Papers by juarez barbisan
Arquivos Brasileiros De Cardiologia, 1986
Journal of the American College of Cardiology, 2018
Background: The PARADIGM-HF trial showed that Sacubitril-Valsartan (SV) was superior to Enalapril... more Background: The PARADIGM-HF trial showed that Sacubitril-Valsartan (SV) was superior to Enalapril in reducing the rates of morbimortality among patients with heart failure and reduced ejection fraction (HFrEF). SV increases B-type natriuretic peptide (BNP) and decreases NT-proBNP levels. The NT-proBNP/BNP ratio might be a valuable prognostic biomarker in HFrEF patients in treatment with SV and indirectly discriminated "responder" and "no responder" patients. We performed a systematic review (SR) and post hoc analysis of the PARADIGM-HF trial to assess the relationship between NT-proBNP/BNP ratio and clinical outcomes in patients with HFrEF undergoing treatment with SV. Methods: SR was conducted in accordance with PRISMA. We included studies evolving HFrEF patients undergoing treatment with SV which measured the levels of NT-proBNP and BNP and morbimortality outcomes. We reviewed PubMed, EMBASE and Web of Science. Data from PARADIGM-HF trial publications was extracted and reanalyzed for the purpose of this study. Associations between NT-proBNP/ BNP ratio and cardiovascular death (SD) or HF hospitalization (HFH) were examined, among others, as was the effect of SV vs enalapril on the NT-proBNP/BNP ratio. Results: 180 publications were screened and 8 included. Decreased NT-proBNP/BNP ratio when compared to baseline before randomization (6.39) was associated with good prognosis: patients alive (6.33) and event-free (6,14) at the end of the study. In contrast, increased NT-proBNP/BNP ratio when compared to baseline was associated with poor prognosis: sudden death (6.49), death due to progression of HF (7.35), CD (6.65), non-CD (6.62), HFH (6.48), emergency visits (6.53) and worsening of cardiac function (6.72). In the Enalapril arm, the NT-proBNP/BNP ratio was not associated with good or poor prognosis outcomes. The ratio was indirectly associated with the efficacy of SV in the treatment of HFrEF. Conclusion: When compared to baseline, reduced NT-proBNP/BNP ratio is associated with better outcomes and increased ratio with worse outcomes. More studies will be conducted to clarify the prognostic value of NT-proBNP/BNP ratio in HFrEF patients in treatment with SV.
Introdução: Pacientes que praticam atividade física de forma regular tem uma qualidade de vida me... more Introdução: Pacientes que praticam atividade física de forma regular tem uma qualidade de vida melhor após uma cirurgia de revascularização do miocárdio (CRM), segundo estudo, mesmo que tenham parado de realizar atividade física há mais de um ano antes da cirurgia. Pacientes ativos antes da CRM tiveram número menor de eventos cardíacos maiores (ECAM) que os sedentários. Objetivos: Verificar possíveis modificações nos escores ALL (Atividade de Lazer e Locomoção), Atividade Física no Tempo Livre (AFTL) e no escore TOTAL, em pacientes submetidos à CRM que passaram do grupo de sedentários no pré-operatório para o grupo de ativos no seguimento de dois anos. Metodologia: Coorte com 202 pacientes, com idade média de 62±10 anos, sendo 134 (66%) do sexo masculino, recrutados de três Hospitais Universitários e encaminhados para CRM. Estes pacientes foram classificados em dois grupos: ativos e sedentários, conforme a prática da AFTL e acompanhados dois anos após a CRM. Foram avaliados os escores ALL, AFTL e TOTAL, nos pacientes que faziam parte do grupo de sedentários no pré-operatório e que passaram para o grupo de ativos, no seguimento de dois anos. Resultados: Entre os 202 pacientes do estudo, 71 deles passaram do grupo de sedentários no pré-operatório para o grupo de ativos no seguimento de dois anos. Na avaliação do escore da ALL, a média no pré-operatório destes pacientes foi de 2,09 (1,32) e no seguimento de dois anos foi de 2,74 (0,66). No escore da AFTL, a média no pré-operatório foi de 2,12 (0,59) e no seguimento de dois anos foi de 2,87 (0,59). Em relação ao escore TOTAL, a média no pré-operatório foi de 4,10 (1,02) e no pós-operatório foi de 5,53 (1,10). Todos os três escores apresentaram diferença significativa (p≤0,01). Conclusões: Os pacientes que passaram do grupo de sedentários no pré-operatório para o grupo de ativos no seguimento de dois anos, apresentaram melhora nos três escores avaliados: ALL, AFTL e TOTAL. Estes resultados representam uma melhora na condição física deste pacientes. Número de aprovação do projeto: 4090/07. Comitê de Ética: Instituto de Cardiologia do RS/FUC.
J Bras Nefrol, Dec 1, 1985
Revista da Associação Médica Brasileira (1992)
To investigate a possible familial predisposition in neurocardiogenic syncope. Cross-sectional su... more To investigate a possible familial predisposition in neurocardiogenic syncope. Cross-sectional survey with 252 subjects, with positive familial history for syncope, who underwent head-up tilt-test (TT) at Instituto de Cardiologia do Rio Grande do Sul, between September 2001 and September 2005. The relationship between familial history for neurocardiogenic syncope and TT result was analysed. Familial history for neurocardiogenic syncope was identified in 40% (49/126 cases) of subjects with positive tilt-test results and 25% (31/126 ) of those with negative TT. There is a correlation between familial history for neurocardiogenic syncope and its occurence. A genetic component can possibly explain this relationship.
Revista Brasileira de Cirurgia Cardiovascular, 2007
Influência da prática da atividade física no resultado da cirurgia de revascularização miocárdica... more Influência da prática da atividade física no resultado da cirurgia de revascularização miocárdica Influence of the practice physical activity in the coronary artery bypass graft surgery results Abstract Objective: To evaluate the frequency changes of physical activity practice in pre-and postoperative of the patients submitted to coronary artery bypass graft surgery (CABG) and the frequency influence on the physical activity practice in the patients' preoperative prognosis. Methods: Cases studies of 55 patients submitted to CABG divided into active and sedentary regarding physical activity practices. Results: After CAGB, 14 (47%) patients classified as sedentary before surgery were practicing exercises (p = 0.03). Seventeen (59%) sedentary patients in the preoperative period presented complications after the surgery compared to 8 (31%) active patients (p = 0.04). The hospital length of stay among sedentary patients versus active patients before surgery was 15 (SD=8) and 12 (SD=5) days; p=0.03, respectively. Conclusion: The present study showed the importance of physical activity practice in the preoperative stage on the outcomes of coronary artery bypass surgery. The patients physically active had a shorter hospital length of stay and a lower number of both trans-and postoperative complications within 1 year. The cardiac surgery promoted the patients' change of habits, increasing the number of physically active patients during the 1-year follow-up.
Revista Brasileira de Cirurgia Cardiovascular, 2010
Efeito da atividade física de lazer no prognóstico da cirurgia de revascularização do miocárdio
Revista da Associação Médica Brasileira, 2009
Investigar uma possível predisposição genética para síncope vasovagal. MÉTODOS.Estudo transversal... more Investigar uma possível predisposição genética para síncope vasovagal. MÉTODOS.Estudo transversal, com 252 indivíduos com história de síncope, submetidos ao teste de inclinação (TI) no Instituto de Cardiologia do Rio Grande do Sul, durante o período de setembro de 2001 a setembro de 2005. Foi analisada a relação entre história familiar positiva para síncope vasovagal e resultado do TI. RESULTADOS. Todos indivíduos foram submetidos ao TI sendo que 126 (50%) casualmente tiveram resultado positivo para síncope vasovagal.História familiar dessa patologia foi identificada em 40% (49/126 casos) dos pacientes com teste de inclinação positivo e em 25% (31/126 pacientes) daqueles que tiveram TI negativo (p= 0,01). CONCLUSÃO. Há uma correlação entre a história familiar de síncope vasovagal e sua ocorrência. É possível que um componente genético possa explicar essa relação. UNITERMOS: Síncope vasovagal. Hereditariedade. Predisposição genética.
Global Heart, 2014
BNP dosage was performed using the POCT Biosite method, and the Framingham score was used as gold... more BNP dosage was performed using the POCT Biosite method, and the Framingham score was used as gold standard. For all patients, one and two-dimensional Doppler echocardiography and chest X-ray were performed. Clinical data on the patients were obtained from the records. In order to adjust accuracy in subgroups with specific clinical characteristics, a multivariate analysis was done with logistic regression. The patients with gold standard Heart Failure(HF) or Not Heart Failure (NHF) in the Test Sample will be analyzed relating the BNP cutoff value to the age, gender, BMI and ECC (renal function was assessed via the Cockroft-Gault formula) and comparing to the cutoff values in the literature. BNP correction formula will be calculated by multiple logistic regression and the probability of having Heart Failure or not will be calculated as well. The calculated formula will be applied to the Validation Sample and the probability of having Heart Failure or not will be estimated. Moreover, AUC, BNP cutoffs will be compared to sensibility values, specificity, positive predictive value, negative predictive value, RV+, RV-, and BNP cutoffs. Results: Below, the results of the stratified analysis of BNP and AUC medians in subgroups BMI>30kg/m2, ECC<30ml/min, age > 80 and gender of the Test Sample. The results showed significant difference in BNP and AUC medians in the studied subgroups, compared to the cutoffs of the General Sample. The observed differences suggest the calculation by multiple logistic regression of a correction factor (Beta) to calculate a new BNP cutoff in subgroups with altered response to improve the biomarker accuracy for diagnosis and prognosis of Heart failure. Conclusion: Validation of new BNP cutoffs in subgroups showing BMI over 30 kg/m2, 80+ years old or ECC under 30 mL/min, with altered response in Heart Failure are expected from this study.
Global Heart, 2014
Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients with he... more Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients with heart failure (HF). The prognostic role of the long-term mortality is not enough studied. Objectives: To validate the BNP test as a biomarker of long-term prognosis in patients with suspected HF. Methods: Three hundred eighteen patients, who presented at the emergency room, from March 2003 through September 2009, with suspected HF, took part of this study. The accuracy of BNP to identify patients with heart failure and the search from the association with the level of BNP (POCT Biosite) and with the long-term prognosis were evaluated. The cause of death was identified through the search of death certificates in registries, informed by the Brazilian Information Service of Mortality. Results: Most of the patients were white (93.1%), female (63.8%), and aged 77.3 8.6 years. HF was diagnosed based in a new gold standard that considered the Framingham and Boston criteria plus echocardiography and ECG. HF was present in 170 pt (53.5%). Most of these 108 pt (63.5%) had HF with Preserved Ejection Fraction (HFPEF). The functional class III and IV NYHA was present in 87%. The BNP presented AUC 0.93 (CI 95%, 0.88 to 0.97). The best cutoff of BNP was 180 pg/ml with S 0.83 (CI 95%, 66.7 to 80.4) and Sp 0.90 (CI 95%, 76.7 to 95.4). LR + 6.7 (95 %, 3.1 to 14.3), accuracy of 77.7. In the bivariate analysis BNP> 180pg/ml was associated with a higher risk of mortality. In multivariate analysis HR BNP> 180pg/ml remained associated with increased risk of mortality HR 3.4 (HF 1.2 to 9.6 p 50% and mortality of 26%. The comparison HFS group and NHF showed RRR 0,21 (CI 95% 0,05 – 0,38) p<0,001. Betwin HFPEF group and N-HF group RRR 0,12 (CI 95% -0,02 0,27). HFS and HFPEF the RRR 0,089 (CI 95% -0,67 – 0,24). Ninety nine 99 deaths were recorded in the total group. Conclusion: The level of the BNP showed association with mortality index. The BNP is an independent prognostic biomarker of long-term mortality in patients with HF. Disclosure of Interest: None Declared
Global Heart, 2014
Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients with he... more Introduction: The BNP is used as a biomarker of prognosis, in the short term, in patients with heart failure (HF). The prognostic role of the long-term mortality is not enough studied. Objectives: To validate the BNP test as a biomarker of long-term prognosis in patients with suspected HF. Methods: Three hundred eighteen patients, who presented at the emergency room, from March 2003 through September 2009, with suspected HF, took part of this study. The accuracy of BNP to identify patients with heart failure and the search from the association with the level of BNP (POCT Biosite) and with the long-term prognosis were evaluated. The cause of death was identified through the search of death certificates in registries, informed by the Brazilian Information Service of Mortality. Results: Most of the patients were white (93.1%), female (63.8%), and aged 77.3 AE 8.6 years. HF was diagnosed based in a new gold standard that considered the Framingham and Boston criteria plus echocardiography and ECG. HF was present in 170 pt (53.5%). Most of these 108 pt (63.5%) had HF with Preserved Ejection Fraction (HFPEF). The functional class III and IV NYHA was present in 87%. The BNP presented AUC 0.93 (CI 95%, 0.88 to 0.97). The best cutoff of BNP was 180 pg/ml with S 0.83 (CI 95%, 66.7 to 80.4) and Sp 0.90 (CI 95%, 76.7 to 95.4). LR + 6.7 (95 %, 3.1 to 14.3), accuracy of 77.7. In the bivariate analysis BNP> 180pg/ml was associated with a higher risk of mortality. In multivariate analysis HR BNP> 180pg/ml remained associated with increased risk of mortality HR 3.4 (HF 1.2 to 9.6 p <0.02). Survival analysis in 30 days, 180 days and at the end of the study (six years and six months) was performed by Kaplan-Meier curve. Systolic HF group the median BNP was 595 pg/ml, The Mean Survival Time (MST) was 27 months and mortality of 47%. The group HFPEF the median BNP was 369 pg/ml, MST was 52 months, and mortality 38%. Group Not-HF BNP was 38 pg/ml, MST was >50% and mortality of 26%. The comparison HFS group and NHF showed RRR 0,21 (CI 95% 0,05-0,38) p<0,001. Betwin HFPEF group and N-HF group RRR 0,12 (CI 95%-0,02-0,27). HFS and HFPEF the RRR 0,089 (CI 95%-0,67-0,24). Ninety nine 99 deaths were recorded in the total group. Conclusion: The level of the BNP showed association with mortality index. The BNP is an independent prognostic biomarker of long-term mortality in patients with HF.
Revista da Associação Médica Brasileira, 2010
objectIve. To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitt... more objectIve. To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitted to elective CABGS in Rio Grande do Sul, RS, Brazil. Methods. This was a cohort study of 202 patients given CABGS between January 2006 and March 2007. Surgical risk was categorized according to the Cleveland Clinic Score and the EuroSCORE as low, medium or high. The incidence of deaths was measured over a 60-day period. results. The mean age of patients was 62±10 years and 134 (66%) of them were men. A correlation was observed between the scores for classifying patients into different levels of risk. According to the Cleveland Clinic score and the EuroSCORE, respectively, patients were categorized as follows: 142(70.3%) and 155(76.7%) low risk patients, 56(27.7%) and 43(21.3) intermediate risk patients and 4(2%) and 4(2%) high risk patients; with a Kaplan correlation coefficient of 0.432; p0.001. Thirteen (13, 6.4%) patients died during the first 60 days after surgery. There was a correlation between greater incidence of death and higher risk categories for both the Cleveland Clinic score and the EuroSCORE. Deaths occurred in the Cleveland and EuroSCORE risk groups, respectively, as follows: 6 (4.4%) and 7 (4.5%) in the low risk group; 5 (8.9%) and 5 (11.6%) in the intermediate risk group and 2 (50%) 3 1(25%) in the high risk group. Observed sensitivity for surgical mortality prediction was 72.5% and 66.5% for the Cleveland score and EuroSCORE respectively. conclusIon. The Cleveland Clinic and EuroSCORE surgical risk prediction instruments are both moderately effective for predicting mortality among elective CABGS patients.
Revista Brasileira de Cirurgia Cardiovascular, 2010
Background: Tobacco use is an important modifiable risk factor for cardiovascular disease. Few st... more Background: Tobacco use is an important modifiable risk factor for cardiovascular disease. Few studies have investigated the frequency of smoking cessation among patients submitted to heart surgery. Objective: To determine the frequency of smoking cessation in patients submitted to coronary artery bypass graft surgery. Methods: In this cohort study, 203 consecutive patients, aged above 18, submitted to coronary artery bypass graft surgery in the period from January 2006 to March 2007, were interviewed in relation to the use of cigarettes in the pre-and postoperative period. Smokers were stratified according to the levels of nicotine dependence with the use of Fagerström Nicotine Dependence Test. They were followed as outpatients during 60 and 90 days for the occurrence of smoking. Results: The mean age of the group was 62 ± 10 years, and 134 (66%) were male. Before surgery, 146 (71.9%) patients were smokers. A significant number of patients stopped smoking in the postoperative period: 136 (93.15%) and 137 (93.84%) on days 60 and 90, respectively, remained not smoking after surgery. Conclusion: Coronary artery bypass graft surgery is an important determinant of smoking cessation.
ConScientiae Saúde, 2012
Introdução: Síncope Vasovagal é uma patologia muito frequente, porém sua fisiopatologia não é bem... more Introdução: Síncope Vasovagal é uma patologia muito frequente, porém sua fisiopatologia não é bem conhecida. Objetivos: Verificar a associação do polimorfismo T102C 5HT-2A e síncope vasovagal. Métodos: Este estudo de caso-controle incluiu 106 pacientes, selecionados entre março de 2007 e dezembro de 2008. Cinquenta e três participantes com história de síncope e teste de inclinação positivo foram comparados com 53, sem história de síncope, em relação à presença do polimorfismo. Resultados: Dos pacientes estudados, 11 (22%) do grupo caso e 4 (8%) do controle tinham história familiar em primeiro grau de síncope (p=0,03). Na análise de regressão logística, os homozigotos 102C (OR 4,54; IC 95%: 1,14–0,97; p= 0,02) e a história familiar (OR 2,86; IC 95%: 0,97 – 8,39; p=0,03) estavam independentemente associados à maior chance de síncope vasovagal. Conclusões: Pacientes com história familiar de síncope e homozigotos 102C têm mais chance de apresentar síncope vasovagal.
Revista Brasileira de Cardiologia Invasiva, 2012
Background: Cardiovascular and periodontal diseases are common inflammatory conditions. In athero... more Background: Cardiovascular and periodontal diseases are common inflammatory conditions. In atherosclerosis, inflammation plays a continuous role in the development, destabilization, and rupture of atheromas. There is controversial scientific evidence regarding the association between chronic periodontitis and coronary artery disease (CAD). The objective of this study was to assess the association between chronic periodontitis and CAD in this practice. Methods: This was a cross-sectional controlled study of 206 patients with no prior CAD and for whom coronary angiography was indicated; the data included clinical history, physical examination and blood sample collection to test for blood glucose, lipid profile, and C-reactive protein levels. The presence of chronic periodontitis was determined by clinical examination performed by a periodontist. The levels of bacterial plaque, gingival calculus, bleeding, exudate, and classical signs of inflammation were recorded. Results: The mean age was 60.3 ± 10.1 years, and 60.2% of the subjects were male. CAD was present in 126 patients (61.2%). There was an association between CAD and gender [male gender, odds ratio (OR) 2.18; P = 0.0075], age (61-70 years, OR 5.63; P = 0.0007), and educational level (higher educational level, OR 2.08; P = 0.02). Inflammatory biomarkers did not differ between the groups with and without CAD. Signs of inflammation and bacterial plaque were present in 88% of patients with CAD, slightly higher than the rate observed in patients without
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Papers by juarez barbisan