Rafael Lois Greco

Ressincronização cardíaca e terapia celular: existe terapia associativa?

Nos ultimos anos, a terapia de ressincronizacao cardiaca tem sido uma conduta bem definida para pacientes com insuficiencia cardiaca (IC), classe funcional III ou IV, que nao tiveram resposta a otimizacao terapeutica. Estudos ja mostraram esta eficacia, mas um grupo bem definido de miocardiopatias dilatadas com areas de fibrose nao tem tido o mesmo sucesso (30%-40%). Por isto decidimos associar a estes pacientes o implante de celulas-tronco. A partir de 04/2005 iniciamos estes implantes em pacientes (pcs.) com IC, classe funcional III/IV, otmizados e fracao de ejecao <35% com dissincronia ventricular. Total de 25 pacientes (16 homens), idade entre 30-80anos (media de 58) e 44% de etiologia chagasica (11 pcs). Ressincronizacao e terapia celular foram por via epicardica (12 pcs) e endocardica (13 pcs) e a selecao celular pela filtracao por Ficoll e 3.0x108 de celulas infundidas CD34 + (5,0 x 106) e CD 133 + (2,5 x 106). Apos 24 meses de evolucao observamos que 84,8% destes pcs permaneceram vivos e a mortalidade (15,2%) nao estava relacionada ao procedimento. A sobrevida dos portadores de marcapasso foi maior (52,4%) e os chagasicos tiveram uma pior sobrevida, mas com teste de long-rank de 0,218 e 0,626, respectivamente. Nos casos de pcs com ressincronizador isoladamente, os resultados nao parecem ser tao bons,e nos optamos pela associacao de celulas-tronco como uma alternativa segura e adequada para estes graves pcs com insuficiencia cardiaca e miocardiopatia dilatada.

Uso de células-tronco no tratamento de pacientes com miocardiopatia dilatada de diferentes etiologias, associada à ressincronização cardíaca artificial

In spite of the development of pharmacological strategies, technology and more sophisticated surgical alternatives, incidences of death from cardiopathies remains high throughout the world, in particular in relation to dilated heart disease. Many of these patients benefit from recent strategies of early myocardial perfusion which significantly reduces mortality rates; even so past-infarction heart failure is common. Recent studies have shown that the infusion of autologous stem cells is a possible treatment to reverse ventricular dysfunction. However, frequently there is an associated electrical conduction defect. Thus, an infusion of stem cells may produce a mechanical correction with heart resynchronization correcting the electrical conduction defect thereby improving the left ventricle ejection fraction. Our institution has been combining stem cell transplantation with resynchronization and, when necessary, cardiofibrilation, to treat these patients giving improvements in the Functional Class, ejection fraction and left ventricle and right ventricle-left ventricle synchrony.

Plasma concentrations of D-Dimer predict mortality?

utilizandocitometria de fluxo quantitativa, demonstraram menor quan-tidade de moleculas de TdT e CD19 e maior quantidade demoleculas de CD10 em blastos leucemicos comparados comas celulas linfoides B precursoras.Nos ultimos anos, o desenvolvimento da metodologiade imunofenotipagem por citometria de fluxo multiparametricatornou possivel utilizar tres a quatro cores simultaneamente.O conhecimento adquirido das expressoes antigenicas naontogenese da linhagem linfocitaria B tem auxiliado na dis-tincao entre as celulas linfoides B precursoras e os linfo-blastos residuais leucemicos, como pode ser lido nos artigospublicados por Wells DA,

Long-term experience with a contractility (autonomic nervous system) driven pacemaker sensor in patients with chronic chagasic cardiomyopathy.

We analyzed performance of a ventricle-paced, ventricle-sensed, inhibited, rate-responsive (VVIR) pacemaker driven by autonomic nervous system activity sensor in chagasic patients with cardiac conduction system disturbances. Forty-seven chagasic patients were studied (28 male, 19 female; age, 24-68 years). Thirty-six patients had complete atrioventricular (AV) block, eight had second-degree AV block, and the remaining three patients had sinus node disease. Patients were divided into two groups according to their heart rate (HR) at rest: group 1 had an HR more than 65 bpm; group 2, HR less than 65 bpm. A comparative study that extended over the first 12 months after pacemaker implantation evaluated: HR at rest and during various types of stress tests, arterial blood pressure at rest and during exercise, and performance of the TIR-60 UP leads in conjunction with the sensor function as compared with the performance of other leads. Patients from group 1 had a higher HR at rest and a smaller HR variation during stress test than did patients from group 2. This indicates that with this type of rate-adaptive system it is possible to control each patient individually. The blood pressure at rest and during stress tests did not differ between the two patient groups. With respect to the sensor function, the TIR-60 UP leads offered the same performance as others leads. The VVIR pacemaker equipped with the sensor of autonomic nervous system activity allowed chagasic patients to restore their physiologic mechanisms. Seventy-four percent of the patients had the New York Heart Association Functional Class improved by 1 or 2 steps, after the pacemaker implantation.