Alfredo Inácio Fiorelli

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, San Paulo, São Paulo, Brazil

Are you Alfredo Inácio Fiorelli?

Claim your profile

Publications (148)273.39 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Clinical and experimental conflicting data have questioned the relationship between infectious agents, inflammation and dilated cardiomyopathy (DCM). Objectives: The aim of this study was to determine the frequency of infectious agents and inflammation in endomyocardial biopsy (EMB) specimens from patients with idiopathic DCM, explanted hearts from different etiologies, including Chagas' disease, compared to donated hearts. Methods: From 2008 to 2011, myocardial samples from 29 heart donors and 55 patients with DCMs from different etiologies were studied (32 idiopathic, 9 chagasic, 6 ischemic and 8 other specific etiologies). Inflammation was investigated by immunohistochemistry and infectious agents by immunohistochemistry, molecular biology, in situ hybridization and electron microscopy. Results: There were no differences regarding the presence of macrophages, expression of HLA class II and ICAM-I in donors and DCM. Inflammation in Chagas' disease was predominant. By immunohistochemistry, in donors, there was a higher expression of antigens of enterovirus and Borrelia, hepatitis B and C in DCMs. By molecular biology, in all groups, the positivity was elevated to microorganisms, including co-infections, with a higher positivity to adenovirus and HHV6 in donors towards DCMs. This study was the first to demonstrate the presence of virus in the heart tissue of chagasic DCM. Conclusions: The presence of inflammation and infectious agents is frequent in donated hearts, in the myocardium of patients with idiopathic DCM, myocardial dysfunction related to cardiovascular diseases, and primary and secondary cardiomyopathies, including Chagas' disease. The role of co-infection in Chagas' heart disease physiopathology deserves to be investigated in future studies.
    Full-text · Article · Jan 2015 · International Journal of Cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Chronic Chagas disease cardiomyopathy (CCC), a late consequence of Trypanosoma cruzi infection, is an inflammatory cardiomyopathy with prognosis worse than those of noninflammatory etiology (NIC). Although the T cell-rich myocarditis is known to play a pathogenetic role, the relative contribution of each of the functional T cell subsets has never been thoroughly investigated. We therefore assessed gene expression of cytokines and transcription factors involved in differentiation and effector function of each functional T cell subset (TH1/TH2/TH17/Treg) in CCC, NIC, and heart donor myocardial samples. Methods and Results. Quantitative PCR showed markedly upregulated expression of IFN-γ and transcription factor T-bet, and minor increases of GATA-3; FoxP3 and CTLA-4; IL-17 and IL-18 in CCC as compared with NIC samples. Conversely, cytokines expressed by TH2 cells (IL-4, IL-5, and IL-13) or associated with Treg (TGF-β and IL-10) were not upregulated in CCC myocardium. Expression of TH1-related genes such as T-bet, IFN-γ, and IL-18 correlated with ventricular dilation, FoxP3, and CTLA-4. Conclusions. Results are consistent with a strong local TH1-mediated response in most samples, possibly associated with pathological myocardial remodeling, and a proportionally smaller FoxP3+CTLA4+ Treg cell population, which is unable to completely curb IFN-γ production in CCC myocardium, therefore fueling inflammation.
    Full-text · Article · Jul 2014 · Mediators of Inflammation
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Chagas’ disease reactivation (CDR) after heart transplantation (HTx) is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. We investigated if a detailed pathological examination of the explanted heart at HTx with evaluation of myocarditis and parasitic persistence/load in the myocardium could be useful to identify patients at high risk of CDR. Methods The native heart of 18 chagasic patients who presented CDR after HTx (CDR+ group) were compared to the native heart of 16 chagasic patients who never presented CDR in a follow-up of at least 18 months after HTx (CDR- group). The intensity of myocarditis was evaluated semi-quantitatively. Parasite persistence/load in the myocardium was investigated through immunohistochemistry for T. cruzi antigens and both qualitative and quantitative real-time PCR for T. cruzi DNA. Results The rate of high-grade myocarditis, parasite persistence and the median of parasitic load and parasitic load/106 cells in CDR+ group were 83.3%, 77.8%, 8.43×10-3 and 9.890, respectively, while in the CDR- group the values were 87.5%, 50%, 7.49×10-3 and 17.800. There was no statistical difference between the groups. High-grade myocarditis was present in 22/22 (100%) samples with parasite persistence and 7/12 (58.3%) samples with no parasite persistence (p=0.003). Conclusion Although associated with high-grade myocarditis, parasite persistence in the myocardium of the native heart is not associated with the occurrence of CDR after HTx.
    No preview · Article · Jul 2014 · The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Inconsistencies in cardiac rejection grading systems corroborate the concept that the evaluation of inflammatory intensity and myocyte damage seems to be subjective. We studied in 36 patients the potential role of the immunohistochemical (IHC) counting of inflammatory cells in endomyocardial biopsy (EMB) as an objective tool, testing the hypothesis of correlation between the International Society for Heart and Lung Transplantation 2004 rejection and IHC counting of inflammatory cells. We observed a progressive increment in CD68+ cells/mm(2) (P = .000) and CD3+ cells/mm(2) (P = .000) with higher rejection grade. A strong correlation between the grade of cellular rejection and both CD68+ cells/mm(2) and CD3+ cells/mm(2) was obtained (P = .000). One patient with CD3+ and CD68+ cells/mm(2) above the upper limit of the 95% confidence interval for cells/mm(2) found in rejection grade 1R evolved to rejection grade 2R without treatment. In patients with 2R that did not respond to treatment the values of CD68+ or CD3+ cells were higher than the overall median values for rejection grade 2R. For diagnosis of rejection needing treatment, the CD68+ and CD3+ cells/mm(2) areas under the receiver operating characteristic curves were 0.956 and 0.934, respectively. IHC counting of mononuclear inflammatory infiltrate in EMB seems to have additive potential role in evaluation of EMB for the diagnosis and prognosis of rejection episodes.
    Full-text · Article · Jun 2014 · Transplantation Proceedings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background/methods: Chagas disease is caused by an intracellular parasite, Trypanosoma cruzi, and it is a leading cause of heart failure in Latin America. The main clinical consequence of the infection is the development of a Chronic Chagas disease Cardiomyopathy (CCC), which is characterized by myocarditis, hypertrophy and fibrosis and affects about 30% of infected patients. CCC has a worse prognosis than other cardiomyopathies, like idiopathic dilated cardiomyopathy (DCM). It is well established that myocardial gene expression patterns are altered in CCC, but the molecular mechanisms underlying these differences are not clear. MicroRNAs are recently discovered regulators of gene expression, and are recognized as important factors in heart development and cardiovascular disorders (CD). We analyzed the expression of nine different miRNAs in myocardial tissue samples of CCC patients in comparison to DCM patients and samples from heart transplant donors. Using the results of a cDNA microarray database on CCC and DCM myocardium, signaling networks were built and nodal molecules were identified. Results: We observed that five miRNAs were significantly altered in CCC and three in DCM; importantly, three miRNAs were significantly reduced in CCC as compared to DCM. We observed that multiple gene targets of the differentially expressed miRNAs showed a concordant inverse expression in CCC. Significantly, most gene targets and involved networks belong to crucial disease-related signaling pathways. Conclusion: These results suggest that miRNAs may play a major role in the regulation of gene expression in CCC pathogenesis, with potential implication as diagnostic and prognostic tools.
    Full-text · Article · May 2014 · International Journal of Cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Discrepancies between pre and post-mortem diagnoses are reported in the literature, ranging from 4.1 to 49.8 % in cases referred for necropsy, with important impact on patient treatment. Objective: To analyze patients who died after cardiac transplantation and to compare the pre- and post-mortem diagnoses. Methods: Perform a review of medical records and analyze clinical data, comorbidities, immunosuppression regimen, laboratory tests, clinical cause of death and cause of death at the necropsy. Then, the clinical and necroscopic causes of death of each patient were compared. Results: 48 deaths undergoing necropsy were analyzed during 2000-2010; 29 (60.4 %) had concordant clinical and necroscopic diagnoses, 16 (33.3%) had discordant diagnoses and three (6.3%) had unclear diagnoses. Among the discordant ones, 15 (31.3%) had possible impact on survival and one (2.1%) had no impact on survival. The main clinical misdiagnosis was infection, with five cases (26.7 % of discordant), followed by hyperacute rejection, with four cases (20 % of the discordant ones), and pulmonary thromboembolism, with three cases (13.3% of discordant ones). Conclusion: Discrepancies between clinical diagnosis and necroscopic findings are commonly found in cardiac transplantation. New strategies to improve clinical diagnosis should be made, considering the results of the necropsy, to improve the treatment of heart failure by heart transplantation.
    Full-text · Article · Apr 2014 · Arquivos brasileiros de cardiologia
  • Source

    Preview · Article · Apr 2014 · Journal of the American College of Cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Inconsistencies in cardiac rejection grading systems corroborate the concept that the evaluation of inflammatory intensity and myocyte damage seems to be subjective. We studied in 36 patients the potential role of the immunohistochemical (IHC) counting of inflammatory cells in endomyocardial biopsy (EMB) as an objective tool, testing the hypothesis of correlation between the International Society for Heart and Lung Transplantation 2004 rejection and IHC counting of inflammatory cells. We observed a progressive increment in CD68+ cells/mm2 (P = .000) and CD3+ cells/mm2 (P = .000) with higher rejection grade. A strong correlation between the grade of cellular rejection and both CD68+ cells/mm2 and CD3+ cells/mm2 was obtained (P = .000). One patient with CD3+ and CD68+ cells/mm2 above the upper limit of the 95% confidence interval for cells/mm2 found in rejection grade 1R evolved to rejection grade 2R without treatment. In patients with 2R that did not respond to treatment the values of CD68+ or CD3+ cells were higher than the overall median values for rejection grade 2R. For diagnosis of rejection needing treatment, the CD68+ and CD3+ cells/mm2 areas under the receiver operating characteristic curves were 0.956 and 0.934, respectively. IHC counting of mononuclear inflammatory infiltrate in EMB seems to have additive potential role in evaluation of EMB for the diagnosis and prognosis of rejection episodes.
    Full-text · Article · Jan 2014 · Transplantation Proceedings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chagas disease, caused by the protozoan Trypanosoma cruzi is endemic in Latin America, and may lead to a life-threatening inflammatory dilated, chronic Chagas cardiomyopathy (CCC). One third of T. cruzi-infected individuals progress to CCC while the others remain asymptomatic (ASY). A possible genetic component to disease progression was suggested by familial aggregation of cases and the association of markers of innate and adaptive immunity genes with CCC development. Since mutations in multiple sarcomeric genes, including alpha-cardiac actin (ACTC1) have been involved in hereditary dilated cardiomyopathy, we investigated the involvement of the ACTC1 gene in CCC pathogenesis. We conducted a proteomic and genetic study on a Brazilian study population. The genetic study was done on a main cohort including 118 seropositive asymptomatic subjects and 315 cases and the replication was done on 36 asymptomatic and 102 CCC cases. ACTC1 protein and mRNA levels were lower in myocardial tissue from patients with end-stage CCC than those found in hearts from organ donors. Genotyping a case-control cohort of CCC and ASY subjects for all informative single nucleotide polymorphism (SNP) in the ACTC1 gene identified rs640249 SNP, located at the 5' region, as associated to CCC. Associations are borderline after correction for multiple testing. Correlation and haplotype analysis led to the identification of a susceptibility haplotype. Functional assays have shown that the rs640249A/C polymorphism affects the binding of transcriptional factors in the promoter regions of the ACTC1 gene. Confirmation of the detected association on a larger independent replication cohort will be useful. Genetic variations at the ACTC1 gene may contribute to progression to chronic Chagas Cardiomyopathy among T. cruzi-infected patients, possibly by modulating transcription factor binding to ACTC1 promoter regions.
    Full-text · Article · Dec 2013 · PLoS ONE
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiopulmonary bypass (CPB) is related to inflammatory response and pulmonary dysfunction. The aim of this study was to evaluate the effects of CPB leukocyte filtration on inflammation and lung function after coronary artery bypass grafting (CABG). A prospective randomized study was performed to compare CABG patients undergoing CPB leukocyte filtration (n = 9) or standard CPB (n = 11). Computed tomography, oxygenation, leukocyte count, hemodynamic data, PaO2/FiO2, shunt fraction, interleukins, elastase, and myeloperoxidase were evaluated. Data were analyzed using two-factor ANOVA for repeated measurements. The filtered group showed lower neutrophil counts up to 50 min of CPB, lower shunt fraction up to 6 h after surgery, and lower levels of IL-10 at the end of surgery (p < 0.05). There was no statistically significant difference between groups related to other parameters. Leukodepletion during CPB results in neutrophil sequestration by a short time, decreased IL-10 serum levels, and lower worsening of lung function only temporarily.
    Full-text · Article · Oct 2013 · Inflammation
  • Source
    N Stolf · A Fiorelli · D Lorenço · L Barbieri · E Tavares · R Maranhão

    Full-text · Article · Sep 2013 · Journal of Cardiothoracic Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Clinical and experimental studies suggest an association between infectious agents and idiopathic dilated cardiomyopathy (DCM), but other data question this relation. The aim of this study was to investigate the presence of infectious agents in endomyocardial biopsy (EMB) specimens of patients with idiopathic DCM and other specific etiologies, compared to a control group of heart donors. Methods and results: Between 2008 and 2011 were studied EMB specimens from hospitalized patients with idiopathic DCM in evaluation for heart transplantation, donors and explanted hearts from different etiologies. 2 groups were defined: donors (29 cases) and DCM (55 cases, including 32 with idiopathic DCM, 9 chagasic, 6 ischemic and 8 other etiologies). Were studied by immunohistochemistry: enterovirus, adenovirus, herpes simplex, Epstein-Barr virus (EBV), parvovirus B19 (PB19), HHV6, hepatitis B and C, mycoplasma, chlamydia and borrelia. Results were presented as median, interquartile range p25, p75 (percentage of positive area), and comparison between donors and DCM were made by Mann Whitney U test. There were an increased expression of enterovirus antigens in donors compared to DCM [2 (0.56 to 5.7) x 0.61 (0.28 - 2.45), p = 0.0075] and increased expression of hepatitis C antigens [1.31 (0.5 to 3.6) x 0.6 (0.37 - 1.41), p = 0.02] in DCM compared to donors. By molecular biology, were investigated: adenovirus, EBV, cytomegalovirus (CMV), HHV6, PB19, mycoplasma, chlamydia and borrelia. The results were presented by percentage of genome positivity, and comparison between groups were made by qui-square and Fisher's exact tests. There was a high genome positivity of microorganisms, including co-infections, with higher positivity in donors comparing to DCM for adenovirus (83.3% vs. 58.7%, p = 0.035) and HHV6 (86.4% vs. 49%, p = 0.0015). To our knowledge, this study is pioneer demonstrating the presence of virus genome in cardiac tissue of chagasic DCM (adenovirus 55%, EBV 40%, CMV 20%, HHV6 75%, PB19 57%). Conclusion: The presence of infectious agents in the myocardium of patients with idiopathic DCM is frequent, and similarly in donors and DCM from other etiologies, including ischemic and chagasic. Based on our results the causal relationship between the presence of infectious agents in cardiac tissue and the development of DCM is controversial. Additional studies are needed to determine the real role of infectious agents in the pathogenesis of DCM.
    Preview · Article · Aug 2013 · European Heart Journal
  • [Show abstract] [Hide abstract]
    ABSTRACT: The ISHLT rejection grading system presents limited reproducibility. The assessment of myocyte injury that is the key point to distinguish high to low-grade rejection and quantification of the inflammatory infiltrate are done in a subjective manner. The primary goal was to determine the number of cells (CD3, CD68) by area in mm2 according to each ISHLT 2004 rejection grade. The secondary purpose was to determine the correlation between cell counting and ISHLT 2004 grading and the correlation between cell counting and follow-up.Methods and MaterialsWe analyzed myocardial fragments of 36 EMB of different patients after heart transplantation. We selected the EMB according 2004 ISHLT criteria: 10 graded as 0R, 10 as 1R, 9 as 2R, and 7 as 3R. Immunohistochemical counting of mononuclear infiltrates for detection of CD 68 (macrophages) and CD 3 (T cells) per mm2 were performed. The evaluation was carried out blindly. It was excluded: reactivation of T. cruzi infection, EMB for monitoring of rejection treatment, EMB up to one month after heart transplantation, retransplantation, graft dysfunction, suspected or diagnosis of humoral rejection, and any recent previous suspected infection episode or actual infection.ResultsThe mean CD3 cells per mm2 in OR, 1R, 2R, and 3R ISHLT grade rejection were 5.3±5.7, 40.6±41.9, 96.6±40.8, 227.4± 130.8 respectively (p=0.000). The mean CD 68 cells per mm2 were 9.3±4.3, 32.1±25.7, 89.2±36.3, and 94.3±35.8 respectively (p=0.000). There was a positive correlation between grade rejection and CD 68 and CD 3 cells per mm2. In the follow-up low CD3 and low CD 68 cells count had a negative predictive value for rejection. In addition, 1R EMB with higher CD3 progressed to 2R.Conclusions Immunohistochemical counting of mononuclear infiltrates in EMB showed strong correlation with ISHLT grade rejection. Also, our results indicate that immunohistochemical counting is a potential objective method to improve diagnosis of rejection.
    No preview · Article · Apr 2013 · The Journal of Heart and Lung Transplantation

  • No preview · Article · Dec 2012
  • Source

    Full-text · Dataset · Nov 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tricuspid regurgitation (TR) is the most commonly valvular dysfunction found after heart transplantation (HTx). It may be related to endomyocardial biopsy (EMB) performed for allograft rejection surveillance. This investigation evaluated the presence of tricuspid valve tissue fragments obtained during routine EMB performed after HTx and its possible effect on short-term and long-term hemodynamic status. This single-center review included prospectively collected and retrospectively analyzed data. From 1985 to 2010, 417 patients underwent 3550 EMB after HTx. All myocardial specimens were reviewed to identify the presence of tricuspid valve tissue by 2 observers initially and in doubtful cases by a third observer. The echocardiographic and hemodynamic parameters were only considered for valvular functional damage analysis in cases of tricuspid tissue inadvertently removed during EMB. The 417 HTx patients to 3550 EMB, including 17,550 myocardial specimens. Tricuspid valve tissue was observed in 12 (2.9%) patients corresponding to 0.07% of the removed fragments. The echocardiographic and hemodynamic parameters of these patients before versus after the biopsy showed increased TR in 2 cases (2/12; 16.7%) quantified as moderate without progression in the long term. Only the right atrial pressure showed a significant increase (P = .0420) after tricuspid injury; however, the worsening of the functional class was not significant enough in any of the subjects. Thus, surgical intervention was not required. Histological evidence of chordal tissue in EMB specimens is a real-world problem of relatively low frequency. Traumatic tricuspid valve injury due to EMB rarely leads to severe valvular regurgitation; only a minority of patients develop significant clinical symptoms. Hemodynamic and echocardiographic alterations are also less often observed in most patients.
    No preview · Article · Oct 2012 · Transplantation Proceedings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Chronic Chagas cardiomyopathy (CCC), a life-threatening inflammatory dilated cardiomyopathy, affects 30% of the approximately 8 million patients infected by Trypanosoma cruzi. Even though the Th1 T cell-rich myocarditis plays a pivotal role in CCC pathogenesis, little is known about the factors controlling inflammatory cell migration to CCC myocardium. Methods and Results Using confocal immunofluorescence and quantitative PCR, we studied cell surface staining and gene expression of the CXCR3, CCR4, CCR5, CCR7, CCR8 receptors and their chemokine ligands in myocardial samples from end-stage CCC patients. CCR5+, CXCR3+, CCR4+, CCL5+ and CXCL9+ mononuclear cells were observed in CCC myocardium. mRNA expression of the chemokines CCL5, CXCL9, CXCL10, CCL17, CCL19 and their receptors was upregulated in CCC myocardium. CXCL9 mRNA expression directly correlated with the intensity of myocarditis, as well as with mRNA expression of CXCR3, CCR4, CCR5, CCR7, CCR8 and their ligands. We also analyzed single-nucleotide polymorphisms for genes encoding the most highly expressed chemokines and receptors in a cohort of Chagas disease patients. CCC patients with ventricular dysfunction displayed reduced genotypic frequencies of CXCL9 rs10336 CC, CXCL10 rs3921 GG, and increased CCR5 rs1799988CC as compared to those without dysfunction. Significantly, myocardial samples from CCC patients carrying the CXCL9/CXCL10 genotypes associated to a lower risk displayed a 2–6 fold reduction in mRNA expression of CXCL9, CXCL10, and other chemokines and receptors, along with reduced intensity of myocarditis, as compared to those with other CXCL9/CXCL10 genotypes. Conclusions Results may indicate that genotypes associated to reduced risk in closely linked CXCL9 and CXCL10 genes may modulate local expression of the chemokines themselves, and simultaneously affect myocardial expression of other key chemokines as well as intensity of myocarditis. Taken together our results may suggest that CXCL9 and CXCL10 are master regulators of myocardial inflammatory cell migration, perhaps affecting clinical progression to the life-threatening form of CCC.
    Full-text · Article · Oct 2012 · PLoS Neglected Tropical Diseases
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.
    Full-text · Article · Oct 2012 · Transplantation Proceedings
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with terminal heart failure have increased more than the available organs leading to a high mortality rate on the waiting list. Use of Marginal and expanded criteria donors has increased due to the heart shortage. We analyzed all heart transplantations (HTx) in Sao Paulo state over 8 years for donor profile and recipient risk factors. This multi-institutional review collected HTx data from all institutions in the state of Sao Paulo, Brazil. From 2002 to 2008 (6 years), only 512 (28.8%) of 1777 available heart donors were accepted for transplantation. All medical records were analyzed retrospectively; none of the used donors was excluded, even those considered to be nonstandard. The hospital mortality rate was 27.9% (n = 143) and the average follow-up time was 29.4 ± 28.4 months. The survival rate was 55.5% (n = 285) at 6 years after HTx. Univariate analysis showed the following factors to impact survival: age (P = .0004), arterial hypertension (P = .4620), norepinephrine (P = .0450), cardiac arrest (P = .8500), diabetes mellitus (P = .5120), infection (P = .1470), CKMB (creatine kinase MB) (P = .8694), creatinine (P = .7225), and Na+ (P = .3273). On multivariate analysis, only age showed significance; logistic regression showed a significant cut-off at 40 years: organs from donors older than 40 years showed a lower late survival rates (P = .0032). Donor age older than 40 years represents an important risk factor for survival after HTx. Neither donor gender nor norepinephrine use negatively affected early survival.
    No preview · Article · Oct 2012 · Transplantation Proceedings
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is a growing need to improve heart preservation benefit the performance of cardiac operations, decrease morbidity, and more important, increase the donor pool. Therefore, the objective of this study was to evaluate the cardioprotective effects of Krebs-Henseleit buffer (KHB), Bretschneider-HTK (HTK), St. Thomas No. 1 (STH-1), and Celsior (CEL) solutions infused at 10°C and 20°C. Hearts isolated from male albino Wistar rats and prepared according to Langendorff were randomly divided equally into 8 groups according to the temperature of infusion (10°C or 20°C) and cardioprotective solutions (KHB, HTK, STH-1, and CEL). After stabilization with KHB at 37°C, baseline values were collected (control) for heart rate (HR), left ventricle systolic pressure (LVSP), coronary flow (CF), maximum rate of rise of left ventricular pressure during ventricular contraction (+dP/dt) and maximum rate of fall of left ventricular pressure during left ventricular relaxation (-dP/dt). The hearts were then perfused with cardioprotective solutions for 5 minutes and kept for 2 hours in static ischemia at 20°C. Data evaluation used analysis of variance (ANOVA) in all together randomized 2-way ANOVA and Tukey's test for multiple comparisons. The level of significance chosen was P < .05. We observed that all 4 solutions were able to recover HR, independent of temperature. Interestingly, STH-1 solution at 20°C showed HR above baseline throughout the experiment. An evaluation of the corresponding hemodynamic values (LVSP, +dP/dt, and -dP/dt) indicated that treatment with CEL solution was superior at both temperatures compared with the other solutions, and had better performance at 20°C. When analyzing performance on CF maintenance, we observed that it was temperature dependent. However, when applying both HTK and CEL, at 10°C and 20°C respectively, indicated better protection against development of tissue edema. Multiple comparisons between treatments and hemodynamic variable outcomes showed that using CEL solution resulted in significant improvement compared with the other solutions at both temperatures. The solutions investigated were not able to fully suppress the deleterious effects of ischemia and reperfusion of the heart. However, these results allow us to conclude that temperature and the cardioprotective solution are interdependent as far as myocardial protection. Although CEL solution is the best for in myocardial protection, more studies are needed to understand the interaction between temperature and perfusion solution used. This will lead to development of better and more efficient cardioprotective methods.
    No preview · Article · Oct 2012 · Transplantation Proceedings

Publication Stats

1k Citations
273.39 Total Impact Points

Institutions

  • 1995-2015
    • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
      • Divisão de Moléstias Infecciosas e Parasitárias
      San Paulo, São Paulo, Brazil
  • 2014
    • Universidade Federal de São Paulo
      San Paulo, São Paulo, Brazil
  • 1986-2014
    • University of São Paulo
      • • Faculty of Medicine (FM)
      • • Department of Surgery
      San Paulo, São Paulo, Brazil
  • 2012
    • Hospital Pró-Cardíaco
      Rio de Janeiro, Rio de Janeiro, Brazil
    • Federal University of Minas Gerais
      Cidade de Minas, Minas Gerais, Brazil
  • 1990-2012
    • Instituto do Coração
      San Paulo, São Paulo, Brazil
  • 2009
    • Escola Superior São Francisco de Assis
      Santa Tereza, Espírito Santo, Brazil
  • 2008
    • University of Toronto
      Toronto, Ontario, Canada
  • 1996-2004
    • Texas Heart Institute
      Houston, Texas, United States