Showing papers by "Guilherme Veiga Guimarães published in 2005"
TL;DR: In elderly patients with optimally treated CHF, meditation reduced NE, improved quality of life, and reduced the VE/VCO(2) slope, which support the possible role of meditation as a new hope in the treatment of CHF.
Abstract: Objective: We tested whether meditation can reduce sympathetic activation, evaluated by norepinephrine blood levels (NE), and improve quality of life in elderly persons with congestive heart failure (CHF). Design and Setting: This was a prospective, randomized study conducted from April 2000 to October 2001 in an ambulatory care teaching hospital in Sao Paulo, Brazil. Subjects: We studied 19 patients with CHF, 74.8 ± 6.7 years old, receiving diuretics, optimal doses of an angiotensin-converting enzyme inhibitor or angiotensin II inhibitor, maximum tolerated carvedilol dose (23.1 ± 13.6 mg) and spironolactone 25 mg (10 patients). Interventions: After 2 months of optimal treatment with carvedilol, patients were randomized into two groups. The meditation group (M) was provided an audiotape, 30 minutes long, to listen to at home, twice a day, for 12 weeks, plus a weekly meeting. The control group (C) just had weekly meetings. Main Outcome Measures: We determined before and after 14 ± k1 weeks, NE (in pg/mL); ...
95 citations
TL;DR: Inflammatory activation in Chagas heart disease differs from IDC and is associated with heart failure severity and higher BNP levels were associated with death and heart transplantation in both aetiologies.
Abstract: Patients with Chagas’ cardiomyopathy have the worst prognosis when compared to other aetiologies. It has been suggested that a more intense inflammatory activation could be responsible for this excessive mortality. We studied 35 patients with idiopathic dilated cardiomyopathy (IDC group) and 28 patients with Chagas’ heart disease (Chagas’ group) and 12 control subjects. We compared plasma tumor necrosis factor a (TNF-a), soluble TNF-a receptor type 1 (sTNF-R1), soluble Fas (sFas), interleukin 6 (IL-6), and brain natriuretic peptide type B (BNP) concentrations between the groups. TNF-a and IL-6 concentrations were higher in the IDC and Chagas groups as compared to controls (pb0.001 and p=0.001, respectively). sTNF-R1 concentration was higher in IDC after stratification for functional class (p=0.039), and there was a trend toward higher plasma TNF-a concentration in the Chagas’ group (p=0.092). IL-6 concentration was higher in Chagas than in IDC (p=0.005). Higher IL-6 levels were associated with worse outcome (p=0.03 for Chagas; p=0.003 for IDC). sFas concentration was similar among groups. BNP concentrations were higher in IDC (350 pg/ml) and in Chagas (444.6 pg/ml) as compared to the controls (20.3 pg/ml; pb0.01). Higher BNP levels were associated with death and heart transplantation in both aetiologies. Inflammatory activation in Chagas heart disease differs from IDC and is associated with heart failure severity. D 2004 European Society of Cardiology. Published by Elsevier B.V.
51 citations
TL;DR: In contrast to what the authors would expect for heart transplant patients at late follow-up, the RV may adapt to pulmonary pressure and resistance, with reverse remodeling characterized by volume and mass reduction, leading to normalization of RV function despite abnormal hemodynamic pulmonary values being measured before HT.
Abstract: Background Right ventricular (RV) dysfunction remains one of the most prominent complications during the period immediately after heart transplantation (HT); however, late adaptation of the RV has not been well described. The aim of our study was to evaluate RV function and remodeling using magnetic resonance imaging (MRI) and to correlate it with exercise capacity and also with hemodynamic data obtained before HT. Methods We prospectively evaluated RV function of 25 heart-transplanted patients, without cardiac allograft vasculopathy, who were documented by negative dobutamine stress echocardiography during late follow-up (Group 1, 6 ± 4.3 years) using MRI. We then compared Group 1 with a control group consisting of 10 patients, who were ≤1 year post-HT (Group 2), hemodynamically stable, and with the same pre-operative hemodynamic features as Group 1. Their pulmonary arterial systolic blood pressure (PSBP) varied from 17 to 67 mm Hg (43.2 ± 15.3) and pulmonary vascular resistance (PVR) from 1.0 to 5.4 Wood units (2.5 ± 1.12). The following parameters were studied: RV end-diastolic volume (EDV) and systolic volume (ESV); stroke volume (SV); ejection fraction (EF); and mass (M). We also evaluated the Vo 2 peak and slope Ve/Vco 2 values during a treadmill test. Data were analyzed and correlated with the hemodynamic values of PVR and PSBP obtained pre-HT. Results In Group 1, treadmill evaluation data showed exercise Vo 2 peak (19.9 ± 3.19 ml/kg/min) and slope Ve/Vco 2 (36.9 ± 4.5) values comparable to those of sedentary individuals; RV variables according to MRI were within normal ranges, with the following mean values for Groups 1 and 2, respectively: RVEDV, 99.6 ± 4.0 ml vs 127 ± 16 ml ( p = 0.03); RVESV, 42 ± 2 ml vs 58.5 ± 9 ml ( p = 0.01); RVSV, 57 ± 3 ml vs 71 ± 10 ml ( p = 0.1); RVEF, 58 ± 1.4% vs 54 ± 3.8% ( p = 0.29); and RVM, 43.4 ± 1.9 g vs 74 ± 8.8 g ( p = 0.001). There was no correlation between hemodynamic pulmonary values before HT or any other index of late RV performance, including RV remodeling and hypertrophy, in our study population ( p = not significant). Conclusions In contrast to what we would expect for heart transplant patients at late follow-up, the RV may adapt to pulmonary pressure and resistance, with reverse remodeling characterized by volume and mass reduction, leading to normalization of RV function despite abnormal hemodynamic pulmonary values being measured before HT. There was no influence on the low exercise capacity observed in these patients, in the absence of cardiac allograft vasculopathy.
16 citations