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1.
Int. j. cardiovasc. sci. (Impr.) ; 36: e20210026, 2023. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1421774

ABSTRACT

Abstract This study presents a 47-year-old female patient, with a history of diabetes, who contracted SARS-CoV-2 and exhibited cardiovascular complications.

2.
Melo, Marcelo Dantas Tavares de; Paiva, Marcelo Goulart; Santos, Maria Verônica Câmara; Rochitte, Carlos Eduardo; Moreira, Valéria de Melo; Saleh, Mohamed Hassan; Soares, Brandão, Simone Cristina; Gallafrio, Claudia Cosentino; Goldwasser, Daniel; Gripp, Eliza de Almeida; Piveta, Rafael Bonafim; Silva, Tonnison Oliveira; Santo, Thais Harada Campos Espirito; Ferreira, Waldinai Pereira; Salemi, Vera Maria Cury; Cauduro, Sanderson A; Barberato, Silvio Henrique; Lopes, Heloísa M Christovam; Pena, José Luiz Barros; Rached, Heron Rhydan Saad; Miglioranza, Marcelo Haertel; Pinheiro, Aurélio Carvalho; Vrandecic, Bárbara Athayde Linhares Martins; Cruz, Cecilia Beatriz Bittencourt Viana; Nomura, César Higa; Cerbino, Fernanda Mello Erthal; Costa, Isabela Bispo Santos da Silva; Coelho-Filho, Otavio Rizzi; Carneiro, Adriano Camargo de Castro; Burgos, Ursula Maria Moreira Costa; Fernandes, Juliano Lara; Uellendahl, Marly; Calado, Eveline Barros; Senra, Tiago; Assunção, Bruna Leal; Freire, Claudia Maria Vilas; Martins, Cristiane Nunes; Sawamura, Karen Saori Shiraishi; Brito, Márcio Miranda; Jardim, Maria Fernanda Silva; Bernardes, Renata Junqueira Moll; Diógenes, Tereza Cristina; Vieira, Lucas de Oliveira; Mesquita, Claudio Tinoco; Lopes, Rafael Willain; Neto, Elry Medeiros Vieira Segundo; Rigo, Letícia; Marin, Valeska Leite Siqueira; Santos, Marcelo José; Grossman, Gabriel Blacher; Quagliato, Priscila Cestari; Alcantara, Monica Luiza de; Teodoro, José Aldo Ribeiro; Albricker, Ana Cristina Lopes; Barros, Fanilda Souto; Amaral, Salomon Israel do; Porto, Carmen Lúcia Lascasas; Barros, Marcio Vinícius Lins; Santos, Simone Nascimento dos; Cantisano, Armando Luís; Petisco, Ana Cláudia Gomes Pereira; Barbosa, José Eduardo Martins; Veloso, Orlando Carlos Glória; Spina, Salvador; Pignatelli, Ricardo; Hajjar, Ludhmilla Abrahão; Filho, Roberto Kalil; Lopes, Marcelo Antônio Cartaxo Queiroga; Vieira, Marcelo Luiz Campos; Almeida, André Luiz Cerqueira.
Arq. bras. cardiol ; 117(4): 845-909, Oct. 2021. graf, ilus, tab
Article in Portuguese | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1344557
3.
Arq Bras Cardiol ; 117(4): 845-909, 2021 10.
Article in English, Portuguese | MEDLINE | ID: mdl-34709307
4.
Int. j. cardiovasc. sci. (Impr.) ; 33(1): 57-64, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090642

ABSTRACT

Abstract Background: Although associated with traditional cardiovascular risk factors, it is unclear whether obesity alone is associated with coronary artery disease (CAD). Objective: To investigate the role of obesity as a risk factor for CAD, defined by coronary computed tomography angiography (CCTA). Methods: This study retrospectively included 1,814 patients referred for CCTA in a hospital in São Paulo, from August 2010 to July 2012. CAD was identified by coronary calcium score and presence of coronary stenosis > 50%. Images were analyzed by two specialists, and the coronary findings were compared between obese and non-obese groups. A multivariate analysis model was used to assess obesity as an independent variable for the occurrence of obstructive CAD. Results: Among the study population, mean age was 58.5 +/- 11.5 years, 22.8% were obese (BMI = 30 kg/m2) and 66.3% were male. The prevalence of obstructive CAD was 18.4% in both groups. Obese patients had higher median calcium score compared to non-obese subjects (14.7 vs. 1.4, respectively, p = 0.019). In the multivariate analysis, obesity was not an independent factor for obstructive CAD (coefficient = -0.035, p = 0.102). Conclusion: Although no differences were observed in the prevalence of obstructive CAD between obese and non-obese individuals, coronary calcium scores were significantly in lower the latter group.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/complications , Obesity/complications , Coronary Artery Disease/epidemiology , Body Mass Index , Calcium/blood , Prevalence , Retrospective Studies , Dyslipidemias , Computed Tomography Angiography/methods , Heart Disease Risk Factors
5.
ABC., imagem cardiovasc ; 33(3): eabc81, 2020. ilus, graf, tab
Article in English, Portuguese | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1401706

ABSTRACT

BACKGROUND: Coronary computed tomography angiography is a noninvasive anatomic test for the diagnosis of coronary artery disease. The coronary fractional flow reserve is the gold standard method to determine if coronary stenosis is hemodynamically significant but requires an invasive procedure. Fractional flow reserve measurement by tomography is a new method to determine the hemodynamic significance of coronary luminal reduction. OBJECTIVE: To compare the accuracy of the invasive fractional flow reserve with the fractional flow reserve measurement by tomography. METHOD: Patients submitted to invasive coronary computed tomography angiography and fractional flow reserve were included in the study. Flow-restricted stenosis was defined by fractional flow reserve measurement by tomography and fractional flow reserve ≤ 0.8, and anatomically significant coronary artery disease was defined as stenosis ≥ 50%. Diagnostic performance of fractional flow reserve measurement by tomography and stenosis by coronary computed tomography angiography was accessed with invasive fractional flow reserve as the gold standard. RESULTS: Among the patients, 33% had fractional flow reserve ≤0.8. There was no significant difference between the fractional flow reserve measurement by tomography and fractional flow reserve averages (0.87 versus 0.84; p = 0.4). The correlation between the values of the methods was r = 0.77, and concordance was moderate (k = 0.54). When fractional flow reserve ≤ 0.75 was analyzed, the concordance between the methods was absolute. The sensitivity, specificity, positive predictive value and negative predictive value of fractional flow reserve measurement by tomography were, respectively, 50%, 100%, 100% and 75%, for the threshold of 0.8. The mean difference between fractional flow reserve and fractional flow reserve measurement by tomography was -0.033 (95%CI -0.072-0.007), with concordance limits between -0.176 and -0.1111. CONCLUSION: Fractional flow reserve measurement by tomography is a new method with high diagnostic performance in the detection of hemodynamically significant coronary stenoses and significantly elevates the specificity of the isolated coronary computed tomography angiography.


FUNDAMENTO: A angiotomografia de coronárias é um teste anatômico não invasivo para diagnóstico de doença arterial coronariana. A reserva de fluxo fracionado coronariano é o método padrão-ouro para determinar se a estenose coronariana é hemodinamicamente significativa e requer procedimento invasivo. A mensuração da reserva de fluxo fracionado por tomografia é um novo método para determinar a significância hemodinâmica da redução luminal coronária. OBJETIVO: Comparar a acurácia da reserva de fluxo fracionado invasiva com a reserva de fluxo fracionado por tomografia. MÉTODO: Pacientes submetidos à angiotomografia de coronárias e à reserva de fluxo fracionado invasiva foram incluídos neste estudo. Estenose com limitação de fluxo foi definida por reserva de fluxo fracionado por tomografia e reserva de fluxo fracionado ≤ 0,8. Doença arterial coronariana anatomicamente significativa foi definida por estenose ≥ 50%. O desempenho da reserva de fluxo fracionado por tomografia e da estenose pela angiotomografia de coronárias foi acessado com a reserva de fluxo fracionado invasiva como padrão-ouro. RESULTADOS: Dentre os pacientes, 33% tinham reserva de fluxo fracionado ≤ 0,8. Não houve diferença significativa entre as médias de reserva de fluxo fracionado por tomografia e reserva de fluxo fracionado (0,87 versus 0,84; p=0,4). A correlação entre os valores dos métodos foi r = 0,77, com concordância moderada (k=0,54). Quando analisada a reserva de fluxo fracionado ≤ 0,75, a concordância entre os métodos foi absoluta. Sensibilidade, especificidade, valor preditivo positivo e negativo da reserva de fluxo fracionado por tomografia foram, respectivamente, 50%, 100%, 100% e 75%, para o limiar de 0,8. A média da diferença entre reserva de fluxo fracionado e reserva de fluxo fracionado por tomografia foi de -0,033 (IC95% -0,072-0,007), com limites de concordância entre -0,176 e -0,111. CONCLUSÃO: A reserva de fluxo fracionado por tomografia é um novo método, com alto desempenho diagnóstico na detecção de estenoses coronárias hemodinamicamente significativas, e eleva significativamente a especificidade da angiotomografia de coronárias isolada.


Subject(s)
Coronary Artery Disease , Computed Tomography Angiography , Myocardial Ischemia
6.
J Comput Assist Tomogr ; 42(1): 45-53, 2018.
Article in English | MEDLINE | ID: mdl-28448411

ABSTRACT

OBJECTIVE: The aim of this study was to compare image quality and radiation dose of coronary computed tomography (CT) angiography performed with dual-source CT scanner using 2 different protocols in patients with atrial fibrillation. METHODS: Forty-seven patients with AF underwent 2 different acquisition protocols: double high-pitch (DHP) spiral acquisition and retrospective spiral acquisition. The image quality was ranked according to a qualitative score by 2 experts: 1, no evident motion; 2, minimal motion not influencing coronary artery luminal evaluation; and 3, motion with impaired luminal evaluation. A third expert solved any disagreement. RESULTS: A total of 732 segments were evaluated. The DHP group (24 patients, 374 segments) showed more segments classified as score 1 than the retrospective spiral acquisition group (71.3% vs 37.4%). Image quality evaluation agreement was high between observers (κ = 0.8). There was significantly lower radiation exposure for the DHP group (3.65 [1.29] vs 23.57 [10.32] mSv). CONCLUSIONS: In this original direct comparison, a DHP spiral protocol for coronary CT angiography acquisition in patients with atrial fibrillation resulted in lower radiation exposure and superior image quality compared with conventional spiral retrospective acquisition.


Subject(s)
Atrial Fibrillation/diagnostic imaging , Computed Tomography Angiography/methods , Coronary Angiography/methods , Tomography, Spiral Computed/methods , Aged , Cardiac-Gated Imaging Techniques , Female , Humans , Male , Radiation Exposure , Radiographic Image Interpretation, Computer-Assisted
7.
Arq. bras. cardiol ; 101(6): 562-569, dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-701273

ABSTRACT

A angiotomografia de coronárias emergiu recentemente como uma ferramenta diagnóstica acurada na avaliação da doença arterial coronariana, fornecendo dados diagnósticos e prognósticos que se correlacionam diretamente com os dados fornecidos pela cineangiocoronariografia. Com a evolução tecnológica, permitindo melhora na resolução temporal, espacial, melhor cobertura do volume cardíaco com redução significativa da dose de radiação, somada à necessidade de protocolos de estratificação de risco mais efetivos para pacientes com dor torácica no pronto-socorro, sua aplicação passou a ser testada no cenário da dor torácica aguda, já que cerca de dois terços das angiografias coronarianas invasivas não demonstram doença coronariana obstrutiva significativa. Na prática diária, sem o uso de tecnologias mais eficientes, como a angiotomografia de coronárias, permanece um desafio ao médico do setor de emergência a estratificação segura e eficiente do paciente com dor torácica aguda. Recentemente, vários estudos, incluindo três randomizados, mostraram resultados favoráveis ao uso dessa tecnologia no pronto-socorro para pacientes com baixa a intermediária probabilidade de doença arterial coronariana. Nesta revisão, apresentamos os dados do uso da angiotomografia de coronárias na estratificação de risco de pacientes com dor torácica na sala de emergência, o seu valor diagnóstico, prognóstico e custo-efetividade e uma análise crítica dos recentes estudos multicêntricos publicados.


The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.


Subject(s)
Female , Humans , Middle Aged , Chest Pain/diagnosis , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Tomography, X-Ray Computed/methods , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/economics , Cost-Benefit Analysis , Chest Pain/economics , Coronary Angiography/economics , Coronary Artery Disease/economics , Emergency Service, Hospital , Multicenter Studies as Topic , Myocardial Revascularization , Prognosis , Risk Assessment , Risk Factors
8.
Arq Bras Cardiol ; 101(6): 562-9, 2013 Dec.
Article in English, Portuguese | MEDLINE | ID: mdl-24145392

ABSTRACT

The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.


Subject(s)
Chest Pain/diagnosis , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Tomography, X-Ray Computed/methods , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/economics , Chest Pain/economics , Coronary Angiography/economics , Coronary Artery Disease/economics , Cost-Benefit Analysis , Emergency Service, Hospital , Female , Humans , Middle Aged , Multicenter Studies as Topic , Myocardial Revascularization , Prognosis , Risk Assessment , Risk Factors
9.
In. Sousa, Amanda GMR; Piegas, Leopoldo S; Sousa, J Eduardo MR. Nova Série Monografias Dante Pazzanese Fundação Adib Jatene 2009. Rio de Janeiro, Elsevier, 2009. p.7-86. (Nova Série Monografias Dante Pazzanese Fundação Adib Jatene).
Monography in Portuguese | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1072987

ABSTRACT

Em decorrência da maior expectativa de vida e do aumento progressivo do número de idosos na população geral, as doenças degenerativas se tornam cada vez mais frequentes. Dentre elas, a doença valvar aórtica merece especial atenção, por ter elevada prevalência e por representar geralmente mau prognóstico para o paciente que apresenta sua forma avançada. Até alguns anos atrás, o único tratamento disponível para tal doença era cirúrgico, reservado basicamente para aqueles com risco pré-operatório médio ou baixo. Em 2002, o primeiro implante percutâneo de prótese valvar aórtica em humanos constituiu, sem dúvida, um dos maiores avanços na área da cardiologia dos últimos tempos, estabelecendo-se como opção terapêuticapara pacientes antes considerados "incuráveis". Inicialmente testados em pacientes com mau prognóstico e pobre expectativa de vida, os trabalhos mais recentes demonstraram resultados comparáveis com o tradicional procedimento de correção cirúrgica, criando, assim, um campo novo dentro da cardiologia. Esta monografia apresenta, de forma reduzida, os aspectos mais relevantes da evolução dessas novas técnicas e relata um breve histórico desde os primeiros implantes até a última série de casos, revelando as indicações e contraindicações do procedimento e comparando-as com aquelas da cirurgia. Também são descritas as técnicas , os dispositivos atualmente disponíveis, os resultados obtidos atualmente disponíveis, os resultados obtidos até o momento e a evolução dos pacientes tratados. Ainda com grande potencial de desenvolvimento, o campo da abordagem percutânea das valvopatias continua sua busca pelo procedimento ideal para o tratamento dessas doenças.


Subject(s)
Cardiology , Prosthesis Implantation , Heart Valve Prosthesis , Aortic Valve
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