Papers by Mauricio Wajngarten
International Braz J Urol, 2005
Objective: To evaluate the efficacy, safety and tolerability of sildenafil among Brazilian patien... more Objective: To evaluate the efficacy, safety and tolerability of sildenafil among Brazilian patients with hypertension treated with combinations of anti-hypertensive drugs.
Einstein (São Paulo, Brazil), 2015
Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic... more Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.
Annals of Noninvasive Electrocardiology, 2015
Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detectio... more Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detection. The aims of this study were to evaluate the incidence of silent AF, the role of PRM, and to determine predictors of silent AF occurrence. Three hundred elderly patients with permanent pacemaker (PPM) were randomly assigned to the remote group (RG) or control group (CG). All patients received PPM with remote monitoring capabilities. Primary end point was AF occurrence rate and the secondary end points were time to AF detection and number of days with AF. During the average follow-up of 15.7±7.7 months, AF episodes were detected in 21.6% (RG = 24% vs CG = 19.3%, P = 0.36]. There was no difference in the time to detect the first AF episode. However, the median time to detect AF recurrence in the RG was lower than that in the CG (54 days vs 100 days, P = 0.004). The average number of days with AF was 16.0 and 51.2 in the RG and CG, respectively (P = 0.028). Predictors of silent AF were left atrial diameter (odds ratio [OR] 1.2; 95% CI = 1.1-1.3; P < 0.001) and diastolic dysfunction (OR 4.8; 95% CI = 1.6-14.0; P = 0.005). The incidence of silent AF is high in elderly patients with pacemaker; left atrial diameter and diastolic dysfunction were predictors of its occurrence. AF monitoring by means of pacemaker is a valuable tool for silent AF detection and continuous remote monitoring allows early AF recurrence detection and reduces the number of days with AF.
Journal of Geriatric Cardiology, 2012
Acute coronary syndromes (ACS) are the leading causes of death in the elderly. The suspicion and ... more Acute coronary syndromes (ACS) are the leading causes of death in the elderly. The suspicion and diagnosis of ACS in this age group is more difficult, since typical angina is less frequent. The morbidity and mortality is greater in older age patients presenting ACS. Despite the higher prevalence and greater risk, elderly patients are underrepresented in major clinical trials from which evidence based recommendations are formulated. The authors describe, in this article, the challenges in the diagnosis and management of ST elevation myocardial infarction in the elderly, and discuss the available evidence.
Arq Bras Cardiol, Sep 1, 1989
Arq Bras Cardiol, Nov 1, 2002
Page 1. 494 Szlejf e cols Relação entre dispersões da onda P e do intervalo QT em idosos Arq Bras... more Page 1. 494 Szlejf e cols Relação entre dispersões da onda P e do intervalo QT em idosos Arq Bras Cardiol 2002; 79: 494-6. Instituto do Coração do Hospital das Clínicas da FMUSP Correspondência: Claudia Szlejf - InCor - Departamento de Cardiogeriatria - Av. ...
The American Journal of Geriatric Cardiology, Feb 1, 1997
Hypertension is accepted as a risk factor for cardiovascular disease in the elderly population. D... more Hypertension is accepted as a risk factor for cardiovascular disease in the elderly population. Data supporting the benefit of treating hypertension in the elderly is extensive but it continues to be poorly recognized and treated in the general population. The correct diagnosis is the initial step for avoiding common side effects of the treatment. In this article we summarize important particularities of the diagnosis and treatment of hypertension in the elderly. The decision on when and how to treat hypertension must be carefully evaluated and individualized. Emphasis should be on the patient, treating the elderly patient with hypertension rather than the hypertension in the elderly patient.
Arq Bras Cardiol, 1997
Barretto e col Tratamento da ICC em hospital terciário 375 Instituto do Coração do Hospital das C... more Barretto e col Tratamento da ICC em hospital terciário 375 Instituto do Coração do Hospital das Clínicas -FMUSP Correspondência: Antonio Carlos Pereira Barretto -Incor -Divisão de Cardiologia Social -Av. Dr. Enéas C. Aguiar, 44 -05403-000 -São Paulo, SP Recebido para publicação em 4/9/97 Aceito em 8/10/97 Heart Failure Medical Treatment in a Tertiary Hospital of São Paulo Purpose -To study how patients with heart failure (HF) are treated in a tertiary hospital in São Paulo. Methods -One hundred patients with HF during ambulatory care were analyzed. Seventy-six were men, and the average population age was 56.8 years old. All patients were submitted to echocardiogram, which identified ventricular diameters ranging between 48 and 89mm (average 65.9) and ejection fraction (EF) between 0.22 and 0.59 (average 0.43). The cause of HF was ischemic in 42 cases, dilated cardiomyopathy in 28, valvular heart disease in 12, Chagas' disease in 10 and systemic hypertension in 8 patients. The prescribed treatment was analyzed, with attention to the prescription and dosage of angiotensin converting enzyme (ACE) inhibitors. We also analyzed whether the cause and/or the degree of HF influenced the treatment chosen. Results -Eighty-seven patients received ACE inhibitors, 31 received doses below those recommended in the large trials. Digoxin was prescribed in 69 cases, diuretics in 85, and aspirin in 33. When dividing the patients according to EF, the group with EF below 0.45 was prescribed more often ACE inhibitors (91.5% vs 80.4%) and had more often usage of adequate doses (61% vs 48.7%).
Arq Bras Cardiol, Dec 1, 1988
The American Journal of Cardiology, Jun 1, 2003
D epression and systemic hypertension are both common medical disorders in the elderly. Although ... more D epression and systemic hypertension are both common medical disorders in the elderly. Although we now have a wide range of antidepressant medications with different mechanisms of action, tricyclic antidepressants continue to be used frequently. 1 Recently, the use of tricyclic antidepressants has been associated with an increased risk of myocardial infarction 2 and mortality in older adults. 3 In addition, tricyclic antidepressant use has been associated with increased frequency of orthostatic hypotension, although clinical measurements of blood pressure (BP) remain relatively stable. 4 Day-night systolic BP difference is a predictor of outcome in older adults with hypertension 5 (a lower day-to-night ratio of systolic BP is associated with increased cardiovascular risk) and the absence of a nocturnal decrease in BP has been associated with increased mortality. 6 At present, little is known about the nocturnal behavior of BP in elderly patients with depression. The present study was designed to compare the effects of nortriptyline on nocturnal systolic BP in elderly depressed hypertensive and normotensive women.
Arch Clin Psychiatry, 2009
J Neuroimaging, 2005
Background and Purpose. Reduced resting global cerebral blood flow has been previously detected i... more Background and Purpose. Reduced resting global cerebral blood flow has been previously detected in association with heart failure (HF), but it is not clear whether there are brain regions that could be specifically affected by those brain perfusion deficits. The authors used a fully automated, voxel-based image analysis method to investigate, across the entire cerebral volume, the presence of resting regional cerebral blood flow (rCBF) abnormalities in HF patients compared to healthy controls. Methods. rCBF was evaluated with 99m Tc-single-photon emission computed tomography in 17 HF patients (New York Heart Association functional class II or III) and 18 elderly healthy volunteers. Voxel-based analyses of rCBF data were conducted using the statistical parametric mapping software. Results. Significant rCBF reductions in HF patients relative to controls (P < .05, corrected for multiple comparisons) were detected in 2 foci, encompassing, respectively, the left and right precuneus and cuneus and the right lateral temporoparietal cortex and posterior cingulate gyrus. In the HF group, there was also a significant direct correlation between the degree of cognitive impairment as assessed using the Cambridge Mental Disorders of the Elderly Examination and rCBF on a voxel cluster involving the right posterior cingulate cortex and precuneus, located closely to the site where between-group rCBF differences had been identified. Conclusions. These preliminary findings indicate that posterior cortical areas of the brain may be particularly vulnerable to brain perfusion reductions associated with HF and suggest that functional deficits in these regions might be relevant to the pathophysiology of the cognitive impairments presented by HF patients. Localized cerebral blood flow reductions in patients with heart failure: a study using 99m Tc-HMPAO SPECT.
Arq Bras Cardiol, Dec 1, 1989
Jornal Brasileiro De Nefrologia, Sep 1, 2010
This study examines the association between body mass index (BMI), waist-to-hip ratio ( WHR), and... more This study examines the association between body mass index (BMI), waist-to-hip ratio ( WHR), and waist circumference ( WC) and all- cause and cardiovascular mortality in elderly women in a 5-year longitudinal study of 575 fe- male outpatients 60 years and over. The highest BMI, WHR, and WC quartiles and predefined BMI categories were analyzed as predictive vari- ables. Death
Objective: To determine the clinical risks and procedural outcomes for elderly patients undergoin... more Objective: To determine the clinical risks and procedural outcomes for elderly patients undergoing percutaneous coronary intervention (PCI).
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Papers by Mauricio Wajngarten