Papers by Guilherme H Oliveira
Clinical Journal of The American Society of Nephrology, Nov 1, 2010
Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pr... more Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complications have yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospective designs. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE and a meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes. Design, setting, participants, & measurements: We searched electronic databases from 1980 to 2009 and reviewed papers with validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates. Results: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications included lupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortion rate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonatal deaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the premature birth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birth rate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. History of nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension, premature birth, and an increased rate of induced abortion. Conclusions: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternal hypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity and multispecialty care of these patients.
Journal of Cardiac Failure, Aug 1, 2019
Background: Renal impairment is common among patients with heart failure and portends worse outco... more Background: Renal impairment is common among patients with heart failure and portends worse outcomes. We sought to describe the impact of euvolemia maintenance via pulmonary artery pressure-guided management of heart failure on the trajectory of kidney function. Hypothesis: We hypothesized that PAP-guided management is associated with slowing eGFR decline in heart failure patients. Methods: We retrospectively reviewed kidney function 1 year prior to implant, and 1 year after implantation of a wireless pulmonary-artery hemodynamic monitoring sensor (CardioMEMS, St Jude Medical, St Paul, MN). Glomerular filtration rate (eGFR) was estimated using standard equations (MDRD, Cockroft-Gault, and CKD-EPI). Standardized annual change in eGFR was compared prior to and after CardioMEMS implantation using related-samples Wilcoxon Signed Rank Test. Results: A total of 70 patients were included with a median age of 74 [67-79] years. Forty-two patients (60%) were male and 53 (76%) were white. Their median left ventricular ejection fraction was 41% . Median eGFR before CardioMEMS implantation decreased from 61 to 48 [30-64] ml/ min/1.73 m 2 (P<0.001) but did not change after CardioMEMs implantation (44 [30-67] ml/min/1.73 m 2 , P=0.17). Annualized rate of eGFR change was -6.1 [-18.6 to 2.2] ml/min/1.73 m 2 before vs -1.1 [-9.6 to 4.0] ml/min/1.73 m 2 after CardioMEMS (P=0.046). This difference was more pronounced among patients <74 years (P=0.009), with left ventricular ejection fraction 50% (P=0.039), RA pressure <10 mmHg (P=0.022), eGFR 60 (P=0.015), diabetes (P=0.019), not receiving ACE/ARB (P=0.025) and not receiving aldosterone antagonists (P=0.045). Conclusions: Decline in kidney function slows down after the maintenance of euvolemia with pulmonary artery pressure-guided therapy of heart failure.
Journal of Cardiac Failure, Aug 1, 2017
follow-up period cardiovascular death was registered in 10 patients (20%). Composite end-point wa... more follow-up period cardiovascular death was registered in 10 patients (20%). Composite end-point was observed in 23 patients (46%). Regression analysis demonstrated significant prognostic value of SHFM score both for cardiovascular mortality (Chisquared = 7,035; p = 0,008) and composite end-point (Chi-squared = 6,555; p = 0,01). These results were confirmed by ROC analysis both for cardiovascular death (AUC = 0,794; 95% CI = 0,641-0,903; p = 0,004) and composite end-point (AUC = 0,713, 95% CI = 0,564-0,834; p = 0,005). Conclusions: Seattle Heart Failure Model seems to maintain its prognostic value in heart failure patients with preserved ejection fraction. Further prospective trials enrolling larger groups of patients are required to confirm this data.
American Journal of Hematology, Oct 23, 2017
Cardio-oncology, Apr 1, 2023
Background Chimeric antigen receptor T-Cell (CAR-T) immunotherapy has been a breakthrough treatme... more Background Chimeric antigen receptor T-Cell (CAR-T) immunotherapy has been a breakthrough treatment for various hematological malignancies. However, cardiotoxicities such as new-onset heart failure, arrhythmia, acute coronary syndrome and cardiovascular death occur in 10-15% of patients treated with CART. This study aims to investigate the changes in cardiac and inflammatory biomarkers in CART therapy to determine the role of proinflammatory cytokines. Methods In this observational study, ninety consecutive patients treated with CART underwent baseline cardiac investigation with electrocardiogram (ECG), transthoracic echocardiogram (TTE), troponin-I, and B-type natriuretic peptide (BNP). Follow-up ECG, troponin-I and BNP were obtained five days post-CART. In a subset of patients (N = 53), serum inflammatory cytokines interleukin (IL)-2, IL-6, IL-15, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and angiopoietin 1 & 2 were tested serially, including baseline and daily during hospitalization. Adverse cardiac events were defined as new-onset cardiomyopathy/heart failure, acute coronary syndrome, arrhythmia and cardiovascular death. Results Eleven patients (12%) had adverse cardiac events (one with new-onset cardiomyopathy and ten with newonset atrial fibrillation). Adverse cardiac events appear to have occurred among patients with advanced age (77 vs. 66 years; p = 0.002), higher baseline creatinine (0.9 vs. 0.7 mg/dL; 0.007) and higher left atrial volume index (23.9 vs. 16.9mL/m 2 ; p = 0.042). Day 5 BNP levels (125 vs. 63pg/mL; p = 0.019), but not troponin-I, were higher in patients with adverse cardiac events, compared to those without. The maximum levels of IL-6 (3855.0 vs. 254.0 pg/mL; p = 0.021),
Journal of Heart and Lung Transplantation, Apr 1, 2016
To investigate pre-implant variables associated with RVAD use in pts undergoing CF-LVAD surgery. ... more To investigate pre-implant variables associated with RVAD use in pts undergoing CF-LVAD surgery. Methods: Pts in INTERMACS registry from 6/06 to 3/14 who underwent CF-LVAD surgery (n= 9978) were examined for concurrent or subsequent RVAD use within 14d of LVAD. Risk factors for RVAD were assessed with stepwise logistic regression using univariate p-value < 0.05. Model performance was assessed with ROC analysis for the outcomes of 1) early RVAD and 2) combined RVAD or death within 14d. Log-rank test and Cox-PH models were used to compare survival between pts with and without RVAD. Results: 386 pts (3.9%) required an RVAD within 14d of LVAD. Characteristics associated with RVAD use are listed in the Table. INTERMACS pt profiles 1 & 2 as well as need for preoperative ECMO or dialysis/UF were independently associated with RVAD. Hemodynamic determinants included elevated right atrial and reduced pulmonary artery pulse pressure (systolic-diastolic). Other notable predictors included severe pre-implant tricuspid (TV) regurgitation and history of prior cardiac surgery. Concomitant procedures other than TV repair at time of LVAD were also associated with RVAD. The final model demonstrated good performance for RVAD implant (AUC 0.78) and the combined end-point of RVAD or death within 14d (AUC 0.73). Patients requiring RVAD had decreased survival: 1and 6-mo 78.1% and 63.6% vs. 95.8% and 87.9% for pts receiving isolated LVAD (p< 0.0001). Adjusting for baseline risk, RVAD remained associated with increased risk of death: HR 2.76 (95% CI 2.34-3.24). Conclusion: Correlates of overall severity of illness, including markers of end-organ dysfunction and profiles of hemodynamic instability, are associated with RVAD implantation.
Journal of Heart and Lung Transplantation, Apr 1, 2013
Society of Heart and Lung Transplantation 2010 standardized nomenclature for CAV. The mean post-T... more Society of Heart and Lung Transplantation 2010 standardized nomenclature for CAV. The mean post-Tx follow-up was 94 months [1-181]. Kaplan-Meyer analysis was used to calculate actuarial survival. Results: Freedom from CAV (grade 1 or more) survival was 65% at 5 years and 53.9% at 10 years after HLTx and 62.5% and 42.5% respectively after HTx (P¼0.21). There were 81% of CAV grade 0, 10% of CAV grade 1, 6% of CAV grade 2 and 3% of CAV grade 3 at 5 years after HLTx whereas there were 58%, 21%, 12% and 9% respectively after HTx. Overall 5 and 10-year survival were 49.4% and 41.2% after HLTx and 66.6% and 54.5% after HTx (P¼0.04) and 41,2% in HLT recipients at 10 years (P¼0.04). The main mortality risk factors were CAV and bronchiolitis obliterans for HTx and HLTx respectively. Transplantation type has not been found as a protective factor for CAV development at univariate and multivariate analysis. By multivariate analysis, only HTx recipients who developed more than 3 acute myocardial rejections during the first post-HTx year had a higher risk factor of CAV occurrence (P¼0.02, CI[1.065-2.33]). Bronchiolitis obliterans was not associated with an increased risk of CAV after HLTx (P¼0.30). Conclusions: We report an original 15-year comparative study. Combined HLTx did not protect from CAV development compared to isolated HTx. However CAV severity seems to be higher in HTx recipients.
Blood Advances, Aug 22, 2023
Introduction:Idecabtagene vicleucel(ide-cel) is a type of B-cell maturation antigen(BCMA)-targeti... more Introduction:Idecabtagene vicleucel(ide-cel) is a type of B-cell maturation antigen(BCMA)-targeting CART approved for treatment of relapsed and refractory multiple myeloma(RRMM). Currently, the incidence of cardiac events associated with ide-cel remains unclear. Method:This was a retrospective single-center observational study of patients treated with ide-cel for RRMM. We included all consecutive patients who underwent standard-of-care ide-cel treatment with at least 1month follow-up. Baseline clinical risk factors, safety profile, and responses were examined by development of a cardiac event. Result:A total of 78patients were treated with ide-cel and 11patients(14.1%) developed cardiac events: heart failure (5.1%), atrial fibrillation(10.3%), nonsustained ventricular tachycardia (3.8%) and cardiovascular death(1.3%). Only 11 of the 78 patients had repeat echocardiogram. Baseline risk factors associated with the development of cardiac events included: female sex, worse performance status, lambda light chain disease, and advanced R-ISS. Baseline cardiac characteristics were not associated with cardiac events. During index hospitalization post-CART , higher grade({greater than or equal to}Grade 2) CRS and ICANS were associated with cardiac events. In multivariable analyses, the hazard ratio for the association of the presence of cardiac events with overall survival was 2.66(95%CI:0.85-8.26) and with progression-free survival was 1.98(95%CI:0.90-4.37). Conclusion:Ide-cel CART for RRMM is associated with similar cardiac events as other types of CART. Worse baseline performance status and higher-grade CRS and neurotoxicity are associated with cardiac events post-BCMA-directed CAR-Tcell therapy. Our results suggest that the presence of cardiac events may confer worse PFS or OS, although due to the small sample size, the power to detect an association was limited.
Introduction Endomyocardial biopsy (EMB)-based traditional microscopy remains the gold standard f... more Introduction Endomyocardial biopsy (EMB)-based traditional microscopy remains the gold standard for the detection of cardiac allograft rejection, despite its limitation of inherent subjectivity leading to inter-reader variability. Alternative techniques now exist to surveil for allograft injury and classify rejection. Donor-derived cell-free DNA (dd-cfDNA) testing is now a validated blood-based assay used to surveil for allograft injury. The molecular microscope diagnostic system (MMDx) utilizes intragraft rejection-associated transcripts (RATs) to classify allograft rejection and identify injury. The use of dd-cfDNA and MMDx together provides objective molecular insight into allograft injury and rejection. The aim of this study was to measure the diagnostic agreement between dd-cfDNA and MMDx and assess the relationship between dd-cfDNA and MMDx-derived RATs which may provide further insight into the pathophysiology of allograft rejection and injury. Methods: This is a retrospectiv...
Arquivos Brasileiros de Cardiologia
Nota: Estas diretrizes se prestam a informar e nĂ£o a substituir o julgamento clĂnico do mĂ©dico qu... more Nota: Estas diretrizes se prestam a informar e nĂ£o a substituir o julgamento clĂnico do mĂ©dico que, em Ăºltima anĂ¡lise, deve determinar o tratamento apropriado para seus pacientes.
Journal of Cardiac Failure, 2017
and the rest had LV support. In hospital mortality remained high in the biV failure group regardl... more and the rest had LV support. In hospital mortality remained high in the biV failure group regardless of support strategy (Table 1). One isolated LV failure patient survived to durable MCS after LV support alone, and the RV failure patient recovered to discharge. Conclusions: In this single center review, the majority of patients with cardiogenic shock characterized by invasive hemodynamics had biV failure, with acute MI and chronic heart failure equally represented. In hospital mortality with either percutaneous MCS or ECMO remained high. Biventricular percutaneous support to unload both ventricles was employed rarely and may be a strategy to help improve outcomes.
Journal of Cardiac Failure, 2017
Introduction: There is growing popularity in social media use among physicians and health care pr... more Introduction: There is growing popularity in social media use among physicians and health care practitioners for data collection and health promotion among cardiovascular disease. However, there is little knowledge regarding the ongoing dialogue, and who are communicating. Hypothesis: This is an exploratory study to capture the users and contents of tweets related to heart failure. Methods: We searched Twitter for these hash users and the hashtags #chf #congestiveheartfailure and #heartfailure between the dates of January 2017-March 2017. We we categorized the type of user and content of each tweet. For any discrepancies for categorization, another reviewer would examine the tweet. For the hashtag #heartfailure as there were more than 2500 tweets per month, we randomly selected 5% of tweets to hand code. Results: During this time period, users infrequently used #congestiveheartfailure and #chf, with only 37 and 222 tweets respectively, while #heartfailure was more commonly used. Within our random sample of coded tweets, 29.4% (204/693) of tweets were from patients, caretakers, or advocacy groups, while 35.2% (244/693) were from physicians, academic journals, medical groups, and industry. The most common content areas were medical education (such as journal articles) (34.6%, 240/693), disease awareness and advocacy (18.76%, 130/ 693), and personal experience (16.3%, 113/693). There was little overlap between discussions from patients and academic discussions, and lack of patient and academic engagement. There were few tweets of patients sharing journal articles (2 tweets), and by the lack of retweets between patients and physicians. Conclusions: Twitter, a social media platform, is used by both health care providers and patients. However, conversations are significantly siloed, and engagement between laypersons/advocacy groups and professionals were not observed.
Journal of Cardiac Failure, 2017
patients started with similar therapy rates, the "more likely" programming strategy resulted in a... more patients started with similar therapy rates, the "more likely" programming strategy resulted in a higher likelihood of shocks (10.7) and ATP (55.5) compared to "no change" (P < .001). Conclusions: The dominant US practice pattern is to maintain ICD therapy in LVAD patients, but device reprogramming is rarely performed post-LVAD. Clinicians should consider extended detections to promote spontaneous tachyarrhythmia termination and minimize shocks, as LVAD patients may better tolerate arrhythmias due to continuous hemodynamic support.
Journal of the American Society of Echocardiography, 2011
Doppler-derived hemodynamic data for normal tricuspid mechanical valve prostheses are limited. A ... more Doppler-derived hemodynamic data for normal tricuspid mechanical valve prostheses are limited. A comprehensive retrospective Doppler echocardiographic assessment of 78 normal St. Jude Medical Standard (St. Jude Medical, Inc., St. Paul, MN), CarboMedics Standard (CarboMedics, Inc., Sorin Group, Burnaby, British Columbia, Canada), and Starr-Edwards (Edwards Lifesciences, LLC, Irvine, CA) mechanical tricuspid valve prostheses was performed early after implantation. We used all the important Doppler-derived hemodynamic variables reported to date, including peak early diastolic velocity (E velocity), mean gradient, pressure half-time, time velocity integral of the tricuspid valve prosthesis (TVI(TVP)), and ratio of the time velocity integral of the tricuspid valve prosthesis to the time velocity integral of the left ventricular outflow tract (TVI(TVP)/TVI(LVOT)). The mean values obtained for the Doppler parameters did not differ significantly when the measurements from five or nine consecutive cardiac cycles were averaged. Pressure half-time was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;130 msec in all 43 patients with St. Jude Medical Standard and CardioMedics Standard prostheses in whom it could be measured. Mean gradient &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6 mm Hg, E velocity &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.9 m/s, TVI(TVP) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;46 cm, and TVI(TVP)/TVI(LVOT) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.1 were recorded in 59 (87%) of the 68 patients with either of these prostheses. Hemodynamic variables were considerably less favorable in patients with Starr-Edwards prostheses. These calculated threshold values (mean + 2 SD) are useful for identifying normal tricuspid mechanical valve function. Prostheses with values for hemodynamic variables that are outside the mean + 2 SD parameters that we have calculated are most likely to be dysfunctional. However, in rare cases, mechanical tricuspid valve prostheses may be dysfunctional even when their hemodynamic parameters are within these specified ranges because of small body surface area or other factors.
Community Mental Health Journal, 2009
People with serious mental illness have higher rates of morbidity and mortality from cardiovascul... more People with serious mental illness have higher rates of morbidity and mortality from cardiovascular disease. This study describes health practitioners' views on their role and confidence assessing and managing cardiovascular risk. The key findings were of a widespread acknowledgement of the need to undertake systematic risk assessment and offer structured approaches to risk factor management. Barriers of client engagement, lack of good systems and poor information sharing between primary and secondary care providers were identified. Solutions discussed included a collaborative care model or the integration of physical health services, perhaps a general practitioner-led clinic, within the secondary care setting. Whilst there is a need to identify an optimal care model there is an even greater need to take some rather than no action.
The Journal of Heart and Lung Transplantation, 2016
correlation with serum albumin, bilirubin, and creatinine. We also explored the association betwe... more correlation with serum albumin, bilirubin, and creatinine. We also explored the association between listing Karnofsky scale score and waitlist survival. Results: We identified 27091 patients, with an average Karnofsky scale of 50.8%. More than half of all patients (51%) had severe functional limitation (Karnofsky scale < 50%). Karnofsky scale negatively correlated with bilirubin (p< 0.001), creatinine (p< 0.001), and correlated positively with serum albumin (p< 0.001). After adjusting for UNOS listing status, baseline characteristics, there was a gradual decrease in wait-list survival with decreasing Karnofsky scale (p< 0.001). Similar results were seen in patients with mechanical circulatory support. Conclusion: Functional status, as measured by Karnofsky scale, correlates with measures of hepatorenal dysfunction, and predicts outcomes in patients listed for heart transplantation and in patients with mechanical circulatory support.
The American Journal of Cardiology
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Current Cardiology Reports, 2014
Objective: To identify in the literature the cardiovascular adverse events resulting from oral an... more Objective: To identify in the literature the cardiovascular adverse events resulting from oral antineoplastic therapy. Method: Integrative review of the literature through the SCOPUS, Scientifi c Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE) databases. The antineoplastic, cardiotoxicity, cardiovascular system and adverse reaction descriptors were used in Portuguese, English and Spanish. We selected 23 articles published between 1985 and 2015. Results: Twenty studies were related to cardiac events and eleven to peripheral vascular events. The most frequent adverse cardiac events were reduced left ventricular ejection fraction, myocardial infarction, changes in the electrocardiogram, heart failure and angina, whereas peripheral vascular events were hypertension and thromboembolism. Conclusion: Oral antineoplastic therapy is associated with different adverse events, including cardiac and peripheral vascular events.
Angiology, 2007
The presented case report describes a female patient suffering from systemic lupus erythematosus,... more The presented case report describes a female patient suffering from systemic lupus erythematosus, in whom dilated cardiomyopathy with progressive heart failure was a very first symptom of the disease. The advanced invasive treatment method, cardiac resynchronization therapy, was successfully applied to improve the quality of life, clinical symptoms, and exercise tolerance.
Journal of Cardiac Failure, 2018
Background: Kidney and liver dysfunction are common in patients with advanced heart failure under... more Background: Kidney and liver dysfunction are common in patients with advanced heart failure undergoing left ventricular assistant device (LVAD) implantation. We have previously shown that Model of End-Stage Liver Disease excluding INR (MELD-XI) scores can predict poor outcomes after heart transplantation. Whether MELD-XI predicts outcomes after LVAD implantation is not well understood. Methods: All patients who underwent LVAD implantation at a tertiary referral center (2007-2017) were included and preoperative MELD-XI was calculated. Cox proportional hazard models and Kaplan Meier method were used to describe association with overall post-implant mortality. Penalized smoothed splines were used to visualize the association between continuous MELDXI and mortality. Results: A total of 94 patients were included. Mean age was 60 §13 years, 78% males, 64% Caucasian, 76% had the HeartMate II. Median MELD-XI was 12.4(9.9-15.9). At a median follow-up of 2.8 years, 31 patients died. There was no difference between patients with MELD-XI >12.4 and MELD-XI 12.4 in overall mortality (P=0.14), figure (panel A). There was no association between continuous MELD-XI and mortality (HR 1.04; 95% CI: 0.96-1.13, P=0.32), figure (panel B). Conclusion: Our findings showed that MELD-XI is not associated with mortality after LVAD implantation. These findings need to be validated in a larger group registry to identify best bridging strategy in patients with advanced heart failure and combined kidney-liver dysfunction.
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Papers by Guilherme H Oliveira