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Andrade VC, Rezende PC, Hueb W, Ramires JAF. Interpreting Acute Myocardial Infarction 40 Years Later. Evolution of Knowledge: What is the Best Explanation? Arq Bras Cardiol 2024; 121:e20230757. [PMID: 38695441 PMCID: PMC11081065 DOI: 10.36660/abc.20230757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Vitor Coutinho Andrade
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Paulo Cury Rezende
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Whady Hueb
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Antonio Franchini Ramires
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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Strunz CMC, Hueb W, Rezende PC, Vendramini SPDA, de Assis ACR, Roggerio A, Tairova MS, Silva MF, Oliveira SA, Kisser GDCA, Kalil Filho R. High-Sensitivity Troponin I and Cardiovascular Events in Stable Coronary Artery Disease: Insights from a Longitudinal Outpatient Study. Int J Mol Sci 2023; 24:17286. [PMID: 38139114 PMCID: PMC10743542 DOI: 10.3390/ijms242417286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Numerous studies have been published suggesting that troponin levels are related to adverse outcomes in chronic cardiac and non-cardiac conditions. Our study investigated whether troponin levels gathered from unselected blood samples taken during outpatient care are associated with adverse outcomes in a population with stable coronary artery disease. In a cohort of 949 patients with stable coronary artery disease, an average age of 67.5 ± 9.5 years, 69.5% male, 52.1% diabetics, 51.6% with previous myocardial infarction, and 57.9% with triple-vessel disease, 21.7% of patients encountered new events during an average period of monitoring of 2.07 ± 0.81 years. Troponin I/99th percentile categorized into tertiles emerged as an independent predictor of death and combined events risk (hazard ratio: 2.02 (1.13-3.60), p = 0.017; 2.30 (1.37-3.88, p = 0.002, respectively). A troponin ratio > 0.24 was able to identify 53.3% of patients at risk of death and heart failure hospitalization. In patients with stable coronary artery disease who are adherent to treatment, troponin levels are independently associated with death and heart failure hospitalization in a medium-term follow-up.
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Affiliation(s)
- Celia Maria Cassaro Strunz
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Whady Hueb
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Paulo Cury Rezende
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Sabrina Pacheco do Amaral Vendramini
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Arthur Cicupira Rodrigues de Assis
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Alessandra Roggerio
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Maria Stanislavovna Tairova
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Marcela Francisca Silva
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
| | - Senili Avila Oliveira
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Gyovanna de Cassia Agreste Kisser
- Clinical Laboratory, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (S.P.d.A.V.); (A.R.); (S.A.O.); (G.d.C.A.K.)
| | - Roberto Kalil Filho
- Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, SP, Brazil; (W.H.); (P.C.R.); (A.C.R.d.A.); (M.S.T.); (M.F.S.); (R.K.F.)
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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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Dallazen AR, Rezende PC, Hueb W, Hlatky MA, Nomura CH, Rochitte CE, Boros GAB, Ribas FF, de Oliveira Laterza Ribeiro M, Scudeler TL, Nery Dantas Junior R, Ramires JAF, Kalil Filho R. Myocardial microstructure assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. J Thorac Dis 2023; 15:3208-3217. [PMID: 37426129 PMCID: PMC10323545 DOI: 10.21037/jtd-23-101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
Background The correlation between the release of cardiac biomarkers after revascularization, in the absence of late gadolinium enhancement (LGE) or myocardial edema, and the development of myocardial tissue damage remains unclear. This study sought to identify whether the release of biomarkers is associated with cardiac damage by assessing myocardial microstructure on T1 mapping after on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB). Methods Seventy-six patients with stable multivessel coronary artery disease (CAD) and preserved systolic ventricular function were included. T1 mapping, high-sensitive cardiac troponin I (cTnI), creatine kinase myocardial band (CK-MB) mass, and ventricular dimensions and function were measured before and after procedures. Results Of the 76 patients, 44 underwent OPCAB, and 32 ONCAB; 52 were men (68.4%), and the mean age was 63±8.5 years. In both OPCAB and ONCAB the native T1 values were similar before and after surgeries. An increase in extracellular volume (ECV) values after the procedures was observed, due to the decrease in hematocrit levels during the second cardiac resonance. However, the lambda partition coefficient showed no significant difference after the surgeries. The median peak release of cTnI and CK-MB were higher after ONCAB than after OPCAB [3.55 (2.12-4.9) vs. 2.19 (0.69-3.4) ng/mL, P=0.009 and 28.7 (18.2-55.4) vs. 14.3 (9.3-29.2) ng/mL, P=0.009, respectively]. Left ventricular ejection fraction (LVEF) was similar in both groups before and after surgery. Conclusions In the absence of documented myocardial infarction, T1 mapping did not identify structural tissue damage after surgical revascularization with or without cardiopulmonary bypass (CPB), despite the excessive release of cardiac biomarkers.
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Affiliation(s)
- Anderson Roberto Dallazen
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Cesar Higa Nomura
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Andre Boeing Boros
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Nery Dantas Junior
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Antonio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, 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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Segre CAW, de Lemos JA, Assunção Junior AN, Nomura CH, Favarato D, Strunz CMC, Villa AV, Parga Filho JR, Rezende PC, Hueb W, Ramires JAF, Kalil Filho R, Serrano Junior CV. Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease. Medicine (Baltimore) 2023; 102:e33548. [PMID: 37083772 PMCID: PMC10118361 DOI: 10.1097/md.0000000000033548] [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: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. METHODS We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. RESULTS A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. CONCLUSION In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
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Affiliation(s)
| | - James A. de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Cesar Higa Nomura
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Desiderio Favarato
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | | | | | - Paulo Cury Rezende
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Whady Hueb
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | - Roberto Kalil Filho
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
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Carvalho FPCD, Hueb W, Lima EG, Rezende PC, Linhares Filho JPP, Garcia RMR, Soares PR, Ramires JAF, Kalil Filho R. Cardiovascular events in patients with coronary artery disease with and without myocardial ischemia: Long-term follow-up. Am Heart J 2023; 256:95-103. [PMID: 36400185 DOI: 10.1016/j.ahj.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND After the results of the ISCHEMIA Trial, the role of myocardial ischemia in the prognosis of coronary artery disease (CAD) was under debate. We sought to comparatively evaluate the long-term prognosis of patients with multivessel CAD with or without documented myocardial ischemia. METHODS This is a single-center, retrospective, observational cohort study that included patients with CAD obtained from the research protocols database of "The Medicine, Angioplasty or Surgery Study," the MASS Study Group. Patients were stratified according to the presence or absence of myocardial ischemia. Cardiovascular events (overall mortality and myocardial infarction) were tracked from the registry entry up to a median follow-up of 8.7 years. Myocardial ischemia was assessed at baseline by a functional test with or without imaging. RESULTS From 1995 to 2018, 2015 patients with multivessel CAD were included. Of these, 1001 presented with conclusive tests at registry entry, 790 (79%) presenting with ischemia and 211 (21%) without ischemia. The median follow-up was 8.7 years (IQR 4.04 to 10.07). The primary outcome occurred in 228 (28.9%) patients with ischemia and in 64 (30.3%) patients without ischemia (plog-rank=0.60). No significant interaction was observed with the presence of myocardial ischemia and treatment strategies in the occurrence of the combined primary outcome (pinteration=0.14). CONCLUSIONS In this sample, myocardial ischemia was not associated with a worse prognosis compared with no ischemia in patients with multivessel CAD. These results refer to debates about the role of myocardial ischemia in the occurrence of cardiovascular events.
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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.
| | - Eduardo Gomes Lima
- 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
| | | | - Rosa Maria Rahmi Garcia
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Paulo Rogério Soares
- 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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Silva RRM, Hueb W, Lima EG, Rezende PC, Soares PR, Ramires JAF, Filho RK. Long-term analysis of ventricular function in patients with symptomatic coronary disease who underwent on-pump or off-pump coronary artery bypass grafting. J Cardiothorac Surg 2022; 17:326. [PMID: 36536451 PMCID: PMC9762065 DOI: 10.1186/s13019-022-02069-1] [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: 07/19/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Systemic deleterious effects of cardiopulmonary bypass have been observed in the postprocedural period. Long-term assessment, including ventricular function (VF), is unclear. The objective of this study was to compare the change of left ventricular ejection fractions (LVEFs) during a long-term follow-up of coronary artery disease (CAD) patients who underwent off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). METHODS This study is a prespecified analysis of the MASS III trial, which was a single-center and prospective study that enrolled stable CAD patients with preserved VF. The CAD patients in our study were randomized to OPCAB or ONCAB. A transthoracic echocardiogram was performed during follow-up and a LVEF value was obtained. The primary endpoint was the difference between the final LVEF and the baseline LVEF. RESULTS Of the 308 randomized patients, ventricular function were observed in 225 over a mean of 5.9 years of follow-up: 113 in the ONCAB group and 112 in the OPCAB group. Baseline characteristics were similar between the two groups, but there was a larger proportion of subjects with 3-vessel disease in the ONCAB group. There was no difference in the LVEF at the beginning (P = 0.08), but there was a slight decrease in the LVEF in the ONCAB and OPCAB groups (P < 0.001 in both groups) at 5.9 years. The decline was not significantly different between the two groups (delta of -6% for ONCAB and -5% for OPCAB; P = 0.78). In a multivariate analysis, myocardial infarction in the follow-up was a predictor of an LVEF < 40%. CONCLUSIONS There was no difference in the long-term development of ventricular function between the surgical techniques, despite a decline in the LVEF in both groups. Trial registration Clinical Trial Registration Information-URL: http://www.controlled-trials.com . REGISTRATION NUMBER ISRCTN59539154. Date of first registration: 10/03/2008.
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Affiliation(s)
- Rafael Rocha Mol Silva
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - Whady Hueb
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - Eduardo Gomes Lima
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - Paulo Cury Rezende
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - Paulo Rogério Soares
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - José Antonio Franchini Ramires
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
| | - Roberto Kalil Filho
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 44 – AB 1 S114 Cerqueira Cesar, São Paulo, SP CEP – 05403-000 Brazil
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Scudeler TL, Farkouh ME, Hueb W, Rezende PC, Campolina AG, Martins EB, Godoy LC, Soares PR, Ramires JAF, Kalil Filho R. Coronary atherosclerotic burden assessed by SYNTAX scores and outcomes in surgical, percutaneous or medical strategies: a retrospective cohort study. BMJ Open 2022; 12:e062378. [PMID: 36137633 PMCID: PMC9511539 DOI: 10.1136/bmjopen-2022-062378] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Coronary atherosclerotic burden and SYNTAX Score (SS) are predictors of cardiovascular events. OBJECTIVES To investigate the value of SYNTAX scores (SS, SYNTAX Score II (SSII) and residual SYNTAX Score (rSS)) for predicting cardiovascular events in patients with coronary artery disease (CAD). DESIGN Retrospective cohort study. SETTING Single tertiary centre. PARTICIPANTS Medicine, Angioplasty or Surgery Study database patients with stable multivessel CAD and preserved ejection fraction. INTERVENTIONS Patients with CAD undergoing coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical treatment (MT) alone from January 2002 to December 2015. PRIMARY AND SECONDARY OUTCOMES Primary: 5-year all-cause mortality. Secondary: composite of all-cause death, myocardial infarction, stroke and subsequent coronary revascularisation at 5 years. RESULTS A total of 1719 patients underwent PCI (n=573), CABG (n=572) or MT (n=574) alone. The SS was not considered an independent predictor of 5-year mortality in the PCI (low, intermediate and high SS at 6.5%, 6.8% and 4.3%, respectively, p=0.745), CABG (low, intermediate and high SS at 5.7%, 8.0% and 12.1%, respectively, p=0.194) and MT (low, intermediate and high SS at 6.8%, 6.9% and 6.5%, respectively, p=0.993) cohorts. The SSII (low, intermediate and high SSII at 3.6% vs 7.9% vs 10.5%, respectively, p<0.001) was associated with a higher mortality risk in the overall population. Within each treatment strategy, SSII was associated with a significant 5-year mortality rate, especially in CABG patients with higher SSII (low, intermediate and high SSII at 1.8%, 9.7% and 10.0%, respectively, p=0.004) and in MT patients with high SSII (low, intermediate and high SSII at 5.0%, 4.7% and 10.8%, respectively, p=0.031). SSII demonstrated a better predictive accuracy for mortality compared with SS and rSS (c-index=0.62). CONCLUSIONS Coronary atherosclerotic burden alone was not associated with significantly increased risk of all-cause mortality. The SSII better discriminates the risk of death. TRIAL REGISTRATION NUMBER ISRCTN66068876.
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Affiliation(s)
- Thiago Luis Scudeler
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Michael E Farkouh
- Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Whady Hueb
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo C Rezende
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alessandro G Campolina
- Center for Translational Research in Oncology, Instituto do Câncer Doutor Arnaldo Vieira de Carvalho, São Paulo, São Paulo, Brazil
| | - Eduardo Bello Martins
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas C Godoy
- Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paulo Rogério Soares
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Jose A F Ramires
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Department of Atherosclerosis, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Martins EB, Hueb W, Brown DL, Scudeler TL, Lima EG, Rezende PC, Soares PR, Garzillo CL, Filho JPPL, Batista DV, Ramires JAF, Filho RK. Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study. J Cardiothorac Surg 2021; 16:248. [PMID: 34479587 PMCID: PMC8418036 DOI: 10.1186/s13019-021-01616-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17–29.5), median SSII of 25.4 (IQR 19.2–32.8), and median rSS of 2 (IQR 0–6.5); in PCI SSI had a median of 14 (IQR 10–19.1), median SSII of 28.7 (IQR 23–34.2), and median rSS of 4.7 (IQR 0–9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13–3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74–10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01–1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01616-6.
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Affiliation(s)
- Eduardo Bello Martins
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - David L Brown
- Washington University School of Medicine, St. Louis, MO, USA
| | - Thiago Luis Scudeler
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Cury Rezende
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Paulo Rogério Soares
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jaime Paula Pessoa Linhares Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Valente Batista
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberto Kalil Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Batista DV, Hueb W, Lima EG, Rezende PC, Garzillo CL, Garcia RMR, Filho JPPL, Martins EB, Junior CVS, Ramires JAF, Filho RK. Effect of diabetic kidney disease on therapeutic strategies for coronary artery disease: ten year follow-up. Aging (Albany NY) 2021; 13:20081-20093. [PMID: 34433133 PMCID: PMC8436946 DOI: 10.18632/aging.203476] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The best treatment for coronary artery disease (CAD) in patients with type 2 diabetes (DM2) and chronic kidney disease is unknown. METHODS This retrospective study included MASS registry patients with DM2 and multivessel CAD, stratified by kidney function. Primary endpoint was combined of mortality, myocardial infarction, or additional revascularization. RESULTS Median follow-up was 9.5 years. Primary endpoint occurrences among strata 1 and 2 were 53.4% and 40.7%, respectively (P=.020). Mortality rates were 37.4% and 24.6% in strata 1 and 2, respectively (P<.001). We observed a lower rate of major adverse cardiovascular events (MACE) (P=.027 for stratum 1 and P<.001 for stratum 2) and additional revascularization (P=.001 for stratum 1 and P<.001 for stratum 2) for those in the surgical group. In a multivariate analysis, eGFR was an independent predictor of MACE (P=.034) and mortality (P=.020). CONCLUSIONS Among subjects with DM2 and CAD the presence of lower eGFR rate was associated with higher rates of MACE and mortality, irrespective of treatment choice. CABG was associated with lower rates of MACE in both renal function strata. eGFR was an independent predictor of MACE and mortality in a 10-year follow-up.
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Affiliation(s)
- Daniel Valente Batista
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Eduardo Gomes Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Paulo Cury Rezende
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Cibele Larrosa Garzillo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Rosa Maria Rahmi Garcia
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | | | - Eduardo Bello Martins
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | - Carlos Vicente Serrano Junior
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
| | | | - Roberto Kalil Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR
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Batista DV, Lima E, Hueb W, Filho JL, Martins E, Rezende P, Ramires J, Garzillo C, Kalil-Filho R, Serrano C. THE EVOLUTION OF RENAL FUNCTION IS NOT IMPACTED BY THE THERAPEUTIC MODALITY OF CORONARY ARTERY DISEASE IN DIABETIC PATIENTS. MASS REGISTRY 10-YEAR FOLLOW-UP. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01455-8] [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: 11/28/2022]
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13
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Soares A, Boden WE, Hueb W, Brooks MM, Vlachos HEA, O'Fee K, Hardi A, Brown DL. Death and Myocardial Infarction Following Initial Revascularization Versus Optimal Medical Therapy in Chronic Coronary Syndromes With Myocardial Ischemia: A Systematic Review and Meta-Analysis of Contemporary Randomized Controlled Trials. J Am Heart Assoc 2021; 10:e019114. [PMID: 33442990 PMCID: PMC7955292 DOI: 10.1161/jaha.120.019114] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background In chronic coronary syndromes, myocardial ischemia is associated with a greater risk of death and nonfatal myocardial infarction (MI). We sought to compare the effect of initial revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) with OMT alone in patients with chronic coronary syndrome and myocardial ischemia on long‐term death and nonfatal MI. Methods and Results Ovid Medline, Embase, Scopus, and Cochrane Library databases were searched for randomized controlled trials of PCI or CABG plus OMT versus OMT alone for patients with chronic coronary syndromes. Studies were screened and data were extracted independently by 2 authors. Random‐effects models were used to generate pooled treatment effects. The search yielded 7 randomized controlled trials that randomized 10 797 patients. Median follow‐up was 5 years. Death occurred in 640 of the 5413 patients (11.8%) randomized to revascularization and in 647 of the 5384 patients (12%) randomized to OMT (odds ratio [OR], 0.97; 95% CI, 0.86–1.09; P=0.60). Nonfatal MI was reported in 554 of 5413 patients (10.2%) in the revascularization arms compared with 627 of 5384 patients (11.6%) in the OMT arms (OR, 0.75; 95% CI, 0.57–0.99; P=0.04). In subgroup analysis, nonfatal MI was significantly reduced by CABG (OR, 0.35; 95% CI, 0.21–0.59; P<0.001) but was not reduced by PCI (OR, 0.92; 95% CI, 0.75–1.13; P=0.43) (P‐interaction <0.001). Conclusions In patients with chronic coronary syndromes and myocardial ischemia, initial revascularization with PCI or CABG plus OMT did not reduce long‐term mortality compared with OMT alone. CABG plus OMT reduced nonfatal MI compared with OMT alone, whereas PCI did not.
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Affiliation(s)
- Andrea Soares
- Department of Medicine Washington University School of Medicine St. Louis MO.,Washington University School of Medicine St. Louis MO
| | | | - Whady Hueb
- Heart Institute of the University of São Paolo São Paolo Brazil
| | | | | | - Kevin O'Fee
- Department of Medicine Washington University School of Medicine St. Louis MO.,Washington University School of Medicine St. Louis MO
| | - Angela Hardi
- Washington University School of Medicine St. Louis MO
| | - David L Brown
- Department of Medicine Washington University School of Medicine St. Louis MO.,Cardiovascular Medicine Washington University School of Medicine St. Louis MO.,Washington University School of Medicine St. Louis MO
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14
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Lima EG, Charytan DM, Hueb W, de Azevedo DFC, Garzillo CL, Favarato D, Linhares Filho JPP, Martins EB, Batista DV, Rezende PC, Hueb AC, Ramires JAF, Kalil Filho R. Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial. Nephrol Dial Transplant 2020; 35:1369-1376. [PMID: 30590726 DOI: 10.1093/ndt/gfy379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/12/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). METHODS Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (≥90, 89-60 and 59-30 mL/min/1.73 m2, respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com. Registration number: ISRCTN66068876). RESULTS Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07-0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31-0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25-0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07-4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. CONCLUSIONS Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.
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Affiliation(s)
- Eduardo Gomes Lima
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - David M Charytan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Whady Hueb
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | | | - Cibele Larrosa Garzillo
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Desiderio Favarato
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | | | - Eduardo Bello Martins
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Daniel Valente Batista
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Paulo Cury Rezende
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Alexandre Ciappina Hueb
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | | | - Roberto Kalil Filho
- Department of Clinical Cardiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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Linhares-Filho J, Hueb W, Lima E, Rezende P, Azevedo D, Rochitte C, Nomura C, Serrano-Junior C, Ramires J, Kalil-Filho R. Long-term prognostic value of late gadolinium enhancement and periprocedural myocardial infarction after uncomplicated revascularization: MASS-V follow-up. Eur Heart J Cardiovasc Imaging 2020; 23:255-265. [PMID: 33280019 DOI: 10.1093/ehjci/jeaa328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 11/13/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS Cardiac biomarkers elevation is common after revascularization, even in absence of periprocedural myocardial infarction (PMI) detection by imaging methods. Thus, late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We sought to evaluate long-term prognostic value of PMI and new LGE after revascularization. METHODS AND RESULTS Two hundred and two patients with multivessel coronary disease and preserved ventricular function who underwent elective revascularization were included, of whom 136 (67.3%) underwent coronary artery bypass grafting and 66 (32.7%) percutaneous coronary intervention. The median follow-up was 5 years (4.8-5.8 years). Cardiac biomarkers measurement and LGE-CMR were performed before and after procedures. The Society for Cardiovascular Angiography and Interventions definition was used to assess PMI. Primary endpoint was composed of death, infarction, additional revascularization, or cardiac hospitalization. Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%) had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9 (25.2%) in patients with it (P = 0.045). LGE was also associated to increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects without and with it (P = 0.02). LGE was the only independent predictor of primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass was estimated at 4.6 g. Patients with new LGE had a greater biomarkers release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P < 0.001 in both comparisons). CONCLUSIONS New LGE was shown to be better prognostic predictor than biomarker-only PMI definition after uncomplicated revascularization. Furthermore, new LGE was the only independent predictor of cardiovascular events and mortality. CLINICAL TRIAL REGISTRATION http://www.controlled-trials.com/ISRCTN09454308.
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Affiliation(s)
- Jaime Linhares-Filho
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Whady Hueb
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Eduardo Lima
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Paulo Rezende
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Diogo Azevedo
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Carlos Rochitte
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Cesar Nomura
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Carlos Serrano-Junior
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - José Ramires
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
| | - Roberto Kalil-Filho
- Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil
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Boros G, Bellini V, Fatori D, Bernoche C, Macatrao-Costa M, Lopes L, Bacal F, Hueb W, Kopel L, Lage S. Intra-aortic balloon pump as a bridge therapy to heart transplant in refractory heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1234] [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 role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device.
Purpose
Describe the impact of IABP treatment in advanced HF patients who underwent HTx.
Methods
We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx.
Results
We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p<0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p<0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p<0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury).
Conclusion
In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G.A.B Boros
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - V.S.C Bellini
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - D Fatori
- University of Sao Paulo, Department of Psychiatry, Sao Paulo, Brazil
| | - C Bernoche
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M.F Macatrao-Costa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L.N.G.D Lopes
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Bacal
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - W Hueb
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L Kopel
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - S.G Lage
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Ribeiro M, Hueb W, Rezende P, Rochitte C, Nomura C, Morais T, Lima E, Boros G, Ribas F, Carvalho F, Carvalho G, Mocha M, Serrano C, Ramires J, Kalil Filho R. T1 mapping for myocardial tissue evaluation in patients with ischemia and stable coronary artery disease: MASS V-Trial Study Group. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0260] [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
T1 mapping is a magnetic resonance imaging (MRI) technique that enables the identification of myocardial structural changes during acute ischemic injury. However, it is not known whether these structural changes are present in patients with chronic effort induced ischemia.Thus, we sought to document the possible T1 mapping changes in chronic coronary artery disease (CAD) patients with documented myocardial ischemia.
Methods
Multivessel CAD patients from MASS V Trial with indication of myocardial revascularization, were evaluated for the presence of ischemia by myocardial scintigraphy. MRI with T1 mapping was performed in all patients. Based on the results of the scintigraphy, the myocardial segments were identified as ischemic and non-ischemic segments. The corresponding segments of scintigraphy and MRI were compared in relation to native T1 map (NT1), post-contrast T1 (CAT1) and extracellular volume (ECV).
Results
Of the 720 myocardial segments analyzed, there were 161 ischemic and 559 non-ischemic segments. Comparing ischemic vs non-ischemic segments, respectively, NT1 was 1022.7 (980.0–1052.0) versus 1029.3 (985.0–1066.3), p=0.57, ECV results were 25.4 (24.0–28.1) versus 26.4 (25.3–29.9), p=0.75 and CAT1 results were 492 (461.9–515.4) versus 488 (469.2–521.7), p=0.09. Myocardial segments supplied by obstructive coronary arteries were compared to those supplied by non-obstructive coronary arteries in relation to NT1 and ECV. NT1 values in obstructive and non-obstructive territories were, respectively, 1024.7 (998.5–1043.5) versus 1036.8 (1008.6–1046.9), p=0.30 and ECV results were 26.8 (24.4–29.9) versus 26.8 (24.4–30.0), p=0.90.
Conclusion
In this study, MRI identified structural similarities between chronic ischemic myocardium compared to the non-ischemic myocardium. This finding supports myocardial tissue stability in the presence of stress induced ischemia.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Zerbini Foundation and also by the FAPESP (2011/ 20876-2)
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Affiliation(s)
- M Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - W Hueb
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P.C Rezende
- 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
| | - C.H Nomura
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - T Morais
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E.G Lima
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - G.A.B Boros
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F.F Ribas
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F.P.C Carvalho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - G.F Carvalho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M.R Mocha
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - C.V Serrano
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J.A.F Ramires
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Camara De Carvalho F, Hueb W, Lima E, Linhares Filho J, Ribeiro M, Martins E, Batista D, Garzillo C, Ribas F, Boros G, Rezende P, Serrano Junior C, Ramires J, Kalil Filho R. Effect of myocardial ischemia in diabetic and non-diabetic patients: long-term follow-up of MASS registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1261] [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
Prognostic role of ischemia has been debated. The association with diabetes mellitus (DM) seems to add risks of cardiovascular events. We aimed to assess whether ischemia confers additional risks in diabetic population.
Methods
A single-center, prospective study including subjects with multivessel coronary artery disease who underwent surgery, percutaneous intervention or medical therapy. They were stratified according to presence of ischemia and DM. Primary endpoint was defined as death or myocardial infarction (MI). Secondary endpoint was death.
Results
We enrolled 1001 patients with conclusive stress tests: 790 (79%) with ischemia and 211 (21%) without ischemia. Mean follow-up was 8.7 years (IQR 4.04–10.07). The primary outcome occurred in 228 (28.9%) patients with ischemia and 64 (30.3%) without ischemia (p=0.60). Event rate among those with negative stress test, with or without DM, was similar (p=0.96 and p=0.60 respectively). Among those with ischemia, 145 (35.6%) with DM presented the combined event compared to 83 (21.7%) without DM (HR: 1.39; 95% CI 1.06–1.83, p=0.01). Death occurred in 117 diabetic and 65 (17%) in non-diabetic subjects (HR: 1.49, 95% CI: 2.03, p=0.01).
Conclusion
Overall, the presence or absence of ischemia was not related to death or MI. However, subset of patients with DM and ischemia revealed increased risk of death and cardiovascular events irrespective of treatment strategy.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Zerbini Foundation
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Affiliation(s)
| | - W Hueb
- Heart Institute, Sao Paulo, Brazil
| | - E.G Lima
- Heart Institute, Sao Paulo, Brazil
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Rezende PC, Hueb W, Bocchi EA, Farkouh M, Junior CVS, Lima EG, Silva EER, Dallan LAO, Gaiotto FA, Garzillo CL, Rochitte CE, Nomura CH, Scudeler TL, Soares PR, Jatene FB, Ramires JAF, Filho RK. Hypotheses, rationale, design, and methods for prognostic evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy who undergo medical or surgical treatment: MASS-VI (HF). Trials 2020; 21:337. [PMID: 32299458 PMCID: PMC7164251 DOI: 10.1186/s13063-020-04270-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/20/2020] [Indexed: 12/03/2022] Open
Abstract
Background Ischemic cardiomyopathy and severe left ventricular dysfunction are well established to represent the main determinants of poor survival and premature death compared with preserved ventricular function. However, the role of myocardial revascularization as a therapeutic alternative is not known to improve the long-term prognosis in this group of patients. This study will investigate whether myocardial revascularization contributes to a better prognosis for patients compared with those treated with drugs alone and followed over the long term. Methods The study will include 600 patients with coronary artery disease associated with ischemic cardiomyopathy. The surgical or drug therapy option will be randomized, and the events considered for analysis will be all-cause mortality, nonfatal infarction, unstable angina requiring additional revascularization, and stroke. The events will be analyzed according to the intent-to-treat principle. Patients with multivessel coronary disease and left ventricular ejection fraction measurements of less than 35% will be included. In addition, myocardial ischemia will be documented by myocardial scintigraphy. Markers of myocardial necrosis will be checked at admission and after the procedure. Discussion The role of myocardial revascularization (CABG) in the treatment of patients with coronary artery disease and heart failure is not clearly established. The surgical option of revascularizing the myocardium is a procedure designed to reduce the load of myocardial hibernation in patients with heart failure caused by coronary artery disease. On the other hand, the assessment of myocardial viability is frequently used to identify patients with left ventricular ischemic dysfunction in which CABG may add survival benefit. However, the effectiveness of this option is uncertain. The great difficulty in establishing the efficacy of surgical intervention is based on the understanding of viability without ischemia. Thus, this study will include only patients with viable and truly ischemic myocardium to correct this anomaly. Trial registration Evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy submitted to medical or surgical treatment: MASS-VI (HF), ISRCTN77449548, Oct 10th, 2019 (retrospectively registered).
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Whady Hueb
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Edimar Alcides Bocchi
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Michael Farkouh
- Toronto General Hospital Research Institute (TGHRI), Toronto, Ontario, Canada
| | - Carlos Vicente Serrano Junior
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Expedito Eustáquio Ribeiro Silva
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Luis Alberto Oliveira Dallan
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fabio Antonio Gaiotto
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Cesar Higa Nomura
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Paulo Rogério Soares
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - José Antonio Franchini Ramires
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Roberto Kalil Filho
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
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de Carvalho FPC, Hueb W, Lima EG, Filho JL, Ribeiro M, Martins E, Batista DV, Garzillo C, Boros GAB, Rezende P, Ribas FF, Serrano C, Ramires J, Kalil-Filho R. EFFECT OF MYOCARDIAL ISCHEMIA IN DIABETIC AND NON-DIABETIC PATIENTS: LONG-TERM FOLLOW-UP OF MASS REGISTRY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30736-1] [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: 10/24/2022]
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Ribeiro M, Hueb W, Rezende P, Rochitte C, Nomura C, Morais T, Lima EG, Boros G, Ribas FF, Carvalho FPC, Carvalho G, Serrano C, Ramires J, Kalil-Filho R. T1 MAPPING FOR MYOCARDIAL TISSUE EVALUATION IN PATIENTS WITH ISCHEMIA AND STABLE CORONARY ARTERY DISEASE: MASS V-TRIAL STUDY GROUP. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32310-x] [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: 11/25/2022]
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Moreira E, Garzillo C, Ayres S, Favarato D, Pitta F, Lima EG, Hueb W, Serrano C. CHARACTERIZATION, TREATMENT AND OUTCOMES OF PATIENTS WITH STABLE ISCHEMIC HEART DISEASE IN A TERTIARY-CARE CENTER IN BRAZIL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)34217-0] [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: 10/24/2022]
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Boros GAB, Hueb W, Rezende P, Nomura C, Rochitte C, Ribeiro M, Dallazen AR, Ribas FF, Morais T, Lima EG, Garzillo C, Serrano C, Ramires J, Kalil-Filho R. T1 MAPPING AND EXTRACELLULAR VOLUME FOR THE EVALUATION OF MYOCARDIAL INTERSTITIAL MATRIX IN DIABETIC AND NON-DIABETIC PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32314-7] [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: 11/29/2022]
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de Azevedo DFC, Hueb W, Lima EG, Rezende PC, Linhares Filho JPP, de Carvalho GF, Martins EB, Nomura CH, Strunz CMC, Serrano Junior CV, Ramires JAF, Kalil Filho R. Significant association of SYNTAX score on release of cardiac biomarkers in uncomplicated post-revascularization procedures among patients with stable multivessel disease: MASS-V Study group. Medicine (Baltimore) 2020; 99:e18973. [PMID: 32080075 PMCID: PMC7034737 DOI: 10.1097/md.0000000000018973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study investigated the relationship between angiographic complexities of coronary artery disease (CAD) assessed by SYNTAX Score synergy between percutaneous coronary intervention with taxus and cardiac surgery score (SYNTAX Score) and cardiac biomarker elevation after revascularization procedures.This is a post-hoc analysis of the medicine, angioplasty or surgery study V study of patients with stable CAD. High-sensitivity troponin 1 (hs-TnI) and creatinine kinase-muscle/brain (CK-MB) were assessed before and after cardiovascular procedures. Baselines SYNTAX Scores (SXScores) were calculated by blinded investigators to patient characteristics.Of the 202 patients studied, the mean SXScore was 21.25 ± 9.24; 40.10 ± 7.09 in the high SXScore group and 19.06 ± 6.61 in low/mid SXscore group (P < .0001). Positive correlations existed between SXScore and median peaks after procedural hs-TnI (r = 0.18, P = .009) and CK-MB (r = 0.24, P = .001) levels. In patients with high SXScores (≥33), the median peaks of post-procedural hs-TnI (P = .034)and CK-MB (P = .004) levels were higher than in low/mid SXScore group (<33).The release of hs-TnI at 6 (P = .002), 12 (P = .008), and 24 hours (P = .039) was higher in high SXScore group than in low/mid SXscore group (<33) as was the release of CK-MB at 6 (P < .0001), 12 (P < .0001), 24 (P = .001), 36 (P = .007), 48 (P = .008), and 72 hours (P = .023). After multivariable analysis, high SXScore was a significant independent predictor of release of CK-MB and hs-TnI peaks higher than the median.The increase in release of cardiac biomarkers was significantly associated with the extent of atherosclerosis identified by the SYNTAX Score.
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Rezende PC, Hlatky MA, Hueb W, Garcia RMR, da Silva Selistre L, Lima EG, Garzillo CL, Scudeler TL, Boros GAB, Ribas FF, Serrano CV, Ramires JAF, Kalil Filho R. Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease. JAMA Netw Open 2020; 3:e1919666. [PMID: 31968117 PMCID: PMC6991270 DOI: 10.1001/jamanetworkopen.2019.19666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Glycated hemoglobin (HbA1c) values are used to guide glycemic control, but in patients with type 2 diabetes and multivessel coronary artery disease (CAD), the association of the longitudinal values of HbA1c with cardiovascular outcomes is unclear. OBJECTIVE To assess whether longitudinal variation of HbA1c is associated with cardiovascular events in long-term follow-up among patients with diabetes and multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 888 patients with type 2 diabetes and multivessel CAD in the Medicine, Angioplasty, or Surgery Study (MASS) Registry of the Heart Institute of the University of São Paulo from January 2003 to December 2007. Data were analyzed from January 15, 2018, to October 15, 2019. EXPOSURE Longitudinal HbA1c values. MAIN OUTCOMES AND MEASURES The combined outcome of all-cause mortality, myocardial infarction, and ischemic stroke. RESULTS Of 888 patients with type 2 diabetes and multivessel CAD, 725 (81.6%; median [range] age, 62.4 [55.7-68.0] years; 467 [64.4%] men) had complete clinical and HbA1c information during a median (interquartile range) follow-up period of 10.0 (8.0-12.3) years, with a mean (SD) of 9.5 (3.8) HbA1c values for each patient. The composite end point of death, myocardial infarction, or ischemic stroke occurred in 262 patients (36.1%). A 1-point increase in the longitudinal value of HbA1c was significantly associated with a 14% higher risk of the combined end point of all-cause mortality, myocardial infarction, and ischemic stroke (hazard ratio, 1.14; 95% CI, 1.04-1.24; P = .002) in the unadjusted analysis. After adjusting for baseline factors (ie, age, sex, 2-vessel or 3-vessel CAD, initial CAD treatments, ejection fraction, and creatinine and low-density lipoprotein cholesterol levels), a 1-point increase in the longitudinal value of HbA1c was associated with a 22% higher risk of the combined end point (hazard ratio, 1.22; 95% CI, 1.12-1.35; P < .001). CONCLUSIONS AND RELEVANCE Longitudinal increase of HbA1c was independently associated with higher rates of cardiovascular events in patients with type 2 diabetes and multivessel CAD.
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rahmi Garcia
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eduardo Gomes Lima
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Andre Boeing Boros
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Garzillo CL, Rezende PC, Hueb W. Stress Testing and Risk Prediction in People With Known Symptomatic Multivessel Coronary Artery Disease-Reply. JAMA Intern Med 2020; 180:166-167. [PMID: 31904792 DOI: 10.1001/jamainternmed.2019.5857] [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]
Affiliation(s)
- Cibele Larrosa Garzillo
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 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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Garzillo CL, Hueb W, Gersh B, Rezende PC, Lima EG, Favarato D, Franchini Ramires JA, Kalil Filho R. Association Between Stress Testing-Induced Myocardial Ischemia and Clinical Events in Patients With Multivessel Coronary Artery Disease. JAMA Intern Med 2019; 179:1345-1351. [PMID: 31329221 PMCID: PMC6647357 DOI: 10.1001/jamainternmed.2019.2227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The long-term prognostic implications of myocardial ischemia documented during stress testing in patients with multivessel coronary artery disease (CAD) are unclear. OBJECTIVE To assess whether documented stress testing-induced myocardial ischemia is associated with major adverse cardiovascular events or ventricular function changes in patients with stable multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted using data from a single-center randomized clinical trial (Medicine, Angioplasty, or Surgery Study [MASS] II) to examine the association of myocardial ischemia documented during stress testing at baseline with cardiovascular events and ventricular function changes during follow-up. Participants were previously randomized (May 1, 1995, to May 31, 2000) to medical therapy, percutaneous coronary intervention with bare metal stents, or coronary artery bypass grafting. Event-free survival was estimated by the Kaplan-Meier method, and multivariable Cox regression models were calculated to assess the association between ischemia and the primary composite end point. The vital status was determined on February 28, 2011. Data were analyzed from February 1, 2016, to April 1, 2017. MAIN OUTCOMES AND MEASURES Cardiovascular events (overall mortality, myocardial infarction, and revascularization for refractory angina) were tracked from the time of randomization to the end of the 10-year follow-up (mean [SD] duration, 11.4 [4.3] years). Myocardial ischemia was assessed at baseline and at 1-year intervals by exercise stress testing, and ventricular function (left ventricular ejection fraction) was assessed by echocardiography at baseline and after 10 years. Patients with documented ischemia were compared with those without ischemia regarding the outcomes and changes in ventricular function. RESULTS Of 611 participants, 535 underwent exercise stress testing at baseline: 270 with documented ischemia and 265 without. Of these 535 patients, 373 (69.7%) were men, and the mean (SD) age for the entire cohort was 59.7 (9.2) years. No association was found between the presence of ischemia at baseline and survival free of combined cardiovascular events (hazard ratio, 1.00; 95% CI, 0.80-1.27; P = .95) after multivariable adjustment that included CAD initial randomized treatments. In addition, among 320 patients who underwent echocardiographic evaluation, the slight decline in left ventricular ejection fraction after 10 years was similar in both groups (median [SD] difference, -4.9% [18.7%] vs -6.6% [20.0%], respectively, for groups with and without ischemia; P = .97). CONCLUSIONS AND RELEVANCE In this study, regardless of the therapeutic strategy applied, the presence of documented myocardial ischemia did not appear to be associated with an increased occurrence of major adverse cardiovascular events or changes in ventricular function in patients with multivessel CAD during a long-term follow-up.
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Affiliation(s)
- Cibele Larrosa Garzillo
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bernard Gersh
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Desiderio Favarato
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Antônio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São 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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Mocha M, Ribeiro MOL, Carvalho GF, Filho JL, Lima E, Hueb W, Rezende P, Batista DV, Martins E, Azevedo DFC, Garzillo C, Ramires J, Kalil-Filho R. VERY LONG-TERM FOLLOW-UP OF DIABETIC PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING ANGIOPLASTY WITH CONVENTIONAL AND DRUG-ELUTING STENTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30745-4] [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: 11/25/2022]
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Martins E, Hueb W, Lima EG, Carvalho GF, Dallazen AR, Filho JL, Batista DV, Silva R, Azevedo DFC, Rezende P, Ramires J, Filho RK. APPLICATION OF SYNTAX SCORE I, II AND RESIDUAL SYNTAX AS PREDICTORS OF LONG-TERM CLINICAL OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30782-x] [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: 11/26/2022]
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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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Lima EG, Hueb W, Filho JL, Batista DV, Silva R, Martins E, Azevedo DFC, Rezende P, Ramires J, Kalil-Filho R. ALBUMINURIA AS A LONG-TERM PREDICTOR OF CARDIOVASCULAR EVENTS AMONG PATIENTS WITH DIABETES AND CORONARY ARTERY DISEASE: MASS REGISTRY INSIGHTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30788-0] [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: 11/28/2022]
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Abstract
Myocardial ischemia is considered the cornerstone of the treatment of patients with coronary artery disease (CAD). Although the deleterious effects of myocardial infarction, the maximum expression of ischemia, have been extensively studied and described, the clinical effects of chronic, documented myocardial ischemia are not completely clarified. The first studies that compared therapies for coronary disease focused on the presence of anatomical features and assessed ischemia based on the interpretation of the findings of obstructive atherosclerotic lesions. They suggested that revascularization interventions did not confer any clinical advantage over medical therapy (MT), in terms of cardiac or overall death. Other retrospective studies that were dedicated to assessing the impact of documented stress-induced ischemia on cardiovascular outcomes have suggested a prognostic impact of chronic ischemia. However, this has been questioned in recent studies. Moreover, the previous understanding that chronic ischemia could lead to worsening of ventricular function was not confirmed in a recent study. Thus, the prognostic significance of stress-induced ischemia has been questioned. Regarding treatment options, although some previous analyses have suggested that interventional therapies would reduce cardiovascular events in CAD patients with documented ischemia, recent post-hoc studies and metanalysis have shown distinct results. In this review article, the authors discuss myocardial ischemia, the different responses of the myocardium to ischemic insults, ischemic preconditioning, and the main findings of recent studies about the clinical aspects and treatment of patients with chronic, documented myocardial ischemia.
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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37
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Affiliation(s)
- Whady Hueb
- Instituto do Coração (InCor) Hospital das
Clínicas da Faculdade de Medicina da Universidade de São Paulo
(FMUSP), São Paulo, SP - Brazil
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38
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Abrantes RD, Hueb AC, Hueb W, Jatene FB. Behavior of Ultrasensitive C-Reactive Protein in Myocardial Revascularization with and without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2019; 33:535-541. [PMID: 30652741 PMCID: PMC6326455 DOI: 10.21470/1678-9741-2018-0235] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To analyze the inflammation resulting from myocardial revascularization
techniques with and without cardiopulmonary bypass, based on ultrasensitive
C-reactive protein (US-CRP) behavior. Methods A prospective non-randomized clinical study with 136 patients was performed.
Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery
bypass - ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary
artery bypass - OPCAB). All study participants had blood samples collected
for analysis of glucose, triglycerides, creatinine, total cholesterol,
high-density lipoprotein (HDL), low-density lipoprotein (LDL) and
creatinephosphokinase (CPK) in the preoperative period. The samples of
creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected
in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after
surgery. We also analyzed the preoperative biological variables of each
patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body
mass index, previous myocardial infarction, myocardial fibrosis). All
angiographically documented patients with >70% proximal multiarterial
stenosis and ischemia, documented by stress test or classification of stable
angina (class II or III), according to the Canadian Cardiovascular Society,
were included. Reoperations, combined surgeries, recent acute myocardial
infarction, recent inflammatory disease, deep venous thrombosis or recent
pulmonary thromboembolism, acute kidney injury or chronic kidney injury were
not included. Results Correlation values between the US-CRP curve and the ONCAB group, the
treatment effect and the analyzed biological variables did not present
expressive results. Laboratory variables were evaluated and did not
correlate with the applied treatment (P>0.05). Conclusion The changes in the US-CRP at each moment evaluated from the postoperative
period did not show any significance in relation to the surgical technique
applied.
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Affiliation(s)
- Rafael Diniz Abrantes
- Cardiovascular Surgery Division, Hospital das Clínicas Samuel Libânio (HCSL), Pouso Alegre, MG, Brazil
| | - Alexandre Ciappina Hueb
- Cardiovascular Surgery Division, Hospital das Clínicas Samuel Libânio (HCSL), Pouso Alegre, MG, Brazil.,Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Whady Hueb
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Esper RB, Farkouh ME, Ribeiro EE, Hueb W, Domanski M, Hamza TH, Siami FS, Godoy LC, Mathew V, French J, Fuster V. SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial. J Am Coll Cardiol 2018; 72:2826-2837. [DOI: 10.1016/j.jacc.2018.09.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
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Farkouh ME, Domanski M, Dangas GD, Godoy LC, Mack MJ, Siami FS, Hamza TH, Shah B, Stefanini GG, Sidhu MS, Tanguay JF, Ramanathan K, Sharma SK, French J, Hueb W, Cohen DJ, Fuster V. Long-Term Survival Following Multivessel Revascularization in Patients With Diabetes: The FREEDOM Follow-On Study. J Am Coll Cardiol 2018; 73:629-638. [PMID: 30428398 DOI: 10.1016/j.jacc.2018.11.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial demonstrated that for patients with diabetes mellitus (DM) and multivessel coronary disease (MVD), coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention with drug-eluting stents (PCI-DES) in reducing the rate of major adverse cardiovascular and cerebrovascular events after a median follow-up of 3.8 years. It is not known, however, whether CABG confers a survival benefit after an extended follow-up period. OBJECTIVES The purpose of this study was to evaluate the long-term survival of DM patients with MVD undergoing coronary revascularization in the FREEDOM trial. METHODS The FREEDOM trial randomized 1,900 patients with DM and MVD to undergo either PCI with sirolimus-eluting or paclitaxel-eluting stents or CABG on a background of optimal medical therapy. After completion of the trial, enrolling centers and patients were invited to participate in the FREEDOM Follow-On study. Survival was evaluated using Kaplan-Meier analysis, and Cox proportional hazards models were used for subgroup and multivariate analyses. RESULTS A total of 25 centers (of 140 original centers) agreed to participate in the FREEDOM Follow-On study and contributed a total of 943 patients (49.6% of the original cohort) with a median follow-up of 7.5 years (range 0 to 13.2 years). Of the 1,900 patients, there were 314 deaths during the entire follow-up period (204 deaths in the original trial and 110 deaths in the FREEDOM Follow-On). The all-cause mortality rate was significantly higher in the PCI-DES group than in the CABG group (24.3% [159 deaths] vs. 18.3% [112 deaths]; hazard ratio: 1.36; 95% confidence interval: 1.07 to 1.74; p = 0.01). Of the 943 patients with extended follow-up, the all-cause mortality rate was 23.7% (99 deaths) in the PCI-DES group and 18.7% (72 deaths) in the CABG group (hazard ratio: 1.32; 95% confidence interval: 0.97 to 1.78; p = 0.076). CONCLUSIONS In patients with DM and MVD, coronary revascularization with CABG leads to lower all-cause mortality than with PCI-DES in long-term follow-up. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).
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Affiliation(s)
- Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada.
| | | | - George D Dangas
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lucas C Godoy
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Flora S Siami
- New England Research Institutes, Watertown, Massachusetts
| | - Taye H Hamza
- New England Research Institutes, Watertown, Massachusetts
| | - Binita Shah
- VA New York Harbor Healthcare System, New York University School of Medicine, New York, New York
| | | | | | - Jean-François Tanguay
- Division of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Samin K Sharma
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John French
- Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Whady Hueb
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - David J Cohen
- Saint-Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Valentin Fuster
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
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Brandão SMG, Rezende PC, Rocca HPBL, Ju YT, de Lima ACP, Takiuti ME, Hueb W, Bocchi EA. Comparative cost-effectiveness of surgery, angioplasty, or medical therapy in patients with multivessel coronary artery disease: MASS II trial. Cost Eff Resour Alloc 2018; 16:55. [PMID: 30410425 PMCID: PMC6215652 DOI: 10.1186/s12962-018-0158-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background The costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD. Methods From May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Results Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. Conclusions At 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT.Trial registration ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876.
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Affiliation(s)
- Sara Michelly Gonçalves Brandão
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Paulo Cury Rezende
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Hans-Peter Brunner-La Rocca
- 2Heart Failure Clinic, Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yang Ting Ju
- 3Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, SP Brazil
| | | | - Myrthes Emy Takiuti
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Whady Hueb
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
| | - Edimar Alcides Bocchi
- 1Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Eneas de Carvalho Aguiar 44 - Cerqueira Cesar, São Paulo, SP CEP 05403-000 Brazil
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Hueb W, Rezende PC, Gersh BJ, Soares PR, Favarato D, Lima EG, Garzillo CL, Jatene FB, Ramires JAF, Filho RK. Ten-Year Follow-Up of Off-Pump and On-Pump Multivessel Coronary Artery Bypass Grafting: MASS III. Angiology 2018; 70:337-344. [PMID: 30286625 DOI: 10.1177/0003319718804402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It was a randomized trial, and 308 patients undergoing revascularization were randomly assigned: 155 to off-pump coronary artery bypass (OPCAB) and 153 to on-pump coronary artery bypass (ONCAB). End points were freedom from death, myocardial infarction, revascularization, and cerebrovascular accidents. The rates for 10-year, event-free survival for ONCAB versus OPCAB were 69.6% and 64%, (hazard ratio [HR]: 0.88; 95% confidence interval [CI] 0.86-1.02; P = .41), respectively. Adjusted Cox proportional hazard ratio was similar (HR: 0.92; 95% CI 0.61-1.38, P = .68). A difference occurred between the duration of OPCAB and ONCAB, respectively (4.9 ± 1.5 vs 6.6 ± 1.1 h, P < .001). Statistical differences occurred between OPCAB and ONCAB in the length of intensive care unit (ICU) stay (20 ± 2.5 vs 48 ± 10 hours, P < .001), time to extubation (5.5 ± 4.2 vs 10.2 ± 3.5 hours, P < .001), hospital stay (6.7 ± 1.4 vs 9.2 ± 1.3 days, P < .001), higher incidence of atrial fibrillation (AF; 33 vs 5 patients, P < .001), and blood requirements (46 vs 64 patients, P < .001). Grafts per patient was higher in ONCAB (3.15 vs 2.55 grafts, P < .001). No difference existed between the groups in primary composite end points at 10-year follow-up. Although OPCAB surgery was related to a lower number of grafts and higher incidence of AF, it had no effects related to long-term outcomes.
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Affiliation(s)
- Whady Hueb
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Cury Rezende
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paulo Rogério Soares
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Desidério Favarato
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Gomes Lima
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cibele Larrosa Garzillo
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Antonio Franchini Ramires
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- 1 Clinical Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Scudeler TL, Hueb W, De Soarez PC, Campolina AG, Hueb AC, Rezende PC, Lima EG, Garzillo CL, Ribas FF, Takiuti ME, Ramires JAF, Kalil Filho R. P2657Cost-effectiveness analysis of on-pump and off-pump coronary artery bypass grafting for patients with multivesselcoronary artery disease: a Markov model based on data from the MASS III trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2657] [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: 11/13/2022] Open
Affiliation(s)
- T L Scudeler
- 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
| | | | - A G Campolina
- University of Sao Paulo, Cancer Institute, Sao Paulo, Brazil
| | - A C Hueb
- 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
| | - E G Lima
- 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
| | - F F Ribas
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M E Takiuti
- 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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Batista DV, Hueb W, Linhares Filho JPP, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. 2363Impact of chronic kidney disease on diabetic patients with stable coronary disease undergoing surgery, angioplasty or medical treatment in a ten-year follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2363] [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)
- D V Batista
- 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 P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- 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
| | - E B Martins
- 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
| | - D F C Azevedo
- 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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Lima EG, Hueb W, Linhares Filho JPP, Batista DV, Rezende PC, Martins EB, Azevedo DFC, Garzillo CL, Ramires JAF, Kalil Filho R. P3591Very long-term follow-up of diabetic patients with coronary artery disease undergoing angioplasty with conventional and drug-eluting stents. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3591] [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: 11/13/2022] Open
Affiliation(s)
- E G Lima
- 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 P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- 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
| | - E B Martins
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- 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
| | - 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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46
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Martins EB, Hueb W, Silva RR, Linhares Filho JPP, Batista DV, Ribas FF, Rezende PC, Lima EG, Azevedo DFC, Ramires JAF, Kalil Filho R. P6361SYNTAX score and outcomes after coronary artery bypass grafting: a long-term follow-up analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6361] [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: 11/13/2022] Open
Affiliation(s)
- E B Martins
- 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
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - 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
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D F C Azevedo
- 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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47
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Silva RR, Lima EG, Batista DV, Linhares Filho JPP, Martins EB, Rezende PC, Garzillo CL, Ribas FF, Hueb W, Ramires JAF, Kalil Filho R. P2658Long-term analysis of ventricular functionin patients with stable coronary disease submitted to on-pump or off-pump coronary artery bypass graft in MASS III. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2658] [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)
- R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J P P Linhares Filho
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E B Martins
- 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
| | - C L Garzillo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F F Ribas
- 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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48
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Linhares Filho JPP, Hueb W, Batista DV, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. P2265Impact of glycated hemoglobin in diabetic patients with coronary artery disease undergoing surgery, angioplasty or clinical treatment in a very long-term follow-up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2265] [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: 11/13/2022] Open
Affiliation(s)
- J P P Linhares Filho
- 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
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- 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
| | - E B Martins
- 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
| | - D F C Azevedo
- 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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49
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Linhares Filho JPP, Hueb W, Batista DV, Silva RR, Lima EG, Rezende PC, Martins EB, Garzillo CL, Azevedo DFC, Ramires JAF, Kalil Filho R. 3270Prognostic evaluation of elevation of cardiac biomarkers after myocardial revascularization. Long-term follow-up of MASS-V trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3270] [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)
- J P P Linhares Filho
- 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
| | - D V Batista
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - R R Silva
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Lima
- 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
| | - E B Martins
- 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
| | - D F C Azevedo
- 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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50
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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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