Evandro Tinoco Mesquita

Transendocardial, Autologous Bone Marrow Cell Transplantation for Severe, Chronic Ischemic Heart Failure

Background—This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in patients with end-stage ischemic heart disease could safely promote neovascularization and improve perfusion and myocardial contractility. Methods and Results—Twenty-one patients were enrolled in this prospective, nonrandomized, open-label study (first 14 patients, treatment; last 7 patients, control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage ≥6.9 mV) for treatment. Treated and control patients underwent 2-month noninvasive follow-up, and treated patients alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. Patient population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum creatinine and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control patients. At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (P =0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (P =0.003) and a reduction in end-systolic volume (P =0.03) in the treated patients. Electromechanical mapping revealed significant mechanical improvement of the injected segments (P <0.0005) at 4 months after treatment. Conclusions—Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrow–derived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.

I Latin American Guidelines for the assessment and management of decompensated heart failure

Edimar Alcides Bocchi, Fabio Vilas-Boas, Sergio Perrone, Angel G Caamano, Nadine Clausell, Maria da Consolacao VMoreira, Jorge Thierer, Hugo Omar Grancelli, Carlos Vicente Serrano Junior, Denilson Albuquerque, Dirceu Almeida,Fernando Bacal, Luis Felipe Moreira, Adonay Mendonza, Antonio Magana, Arturo Tejeda, Daniel Chafes, Efraim Gomez,Erick Bogantes, Estela Azeka, Evandro Tinoco Mesquita, Francisco Jose Farias B Reis, Hector Mora, Humberto Vilacorta,Jesus Sanches, Joao David de Souza Neto, Jose Luis Vuksovic, Juan Paes Moreno, Julio Aspe y Rosas, Lidia ZytynskiMoura, Luis Antonio de Almeida Campos, Luis Eduardo Rohde, Marcos Parioma Javier, Martin Garrido Garduno, MucioTavares, Pablo Castro Galvez, Raul Spinoza, Reynaldo Castro de Miranda, Ricardo Mourilhe Rocha, Roberto Paganini,Rodolfo Castano Guerra, Salvador Rassi, Sofia Lagudis, Solange Bordignon, Solon Navarette, Waldo Fernandes, AntonioCarlos Pereira Barretto, Victor Issa, Jorge Ilha Guimaraes.

Custo da insuficiência cardíaca no Sistema Único de Saúde

Heart failure is the major cause of hospitalization in Unified Health System - Sistema Unico de Saude (SUS), from 65 years of age. The prevalence of heart failure is ascending, arising out of the increase in life expectancy of our population and a greater effectiveness of new medications for the treatment, which extends life. There are few national studies for the dimensioning of the socioeconomic impact and epidemiology of heart failure. There is the need for implementing economic methods to estimate the costs, instead of simply incurring expenses with heart failure. The estimate of the socioeconomic impact of the syndrome will provide the health policy formulators with a greater base for decisionmaking, before a scenario of lack of funds and need for prioritizing in its allocation. Stewart et al. 1OBJECTIVE To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antonio Pedro, Niterói. METHODS A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were evaluated in Brazilian Reais (2002). The studys point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version. RESULTS The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R

Epidemiologia da insuficiência cardíaca descompensada em Niterói: Projeto EPICA - Niterói

14.40. The expenses with ambulatory medications amounted R

Pré-hipertensão arterial e pressão de pulso aumentada em adolescentes: prevalência e fatores associados

83,430.00 (R

The Role of B-Type Natriuretic Peptide in the Diagnosis of Congestive Heart Failure in Patients Presenting to an Emergency Department with Dyspnea

1,191.86/patient/year). The cost per hospitalized patient was R

Insuficiência cardíaca com fração de ejeção preservada e com disfunção sistólica na comunidade

4,033.62. The cost with complementary examinations totaled R

Anemia como fator prognóstico em uma população hospitalizada por insuficiência cardíaca descompensada

39,009.50 (R

Cardiac function during mental stress: cholinergic modulation with pyridostigmine in healthy subjects

557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R

Noninvasive ventilation with continuous positive airway pressure acutely improves 6-minute walk distance in chronic heart failure.

182,000.00. The total cost was R