Publications by authors named "Fernando L Scolari"

Background: While COVID-19 vaccination has been shown to reduce the risk of severe illness, its impact on the occurrence of persistent symptoms in patients with mild Omicron infection remains uncertain. Our objective was to investigate whether COVID-19 vaccination reduces the occurrence of persistent COVID-19-related symptoms 3 months after mild Omicron infection.

Methods: Multicenter prospective cohort study was conducted in Brazil between January 2022 and June 2023 when Omicron was predominant.

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Background: Cardiogenic shock (CS) is a complex, life-threatening condition that requires timely care of patients. The purpose of this study is to evaluate the characteristics and outcomes of patients transferred to a cardiac intensive-care unit from outside hospitals, compared to those of patients admitted directly to a CS centre.

Methods: Patients admitted with CS (January 1, 2014-December 31, 2019) were analyzed.

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Sudden cardiac death (SCD) risk stratification and primary prevention implantable cardioverter-defibrillator (ICD) recommendations are based on differing strategies for hypertrophic cardiomyopathy (HCM). This study aimed to evaluate the impact of the 2023 European Society of Cardiology (ESC) guidelines on the 2014 ESC and the 2024 American Heart Association (AHA)/American College of Cardiology (ACC) systems in terms of primary prevention ICD recommendations for HCM. A cohort of 200 patients with HCM in Brazil was assessed for SCD risk profile according to current guidelines.

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Background: Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients.

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Article Synopsis
  • The study investigates the relationship between clonal haematopoiesis (CH) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM), highlighting that CH may increase cardiovascular risks.
  • Out of 799 HCM patients, 22.9% had CH, which correlated with more severe symptoms and greater fibrosis compared to those without CH.
  • Patients with both HCM and CH faced significantly higher rates of major adverse cardiovascular events (MACE), especially those with specific gene mutations like DNMT3A, TET2, and ASXL1.
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Development of ventricular failure and pulmonary edema is associated with a worse prognosis in ST-elevation myocardial infarction (STEMI). We aimed to evaluate the prognostic ability of a novel classification combining lung ultrasound (LUS) and left ventricular outflow tract (LVOT) velocity time integral (VTI) in patients with STEMI. LUS and LVOT-VTI were performed within 24 h of admission in STEMI patients.

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Rationale: Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.

Purpose: To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.

Methods: This will be a multicenter case-control study of 220 participants.

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Article Synopsis
  • Diaphragm atrophy can worsen breathing issues in heart failure patients, possibly linked to medication effects on the brain.
  • A study of 624 heart failure patients examined the respiratory benefits of central-acting vs peripheral-acting drugs through cardiopulmonary exercise tests (CPET).
  • Results showed that patients on central-acting drugs had improved respiratory function and potentially fewer adverse outcomes, highlighting their effectiveness in managing heart failure symptoms.
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Background: Cardiogenic shock (CS) is associated with high in-hospital mortality. Objective assessment of its severity and prognosis is paramount for timely therapeutic interventions. This study aimed to evaluate the efficacy of the shock index (SI) and its variants as prognostic indicators for in-hospital mortality.

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Background: Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear.

Research Question: To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19.

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Article Synopsis
  • - The study focused on patients with cardiogenic shock (CS) and evaluated the impact of pulmonary artery catheters (PACs) on their clinical outcomes, specifically in-hospital mortality rates and use of advanced therapies.
  • - Analysis of 1,043 patients revealed that those receiving PACs had a lower in-hospital mortality rate (29.3% vs 36.2%) and were more likely to receive advanced heart failure treatments, such as mechanical circulation support.
  • - The findings suggest that PACs are beneficial in managing CS, particularly for patients in more severe stages (SCAI D and E), though their use was also linked to longer stays in intensive care and hospitals.
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Background: The long-term impact of hospitalization for COVID-19 on patients' physical, mental, and cognitive health still needs further assessment.

Objectives: This study aims to evaluate factors associated with quality of life and cardiovascular and non-cardiovascular outcomes 12 months after hospitalization for COVID-19.

Methods: This prospective multicenter study intends to enroll 611 patients hospitalized due to COVID-19 (NCT05165979).

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Background: The long-term effects of mild COVID-19 on physical, cognitive, and mental health are not yet well understood.

Objective: The purpose of this paper is to describe the protocol for the ongoing "Post-COVID Brazil" study 2, which aims to evaluate the factors associated with health-related quality of life and long-term cardiovascular and non-cardiovascular outcomes one year after a mild episode of symptomatic COVID-19.

Methods: The "Post-COVID Brazil" study 2 is a prospective multicenter study that plans to enroll 1047 patients (NCT05197647).

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Objectives: There is limited data regarding the impact of exercise on phenotypic expression in hypertrophic cardiomyopathy (HCM). We aimed to investigate whether such an association exists in a cohort of genotype-positive HCM patients.

Methods: In this cross-sectional study of genotype-positive HCM families, we used structured questionnaires to obtain data regarding intensity and duration of exercise of participants starting at the age of 10, as well as data regarding exercise recommendations and their impact on quality of life (QOL).

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Article Synopsis
  • Hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy frequently experience postoperative atrial fibrillation (POAF), with 31.9% of patients in the study affected.
  • Factors like age, left atrial diameter before surgery, and smoking are linked to the likelihood of developing POAF.
  • While POAF is a significant predictor of atrial fibrillation during follow-up, it does not increase the risk of cardioembolic events, suggesting that long-term anticoagulation treatment for all HCM patients with postmyectomy AF may not be necessary.
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This is a reply to the letter titled "Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients" by Eva Rully Kurniawati et al. In response to the concerns raised about our paper published in BMC Cardiovascular Disorders, titled "Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study," we have addressed the confounding bias on the population included and the use of VA-ECMO and Impella CP. Furthermore, we have provided new data on the correlation of oxygen supply and lactate levels at admission of cardiogenic shock.

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Background: In advanced heart failure (HF), diagnostic performance of physical exam may be poor. Physical examination associated with lung ultrasound (LUS) may be an important tool to facilitate congestion screening.

Objective: To evaluate performance of LUS for congestion screening in advanced HF referred for transplant, as compared to findings of right heart catheterization (RHC).

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Our purpose is to evaluate the combined predictive value of cardiopulmonary exercise testing (CPET) and echocardiographic evidence of left ventricular (LV) and right ventricular (RV) strain in predicting mortality and heart transplant (HTx) in a series of outpatients with heart failure with reduced ejection fraction (HFrEF). A retrospective cohort study of 66 patients with HFrEF (median age, 57 years; 51% women) who underwent CPET and echocardiography (up to 90 days apart) to assess prognosis. The primary outcome was a composite of death and need for HTx.

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Background: The modern-day cardiac intensive care unit (CICU) has evolved to care for patients with acute critical cardiac illness. We describe the current population of cardiac patients in a quaternary CICU.

Methods: Consecutive CICU patients admitted to the CICU at the Toronto General Hospital from 2014 to 2020 were studied.

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Novel risk stratification and non-invasive surveillance methods are needed in orthotopic heart transplant (OHT) to reduce morbidity and mortality post-transplant. Clonal hematopoiesis (CH) refers to the acquisition of specific gene mutations in hematopoietic stem cells linked to enhanced inflammation and worse cardiovascular outcomes. The purpose of this study was to investigate the association between CH and OHT.

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Aims: Cardiogenic shock (CS) with variable systemic inflammation may be responsible for patient heterogeneity and the exceedingly high mortality rate. Cardiovascular events have been associated with clonal haematopoiesis (CH) where specific gene mutations in haematopoietic stem cells lead to clonal expansion and the development of inflammation. This study aims to assess the prevalence of CH and its association with survival in a population of CS patients in a quaternary centre.

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