Papers by Roberto Gamarski
Critical Care, 2005
Third International Symposium on Intensive Care and Emergency Medicine for Latin America plays a ... more Third International Symposium on Intensive Care and Emergency Medicine for Latin America plays a critical role in the inflammatory response and, potentially, a polymorphism in IRAK1 may alter the immune response impacting clinical outcome. P2 Gene expression and intracellular NF-κ κB activation after HMGB1 and LPS stimuli in neutrophils from septic patients
Annals of Emergency Medicine, 1999
S ters, it is also important to understand the effects of a primary change in frequency of cardia... more S ters, it is also important to understand the effects of a primary change in frequency of cardiac contraction on general circulatory, dynamics. Methods: The hemodynamic parameters of stroke volume, cardiac output, pulse pressure, mean arterial pressure, and peripheral resistance were measured in chronically instrumented conscious dogs in which a pacemaker was implanted to control heart rate. After monitoring the dogs for a 24-hour control period, the heart rate was manually increased abruptly while changes in circuIatory dynamics were recorded for an additional 24 hours. Observed differences are reported as an average percent ol the 24-hour control means. Results: In 6 dogs studied, the heart rate was increased an average of 2.3-fold over the basal control level by pacing. This increase in heart rate resulted in a mean fall in stroke volume and arterial pressure by 73% and 20% respectively, while peripheral resistance increased by 45%. There was also a 43% average fall in the pulse pressure while cardiac output changes were highly variable Conclusion: Although a substantial primary change in heart rate can significantly affect the stroke volume, peripheral resistance, and pulse pressure, there is a much less consequential effect on the mean arterial pressure.
Arquivos Brasileiros de Cardiologia, 2019
Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment ... more Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment of doctors who, in final analysis, must determine which treatments are appropriate for their patients.
Arquivos Brasileiros de Cardiologia, 2000
Arquivos Brasileiros de Cardiologia, 2002
To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitt... more To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG).
Arquivos Brasileiros De Cardiologia, 2000
Bassan e cols. Estratégia diagnóstica para pacientes com dor torácica e sem supradesnível do segm... more Bassan e cols. Estratégia diagnóstica para pacientes com dor torácica e sem supradesnível do segmento ST 405 405 405 405 405
Dos 1.003 pacientes, 224 foram liberadospara casa pela ausencia de suspeita clinica de insuficien... more Dos 1.003 pacientes, 224 foram liberadospara casa pela ausencia de suspeita clinica de insuficien-cia coronariana aguda (rota 5), e 119 foram transferidospara a unidade coronariana por apresentar supradesnivelde ST ou bloqueio de ramo esquerdo (rota 1) (74% com odiagnostico final de infarto agudo do miocardio). Dos 660pacientes que permaneceram sob investigacao/observacaona sala de emergencia, 77 (12%) tinham infarto agudo domiocardio sem supradesnivel de ST e 202 (31%) anginainstavel. Na rota 2 (alta probabilidade de insuficienciacoronariana aguda) 17% dos pacientes eram infarto agu-do do miocardio e 43% angina instavel, enquanto na rota 3(baixa probabilidade) 2% infarto agudo do miocardio e7% angina instavel. O ECG de admissao foi pouco sensivelpara o diagnostico de infarto agudo do miocardio (49%),com um valor preditivo positivo de (79%).
Annals of Emergency Medicine, 1999
Critical Pathways in Cardiology a Journal of Evidence Based Medicine, 2004
Rev Socerj, Mar 1, 1999
Título: Utilização da CK-MB (massa) na sala de emergência para o diagnóstico de macro CK simuland... more Título: Utilização da CK-MB (massa) na sala de emergência para o diagnóstico de macro CK simulando IAM/Use of a based CK-MB mass assay in the emergency room to diagnose macro CK simulating acute myocardial infaciton
Artigo original C o r r e s p o n d ê n c i a : A l f r e d o A n t o n i o P o t s c h • R u a C... more Artigo original C o r r e s p o n d ê n c i a : A l f r e d o A n t o n i o P o t s c h • R u a C o n d e d e I r a j á , 1 2 2 / 3 0 2 -2 2 2 7 1 -0 2 0 -R i o d e J a n e i r o , R J
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2004
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2002
Management of chest pain patients in the emergency department has been a dilemma because of diffi... more Management of chest pain patients in the emergency department has been a dilemma because of difficulty in identifying those who can be immediately discharged and those who need to be hospitalized. We assessed the efficacy of a probability stratification model and a systematic diagnostic strategy in 1003 consecutive chest pain patients prospectively evaluated and stratified for acute coronary syndromes according to chest pain characteristics and admission electrocardiogram. Patients with no suspicion of acute coronary syndromes (n ϭ 224) were immediately discharged, whereas those with very-high probability (n ϭ119) were admitted to the coronary care unit. Remaining patients were evaluated in a Chest Pain Unit and investigated during a 9-hour period (intermediateprobability, n ϭ 433) (route 2) and a 6-hour period (low-probability, n ϭ 277) (route 3). Sensitivity and negative predictive value of chest pain type for the diagnosis of acute myocardial infarction (94% and 97%, respectively) was much better than the admission electrocardiogram (49% and 86%, respectively) and admission creatine kinase-MB (46% and 86%, respectively). Serial creatine kinase-MB determinations ruled out acute myocardial infarction by the thirdhour postadmission in all route 3 patients but only at the ninth-hour in route 2 patients. For patients with no ST-segment elevation, chest pain type was the strongest independent predictor of acute coronary syndromes. It is concluded that chest pain type is the best single diagnostic tool to rule in/out acute coronary syndromes on admission to the emergency department. Patients with suspicious chest pain must have serum creatine kinase-MB measurements up to 9 hours postadmission to rule out acute myocardial infarction.
Hospital Pró-Cardíaco e PROCEP, Centro de Ensino e Pesquisa do Pró-Cardíaco Rio de Janeiro Corr... more Hospital Pró-Cardíaco e PROCEP, Centro de Ensino e Pesquisa do Pró-Cardíaco Rio de Janeiro Correspondência: Roberto Bassan - Hospital Pró-Cardíaco - Rua Dona Mariana, 219 - 22280-020-Rio de Janeiro, RJ Recebido para publicação em 13/1/00 Aceito em 15/3/00
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2004
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2004
Management of chest pain patients in the emergency department has been a dilemma because of diffi... more Management of chest pain patients in the emergency department has been a dilemma because of difficulty in identifying those who can be immediately discharged and those who need to be hospitalized. We assessed the efficacy of a probability stratification model and a systematic diagnostic strategy in 1003 consecutive chest pain patients prospectively evaluated and stratified for acute coronary syndromes according to chest pain characteristics and admission electrocardiogram. Patients with no suspicion of acute coronary syndromes (n ϭ 224) were immediately discharged, whereas those with very-high probability (n ϭ119) were admitted to the coronary care unit. Remaining patients were evaluated in a Chest Pain Unit and investigated during a 9-hour period (intermediateprobability, n ϭ 433) (route 2) and a 6-hour period (low-probability, n ϭ 277) (route 3). Sensitivity and negative predictive value of chest pain type for the diagnosis of acute myocardial infarction (94% and 97%, respectively) was much better than the admission electrocardiogram (49% and 86%, respectively) and admission creatine kinase-MB (46% and 86%, respectively). Serial creatine kinase-MB determinations ruled out acute myocardial infarction by the thirdhour postadmission in all route 3 patients but only at the ninth-hour in route 2 patients. For patients with no ST-segment elevation, chest pain type was the strongest independent predictor of acute coronary syndromes. It is concluded that chest pain type is the best single diagnostic tool to rule in/out acute coronary syndromes on admission to the emergency department. Patients with suspicious chest pain must have serum creatine kinase-MB measurements up to 9 hours postadmission to rule out acute myocardial infarction.
Arquivos brasileiros de cardiologia, 2006
To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitt... more To test immediate diagnostic and prognostic values of C-reactive protein (CRP) in patients admitted to the emergency room (ER) with chest pain (CP) without ST-segment elevation on the electrocardiogram (ECG). From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS) (age = 64.9 +/- 14.3, men = 55%, diabetic = 18%, normal ECG = 84%). Serial CRP, creatine kinase MB mass (CKMB-mass) and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP) by the upper limit of normal (ULN) of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]). One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI), and their s-CRP values were 1.31 +/- 2.90 (median = 0.47) compared to 0.79 +/- 1.39 (0.30) in no-AMI patients (p = 0.031). The s-CRP > 1.0 showed 30% sensitivity...
European Heart Journal, 2004
Aims This study was undertaken to determine the diagnostic value of admission B-type natriuretic ... more Aims This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation. Methods and results A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cutoff value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P , 0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model. Conclusion BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic. Model 1, all variables except CKMB and troponin-I; Model 2, all variables including CKMB .5.0 ng/mL and troponin-I .0.28 ng/mL; Model 3, all variables including CKMB .5.0 ng/mL and troponin-I .1.0 ng/mL. 238 R. Bassan et al. by guest on April 26, 2016 http://eurheartj.oxfordjournals.org/ Downloaded from
Critical Care, 2001
In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of th... more In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables. We divided our patient population into two groups. Group A (GA) included patients with DBT less than 120 min and group B (GB) patients with DBT greater or equal to 120 min. We evaluated several clinical variables, such as left ventricular ejection fraction (LVEF) on their first echocardiogram during hospitalization, admission Killip classification, in-hospital length of stay (LOS) and major cardiovascular events (MACE) during hospitalization and up to 6-month follow-up (in 23 patients).
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Papers by Roberto Gamarski