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Santos LDM, Campos CM, Garcia-Garcia HM, Godinho RR, Lopes MAAM, Seleme VB, Côrtes RS, Mendes GDAC, Rosa VEE, Lopes NHM, de Brito Junior FS, Abizaid AAC. Concordance between vessel-specific and vascular territory coronary functional assessment: A comparison of quantitative flow ratio and myocardial perfusion scintigraphy. Catheter Cardiovasc Interv 2024. [PMID: 38558510 DOI: 10.1002/ccd.31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS) are utilized for assessing coronary artery disease (CAD) significance. We aimed to analyze their concordance and prognostic impact. AIMS We aimed to analyze the concordance between QFR and MPS and their risk stratification. METHODS Patients with invasive coronary angiography and MPS were categorized as concordant if QFR ≤ 0.80 and summed difference score (SDS) ≥ 4 or if QFR > 0.80 and SDS < 4; otherwise, they were discordant. Concordance was classified by coronary territory involvement: total (three territories), partial (two territories), poor (one territory), and total discordance (zero territories). Leaman score assessed coronary atherosclerotic burden. RESULTS 2010 coronary territories (670 patients) underwent joint QFR and MPS analysis. MPS area under the curve for QFR ≤ 0.80 was 0.637. Concordance rates were total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%). Most concordance occurred in patients without significant CAD or with single-vessel disease (89.5%), particularly without MPS perfusion defects (91.5%). Leaman score (odds ratio [OR]: 0.839, 95% confidence interval [CI]: 0.805-0.875, p < 0.001) and MPS perfusion defect (summed stress score [SSS] ≥ 4) (OR: 0.355, 95% CI: 0.211-0.596, p < 0.001) were independent predictors for discordance. After 1400 days, no significant difference in death/myocardial infarction was observed based on MPS assessment, but Leaman score, functional Leaman score, and average QFR identified higher risk patients. CONCLUSIONS MPS showed good overall accuracy in assessing QFR significance but substantial discordance existed. Predictors for discordance included higher atherosclerotic burden and MPS perfusion defects (SSS ≥ 4). Leaman score, QFR-based functional Leaman score, and average QFR provided better risk stratification for all-cause death and myocardial infarction than MPS.
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Affiliation(s)
- Luciano de Moura Santos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Instituto Prevent Senior, Sao Paulo, Brazil
| | - Hector Manuel Garcia-Garcia
- Instituto Prevent Senior, Sao Paulo, Brazil
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | | | | | - Rafael Silva Côrtes
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
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Campos CM, Mehran R, Capodanno D, Owen R, Windecker S, Varenne O, Stone GW, Valgimigli M, Hajjar LA, Kalil Filho R, Oldroyd K, Morice MC, Urban P, Abizaid A. Risk Burden of Cancer in Patients Treated With Abbreviated Dual Antiplatelet Therapy After PCI: Analysis of Multicenter Controlled High-Bleeding Risk Trials. Circ Cardiovasc Interv 2024; 17:e013000. [PMID: 38626080 DOI: 10.1161/circinterventions.122.013000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 01/16/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Oncological patients with coronary artery disease face an elevated risk of hemorrhagic and ischemic events following percutaneous coronary intervention. Despite medical guidelines recommending minimal dual antiplatelet therapy (DAPT) duration for patients with cancer, dedicated data on abbreviated DAPT in this population is lacking. This study aims to evaluate the occurrence of ischemic and hemorrhagic events in patients with cancer compared with other high-bleeding risk individuals. METHODS Patient-level data from 4 high-bleeding risk coronary drug-eluting stent studies (ONYX One, LEADERS FREE, LEADERS FREE II, and SENIOR trials) treated with short DAPT were analyzed. The comparison focused on patients with high-bleeding risk with and without cancer, assessing 1-year rates of net adverse clinical events (all-cause death, myocardial infarction, stroke, revascularization, and Bleeding Academic Research Consortium [BARC] types 3 to 5 bleeding) and major adverse clinical events (all-cause death, myocardial infarction, stroke). RESULTS A total of 5232 patients were included, of whom 574 individuals had cancer, and 4658 were at high-bleeding risk without previous cancer. Despite being younger with fewer risk factors, patients with cancer had higher net adverse clinical event (HR, 1.25; P=0.01) and major adverse clinical event (HR, 1.26; P=0.02), primarily driven by all-cause mortality and major bleeding (BARC 3-5), but not myocardial infarction, stroke, stent thrombosis, or repeat revascularization. Cancer was an independent predictor of net adverse clinical event (P=0.005), major adverse clinical event (P=0.01), and major bleeding (P=0.03). CONCLUSIONS The present work is the first report on abbreviated DAPT dedicated to patients with cancer. Cancer is a major marker of adverse outcomes and these events had high lethality. Despite short DAPT, patients with cancer experienced higher rates of major bleeding compared with patients without cancer with high-bleeding risk, which occurred mainly after DAPT discontinuation. These findings reinforce the need for a more detailed and individualized stratification of those patients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03344653, NCT01623180, NCT02843633, NCT0284.
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Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
- Instituto Prevent Senior, Sao Paulo, Brazil (C.M.C.)
| | - Roxana Mehran
- Division of Cardiology (R.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Davide Capodanno
- Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, United Kingdom (R.O.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), Bern University Hospital, University of Bern, Switzerland
- Department of Cardiology (M.V., S.W.), Bern University Hospital, University of Bern, Switzerland
| | - Olivier Varenne
- Département de Cardiologie, Hôpital Cochin, Paris, France and Université Paris Cité, France (O.V.)
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute (G.W.S.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marco Valgimigli
- Department of Cardiology (M.V., S.W.), Bern University Hospital, University of Bern, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.)
| | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
| | - Keith Oldroyd
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.O.)
- Golden Jubilee National Hospital, Clydebank, United Kingdom (K.O.)
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France (M.-C.M.)
- ICV Paris Sud, Ramsay, Massy, France (M.-C.M.)
| | | | - Alexandre Abizaid
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
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Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. AIM Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. RESULTS From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups. CONCLUSION In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.
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Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Oliveira FC, Corrêa-Filho RAC, Acunha RMG, Povh JA, Ferraz ALJ, Campos CM. Brycon hilarii produced in hapas: effects in allometric growth. BRAZ J BIOL 2024; 83:e275286. [PMID: 38422262 DOI: 10.1590/1519-6984.275286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/23/2023] [Indexed: 03/02/2024] Open
Abstract
Biometric evaluations are essential to determine the growth characteristics related to the weight and length of fish. This study aimed to determine the growth patterns of juvenile piraputangas (Brycon hilarii) produced in hapas within an excavated pond. The piraputangas were anesthetized and micro-chipped and their biometric characteristics were measured. Subsequently, the fish were distributed in six hapas of eight m3 at the density of 20 fish/hapa, totaling 120 animals. During the experimental period six months, the fish were fed twice (5% of the biomass) a day. Every 30 days, all fish were sampled to measure the biometric characteristics of body weight (g); standard length; total length; head height; head length; body height and body width (cm). The calculations of the weight ratio with the biometric characteristics were determined using allometric equation and estimated by linear regression according to the equation log Y = log a + b log X. All tested relationships were significant by the Student t-test (p < 0.05). Allometric growth was positive for: weight x total length; standard weight x length; weight x head height; weight x head length and weight x body height. The relative condition factor of piraputangas observed in this study was 1.00. The study provided information on the allometric parameters of juvenile Brycon hilarii produced in hapas, and the relative condition factor indicated good growth conditions for piraputangas with positive allometric growth.
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Affiliation(s)
- F C Oliveira
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
| | - R A C Corrêa-Filho
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
| | - R M G Acunha
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
| | - J A Povh
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
| | - A L J Ferraz
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
| | - C M Campos
- Universidade Federal de Mato Grosso do Sul - UFMS, Programa de Pós-graduação em Ciência Animal, Campo Grande, MS, Brasil
- Universidade Estadual de Mato Grosso do Sul - UEMS, Programa de Pós-graduação em Zootecnia, Aquidauana, MS, Brasil
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Brasileiro LO, Povh JA, Spica LN, Silva TV, Stringhetta GR, Teodoro GC, Sousa RM, Fernandes CE, Campos CM, Kasai RYD, Teixeira SA, Côrrea-Filho RAC. Induced reproduction of yellow-tailed lambari (Astyanax lacustris) with Ovopel® and buserelin acetate as alternatives to the protocol with carp pituitary extract. BRAZ J BIOL 2023; 83:e275678. [PMID: 38126637 DOI: 10.1590/1519-6984.275678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The objective of this study was to evaluate reproductive traits in adults of Astyanax lacustris subjected to different spawning inducers. The study involved 240 females (12.54 g ± 2.33 and 7.66 cm ± 0.63 cm) and 240 males (5.83 g ± 0.39 g and 6.14 cm ± 0.64 cm), all at reproductive age. Three different inducers were evaluated: (i) 0.4 pellets of Ovopel®/kg of body weight; (ii) 0.5 ml of buserelin acetate/kg of body weight; and (iii) carp pituitary extract (CPE) (5.5 mg CPE/kg body weight for females and 2.5 mg CPE/kg body weight for males), as well as saline solution (without hormone). The degree-hours for spawning were greater (P<0.05) for the Ovopel® treatment (with 204.93) than in the treatment with CPE (183.2). Ovary weight and gonadosomatic index were higher (P<0.05) in CPE and Ovopel® treatments when compared to buserelin acetate. The number of oocytes per female, absolute and relative fecundity were greater (P<0.05) for Ovopel® and CPE treatments. Fertilization rate was higher (P<0.05) in treatment with buserelin acetate (82.3%) in relation to Ovopel® (72.33%) and CPE (62.40%) treatments, and the highest (P<0.05) hatching rates were achieved with buserelin acetate and Ovopel®. The number of larvae per female body weight was greater (P<0.05) when Ovopel® was used. In conclusion, Ovopel® proves to be a more effective reproductive inducer for induced reproduction of A. lacustris when compared to CPE and buserelin acetate.
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Affiliation(s)
- L O Brasileiro
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - J A Povh
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - L N Spica
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - T V Silva
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - G R Stringhetta
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - G C Teodoro
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - R M Sousa
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - C E Fernandes
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - C M Campos
- Universidade Estadual de Mato Grosso do Sul - UEMS, Programa de Pós-Graduação em Zootecnia, Aquidauana, MS, Brasil
| | | | - S A Teixeira
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
| | - R A C Côrrea-Filho
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina Veterinária e Zootecnia - FAMEZ, Campo Grande, MS, Brasil
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Cavalcante PN, Kanhouche G, Rosa VEE, Campos CM, Lopes MP, Lopes MAAADM, Sampaio RO, de Brito Júnior FS, Tarasoutchi F, Abizaid AAC. B-type natriuretic peptide and N-terminal Pro-B-type natriuretic peptide in severe aortic stenosis: a comprehensive literature review. Front Cardiovasc Med 2023; 10:1182530. [PMID: 37727304 PMCID: PMC10506406 DOI: 10.3389/fcvm.2023.1182530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 09/21/2023] Open
Abstract
B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro BNP) are cardiac biomarkers that are released in response to increased ventricular and atrial wall stress. Aortic stenosis (AS) leads to hemodynamic changes and left ventricular hypertrophy and may be associated with natriuretic peptide levels. Several studies have shown that increased natriuretic peptide levels are correlated with AS severity and can predict the need for intervention. It can be useful in risk stratification, monitoring follow-up, and predicting cardiovascular outcomes of patients with severe AS. This paper aims to summarize the evidence of the role of BNP and NT-pro BNP in AS, before and after intervention.
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Affiliation(s)
- Pâmela Nogueira Cavalcante
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gabriel Kanhouche
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vitor Emer Egypto Rosa
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos M. Campos
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Departament of Hemodynamic, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Mariana Pezzute Lopes
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Roney Orismar Sampaio
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Sândoli de Brito Júnior
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Antonio Cunha Abizaid
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Câmara SF, Campos CM, Machado RD, Padilla L, Tinoco J, Botelho AC, Santiago R, Echavarria M, de Los Santos FD, Oliveira MDP, Abelin AP, Perez L, de Oliveira PP, Ribeiro MH, Brilakis ES, Abizaid A, Quadros A. DES Strut Thickness and Clinical Outcomes After CTO Recanalization: Insights From LATAM CTO Registry. Cardiovasc Revasc Med 2023; 53:28-35. [PMID: 36907696 DOI: 10.1016/j.carrev.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Ultra-thin strut drug-eluting stent (UTS-DES) may improve outcomes after percutaneous coronary intervention (PCI) but have received limited study in chronic total occlusion (CTO) PCI. AIMS To compare of 1-year incidence of major adverse cardiac events (MACE) between patients who underwent CTO PCI with ultrathin (≤ 75 μm) versus thin (>75 μm) strut DES in the LATAM CTO registry. METHODS Patients were considered for inclusion only if successful CTO PCI was performed and when only one type of stent strut thickness (ultrathin or thin) was used. A propensity score matching (PSM) was computed to produce similar groups in relation to clinical and procedural characteristics. RESULTS Between January 2015 and January 2020, 2092 patients underwent CTO PCI, of whom 1466 were included in the present analysis (475 in the ultra-thin and 991 in the thin strut DES). In unadjusted analysis the UTS-DES group had lower rate of MACE (HR: 0.63 95 % CI 0.42 to 0.94, p = 0.04) and repeat revascularizations (HR: 0.50 95 % CI 0.31 to 0.81, p = 0.02) at 1-year follow-up. After adjustment for confounding factors in a Cox regression model there was no difference in 1-year incidence of MACE between groups (HR: 1.15 95 % CI 0.41 to 2.97, p = 0.85). On PSM of 686 patients (343 in each group) the 1-year incidence of MACE (HR 0.68 95 % CI 0.37-1.23; P = 0.22) and individual components of MACE did not differ between groups. CONCLUSIONS One-year clinical outcomes after CTO PCI were similar with ultrathin and thin strut DES.
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Affiliation(s)
- Sérgio F Câmara
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil.; Instituto Prevent Senior, São Paulo, Brazil..
| | - Rodrigo D Machado
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil
| | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - João Tinoco
- Instituto Cardiovascular de Linhares UNICOR, Linhares, Espírito Santo, Brazil
| | | | | | | | | | | | - Anibal P Abelin
- Instituto do Coração (ICOR), Santa Maria, Rio Grande do Sul, Brazil
| | - Luiz Perez
- Hospital Guillermo Grant Benavente, Concepcion, Chile
| | - Pedro P de Oliveira
- Hospital Divina Providência, Porto Alegre, Rio Grande do Sul, Brazil.; LATAM CTO Coordination, Chile
| | - Marcelo H Ribeiro
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Alexandre Abizaid
- Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre Quadros
- Interventional Cardiology Division, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.; LATAM CTO Coordination, Chile
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8
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Tessari FC, Lopes MAAADM, Campos CM, Rosa VEE, Sampaio RO, Soares FJMM, Lopes RRS, Nazzetta DC, de Brito Jr FS, Ribeiro HB, Vieira MLC, Mathias W, Fernandes JRC, Lopes MP, Rochitte CE, Pomerantzeff PMA, Abizaid A, Tarasoutchi F. Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention. Front Cardiovasc Med 2023; 10:1197408. [PMID: 37378406 PMCID: PMC10291604 DOI: 10.3389/fcvm.2023.1197408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Classical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR. Methods This is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups according to the median value of the mean transaortic gradient (≤25 and >25 mmHg). All-cause, intraprocedural, 30-day, and 1-year mortality rates were evaluated. Results All of the patients had degenerative aortic stenosis, with a median age of 66 (60-73) years; most of the patients were men (83%). The median EuroSCORE II was 2.19% (1.5%-4.78%), and the median STS was 2.19% (1.6%-3.99%). On DSE, 73.2% had flow reserve (FR), i.e., an increase in stroke volume ≥20% during DSE, with no significant differences between groups. On CMR, late gadolinium enhancement mass was lower in the group with mean transaortic gradient >25 mmHg [2.0 (0.0-8.9) g vs. 8.5 (2.3-15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3-5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864-0.986, p = 0.019). A mean transaortic gradient ≤25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114). Conclusions In patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if ≤25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.
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Affiliation(s)
- Fernanda Castiglioni Tessari
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Antonieta Albanez A. de M. Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Hemodynamic, Real Hospital Português, Recife, Brazil
| | - Carlos M. Campos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Hemodynamic, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Vitor Emer Egypto Rosa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roney Orismar Sampaio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Rener Romulo Souza Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniella Cian Nazzetta
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Sândoli de Brito Jr
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Henrique Barbosa Ribeiro
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo L. C. Vieira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Mathias
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joao Ricardo Cordeiro Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Pezzute Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos E. Rochitte
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pablo M. A. Pomerantzeff
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Abizaid
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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9
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da Silva ACB, de Paula JET, Campos CM, Ribeiro MH, Martins E, Oliveira MDP, Côrtes LA, Abelin AP, Zukowski CN, Martinelli GC, de Brito FS, Muniz AJ, Cantarelli MJDC, de Andrade PB, Medeiros CR, Falcão BDAA, Fuchs FC, Silva LS, Fattah T, Degrazia RC, Mangione JA, Bezerra CG, Baradel S, Silveira JB, Ybarra LF, Weillenmann D, Gottschall C, Lemke V, da Silva FR, Schmidt MM, Belli KC, de Oliveira PP, de Quadros AS. Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry. Arq Bras Cardiol 2023; 120:e20210462. [PMID: 37132671 PMCID: PMC10263433 DOI: 10.36660/abc.20210462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. OBJECTIVES To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. METHODS Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. RESULTS Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. CONCLUSIONS CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.
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Affiliation(s)
| | - João Eduardo Tinoco de Paula
- Instituto Cardiovascular de LinharesUNICORLinharesESBrasilInstituto Cardiovascular de Linhares UNICOR, Linhares, ES – Brasil
| | - Carlos M. Campos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | | | - Evandro Martins
- Santa Casa de MisericórdiaMaceióALBrasilSanta Casa de Misericórdia, Maceió, AL – Brasil
| | - Marcos Danillo Peixoto Oliveira
- Hospital São PauloEscola Paulista de MedicinaUNIFESPSão PauloSPBrasilHospital São Paulo – Escola Paulista de Medicina – UNIFESP, São Paulo, SP – Brasil
| | - Leandro Assumpção Côrtes
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Aníbal Pereira Abelin
- Instituto do Coração de Santa MariaSanta MariaRSBrasilInstituto do Coração de Santa Maria (ICOR), Santa Maria, RS – Brasil
| | | | - Gustavo Cervino Martinelli
- Hospital Santa IzabelSanta Casa Misericórdia de SalvadorSalvadorBABrasilHospital Santa Izabel Santa Casa Misericórdia de Salvador, Salvador, BA – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital São CamiloSão PauloSPBrasilHospital São Camilo, São Paulo, SP – Brasil
| | - Antônio José Muniz
- Santa Casa de Misericórdia Juiz de ForaJuiz de ForaMGBrasilSanta Casa de Misericórdia Juiz de Fora, Juiz de Fora, MG – Brasil
| | | | | | | | | | - Felipe Costa Fuchs
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
| | | | - Tammuz Fattah
- Instituto de Cardiologia do Estado de Santa CatarinaSão JoseSCBrasilInstituto de Cardiologia do Estado de Santa Catarina, São Jose, SC – Brasil
| | - Ramiro Caldas Degrazia
- Hospital Círculo Operário CaxienseCaxias do SulRSBrasilHospital Círculo Operário Caxiense, Caxias do Sul, RS – Brasil
- Hospital Nossa Senhora do PompeiaSalvadorBABrasilHospital Nossa Senhora do Pompeia, Salvador, BA – Brasil
- Hospital UnimedRio de JaneiroRJBrasilHospital Unimed, Rio de Janeiro, RJ – Brasil
| | - José Armando Mangione
- Beneficência Portuguesa de São PauloSão PauloSPBrasilBeneficência Portuguesa de São Paulo, São Paulo, SP – Brasil
| | - Cristiano Guedes Bezerra
- Rede D’OrHospitais Aliança, São Rafael e CardioPulmonarSalvadorBABrasilRede D’Or – Hospitais Aliança, São Rafael e CardioPulmonar, Salvador, BA – Brasil
| | - Sandra Baradel
- Sociedade Brasileira de Hemodinâmica e Cardiologia IntervencionistaSão PauloSPBrasilSociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, São Paulo, SP – Brasil
| | - João Brum Silveira
- Centro Hospitalar e Universitário do PortoHospital Santo AntôniPortoPortugalCentro Hospitalar e Universitário do Porto, Hospital Santo Antônio, Porto – Portugal
| | - Luiz Fernando Ybarra
- London Health Sciences CentreSchulich School of Medicine and DentistryWestern UniversityOntarioCanadáLondon Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, Ontario – Canadá
| | | | - Carlos Gottschall
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Viviana Lemke
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Franciele Rosa da Silva
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Marcia Moura Schmidt
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Karlyse Claudino Belli
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Pedro Piccaro de Oliveira
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
| | - Alexandre Schaan de Quadros
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
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10
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Esper PLG, Rodrigues FG, Melo TL, Ormanji MS, Campos CM, Alvarenga JC, Caparbo VDF, Carvalho AB, Pereira RMR, Heilberg IP. Bone density, microarchitecture and estimated strength in stone formers: a cross-sectional HR-pQCT study. Nephrol Dial Transplant 2023; 38:425-434. [PMID: 35274705 DOI: 10.1093/ndt/gfac128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low areal bone mineral density (BMD), increased fracture risk and altered bone remodeling have been described among stone formers (SFs), but the magnitude of these findings differs by age, sex, menopausal status and urinary calcium (uCa). This study aimed to investigate volumetric BMD (vBMD), bone microarchitecture and biomechanical properties by high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA) in young SFs, irrespective of calciuria, further distinguishing trabecular from cortical compartments. METHODS HR-pQCT/FEA was performed at the distal tibia (DT) and distal radius (DR) in 106 SFs (57 males and 49 premenopausal females; median age 37 years) and compared with 106 non-SFs (NSFs) retrieved from an existing database, matched for age, sex and body mass index (BMI). Biochemical/hormonal serum and urinary parameters were obtained from SFs. RESULTS SFs exhibited significantly lower trabecular number (TbN) and higher trabecular separation (TbSp) than NSFs at both anatomical sites and lower cortical porosity in the DR. In a subgroup analysis separated by sex, female SFs presented significantly lower TbvBMD, relative bone volume fraction (BV/TV) and TbN and higher TbSp than NSFs at both sites, while male SFs showed significantly lower stiffness and failure load. Multivariate analysis showed TbN to be independently associated with sex and BMI at both sites and with uCa at the DR. CONCLUSIONS The present findings suggest that bone disease represents an early event among SFs, associated at least in part with calcium excretion and mainly characterized by trabecular bone microarchitecture impairment, especially among women, but with reduced bone strength parameters in men.
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Affiliation(s)
| | | | - Thalita Lima Melo
- Nutrition Post Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Carlos M Campos
- Heart Institute, Universidade de São Paulo, São Paulo, Brazil; Instituto Prevent Senior
| | - Jackeline Couto Alvarenga
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Valeria de Falco Caparbo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ita Pfeferman Heilberg
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil.,Nutrition Post Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
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11
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Hajjar LA, Ancona MB, Filho RK, Tresoldi M, Caldas JG, Monti G, Carnevale FC, De Cobelli F, Moreira de Assis A, Ciceri F, Landoni G, Dijkstra J, Moroni F, Abizaid AAC, Willemann Ungaretti F, Carvalho Carmona MJ, De Backer D, Pompilio CE, de Britto FS, Campos CM, Zangrillo A, Montorfano M. Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography. Front Med (Lausanne) 2023; 10:1050531. [PMID: 36873865 PMCID: PMC9978141 DOI: 10.3389/fmed.2023.1050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. Clinical trial registration ClinicalTrial.gov, identifier NCT04410549.
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Affiliation(s)
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Kalil Filho
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francesco De Cobelli
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria José Carvalho Carmona
- Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Eduardo Pompilio
- Department of Intensive Care, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio S de Britto
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Zangrillo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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12
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Lopes MAAADM, Campos CM, Rosa VEE, Sampaio RO, Morais TC, de Brito Júnior FS, Vieira MLC, Mathias W, Fernandes JRC, de Santis A, Santos LDM, Rochitte CE, Capodanno D, Tamburino C, Abizaid A, Tarasoutchi F. Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification. Front Cardiovasc Med 2023; 10:1149613. [PMID: 37180790 PMCID: PMC10174252 DOI: 10.3389/fcvm.2023.1149613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS). Background Elevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS. Methods Prospective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (n = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 (n = 14) when BNP or hsTnI were higher than median; and Group 3 (n = 18) when both hsTnI and BNP were higher than median. Results 49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (P = 0.03) and lower left ventricular ejection fraction (P = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31-47] vs. 32 [29-41] vs. 26 [19-33]%; p < 0.01) and right ventricular EF (62 [53-69] vs. 51 [35-63] vs. 30 [24-46]%; p < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8-30.7] vs. 28.2 [26.9-34.5] vs. 31.8 [28.9-35.5]%; p = 0.03) and indexed ECV (iECV) (28.7 [21.2-39.1] vs. 28.8 [25.4-39.9] vs. 44.2 [36.4-51.2] ml/m2, respectively; p < 0.01) from Group 1 to Group 3. Conclusions Higher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.
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Affiliation(s)
- Maria Antonieta Albanez A. de M. Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Real Hospital Português, Real Cardiologia, Recife, PE, Brazil
| | - Carlos M. Campos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Insituto Prevent Senior, São Paulo, SP, Brazil
| | - Vitor Emer Egypto Rosa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Correspondence: Vitor Emer Egypto Rosa
| | - Roney O. Sampaio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thamara C. Morais
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fábio Sândoli de Brito Júnior
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo L. C. Vieira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wilson Mathias
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joao Ricardo Cordeiro Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Antonio de Santis
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luciano de Moura Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos E. Rochitte
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Davide Capodanno
- CardioT Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania, Italy
| | - Corrado Tamburino
- CardioT Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania, Italy
| | - Alexandre Abizaid
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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13
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de Moura Santos L, Borges Carvalho W, Ribeiro MH, Medeiros Lopes MAAA, da Silva EF, Fukushima JT, Abizaid AAC, Campos CM. Offline Assessment of the Quantitative Flow Ratio: Is it Useful in Clinical Practice? J Invasive Cardiol 2022; 34:E620-E626. [PMID: 35920731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fractional flow reserve (FFR) has been established as the gold standard in the physiological assessment of coronary obstructions severity. However, the need to insert an intracoronary pressure guidewire is a factor that limits its use. Quantitative flow ratio (QFR) is a method that infers the value of FFR from 3-dimensional quantitative coronary angiography (3D-QCA), eliminating the use of a pressure wire and coronary hyperemia. The present study aims to evaluate the diagnostic accuracy of QFR and 3D-QCA in comparison with FFR for the identification of significant obstructive coronary lesions (FFR ≤.80) and the feasibility to assess QFR in a cohort of patients without dedicated angiographic acquisition. METHODS Consecutive patients with coronary angiography with moderate obstructive lesions that had previous FFR measurement were evaluated. Validation of QFR was assessed by the area under the curve (AUC) and other statistical tools, using FFR as the reference method. RESULTS Seventy-five arteries from 69 patients were evaluated. The accuracy of the QFR to detect FFR ≤.80 was 84.0% (95% confidence interval, 75.6-92.4). The correlation and agreement between FFR and QFR were r=0.54 (P<.01) and mean difference was -0.02 ± 0.09 (P=.09), respectively. The AUC of QFR and 3D-QCA identifying stenosis >50% was 0.854 and 0.755, respectively (P=.09). CONCLUSION QFR demonstrated good accuracy compared with FFR for the assessment of moderate obstructive coronary lesions in an unselected clinical practice population. However, many patients were excluded from the analysis and there was no statistical difference between the receiver operator characteristic curves of the QFR and percent diameter stenosis.
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Affiliation(s)
- Luciano de Moura Santos
- Heart Institute - InCor, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, Sao Paulo, SP, Brazil.
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14
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Ribeiro MH, Campos CM, Padilla L, da Silva ACB, de Paula JET, Alcantara M, Santiago R, Hanna F, da Silva FR, Belli KC, Azzalini L, de Oliveira PP, Araujo GN, Sucato V, Mashayekhi K, Galassi AR, Abizaid A, Quadros A. Risk Burden of Coronary Perforation in Chronic Total Occlusion Recanalization: Latin American CTO Registry Analysis. J Am Heart Assoc 2022; 11:e024815. [PMID: 35656976 PMCID: PMC9238716 DOI: 10.1161/jaha.121.024815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Coronary perforation is a life‐threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited. Methods and Results Data from LATAM (Latin American)‐CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30‐day, 1‐year major adverse cardiac events of coronary perforation using time‐to‐event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention‐Chronic total occlusions scores were 2.0 (1.0–3.0) and 1.0 (0.0–2.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1‐year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%; P<0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6 months (P=0.04) and 1 year (P<0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time (P<0.01), Multicenter CTO Registry in Japan score ≥2 (P=0.05), antegrade knuckle wire (P=0.04), and right coronary artery CTO PCI (P=0.05). Conclusions Coronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6 months and 1 year follow‐up.
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Affiliation(s)
| | - Carlos M Campos
- Heart Institute (InCor)Universidade de São Paulo (USP) São Paulo Brazil.,Instituto Prevent Senior, Sao Paulo São Paulo Brazil
| | - Lucio Padilla
- Interventional Cardiology Division Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | - João Eduardo T de Paula
- Interventional Cardiology Division Instituto Cardiovascular de Linhares UNICOR Linhares Espírito Santo Brazil
| | - Marco Alcantara
- Centro Médico Nacional 20 de Noviembre ISSSTE System Mexico City México
| | | | | | - Franciele R da Silva
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Karlyse C Belli
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Lorenzo Azzalini
- Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Pedro P de Oliveira
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
| | - Gustavo N Araujo
- Imperial Hospital de Caridade Florianópolis Santa Catarina Brazil
| | | | - Kambis Mashayekhi
- Division of Cardiology and Angiology II University Heartcenter Freiburg - Bad Krozingen Germany
| | | | - Alexandre Abizaid
- Heart Institute (InCor)Universidade de São Paulo (USP) São Paulo Brazil
| | - Alexandre Quadros
- Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Brazil
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15
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Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM, Ribeiro MH, Filho EM, de los Santos FD, Padilla L, Alcantara-Melendez M, Abud MA, Almodóvar-Rivera IA, Schmidt MM, Echavarria M, Botelho AC, Del Rio V, Quadros A, Santiago R. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry. Catheter Cardiovasc Interv 2022; 99:245-253. [PMID: 34931448 PMCID: PMC8885848 DOI: 10.1002/ccd.30041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/13/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without prior coronary artery bypass graft (CABG) surgery. BACKGROUND Data on the outcomes of CTO PCI in patients with versus without CABG remains limited and with scarce representation from developing regions like Latin America. METHODS We evaluated patients undergoing CTO PCI in 42 centers participating in the LATAM CTO registry between 2008 and 2020. Statistical analyses were stratified according to CABG status. The outcomes of interest were technical and procedural success and in-hospital major adverse cardiac and cerebrovascular events (MACCE). RESULTS A total of 1662 patients were included (n = 1411 [84.9%] no-CABG and n = 251 [15.1%] prior-CABG). Compared with no-CABG, those with prior-CABG were older (67 ± 11 vs. 64 ± 11 years; p < 0.001), had more comorbidities and lower left ventricular ejection fraction (52.8 ± 12.8% vs. 54.4 ± 11.7%; p = 0.042). Anatomic complexity was higher in the prior-CABG group (J-CTO score 2.46 ± 1.19 vs. 2.10 ± 1.22; p < 0.001; PROGRESS CTO score 1.28 ± 0.89 vs. 0.91 ± 0.85; p < 0.001). Absence of CABG was associated with lower risk of technical and procedural failure (OR: 0.60, 95% CI: 0.43-0.85 and OR: 0.58, 95% CI: 0.40-0.83, respectively). No significant differences in the incidence of in-hospital MACCE (3.8% no-CABG vs. 4.4% prior-CABG; p = 0.766) were observed between groups. CONCLUSION In a contemporary multicenter CTO-PCI registry from Latin America, prior-CABG patients had more comorbidities, higher anatomical complexity, lower success, and similar in-hospital adverse event rates compared with no-CABG patients.
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Affiliation(s)
- Dagmar F. Hernandez-Suarez
- Division of Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Pablo Lamelas
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina,Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Carlos M. Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil,Instituto Prevent Senior, São Paulo, Brazil
| | | | | | - Felix Damas de los Santos
- National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico,Cardiovascular Center Centro Medico ABC, Mexico City, Mexico
| | - Lucio Padilla
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Marco Alcantara-Melendez
- Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico,Hospital Medica Sur, Mexico City, Mexico
| | - Marcelo A. Abud
- Percutaneous endovascular therapy department, Sanatorio San Gerónimo, Santa Fe, Argentina
| | | | | | | | | | - Valentin Del Rio
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
| | | | - Ricardo Santiago
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
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16
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Lopes M, Campos CM, Rosa VEE, Sampaio RO, Morais TC, Brito FS, Vieira MLC, Mathias W, Medeiros HNAA, Santis ASAL, Rochitte CE, Ribeiro MH, Santos LM, Abizaid A, Tarasoutchi F. Multimodality imaging and systemic biomarkers in classical low-flow low-gradient aortic stenosis: key findings for cardiac remodeling evaluation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Elevated levels of troponin I (hsTnT) and B-type natriuretic peptide (BNP) have been related with poor prognosis in patients with LFLG-AS. Biomarkers are less expensive, more practical and more accessible than imaging tests, so their use can be an alternative to imaging in the evaluation of patients with LFLG-AS.
Purpose
The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers (i.e. hsTnT and BNP) in Low-Flow, Low-Gradient Aortic Stenosis (LFLG-AS) and reduced left ventricular ejection fraction (LVEF) patients.
Methods
Prospective study with LFLG-AS patients (LVEF <50%, aortic valve area ≤1,0 cm2 and mean gradient <40 mmHg) that underwent hsTNnT, BNP, cardiac magnetic resonance (CMR) with T1 mapping and 2 dimensional echocardiogram (2DEcho). All patients also underwent dobutamine stress echocardiogram to define aortic stenosis severity. Patients were divided into 3 groups according to BNP and hsTnT levels: Group 1: BNP and hsTnT levels below median (BNP <395 pg/ml and TnI-Ultra <0.042 ng/ml); Group 2: BNP or hsTnT higher than median; and Group 3: both hsTnT and BNP higher than median.
Results
49 patients with LFLG-AS were included (Group 1: 17 patients, Group 2: 14 patients and Group 3: 18 patients). Clinical characteristics (including risk scores) were not able to stratify these groups. Patients with elevation of both biomarkers had lower valvuloarterial impedance (P=0.03), lower LVEF (P=0.02), less moderate/severe mitral (P=0.01) and tricuspid regurgitation (P<0.01) by 2DEcho. CMR identified a progressive increase (from Group 1 to 3) of right and left chamber volumes; reduction in right and left ejection fraction and a marked increase in myocardial fibrosis assessed by extracellular volume (ECV) and indexed extracellular volume (iECV) (Figure 1).
Conclusion
Higher levels of BNP and hsTnT in LFLG-AS patients were associated with worse multi-modality imaging parameters and can be a surrogate of cardiac remodeling.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): No funding
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Affiliation(s)
- M.A.A.A.M.L Lopes
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F S Brito
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - W Mathias
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - A S A L Santis
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M H Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L M Santos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - A Abizaid
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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17
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Harada Ribeiro M, Quadros A, Padilla LT, Belli KC, Piccaro P, Dallan LA, Silveira CE, Quesada FH, Morales N, Santiago R, Mashayekhi KC, Azzalini LA, Galassi AR, Campos CM. Coronary perforations and its clinical impact during CTO recanalization: a 2054 patients pooled analysis from the Latin American (LATAM) CTO registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) are the most challenging procedures and still associated with the highest complications rates. Coronary perforation is a life-threatening acute PCI complication, but data are limited regarding its impact on mid-term outcome. We aimed to assess 30-days and 1-year outcomes in CTO PCI patients with coronary perforations.
Purpose
Analyze the clinical impact of Cto perforations during CTO PCI at short and mid-term in a muticenter continental registry in Latin America (LATAM).
Methods
We analyzed data from the continental multicenter Latin America CTO Registry including patients who underwent CTO PCI in 57 centers from 9 countries. Coronary perforation during the index procedure were categorized according to Ellis classification. We assessed 30-days adverse events and 1-year major adverse cardiac and cerebrovascular (MACCE) defined as the composite of all-cause death, myocardial infarction (MI), target vessel revascularization and stroke. MI was defined according both the LATAM CTO protocol and SCAI definitions.
Results
From January 2015 to October 2018, 2054 patients underwent CTO PCI. The median J-CTO score was 2.0 (1.0–3.0) and the median Progress score was 1.0 (0.0–2.0). The overall perforation rate was 3.7% (n=76) in which 55% were Ellis class 1, 24% Ellis class 2 and 21% Ellis class 3. No differences were found in any baseline clinical characteristics. Patients with perforation had more frequently retrograde instrumentation (P<0.01) and antegrade knuckle wire (P<0.01) and lower success rate (P<0.01). At 30-days, perforations were associated with more heart failure (6.6% vs 1.5%, p<0.01), bleeding (15.2% vs 3.7%, p<0.01), transfusion (7.9% vs 1.1%, p<0.01) and cardiac tamponade (13.2% vs 0.4%, p<0.01). After 1-year follow-up, patients with perforations had higher MACCE rates according to both LATAM CTO protocol (18.2 vs. 9.4%; P=0.02) and SCAI definitions (22.7% vs. 11.3%; P<0.01).
Conclusions
In this multicenter continental real-world analysis, coronary perforation in CTO PCI was infrequent and was related with higher anatomical and procedural complexity characteristics. Despite the similarity in clinical characteristics, patients that had coronary perforation were exposed to an increased risk of both hemorrhagic and ischemic events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Harada Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Interventional Cardiology, Sao Paulo, Brazil
| | - A Quadros
- Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
| | - L T Padilla
- Instituto Cardiovascular De Buenos Aires, Buenos Aires, Argentina
| | - K C Belli
- Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
| | - P Piccaro
- Divina Providencia Hospital, Porto Alegre, Brazil
| | - L A Dallan
- University Hospitals Cleveland Medical Center, Cleveland, United States of America
| | | | | | - N Morales
- Instituto Nacional de Cardiologia Ignacio Chaves, Mexico, Mexico
| | - R Santiago
- Bayamon Heart & Lung Institute Lung Institute, Puerto Rico, Puerto Rico
| | - K C Mashayekhi
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - L A Azzalini
- VCU Health Pauley Heart Center, Richmond, United States of America
| | | | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor), Interventional Cardiology, Sao Paulo, Brazil
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18
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Campos CM, Albanez RL. HIV and Takotsubo Cardiomyopathy: A Deadly Combination That Could Not Be Explained by the Viral Infection in Isolation. Cardiovasc Revasc Med 2021; 29:59-60. [PMID: 34420693 DOI: 10.1016/j.carrev.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Instituto Prevent Senior, Sao Paulo, Brazil.
| | - Rodrigo L Albanez
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
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19
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Guimarães WVN, Nicz PFG, Garcia-Garcia HM, Abizaid A, Santos LDM, Rosa VE, Ribeiro MH, Mehta S, Ribeiro E, Lemos PA, Brito FS, Hajjar L, Filho RK, Campos CM. Seattle Angina Pectoris Questionnaire and Canadian Cardiovascular Society Angina Categories in the Assessment of Total Coronary Atherosclerotic Burden. Am J Cardiol 2021; 152:43-48. [PMID: 34175106 DOI: 10.1016/j.amjcard.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
The patient reported angina measurement with the Seattle Angina Questionnaire (SAQ) has shown to have prognostic implications and became an endpoint in clinical trials. Our objective was to study physician-reported and SAQ severity with the total coronary atherosclerotic burden as assessed by 4 angiographic scores. We prospectively analyzed data of consecutive patients scheduled for coronary angiography or percutaneous coronary intervention. The Canadian Cardiovascular Society (CCS) angina categories was used as physician-reported angina. SAQ domains were categorized as severe (0 to 24), moderate 25 to 75 and mild angina (>75). All angina assessments were done before coronary angiography. Gensini, Syntax, Friesinger, and Sullivan angiographic scores were used for total atherosclerotic burden quantification: 261 patients were included in the present analysis. The median age was 66.0 (59.0 to 71.8) years, 53.6% were male and 43.7% had diabetes. The median SYNTAX score was 6.0 (0 to 18.0). The worse the symptoms of CCS categories, the more severe was the atherosclerotic burden in all angiographic scores: SYNTAX (p = 0.01); Gensini (p <0.01); Friesinger (p = 0.02) and Sullivan (p = 0.03). Conversely, SAQ domains were not able to discriminate the severity of CAD in any of the scores. The only exception was the severe SAQ quality of life that had worse Gensini score than the mild SAQ quality of life (p = 0.04). In conclusion, CCS angina categories are related to the total atherosclerotic burden in coronary angiography, by all angiographic scores. SAQ domains should be used as a measure of patient functionality and quality of life but not as a measure of CAD severity.
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Affiliation(s)
| | | | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, Washington DC
| | - Alexandre Abizaid
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Vitor E Rosa
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Expedito Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Fábio S Brito
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ludhmila Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Insituto Prevent Senior, Sao Paulo, Brazil.
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20
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Rosa VEE, Campos CM, Bacelar A, Abizaid AAC, Mangione JA, Lemos PA, Esteves V, Caramori P, Sampaio RO, Tarasoutchi F, Mehran R, Brito FS. Performance of Prediction Models for Contrast-Induced Acute Kidney Injury after Transcutaneous Aortic Valve Replacement. Cardiorenal Med 2021; 11:166-173. [PMID: 34261063 DOI: 10.1159/000517058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has shown to adversely affect outcomes in patients undergoing transcutaneous aortic valve replacement (TAVR), and its correct risk estimation may interfere in procedural planning and strategies. The aim of the study was to test and compare 6 scores in predicting AKI after TAVR. METHODS We tested 6 scores (the contrast material limit score, volume-to-creatinine clearance ratio, ACEF, CR4EATME3AD3, Mehran model A, and Mehran model B) in a total of 559 consecutive patients included in the Brazilian TAVR registry. RESULTS All scores had a poor accuracy and calibration to predict the occurrence of AKI grade 1 or 2. All scores improved the accuracy of AKI risk prediction when stratified for AKI grade 2/3 and AKI grade 3 for all scores. The CR4EATME3AD3 was the best predictor of AKI stage 2/3 (AUC: 0.62; OR: 1.12; 95% CI 1.01-1.26; p = 0.04) and AKI stage 3 (AUC: 0.64; OR: 1.16; 95% CI 1.02-1.32; p = 0.02). Mehran models A and B were both good models for AKI stage 3 (AUC: 0.63; OR: 1.10; 95% CI 1.01-1.22; p = 0.05; and AUC: 0.62; OR: 1.10; 95% CI 1.00-1.21; p = 0.05, respectively). CONCLUSIONS None of the current models demonstrated validity in detecting AKI when its lower grades were evaluated. CR4EATME3AD3 was the best score in predicting moderate to severe AKI after TAVR. These findings suggest that contrast-induced AKI may not be the only factor related to kidney injury after TAVR.
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Affiliation(s)
- Vitor E E Rosa
- Hospital Israelita Albert Einstein, São Paulo, Brazil, .,Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil,
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Instituto Prevent Senior, São Paulo, Brazil
| | | | | | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Roney O Sampaio
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Fabio S Brito
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
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21
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Costa IBSDS, Andrade FTDA, Carter D, Seleme VB, Costa MS, Campos CM, Hajjar LA. Challenges and Management of Acute Coronary Syndrome in Cancer Patients. Front Cardiovasc Med 2021; 8:590016. [PMID: 34179121 PMCID: PMC8219848 DOI: 10.3389/fcvm.2021.590016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/20/2021] [Indexed: 01/12/2023] Open
Abstract
Cancer and cardiovascular disease are the leading causes of mortality in the world. The prevalence of cardiovascular risk factors and coronary artery disease in cancer patients is elevated, and it is associated with high mortality. Several mechanisms, such as the proinflammatory and procoagulant states present in cancer patients, may contribute to these scenarios. Oncological therapy can predispose patients to acute thrombosis, accelerated atherosclerosis and coronary spasm. Treatment decisions must be individualized and based on the cancer history and balancing bleeding and thrombosis risks.
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Affiliation(s)
| | | | - Diego Carter
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Vinicius B. Seleme
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Carlos M. Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ludhmila Abrahão Hajjar
- Cancer Institute University of São Paulo, São Paulo, Brazil
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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22
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Lemes da Silva MV, Nunes Filho ACB, Rosa VEE, Caixeta A, Lemos Neto PA, Ribeiro HB, Almeida BO, Mariani J, Campos CM, Abizaid AAC, Mangione JA, Sampaio RO, Caramori P, Sarmento-Leite R, Tarasoutchi F, Franken M, de Brito FS. Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease. PLoS One 2021; 16:e0251066. [PMID: 33984005 PMCID: PMC8118303 DOI: 10.1371/journal.pone.0251066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.
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Affiliation(s)
- Michel V. Lemes da Silva
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio C. B. Nunes Filho
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- * E-mail:
| | - Vitor E. E. Rosa
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Pedro A. Lemos Neto
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Henrique B. Ribeiro
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Breno O. Almeida
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - José Mariani
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos M. Campos
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Department of Cardiology, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Alexandre A. C. Abizaid
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José A. Mangione
- Department of Interventional Cardiology, Hospital Beneficiência Portuguesa, Sao Paulo, Brazil
| | - Roney O. Sampaio
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Caramori
- Department of Interventional Cardiology, Hospital São Lucas – PUCRS, Porto Alegre, Brazil
| | - Rogério Sarmento-Leite
- Department of Interventional Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Tarasoutchi
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Fábio S. de Brito
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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23
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Abizaid A, Campos CM, Guimarães PO, Costa JDR, Falcão BAA, Mangione F, Caixeta A, Lemos PA, de Brito FS, Cavalcante R, Bezerra CG, Cortes L, Ribeiro HB, de Souza FR, Huemer N, do Val RM, Caramelli B, Calderaro D, Lima FG, Hajjar LA, Mehran R, Filho RK. Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study. Catheter Cardiovasc Interv 2021; 98:E370-E378. [PMID: 33904638 PMCID: PMC8239511 DOI: 10.1002/ccd.29709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
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Affiliation(s)
- Alexandre Abizaid
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Hospital do Coração (HCor), São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Instituto Prevent Senior, São Paulo, Brazil
| | - Patrícia O Guimarães
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José de Ribamar Costa
- Hospital do Coração (HCor), São Paulo, Brazil.,Department of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Breno A A Falcão
- Department of Cardiology, Hospital de Messejana, Fortaleza, Brazil
| | - Fernanda Mangione
- Department of Cardiology, Hospital Beneficência Portuguesa, Sao Paulo, Brazil
| | - Adriano Caixeta
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio S de Brito
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Department of Cardiology, Hospital São Camilo, Sao Paulo, Brazil
| | | | | | - Leandro Cortes
- Department of Cardiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Henrique B Ribeiro
- Department of Cardiology, Hospital Samaritano Paulista, Sao Paulo, Brazil
| | - Francis R de Souza
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Natassja Huemer
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renata M do Val
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Felipe G Lima
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Kalil Filho
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil
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24
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Reddin G, Forrestal BJ, Garcia-Garcia HM, Medvedofsky D, Singh M, Asch FM, Ribeiro HB, Campos CM. Left ventricular global longitudinal strain assessment in patients with takotsubo cardiomyopathy: a call for an echocardiography-based classification. Minerva Cardiol Angiol 2021; 70:321-328. [PMID: 33427420 DOI: 10.23736/s2724-5683.20.05386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is classified into 4 types depending on the anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC. METHODS We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient's diagnosed classification and outcomes. RESULTS Based on classification by traditional assessment the 92% (N.=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (N.=16) had abnormal strain (STE>-18) in all three LV regions (base, mid-ventricle and apex). Seventy-one percent of patients (N.=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, N.=8 Vs 30%, N.=4, respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three regions compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, P=0.02). CONCLUSIONS A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance.
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Affiliation(s)
- Gemma Reddin
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | | | | | | | - Manavotam Singh
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | - Federico M Asch
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | - Henrique B Ribeiro
- University of São Paulo Medical School, Heart Institute - InCor, São Paulo, Brazil
| | - Carlos M Campos
- University of São Paulo Medical School, Heart Institute - InCor, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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25
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Reddin G, Forrestal BJ, Garcia-Garcia HM, Medvedofsky D, Singh M, Asch FM, Ribeiro HB, Campos CM. Left ventricular global longitudinal strain assessment in patients with Takotsubo Cardiomyopathy: a call for an echocardiography-based classification. Minerva Cardioangiol 2021. [PMID: 33427420 DOI: 10.23736/s0026-4725.20.05386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo Cardiomyopathy (TTC) is classified into 4 types dependent on anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC. METHODS We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient's diagnosed classification and outcomes. RESULTS Based on classification by traditional assessment the 92% (n=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (n=16) had abnormal strain (STE>-18) in all three LV regions (base, mid ventricle and apex). 71% of patients (n=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, n=8 Vs 30%, n=4 respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three region compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, p value 0.02). CONCLUSIONS A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance.
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Affiliation(s)
- Gemma Reddin
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | | | | | | | - Henrique B Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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26
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Chezar-Azerrad C, Garcia-Garcia HM, Dan K, Barriola R, Kuku KO, Beyene SS, Melaku GD, Shlofmitz E, Yerasi C, Case BC, Forrestal BJ, Ben-Dor I, Medranda GA, Hashim H, De Maria GL, Campos CM, Bourantas C, Waksman R. Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome. Expert Rev Cardiovasc Ther 2021; 19:141-149. [PMID: 33261531 DOI: 10.1080/14779072.2021.1857732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Areas covered:In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.Expert opinion:Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary syndrome that have TIMI flow of 2/3 and either a small or large burden of thrombus and underlying stenosis of less than 50%.
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Affiliation(s)
- Chava Chezar-Azerrad
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kazuhiro Dan
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Rodrigo Barriola
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Solomon S Beyene
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Gebremedhin D Melaku
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Evan Shlofmitz
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Giovanni Luigi De Maria
- Cardiology Department, Heart Centre - John Radcliffe Hospital - Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Carlos M Campos
- Hospital Israelita Albert Einstein, São Paulo, Brazil and Instituto Do Coração (Incor), Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brazil
| | - Christos Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, UK
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
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27
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Prado GFA, Abizaid AAC, Meireles GC, Sarmento-Leite R, Prudente M, Cantarelli M, Dourado AD, Jr JM, Perin MA, Costantini C, Costa R, Costa JR, Chamie D, Campos CM, Ribeiro EE, Lemos PA. Comparative clinical performance of two types of drug-eluting stents with abluminal biodegradable polymer coating: Five-year results of the DESTINY randomized trial. Rev Port Cardiol 2021; 40:71-76. [PMID: 33402278 DOI: 10.1016/j.repc.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 02/18/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The Stents Coated With the Biodegradable Polymer on Their Abluminal Faces and Elution of Sirolimus Versus Biolimus Elution for the Treatment of de Novo Coronary Lesions - DESTINY Trial is a non-inferiority randomized study that compared the Inspiron™ sirolimus-eluting stent (SES) with the control Biomatrix™ Flex biolimus-eluting stent (BES). Previous reports in the first year showed similar outcomes for both stents, in clinical, angiographic, optical coherence tomography, and intravascular ultrasound assessments. The present analysis aims to compare the clinical performance of these two biodegradable polymer drug-eluting stents five years after the index procedure. METHODS A total of 170 patients (194 lesions) were randomized in a 2:1 ratio for treatment with SES or BES, respectively. The primary endpoint for the present study was the five-year rate of combined major adverse cardiac events, defined as cardiac death, myocardial infarction, or target lesion revascularization. RESULTS At five years, the primary endpoint occurred in 12.5% and 17.9% of the SES and BES groups, respectively (p=0.4). There was no definite or probable stent thrombosis among patients treated with the novel SES stent during the five years of follow-up, and no stent thrombosis after the first year in the BES group. CONCLUSIONS The novel Inspiron™ stent had similar good clinical performance in long-term follow-up when compared head-to-head with the control latest-generation Biomatrix™ Flex biolimus-eluting stent.
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Affiliation(s)
- Guy F A Prado
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - George C Meireles
- Hospital do Servidor Público Estadual - IAMSPE, São Paulo, SP, Brazil
| | - Rogério Sarmento-Leite
- Institute of Cardiology/Fundação Universitária de Cardiologia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | | | - Jose Mariani Jr
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - J Ribamar Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Daniel Chamie
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Expedito E Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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28
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Ribeiro MH, Grossi A, Caixeta A, Franken M, Katz M, Seleme V, Ribeiro E, Pesaro AE, Fabri J, Mehta S, Campos CM. Cluster of climatic and pollutant characteristics increases admissions for acute myocardial infarction: Analysis of 30,423 patients in the metropolitan area of Sao Paulo. Heart Lung 2020; 50:161-165. [PMID: 33227571 DOI: 10.1016/j.hrtlng.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of simultaneous adverse climate conditions in the risk of myocardial infarction (MI) was not tested before. The aim of the present study was to investigate the impact of the combination of climate and air pollution features in the number of admissions and mortality due to acute myocardial infarction in 39 municipalities of São Paulo from 2012 to 2015. METHODS Data about MI admissions were obtained from the Brazilian public health system (DataSUS). Daily information on weather were accessed from the Meteorological Database for Teaching and Research. Additionally, daily information on air pollution were obtained from the Environmental Company of the State of São Paulo. A hierarchical cluster analysis was applied for temperature, rainfall patterns, relative air humidity, nitrogen dioxide, particulate matter 2.5 and particulate matter 10. MI admissions and in-hospital mortality were compared among the clusters. RESULTS Data analysis produced 3 clusters: High temperature variation-Low humidity-high pollution (n=218 days); Intermediate temperature variation/high humidity/intermediate pollution (n=751 days) and low temperature variation/intermediate humidity-low pollution (n=123 days). All environmental variables were significantly different among clusters. The combination of high temperature variation, dry weather and high pollution resulted in a significant 9% increase in hospital admissions for MI [30.5 (IQR 25.0-36.0)]; patients/day; P<0.01). The differences in weather and pollution did not have impact on in-hospital mortality (P=0.88). CONCLUSION The combination of atmospheric conditions with high temperature variation, lower temperature, dryer weather and increased inhalable particles was associated with a marked increase of hospital admissions due to MI.
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Affiliation(s)
- Marcelo H Ribeiro
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil; SOS Cárdio Hospital, Florianópolis, Brazil
| | - André Grossi
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | - Adriano Caixeta
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Marcelo Franken
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Marcelo Katz
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 672/701, Morumbi, SP, Brazil
| | - Vinicius Seleme
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | - Expedito Ribeiro
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
| | | | - Jose Fabri
- Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Sameer Mehta
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos M Campos
- Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil; Insituto Prevent Senior, São Paulo, Brazil.
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29
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Kogame N, Guimarães PO, Modolo R, De Martino F, Tinoco J, Ribeiro EE, Kawashima H, Ono M, Hara H, Wang R, Cavalcante R, Moulin B, Falcão BA, Leite RS, de Almeida Sampaio FB, Morais GR, Meireles GC, Campos CM, Onuma Y, Serruys PW, Lemos PA. Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD. JACC Cardiovasc Interv 2020; 13:2251-2262. [DOI: 10.1016/j.jcin.2020.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/09/2023]
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30
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Singh M, Reddin G, Garcia-Garcia HM, Medvedofsky D, Asch FM, Kumar P, Franken M, Campos CM. Comparison of Contractility Patterns on Left Ventriculogram Versus Longitudinal Strain by Echocardiography in Patients With Takotsubo Cardiomyopathy. Cardiovasc Revasc Med 2020; 27:45-51. [PMID: 32883585 DOI: 10.1016/j.carrev.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular (LV) dysfunction, electrocardiographic changes that can mimic acute myocardial infarction (MI), and release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Conventionally, gross visual assessment of LV angiogram has been used to classify TTC. We aim to compare quantitative assessment of different regions of LV on angiogram and segmental strain on transthoracic echo to determine a better way to classify TTC rather than conventional qualitative visual assessment. METHODS We conducted a retrospective observational study of 20 patients diagnosed with TTC who had LV angiogram and transthoracic echocardiograms performed on presentation that were suitable for analysis. Twenty LV angiograms were analyzed using Rubo DICOM viewer software. Areas of different LV regions were measured in diastole and systole, and percentage changes in area of these regions were calculated. Percentage changes in area of less than 10% was considered "akinetic." On the other hand, using echocardiograms of these patients, LV regional longitudinal strain (LS) was derived from speckle-tracking analysis. These findings were compared to determine concordance between both modalities. RESULTS On quantitative analysis of 20 LV angiograms, the area of all the three LV regional (apex, mid ventricle, and base) shortening (>10%) was observed in 16 patients (80%) during systole as compared to diastole. However, only 4 out of 20 patients (20%) were noted to have apical region area change of <10% between diastole and systole. Analysis of LV regional LS patterns of 20 patients showed that 14 patients had abnormal values (> -18%) in all three LV regions: apex, mid ventricle, and base. The apical region was the most severely affected region (mean LS -13.9%), followed by the basal region (mean -14.7%) and the mid ventricular region (mean -15.1%). Comparing the results of both modalities showed that there was 35% (n = 7) concordance in the results noted for base and apical regions of the LV, whereas only 20% (n = 4) concordance was noted in mid ventricular region. CONCLUSION Contractility (shortening) on LV angiogram is present in a majority of patients in the three LV regions, but contractility assessed by LS is impaired in most of them. The concordance in both quantitative assessment modalities was low. LV angiogram may not be an accurate imaging modality to assess contractility patterns in Takotsubo patients, and echocardiographic LS analysis should be taken as the preferred imaging modality.
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Affiliation(s)
- Manavotam Singh
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Gemma Reddin
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Diego Medvedofsky
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Federico M Asch
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Preetham Kumar
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Carlos M Campos
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Costa IBSDS, Rochitte CE, Campos CM, Barberato SH, de Oliveira GMM, Lopes MACQ, Nomura CH, Abizaid AA, Cerri G, Kalil R, Hajjar LA. Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection. Arq Bras Cardiol 2020; 115:111-126. [PMID: 32813825 PMCID: PMC8384321 DOI: 10.36660/abc.20200370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.
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Affiliation(s)
- Isabela Bispo Santos da Silva Costa
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasil Universidade de São Paulo Instituto do Câncer do Estado de São Paulo , São Paulo , SP - Brasil
| | - Carlos Eduardo Rochitte
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasil Hospital do Coração , São Paulo , SP - Brasil
- Hospital Pró-CardíacoRio de JaneiroRJBrasil Hospital Pró-Cardíaco , Rio de Janeiro , RJ - Brasil
| | - Carlos M. Campos
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração - Hemodinâmica e Cardiologia Intervencionista, São Paulo , SP - Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasil Hospital Israelita Albert Einstein - Hemodinâmica e Cardiologia Intervencionista, São Paulo , SP - Brasil
| | - Silvio Henrique Barberato
- CardioEcoCuritibaPRBrasil CardioEco -Centro de Diagnóstico Cardiovascular, Curitiba , PR - Brasil
- Quanta DiagnósticoCuritibaPRBrasil Quanta Diagnóstico – Ecocardiografia, Curitiba , PR - Brasil
| | - Gláucia Maria Moraes de Oliveira
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro – Cardiologia, Rio de Janeiro , RJ - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza WanderleyJoão PessoaPBBrasil Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa , PB - Brasil
- Hospital Metropolitano Dom José Maria PiresJoão PessoaPBBrasil Hospital Metropolitano Dom José Maria Pires , João Pessoa , PB - Brasil
- Sociedade Brasileira de CardiologiaRio de JaneiroRJBrasil Sociedade Brasileira de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Cesar Higa Nomura
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Alexandre A. Abizaid
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
- Hospital Sírio LibanêsSão PauloSPBrasil Hospital Sírio Libanês , São Paulo , SP - Brasil
| | - Giovanni Cerri
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Roberto Kalil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Ludhmila Abrahão Hajjar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasil Universidade de São Paulo Instituto do Câncer do Estado de São Paulo , São Paulo , SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
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Abrão SR, Campos CM, Cavalcante R, Eggermont J, Lemos P, Lederman A, da Silva ES, Aun R, Belczak SQ, Abizaid A, de Brito FS. Percutaneous endovascular delivery of calcium chloride to the intact porcine carotid artery: A novel animal model of arterial calcification. Catheter Cardiovasc Interv 2020; 96:E484-E492. [PMID: 32558228 DOI: 10.1002/ccd.29070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study evaluated the effect of endovascular administration of calcium chloride to the carotid artery of swines, to create a model of arterial calcification. METHODS Fifteen Large White pigs were used for the study. Via endovascular treatment, carotid arteries were exposed during 9 min to either calcium chloride (experimental artery) or saline (control artery) with the use of the TAPAS catheter. Intravascular ultrasound (IVUS) imaging was obtained at baseline, postprocedure and at 30 days. Optical coherence tomography (OCT) imaging was obtained in vitro after carotids were harvested. Longitudinally cut parallel arterial segments were placed in a system of delicate clamps and underwent uniaxial strain test. All arteries underwent histopathological examination. RESULTS Calcium chloride treated segments showed extensive circumferential parietal calcification evident on both IVUS and OCT. Reduction in minimal lumen area on IVUS was evident in experimental arteries both at 24 hr and 30 days postprocedure. Histopathologic assessment (Von Kossa stain) confirmed medial calcification with mild intimal thickening. Biomechanical testing showed treated segments to have smaller breaking strength and less elastic deformation than controls. CONCLUSION We developed a nonexpensive, reproducible model of early carotid medial calcification in pigs. Our model has the potential to help the development of research to unravel mechanisms underlying arterial calcification, the use of current or new devices to treat calcified lesions as well as to serve as an option for training interventionalists on the use of such devices.
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Affiliation(s)
| | - Carlos M Campos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Pedro Lemos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Alex Lederman
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Erasmo S da Silva
- Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Aun
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Department of Vascular Surgery, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Sergio Q Belczak
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Hospital Sao Camilo, Sao Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Sandoli de Brito
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Sao Camilo, Sao Paulo, Brazil
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Esteves V, Oliveira MAP, Feitosa FS, Mariani J, Campos CM, Hajjar LA, Lisboa LA, Jatene FB, Filho RK, Lemos Neto PA. Late clinical outcomes of myocardial hybrid revascularization versus coronary artery bypass grafting for complex triple-vessel disease: Long-term follow-up of the randomized MERGING clinical trial. Catheter Cardiovasc Interv 2020; 97:259-264. [PMID: 31922359 DOI: 10.1002/ccd.28710] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/30/2019] [Accepted: 12/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This article aimed to compare the outcomes after hybrid revascularization with conventional coronary artery bypass grafting (CABG) surgery. BACKGROUND The concept of hybrid coronary revascularization combines the advantages of CABG and percutaneous coronary intervention to improve the treatment of patients with complex multivessel disease. METHODS The Myocardial hybrid revascularization versus coronary artERy bypass GraftING for complex triple-vessel disease-MERGING study is a pilot randomized trial that allocated 60 patients with complex triple-vessel disease to treatment with hybrid revascularization or conventional CABG (2:1 ratio). The primary outcome was the composite of all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization at 2 years. RESULTS Clinical and anatomical characteristics were similar between groups. After a mean follow-up of 802 ± 500 days, the primary endpoint rate was 19.3% in the hybrid arm and 5.9% in the CABG arm (p = NS). The incidence of unplanned revascularization increased over time in both groups, reaching 14.5 versus 5.9% in the hybrid and in the CABG groups, respectively (p = .4). Of note, in the hybrid group, there were no reinterventions driven by the occurrence of stent restenosis. CONCLUSIONS Hybrid myocardial was feasible but associated with increasing rates of major adverse cardiovascular events during 2 years of clinical follow-up, while the control group treated with conventional surgery presented with low rates of complications during the same period. In conclusion, before more definitive data arise, hybrid revascularization should be applied with careful attention in practice, following a selective case-by-case indication.
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Affiliation(s)
- Vinicius Esteves
- Department of Interventional Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Marco A P Oliveira
- Division of Cardiovascular Surgery, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Fernanda S Feitosa
- Division of Clinical Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - José Mariani
- Department of Interventional Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil.,Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil.,Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ludhmila A Hajjar
- Division of Clinical Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Luiz A Lisboa
- Division of Cardiovascular Surgery, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Fabio B Jatene
- Division of Cardiovascular Surgery, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Roberto K Filho
- Division of Clinical Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Pedro A Lemos Neto
- Department of Interventional Cardiology, Heart Institute - InCor, University of Sao Paulo Medical School, São Paulo, Brazil.,Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Harada Ribeiro M, Belli KC, Piccaro P, Padilla LT, Silva ACB, Santiago R, De Paula JET, Ribeiro EE, Franken M, Quadros AS, Campos CM. P4598Clinical implications and predictors of coronary perforations during chronic total occlusion percutaneous coronary interventions: insights from the multicenterLatin America CTO LATAM registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic total occlusions are still considered one of the most challenging procedures in the field of interventional cardiology and the most feared complication are the perforations. In past studies and series from Asia, Europe and United States the rate of perforations in percutaneous coronary interventions are described as 0.2% whereas this rate increases to 3% when recanalization of a chronic total occlusion is attempted.
Purpose
Our study sought to identify the frequency, predictors and clinical implications of coronary perforations in chronic total occlusion percutaneous interventions in a contemporary registry with data from Latin America.
Methods
We reported the data of a prospective multi center Latin American registry from January to December 2018 in 1066 patients who underwent chronic total occlusion percutaneous interventions in 30 centers in the following countries: Brazil, Argentina, Puerto Rico, Chile, Colombia, Ecuador and Mexico. Coronary perforation was defined as evidence of extravasation dye or blood from the coronary artery during or following the procedure. A stepwise logistic regression was performed to investigate the independent predictors of coronary perforations.
Results
The mean age was 64.2±10.7 years, 79.8% were male, 35.3% diabetics and 6.7% had heart failure. The most commonly involved CTO vessel was right coronary artery (41.4%), the mean J-CTO score was 2.0±1.3 and the mean CL score was 2.7±1.6. The overall procedural success rate was 81.9%. Coronary perforation occurred in 3.3% of cases: type 1 in 1.8%, Type 2 in 0.9% and Type 3 in 0.6%. In comparison with patients without coronary perforation was observed, those with such complication required more often blood transfusion (8.6% vs. 0.7%; p<0.001), experienced more cardiac tamponade (13.4% vs. 0.4%; p<0.001), but not all-cause in-hospital mortality (0 vs. 1.0%; p=1.0; respectively). At multivariate analysis, the independent predictor of coronary perforation was an activated clotting time (ACT) during PCI >470 seconds (OR 6.5; 95% CI 2.4 - 17.3; p<0.001), baseline heart failure (OR 4.2; 95% CI 1.2 - 14.6) and J-CTO score ≥2 (OR7.5; 95% CI 1.0–59.1).
Conclusions
Coronary perforation during percutaneous interventions in Latin America occurred in 3.3% of patients, being related with adverse events but not in-hospital all-cause mortality. Pharmacological management, high anatomical complexity and heart failure were identified as independent predictors of this still and so feared complication.
Acknowledgement/Funding
None
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Affiliation(s)
- M Harada Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Interventional Cardiology, Sao Paulo, Brazil
| | - K C Belli
- Institute of Cardiology of Rio Grande do Sul, Interventional Cardiology, Porto Alegre, Brazil
| | - P Piccaro
- Institute of Cardiology of Rio Grande do Sul, Interventional Cardiology, Porto Alegre, Brazil
| | - L T Padilla
- Instituto Cardiovascular de Buenos Aires, Interventional Cardiology, Buenos Aires, Argentina
| | - A C B Silva
- Hospital São José do Avaí, Interventional Cardiology, Rio de Janeiro, Brazil
| | - R Santiago
- Hospital Pavia Santurce, Interventional Cardiology, San Juan, United States of America
| | | | - E E Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Interventional Cardiology, Sao Paulo, Brazil
| | - M Franken
- Hospital Israelita Albert Einstein, Interventional Cardiology, Sao Paulo, Brazil
| | - A S Quadros
- Institute of Cardiology of Rio Grande do Sul, Interventional Cardiology, Porto Alegre, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor), Interventional Cardiology, Sao Paulo, Brazil
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Spadaro AG, Bocchi EA, Souza GE, Filho AE, Mariani J, Campos CM, Lemos PA. Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial. Catheter Cardiovasc Interv 2019; 94:644-650. [PMID: 31334914 DOI: 10.1002/ccd.28393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/27/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Chagas disease is one of the most relevant endemic parasitic diseases in Latin America, affecting approximately 6 million people. Overt Chagas heart disease is an ominous condition, occurring in 20-30% of infected individuals, which has besides the persistent myocarditis a peculiar intracardiac ganglionic neuronal depletion and dysautonomy. This study aims to evaluate the safety and feasibility of renal denervation for patients with advanced symptomatic Chagas cardiomyopathy. METHODS Open-label prospective pilot study that randomized patients with Chagas heart disease to either renal denervation or conservative treatment (2:1 ratio). The primary endpoint was the incidence of major adverse events at 9 months, defined as a composite of all-cause death, myocardial infarction, stroke, need for renal artery invasive treatment, or worsening renal function. RESULTS A total of 17 patients were allocated for renal denervation (n = 11) or conservative treatment (n = 6). Included patients had severe symptomatic heart disease, with markedly depressed left ventricular function (average ejection fraction 26.7 ± 4.9%). For patients randomized to renal denervation, the procedure was performed successfully and uneventfully. After 9 months, the primary endpoint occurred in 36.4% of patients in the renal denervation group and 50.0% in the control arm (p = .6). After 9 months, clinical, laboratory, functional, echocardiographic, and quality of life parameters were similar between groups. CONCLUSIONS This pilot study suggests that renal denervation is safe and feasible in patients with Chagas cardiomyopathy, warranting future studies to better evaluate the clinical efficacy of the interventional strategy in improving the prognosis of this high-risk population.
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Affiliation(s)
- André G Spadaro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Edimar A Bocchi
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Germano E Souza
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Antonio E Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - José Mariani
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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Caixeta A, Campos CM, Felix C, Chieffo A, Capranzano P, Kawamoto H, Tamburino C, Diletti R, de Ribamar Costa J, Onuma Y, van Geuns RJ, Bartorelli AL, Colombo A, Tamburino C, Serruys PW, Abizaid A. Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries. EUROINTERVENTION 2019; 15:623-630. [DOI: 10.4244/eij-d-16-00796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kogame N, Modolo R, Tomaniak M, Cavalcante R, de Martino F, Tinoco J, Ribeiro EE, Mehran R, Campos CM, Onuma Y, Lemos PA, Serruys PW. Prasugrel monotherapy after PCI with the SYNERGY stent in patients with chronic stable angina or stabilised acute coronary syndromes: rationale and design of the ASET pilot study. EUROINTERVENTION 2019; 15:e547-e550. [DOI: 10.4244/eij-d-19-00131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hideo-Kajita A, Garcia-Garcia HM, Shlofmitz E, Campos CM. Update on Coronary Angiography-Based Physiology Technologies. Arq Bras Cardiol 2019; 113:282-285. [PMID: 31365603 PMCID: PMC6777878 DOI: 10.5935/abc.20190140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alexandre Hideo-Kajita
- MedStar Health Research Institute - Medstar Cardiovascular Research Network (MHRI/MCRN), Hyattsville, Maryland - USA.,MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Hector M Garcia-Garcia
- MedStar Health Research Institute - Medstar Cardiovascular Research Network (MHRI/MCRN), Hyattsville, Maryland - USA.,MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Evan Shlofmitz
- MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Carlos M Campos
- Universidade de São Paulo - Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein - Cardiologia Intervencionista, São Paulo, SP - Brazil
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Nunes Filho AC, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella AL, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impacto del daño renal agudo en el seguimiento a corto y a largo plazo tras el implante percutáneo de válvula aórtica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Campos CM, Lemos PA. To Defer or Not Defer? The Challenges of Physiology in Acute Coronary Syndromes. Arq Bras Cardiol 2018; 111:551-552. [PMID: 30365678 PMCID: PMC6199514 DOI: 10.5935/abc.20180206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Carlos M. Campos
- Hospital Israelita Albert Einstein, São Paulo, SP -
Brazil
- Instituto do Coração (InCor), Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
| | - Pedro A. Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP -
Brazil
- Instituto do Coração (InCor), Faculdade de Medicina da
Universidade de São Paulo, São Paulo, SP - Brazil
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Janella BL, Campos CM, Caixeta A, Almeida BO, Brito FS, Abizaid A, Perin MA. Assessment of long-term mortality in patients with complex coronary artery disease undergoing percutaneous intervention: comparison of multiple anatomical and clinical prognostic risk scores. EUROINTERVENTION 2018; 13:1177-1184. [PMID: 28506936 DOI: 10.4244/eij-d-16-00659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Three-vessel and left main coronary artery disease (CAD) have important prognostic implications. Consequently, numerous risk scores have been developed to stratify patients with complex CAD. The aim of the present study was to compare the predictive performance of six risk scores for occurrence of fouryear all-cause mortality. METHODS AND RESULTS From March 2008 to December 2012, 348 consecutive patients with complex CAD undergoing percutaneous coronary intervention (PCI) in a tertiary centre in São Paulo, Brazil, were analysed. Four-year mortality was assessed. The scores compared were: baseline SYNTAX score (SS), residual SYNTAX score (rSS), ACEF score, clinical SYNTAX score (cSS), SYNTAX revascularisation index (SRI) and SYNTAX score II (SSII). SSII had the best predictive performance, AUC 0.82, Brier score 0.10, surpassing all the other scores for long-term mortality prediction. Moreover, SSII discriminated well PCI patients in risk groups with p<0.01 for four-year all-cause mortality. The ACEF score (AUC 0.77) and the cSS (AUC 0.78) were significantly better than the SS (AUC 0.65), SRI (AUC 0.60) or the rSS (AUC 0.55). CONCLUSIONS For patients with complex CAD treated by PCI, the combination of baseline clinical and angiographic factors provided better risk assessment. The SSII demonstrated the most precise predictive performance for long-term mortality.
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Gonzales-Tamayo L, Campos CM, Lisboa L, Oliveira M, Dallan L, Jatene F, Mejia O. P6360STS, EuroSCORE II or SYNTAX II: which is the best score to assess mortality risk for complex coronary artery disease after CABG? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Gonzales-Tamayo
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L Lisboa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M Oliveira
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L Dallan
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Jatene
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - O Mejia
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Emer Egypto Rosa V, Campos CM, Jatene T, Carvalho LAF, Siqueira DA, Lemos PA, Sao Thiago LEK, Esteves V, Tarasoutchi F, De Brito Jr FS. P6309Impact of low-flow, low-gradient aortic stenosis in short- and long-term follow-up after TAVI: Insights from the Brazilian TAVI Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - C M Campos
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - T Jatene
- Anis Rassi Hospital, Goiania, Brazil
| | | | - D A Siqueira
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - P A Lemos
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - V Esteves
- Hospital Brasil – Rede D'Or, São Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor) and Hospital Sírio-Libanês, São Paulo, Brazil
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Campos CM, Lemos PA. Merely subintimal coronary plaque modification improves health status: Not all CTO recanalization failures are alike? Catheter Cardiovasc Interv 2018; 91:1043-1044. [PMID: 29737029 DOI: 10.1002/ccd.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/11/2022]
Abstract
Failed CTO angioplasty was divided in two groups: with and without "subintimal plaque modification." At 1-month, patients treated with "subintimal plaque modification" had larger increases in health status as assessed by the Seattle Angina Questionnaire. The relatively small sample size and the lack of a longer follow-up period does not allow definite conclusion in terms of safety or clinical events.
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Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Nunes Filho ACB, Katz M, Campos CM, Carvalho LA, Siqueira DA, Tumelero RT, Portella ALF, Esteves V, Perin MA, Sarmento-Leite R, Lemos Neto PA, Tarasoutchi F, Bezerra HG, de Brito FS. Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2018; 72:21-29. [PMID: 29358043 DOI: 10.1016/j.rec.2017.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.
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Affiliation(s)
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Carvalho
- Department of Interventional Cardiology, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
| | - Dimytri A Siqueira
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Rogério T Tumelero
- Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil
| | | | - Vinícius Esteves
- Department of Interventional Cardiology, Rede D'OR São Luiz, São Paulo, Brazil
| | - Marco A Perin
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Pedro A Lemos Neto
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Hiram G Bezerra
- Cardiac Catheterization Laboratory, UH Cleveland Medical Center, Cleveland, United States
| | - Fábio S de Brito
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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46
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Campos CM, Garcia-Garcia HM, Iqbal J, Muramatsu T, Nakatani S, Dijkstra J, Onuma Y, Serruys PW. Serial volumetric assessment of coronary fibroatheroma by optical frequency domain imaging: insights from the TROFI trial. Eur Heart J Cardiovasc Imaging 2018; 19:92-100. [PMID: 28200140 DOI: 10.1093/ehjci/jew338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Coronary lesions precursors of acute events remain elusive, since they undergo continuous changes and their temporal changes are not very well-characterized. In natural history studies, optical frequency domain imaging (OFDI) has been used only to assess fibroatheromas as a 2D structure and sometimes in a single frame fashion. We aim at describing the serial volumetric modifications of the fibrous cap (FC) of the fibroatheromas as determined by OFDI over a 6-month follow-up period. Methods and results In 49 patients, OFDI investigation was performed following treatment of culprit lesion and at 6-month follow-up in patients with ST-segment elevation myocardial infarction (STEMI). A fully automatic volumetric quantification of FC was done in all lipid-containing frames of non-culprit lesions in the infarct related artery. These lesions were matched at baseline and 6-month follow-up. A total of 58 non-culprit lipid rich lesions (34 TCFAs and 24 thick-cap fibroatheroma [ThCFA]) were found in 34 patients at baseline. Overall, there was a FC volume decrease of 1.57 (Inter-quartile Range [IQR] -4.13 to 0.54) mm3 at 6-months. 27% of the lesions changed their phenotype over time (TCFA or ThCFA). TCFAs that became ThCFAs at follow-up had smaller mean and maximal FC as compared with lesions that remained TCFAs (P = 0.01 for both). Conclusions Non-culprit fibroatheromas located in the infarct related artery of patients with STEMI had a volumetric reduction of the FC after 6-month follow-up. Quantitative FC assessment was able to differentiate high-risk lesions that became ThCFAs. There was a considerable change of plaque phenotype (TCFAs or ThCFAs) over time.
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Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Javaid Iqbal
- Cardiovascular Science, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Shimpei Nakatani
- Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Leiden, The Netherlands
| | - Yoshinobu Onuma
- Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
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47
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Escaned J, Banning A, Farooq V, Echavarria-Pinto M, Onuma Y, Ryan N, Cavalcante R, Campos CM, Stanetic BM, Ishibashi Y, Suwannasom P, Kappetein AP, Taggart D, Morel MA, van Es GA, Serruys PW. Rationale and design of the SYNTAX II trial evaluating the short to long-term outcomes of state-of-the-art percutaneous coronary revascularisation in patients with de novo three-vessel disease. EUROINTERVENTION 2017; 12:e224-34. [PMID: 27290681 DOI: 10.4244/eijv12i2a36] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The applicability of the results of the SYNTAX trial comparing percutaneous coronary intervention (PCI) using first-generation drug-eluting stents (DES) with coronary artery bypass graft (CABG) surgery for the treatment of patients with complex coronary artery disease (CAD) has been challenged by recent major technical and procedural developments in coronary revascularisation. Functional assessment of coronary lesions has contributed to marked improvements in both safety and efficacy of DES implantation. In addition, the recent development of the SYNTAX score II, a clinical tool based on anatomical and clinical factors, allows individualised objective decision making regarding the optimal revascularisation modality in patients with complex CAD. The ongoing SYNTAX II trial is currently evaluating the effectiveness of the clinical and technological advances in the treatment of patients with complex (de novo three-vessel) CAD. METHODS AND RESULTS The SYNTAX II trial is a multicentre, all-comers, open-label, single-arm trial aiming to recruit 450 patients with de novo three-vessel CAD in approximately 25 European interventional cardiology centres. All patients will be selected and treated following the SYNTAX II strategy, which includes: a) establishing the appropriateness of revascularisation utilising the SYNTAX score II as a clinical tool to allow objective decision making by the Heart Team, b) ischaemia-driven revascularisation based on functional intracoronary assessment, c) implantation of the new-generation everolimus-eluting platinum chromium coronary stent with thin struts and abluminal bioabsorbable polymer coating to promote rapid vessel healing, d) intravascular ultrasound-guided DES implantation, and e) treatment at centres with expertise in CTO recanalisation. The primary endpoint is a composite of the major adverse cardiac and cerebral events (MACCE) rate at one-year follow-up compared to the historical PCI arm of the SYNTAX trial. An exploratory endpoint will be MACCE at five-year follow-up compared to the historical surgical arm of the SYNTAX trial. CONCLUSIONS The SYNTAX II trial will provide valuable information on outcomes of state-of-the-art PCI for the contemporary management of complex (de novo three-vessel) CAD. SYNTAX II will be of critical value in the design of future trials in this arena.
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Affiliation(s)
- Javier Escaned
- Hospital Clinico San Carlos/Faculty of Medicine Complutense University, Madrid, Spain
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Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, Li Paul Kao H, Rosli MA, Carrie D, De Bruyne B, Stone GW, Serruys PW, Abizaid A. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. Catheter Cardiovasc Interv 2017; 91:387-395. [PMID: 28471086 DOI: 10.1002/ccd.27109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/01/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Chiung-Jen Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan
| | - Hsien Li Paul Kao
- Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mohd Ali Rosli
- Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Didier Carrie
- Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France
| | | | - Gregg W Stone
- Department of Interventional Cardiology, Columbia University Medical Center, New York.,Cardiovascular Research Foundation, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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Faillace BLR, Ribeiro HB, Campos CM, Truffa AAM, Bernardi FL, Oliveira MDP, Mariani J, Marchini JF, Tarasoutchi F, Lemos PA. Potential of transcatheter aortic valve replacement to improve post-procedure renal function. Cardiovasc Revasc Med 2017; 18:507-511. [PMID: 29054156 DOI: 10.1016/j.carrev.2017.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 03/26/2017] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Baseline comorbidities including renal dysfunction are frequently found in patients treated with transcatheter aortic valve replacement (TAVR) and may increase the risks of acute kidney injury (AKI), although some of them may actually improve renal function. We aimed to evaluate the potential of TAVR to acutely improve post-procedure renal function. METHODS This is a prospective single-center registry of consecutive patients with severe symptomatic aortic stenosis treated by transfemoral TAVR. Creatinine levels were determined at baseline and daily until hospital discharge. AKI was defined according to VARC-2 criteria. Patients who had improvement of creatinine levels >25% were classified as having TAVR induced renal function improvement (TIRFI). RESULTS A total of 69 patients undergoing TAVR were included, with a mean age of 83.0±7.4 years, being 24.6% diabetics, with a median STS score of 9.2 (5.1-21.6). Using the VARC-2 criteria, the majority of patients (64.6%) did not have renal impairment, while AKI was detected in 35.4% of the patients. Importantly, in those with prior severe renal dysfunction (clearance <30mL/min/1.73m2) or diabetes, AKI reached up to 50% and 56.3% of the patients, respectively. Conversely, acute kidney recovery (TIRFI) occurred in 12 patients (18.5%) being >50% in 1 patient (1.5%), and at hospital discharge the majority of the patients (88.6%) left the hospital in their original or better renal function categories. CONCLUSION Despite multiple comorbidities in a selected TAVR-population and the use of contrast media, TAVR did not impair renal function in a majority of patients, with a significant proportion of them rather having acute renal function improvement.
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Affiliation(s)
- Bruno L R Faillace
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Henrique B Ribeiro
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Adriano A M Truffa
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Fernando L Bernardi
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Marcos D P Oliveira
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - José Mariani
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Julio F Marchini
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Flavio Tarasoutchi
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor) of São Paulo University Medical School (USP), São Paulo, Brazil.
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50
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Abdelghani M, Tateishi H, Miyazaki Y, Cavalcante R, Soliman OII, Tijssen JG, de Winter RJ, Baan J, Onuma Y, Campos CM, Leite RS, Mangione JA, Abizaid A, Lemos PA, de Brito FS, Serruys PW. Angiographic assessment of aortic regurgitation by video-densitometry in the setting of TAVI: Echocardiographic and clinical correlates. Catheter Cardiovasc Interv 2017; 90:650-659. [DOI: 10.1002/ccd.26926] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Mohammad Abdelghani
- Academic Medical Center; Amsterdam The Netherlands
- Cardiology Department; Al-Azhar University; Cairo Egypt
| | - Hiroki Tateishi
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Yosuke Miyazaki
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Osama I. I. Soliman
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management; Rotterdam The Netherlands
| | | | | | - Jan Baan
- Academic Medical Center; Amsterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management; Rotterdam The Netherlands
| | - Carlos M. Campos
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
- Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Rogério S. Leite
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Brazil
| | | | - Alexandre Abizaid
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
| | - Pedro A. Lemos
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
| | | | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London; London United Kingdom
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