CX3CL1 genes, and miR-193a-3p, 125b-5p, 150-5p maintained a statistical significance in the validation cohort. IPA analysis based on the validated genes and miRNAs revealed that eicosanoid and metalloproteinase/TIMP synthesis are potentially involved in AAA., Conclusion: Paired interactions of differentially expressed ALOX5, PTGIS, CX3CL1 genes, and miR-193b-3p, 125b-5p, 150-5p revealed a potentially significant role of the eicosanoid synthesis and metalloproteinase/TIMP pathways in the AAA pathogenesis., Competing Interests: The authors have declared that no competing interests exist.
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- 2019
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16. Use of Quality of Life in Cardiovascular Surgery in Coronary Artery Bypass Grafting: Validation, Reproducibility, and Quality of Life in One Year of Follow-Up.
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Bond MMK, de Oliveira JLR, Farsky PS, Amato VL, Jara AA, Farias E, Jacomine AM, Sehn A, França JÍD, de Souza LCB, and Dos Santos MA
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- Aged, Brazil, Cardiovascular Surgical Procedures methods, Cardiovascular Surgical Procedures mortality, Cardiovascular Surgical Procedures psychology, Cohort Studies, Coronary Artery Bypass methods, Coronary Artery Bypass mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Time Factors, Coronary Artery Bypass psychology, Quality of Life, Surveys and Questionnaires, Survivors psychology
- Abstract
Background: The objectives of this study are to validate the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire and to observe the evolution of quality of life in the first year of postoperative follow-up of patients who underwent coronary artery bypass grafting (CABG)., Methods: This was a prospective observational study of patients undergoing CABG from July 2016 to June 2017 who survived and answered the QLCS with 1, 6, and 12 months of follow-up. Validation was evaluated for internal consistency by Cronbach's alpha, test-retest reproducibility by correlation coefficient of concordance, and accuracy for interrater reliability by the kappa statistic. The nonparametric analysis of variance test was used for analysis of repeated measures, during follow-up, of the QLCS was considered significant at p < 0.05., Results: Included were 360 patients, with a mean age of 63 years; 72% were men. Cronbach's alpha was 0.82, demonstrating adequate internal consistency. The correlation coefficient of concordance was 0.93 and accuracy 0.99, showing good precision and accuracy. The kappa statistic for questions ranged from 0.58 to 0.78, which ensures a moderate reproducibility. Scores of the QLCS in patients undergoing CABG of 17.69, 18.82, and 19.52 were found at 1, 6, and 12 months, respectively. Thus there was a progressive improvement in quality of life over the first year of follow-up (p < 0.0001)., Conclusions: The QLCS proved to be a good questionnaire in this population, with adequate internal consistency and moderate reproducibility. Its use revealed a progressive and significant improvement in the quality of life of patients undergoing CABG., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2019
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17. Quality of Life in Cardiovascular Surgery: Elaboration and Initial Internal Validation of a Quality of Life Questionnaire.
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Bond MMK, Oliveira JLR, Souza LCB, Farsky PS, Amato VL, Togna DJD, Ghorayeb SK, and Santos MAD
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- Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Cardiovascular Surgical Procedures psychology, Quality of Life, Surveys and Questionnaires
- Abstract
Objective: Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery., Methods: Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%., Results: After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P<0.001), shortness of breath (P<0.001), and return to physical activity (P<0.001) were statistically significant., Conclusion: The process of elaboration and validation of questionnaires includes a series of steps. The QLCS questionnaire is probably an adequate tool for the evaluation of QoL in the postoperative patient of cardiovascular surgery, in this first stage of internal validation.
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- 2018
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18. Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent.
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Farsky PS, Hirata MH, Arnoni RT, Almeida AFS, Issa M, Lima PHO, Higuchi ML, and Lin-Wang HT
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- Arteritis diagnosis, Case-Control Studies, Female, Humans, Immunohistochemistry, Male, Middle Aged, Reverse Transcriptase Polymerase Chain Reaction, Angioplasty, Balloon, Coronary adverse effects, Arteritis etiology, Biomarkers blood, Blood Cells metabolism, Myocardial Revascularization adverse effects, Stents adverse effects
- Abstract
Background: Studies have pointed out a higher mortality after coronary artery bypass surgery (CABG) in patients with stent., Objective: To evaluate inflammatory markers in peripheral blood cells and in coronary artery tissue samples obtained during CABG in patients with stent compared to controls., Methods: The case series consisted of two groups, one with previous stent implantation (n = 41) and one control (n = 26). The expression of the LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG genes was analyzed in peripheral blood cells collected preoperatively. The coronary artery was evaluated for: interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha and IFN-gamma by immunohistochemistry. A total of 176 tissue samples were grouped for analysis in: A1- arteries with stent (n = 38); A2- native arteries from patients with stent in another artery (n = 68); and A3- arteries without stent from controls undergoing routinely CABG surgery (n = 70). A significance level of 0.05 was adopted., Results: Patients with stent showed higher TNF (p = 0.03) and lower CD40 gene expression (p = 0.01) in peripheral blood cells than controls without stent. In coronary artery samples, the TNF-alpha protein staining was higher in the group A1, not only in the intima-media layer (5.16 ± 5.05 vs 1.90 ± 2.27; p = 0.02), but also in the adipose tissue (6.69 ± 3.87 vs 2.27 ± 4.00; p < 0.001). Furthermore, group A1 had a higher interleukin-6 protein staining in adipose tissue than group A3 (p = 0.04)., Conclusion: We observed a persistently higher systemic TNF expression associated with exacerbated TNF-alpha and interleukin-6 local production in patients with stents. This finding may contribute to a worse clinical outcome.
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- 2018
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19. Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization: Results From the STICH Trial (Surgical Treatment for Ischemic Heart Failure).
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Piña IL, Zheng Q, She L, Szwed H, Lang IM, Farsky PS, Castelvecchio S, Biernat J, Paraforos A, Kosevic D, Favaloro LE, Nicolau JC, Varadarajan P, Velazquez EJ, Pai RG, Cyrille N, Lee KL, and Desvigne-Nickens P
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Coronary Artery Bypass, Coronary Disease mortality, Coronary Disease physiopathology, Coronary Disease surgery, Sex Characteristics
- Abstract
Background: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term benefit of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study)., Methods: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction ≤35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex., Results: At baseline, women were older (63.4 versus 59.3 years; P =0.016) with higher body mass index (27.9 versus 26.7 kg/m
2 ; P =0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P <0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P <0.05). Over 10 years of follow-up, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confidence interval, 0.52-0.86; P =0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confidence interval, 0.48-0.89; P =0.006) were significantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no significant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P >0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P =0.187) between sexes among patients randomized to CABG per protocol as initial treatment., Conclusions: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595., (© 2018 American Heart Association, Inc.)- Published
- 2018
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20. Blood Transfusion and Increased Perioperative Risk in Coronary Artery Bypass Grafts.
- Author
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Campos IC, Tanganelli V, Maues HP, Coelho MCM, Martins FA, Munhoz G, Egito JGT, Souza HCC, Giannini CMC, and Farsky PS
- Subjects
- Aged, Blood Transfusion mortality, Coronary Artery Bypass methods, Coronary Artery Bypass mortality, Female, Hospital Mortality, Humans, Infections etiology, Male, Middle Aged, Myocardial Ischemia etiology, Perioperative Period, Postoperative Complications, Retrospective Studies, Risk Factors, Blood Transfusion statistics & numerical data, Coronary Artery Bypass adverse effects
- Abstract
Objective: To correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG)., Methods: Transfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results., Results: The transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively]., Conclusion: The use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.
- Published
- 2017
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21. Influence of carotid injury in post-myocardial revascularization surgery and its late evolution.
- Author
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Revelo MS, Oliveira DP, Arantes FB, Batista CC, França JI, Friolani SC, Assef JE, Barbosa JE, Petisco AC, and Farsky PS
- Subjects
- Aged, Aged, 80 and over, Carotid Artery Injuries mortality, Carotid Stenosis complications, Female, Humans, Kaplan-Meier Estimate, Male, Multivariate Analysis, Myocardial Revascularization mortality, Perioperative Period, Retrospective Studies, Risk Factors, Stroke mortality, Time Factors, Treatment Outcome, Carotid Artery Injuries complications, Myocardial Revascularization adverse effects, Stroke etiology
- Abstract
Background: Approximately 30% of perioperative CVA of myocardial revascularization surgery (MRS) are a result of carotid injuries, without reduction of risk confirmed by perioperative intervention., Objectives: Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS., Methods: Observational, retrospective study, evaluating 1169 patients aged > 69 years undergoing MRS from January, 2006 and December, 2010, monitored, on average, for 49 months. All patients were subjected to ultrasonography of carotids before MRS. It was defined as carotid disease when lesion > 50%. The primary outcome was composed of CVA incidence, transitory ischemic accident (TIA) and death due CVA., Results: Prevalence of carotid disease was of 19.9% of patients. The incidence of primary outcome between unhealthy and healthy patients was of 6.5% and 3.7%, respectively (p = 0.0018). In the first 30 days, there were 18.2% of events. Were related to carotid disease: renal dysfunction (OR 2.03, IC95% 1.34-3.07; p < 0.01), peripheral arterial disease (OR 1.80, IC95% 1.22-2.65; p < 0.01) and previous myocardial infarction (OR 0.47, IC95% 0.35-0.65; p < 0.01). Regarding the primary outcome, were associated the previous TIA (OR 5.66, IC95% 1.67-6.35; p < 0.01) and renal dysfunction (OR 3.28, IC95% 1.67-6.45; p < 0.01). In patients with lesion >70%, perioperative carotid intervention demonstrated an incidence of 16% in primary outcome compared to 4.3% in conservatory treatment (p = 0.056) with no difference between percutaneous and surgical approaches (p = 0.516)., Conclusion: Carotid disease increases the risk of CVA, TIA or death due to CVA in MRS. However, the carotid intervention was not related to reduction of primary outcome.
- Published
- 2013
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22. [Update and focus on arterial vascular surgeries from the II Guidelines for Perioperative Evaluation of the Brazilian Society of Cardiology].
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Marques AC, Bellen BV, Caramelli B, Presti C, Pinho C, Calderaro D, Gualandro DM, Carvalho FC, Carmo GA, Corrêa Filho H, Casella IB, Fornari LS, Vacanti LJ, Vieira ML, Monachini MC, Luccia Nd, Yu PC, Farsky PS, Heinisch RH, Gualandro SF, and Mathias W Jr
- Subjects
- Anticoagulants therapeutic use, Brazil, Cardiovascular Diseases diagnosis, Electrocardiography standards, Humans, Monitoring, Intraoperative methods, Myocardial Revascularization standards, Patient Discharge standards, Perioperative Period standards, Platelet Aggregation Inhibitors therapeutic use, Risk Assessment, Societies, Medical, Cardiovascular Diseases surgery, Intraoperative Complications prevention & control, Perioperative Care standards
- Published
- 2013
- Full Text
- View/download PDF
23. [Brazilian guidelines on platelet antiaggregants and anticoagulants in cardiology].
- Author
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Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum A Jr, Marques AC, Franci A, Manica AL, Volschan A, De Paola AA, Greco AI, Ferreira AC, Sousa AC, Pesaro AE, Simão AF, Lopes AS, Timerman A, Ramos AI, Alves BR, Caramelli B, Mendes BA, Polanczyk CA, Montenegro CE, Barbosa CJ, Serrano CV Jr, Melo CC, Pinho C, Moreira DA, Calderaro D, Gualandro DM, Armaganijan D, Machado Neto EA, Bocchi EA, Paiva EF, Stefanini E, D'Amico E, Evaristo EF, Silva EE, Fernandes F, Brito FS Jr, Bacal F, Ganem F, Gomes FL, Mattos FR, Moraes Neto FR, Tarasoutchi F, Darrieux FC, Feitosa GS, Fenelon G, Morais GR, Correa Filho H, Castro I, Gonçalves I Jr, Atié J, Souza Neto JD, Ferreira JF, Nicolau JC, Faria Neto JR, Annichino-Bizzacchi JM, Zimerman LI, Piegas LS, Pires LJ, Baracioli LM, Silva LB, Mattos LA, Lisboa LA, Magalhães LP, Lopes MA, Montera MW, Figueiredo MJ, Malachias MV, Gaz MV, Andrade MD, Bacellar MS, Barbosa MR, Clausell NO, Dutra OP, Coelho OR, Yu PC, Lavítola PL, Lemos Neto PA, Andrade PB, Farsky PS, Franco RA, Kalil RA, Lopes RD, Esporcatte R, Heinisch RH, Kalil Filho R, Giraldez RR, Alves RC, Leite RE, Gagliardi RJ, Ramos RF, Montenegro ST, Accorsi TA, Jardim TS, Scudeler TL, Moisés VA, and Portal VL
- Subjects
- Acute Coronary Syndrome drug therapy, Atrial Fibrillation drug therapy, Brazil, Chagas Disease drug therapy, Female, Heart Failure drug therapy, Humans, Ischemic Attack, Transient drug therapy, Myocardial Infarction drug therapy, Perioperative Period, Societies, Medical, Stroke drug therapy, Venous Thromboembolism drug therapy, Anticoagulants therapeutic use, Cardiovascular Diseases drug therapy, Platelet Aggregation Inhibitors therapeutic use
- Published
- 2013
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24. Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery.
- Author
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Egito JG, Abboud CS, Oliveira AP, Máximo CA, Montenegro CM, Amato VL, Bammann R, and Farsky PS
- Subjects
- Aged, Combined Modality Therapy methods, Female, Humans, Male, Mediastinitis etiology, Middle Aged, Retrospective Studies, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Coronary Artery Bypass adverse effects, Hyperbaric Oxygenation, Mediastinitis therapy
- Abstract
Objective: To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery., Methods: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy., Results: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated., Conclusion: The initial data showed favorable clinical outcomes.
- Published
- 2013
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25. Inducible myocardial ischemia and outcomes in patients with coronary artery disease and left ventricular dysfunction.
- Author
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Panza JA, Holly TA, Asch FM, She L, Pellikka PA, Velazquez EJ, Lee KL, Borges-Neto S, Farsky PS, Jones RH, Berman DS, and Bonow RO
- Subjects
- Coronary Angiography, Coronary Artery Disease diagnosis, Coronary Artery Disease therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Ischemia diagnosis, Myocardial Ischemia therapy, Prognosis, Prospective Studies, Severity of Illness Index, Stroke Volume, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left physiopathology, Coronary Artery Bypass methods, Coronary Artery Disease complications, Echocardiography, Stress methods, Fibrinolytic Agents therapeutic use, Myocardial Ischemia etiology, Thrombolytic Therapy methods, Ventricular Dysfunction, Left classification
- Abstract
Objectives: The study objectives were to test the hypotheses that ischemia during stress testing has prognostic value and identifies those patients with coronary artery disease (CAD) with left ventricular (LV) dysfunction who derive the greatest benefit from coronary artery bypass grafting (CABG) compared with medical therapy., Background: The clinical significance of stress-induced ischemia in patients with CAD and moderately to severely reduced LV ejection fraction (EF) is largely unknown., Methods: The STICH (Surgical Treatment for IsChemic Heart Failure) trial randomized patients with CAD and EF ≤35% to CABG or medical therapy. In the current study, we assessed the outcomes of those STICH patients who underwent a radionuclide (RN) stress test or a dobutamine stress echocardiogram (DSE). A test was considered positive for ischemia by RN testing if the summed difference score (difference in tracer activity between stress and rest) was ≥4 or if ≥2 of 16 segments were ischemic during DSE. Clinical endpoints were assessed by intention to treat during a median follow-up of 56 months., Results: Of the 399 study patients (51 women, mean EF 26 ± 8%), 197 were randomized to CABG and 202 were randomized to medical therapy. Myocardial ischemia was induced during stress testing in 256 patients (64% of the study population). Patients with and without ischemia were similar in age, multivessel CAD, previous myocardial infarction, LV EF, LV volumes, and treatment allocation (all p = NS). There was no difference between patients with and without ischemia in all-cause mortality (hazard ratio: 1.08; 95% confidence interval: 0.77 to 1.50; p = 0.66), cardiovascular mortality, or all-cause mortality plus cardiovascular hospitalization. There was no interaction between ischemia and treatment for any clinical endpoint., Conclusions: In CAD with severe LV dysfunction, inducible myocardial ischemia does not identify patients with worse prognosis or those with greater benefit from CABG over optimal medical therapy. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595)., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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- View/download PDF
26. Use of the pectoralis major fasciocutaneous flap in the treatment of post sternotomy dehiscence: a new approach.
- Author
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Anger J, Farsky PS, Almeida AF, Arnoni RT, and Dantas DC
- Subjects
- Aged, Female, Humans, Inventions, Male, Middle Aged, Surgical Wound Infection surgery, Treatment Outcome, Fasciotomy, Pectoralis Muscles transplantation, Sternotomy adverse effects, Sternum surgery, Surgical Flaps, Surgical Wound Dehiscence surgery
- Abstract
Objective: To describe a new surgical technique for the treatment dehiscence after median thoracotomy transsternal using fasciocutaneous flap composed of the pectoralis major fascia., Methods: Between January 2009 and December 2010, from 1,573 patients submitted to coronary artery bypass graft, 21 developed wound dehiscence after sternotomy and were treated with bilateral pectoralis major muscle fasciocutaneous flap, including partial portion of the rectus abdominis fascia. Patients were followed for a minimum of 90 days postoperatively., Results: All patients had favorable outcome following 90 days, not having any partial or total dehiscence. There were no cases of postoperative infection., Conclusion: The procedure was rapid and effective. Compared with techniques using muscle, myocutaneous or greater omentum flaps, this surgery was less aggressive and maintained the integrity of tissue region. The authors considered that this technique should be used as the first option, leaving the flaps to more complex cases of relapse.
- Published
- 2012
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27. Impact of renal failure on in-hospital outcomes after coronary artery bypass surgery.
- Author
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Barbosa RR, Cestari PF, Capeletti JT, Peres GM, Ibañez TL, da Silva PV, Farran JA, Amato VL, and Farsky PS
- Subjects
- Acute Kidney Injury etiology, Aged, Atrial Fibrillation complications, Brazil epidemiology, Coronary Artery Disease surgery, Epidemiologic Methods, Female, Hospitalization statistics & numerical data, Humans, Intensive Care Units, Kidney Failure, Chronic complications, Length of Stay statistics & numerical data, Male, Middle Aged, Coronary Artery Bypass mortality, Coronary Artery Disease mortality, Kidney Failure, Chronic mortality, Postoperative Complications mortality
- Abstract
Background: Chronic kidney disease (CKD) is a predictor of increased mortality in patients undergoing coronary artery bypass surgery (CABG)., Objective: To evaluate the characteristics and predictors of increased mortality in the CKD population submitted to CABG. To compare in-hospital outcomes between patients with and without CKD, and with and without development of acute renal failure (ARF)., Methods: Retrospective analysis of a prospective database of all isolated CABG performed in a single public tertiary hospital from 1999 to 2007. CKD was considered when creatinine > 1.5 mg/dl. Clinical characteristics, mortality and post-operative complications were evaluated according to renal function., Results: Of 3,890 patients, 362 (9.3%) had CKD. This population was older, presented grater prevalence of hypertension, left ventricular dysfunction, previous stroke, peripheral vascular disease and three-vessel disease. In-hospital outcomes revealed greater incidence of stroke (5.5% vs 2.1%), atrial fibrillation (16 vs 8.3%), low cardiac ouput syndrome (14.4% vs 8.5%), longer stay in intensive care unit (4.04 vs 2.83 days), and greater mortality (10.5% vs 3.8%). Logistic regression: female gender, smoking, diabetes and peripheral vascular disease were associated with higher in-hospital mortality within the CKD group. Patients who did not develop post-operative ARF presented 3.5% mortality; non-dialytic ARF: 35.4%; dialytic ARF: 66.7% mortality. Mortality was directly related to the stage of CKD, according to glomerular filtration rate., Conclusion: CKD patients submitted to CABG represent a high risk population, with increased incidence of complications and mortality. Post-operative ARF is a strong in-hospital mortality predictor. Glomerular filtration rate was inversely related to mortality.
- Published
- 2011
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28. II Guidelines for perioperative evaluation of the Brazilian Society of Cardiology.
- Author
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Gualandro DM, Yu PC, Calderaro D, Marques AC, Pinho C, Caramelli B, Feitosa AC, Ayub B, Polanczyk CA, Jardim C, Vieira CL, lezzi D, Ikeoka DT, Schreen D, D'Amico EA, Pfeferman E, de Lima EQ, Burdmann Ede A, Pachon E, Machado FS, Galas FR, Paula FJ, Carvalho FC, Feitosa-Filho GS, Prado GF, Lopes HF, Lima JJ, Marchini JF, Fornari LS, Drager LF, Vacanti LJ, Hajjar LA, Rohde LE, Gowdak LH, Cardoso LF, Vieira ML, Monachini MC, Macatrão M, Villaça PR, Farsky PS, Lopes RD, Bagnatori RS, Heinisch RH, Gualandro SF, Accorsi TA, Avila WS, and Mathias W Jr
- Subjects
- Brazil, Electrocardiography, Evidence-Based Medicine, Humans, Perioperative Period, Postoperative Complications prevention & control, Societies, Medical, Cardiology standards, Cardiovascular Diseases diagnosis, Cardiovascular Diseases surgery, Perioperative Care standards
- Published
- 2011
29. Selection of patients for myocardial perfusion scintigraphy based on fuzzy sets theory applied to clinical-epidemiological data and treadmill test results.
- Author
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Duarte PS, Mastrocolla LE, Farsky PS, Sampaio CR, Tonelli PA, Barros LC, Ortega NR, and Pereira JC
- Subjects
- Adult, Aged, Coronary Artery Disease classification, Female, Follow-Up Studies, Humans, Male, Middle Aged, Models, Theoretical, Perfusion, Radionuclide Imaging, Risk Factors, Sensitivity and Specificity, Severity of Illness Index, Coronary Artery Disease diagnostic imaging, Exercise Test, Fuzzy Logic, Patient Selection
- Abstract
Coronary artery disease (CAD) is a worldwide leading cause of death. The standard method for evaluating critical partial occlusions is coronary arteriography, a catheterization technique which is invasive, time consuming, and costly. There are noninvasive approaches for the early detection of CAD. The basis for the noninvasive diagnosis of CAD has been laid in a sequential analysis of the risk factors, and the results of the treadmill test and myocardial perfusion scintigraphy (MPS). Many investigators have demonstrated that the diagnostic applications of MPS are appropriate for patients who have an intermediate likelihood of disease. Although this information is useful, it is only partially utilized in clinical practice due to the difficulty to properly classify the patients. Since the seminal work of Lotfi Zadeh, fuzzy logic has been applied in numerous areas. In the present study, we proposed and tested a model to select patients for MPS based on fuzzy sets theory. A group of 1053 patients was used to develop the model and another group of 1045 patients was used to test it. Receiver operating characteristic curves were used to compare the performance of the fuzzy model against expert physician opinions, and showed that the performance of the fuzzy model was equal or superior to that of the physicians. Therefore, we conclude that the fuzzy model could be a useful tool to assist the general practitioner in the selection of patients for MPS.
- Published
- 2006
- Full Text
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30. [Comparative study of 18 F-fluorodeoxyglucose imaging with a dual-head coincidence gamma camera with dobutamine stress echocardiography for the assessment of myocardial viability].
- Author
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Farsky PS, Piegas LS, Gimenes VM, Petisco AC, Duarte PS, Martins LR, Issa M, Paulista PP, and Sousa JE
- Subjects
- Epidemiologic Methods, Female, Gamma Cameras, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Myocardial Infarction surgery, Myocardial Revascularization, Tomography, Emission-Computed, Ventricular Dysfunction, Left surgery, Echocardiography, Stress, Fluorodeoxyglucose F18, Myocardial Contraction, Radiopharmaceuticals, Ventricular Dysfunction, Left diagnostic imaging
- Abstract
Objective: To compare Dual-Head coincidence gamma camera (DCD-AC) with dobutamine stress echocardiography (DSE) in viability assessment, using functional recovery as the gold standard., Methods: Twenty-one patients were prospectively studied, with coronary artery disease and severe left ventricular dysfunction undergoing DSE and DCD-AC at baseline and DSE three months after revascularization., Results: Of the 290 segments analyzed, 83% were akinetic, 15% hypokinetic and 2% dyskinetic at rest. DSE identified 68% of these segments as non-viable. DCD-AC identified 56% of these segments as normal (dysfunctional segments with preserved metabolism and perfusion), 30% as viable (preserved metabolism and reduced perfusion) and 14% as non-viable (reduced perfusion and metabolism). Of the DSE non-viable segments, DCD-AC identified 80% as normal or viable and 19.9% as non-viable (p<0.001). In hypokinetic segments viability and normal segments were detected in a higher proportion by both methods (p<0.001). DSE sensibility and specificity were 48.3% and 78.1% respectively. DCD-AC sensibility and specificity was 92.2% and 20.0%. DCD-AC identifies a higher incidence of function improvement in normal segments than in viable and non-viable., Conclusion: DCD-AC classified as normal or viable most of the non-viable DSE segments. In assessment of functional recovery segments after three months, DCD-AC showed a high sensibility but low specificity.
- Published
- 2005
- Full Text
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31. [Use of a flap composed of skin and breast tissue for repairing a recalcitrant wound resulting from dehiscence of sternotomy in cardiac surgery].
- Author
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Anger J, Farsky PS, Amato VL, Abboud CS, Almeida AF, Arnoni RT, Dinkhuysen JJ, and Paulista PP
- Subjects
- Breast surgery, Female, Humans, Reoperation, Sternum surgery, Surgical Flaps, Surgical Wound Dehiscence surgery, Surgical Wound Infection surgery
- Published
- 2004
- Full Text
- View/download PDF
32. [Immediate results of myocardial revascularization. Comparison between men and women].
- Author
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Amato VL, Timerman A, Paes AT, Baltar VT, Farsky PS, Farran JA, Gun C, Paulista PP, Piegas LS, and Sousa JE
- Subjects
- Adult, Aged, Aged, 80 and over, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Sex Factors, Treatment Outcome, Angina Pectoris surgery, Heart Failure surgery, Myocardial Revascularization mortality
- Published
- 2004
- Full Text
- View/download PDF
33. Consequences of the prolonged waiting time for patient candidates for heart surgery.
- Author
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Haddad N, Bittar OJ, Pereira AA, da Silva MB, Amato VL, Farsky PS, Ramos AI, Sampaio M, Almeida TL, Armaganijan D, and Sousa JE
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Brazil epidemiology, Cardiac Surgical Procedures, Coronary Disease mortality, Coronary Disease psychology, Coronary Disease surgery, Female, Heart Defects, Congenital mortality, Heart Defects, Congenital psychology, Heart Diseases psychology, Heart Valve Diseases mortality, Heart Valve Diseases psychology, Humans, Interviews as Topic, Male, Middle Aged, Myocardial Revascularization, Survival Analysis, Time Factors, Heart Diseases mortality, Waiting Lists
- Abstract
Objective: To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery., Methods: From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases., Results: The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery., Conclusion: Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.
- Published
- 2002
- Full Text
- View/download PDF
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