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Prado GFA, Garzon S, Mariani J, Caixeta A, O Almeida B, O Ramalho F, C Vieira ML, Fischer CH, Szarf G, Ishikawa W, Lemos PA. Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction. Ren Fail 2023; 45:2224888. [PMID: 37350345 DOI: 10.1080/0886022x.2023.2224888] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. METHODS The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. RESULTS All the patients ultimately underwent TAVI. The intervention was successful in all cases, without ≥ moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 ± 12.55 mL/min; after multi-modality imaging: 26.76 ± 11.51 mL/min; post-TAVI at discharge: 29.84 ± 13.98 mL/min; p = 0.3 all). CONCLUSION The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.
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Affiliation(s)
- Guy F A Prado
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Stefano Garzon
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jose Mariani
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Breno O Almeida
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe O Ramalho
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo L C Vieira
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Claudio H Fischer
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gilberto Szarf
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Walther Ishikawa
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Pedro A Lemos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Jordão CP, Dourado LOC, de Assumpção CRA, Vieira MLC, Montenegro CGDSP, Negrão CE, Gowdak LHW, De Matos LDNJ. Exercise Training on Anginal Threshold Does Not Improve Endothelial Function in Refractory Angina Patients. Am J Cardiol 2023; 204:352-359. [PMID: 37573614 DOI: 10.1016/j.amjcard.2023.07.133] [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: 03/16/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
Refractory angina (RA) is a chronic condition of coronary artery disease (CAD). Endothelial function (EF) measured by flow-mediated dilation (FMD) is an important prognostic marker in CAD. Exercise training is a stimulus that improves EF in CAD. However, exercise training effects on EF in RA are unknown. Therefore, we aimed to verify the effects of exercise training on EF in RA. This was a longitudinal, non-randomized clinical study, involving patients with patients limited by angina, aged 45 to 75 years. Patients were prospectively allocated by convenience to either exercise trained (ET) or control group (C). Laboratory analysis, cardiopulmonary exercise test (CPET), and FMD were implemented at inclusion and after 12 weeks of exercise training or clinical treatment period. Exercise training included 60 minutes per session, 3 times a week, including 40 minutes of aerobic exercise on anginal threshold heart rate obtained on the CPET, 15 minutes of resistance training, and 5 minutes of stretching. A total of 38 patients were included (mean age 60 ± 9 years, 22 men); 21 were allocated to the ET and 17 to the C group. Baseline measures showed no differences between groups. After 12 weeks glycated hemoglobin and systolic blood pressure were lower in ET before than ET after (p = 0.004, and p = 0.05, respectively), and exercise time of the CPET was lower in ET before than ET after (p = 0.002). Exercise training did not change FMD. In conclusion, exercise training performed on anginal threshold increases exercise tolerance but causes no changes in EF in patients with RA.
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Affiliation(s)
- Camila P Jordão
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Centro de Reabilitação, Hospital Israelita Albert Einstein, SP, Brazil
| | - Luciana O C Dourado
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Camila R A de Assumpção
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Marcelo L C Vieira
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Carlos E Negrão
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Departamento de Biodinâmica do Movimento do Corpo Humano, Escola de Educação Física e Esporte, Universidade de São Paulo, SP, Brazil
| | - Luís H W Gowdak
- Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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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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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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Piveta RB, Rodrigues ACT, Vieira MLC, Fischer CH, Afonso TR, Daminello E, Cruz FM, Galvão TFG, Filho EBL, Katz M, Morhy SS. Early Change in Area Strain Detected by 3D Speckle Tracking Is Associated With Subsequent Cardiotoxicity in Patients Treated With Low Doses of Anthracyclines. Front Cardiovasc Med 2022; 9:842532. [PMID: 35387440 PMCID: PMC8979028 DOI: 10.3389/fcvm.2022.842532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the prognostic impact of the parameters of myocardial deformation using three-dimensional speckle tracking echocardiography (3DSTE) in patients with breast cancer who underwent chemotherapy with low doses of anthracyclines. Background Chemotherapy-related cardiotoxicity has an important prognostic impact on cancer survivors. Three-dimensional STE has revealed more consistent data than two-dimensional techniques and may represent a more accurate tool in the evaluation of myocardial function in patients who underwent chemotherapy. Methods We evaluated patients with breast cancer who were treated with anthracyclines (associated or not with trastuzumab) in five stages: baseline, after cumulative doses of 120 and 240 mg/m2 of doxorubicin, and then, after 6 months and at least 1 year after anthracyclines. Ultrasensitive troponin I (US-TnI) and a standard echocardiography study were performed at each stage. We analyzed left ventricular ejection fraction (LVEF) by Simpson's method, two-dimensional speckle tracking (2DSTE) with longitudinal and radial strain values, and 3DSTE with longitudinal, radial, and circumferential strain as well as twist, torsion, rotation, and three-dimensional global area strain (3DGAS). Cardiotoxicity was defined as a decrease in LVEF by more than 10 percentage points to a value lower than 53%. Results We evaluated 51 female patients who were aged 50.6 ± 11 years. After the cumulative dose of 240 mg/m2 of doxorubicin, US-TnI was increased (>34 pg/ml) in 21 patients (45%, p > 0.001), LVEF remained unchanged (p = 0.178), while 2DSTE longitudinal strain was decreased (from −17.8% to −17.1%, p < 0.001) and 3DSTE detected changes in longitudinal, radial, circumferential, and area strain. After a lower cumulative dose of doxorubicin (120 mg/m2), 3DGAS (p < 0.001) was the only parameter that was changed. In the follow-up, 7 (13%) patients presented a decrease in LVEF. Three-dimensional GAS early changed to abnormal values was the only variable associated with a subsequent decrease in LVEF (definitive cardiotoxicity). Conclusion In patients with breast cancer, 3DSTE detected early changes in area strain after very low doses of doxorubicin. The 3DGAS early changed to abnormal values was associated with a subsequent decrease in LVEF, representing a promising technique to predict chemotherapy-induced cardiomyopathy.
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Affiliation(s)
- Rafael B. Piveta
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
- *Correspondence: Rafael B. Piveta
| | | | - Marcelo L. C. Vieira
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Cláudio H. Fischer
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Tania R. Afonso
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Edgar Daminello
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe M. Cruz
- Department of Chemotherapy, Instituto Brasileiro de Controle do Câncer, São Paulo, Brazil
| | - Tatiana F. G. Galvão
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Edgar B. L. Filho
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Katz
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Samira S. Morhy
- Department of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil
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de Assumpção CRA, do Prado DML, Jordão CP, Dourado LOC, Vieira MLC, Montenegro CGDSP, Negrão CE, Gowdak LHW, De Matos LDNJ. Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation. Clinics (Sao Paulo) 2022; 77:100003. [PMID: 35134662 DOI: 10.1016/j.clinsp.2021.100003] [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: 06/04/2021] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). METHODS Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. RESULTS The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). CONCLUSION Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.
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Affiliation(s)
- Camila R A de Assumpção
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Camila P Jordão
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luciana O C Dourado
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo L C Vieira
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Carlos E Negrão
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Escola de Educação Fisica e Esporte, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luís H W Gowdak
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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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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8
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Sawamura K, Afonso TR, Oliveira WAA, Lianza ACL, Tavares GMP, Vieira MLC, Fischer CH, Zacharias RSB, Morhy SS. Can the atrial septal defect size in newborn patient predict spontaneous closure? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.001] [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
Funding Acknowledgements
Type of funding sources: None.
onbehalf
Hospital Albert Eisntein"s pediatric echocardiogram team
Can atrial septal defect size in newborn predict spontaneous closure?
Introduction
Spontaneous closure of atrial septal defect (ASD) has been reported to occur in 33%-75% of patients. Factors that influence spontaneous closure are size of the ASD and age of the patients.
Purpose
We aimed to investigate if the diameter of ASD measured by echocardiogram in the newborn can anticipate clinical outcome and predict spontaneous closure.
Methods
We reviewed 1012 two-dimensional echocardiograms (2DE) performed in the first days of life of newborn at our hospital from January 2015 to December 2019 with ASD or patent foramen ovale (PFO) as initial diagnoses. The exclusion criteria were associated congenital heart disease, except ventricular septal defect and patent ductus arteriosus both without repercussion. 153 newborns with ASD or PFO in the first 2DE were included in this study. The individual data collected were age at the exam, birth weight, gestational age, height by birth, ASD diameter, total diameter of atrial septum and Septum/ASD ratio (Table 1). The results were expressed as mean ± SD, or percentage. Comparisons of continuous variables between groups of patients were performed using the Student T test. Statistical significance was determined by p <0,05. The newborn was grouped according to the observation or not of spontaneous closure.
Results
ASD or PFO was found in 153 newborns. 60 had PFO, spontaneous closure was reported in 38 (63%). 93 had ASD in the first 2DE, spontaneous closure was reported in 41 (44%). The mean age of diagnosis was 3,37 ±4,39 days of life. The diameter of the ASD in the first exam and the septum/ASD ratio were associated with spontaneous closure. There was no association between spontaneous closure of ASD and birth weight or gestational age in this studied group.
Conclusion
The ASD diameter obtained at the first 2DE in the first days of life was associated with spontaneous closure of the defect.
Table 1 Non-closure group (N = 52) Closure group (N= 41) P Age at the exam (days) 3,48 (±4,52) 3,2 (±4,27) 0,78 Birth weight (grams) 2459,85 (±1098,79) 2350,12 (±1247,70) 0,65 Gestational age (weeks) 34,88 (±5,17) 34,54 (±5,10) 0,75 Height by birth (cm) 44,46 (±6,81) 43,67 (±6,77) 0,57 ASD diameter (mm) 3,66 (± 2,66 (±0,57) <0,01 Septum diameter (mm) 18,74 (±3,9) 18,92(±4,51) 0,83 Septum/ ASD ratio 5,74 (±2,38) 7,28 (±1,96) <0,01 cm = centimeter, mm = millimeter, ASD = atrial septal defect. Unit: Mean and standard deviation.
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Affiliation(s)
- K Sawamura
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - TR Afonso
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - WAA Oliveira
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - ACL Lianza
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - GMP Tavares
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - MLC Vieira
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - CH Fischer
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - RSB Zacharias
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - SS Morhy
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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9
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Cruz CBBV, Hajjar LA, Bacal F, Lofrano-Alves MS, Lima MSM, Abduch MC, Vieira MLC, Chiang HP, Salviano JBC, da Silva Costa IBS, Fukushima JT, Sbano JCN, Mathias W, Tsutsui JM. Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation. Cardiovasc Ultrasound 2021; 19:6. [PMID: 33422079 PMCID: PMC7797113 DOI: 10.1186/s12947-020-00235-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. METHODS We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. RESULTS Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 - 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09-1.31) vs 0.05 ng/mL (0.01-0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68-0.92), 0.89 (0.81-0.93) and 0.79 (0.66-0.92), respectively. CONCLUSION Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.
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Affiliation(s)
- Cecilia Beatriz Bittencourt Viana Cruz
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil. .,Fleury Medicine & Health, São Paulo, Brazil.
| | - Ludhmila A Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Fernando Bacal
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Marco S Lofrano-Alves
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Márcio S M Lima
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Maria C Abduch
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Marcelo L C Vieira
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Hsu P Chiang
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Juliana B C Salviano
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | | | - Julia Tizue Fukushima
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil
| | - Joao C N Sbano
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.,Fleury Medicine & Health, São Paulo, Brazil
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10
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Sader MA, Dias Y, Costa ZP, Munhoz C, Penha H, Bergès H, Vieira MLC, Pedrosa-Harand A. Correction to: Identification of passion fruit (Passiflora edulis) chromosomes using BAC-FISH. Chromosome Res 2020; 29:237-238. [PMID: 32430859 DOI: 10.1007/s10577-020-09633-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M A Sader
- Departamento de Botânica, Laboratório de Citogenética e Evolução Vegetal, Centro de Biociências, Universidade Federal de Pernambuco, R. Prof. Moraes Rego, s/n, CDU, Recife, PE, 50670-901, Brazil
| | - Y Dias
- Departamento de Botânica, Laboratório de Citogenética e Evolução Vegetal, Centro de Biociências, Universidade Federal de Pernambuco, R. Prof. Moraes Rego, s/n, CDU, Recife, PE, 50670-901, Brazil
| | - Z P Costa
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - C Munhoz
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - H Penha
- Department of Technology, Faculty of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - H Bergès
- French Plant Genomic Resources Center (CNRGV)/INRA, Toulouse, France
| | - M L C Vieira
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - A Pedrosa-Harand
- Departamento de Botânica, Laboratório de Citogenética e Evolução Vegetal, Centro de Biociências, Universidade Federal de Pernambuco, R. Prof. Moraes Rego, s/n, CDU, Recife, PE, 50670-901, Brazil.
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11
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Hotta VT, Martinelli LMB, Fernandes F, Moises VA, Vieira MLC, Mady C. P697 Left ventricular non compaction highlighted by three-dimensional and speckle tracking echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.371] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left ventricular non-compaction (LVNC) is a relatively new cardiomyopathy, first reported by Chin et al. in 1990. Since then, much has been learned about this entity, but until now, there are some limitations for the diagnosis of this disease. Cardiac Magnetic Resonance Imaging is considered the gold standard for the diagnosis of LVNC, but echocardiography remains the first line imaging modality due to its availability and cost efficacy.
Case report
In this case, we report a case of an asymptomatic 21 years old young male with no personal or familiar history of cardiomyopathies. Two dimensional echocardiography (2D Echo) evidenced increased left ventricular trabeculation in the apical segments of lateral and anterior walls and a non compacted myocardium/ (compacted + non compacted myocardium) ratio of 0,33, compatible with LVNC according to Chin´s criteria. 3D Echo provided more detailed LV morphology analysis and 3D Echo Color Doppler evidenced ventricular flow within the intraventricular recesses. Strain analysis by speckle tracking (STE) evidenced global longitudinal strain = - 17% (Normal values < -18%), probably related to an incipient systolic dysfunction not evidenced by the evaluation of left ventricular ejection fraction by 2D Echo.
Conclusions
This case illustrates new echocardiographic modalities for LVNC diagnosis. 3D Echo and STE are new technologies that may play an incremental role in the evaluation of LVNC but need further investigation and validation.
Abstract P697 Figure.
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | - F Fernandes
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - V A Moises
- Fleury Medicina e Saúde, Sao Paulo, Brazil
| | | | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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12
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Hotta VT, Monge NMS, Vieira MLC, Fernandes F, Mady C. 1102 Rare association of left ventricular non-compaction and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.651] [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
LVNC and HCM are cardiomyopathies with distinct clinical presentation that may present common genetic mutations. Some studies suggest a common genetic basis between HCM and LVNC and the possibility of a phenotypic association of these two cardiomyopathies in the same patient.
Case report
A 39 year old man was referred to our hospital with syncope. His past medical history was unremarkable. His father died of sudden death, at age 49, without investigation of Left ventricular non compaction (LVNC) or Hypertrophic cardiomyopathy (HCM). Physical examination was unremarkable. Electrocardiogram showed sinus rhythm with left chambers overload and isolated ventricular extrasystoles. Transthoracic Echocardiogram (TTE) evidenced significant left ventricular (LV) hypertrophy predominantly in the apical region and inferolateral wall, in the absence of a significant intraventricular gradient at rest and after provocative maneuvers, with preserved LV function, suggesting non-obstructive HCM. Cardiac magnetic resonance imaging (CMRI) showed LV hypertrophy predominantly in the lateral wall, with a maximum thickness of 35 mm, no signs of left ventricular outflow tract (LVOT) obstruction and prominent apical trabeculation, compatible with the association of LVNC and HCM. A genetic test was performed on this patient with inconclusive results.
Conclusions
The association of diagnostic criteria in cardiac imaging tests (TTE and CMRI) compatible with LVNC and HCM in the same patient is uncommon. This patient shows an infrequent location of the most prominent hypertrophy in the inferolateral wall.This case highlights the importance of integrating cardiac imaging methods in the diagnosis of these two disctinct and rare cardiomyopathies.
Legend Figure 1: 2D TTE evidencing prominent hypertropfhy and intraventricular recesses at apical region and inferolateral wall (red arrows), abnormalities suggesting HCM and LVNC at LV apex (blue arrows) in Paraesternal Long Axis (A and B), Short Axis View (C to F), Apical 4 Chambers (G and H) and Apical 2 Chambers View (I and H). Speckle tracking analysis evidencing incipient LV systolic dysfunction by reduced global longitudinal strain (GLS:-8,9%) despite the preserved LVEF (K to N). CMR evidencing findings compatible with the association of LVNC (blue arrows) and HCM (red arrow) in 4 Chambers (O and P), 2 Chambers (Q and R) and Short Axis Views (S to V).
Abstract 1102 Figure 1
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - N M S Monge
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | - F Fernandes
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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13
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Costa RCPLD, Rodrigues ACT, Fischer CH, Lira-Filho EB, Monaco CG, Afonso TR, Vieira MLC, Caixeta AM, Morhy SS. 1186 Three-dimensional analysis of right ventricle strain in transplanted hearts and rejection: an ongoing prospective study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.685] [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
The main obstacle for success after heart transplantation is graft rejection, since is mainly asymptomatic and diagnosed by endomyocardial biopsy (EMB). New echocardiographic technologies could bring benefits to that population if subtle changes in heart mechanics were related to an incipient state of rejection.
Purpose
To quantify echocardiographic parameters of right ventricle strain and volumes by a semi-automated offline software and to identify the presence of any relation between those findings and the histopathologic diagnose of rejection.
Methods
a prospective cohort of 35 postoperative heart transplant patients who were submitted to echocardiographic evaluation up to six hours after EMB, including two-dimensional chamber quantification of left ventricular (LV) volumes and ejection fraction; conventional and tissue Doppler measurements were used for flow and functional analysis. Offline assessment of the right ventricle (RV) was made by TOMTEC software, with the acquisition of RV volumes (EDV, ESV, SV) and ejection fraction, TAPSE, FAC and three-dimensional(3D) RV free wall and septal strain using speckle tracking. EMB results were classified as positive for cellular rejection if graded as 2R (two or more interstitial infiltrate spots and myocyte damage) and positive for humoral rejection if they show any response by immunofluorescence assay.
Results
We studied 35 patients, aged 50 ±11, 21 male (67%), totaling 58 examinations, and then we made two analysis of EMB: one in two groups regarding cellular rejection (53 negative and 5 positive) and other regarding humoral rejection (50 negative and 8 positive). RVEDV was higher in the cellular rejection group (112,5 ± 29,6 ml) compared to those with negative biopsy (86,8 ± 24,7 mL; p = 0,01). RV stroke volume showed a similar behavior (53,5 ± 22,3 mL vs. 34,5 ± 11,3 mL; p < 0,01). Regarding humoral rejection by immunofluorescence, patients who tested positive showed lower RVEDV (79,5 ± 10,5 mL vs. 90,57 ± 27,31 mL; p = 0,02) and RVESV (45,53 ± 6,33 mL vs. 53,87 ± 19,87 mL; p = 0,01). RV free wall strain was lower in the group with positive immunofluorescence (-18,35 ± 2,79% vs. -15,34 ± 5,35%; p = 0,01). Regarding 2D measurements , interventricular septal (11,5 ± 1,06 mm vs. 10,56 ± 1,38 mm; p = 0,02) and left ventricular posterior wall (10,75 ± 1,03 mm vs. 10,04 ± 1,1 mm; p = 0,05) were also thicker in the group with positive immunofluorescence for rejection.
Conclusion
Both cellular and humoral rejection after heart transplantation are associated to increased 3D RV volumes whereas a decrease in RV free wall strain is only observed in humoral rejection; in patients with positive immunofluorescence results a significant increase is seen for septal and posterior wall thickness.
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Affiliation(s)
- RCPLD Costa
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - C H Fischer
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - C G Monaco
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - T R Afonso
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M L C Vieira
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - A M Caixeta
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - S S Morhy
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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14
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Hotta VT, Abduch MCD, Vieira MLC, Ianni BM, Mady C, Bocchi EA. P1396 Three-dimensional cardiac mechanics for prediction of events in Chagas disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.829] [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
Introduction
Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.
Methods
This was a convenience sample. Patients with any systemic disease were excluded. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.
Results
Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) < 0.35 (N = 22); Group 2 (G2), LVEF between 0.35 and 0.55 (N = 22); Group 3 (G3), normal LVEF (N = 28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1.
Hospitalization was related do indexed left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS values (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.
Conclusions
In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.
Table 1 INTEROBSERVER INTRAOBSERVER 2D GLS 0.96 ± 0.04 0.90 ± 0.08 3D GLS 0.92 ± 0.07 0.93 ± 0.10 3D GCS 0.88 ± 0.07 0.82 ± 0.15 3D AS 0.93 ± 0.05 0.90 ± 0.05 3D RS 0.85 ± 0.05 0.84 ± 0.11 Table 1. Interobserver and intraobserver variabilities for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS).
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Affiliation(s)
- V T Hotta
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | | | | | - B M Ianni
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - C Mady
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - E A Bocchi
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
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15
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Emer Egypto Rosa V, Ribeiro HB, Samapio RO, Morais TC, Rosa MEE, De Santis ASAL, Fernandes JRC, Spina GS, Vieira MLC, Pomerantzeff PMA, Rochitte CE, Mathias Jr W, Tarasoutchi F. P6483Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1073] [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
There is a lack of information on factors that influence contractile reserve (CR) on dobutamine stress echocardiography (DSE) in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS).
Purpose
This study sought to evaluate the predictors of CR in patients with LFLG-AS.
Methods
Prospective study including 43 consecutive LFLG-AS patients (aortic valve area [AVA] ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction [LVEF] <50%) with true severe aortic stenosis. All patients underwent dobutamine stress echocardiography and T1-mapping cardiac magnetic resonance (CMR). CR was defined as an increase ≥20% in the left ventricular stroke volume at peak stress. Patients with pseudo-severe aortic stenosis were excluded.
Results
All of the patients in the study had degenerative aortic stenosis, with a median age of 67 [60–74] years, most of them being male (83.7%). A high prevalence of comorbidities was found, highlighted by diabetes (42%), hypertension (70%), atrial fibrillation (25%) and coronary artery disease (38%). Mean transaortic gradient was 25 [20–33] mmHg, AVA was 0.88 [0.68–0.95] cm2, LVEF was 35 [28–43]% and 32.6% had moderate/severe functional mitral regurgitation. CMR myocardium extracellular volume fraction (ECV) was 28.8 [26.3–33.0] %, indexed ECV was 35.4 [25.0–41.2] ml/m2, 32.6% had positive transmural delayed-enhancement images and 25.6% had positive mesocardial delayed-enhancement images. On DSE, 30 patients (69.7%) had CR and 13 patients (30.3%) had no CR. Global longitudinal strain was 10 [7–12] %, Δ indexed flow rate was 25 [3–38] ml/m2.seg and Δ mean gradient was 10 [3–16] mmHg. By multivariate analysis, moderate/severe functional mitral regurgitation (HR 0.122, 95% CI 0.020–0.759, p=0.024) and AVA (HR 0.606, 95% CI 0.396–0.925, p=0.020 [for each increase of 0.05 cm2]) were the only factors associated with CR. ECV, indexed ECV and positive transmural or mesocardial delayed-enhancement images were not associated with CR in the univariate analysis.
Conclusions
In our study, the absence of moderate/severe functional mitral regurgitation and AVA were predictors of CR on DSE in patients with LFLG-AS. As AVA was smaller in patients with CR, our finding contradicts the hypothesis that more severe aortic stenosis could also contribute to the lack of CR. Other possible factors that are surrogate of myocardium fibrosis, as ECV, indexed ECV and positive delayed-enhancement images, were not associated with the absence of CR.
Acknowledgement/Funding
FAPESP
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - R O Samapio
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
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Dourado L, Assumpcao CRAA, Jordao CP, Vieira MLC, Gowdak LHW, Cesar LAM, Matos LDNJ. P2515Cardiac rehabilitation in patients with refractory angina: preliminary results. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0844] [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
Introduction
Refractory angina (RA) implies important impairment of quality of life. Cardiac rehabilitation (CR) is still not recommended by guidelines due to few evidence regarding its effects in this population. This study evaluated the impact of CR on physical performance and on angina/ischemia threshold.
Methods
36 RA patients undergoing optimal medical therapy were randomly assigned to a 12-week exercise based CR program or stablished clinical follow-up (CF). Clinical evaluation, exercise bicycle stress echocardiography (SE) and cardiopulmonary exercise testing (CP) were performed before and after the protocol. CR group performed in-hospital exercise sessions, and the aerobic training prescription was based on CP parameters or ischemia/ angina threshold. Each CR class was 60 min in duration (5min warm-up, 30min aerobic and 5min cooldown, 15min low load resistance training and 5min stretching). Bonferroni multiple comparison and t test were used in statistical analysis.
Results
Baseline characteristics didn't differ between groups. In RC group, 40% presented CCS 2, 25% CCS 3 and 35% CCS 4, while in CF group, 41%, 23.5% and 35.5%, respectively (p=0.5). There was no change in CCS between groups after intervention. CR group presented an increase in ischemic threshold in SE when compared to CF group (234.6±87.9s to 293.8±130.9 s vs. 200.9±78.6s to 203.7±93.7s, p=0.044), increase in angina threshold in SE (156.00±62.2s to 260.1±152.8s vs. 190.6±96.6s to 152.9±76, 7s, p=0.041) and increase in CP total duration (347.9±143.2s to 489.8±170.2s vs. 331.7±128.5s to 323.5±101.0s, p=0,016).
Baseline characteristics in both groups Variables CR group (n=19) CF group (n=17) p Male sex (%) 63.2 58.8 0.8 Age, years (mean ± SD) 61.2±8.7 62.9±8.8 0.6 LVEF, % (mean ± SD) 55.7±7.3 50.0±10.4 0.08 SBP, mmHg (mean ± SD) 125.6±18.0 122.6±14.5 0.6 DBP, mmHg (mean ± SD) 77.5±9.6 76.2±13,1 0.7 HR, bpm (mean ± SD) 60.5±6.2 60.6±7.1 0.9 BMI, kg/m2 (mean ± SD) 28.8±4.1 26.1±10.9 0.4 Fasting glucose, mg/dl (mean ± SD) 136.4±33.6 153.6±64.7 0.3 HBA1C, % (mean ± SD) 6.8±1.2 7.2±1.6 0.4 LDL-c, mg/dl (mean ± SD) 77.8±29.0 84.7±28.6 0.5
Results
CR seems to be an effective adjuvant treatment in RA, increasing ischemia and angina threshold, improving physical performance.
Acknowledgement/Funding
FAPESP
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Affiliation(s)
- L Dourado
- University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - C P Jordao
- University of Sao Paulo (USP), Sao Paulo, Brazil
| | - M L C Vieira
- University of Sao Paulo (USP), Sao Paulo, Brazil
| | - L H W Gowdak
- University of Sao Paulo (USP), Sao Paulo, Brazil
| | - L A M Cesar
- University of Sao Paulo (USP), Sao Paulo, Brazil
| | - L D N J Matos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Sader MA, Dias Y, Costa ZP, Munhoz C, Penha H, Bergès H, Vieira MLC, Pedrosa-Harand A. Identification of passion fruit (Passiflora edulis) chromosomes using BAC-FISH. Chromosome Res 2019; 27:299-311. [PMID: 31321607 DOI: 10.1007/s10577-019-09614-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/12/2019] [Revised: 06/13/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
Passiflora edulis, the yellow passion fruit, is the main crop from the Passiflora genus, which comprises 525 species with its diversity center in South America. Genetic maps and a BAC (bacterial artificial chromosome) genomic library are available, but the nine chromosome pairs of similar size and morphology (2n = 18) hamper chromosome identification, leading to different proposed karyotypes. Thus, the aim of this study was to establish chromosome-specific markers for the yellow passion fruit using single-copy and repetitive sequences as probes in fluorescent in situ hybridizations (FISH) to allow chromosome identification and future integration with whole genome data. Thirty-six BAC clones harboring genes and three retrotransposons (Ty1-copy, Ty3-gypsy, and LINE) were selected. Twelve BACs exhibited a dispersed pattern similar to that revealed by retroelements, and one exhibited subtelomeric distribution. Twelve clones showed unique signals in terminal or subterminal regions of the chromosomes, allowing their genes to be anchored to six chromosome pairs that can be identified with single-copy markers. The markers developed herein will provide an important tool for genomic and evolutionary studies in the Passiflora genus.
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Affiliation(s)
- M A Sader
- Department of Botany, Federal University of Pernambuco, Recife, Brazil
| | - Y Dias
- Department of Botany, Federal University of Pernambuco, Recife, Brazil
| | - Z P Costa
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - C Munhoz
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - H Penha
- Department of Technology, Faculty of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - H Bergès
- French Plant Genomic Resources Center (CNRGV)/ INRA, Toulouse, France
| | - M L C Vieira
- Department of Genetics, "Luiz de Queiroz" College of Agriculture, University of São Paulo, Piracicaba, Brazil
| | - Andrea Pedrosa-Harand
- Department of Botany, Federal University of Pernambuco, Recife, Brazil.
- Laboratório de Citogenética e Evolução Vegetal, Departamento de Botânica, Centro de Biociências, Universidade Federal de Pernambuco, R. Prof. Moraes Rego, s/n, CDU, Recife, PE, 50670-901, Brazil.
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Emer Egypto Rosa V, Ribeiro HB, Sampaio RO, Morais TC, Rosa MEE, De Santis ASAL, Fernandes JRC, Vieira MLC, Pomerantzeff PMA, Rochitte CE, Mathias Jr W, Tarasoutchi F. P5455Impact of interstitial myocardial fibrosis measured by T1-mapping cardiac magnetic resonance on post-operative cardiac remodeling in patients with classical low-flow, low-gradient aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5455] [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), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
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Pardi MM, Pomerantzeff PMA, Sampaio RO, Abduch MC, Brandão CMA, Mathias W, Grinberg M, Tarasoutchi F, Vieira MLC. Relation of mitral valve morphology to surgical repair results in patients with mitral valve prolapse: A three-dimensional transesophageal echocardiography study. Echocardiography 2018; 35:1342-1350. [PMID: 29920772 DOI: 10.1111/echo.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The identification of predictors of mitral valve (MV) repair results is important for quality improvement in cardiac surgery. The aim of this study was to evaluate the relationship between MV morphological quantification by three-dimensional (3D) transesophageal echocardiography and mitral repair results. METHODS Fifty-four patients with MV prolapse who were submitted to surgical repair were divided into 2 groups according to their postoperative mitral regurgitation (MR) degree (group 1, grade 0-I MR; group 2, ≥grade II MR). Morphological parameters related to the mitral ring, dimension of leaflets and prolapse, coaptation line, distance from papillary muscles to the leaflet border and valve angles were analyzed by 3D MV quantification. Cardiac remodeling and MR quantitative parameters were also evaluated. RESULTS There was no correlation between 3D MV quantification and surgical results; a multivariate analysis did not show an association between morphological parameters and surgical outcome. The distance from the posteromedial papillary muscle to the leaflet border was higher (P = .038) in patients with ≥grade II postoperative MR. The left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic and end-systolic volumes were larger in patients with a significant residual MR (P < .05). CONCLUSION Three-dimensional MV quantification did not predict the postoperative MR grade; however, the distance from the posteromedial papillary muscles to the leaflet border may be related to suboptimal repair results. Furthermore, excessive cardiac remodeling was related to postoperative MR ≥ grade II, what could suggest a potential benefit of early surgical treatment.
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Affiliation(s)
- Mirian M Pardi
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Maria C Abduch
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos M A Brandão
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Mathias
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Max Grinberg
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Flavio Tarasoutchi
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcelo L C Vieira
- Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Purić J, Vieira G, Cavalca LB, Sette LD, Ferreira H, Vieira MLC, Sass DC. Activity of Antarctic fungi extracts against phytopathogenic bacteria. Lett Appl Microbiol 2018. [PMID: 29527704 DOI: 10.1111/lam.12875] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study aims to obtain secondary metabolites extracts from filamentous fungi isolated from soil and marine sediments from Antarctic ecosystems and to assess its potential antibacterial activity on Xanthomonas euvesicatoria and Xanthomonas axonopodis pv. passiflorae (phytopathogenic bacteria causing diseases in pepper and tomato and passionfruit, respectively). Among the 66 crude intracellular and extracellular extracts obtained from fungi recovered from soil and 79 obtained from marine sediment samples, 25 showed the ability to prevent the growth of X. euvesicatoria in vitro and 28 showed the ability to prevent the growth of X. axonopodis pv. passiflorae in vitro. Intracellular and extracellular extracts from soil fungi inhibited around 97% of X. euvesicatoria and 98% of X. axonopodis pv. passiflorae at 2·1 mg ml-1 . The average inhibition rates against X. euvesicatoria and X. axonopodis pv. passiflorae for intracellular and extracellular extracts from marine sediments fungi were around 96 and 97%, respectively, at 3·0 mg ml-1 . Extracts containing secondary metabolites with antimicrobial activity against X. euvesicatoria and X. axonopodis pv. passiflorae were obtained, containing possible substitutes for the products currently used to control these phytopathogens. SIGNIFICANCE AND IMPACT OF THE STUDY Micro-organisms from extreme ecosystems, such as the Antarctic ecosystem, need to survive in harsh conditions with low temperatures, low nutrients and high UV radiation. Micro-organisms adapt to these conditions evolving diverse biochemical and physiological adaptations essential for survival. All this makes these micro-organisms a rich source of novel natural products based on unique chemical scaffolds. Discovering novel bioactive compounds is essential because of the rise in antibiotic-resistant micro-organisms and the emergence of new infections. Fungi from Antarctic environments have been proven to produce bioactive secondary metabolites against various micro-organisms, but few studies have shown activity against Xanthomonas phytopathogens.
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Affiliation(s)
- J Purić
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
| | - G Vieira
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
| | - L B Cavalca
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
| | - L D Sette
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
| | - H Ferreira
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
| | - M L C Vieira
- Escola Superior de Agricultura 'Luiz de Queiroz', Departamento de Genética, Piracicaba, Brazil
| | - D C Sass
- Department of Biochemistry and Microbiology, Institute of Biosciences, São Paulo State University (UNESP) 'Júlio de Mesquita Filho', Rio Claro, São Paulo, Brazil
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Tarasoutchi F, Montera MW, Ramos AIO, Sampaio RO, Rosa VEE, Accorsi TAD, Lopes ASSA, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PL, Bignoto TC, Togna DJD, Mesquita ET, Esteves WAM, Atik FA, Colafranceschi AS, Moisés VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Jr. FS, Clara W, Brandão CMA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MM, Souza Neto JD, Saraiva JFK. ATUALIZAÇÃO DAS DIRETRIZES BRASILEIRAS DE VALVOPATIAS: ABORDAGEM DAS LESÕES ANATOMICAMENTE IMPORTANTES. Arq Bras Cardiol 2017. [DOI: 10.5935/abc.20180007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Marques AC, Bellen BV, Caramelli B, Presti C, Pinho C, Calderaro D, Gualandro DM, Carvalho FC, Carmo GAL, Correa Filho H, Casella IB, Fornari LS, Vacanti LJ, Vieira MLC, Monachini MC, Luccia N, Yu PC, Farsky OS, Heinisch RH, Gualandro SFM, Mathias Junior W. Atualização e Enfoque em Operações Vasculares Arteriais da II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2013; 101:2-32. [DOI: 10.5935/abc.2013s011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hotta VT, Martinelli Filho M, Mathias W, Vieira MLC. New equation for prediction of reverse remodeling after cardiac resynchronization therapy. Echocardiography 2012; 29:678-87. [PMID: 22348339 DOI: 10.1111/j.1540-8175.2011.01658.x] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To integrate data from two-dimensional echocardiography (2D ECHO), three-dimensional echocardiography (3D ECHO), and tissue Doppler imaging (TDI) for prediction of left ventricular (LV) reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). It was also compared the evaluation of cardiac dyssynchrony by TDI and 3D ECHO. METHODS Twenty-four consecutive patients with heart failure, sinus rhythm, QRS ≥ 120 msec, functional class III or IV and LV ejection fraction (LVEF) ≤ 0.35 underwent CRT. 2D ECHO, 3D ECHO with systolic dyssynchrony index (SDI) analysis, and TDI were performed before, 3 and 6 months after CRT. Cardiac dyssynchrony analyses by TDI and SDI were compared with the Pearson's correlation test. Before CRT, a univariate analysis of baseline characteristics was performed for the construction of a logistic regression model to identify the best predictors of LVRR. RESULTS After 3 months of CRT, there was a moderate correlation between TDI and SDI (r = 0.52). At other time points, there was no strong correlation. Nine of twenty-four (38%) patients presented with LVRR 6 months after CRT. After logistic regression analysis, SDI (SDI > 11%) was the only independent factor in the prediction of LVRR 6 months of CRT (sensitivity = 0.89 and specificity = 0.73). After construction of receiver operator characteristic (ROC) curves, an equation was established to predict LVRR: LVRR =-0.4LVDD (mm) + 0.5LVEF (%) + 1.1SDI (%), with responders presenting values >0 (sensitivity = 0.67 and specificity = 0.87). CONCLUSIONS In this study, there was no strong correlation between TDI and SDI. An equation is proposed for the prediction of LVRR after CRT. Although larger trials are needed to validate these findings, this equation may be useful to candidates for CRT.
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Quaio CRDC, Grinberg H, Vieira MLC, Paula AC, Leal GN, Gomy I, Leistner-Segal S, Giugliani R, Bertola DR, Kim CA. Report of a Large Brazilian Family With a Very Attenuated Form of Hunter Syndrome (MPS II). JIMD Rep 2011; 4:125-8. [PMID: 23430907 DOI: 10.1007/8904_2011_90] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 07/25/2011] [Revised: 08/25/2011] [Accepted: 09/05/2011] [Indexed: 12/12/2022] Open
Abstract
Hunter syndrome, or Mucopolysaccharidosis type II (MPS II), is a rare X-linked recessive disorder caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase (IDS). The phenotypic spectrum varies from severe to attenuated clinical forms. We report a large Brazilian family with 16 affected individuals exhibiting a very attenuated form of MPS II. Fourteen female carriers were also identified. Twelve affected male patients, whose ages ranged from 1 to 35 years, were examined. Molecular analysis showed a novel missense mutation (p.A77D) in the IDS gene, confirming the diagnosis. Nine of the family members presented some degree of heart damage, though only the proband became symptomatic and required heart transplantation. One 19-year-old adult and 1-year-old twin boys each had a normal echocardiogram. Short stature was found in two adults while macrocephaly was found in one; the remaining adults had anthropometric measures within normal range. All affected adults had normal cognitive development and were able to perform normal daily activities, except one who had mild learning disability. Two patients died due to natural causes beyond 70 years of age. The female carriers did not present any signs of disease. In this large family with a mild form of MPS II and variable degree of clinical manifestations, it is noteworthy that several affected individuals have remained asymptomatic even at advanced age and even without enzyme replacement therapy.
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Affiliation(s)
- C R D C Quaio
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo - SP, Brazil
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Munhoz CF, Weiss B, Hanai LR, Zucchi MI, Fungaro MHP, Oliveira ALM, Monteiro-Vitorello CB, Vieira MLC. Genetic diversity and a PCR-based method for Xanthomonas axonopodis detection in passion fruit. Phytopathology 2011; 101:416-424. [PMID: 21077774 DOI: 10.1094/phyto-06-10-0169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Xanthomonas axonopodis pv. passiflorae causes bacterial spot in passion fruit. It attacks the purple and yellow passion fruit as well as the sweet passion fruit. The diversity of 87 isolates of pv. passiflorae collected from across 22 fruit orchards in Brazil was evaluated using molecular profiles and statistical procedures, including an unweighted pair-group method with arithmetical averages-based dendrogram, analysis of molecular variance (AMOVA), and an assigning test that provides information on genetic structure at the population level. Isolates from another eight pathovars were included in the molecular analyses and all were shown to have a distinct repetitive sequence-based polymerase chain reaction profile. Amplified fragment length polymorphism technique revealed considerable diversity among isolates of pv. passiflorae, and AMOVA showed that most of the variance (49.4%) was due to differences between localities. Cluster analysis revealed that most genotypic clusters were homogeneous and that variance was associated primarily with geographic origin. The disease adversely affects fruit production and may kill infected plants. A method for rapid diagnosis of the pathogen, even before the disease symptoms become evident, has value for producers. Here, a set of primers (Xapas) was designed by exploiting a single-nucleotide polymorphism between the sequences of the intergenic 16S-23S rRNA spacer region of the pathovars. Xapas was shown to effectively detect all pv. passiflorae isolates and is recommended for disease diagnosis in passion fruit orchards.
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Affiliation(s)
- C F Munhoz
- Universidade de São Paulo, Escola Superior de Agricultura Luiz de Queiroz, Departamento de Genética, P.O. Box 83, 13400-970 Piracicaba, Brazil
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Vieira MLC, Oliveira WA, Cury AF, Cordovil A, Rodrigues ACT, Naccarato G, Mônaco CG, Costa LPRV, Romano RB, Calatróia JR, Afonso TR, Azevedo REU, Tavares GMP, Guimarães L, Lira Filho EB, Perin MA, Fischer CH, Morhy SS. Three-dimensional and two-dimensional echocardiography and biochemical analysis in patients with ST-segment elevation myocardial infarction percutaneously treated: relationship between LV function, remodeling and serum cardiac markers. Crit Care 2011. [PMCID: PMC3124175 DOI: 10.1186/cc10173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Restrepo G, Gutiérrez Fajardo P, Lowenstein J, Paz-Ardaya A, Vieira MLC, Spina S, Córdova-Alvéstegui S, Beltrán A, Pizzano N, Revilla-Alcocer H. [Guidelines for the accreditation in adult echocardiography and of the echocardiography laboratory from the Echocardiography Association of the Inter-American Society of Cardiology (ECHOIASC)]. Arch Cardiol Mex 2011; 81:53-65. [PMID: 21592892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Gustavo Restrepo
- Director de la Unidad Cardiovascular. Fundación Clínica Valle del Lili, Cali, Colombia. Presidente Electo ECOSIAC.
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Hotta VT, Cruz CBBV, Rassi DDC, Vieira MLC, Mathias W, de Avila LFR, Pommerantzeff PMA. Subvalvular mitral pseudoaneurysm evaluated by three-dimensional echo. Echocardiography 2010; 27:473-5. [PMID: 20529111 DOI: 10.1111/j.1540-8175.2009.01130.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Viviane T Hotta
- Heart Institute, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, numero 44, Cerqueira Cesar ZIP CODE: 05403-000. São Paulo, SP - Brasil.
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Angelo LC, Vieira MLC, Rodrigues SL, Morelato R, Pereira AC, Mill JG, Krieger JE. Reference Values of Tissue Doppler Imaging and Pulsed Doppler Echocardiography for Analysis of Left Ventricular Diastolic Function in Healthy Adults. Echocardiography 2010; 27:777-82. [DOI: 10.1111/j.1540-8175.2009.01146.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Vieira MLC, Nomura CH, Tranchesi B, de Oliveira WA, Naccarato G, Serpa BS, Passos RBD, Funari MBG, Fischer CH, Morhy SS. Real-time three-dimensional echocardiographic left ventricular systolic assessment: side-by-side comparison with 64-slice multi-detector cardiac computed tomography. Eur J Echocardiogr 2009; 11:257-63. [PMID: 19969534 DOI: 10.1093/ejechocard/jep199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS To investigate by real-time 3D echocardiography (RT3DE) and cardiac computed tomography (CCT) the analysis of left ventricle ejection fraction (LVEF) and volumes. METHODS AND RESULTS A total of 67 patients (37 males, 55 +/- 11 years) were studied prospectively by RT3DE and by 64-slice CCT. RT3DE data: LVEF ranged from 30 to 78.6% (63.1 +/- 7.33); left ventricular end-diastolic volume (LVEDV) from 44.1 to 210 (104.9 +/- 29.7) mL; left ventricular end-systolic volume (LVESV) from 11.4 to 149 ( 38.9 +/- 19.3) mL. CCT data: LVEF ranged from 28 to 86% (66 +/- 8.4); LVEDV from 51 to 212 (110.3 +/- 31.2) mL; LVESV from 7 to 152 (38.2 +/- 19.2) mL. Correlations relative to RT3DE and CCT were: LVEF (r: 0.79, P < 0.0001); LVEDV (r: 0.82, P < 0.0001); and LVESV (r: 0.91, P < 0.0001). CONCLUSION It was observed adequate correlation between RT3DE and CCT ventricular systolic function and geometry assessment.
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Affiliation(s)
- Marcelo L C Vieira
- Echocardiography Sector, Hospital Israelita Albert Einstein, R. Cardoso de melo, 463, apt 21, Vila Olímpia, São Paulo 04548-002, Brazil.
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Giannini G, Grativvol PS, Vieira MLC, Oliveira MD, Lisboa LA, Oliveira SAD. Intraoperative transesophageal echocardiography in septal hypertrophic cardiomyopathy. Arq Bras Cardiol 2009; 93:e8-e10. [PMID: 19838461 DOI: 10.1590/s0066-782x2009000700015] [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] [Received: 09/16/2008] [Accepted: 10/28/2008] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient with septal hypertrophic cardiomyopathy undergoing surgical correction in which the use of intraoperative transesophageal echocardiography permitted the planning of the surgical approach and an immediate knowledge of the surgical outcome.
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Oliveira W, Campos O, Cintra F, Matos L, Vieira MLC, Rollim B, Fujita L, Tufik S, Poyares D. Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography. Heart 2009; 95:1872-8. [PMID: 19643769 PMCID: PMC2764351 DOI: 10.1136/hrt.2009.173625] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Obstructive sleep apnoea (OSA) has been reported as a predictor of left ventricle (LV) diastolic dysfunction and left atrium (LA) remodelling. The aim of this study is to evaluate the impact of OSA treatment with a continuous positive airway pressure device (CPAP) on the LA volume and function, as well as on the LV diastolic function. Methods: In total, 56 OSA patients were studied. All patients underwent real-time three-dimensional (RT3DE) and two-dimensional echocardiogram with tissue Doppler evaluation in order to estimate LA volumes, function and LV diastolic performance. A total of 30 patients with an apnoea-hypopnoea index greater than 20 were randomly selected to receive sham CPAP (n = 15) or effective CPAP (n = 15) for 24 weeks. They underwent echo examination on three different occasions: at baseline, after 12 weeks and 24 weeks of CPAP or sham CPAP. Results: In the effective CPAP group we observed the following changes from the baseline to the 24-week echo evaluation: (a) a reduction in the E/E′ ratio (10.3 (1.9) to 7.9 (1.3), p = 0.03); (b) an increase in the LA passive emptying fraction (28.8% (11.9%) to 46.8% (9.3%), p = 0.01); and (c) a reduction in the LA active emptying fraction (42.7% (11.5%) to 25.7 (15.7), p<0.01). In the sham group, there were no changes from the baseline to the 24-week echo. We found a positive correlation between 24 week/baseline LA active emptying volume and 24 week/baseline E/E′ ratios (r = 0.40, p<0.05) and a negative correlation between 24 week/baseline LA passive emptying volume and 24 week/baseline E/E′ ratios (r = −0.53, p<0.05). No significant changes were found on LA total emptying fraction. Conclusion: CPAP improved LV diastolic function and LA passive emptying, but not LA structural variables in OSA patients. Trial registration number: NCT00768807.
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Affiliation(s)
- W Oliveira
- Discipline of Sleep Biology and Medicine, Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Vieira MLC, Nomura C, Tranchesi B, Serpa B, Naccarato G, Oliveira W, Funari M, Filho EBL, Rodrigues ACT, Cordovil A, Monaco C, Passos R, Cury A, Fischer CH, Morhy SS. Real-time three-dimensional echocardiographic left ventricular systolic assessment: head-to-head comparison with cardiac computed tomography. Crit Care 2009. [PMCID: PMC4085429 DOI: 10.1186/cc7831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Vieira MLC, Cury AF, Naccarato G, Oliveira WA, Mônaco CG, Rodrigues ACT, Cordovil A, Tavares GMP, Lira Filho EB, Pfeferman A, Fischer CH, Morhy SS. Analysis of left ventricular regional dyssynchrony: comparison between real time 3D echocardiography and tissue Doppler imaging. Echocardiography 2009; 26:675-83. [PMID: 19392841 DOI: 10.1111/j.1540-8175.2008.00856.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is a paucity of information concerning left ventricular (LV) dyssynchrony assessment by real time three-dimensional (3D) echocardiography (RT3DE) versus tissue Doppler imaging (TDI). AIMS To compare RT3DE and TDI LV dyssynchrony assessment. METHODS A prospective study of 92 individuals (56 men, age 47 +/- 10 years), 32 with dilated cardiomyopathy (CMP), and 60 healthy individuals. By RT3DE, we measured the LV% dyssynchrony index (DI) of 6, 12, and 16 segments (SDI). By pulsed-wave TDI, we measured the QS electromechanical interval in the basal segments of the mitral valve annulus of the septum, the lateral, anterior and inferior walls, and the TDI% DI. RESULTS In the normal group, the 3D DI was 1.1 +/- 0.8%, 1.4 +/- 1.3%, 1.8 +/- 1.7%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient (Pearson's r) for the TDI DI and SDI was r = 0.2381 (P = 0.0470). In CMP group, the 3D DI was 4.6 +/- 5.4%, 7.9 +/- 7.1%, 11.1 +/- 7.1%, for 6 segments, 12 segments, and SDI, respectively. The correlation coefficient for TDI DI and SDI was r = 0.7838 (P < 0.0001). CONCLUSIONS We observed a good correlation between RT3DE and tissue Doppler LV dyssynchrony assessment in patients with advanced heart failure.
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Affiliation(s)
- Marcelo L C Vieira
- Sector of Echocardiography, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Vieira MLC, Monaco CG, Oliveira W, Cury A, Guimarães LB, Rodrigues ACT, Cordovil A, Calatróia J, Ferreira MJ, Afonso T, Romano R, Filho EBL, Fischer CH, Morhy SS. Standard values for transthoracic three-dimensional echocardiographic new systolic-derived speckle tracking parameters in a normal population. Crit Care 2009. [PMCID: PMC4085428 DOI: 10.1186/cc7830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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36
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Noritomi DT, Vieira MLC, Pesaro AEP, Bastos JF, Rached FH, Mohovic T, Cordioli RL, Mattos GFJ, Akamine N, Fischer CH. Validation of an echochardiography training program for intensivists. Crit Care 2009. [PMCID: PMC4085403 DOI: 10.1186/cc7805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Gimenes VML, Vieira MLC, Andrade MM, Pinheiro J, Hotta VT, Mathias W. Standard values for real-time transthoracic three-dimensional echocardiographic dyssynchrony indexes in a normal population. J Am Soc Echocardiogr 2008; 21:1229-35. [PMID: 18848431 DOI: 10.1016/j.echo.2008.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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: 02/19/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a paucity of information describing the real-time 3-dimensional echocardiography (RT3DE) and dyssynchrony indexes (DIs) of a normal population. We evaluate the RT3DE DIs in a population with normal electrocardiograms and 2- and 3-dimensional echocardiographic analyses. This information is relevant for cardiac resynchronization therapy. METHODS We evaluated 131 healthy volunteers (73 were male, aged 46 +/- 14 years) who were referred for routine echocardiography; who presented normal cardiac structure on electrocardiography, 2-dimensional echocardiography, and RT3DE; and who had no history of cardiac diseases. We analyzed 3-dimensional left ventricular ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricular systolic DI% (6-, 12-, and 16-segment models). RT3DE data were analyzed by quantifying the statistical distribution (mean, median, standard deviation [SD], relative SD, coefficient of skewness, coefficient of kurtosis, Kolmogorov-Smirnov test, D'Agostino-Pearson test, percentiles, and 95% confidence interval). RESULTS Left ventricular ejection fraction ranged from 50% to 80% (66.1% +/- 7.1%); left ventricle end-diastolic volume ranged from 39.8 to 145 mL (79.1 +/- 24.9 mL); left ventricle end-systolic volume ranged from 12.9 to 66 mL (27 +/- 12.1 mL); 6-segment DI% ranged from 0.20% to 3.80% (1.21% +/- 0.66%), median: 1.06, relative SD: 0.5482, coefficient of skewness: 1.2620 (P < .0001), coefficient of Kurtosis: 1.9956 (P = .0039); percentile 2.5%: 0.2900, percentile 97.5%: 2.8300; 12-segment DI% ranged from 0.22% to 4.01% (1.29% +/- 0.71%), median: 1.14, relative SD: 0.95, coefficient of skewness: 1.1089 (P < .0001), coefficient of Kurtosis: 1.6372 (P = .0100), percentile 2.5%: 0.2850, percentile 97.5%: 3.0700; and 16-segment DI% ranged from 0.29% to 4.88% (1.59 +/- 0.99), median: 1.39, relative SD: 0.56, coefficient of skewness: 1.0792 (P < .0001), coefficient of Kurtosis: 0.9248 (P = .07), percentile 2.5%: 0.3750, percentile 97.5%: 3.750. CONCLUSION This study allows for the quantification of RT3DE DIs in normal subjects, providing a comparison for patients with heart failure who may be candidates for cardiac resynchronization therapy.
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Affiliation(s)
- Vera M L Gimenes
- Hospital do Coração, Echocardiography Laboratory, São Paulo, Brazil
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38
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Vieira MLC, Cury AF, Gustavo N, Oliveira WA, Monaco CG, Cordovil A, Rodrigues ACT, Lira Filho EB, Fischer CH, Morhy SS. Ventricular dyssynchrony index: comparison with two-dimensional and three-dimensional ejection fraction. Arq Bras Cardiol 2008; 91:142-162. [PMID: 18853055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 01/08/2008] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Left ventricular (LV) electromechanical coupling (synchrony) is important in the analysis of the systolic performance, especially for the indication of cardiac resynchronization therapy in patients with advanced CHF. OBJECTIVE To compare LV synchrony as analyzed by real-time three-dimensional (3D) echocardiography (ECHO) with LVEF measurements as obtained with 2D and 3D ECHO. METHODS Prospective study of 92 individuals (56 men, 47 +/- 10 years of age), of which 60 had normal heart structure (ECHO) and ECG (N group), and 32 had dilated cardiomyopathy (DCM group). Using 3D ECHO, LVEF, volumes and dyssynchrony index (%DI) for 16 LV segments were measured. Using 2D ECHO, LVEF (Simpson's method), and LV systolic and diastolic volumes were measured. STATISTICAL ANALYSIS Pearson's correlation coefficient, 95% CI, linear regression model, Bland & Altman analysis, p<0.05. RESULTS %DI ranged from 0.2900 to 28.1000 (5.2014+/-6.3281), 3D LVEF ranged from 0.17 to 0.81 (0.52+/-0.17); and 2D LVEF ranged from 0.3 to 0.69 (0.49+/-0.11). The correlation between DI and 3D LVEF was (r): -0.7432, p<0.0001, CI: -0.8227 to -0.6350, the linear relation between DI (x) and 3D LVEF (y) was y = 19.8124 + (-27.9578) x, p<0.0001. The correlation between DI and 2D LVEF was (r): -0.7012, p<0.0001, CI: -0.7923 to -0.5797. CONCLUSION In this case series, a good negative correlation was observed between LV electromechanical three-dimensional systolic coupling and LVEF as measured by echocardiography (3D and 2D).
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Vieira MLC, Cury AF, Gustavo N, Oliveira WA, Monaco CG, Cordovil A, Rodrigues ACT, Lira Filho EB, Fischer CH, Morhy SS. Índice de dissincronia ventricular: comparação com a fração de ejeção bidimensional e tridimensional. Arq Bras Cardiol 2008. [DOI: 10.1590/s0066-782x2008001500004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nishioka SAD, Martinelli Filho M, Brandão SCS, Giorgi MC, Vieira MLC, Costa R, Mathias W, Meneghetti JC. Cardiac sympathetic activity pre and post resynchronization therapy evaluated by 123I-MIBG myocardial scintigraphy. J Nucl Cardiol 2007; 14:852-9. [PMID: 18022112 DOI: 10.1016/j.nuclcard.2007.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Imaging with (123)I-metaiodobenzylguanidine (MIBG) is used for the assessment of cardiac sympathetic activity (CSA). We analyzed CSA before and after cardiac resynchronization therapy (CRT), and correlated these data with CRT response. METHODS AND RESULTS Thirty patients with chronic heart failure and classic indications for CRT were prospectively studied before and at least 3 months after CRT. The variables analyzed were: QRS width, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic diameter (LVEDD), heart/mediastinum MIBG uptake ratio (H/M), and washout rate (WR). After CRT, patients were divided into two groups: group 1 (21 patients), responders improving to functional class (FC) I or II; and group 2 (9 patients), nonresponders remaining in FC III or IV. After CRT, only group 1 showed favorable changes in QRS width (P =.003), LVEF (P =.01), LVEDD (P =.04), and H/M ratio (P =.003). The H/M ratio and WR were associated with CRT response (P =.005 and P =.04, respectively). The H/M ratio was the only independent predictor of CRT response (P =.01). Receiver operating characteristic curves showed that the optimal H/M ratio cutoff point was 1.36 (sensitivity, 75%; specificity, 71%). CONCLUSIONS Improvement in CSA correlated with a positive CRT response. Lower MIBG uptake before therapy was associated with CRT nonresponse. The H/M ratio could be helpful in selecting patients for CRT.
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Affiliation(s)
- Silvana A D'Orio Nishioka
- Department of Arrhythmia and Cardiac Stimulation, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
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Endo Y, Maddukuri PV, Vieira MLC, Pandian NG, Patel AR. Quantification of right ventricular volumes and function by real time three-dimensional echocardiographic longitudinal axial plane method: validation in the clinical setting. Echocardiography 2007; 23:853-9. [PMID: 17069604 DOI: 10.1111/j.1540-8175.2006.00327.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Measurement of right ventricular (RV) volumes and right ventricular ejection fraction (RVEF) by three-dimensional echocardiographic (3DE) short-axis disc summation method has been validated in multiple studies. However, in some patients, short-axis images are of insufficient quality for accurate tracing of the RV endocardial border. This study examined the accuracy of long-axis analysis in multiple planes (longitudinal axial plane method) for assessment of RV volumes and RVEF. METHODS 3DE images were analyzed in 40 subjects with a broad range of RV function. RV end-diastolic (RVEDV) and end-systolic volumes (RVESV) and RVEF were calculated by both short-axis disc summation method and longitudinal axial plane method. RESULTS Excellent correlation was obtained between the two methods for RVEDV, RVESV, and RVEF (r = 0.99, 0.99, 0.94, respectively; P < 0.0001 for all comparisons). CONCLUSION 3DE longitudinal-axis analysis is a promising technique for the evaluation of RV function, and may provide an alternative method of assessment in patients with suboptimal short-axis images.
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Affiliation(s)
- Yuka Endo
- Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
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Vieira MLC, Pommerantzeff PM, Mathias W, Ramires JAF. Ecocardiografia transesofágica tridimensional em paciente com comunicação interatrial tipo Ostium Secundum. Arq Bras Cardiol 2006; 87:e15. [PMID: 17057909 DOI: 10.1590/s0066-782x2006001600029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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Maddukuri PV, Vieira MLC, DeCastro S, Maron MS, Kuvin JT, Patel AR, Pandian NG. What Is the Best Approach for the Assessment of Left Atrial Size? Comparison of Various Unidimensional and Two-dimensional Parameters with Three-dimensional Echocardiographically Determined Left Atrial Volume. J Am Soc Echocardiogr 2006; 19:1026-32. [PMID: 16880098 DOI: 10.1016/j.echo.2006.03.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [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: 11/18/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left atrial (LA) size has prognostic importance in a variety of cardiac conditions. Diameters, area, or volume derived from 2-dimensional (2D) echocardiography (2DE) are commonly used to measure LA size, but involve numerous assumptions. This study examined the accuracy of these 2DE parameters compared to 3-dimensional echocardiographic LA volume (3DV). METHODS LA diameters, area, and volume measured from 2DE were correlated with 3DV in 118 patients with dilated cardiomyopathy, hypertrophic cardiomyopathy, or without structural heart disease. RESULTS Diameter (anterior-posterior, superior-inferior, and medial-lateral) and 2DE area measurements had statistically significant, but modest, correlations with 3DV, and exhibited a large degree of scatter in comparison with 3DV. The 2DE-derived volume had an excellent correlation with 3DV, but consistently underestimated LA volume. CONCLUSION The 2DE LA volume correlates better than other parameters with 3DV, but often results in underestimation. Thus, caution should be exercised when using unidimensional and 2D measurements of LA size.
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Affiliation(s)
- Prasad V Maddukuri
- Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
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Trevisan F, Mendes BMJ, Maciel SC, Vieira MLC, Meletti LMM, Rezende JAM. Resistance to Passion fruit woodiness virus in Transgenic Passionflower Expressing the Virus Coat Protein Gene. Plant Dis 2006; 90:1026-1030. [PMID: 30781294 DOI: 10.1094/pd-90-1026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report the use of the coat protein (CP) gene from Passion fruit woodiness virus (PWV) to produce resistant transgenic plants of yellow passion fruit. A full-length CP gene from a severe PWV isolate from the state of São Paulo, Brazil (PWV-SP) was cloned into pCAMBIA 2300 binary vector, which was further introduced into Agrobacterium tumefaciens strain EHA 105. Leaf disks were used as explants for transformation assays, e.g., 2,700 and 2,730 disks excised from plants from the Brazilian cultivars IAC-275 and IAC-277, respectively. In vitro selection was performed in kanamycin. After transferring to the elongation medium, 119 and 109 plantlets of IAC-275 and IAC-277, respectively, were recovered. Integration of the PWV CP gene was confirmed in seven of eight plants evaluated by Southern blot analysis, showing different numbers of insertional events for the CP gene. Three transgenic plants (T3, T4, and T7) expressed the expected transcript, but the 32 kDa PWV CP was detected by Western blot in only two plants (T3 and T4). The results of three successive mechanical inoculations against the transgenic plants using three PWV isolates showed that the primary transformant T2 of IAC-277 was immune to all isolates.
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Affiliation(s)
- F Trevisan
- Laboratório de Biotecnologia Vegetal, CENA/USP, 13400-970 Piracicaba, SP, Brazil
| | - B M J Mendes
- Laboratório de Biotecnologia Vegetal, CENA/USP, 13400-970 Piracicaba, SP, Brazil
| | - S C Maciel
- Dept. de Entomologia, Fitopatologia e Zoologia Agrícola, ESALQ/USP, 13418-900 Piracicaba, SP, Brazil
| | - M L C Vieira
- Dept. de Genética, ESALQ/USP, 13418-900 Piracicaba, SP, Brazil
| | - L M M Meletti
- Centro de Fruticultura, Instituto Agronômico, 13020-902 Campinas, SP, Brazil
| | - J A M Rezende
- Dept. de Entomologia, Fitopatologia e Zoologia Agrícola, ESALQ/USP, 13418-900 Piracicaba, SP, Brazil
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Cordovil A, Fischer CH, Rodrigues ACT, Lira Filho EB, Vieira MLC, Cury AF, Naccarato GAF, Valente C, Brandão CM, Pommerantzeff PM, Morhy SS. Papillary Muscle Rupture After Blunt Chest Trauma. J Am Soc Echocardiogr 2006; 19:469.e1-3. [PMID: 16581491 DOI: 10.1016/j.echo.2005.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/03/2005] [Indexed: 11/23/2022]
Abstract
We report a case of anterolateral papillary muscle rupture in a 22-year-old man who had blunt chest trauma caused by a car accident. Transesophageal echocardiography revealed severe mitral regurgitation caused by the rupture. He successfully underwent emergency mitral valve replacement and was discharged 9 days after the surgical correction.
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Affiliation(s)
- Adriana Cordovil
- Echocardiography Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Campos PC, Baruzzi AC, Vieira MLC, Knobel E. Successful treatment of colon cancer related right heart thromboemboli with prolonged intravenous streptokinase during serial TOE monitoring. Heart 2005; 91:390. [PMID: 15710735 PMCID: PMC1768740 DOI: 10.1136/hrt.2004.038687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vieira MLC, Andrade JL, Mathias W, Morhy SS, Cardoso LF, Kajita LJ, Ramires JAF. Ecocardiografia tridimensional em tempo real da valva mitral em paciente com estenose valvar submetido a valvoplastia com cateter balão. Arq Bras Cardiol 2005; 84:193-4. [PMID: 15761651 DOI: 10.1590/s0066-782x2005000200023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Vieira MLC, Grinberg M, Pomerantzeff PMA, Andrade JL, Mansur AJ. Repeated echocardiographic examinations of patients with suspected infective endocarditis. Heart 2004; 90:1020-4. [PMID: 15310690 PMCID: PMC1768449 DOI: 10.1136/hrt.2003.025585] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To study the diagnostic contribution of repeated transthoracic (TTE) and transoesophageal echocardiography (TOE) among patients with suspected infective endocarditis. METHODS 262 patients with 266 episodes of suspected infective endocarditis were referred for TTE and TOE over three years in a 423 bed university cardiology hospital. Patients were a mean (SD) of 47.6 (17.9) years old. 139 (52.3%) episodes occurred in men and 127 (47.7%) in women. The diagnostic information obtained from repeated TTE and TOE examinations was evaluated relative to the diagnosis of endocarditis. RESULTS TTE examinations were repeated in 192 (72.2%) and TOE examinations were repeated in 49 (18.4%) of 266 episodes. A mean of 2.4 TTE and 1.2 TOE examinations were performed for each episode of suspected endocarditis. The second and third TTEs added diagnostic information in 34 (26.7%) and the second and third TOEs added diagnostic information in 25 (19.7%) of 127 episodes with definite endocarditis. After the third TTE or TOE no additional diagnostic information was obtained. CONCLUSIONS The diagnostic contribution of repeated TTE or TOE for the diagnosis of endocarditis decreased as the number of repetitions increased. In this setting, the data do not substantiate more than three TTE or TOE examinations as an efficient strategy to increase the diagnostic yield for all but selected patients with suspected endocarditis.
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Affiliation(s)
- M L C Vieira
- Heart Institute (InCor), University of São Paulo Medical School, Brazil.
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Vieira MLC, Ianni BM, Mady C, Encinas J, Pommerantzeff PMA, Fernandes PP, Leal SB, Mathias W, Andrade JL, Ramires JAF. Mixoma de átrio esquerdo: avaliação ecocardiográfica tridimensional. Arq Bras Cardiol 2004; 82:281-3. [PMID: 15073654 DOI: 10.1590/s0066-782x2004000300009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The patient was a 70-year-old female with antecedents of diabetes mellitus and hypertension, being followed up in the outpatient care clinic due to chronic anemia after corrective surgery for angiodysplasia of the proximal jejunum, in whom an image suggestive of left atrial myxoma was found on routine transthoracic echocardiography. Then multiplanar transesophageal echocardiography and 3-dimensional echocardiography were performed, showing the latter better anatomical details of the tumor. The patient underwent exeresis of the mass with anatomicopathological confirmation of the tumor. Three-dimensional echocardiography proved to be a technique that can provide additional contributions to the diagnostic investigation of structural heart diseases.
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Vieira MLC, Silva Filho RM, Brito Filho FS, Leal SB, Lira Filho EB, Fischer CH, de Souza JA, Perin MA. Selective contrast echocardiography in percutaneous transluminal septal myocardial ablation in an elderly patient with left ventricular concentric hypertrophy. Echocardiography 2003; 20:563-6. [PMID: 12859372 DOI: 10.1046/j.1540-8175.2003.03096.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report an elderly patient, with hypertension and left ventricular concentric hypertrophy with sigmoid shape of the septum, who presented an unsatisfactory response to medical treatment and who was successfully submitted to myocardial contrast echocardiography-guided percutaneous transluminal septal myocardial ablation.
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Affiliation(s)
- Marcelo L C Vieira
- Division of Imaging Diagnosis, Echocardiography Laboratory Department of Cardiology Division of Imaging Diagnosis, Hemodynamic Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
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