Valéria Bezerra de Carvalho

Hemodynamic determinants of coronary constriction in human myocardial bridges

To study the physiopathology of myocardial bridges, we assessed the degree of systolic coronary artery constriction (%SC) in different hemodynamic situations in six patients submitted for coronary angiograms. There was an increase of %SC (p less than 0.05) with sodium nitroprusside (NP), no modification during fast atrial stimulation (AS), and a decrease (p less than 0.05) during noradrenaline infusion (Nor). Hemodynamic studies indicate an inverse relation (p less than 0.05) between %SC and systolic and diastolic aortic pressure and left ventricular dP/dt. There was no correlation between changes in %SC and changes in Vmax or heart rate. Thus we conclude that changes in systemic arterial pressure and coronary perfusion pressure may significantly affect the degree of severity of myocardial bridges, possibly through an influence upon intraluminal coronary pressure and an intramyocardial tension relationship.

Assessing users’ emotion at interaction time: a multimodal approach with multiple sensors

Users’ emotional states influence decision making and are essential for the knowledge and explanation of users’ behavior with computer applications. However, collecting emotional states during the interaction time with users is a onerous task because it requires very careful handling of the empirical observation, leading researchers to carry out assessments of emotional responses only at the end of the interaction. This paper reports our research in assessing users’ behavior at interaction time and also describes the results of a case study which analyzed users’ emotional responses while interacting with a game. We argue that capturing emotions during interaction time can help us in making changes on users’ behavior (e.g., changing from stressed to a less stressed state) or even suggesting an user to have a break. This can be all possible if both (1) emotions are captured during interaction and (2) changes are suggested at runtime (e.g., through persuasion). The results of this study suggest that there are significant differences between emotional responses captured during the interaction and those declared at the end.

Cell Therapy in Chagas Cardiomyopathy (Chagas Arm of the MiHeart Study): A Multicenter Randomized Trial

Background —Previous studies suggested that transplantation of autologous bone marrow derived mononuclear cells (BMNC) improves heart function in chronic chagasic cardiomyopathy (CCC). We report the results of the first randomized trial of BMNC therapy in CCC. Methods and Results —Patients aged 18-75 years with CCC, NYHA class III or IV, LVEF less than 35%, and optimized therapy were randomized to intracoronary injection of autologous BMNC or placebo. Primary endpoint was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5%. Between July 2005 and October 2009 234 patients were enrolled. Two abandoned the study and 49 were excluded due to protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had trimmed mean age of 52.4 years (50.8 to 54.0) and LVEF of 26.1% (25.1 to 27.1) at baseline. Median number of injected BMNCs was 2.20 x 108 (1.40-3.50 x 108). Change in LVEF did not differ significantly between treatment groups: trimmed mean ΔEF= 3.0 (1.3 to 4.8) for BMNC and 2.5 (0.6 to 4.5) for placebo (p=0.519) at 6 months; ΔEF= 3.5 (1.5 to 5.5) for BMNC and ΔEF= 3.7 (1.5 to 6.0) for placebo (p=0.850) at 12 months. Left ventricular systolic and diastolic volumes, NYHA class, Minnesota life quality questionnaire, BNP concentrations, and 6-min walking test did also not differ between groups. Conclusions —Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with CCC. Clinical Trial Registration Information —ClinicalTrials.gov; Identifier: [NCT00349271][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00349271&atom=%2Fcirculationaha%2Fearly%2F2012%2F04%2F19%2FCIRCULATIONAHA.111.067785.atomBackground— Previous studies suggested that transplantation of autologous bone marrow–derived mononuclear cells (BMNCs) improves heart function in chronic chagasic cardiomyopathy. We report the results of the first randomized trial of BMNC therapy in chronic chagasic cardiomyopathy. Methods and Results— Patients 18 to 75 years of age with chronic chagasic cardiomyopathy, New York Heart Association class II to IV heart failure, left ventricular ejection fraction (LVEF) <35, and optimized therapy were randomized to intracoronary injection of autologous BMNCs or placebo. The primary end point was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5. Between July 2005 and October 2009, 234 patients were enrolled. Two patients abandoned the study and 49 were excluded because of protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had a trimmed mean age of 52.4 years (range, 50.8–54.0 years) and LVEF of 26.1 (range, 25.1–27.1) at baseline. Median number of injected BMNCs was 2.20×108 (range, 1.40–3.50×108). Change in LVEF did not differ significantly between treatment groups: trimmed mean change in LVEF at 6 months, 3.0 (1.3–4.8) for BMNCs and 2.5 (0.6–4.5) for placebo (P=0.519); change in LVEF at 12 months, 3.5 (1.5–5.5) for BMNCs and 3.7 (1.5–6.0) for placebo (P=0.850). Left ventricular systolic and diastolic volumes, New York Heart Association functional class, Minnesota quality-of-life questionnaire, brain natriuretic peptide concentrations, and 6-minute walking test did also not differ between groups. Conclusion— Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with chronic chagasic cardiomyopathy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00349271.

A 23 years of uneventful evolution in a heart-transplanted patient with chagasic cardiomyopathy on a two-drug immunosuppressive protocol.

Address correspondence to: Lionel Rostaing, M.D., Ph.D., Department of Nephrology, Dialysis and Multiorgan Transplantation, Toulouse University Hospital, 1 Avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cédex 9, France. E-mail: rostaing.l@chu-toulouse.fr Received 19 September 2008. Accepted 29 October 2008. Copyright

Cell Therapy in Chagas Cardiomyopathy (Chagas Arm of the Multicenter Randomized Trial of Cell Therapy in Cardiopathies Study)Clinical Perspective

Background —Previous studies suggested that transplantation of autologous bone marrow derived mononuclear cells (BMNC) improves heart function in chronic chagasic cardiomyopathy (CCC). We report the results of the first randomized trial of BMNC therapy in CCC. Methods and Results —Patients aged 18-75 years with CCC, NYHA class III or IV, LVEF less than 35%, and optimized therapy were randomized to intracoronary injection of autologous BMNC or placebo. Primary endpoint was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5%. Between July 2005 and October 2009 234 patients were enrolled. Two abandoned the study and 49 were excluded due to protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had trimmed mean age of 52.4 years (50.8 to 54.0) and LVEF of 26.1% (25.1 to 27.1) at baseline. Median number of injected BMNCs was 2.20 x 108 (1.40-3.50 x 108). Change in LVEF did not differ significantly between treatment groups: trimmed mean ΔEF= 3.0 (1.3 to 4.8) for BMNC and 2.5 (0.6 to 4.5) for placebo (p=0.519) at 6 months; ΔEF= 3.5 (1.5 to 5.5) for BMNC and ΔEF= 3.7 (1.5 to 6.0) for placebo (p=0.850) at 12 months. Left ventricular systolic and diastolic volumes, NYHA class, Minnesota life quality questionnaire, BNP concentrations, and 6-min walking test did also not differ between groups. Conclusions —Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with CCC. Clinical Trial Registration Information —ClinicalTrials.gov; Identifier: [NCT00349271][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00349271&atom=%2Fcirculationaha%2Fearly%2F2012%2F04%2F19%2FCIRCULATIONAHA.111.067785.atomBackground— Previous studies suggested that transplantation of autologous bone marrow–derived mononuclear cells (BMNCs) improves heart function in chronic chagasic cardiomyopathy. We report the results of the first randomized trial of BMNC therapy in chronic chagasic cardiomyopathy. Methods and Results— Patients 18 to 75 years of age with chronic chagasic cardiomyopathy, New York Heart Association class II to IV heart failure, left ventricular ejection fraction (LVEF) <35, and optimized therapy were randomized to intracoronary injection of autologous BMNCs or placebo. The primary end point was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5. Between July 2005 and October 2009, 234 patients were enrolled. Two patients abandoned the study and 49 were excluded because of protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had a trimmed mean age of 52.4 years (range, 50.8–54.0 years) and LVEF of 26.1 (range, 25.1–27.1) at baseline. Median number of injected BMNCs was 2.20×108 (range, 1.40–3.50×108). Change in LVEF did not differ significantly between treatment groups: trimmed mean change in LVEF at 6 months, 3.0 (1.3–4.8) for BMNCs and 2.5 (0.6–4.5) for placebo (P=0.519); change in LVEF at 12 months, 3.5 (1.5–5.5) for BMNCs and 3.7 (1.5–6.0) for placebo (P=0.850). Left ventricular systolic and diastolic volumes, New York Heart Association functional class, Minnesota quality-of-life questionnaire, brain natriuretic peptide concentrations, and 6-minute walking test did also not differ between groups. Conclusion— Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with chronic chagasic cardiomyopathy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00349271.

Cell Therapy in Chagas Cardiomyopathy (Chagas Arm of the Multicenter Randomized Trial of Cell Therapy in Cardiopathies Study)

Background —Previous studies suggested that transplantation of autologous bone marrow derived mononuclear cells (BMNC) improves heart function in chronic chagasic cardiomyopathy (CCC). We report the results of the first randomized trial of BMNC therapy in CCC. Methods and Results —Patients aged 18-75 years with CCC, NYHA class III or IV, LVEF less than 35%, and optimized therapy were randomized to intracoronary injection of autologous BMNC or placebo. Primary endpoint was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5%. Between July 2005 and October 2009 234 patients were enrolled. Two abandoned the study and 49 were excluded due to protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had trimmed mean age of 52.4 years (50.8 to 54.0) and LVEF of 26.1% (25.1 to 27.1) at baseline. Median number of injected BMNCs was 2.20 x 108 (1.40-3.50 x 108). Change in LVEF did not differ significantly between treatment groups: trimmed mean ΔEF= 3.0 (1.3 to 4.8) for BMNC and 2.5 (0.6 to 4.5) for placebo (p=0.519) at 6 months; ΔEF= 3.5 (1.5 to 5.5) for BMNC and ΔEF= 3.7 (1.5 to 6.0) for placebo (p=0.850) at 12 months. Left ventricular systolic and diastolic volumes, NYHA class, Minnesota life quality questionnaire, BNP concentrations, and 6-min walking test did also not differ between groups. Conclusions —Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with CCC. Clinical Trial Registration Information —ClinicalTrials.gov; Identifier: [NCT00349271][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00349271&atom=%2Fcirculationaha%2Fearly%2F2012%2F04%2F19%2FCIRCULATIONAHA.111.067785.atomBackground— Previous studies suggested that transplantation of autologous bone marrow–derived mononuclear cells (BMNCs) improves heart function in chronic chagasic cardiomyopathy. We report the results of the first randomized trial of BMNC therapy in chronic chagasic cardiomyopathy. Methods and Results— Patients 18 to 75 years of age with chronic chagasic cardiomyopathy, New York Heart Association class II to IV heart failure, left ventricular ejection fraction (LVEF) <35, and optimized therapy were randomized to intracoronary injection of autologous BMNCs or placebo. The primary end point was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5. Between July 2005 and October 2009, 234 patients were enrolled. Two patients abandoned the study and 49 were excluded because of protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had a trimmed mean age of 52.4 years (range, 50.8–54.0 years) and LVEF of 26.1 (range, 25.1–27.1) at baseline. Median number of injected BMNCs was 2.20×108 (range, 1.40–3.50×108). Change in LVEF did not differ significantly between treatment groups: trimmed mean change in LVEF at 6 months, 3.0 (1.3–4.8) for BMNCs and 2.5 (0.6–4.5) for placebo (P=0.519); change in LVEF at 12 months, 3.5 (1.5–5.5) for BMNCs and 3.7 (1.5–6.0) for placebo (P=0.850). Left ventricular systolic and diastolic volumes, New York Heart Association functional class, Minnesota quality-of-life questionnaire, brain natriuretic peptide concentrations, and 6-minute walking test did also not differ between groups. Conclusion— Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with chronic chagasic cardiomyopathy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00349271.

Cell Therapy in Chagas Cardiomyopathy (Chagas Arm of the Multicenter Randomized Trial of Cell Therapy in Cardiopathies Study)Clinical Perspective: A Multicenter Randomized Trial

Background —Previous studies suggested that transplantation of autologous bone marrow derived mononuclear cells (BMNC) improves heart function in chronic chagasic cardiomyopathy (CCC). We report the results of the first randomized trial of BMNC therapy in CCC. Methods and Results —Patients aged 18-75 years with CCC, NYHA class III or IV, LVEF less than 35%, and optimized therapy were randomized to intracoronary injection of autologous BMNC or placebo. Primary endpoint was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5%. Between July 2005 and October 2009 234 patients were enrolled. Two abandoned the study and 49 were excluded due to protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had trimmed mean age of 52.4 years (50.8 to 54.0) and LVEF of 26.1% (25.1 to 27.1) at baseline. Median number of injected BMNCs was 2.20 x 108 (1.40-3.50 x 108). Change in LVEF did not differ significantly between treatment groups: trimmed mean ΔEF= 3.0 (1.3 to 4.8) for BMNC and 2.5 (0.6 to 4.5) for placebo (p=0.519) at 6 months; ΔEF= 3.5 (1.5 to 5.5) for BMNC and ΔEF= 3.7 (1.5 to 6.0) for placebo (p=0.850) at 12 months. Left ventricular systolic and diastolic volumes, NYHA class, Minnesota life quality questionnaire, BNP concentrations, and 6-min walking test did also not differ between groups. Conclusions —Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with CCC. Clinical Trial Registration Information —ClinicalTrials.gov; Identifier: [NCT00349271][1] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00349271&atom=%2Fcirculationaha%2Fearly%2F2012%2F04%2F19%2FCIRCULATIONAHA.111.067785.atomBackground— Previous studies suggested that transplantation of autologous bone marrow–derived mononuclear cells (BMNCs) improves heart function in chronic chagasic cardiomyopathy. We report the results of the first randomized trial of BMNC therapy in chronic chagasic cardiomyopathy. Methods and Results— Patients 18 to 75 years of age with chronic chagasic cardiomyopathy, New York Heart Association class II to IV heart failure, left ventricular ejection fraction (LVEF) <35, and optimized therapy were randomized to intracoronary injection of autologous BMNCs or placebo. The primary end point was the difference in LVEF from baseline to 6 and 12 months after treatment between groups. Analysis was by intention to treat and powered to detect an absolute between-group difference of 5. Between July 2005 and October 2009, 234 patients were enrolled. Two patients abandoned the study and 49 were excluded because of protocol violation. The remaining 183 patients, 93 in the placebo group and 90 in the BMNC group, had a trimmed mean age of 52.4 years (range, 50.8–54.0 years) and LVEF of 26.1 (range, 25.1–27.1) at baseline. Median number of injected BMNCs was 2.20×108 (range, 1.40–3.50×108). Change in LVEF did not differ significantly between treatment groups: trimmed mean change in LVEF at 6 months, 3.0 (1.3–4.8) for BMNCs and 2.5 (0.6–4.5) for placebo (P=0.519); change in LVEF at 12 months, 3.5 (1.5–5.5) for BMNCs and 3.7 (1.5–6.0) for placebo (P=0.850). Left ventricular systolic and diastolic volumes, New York Heart Association functional class, Minnesota quality-of-life questionnaire, brain natriuretic peptide concentrations, and 6-minute walking test did also not differ between groups. Conclusion— Intracoronary injection of autologous BMNCs does not improve left ventricular function or quality of life in patients with chronic chagasic cardiomyopathy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00349271.