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North America Immigration Law Group (Chen Immigration Law Associates) is a U.S. immigration law firm dedicated to representing corporations, research institutions, and individuals from all 50 U.S. states regarding I-140 immigration petitions. We specialize in employment-based immigration petition and have a proven record of high success rate for the categories of:
We keep close track of the latest immigration trends and regulations of USCIS (U.S. Citizenship and Immigration Services), decisions of AAO (Administrative Appeal Office) and judicial review opinions. The massive collected material contributes to the winning strategies for our clients' cases.
Approval of each case is the goal of our law firm. The key to our success is how we present supporting evidence and the high-quality petition letters based on systematic knowledge and comprehensive database developed by our firm. To provide the best immigration service, North America Immigration Law Group only hires attorneys with J.D. degree from top law schools.
We have one hundred percent confidence in our capability to successfully represent our clients, and we are the only U.S. immigration law firm with refund policy on I-140 petition. This is not an empty guarantee but specifically laid out in the .
We are pleased to announce in year 2014, we have received 915 EB-1A, EB-1B and EB-2 NIW approval notices. Our firm's overall approval rate in 2014 is 97.65% for all EB1/NIW cases and 98.65% for all EB1/NIW cases using our "Approval or Refund(R)" (money back guarantee) service.
In 2014, for NIW cases, the approval rate is 99.75% for cases using our "Approval or Refund(R)" (money back guarantee) service and 95.37% using our regular service. The overall approval rate for NIW cases is 98.81%.
In 2014, the approval rate is 97.32% for "Approval or Refund(R)" (money back guarantee) EB1A cases and 91.30% for regular EB1A cases. The overall approval rate for EB1-A cases is 96.20%.
We are a leading U.S. immigration law firm pioneering in a large volume of approval cases and high approval rate for NIW/EB-1 I-140 immigration petitions with the most comprehensive services.
*The number of approval notice for EB1B cases is under-estimated of the total EB1B cases we successfully petitioned because many EB1B employer petitioners did not submit G-28 and we are not the attorney on the record.
*In 2014, our approval rate is 98.81% for all NIW cases and 99.75% for "Approval or Refund(R)" (money back guarantee) NIW cases.
*In 2014, our approval rate for all EB-1 cases is 96.30% and 97.39% for our "Approval or Refund(R)" (money back guarantee) EB-1 cases.
*The approval rate statistics only include cases that were originally filed by our law firm and exclude RFE cases that were taken over in the middle from other law firms or DIY clients.
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Akron Biotechnology
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AlphaSTAR Corporation
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University of California, Los Angeles
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UTHealth Houston
In view of my busy schedule, I could not have wished anything better that services offered ! They are highly professional and swift in responding to all sorts of questions. I couldn't believe that I never required to call them till I heard about my I-140 approval from them! All my queries and concerns were answered through their secure web-messaging portal. This helped me immensely because each time I had a question, I would simply post it on their portal and in a short while they will get back to me with their answers and suggestions! I liked it very much as it saved lot of time. What impressed me the most is their punctuality in meeting deadlines as promised by them at various steps. Thank you so
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Columbia University
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Texas A&M U
Dear Chen Immigration law firm: I received my EB1-A approval yesterday. Your team was very thorough and professional and gave me good and timely advice in the preparation of my application. You did a great job assembling my petition. This will help me and my family a lot - I cannot thank you enough for making this possible.
I recommend your service wholeheartedly!
Many Many thanks for your thorough and professional work during case preparation and for promptly answering all my questions. I will definitely and highly recommend you to my friends and family !
“I have MS in Materials Science Engineer and PhD in Polymer Science. I had applied for i-140 in EB 1-b in 2012 with an attorney based in Huston TX. Attorney disappeared after getting retaining fee from me. Was not happy with service they had provided or way my application was filed. When I had applied I had 8 publications, excellent recommendation letters and all the right credentials in spite of that, i got RFE from USCIS. The attorney did not handle RFE response properly and my application was denied in December 2012.
When immigration application gets denied it takes lot on emotions and piece of mind. With limited time available with my H1B visa, I had only one chance left either get my i-140 approved in limited time or if it gets rejected again, I would have had to leave to my native country.
I regretted my decision to going economical attorney rather than effective one. Second time, I did my extensive research and found Victoria Chen firm. Chen associates suggested me to apply concurrently in NIW and EB1-a.
I am extremely satisfied with the system they have in place to answer clients questions, upload documents, share documents, recommend corrections and so on…I am satisfied with firm’s due diligence, response and way they handled my case.
Both my NIW and EB1-a application got approved.
On behalf of me and my family I would like to thank Chen Immigration Law Associates very much for the way you handled our i-140 application and for getting it approved.
When it comes to i-140 application, what I have learned hard way is it’s not just your credentials, it is also how your attorney can help an officer to understand your credentials and craft right petition letter. Based on experience I had so far, I would recommend Chen associates to others.”
January 4, 2015, R. H. was WeGreened (Chen Immigration) - North America Immigration Law Group's client (from Email)
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University of California Riverside
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Kansas State University
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Gladstone Institutes
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Universityof South Dakota
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December 29, 2014, N. R. was WeGreened (Chen Immigration) - North America Immigration Law Group's client (from Email)
Post doctoral research associate
University of California
Thank you for your great services. My I-140 (EB2/NIW) case was approved recently. Chen immigration group is very efficient and professional. I prepared and submitted my case in only 2 months with their exceptional expertise and advice.
I definitely recommend Chen Law Associates to my friends and colleagues.
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Great service with professional advises and excellent results! In my experience, Chen Immigration Law Associates stands at the very top in their professionalism. My Thanks to the group that steered my I-140EB1 case to approval!
Will definitely recommended Chen Law Associates to my colleagues
Post-doctoral research associate
University of Wisconsin
I would like to thank Attorney Chen and all the other attorneys in the North America Immigration Law Group for all their efforts for my EB1-A approval. They are a great firm and I will definitely recommend them for all kind of immigration purposes to my friends as I have done so far.
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WASHINGTON UNIVERSITY IN SAINT LOUIS
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University Of Cincinnati
Very efficient service. Chen immigration firm knew exactly what to do to get my EB2/NIW visa approved. I will highly recommend to my friends who are applying for green card
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Houston Methodist Research Institute
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And now I can recommend you for the success as well!"
December 15, 2014, A. B. was WeGreened (Chen Immigration) - North America Immigration Law Group's client (from Email)
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Copyright © North America Immigration Law Group, All Rights Reserved.Servi?os PersonalizadosArtigoIndicadoresLinks relacionadosCompartilharvers?o impressa ISSN XArq. Bras. Cardiol. v.71 n.2 S?o Paulo ago. 1998 http://dx.doi.org/10.-782X4
Ensaio Terapêutico
Efeitos do Carvedilol (Bloqueador b1,b2,a1) na Insuficiência Cardíaca Refratária
Edimar Alcides Bocchi, Fernando Bacal, Giovanni Bellotti, Dirceu Carrara, José Antonio Franchini Ramires
S?o Paulo, SP
OBJETIVO: Os efeitos dos b-bloqueadores na insuficiência cardíaca (IC) refratária n?o têm sido adequadamente estudados. Investigamos os efeitos do carvedilol (bloqueador b1,b2,a1) nos sintomas e na fun??o ventricular de portadores de IC refratária.
M?TODOS: Foram estudados 21 pacientes, idade média de 56±10 anos, 9 em classe funcional (CF) IV, e 12 em CF III intermitente com IV. A dose inicial de carvedilol foi de 6,25mg e, se tolerada, aumentada progressivamente. A dose média final foi 42±11mg. Os pacientes foram submetidos a avalia??es clínicas e eletrocardiográficas seriadas. Realizaram-se, antes e com 196±60 dias de evolu??o, ecocardiograma e ventriculografia radioisotópica.
RESULTADOS: O medicamento foi tolerado em 16 (76%) pacientes. Um paciente está em fase de titula??o em CF II. Com 196±60 dias de evolu??o observaram-se 8 pacientes em CF I e 7 em II; redu??o da freqüência cardíaca de 96±15 para 67±10bpm (p&0,0001); redu??o do di?metro diastólico final de ventrículo esquerdo (VE) de 73±13 para 66±12mm (ecocardiograma) (p&0,009); e aumento da fra??o de eje??o de VE de 0,21±0,06 para 0,34±0,12 (p&0,0003).
CONCLUS?O: O carvedilol devido aos seus efeitos benéficos na fun??o ventricular, remodelamento e CF é, se tolerado, uma potencial alternativa terapêutica no tratamento medicamentoso da IC refratária. Entretanto, estudos adicionais s?o necessários para defini??o do efeito a longo prazo neste específico subgrupo de pacientes.
Palavras-chave: insuficiência cardíaca congestiva, antagonistas beta-adrenérgicos, transplante
Effects of Carvedilol (b1,b2,a1-blocker) on Refractory Congestive Heart Failure
PURPOSE: The effects of b-blockers on severe heart failure are not well known. We investigated the effects of carvedilol (b1,b2,a1-blocker) on symptoms, functional class (FC), and left ventricular function in patients with refractory heart failure.
METHODS: We studied 21 patients, mean age 56±10 years, 9 in FC IV, e 12 in FC III (intermittently with class IV). The initial dosage was 6.25mg, and it was increased progressively as tolerated. The mean dose was 42±11mg. The patients were submitted to routine clinical evaluation, and electrocardiogram. We determined after 196±60 days of follow-up the left ventricular end diastolic dimension (by echocardiogram), and left ventricular ejection fraction (using MUGA).
RESULTS: Carvedilol was well tolerated by 16 (76%) patients. One patient is in FC II during increment of the dosage. Eight patients were in FC I, and 7 in FC II at 196±60 days of follow-up. Heart rate decreased from 96±15 to 67±10bpm (p&0.0001), left ventricular end diastolic diameter from 73±13 to 66±12mm (p&0.009), and the left ventricular ejection fraction increased from 0.21±0.06 to 0.34±0.12 (p&0.0003).
CONCLUSION: Carvedilol may have beneficial effects on cardiac function, remodeling process, and FC. If tolerated, it seems to be a potential alternative option in the medical treatment of refractory heart failure. However, investigations are still necessary to clarify the long-term effects of carvedilol on this specific subgroup of patients.
Key-words: congestive heart failure, adrenergic beta-antagonists, transplantation
O objetivo do tratamento de portadores de insuficiência cardíaca (IC) inclui a redu??o da mortalidade, morbidade, com conseqüente melhoria da qualidade de vida, evitando a evolu??o da doen?a.1 Atualmente, o tratamento medicamentoso usual e disponível ainda está associado a alta morbidade e mortalidade em subgrupos selecionados de portadores de IC 2. O tratamento cirúrgico está limitado pela dificuldade de aplica??o do método devido a critérios de sele??o, pela limita??o de doadores, pelas complica??es tardias, pela degenera??o de enxertos, arritmias, rejei??o, ou pelo reduzido benefício hemodin?mico 3-12. Outros métodos, incluindo a ventriculectomia parcial, ainda est?o em fase inicial de estudo e sua utiliza??o é controversa ou n?o é conhecido o subgrupo de pacientes a ser beneficiado 13.
Embora os b-bloqueadores já tenham sido preconizado no tratamento da IC desde 1975 14, só recentemente depois da introdu??o de b-bloqueadores de 3a gera??o é que tem havido maior entusiasmo para o seu uso. Resultados recentes com b-bloqueadores de 3a gera??o têm sido animadores em pacientes predominantemente em classe funcional (CF) II ou III 15,16. Entretanto, nesses estudos n?o foram especificamente incluídos portadores de IC em CF predominantemente IV ou III intermitente com IV, deixando a efetividade da utiliza??o da medica??o nesse grupo ainda indeterminada apesar da refratariedade dos sintomas e da alta mortalidade 15-18.
O objetivo desta investiga??o foi estudar os efeitos de um bloqueador b1,b2,a1 (carvedilol) nos sintomas e na fun??o ventricular de portadores de IC refratária encaminhados para transplante cardíaco.
Vinte e um pacientes com IC refratária, encaminhados para avalia??o para transplante cardíaco, de acordo com critério de Bocchi e col 8 foram incluídos neste estudo. A etiologia era isquêmica em nove pacientes, indeterminada (miocardiopatia dilatada idiopática) em 11, e miocardiopatia hipertrófica em fase dilatada em um. A etiologia foi confirmada através de estudo cinecoronarioventriculográfico, e ou ecocardiográfico. A idade média era de 56±10 anos, sendo 19 do sexo masculino e dois do feminino. O tempo de história dos sintomas era de 7,2±3,9 anos. Antes de receberem carvedilol, nove pacientes estavam em CF IV, segundo a classifica??o da New York Heart Association e 12 em CF III intermitente com IV, com episódios de dispnéia paroxística noturna e ortopnéia. No momento da introdu??o da medica??o, n?o foi detectado nenhum fator de descompensa??o aguda nos pacientes. Três pacientes apresentavam episódios de angina além do quadro de IC. Os pacientes estudados recusaram o transplante cardíaco, no momento, ou apresentavam alguma contra-indica??o para o procedimento (sete pacientes). Dois pacientes haviam sido submetidos a cardiomioplastia ou ventriculectomia parcial para tratamento da IC, e cinco haviam sido submetidos a revasculariza??o miocárdica. Dezenove pacientes estavam em uso de digoxina (0,23±0,04mg); todos recebiam diuréticos incluindo furosemida (66±27mg), associados a hidroclorotiazida em oito pacientes, a amilorida em três, e a espironolactona em três; 17 pacientes em uso de inibidores de enzima de convers?o da angiotensina (IECA) (enalapril 17±14mg em seis, captopril 79±28mg em 10 pacientes); inibidor de AT1 10 pacientes em uso de amiodarona (210±74mg); nitratos em 10; além das medidas usuais de restri??o de sódio e água com suplementa??o de potássio. A medica??o, exceto diuréticos, n?o foi modificada após o início do estudo. Ao estudo ecocardiográfico, o di?metro diastólico final de ventrículo esquerdo (VE) era de 72± 20mm. A fra??o de eje??o de ventrículo esquerdo (FEVE) e a de ventrículo direito (FEVD) determinada pelo ventriculografia radioisotópica era de 22±7% e 27±6%, respectivamente.
Foram excluídos pacientes nos quais a investiga??o da etiologia n?o afastava a possibilidade de alcoolismo, miocardiopatia restritiva, história de infarto do miocárdio ou procedimento como cirurgia ou angioplastia nos últimos três meses, miocardite, doen?as infiltrativas, portadores de etiologia isquêmica com possibilidade de revasculariza??o miocárdica, portadores de miocardiopatia devido à doen?a de Chagas, valvulopatias, pacientes com episódios prévios de taquicardia ventricular sustentada ou reanimados, uso prévio de b-bloqueadores, portadores de asma br?nquica ou episódios n?o esclarecidos de broncoespasmo, doen?a pulmonar cr?nica obstrutiva, distúrbios de condu??o atrioventricular de 2o e 3o grau, situa??o hemodin?mica instável com tendência a hipotens?o arterial (press?o arterial sistólica (PAS) &90mmHg), PAS &140mmHg ou/e press?o arterial diastólica (PAD) &90mmHg, ou necessidade de uso endovenoso de drogas inotrópicas para manuten??o de perfus?o periférica ou débito urinário.
O medicamento carvedilol foi introduzido na dose inicial de 6,25mg, uma vez ao dia no período noturno durante um período de sete a 10 dias. Se o paciente apresentasse intoler?ncia ao medicamento pelo aparecimento de novo sintoma incapacitante ou de risco caracterizado por bradicardia &55bpm, bloqueios, ou piora importante da IC, a medica??o era suspensa. Em contrário, a cada 7-10 dias a dose era aumentada de 6,25mg ao dia dividida em duas vezes. Se a cada aumento de dose houvesse aparecimento de intoler?ncia, a dose voltava aos valores anteriores ao do aumento. Nesses pacientes era novamente tentado um novo aumento da dose numa evolu??o mais tardia. Na ausência de intoler?ncia aumentava-se a dose até 50mg ao dia para peso &75kg e 75mg para peso &75kg ou presen?a de freqüência ventricular &80bpm na dose de 50mg. As consultas de ambulatório eram realizadas semanalmente durante a titula??o e mensalmente após este período e sempre pela mesma equipe.
Após confirma??o do diagnóstico, os pacientes foram submetidos a avalia??o clínica, eletrocardiograma, ecocardiograma com determina??o de di?metro diastólico final de VE, e ventriculografia radioisotópica com determina??o de FEVE e FEVD. As avalia??es clínicas e eletrocardiográficas foram repetidas conforme consultas. O ecocardiograma e a ventriculografia radiosotópica foram repetidos com 196±60 dias após o início da medica??o.
Resultados
Tolerabilidade e efeitos na CF: a dose média utilizada do carvedilol foi 42±11mg. Cinco (24%) pacientes n?o toleraram a medica??o devido ao aparecimento de tontura e dor epigástrica (dois casos), piora n?o tolerável da IC (dois), e cansa?o (um). Em todos os pacientes os sintomas desapareceram após a retirada da medica??o. Em um caso, a medica??o foi reintroduzida recentemente com sucesso. Assim, 16 (76%) pacientes toleraram o medicamento, sendo que quatro apresentaram sintomas na introdu??o da medica??o, que desapareceram ou ficaram estáveis. Estes sintomas incluíram discreto broncoespasmo (um), tontura (um), diarréia (um), e piora da IC (um).Aumento de dose de diurético foi necessário inicialmente em 1 paciente. Um paciente está em fase de titula??o mas já em CF II. Em 15 pacientes que toleraram a medica??o observou-se com 196±60 dias de evolu??o CF I em oito pacientes e II em sete. Com 288±176 dias de evolu??o nove pacientes estavam em CF I, três em CF II, um em CF III, e um teve morte súbita apesar da melhora da CF de IV para II. (). O maior tempo de seguimento é de 503 dias. N?o houve desenvolvimento tardio de intoler?ncia. Nenhum dos pacientes que tolerou a medica??o reinternou devido a sintomas de IC. Entre os que n?o toleraram a medica??o dois pacientes foram submetidos a transplante cardíaco em CF IV, um foi submetido a ventriculectomia em CF IV, e dois est?o em CF III.
Efeitos na freqüência cardíaca, di?metros e fun??o ventricular esquerda: em 15 pacientes reavaliados após 196±60 dias de início da medica??o a freqüência cardíaca média diminuiu de 96±15 para 67± 10bpm (p&0,0001) (). Observou-se ao ecocardiograma em 14 pacientes redu??o do di?metro diastólico de VE de 73±13 para 66±12mm (p&0,009) (). Observou-se à ventriculografia radioisotópica repetida em 12 pacientes aumento da FEVE de 0,21±0,06 para 0,34±0,12 (p&0,0003) (). Em dois pacientes em que se repetiu a FEVD observou-se melhora de 0,26 para 0,43 e de 0,26 para 0,33.
Os resultados deste estudo demonstram que o uso do carvedilol, bloqueador b1-b2-a1 de 3a gera??o pode determinar melhora da CF, e da fun??o ventricular esquerda em pacientes encaminhados para transplante cardíaco predominantemente ou intermitentemente em CF IV. Em contraste com a tradicional contra-indica??o de b-bloqueadores para portadores de IC, o seu uso mostrou-se seguro desde que devidamente monitorizado e com a titula??o sendo feita em pequenas doses.
A melhora clínica observada neste subgrupo de pacientes de etiologia isquêmica e n?o isquêmica em CF IV intermitente, que tolerou a medica??o está concordante com o descrito para pacientes em CF II e III.15-18 Estudos prévios n?o têm especificamente investigado o possível benefício do carvedilol neste subgrupo de pacientes mais graves, e tem incluído pacientes com idade avan?ada ou freqüência cardíaca menos elevada. Nossos resultados n?o necessariamente podem ser aplicados ao uso de outros b-bloqueadores, pois é discordante de investiga??o prévia com o b-bloqueador bisoprolol de 2a gera??o 19. A melhora funcional poderia ser explicada pelo aumento da fun??o ventricular esquerda e direita. Adicionalmente, os b-bloqueadores teriam efeito prevenindo e revertendo o remodelamento ventricular. A redu??o do di?metro diastólico final em nossos resultados sugere efeito do carvedilol na remodela??o ventricular, também neste subgrupo de pacientes. Os mecanismos propostos de a??o dos b-bloqueadores, embora n?o totalmente esclarecidos incluem 20,21: bloqueio da hiperatividade adrenérgica cardíaca com ressensibiliza??o de mecanismos de transdu??o gênica mediada adrenergicamente via receptor b, aumento da densidade de b receptores, reacoplamento de receptores b2 e b1, redu??o da freqüência cardíaca, efeito vasodilatador através ou n?o de bloqueio a1, propriedades antioxidantes, diminui??o da regula??o da cinase b-receptor mediada, diminui??o da atividade da proteína G inibidora, aumento da fun??o de adenilciclase, diminui??o da apoptose 22, diminui??o da hipertrofia excêntrica, inibi??o do sistema renina-angiotensina, preven??o da produ??o de cardiotrofina-1, inibi??o da síntese de endotelina, e efeito anti-isquêmico. O fato do carvedilol n?o restaurar a regula??o de receptores b1, ou alterar a transcri??o do sinal do receptor b 23 sugere que seus efeitos benéficos adicionais possam ser devidos a bloqueio a1 e efeito antioxidante, além de efeitos biológicos n?o totalmente esclarecidos. O efeito benéfico maior do carvedilol 24 em rela??o ao b-bloqueadores seletivos b1 tem sido explicado pelo aumento da propor??o de b2/b1 conforme a IC progride, e em rela??o aos n?o seletivos pelo a??o nos receptores a1 que desempenham papel no remodelamento cardíaco e estresse oxidativo. A maioria dos efeitos do carvedilol teria a??o anti-arrítmica, além do efeito intrínseco tipo Classe II.
O efeito benéfico na miocardiopatia isquêmica poderia ser devido à a??o antiisquêmica conseqüente a redu??o da freqüência cardíaca e bloqueadora a1 diminuindo pós-carga e tens?o intracavitá ao efeito antioxidante inibindo forma??o de radicais livres derivados do oxigênio diminuindo apoptose, e redu??o da express?o da ICAM-1 (molécula de ades?o intercelular) que é molécula chave de ades?o dos neutrófilos a células endoteliais e musculares lisas 25. O carvedilol parece acumular em membranas plasmáticas excedendo até de 10.000 vezes o encontrado no extracelular explicando a alta potência antioxidante. Experimentalmente o carvedilol tem maior capacidade de diminui??o de áreas de infarto quando comparados a outros bloqueadores b, sugerindo um efeito cardioprotetor independente do efeito bloqueador b. 26,27
A porcentagem maior de pacientes com intoler?ncia inicial à medica??o foi maior que o descrito para pacientes menos graves (5,6%-6%) 15,16 e pode ser explicada pela maior sensibilidade aguda ao efeito b-bloqueador devido a maior dependência dos doentes mais graves do suporte adrenérgico inotrópico e cronotrópico. O aumento mais lento das doses em nossa investiga??o acrescentando 6,25mg a cada semana e n?o dobrando a dose, poderia justificar a ausência de intoler?ncia tardia.
Neste estudo foi incluido de maneira n?o cega e n?o sorteada um número limitado de pacientes, mas os resultados foram expressivos neste subgrupo de pacientes de alto risco. As conclus?es após o uso de carvedilol n?o necessariamente podem ser estendidas para outros b-bloqueadores, desde que estes fazem parte de um grupo heterogêneo de drogas, diferindo em efeitos farmacológicos agudos e cr?nicos, hemodin?micos, e biológicos 20. O tempo de seguimento e o número de pacientes n?o é suficiente para conclus?o definitiva a respeito de efeitos na mortalidade a longo prazo. Entretanto, os efeitos obtidos na fun??o ventricular sugerem um efeito benéfico desde que esta é importante na determina??o do prognóstico. Mas, a possibilidade de morte súbita ou piora da IC pode ainda persistir. Os resultados também n?o devem ser estendidos a IC diastólica. A avalia??o da CF é ausente de sofistica??o e com certo grau de subjetividade, no entanto é largamente aceita e tem rela??o com a sobrevida.
Os efeitos benéficos do carvedilol na fun??o ventricular e remodelamento podem favorecer o aumento da sobrevida nos portadores de IC. Sobrevida inesperadamente longa foi observada neste subgrupo de pacientes graves corroborando com o descrito para pacientes menos graves. Nossos resultados sugerem que pacientes com IC refratária na ausência de contra-indica??es deveriam ser considerados para o tratamento com b-bloqueadores com o objetivo de diminuir a progress?o da doen?a, com conseqüente redu??o da mortalidade e morbidade. O uso do carvedilol pode ser importante na redu??o do número de pacientes necessitando de tratamento cirúrgico para IC refratária.
Concluindo, o carvedilol (bloqueador b1-b2-a1) com seus efeitos benéficos na fun??o ventricular, remodelamento e CF, é uma potencial alternativa terapêutica no tratamento medicamentoso da IC refratária. Entretanto, estudos adicionais s?o necessários para defini??o do efeito a longo prazo neste subgrupo específico de pacientes.
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Instituto do Cora??o do Hospital das Clínicas - FMUSP
Correspondência: Edimar Alcides Bocchi - Rua Oscar Freire,
- S?o Paulo, SP
Recebido para publica??o em 26/3/98
Aceito em 24/6/98