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Ribas FF, Hueb W, Rezende PC, Rochitte CE, Nomura CH, Villa AV, Morais TC, Lima EG, Boeing Boros GA, Ribeiro MDOL, Linhares-Filho JPP, Dallazen AR, Silva RRM, Franchini Ramires JA, Kalil-Filho R. Abnormal release of cardiac biomarkers in the presence of myocardial oedema evaluated by cardiac magnetic resonance after uncomplicated revascularization procedures. Eur Heart J Cardiovasc Imaging 2023; 24:1700-1709. [PMID: 37453130 DOI: 10.1093/ehjci/jead171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/15/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
AIMS To analyse the association of myocardial oedema (ME), observed as high T2 signal intensity (HT2) in cardiac magnetic resonance imaging, with the release of cardiac biomarkers, ventricular ejection, and clinical outcomes after revascularization. METHODS AND RESULTS Patients with stable coronary artery disease with the indication for revascularization were included. Biomarker levels [troponin I (cTnI) and creatine kinase MB (CK-MB)] and T2-weighted and late gadolinium enhancement (LGE) images were obtained before and after the percutaneous or surgical revascularization procedures. The association of HT2 with the levels of biomarkers, with and without LGE, evolution of left ventricular ejection fraction (LVEF), and 5-year clinical outcomes were assessed. A total of 196 patients were divided into 2 groups: Group 1 (HT2, 40) and Group 2 (no HT2, 156). Both peak cTnI (8.9 and 1.6 ng/mL) and peak CK-MB values (44.7 and 12.1 ng/mL) were significantly higher in Group 1. Based on the presence of new LGE, patients were stratified into Groups A (no HT2/LGE, 149), B (HT2, 9), C (LGE, 7), and D (both HT2/LGE, 31). The peak cTnI and CK-MB values were 1.5 and 12.0, 5.4 and 44.7, 5.0 and 18.3, and 9.8 and 42.8 ng/mL in Groups A, B, C, and D, respectively, and were significantly different. The average LVEF decreased by 4.4% in Group 1 and increased by 2.2% in Group 2 (P = 0.057). CONCLUSION ME after revascularization procedures was associated with increased release of cardiac necrosis biomarkers, and a trend towards a difference in LVEF, indicating a role of ME in cardiac injury after interventions.
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Affiliation(s)
- Fernando Faglioni Ribas
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Whady Hueb
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Paulo Cury Rezende
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Carlos Eduardo Rochitte
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Cesar Higa Nomura
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Alexandre Volney Villa
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Thamara Carvalho Morais
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Eduardo Gomes Lima
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Gustavo André Boeing Boros
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Matheus de Oliveira Laterza Ribeiro
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Jaime Paula Pessoa Linhares-Filho
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Anderson Roberto Dallazen
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Rafael Rocha Mol Silva
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Jose Antonio Franchini Ramires
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Roberto Kalil-Filho
- Divisão Clínica Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, AB floor, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
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de Oliveira Laterza Ribeiro M, Hueb W, Rezende PC, Lima EG, Nomura CH, Rochitte CE, da Silva Selistre L, Boros GAB, Ramires JAF, Filho RK. Myocardial tissue microstructure with and without stress-induced ischemia assessed by T1 mapping in patients with stable coronary artery disease. Clin Imaging 2023; 101:142-149. [PMID: 37348160 DOI: 10.1016/j.clinimag.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Stress-induced myocardial ischemia seems not to be associated with cardiovascular events. However, its effects on myocardial tissue characteristics remain under debate. Thus, we sought to assess whether documented stress-induced ischemia is associated with changes in myocardial microstructure evaluated by magnetic resonance native T1 map and extracellular volume fraction (ECV). METHODS This is a single-center, analysis of the previously published MASS V Trial. Multivessel patients with a formal indication for myocardial revascularization and with documented stress-induced ischemia were included in this study. Native T1 and ECV values evaluated by cardiac magnetic resonance imaging of ischemic and nonischemic myocardial segments at rest and after stress were compared. Myocardial ischemia was detected by either nuclear scintigraphy or stress magnetic cardiac resonance protocol. RESULTS Between May 2012 and March 2014, 326 prospective patients were eligible for isolated CABG or PCI and 219 were included in the MASS V trial. All patients underwent resting cardiac magnetic resonance imaging. Of a total of 840 myocardial segments, 654 were nonischemic segments and 186 were ischemic segments. Native T1 and ECV values of ischemic segments were not significantly different from nonischemic segments, both at rest and after stress induction. In addition, native T1 and ECV values of myocardial segments supplied by vessels with obstructive lesions were similar to those supplied by nonobstructive ones. CONCLUSION AND RELEVANCE In this study, cardiac magnetic resonance identified similar T1 mapping values between ischemic and nonischemic myocardial segments. This finding suggests integrity and stability of myocardial tissue in the presence of stress-induced ischemia.
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Affiliation(s)
| | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Cesar Higa Nomura
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Gustavo André Boeing Boros
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Bailuni Neto JJ, Siqueira BDL, Machado FC, Boros GAB, Akamine MAV, Cordeiro de Paula LJ, Rodrigues de Assis AC, Soares PR, Scudeler TL. BRASH Syndrome: A Case Report. Am J Case Rep 2022; 23:e934600. [PMID: 35058422 PMCID: PMC8793789 DOI: 10.12659/ajcr.934600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/29/2022]
Abstract
Patient: Male, 76-year-old
Final Diagnosis: Cardiogenic shock
Symptoms: Lethargy
Medication:—
Clinical Procedure: N/A
Specialty: Cardiology
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Affiliation(s)
- José João Bailuni Neto
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Bernardo de Lima Siqueira
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Fernando Chiodini Machado
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Gustavo André Boeing Boros
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Marco Alexander Valverde Akamine
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Leonardo Jorge Cordeiro de Paula
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | | | - Paulo Rogério Soares
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
| | - Thiago Luis Scudeler
- Department of Emergency, Heart Institute (InCor), University of São Paulo Faculty of Medicine Clinics Hospital, São Paulo, SP, Brazil
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Boros GAB, Hueb W, Rezende PC, Ribas FF, Dallazen AR, Ribeiro MOL, Garcia RMR, Garzillo CL, Lima EG, Morais T, Nomura CH, Rochitte CE, Serrano Junior CV, Ramires JAF, Kalil Filho R. P598T1 mapping and myocardial extracellular volume assessed by cardiac magnetic resonance in diabetic patients with stable coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
T1 mapping is a quantitative technique of cardiac magnetic resonance (CMR) increasingly used for characterization of the myocardium. Type 2 diabetes mellitus (T2DM) may impact myocardial tissue structure, however studies that assessed this association using non-invasive methods have conflicting results.
Purpose
We sought to compare the tissue characteristics of the non-infarcted myocardium of patients with and without diabetes with multivessel CAD.
Methods
Patients with stable multivessel CAD and preserved left ventricular ejection fraction (LVEF), included in the MASS V trial, underwent contrast-enhanced CMR before revascularization procedures. Patients were stratified according to the T2DM diagnosis at baseline. Values of myocardial native T1, post-contrast T1 and extracellular volume fraction (ECV) were compared between diabetic and non-diabetic patients. Only myocardial tissue without late gadolinium enhancement were assessed.
Results
Of 155 patients studied, 67 (43%) were diabetic and 88 (57%) non-diabetic. Baseline characteristics were similiar between groups (age 70±10 vs 69±11; 69% vs 68% males; LVEF 65±13 vs 67±9). Mean Syntax score was 21.2±8.5 and 20.4±8.5 (p=0.52) in diabetic and non-diabetic, respectively. Myocardial native T1 values showed no diference in diabetic and non-diabetic (1013±67.9 vs 1015±61.4, p=0.72). However, in diabetic patients values of post-contrast T1 were significantly lower (482.2±43.8 vs 499.4±47.2, p=0.024) and ECV were higher (29.62±6.61 vs 27.08. ± 4.22, p=0.004). Multivariable analyses adjusted for age, sex, BMI, hypertension and Syntax score showed no differences in the results.
Figure1
Conclusion
In this study, T2DM was associated with higher ECV and lower post-contrast T1 values in the myocardial tissue. These findings suggest an increase in the myocardial intersticial matrix in patients with diabetes and stable multivessel CAD.
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Affiliation(s)
- G A B Boros
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - W Hueb
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - P C Rezende
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - F F Ribas
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - A R Dallazen
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - M O L Ribeiro
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R M R Garcia
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C L Garzillo
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - E G Lima
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - T Morais
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C H Nomura
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C E Rochitte
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C V Serrano Junior
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J A F Ramires
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R Kalil Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
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Dallazen AR, Hueb W, Rezende PC, Boros GAB, Ribas FF, Nomura CH, Rochitte CE, Morais T, Lima EG, Martins EB, Carvalho GF, Ribeiro MOL, Serrano Junior CV, Ramires JAF, Kalil Filho R. P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0584] [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
Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG.
Methods
Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures.
Results
Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p<0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B.
Figure 1
Conclusion
In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.
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Affiliation(s)
- A R Dallazen
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - W Hueb
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - P C Rezende
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G A B Boros
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - F F Ribas
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C H Nomura
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C E Rochitte
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - T Morais
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - E G Lima
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - E B Martins
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G F Carvalho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - M O L Ribeiro
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C V Serrano Junior
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J A F Ramires
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R Kalil Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
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Martins EB, Hueb W, Lima EG, Rezende PC, Garzillo CL, Carvalho GF, Carvalho FPC, Linhares Filho JPP, Batista DV, Silva RR, Boros GAB, Azevedo DFC, Serrano Junior CV, Ramires JAF, Kalil Filho R. P1835Application of SYNTAX score I, II and residual SYNTAX as predictors of long-term clinical outcomes after coronary artery bypass grafting. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0587] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The evaluation of coronary disease by SYNTAX score I (SSI) is used to grade coronary complexity. Following SSI, two other scores were developed: SYNTAX score II (SSII) and residual SYNTAX score (rSS). Nevertheless, there is still a lack of evidence about the prognostic significance of these scores among patients undergoing CABG.
Purpose
Our aim was to evaluate the relation of the SSI, SSII and rSS score with outcomes in a long-term follow-up after elective CABG.
Methods
This is a single center, registry-based study. Baseline SSI was calculated from patients undergoing CABG by interventional cardiologists. SSI results were considered as usual: <23, 23–32 and >32. SSII and rSRR were then calculated and categorized in tertiles: <21.4, 21.4–29.4 and >29.4 for SSII and 0, 1–5 and >5 for rSS. Primary outcome was a composite of overall death, myocardial infarction, additional revascularization, or stroke (MACCE).
Results
Data were obtained from 559 patients. Median follow-up was 6 years (IQR: 4.9–9.8) and 170 events were documented. The Kaplan-Meier curves (figure 1) showed significant differences of MACCE in higher SSI, SSII and rSS (p=0.039, 0.033, <0.001 respectively). After multivariate adjustment, rSS, ejection fraction (EF) and age were found to be independent predictors of MACCE (p<0.001, 0.034 and 0.006, respectively).
Figure 1
Conclusion
In this sample SSI, II and residual were associated with the occurrence of events. However, just the rSS remained an independent predictor of MACCE together with age and EF.
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Affiliation(s)
- E B Martins
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - W Hueb
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - E G Lima
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - P C Rezende
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C L Garzillo
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G F Carvalho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - F P C Carvalho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - D V Batista
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R R Silva
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - G A B Boros
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - D F C Azevedo
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - C V Serrano Junior
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - J A F Ramires
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
| | - R Kalil Filho
- Instituto do Coracao InCor Hospital das Clinicas Faculdade de Medicina Universidade de Sao Paulo SP, Sao Paulo, Brazil
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Rezende P, Hueb W, Hlatky M, Garcia R, Garzillo C, Scudeler T, Boros GAB, Ribas FF, Dallazen AR, Favarato D, Ramires J, Kalil-Filho R. VARIABILITY IN GLYCATED HEMOGLOBIN VALUES AND CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES AND MULTIVESSEL CORONARY ARTERY DISEASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dallazen AR, Boros GAB, Ribas FF, Nomura C, Rochitte C, Morais T, Lima E, Martins E, Rezende P, Hueb W, Ramires J, Filho RK. MYOCARDIAL INJURY ASSESSED BY T1 MAPPING AFTER ON-PUMP AND OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: A PRE-SPECIFIED ANALYSIS OF MASS V TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ribas FF, Rezende PC, Boros GAB, Dallazen AR, Nomura CH, Rochitte CE, Morais T, Villa AV, Garzillo CL, Hueb W, Ramires JAF, Kalil Filho R. P3705Role of myocardial edema assessed by cardiac magnetic resonance after revascularization procedures. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3705] [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: 11/12/2022] Open
Affiliation(s)
- F F Ribas
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - P C Rezende
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - G A B Boros
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - A R Dallazen
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C H Nomura
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - T Morais
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - A V Villa
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W Hueb
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J A F Ramires
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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