94 results on '"José Rodrigues Parga"'
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2. Performance Diagnóstica da FFR por Angiotomografia de Coronárias através de Software Baseado em Inteligência Artificial
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Thamara Carvalho Morais, Antonildes Nascimento Assunção-Jr, Roberto Nery Dantas Júnior, Carla Franco Grego da Silva, Caroline Bastida de Paula, Roberto Almeida Torres, Tiago Augusto Magalhães, César Higa Nomura, Luiz Francisco Rodrigues de Ávila, and José Rodrigues Parga Filho
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Reserva Fracionada de Fluxo Miocárdico ,Doença Arterial Coronariana ,Tomografia Computadorizada ,Isquemia Miocárdica ,Aprendizado de Máquina ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Resumo Fundamento A quantificação não invasiva da reserva fracionada de fluxo miocárdico (FFR TC ) através de software baseado em inteligência artificial em versão mais atualizada e tomógrafo de última geração (384 cortes) apresenta elevada performance na detecção de isquemia coronariana. Objetivos Avaliar o desempenho diagnóstico da FFR TC na detecção de doença arterial coronariana (DAC) significativa em relação ao FFRi, em tomógrafos de gerações anteriores (128 e 256 cortes). Métodos Estudo retrospectivo com pacientes encaminhados à angiotomografia de artérias coronárias (TCC) e cateterismo (FFRi). Foram utilizados os tomógrafos Siemens Somatom Definition Flash (256 cortes) e AS+ (128 cortes). A FFR TC e a área luminal mínima (ALM) foram avaliadas em software (cFFR versão 3.0.0, Siemens Healthineers, Forchheim, Alemanha). DAC obstrutiva foi definida como TCC com redução luminal ≥50% e DAC funcionalmente obstrutiva como FFRi ≤0,8. Todos os valores de p reportados são bicaudais; e quando
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- 2021
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3. Evaluation of Myocardial Perfusion by Computed Tomography - Principles, Technical Background and Recommendations
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Tiago Augusto Magalhães, Roberto Caldeira Cury, Rodrigo Julio Cerci, José Rodrigues Parga Filho, Ilan Gottlieb, Marcelo Souto Nacif, Ibraim Masciarelli Pinto, Carlos Eduardo Rochitte, Fabio Vilas-Boas, and Paulo R. Schvartzman
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Computed Tomography Angiography/methods ,Myocardial Perfusion Imaging/methods ,Coronary Artery Disease ,Dipyridamole ,Adenosine ,Vasodilatation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Coronary computed tomography angiography (CCTA) has gained a prominent role in the evaluation of coronary artery disease. However, its anatomical nature does not allow the evaluation of the functional repercussion of coronary obstructions. It has been made possible to evaluate Myocardial computed tomography perfusion (Myocardial CTP) recently, based on myocardial contrast changes related to coronary stenoses. Several studies have validated this technique against the anatomical reference method (cardiac catheterization) and other functional methods, including myocardial perfusion scintigraphy and fractional flow reserve. The Myocardial CTP is performed in conjunction with the CCTA, a combined analysis of anatomy and function. The stress phase (with assessment of myocardial perfusion) can be performed before or after the resting phase (assessment of resting perfusion and coronary arteries), and different acquisition parameters are proposed according to the protocol and type of equipment used. Stressors used are based on coronary vasodilation (e.g. dipyridamole, adenosine). Image interpretation, similar to other perfusion assessment methods, is based on the identification and quantification of myocardial perfusion defects. The integration of both perfusion and anatomical findings is fundamental for the examination interpretation algorithm, allowing to define if the stenoses identified are hemodynamically significant and may be related to myocardial ischemia.
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- 2019
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4. II Diretriz de Ressonância Magnética e Tomografia Computadorizada Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia
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Leonardo Sara, Gilberto Szarf, Adriano Tachibana, Afonso Akio Shiozaki, Alexandre Volney Villa, Amarino Carvalho de Oliveira, Andrei Skromov de Albuquerque, Carlos Eduardo Rochitte, César Higa Nomura, Clerio Francisco Azevedo, Dany Jasinowodolinski, Eduardo Marinho Tassi, Fabio de Morais Medeiros, Fernando Uliana Kay, Flávia Pegado Junqueira, Guilherme S. A. Azevedo, Guilherme Urpia Monte, Ibraim Masciarelli Francisco Pinto, Ilan Gottlieb, Joalbo Andrade, João A. C. Lima, José Rodrigues Parga Filho, Juliana Kelendjian, Juliano Lara Fernandes, Leonardo Iquizli, Luis C. L. Correia, Luiz Augusto Quaglia, Luiz Flavio Galvão Gonçalves, Luiz Francisco Ávila, Marcello Zapparoli, Marcelo Hadlich, Marcelo Souto Nacif, Márcia de Melo Barbosa, Márcio Hiroshi Minami, Marcio Sommer Bittencourt, Maria Helena Albernaz Siqueira, Marly Conceição Silva, Marly Maria Uellendahl Lopes, Mateus Diniz Marques, Mônica La Rocca Vieira, Otávio Rizzi Coellho Filho, Paulo R. Schvartzman, Raul D. Santos, Ricardo C. Cury, Ricardo Loureiro, Roberto Caldeira Cury, Roberto Sasdelli Neto, Robson Macedo, Rodrigo Julio Cerci, Rui Alberto de Faria Filho, Sávio Cardoso, Thiago Naves, Tiago Augusto Magalhães, Tiago Senra, Ursula Maria Moreira Costa Burgos, Valéria de Melo Moreira, and Walther Yoshiharu Ishikawa
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2014
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5. Diagnóstico incidental tardio de teratoma intrapericárdico – relato de caso
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Annelisa Moura Garcia, Roberto Nery Dantas Junior, Chang Kai Chi, and José Rodrigues Parga
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Resumo: Descrevemos um caso de teratoma intrapericárdico, tumor cardíaco primário raro, usualmente encontrado em neonatos e lactentes. O teratoma pode causar insuficiência respiratória, grande acúmulo de líquido pericárdico e compressão cardíaca, levando à morte no período intrauterino ou neonatal. O presente caso é raro, pois se trata de uma jovem de 16 anos, assintomática, portadora de tumor intrapericárdico em achado ecocardiográfico. As características à ressonância magnética cardíaca sugeriram cisto pericárdico complexo. Ela foi submetida à cirurgia para retirada do tumor e o diagnóstico de teratoma foi firmado pelo estudo histopatológico. O acompanhamento clínico mostrou‐se de boa evolução. Abstract: We report a case of intrapericardial teratoma, which is a rare primary cardiac tumor usually found in newborns and infants. Cardiac teratomas can cause respiratory failure, large accumulations of pericardial fluid and cardiac compression leading to death in the intrauterine or neonatal period. The case described is rare because it is of a 16‐year‐old asymptomatic girl with an intrapericardial tumor as an incidental echocardiographic finding. Cardiac magnetic resonance imaging showed a complex pericardial cyst. Due to the potential for malignant evolution, she was referred for surgery to remove the tumor and a diagnosis of teratoma was confirmed by histopathology. Clinical follow‐up had a good outcome. Palavras‐chave: Cisto mediastínico, Teratoma, Pericárdio, Imagem em ressonância magnética, Keywords: Mediastinal cyst, Teratoma, Pericardium, Magnetic resonance imaging
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- 2017
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6. Perfusão miocárdica dinâmica por tomografia computadorizada de dupla fonte de raio X
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José Rodrigues Parga Filho, Cintia Souza Lima Moraes Lima, Felipe Gallego Lima, Tiago da Silveira Jaques, Luiz Francisco Rodrigues de Ávila, and Roberto Kalil Filho
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Reperfusión miocárdica ,tomografía computarizada ,enfermedad de las coronarias ,evaluación ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Relatamos caso de perfusão dinâmica e quantitativa pela tomografia computadorizada de múltiplos detectores de dupla fonte de Raio X em um paciente de 44 anos, com diagnóstico prévio de doença coronariana. A tomografia demonstrou quantitativamente déficit de perfusão miocárdica nos territórios irrigados por artérias com estenoses significativas confirmadas pela angiotomografia e pela cineangiocoronariografia. A tomografia computadorizada com dupla fonte de Raio X permitiu a avaliação dinâmica perfusional e anatômica, em um único estudo, durante o controle evolutivo desse paciente.
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- 2012
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7. Avaliação do metabolismo dos fosfatos de alta energia em pacientes com doença de Chagas Evaluation of the metabolism of high energy phosphates in patients with Chagas' disease
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Ana Maria Betim Paes Leme, Vera Maria Cury Salemi, José Rodrigues Parga, Bárbara Maria Ianni, Charles Mady, Robert G. Weiss, and Roberto Kalil-Filho
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Metabolismo energético ,doença de Chagas ,cardiomiopatia chagásica ,Energy metabolism ,Chagas' disease ,chagas cardiomyopathy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: Anormalidades do metabolismo miocárdico têm sido observadas em pacientes com insuficiência cardíaca de diferentes etiologias. A espectroscopia por ressonância magnética (ERM) com fósforo 31 é uma técnica não invasiva que permite a detecção de alterações metabólicas miocárdicas. OBJETIVO: Determinar o metabolismo de repouso dos fosfatos de alta energia em pacientes portadores de doença de Chagas (DC) pela ERM com fósforo 31. MÉTODOS: Foram estudados 39 pacientes com DC, sendo 23 com função ventricular preservada (Grupo FP) e 16 com disfunção ventricular (Grupo DV), avaliados pela ecodopplercardiografia. A ERM da região anterosseptal foi realizada nos 39 pacientes e em 8 indivíduos normais (Grupo C), por meio de um aparelho Phillips de 1,5 Tesla, obtendo-se a relação fosfocreatina/trifosfato de adenosina beta (PCr/β-ATP) miocárdicos. RESULTADOS: Os níveis cardíacos de PCr/β-ATP estavam reduzidos no Grupo DV em relação ao Grupo FP, e estes apresentaram níveis reduzidos em relação ao Grupo C (Grupo DV: 0,89 ± 0,31 vs Grupo FP: 1,47 ± 0,34 vs Grupo C: 1,88 ± 0,08, p < 0,001). Houve correlação entre a fração de ejeção do ventrículo esquerdo e a PCr/β-ATP nos 39 pacientes estudados (r = 0,64, p < 0,001). Os pacientes em classe funcional I (n = 22) apresentaram PCr/β-ATP de 1,45 ± 0,35, e aqueles em classes funcionais II e III (n = 17), PCr/β-ATP de 0,94 ± 0,36 (p < 0,001). CONCLUSÃO: A ERM permitiu detectar de forma não invasiva alterações no metabolismo energético em pacientes com DC, mesmo sem disfunção sistólica; tais alterações estavam relacionadas com a gravidade do comprometimento cardíaco.BACKGROUND: Abnormalities in myocardial metabolism have been observed in patients with heart failure of different etiologies. Magnetic resonance spectroscopy (MRS) with phosphorus-31 is a noninvasive technique that allows detection of myocardial metabolic changes. OBJECTIVE: To determine the resting metabolism of high-energy phosphates in patients with Chagas' disease (CD) by MRS with phosphorus-31. METHODS: We studied 39 patients with CD, 23 with preserved ventricular function (PF Group) and 16 with ventricular dysfunction (VD Group), assessed by Doppler echocardiography. MRS of the anterosseptal region was performed in 39 patients and 8 normal subjects (C Group) through a Phillips 1.5 Tesla device, obtaining the phosphocreatine/beta-adenosine triphosphate myocardial ratio (PCr/β-ATP). RESULTS: The levels of cardiac PCr/β-ATP were reduced in VD Group in relation to PF Group, and the latter presented reduced levels compared to C Group (VD Group: 0.89 ± 0.31 vs PF Group: 1.47 ± 0.34 vs C Group: 1.88 ± 0.08, p < 0.001). A correlation was found between left ventricular ejection fraction and PCr/β-ATP in 39 patients (r = 0.64, p < 0.001). Patients under functional class I (n = 22) presented PCr/β-ATP of 1.45 ± 0.35, and those in functional classes II and III (n = 17), PCr/β-ATP of 0.94 ± 0.36 (p < 0.001). CONCLUSION: The 31-phosphorus MRS was able to detect non-invasively changes in the rest energy metabolism of patients with Chagas' disease, with and without systolic dysfunction. These changes were related to the severity of heart impairment.
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- 2010
8. Realce tardio e perfusão miocárdica em cardiomiopatia hipertrófica (comparação entre grupos) Realce tardío y perfusión miocárdica en cardiomiopatía hipertrófica (comparación entre grupos) Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison betw een groups)
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Clarissa Almeida Sarmento Barbosa, Cláudio Campi de Castro, Luiz Francisco Rodrigues de Ávila, José Rodrigues Parga Filho, Domingos Mohanad Hattem, and Edmundo Arteaga Fernandez
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Perfusión miocárdica ,cardiomiopatía hipertrófica ,estudio comparativo ,imagen de resonancia magnética ,Perfusão miocárdica ,cardiomiopatia hipertrófica ,estudo comparativo ,imagem de ressonância magnética ,Myocardial perfusion ,hypertrophic cardiomyopathy ,comparative study ,resonance imaging ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: A ressonância magnética é um método eficaz para estudo da cardiomiopatia hipertrófica. OBJETIVO: Avaliar, pela ressonância magnética, os parâmetros de função sistólica, perfusão e viabilidade miocárdica em pacientes portadores de cardiomiopatia hipertrófica, comparando os grupos com e sem obstrução na via de saída do ventrículo esquerdo. MÉTODO: Vinte e um pacientes com diagnóstico de cardiomiopatia hipertrófica realizaram estudos de função, viabilidade e perfusão miocárdica nas fases de estresse e de repouso pela ressonância magnética. RESULTADOS: Os segmentos ventriculares mais comprometidos pela hipertrofia foram os da região septal. O grupo obstrutivo apresentou distribuição segmentar de espessura miocárdica semelhante ao não-obstrutivo, porém com maiores médias que o primeiro grupo. A média da fração de ejeção dos pacientes do grupo obstrutivo foi maior que o grupo não-obstrutivo, enquanto as médias dos volumes sistólico e diastólico finais foram menores no grupo obstrutivo. Houve correlação positiva entre a espessura segmentar do ventrículo e a massa segmentar do realce tardio. A indução de estresse determinou aumento do número de segmentos com alteração de perfusão e essa alteração foi mais evidente no grupo obstrutivo. CONCLUSÃO: Os segmentos ventriculares com maior espessura são os septais. As regiões hipertróficas estão associadas à maior extensão de realce tardio. Houve correlação positiva entre as áreas de hipertrofia ventricular e perfusão miocárdica alterada, e esses achados foram mais evidentes no grupo obstrutivo.FUNDAMENTO: La resonancia magnética es un método eficaz para estudio de la cardiomiopatía hipertrófica. OBJETIVO: Evaluar, por la resonancia magnética, los parámetros de función sistólica, perfusión y viabilidad miocárdica en pacientes portadores de cardiomiopatía hipertrófica, comparando los grupos con y sin obstrucción en la vía de salida del ventrículo izquierdo. MÉTODO: Veinte y un pacientes con diagnóstico de cardiomiopatía hipertrófica realizaron estudios de función, viabilidad y perfusión miocárdica en las fases de estrés y de reposo por la resonancia magnética. RESULTADOS: Los segmentos ventriculares más comprometidos por la hipertrofia fueron los de la región septal. El grupo obstructivo presentó distribución segmental de espesor miocárdico semejante al no obstructivo, pero con mayores promedios que el primer grupo. El promedio de la fracción de eyección de los pacientes del grupo obstructivo fue mayor que el grupo no obstructivo, mientras que los promedios de los volúmenes sistólico y diastólico finales se hallaron menores en el grupo obstructivo. Hubo correlación positiva entre el espesor de los segmentos del ventrículo y la masa segmental del realce tardío. La inducción de estrés determinó aumento del número de segmentos con alteración de perfusión, y esa alteración fue más evidente en el grupo obstructivo. CONCLUSIÓN: Los segmentos ventriculares con mayor espesor son los septales. Las regiones hipertróficas están asociadas a la mayor extensión de realce tardío. Hubo correlación positiva entre las áreas de hipertrofia ventricular y perfusión miocárdica alterada, y estos hallazgos fueron más evidentes en el grupo obstructivo.BACKGROUND: The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE: To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS: Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS: The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION: The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.
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- 2009
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9. Ressonância magnética vs cintilografia com pirofosfato marcado com tecnécio-99m para a detecção de necrose miocárdica perioperatória Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis
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Guilherme Urpia Monte, Luciano Ferreira Drager, Fábio Solano de Freitas Souza, Luiz Francisco Rodrigues de Ávila, José Rodrigues Parga Filho, Luiz Antônio Machado César, Marisa Izaki, José Cláudio Meneghetti, Carlos Eduardo Rochitte, and Roberto Kalil Filho
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Estudo comparativo ,imagem por ressonância magnética ,miocárdio ,pirofosfato de Tecnécio Tc 99 m ,infarto do miocárdio ,revascularização miocárdica ,Comparative studies ,magnetic resonance imaging ,myocardial ,technetium Tc99m pyrophosphate ,myocardial infarction ,myocardial revascularization ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: O infarto do miocárdio perioperatório (IMPO) é uma complicação da cirurgia de revascularização miocárdica (CRM) com potencial impacto prognóstico. A cintilografia miocárdica (CM) com pirofosfato marcado com tecnécio-99m é utilizada no diagnóstico de IMPO, mas demonstra limitada sensibilidade para lesões subendocárdicas. A ressonância magnética cardiovascular (RMC), por sua vez, detém alta acurácia para a detecção de necrose miocárdica. OBJETIVO: Comparar a RMC e a CM para a detecção de IMPO após CRM. MÉTODOS: Foram estudados 24 pacientes portadores de doença arterial coronária crônica, com a técnica de realce tardio pela RMC e com a CM, antes e depois da CRM, analisando-se o surgimento de áreas de necrose miocárdica perioperatória (IMPO). Mensuraram-se também marcadores bioquímicos de lesão miocárdica (CKMB e troponina I), antes e depois da cirurgia. RESULTADOS: Dezenove pacientes completaram o estudo. Desses, 6 (32%) apresentaram IMPO à RMC, e 4 (21%) à CM (p = NS). Dos 323 segmentos do ventrículo esquerdo avaliados, 17 (5,3%) exibiram necrose perioperatória à RMC, e 7 (2,2%) à CM (p = 0,013). Observou-se moderada concordância entre os métodos (kappa = 0,46), havendo divergência, quanto ao diagnóstico de IMPO, em 4 (21%) casos, a maioria com pequenas áreas de necrose perioperatória à RMC, não visualizadas à CM. Em todos os casos com IMPO à RMC, houve elevação significativa de CKMB e troponina I. CONCLUSÃO: Houve moderada concordância diagnóstica entre os métodos para a detecção de IMPO, mas a RMC permitiu a visualização de pequenas áreas de necrose miocárdica perioperatória, não identificadas pela CM e associadas à elevação de marcadores bioquímicos de lesão miocárdica.BACKGROUND: Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis. OBJECTIVE: To compare CMRI and MS for the detection of POMI after CABG. METHODS: A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery. RESULTS: Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed. CONCLUSION: Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.
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- 2008
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10. Ressonância magnética cardiovascular na cardiomiopatia hipertrófica Cardiovascular magnetic resonance in hypertrophic cardiomyopathy
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Afonso Akio Shiozaki, Raymond J. Kim, José Rodrigues Parga, Eduardo Marinho Tassi, Edmundo Arteaga, and Carlos Eduardo Rochitte
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Cardiomiopatia hipertrófica ,ressonância magnética ,diagnóstico ,prognóstico ,Hypertrophic cardiomyopathy ,magnetic resonance ,diagnosis ,prognosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2007
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11. I Diretriz de Ressonância e Tomografia Cardiovascular da Sociedade Brasileira de Cardiologia Sumário Executivo
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César Augusto Mastrofrancisco Cattani, Dany Jasinowodolinsk, Fabiano Lucchesi, Fábio Berezowsky Rocha, Fátima Cristina Pedroti, Gilberto Szarf, Guilherme Urpia Monte, Iugiro Roberto Kuroki, Joalbo Andrade, José Rodrigues Parga Filho, Luis Cláudio Correia, Luiz Francisco Ávila, Marcelo Hadlich, Marcelo Zapparoli, Marcia Barbosa, Márcia Lima Mugnaini, Maria Helena Albernaz Siqueira, Marly Maria Uellendhal, Miguel Abraão Rosário Neto, Paulo R. Schwarzman, Raul Dias dos Santos Filho, Ricardo Loureiro, Roberto Kalil Filho, and Robson de Macedo Vieira
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Imagem por ressonância magnética ,tomografia ,técnicas de diagnóstico cardiovascular ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2006
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12. Valvopatia aórtica crônica grave sintomática: estudo comparado da ressonância magnética cardíaca e ecocardiografia
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Marcelo Nigri, Carlos Eduardo Rochitte, Flávio Tarasoutchi, Guilherme S Spina, José Rodrigues Parga, Luiz Francisco Ávila, Roney Orismar Sampaio, José Antonio Franchini Ramires, and Max Grinberg
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valvopatia aórtica ,ressonância magnética cardíaca ,ecocardiograma ,classe funcional ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: Mostrar o real valor da ressonância magnética cardíaca (RMC) na avaliação dos portadores de valvopatia aórtica crônica sintomática. MÉTODOS: Foram estudados 70 pacientes, 35 com estenose aórtica (EAo) e 35 com insuficiência aórtica (IAo), com indicação cirúrgica, que realizaram ecocardiograma (ECO) e RMC pré-operatórios para avaliação da função ventricular, volumes e índice de massa ventricular esquerda por meio da cinerressonância. RESULTADOS: Quando comparadas as variáveis do ECO e da RMC, nos grupos da EAo e da IAo não houve diferença estatística entre os dois métodos. Quando comparadas com o tipo de sintoma, as variáveis pelo ECO e pela RMC apresentam o mesmo comportamento. CONCLUSÃO: A RMC apresentou concordância com o ECO na avaliação do volume ventricular esquerdo e fração de ejeção e com a clínica dos pacientes com valvopatia aórtica crônica.
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- 2006
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13. Análise da função ventricular de pacientes com doença pulmonar obstrutiva crônica avançada pela ressonância magnética Assessment of the ventricular function of patients with advanced chronic obstructive pulmonary disease by using magnetic resonance imaging
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Nazareth de Novaes Rocha, Rafael Stelmach, Alberto Cukier, José Rodrigues Parga, Luiz Francisco Ávila, Márcia Caldas, Paula Buck, and Charles Mady
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doença pulmonar obstrutiva crônica ,função ventricular ,ressonância magnética ,chronic obstructive pulmonary disease ,ventricular function ,magnetic resonance imaging ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: Avaliar os possíveis mecanismos envolvidos na evolução da disfunção ventricular direita e esquerda em pacientes com doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: A ressonância magnética foi aplicada em 27 pacientes com DPOC divididos em grupos, DPOCc e DPOCs, de acordo com a presença ou ausência de disfunção ventricular direita, respectivamente, e 11 controles (grupo C). O exame Doppler ecocardiográfico foi empregado para análise do grau de hipertensão pulmonar. RESULTADOS: O diâmetro do ventrículo direito foi similar nos 3 grupos, DPOCs, DPOCc e C, 29±8 mm vs 31±7 mm vs 30±6 mm; p NS, respectivamente. Foram observados hipertrofia ventricular direita somente nos grupos DPOC (8±2 mm e 9±3 mm vs 5±1 mm; pOBJECTIVE: To assess the mechanisms that may be involved in the evolution of right and left ventricular dysfunction in patients with chronic obstructive pulmonary disease (COPD). METHODS: Magnetic resonance imaging was used in 11 control patients (group C) and 27 patients with COPD, who were divided into 2 groups, COPDc and COPDs, according to the presence or absence of right ventricular dysfunction, respectively. Doppler echocardiography was used for assessing the degree of pulmonary hypertension. RESULTS: The right ventricular diameter was similar in the 3 groups, COPDs, COPDc and C (29±8 mm; 31±7 mm; and 30±6 mm; respectively, P=NS). Right ventricular hypertrophy was observed only in the COPD groups (8±2 mm and 9±3 mm vs 5±1 mm; P
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- 2004
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14. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block
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Estêvan Vieira Cabeda, Andréa Maria Gomes Falcão, José Soares Jr., Carlos Eduardo Rochitte, César Higa Nomura, Luiz Francisco Rodrigues Ávila, and José Rodrigues Parga
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Bloqueio de Ramo ,Imagem de Perfusão Miocárdica ,Tomografia Computadorizada por Multidetectores ,Angiografia Coronária ,Dipiridamol ,Doença Arterial Coronariana ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AbstractBackground:Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB).Objective:To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy.Methods:Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee.Results:The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001).Conclusion:The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.
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- 2015
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15. Desenvolvimento de modelo clínico para predição da possibilidade de identificação da artéria de Adamkiewicz por angiotomografia
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Alexandre Campos Moraes Amato, José Rodrigues Parga Filho, and Noedir Antônio Groppo Stolf
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spinal marrow ,spinal column ,aorta ,Adamkiewicz ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Resumo Contexto Diferenças morfológicas da artéria de Adamkiewicz (AKA) entre a população portadora e não portadora de doença aórtica têm importância clínica, influenciando as complicações neuroisquêmicas da medula espinhal em procedimentos operatórios. Ainda não é conhecida a correlação entre parâmetros clínicos e a previsibilidade da identificação dessa artéria pela angiotomografia. Objetivo Desenvolver um modelo matemático que, através de parâmetros clínicos correlacionados com aterosclerose, possa prever a probabilidade de identificação da AKA em pacientes submetidos a angiotomografias. Método Estudo observacional transversal utilizando banco de imagens e dados de pacientes. Foi feita análise estatística multivariada e criado modelo matemático logit de predição para identificação da AKA. Variáveis significativas foram utilizadas na montagem da fórmula para cálculo da probabilidade de identificação. O modelo foi calibrado, e a discriminação foi avaliada pela curva receiver operating characteristic (ROC). A seleção das variáveis explanatórias foi guiada pela maior área na curva ROC (p = 0,041) e pela significância combinada das variáveis. Resultados Foram avaliados 110 casos (54,5% do sexo masculino, com idade média de 60,97 anos e etnia com coeficiente B -2,471, M -1,297, N -0,971), com AKA identificada em 60,9%. Índice de massa corporal: 27,06 ± 0,98 (coef. -0,101); fumantes: 55,5% (coef. -1,614/-1,439); diabéticos: 13,6%; hipertensos: 65,5% (coef. -1,469); dislipidêmicos: 58,2%; aneurisma aórtico: 38,2%; dissecção aórtica: 12,7%; e trombo mural: 24,5%. Constante de 6,262. Fórmula para cálculo da probabilidade de detecção: ( e − ( C o e f . E t n i a + ( C o e f . I M C × I M C ) + C o e f . f u m a n t e + C o e f . H A S + C o e f . d i s l i p + C o n s tan t e ) + 1 ) − 1 . O modelo de predição foi criado e disponibilizado no link https://vascular.pro/aka-model . Conclusão Com as covariáveis etnia, índice de massa corporal, tabagismo, hipertensão arterial e dislipidemia, foi possível criar um modelo matemático de predição de identificação da AKA com significância combinada de nove coeficientes (p = 0,042).
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16. New Application of FFRCT in Clinical Practice: Evaluation of Interarterial Anomalous Coronary Course
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Fábio Bordin Trindade, Thamara Carvalho Morais, Roberto Nery Dantas, Roberto Vitor Almeida Torres, Clarice Santos Parreira Soares, and José Rodrigues Parga
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General Medicine - Published
- 2023
17. Maxillary sinus volumetric changes in jet aircraft pilots: A multislice computed tomography pilot study
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Yeda da Silva, Luciana Munhoz, José Rodrigues Parga Filho, Andreza Gomes Damasceno, Cesar Felipe França da Rosa, Eduardo Bilaqui Zukovski, Erik Zhu Teng, and Cláudio Campi de Castro
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging ,General Dentistry - Published
- 2023
18. Maxillary sinus volumetric changes in jet aircraft pilots: A multislice computed tomography pilot study
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Silva, Yeda da, primary, Munhoz, Luciana, additional, Filho, José Rodrigues Parga, additional, Damasceno, Andreza Gomes, additional, da Rosa, Cesar Felipe França, additional, Zukovski, Eduardo Bilaqui, additional, Teng, Erik Zhu, additional, and de Castro, Cláudio Campi, additional
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- 2022
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19. Performance Diagnóstica da FFR por Angiotomografia de Coronárias através de Software Baseado em Inteligência Artificial
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Roberto Nery Dantas Junior, Cesar Higa Nomura, Luiz Francisco Rodrigues de Ávila, Carla Franco Grego da Silva, Tiago A. Magalhães, José Rodrigues Parga Filho, Thamara C Morais, Caroline Bastida de Paula, Roberto Vitor Almeida Torres, and Antonildes N Assuncao-Jr
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SciELO ,Computed Tomography Angiography ,Myocardial Ischemic ,Perfusão Miocárdica ,Computed tomography ,Constriction, Pathologic ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Severity of Illness Index ,Cardiovascular System ,Machine Learning ,0302 clinical medicine ,Doenças Cardiovasculares/diagnostico por imagem ,Myocardial Fractional Flow Reserve ,Reserva Fracionada de Fluxo Miocárdico ,medicine.diagnostic_test ,Tomografia Computadorizada ,Artigo Original ,Coronary Vessels ,Coronary, Tomography ,Isquemia Miocárdica ,Fractional Flow Reserve, Myocardial ,Original Article ,Short Editorial ,Cardiology and Cardiovascular Medicine ,Doença Arterial Coronariana ,Diagnostic, Imaging/trends ,Minieditorial ,Cardiovascular Diseases/diagnostic, imaging ,03 medical and health sciences ,Computed Tomography ,Artificial Intelligence ,Predictive Value of Tests ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Retrospective Studies ,business.industry ,Diagnóstico por Imagem/tendências ,Coronary Stenosis ,Myocardial Perfusion ,Tomografia Coronariana ,Aprendizado de Máquina ,RC666-701 ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Delivery of Health Care - Abstract
Resumo Fundamento A quantificação não invasiva da reserva fracionada de fluxo miocárdico (FFR TC ) através de software baseado em inteligência artificial em versão mais atualizada e tomógrafo de última geração (384 cortes) apresenta elevada performance na detecção de isquemia coronariana. Objetivos Avaliar o desempenho diagnóstico da FFR TC na detecção de doença arterial coronariana (DAC) significativa em relação ao FFRi, em tomógrafos de gerações anteriores (128 e 256 cortes). Métodos Estudo retrospectivo com pacientes encaminhados à angiotomografia de artérias coronárias (TCC) e cateterismo (FFRi). Foram utilizados os tomógrafos Siemens Somatom Definition Flash (256 cortes) e AS+ (128 cortes). A FFR TC e a área luminal mínima (ALM) foram avaliadas em software (cFFR versão 3.0.0, Siemens Healthineers, Forchheim, Alemanha). DAC obstrutiva foi definida como TCC com redução luminal ≥50% e DAC funcionalmente obstrutiva como FFRi ≤0,8. Todos os valores de p reportados são bicaudais; e quando
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- 2021
20. Biventricular imaging markers to predict outcomes in noncompaction cardiomyopathy: a machine learning study
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Jan D'hooge, Vera Maria Cury Salemi, Marcelo Dantas Tavares de Melo, Camila Rocon, José Rodrigues Parga Filho, Mahdi Tabassian, Edimar Alcides Bocchi, José Arimateia Batista de Araújo Filho, and Cesar José Grupi
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Male ,Cardiac & Cardiovascular Systems ,Heart disease ,FEATURES ,Cardiomyopathy ,Contrast Media ,Gadolinium ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,computer.software_genre ,RECOMMENDATIONS ,Sudden cardiac death ,Machine Learning ,Follow‐up ,0302 clinical medicine ,030212 general & internal medicine ,Ejection fraction ,medicine.diagnostic_test ,CARDIAC MAGNETIC-RESONANCE ,Follow-up ,Echocardiography ,NONCOMPACTION ,Female ,Cardiology and Cardiovascular Medicine ,Cardiomyopathies ,Life Sciences & Biomedicine ,Machine learning ,DIAGNOSIS ,CLASSIFICATION ,03 medical and health sciences ,VENTRICULAR NON-COMPACTION ,Magnetic resonance imaging ,Cardiac magnetic resonance imaging ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,cardiovascular diseases ,Non‐compaction ,Retrospective Studies ,Science & Technology ,business.industry ,ADULTS ,medicine.disease ,Transplantation ,Non-compaction ,RC666-701 ,Heart failure ,Cardiovascular System & Cardiology ,Artificial intelligence ,business ,computer - Abstract
AIMS: Left ventricular non-compaction cardiomyopathy (LVNC) is a genetic heart disease, with heart failure, arrhythmias, and embolic events as main clinical manifestations. The goal of this study was to analyse a large set of echocardiographic (echo) and cardiac magnetic resonance imaging (CMRI) parameters using machine learning (ML) techniques to find imaging predictors of clinical outcomes in a long-term follow-up of LVNC patients. METHODS AND RESULTS: Patients with echo and/or CMRI criteria of LVNC, followed from January 2011 to December 2017 in the heart failure section of a tertiary referral cardiologic hospital, were enrolled in a retrospective study. Two-dimensional colour Doppler echocardiography and subsequent CMRI were carried out. Twenty-four hour Holter monitoring was also performed in all patients. Death, cardiac transplantation, heart failure hospitalization, aborted sudden cardiac death, complex ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, pulmonary thromboembolism and/or peripheral arterial embolism) were registered and were referred to as major adverse cardiovascular events (MACEs) in this study. Recruited for the study were 108 LVNC patients, aged 38.3 ± 15.5 years, 48.1% men, diagnosed by echo and CMRI criteria. They were followed for 5.8 ± 3.9 years, and MACEs were registered. CMRI and echo parameters were analysed via a supervised ML methodology. Forty-seven (43.5%) patients had at least one MACE. The best performance of imaging variables was achieved by combining four parameters: left ventricular (LV) ejection fraction (by CMRI), right ventricular (RV) end-systolic volume (by CMRI), RV systolic dysfunction (by echo), and RV lower diameter (by CMRI) with accuracy, sensitivity, and specificity rates of 75.5%, 77%, 75%, respectively. CONCLUSIONS: Our findings show the importance of biventricular assessment to detect the severity of this cardiomyopathy and to plan for early clinical intervention. In addition, this study shows that even patients with normal LV function and negative late gadolinium enhancement had MACE. ML is a promising tool for analysing a large set of parameters to stratify and predict prognosis in LVNC patients. ispartof: Esc Heart Failure vol:7 issue:5 pages:2431-2439 ispartof: location:England status: published
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- 2020
21. Regression of coronary artery outward remodeling in patients with non–ST-segment acute coronary syndromes: A longitudinal study using noninvasive magnetic resonance imaging
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Fernandes, Juliano Lara, Serrano, Carlos Vicente, Jr, Blotta, Maria Heloisa S.L., Coelho, Otavio Rizzi, Nicolau, Jose Carlos, Ávila, Luis Francisco, Rochitte, Carlos Eduardo, and Filho, Jose Rodrigues Parga
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- 2006
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22. Decreased glycolytic metabolism in non-compaction cardiomyopathy by 18F-fluoro-2-deoxyglucose positron emission tomography: new insights into pathophysiological mechanisms and clinical implications
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Antonildes N Assunção, Roberto Kalil Filho, Maria Clementina Pinto Giorgi, Edimar Alcides Bocchi, Vera Maria Cury Salemi, Roberto Nery Dantas, José Soares, Ludhmila Abrahão Hajjar, José de Arimatéia Batista Araújo Filho, José Rodrigues Parga Filho, Ana Luiza Bierrenbach, Camila Rocon de Lima, J. C. Meneguetti, Charles Mady, and Marcelo Dantas Tavares de Melo
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Pathology ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Single-photon emission computed tomography ,Severity of Illness Index ,Cohort Studies ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Tomography, Emission-Computed, Single-Photon ,Analysis of Variance ,Isolated Noncompaction of the Ventricular Myocardium ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,Magnetic resonance imaging ,General Medicine ,Stroke volume ,Middle Aged ,Image Enhancement ,medicine.disease ,Glucose ,030104 developmental biology ,Positron emission tomography ,Case-Control Studies ,Positron-Emission Tomography ,Multivariate Analysis ,Cardiology ,Left ventricular noncompaction ,Female ,MIOCARDIOPATIA CONGESTIVA ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Emission computed tomography - Abstract
Aims The pathophysiological mechanisms of left ventricular non-compaction cardiomyopathy (LVNC) remain controversial. This study performed combined 18F-fluoro-2-deoxyglucose dynamic positron emission tomography (FDG-PET) and 99mTc-sestamibi single-photon emission computed tomography (SPECT) studies to evaluate myocardial glucose metabolism and perfusion in patients with LVNC and their clinical implications. Methods and results Thirty patients (41 ± 12 years, 53% male) with LVNC, diagnosed by cardiovascular magnetic resonance (CMR) criteria, and eight age-matched healthy controls (42 ± 12 years, 50% male) were prospectively recruited to undergo FDG-PET with measurement of the myocardial glucose uptake rate (MGU) and SPECT to investigate perfusion-metabolism patterns. Patients with LVNC had lower global MGU compared with that in controls (36.9 ± 8.8 vs. 44.6 ± 5.4 μmol/min/100 g, respectively, P = 0.02). Of 17 LV segments, MGU levels were significantly reduced in 8, and also a reduction was observed when compacted segments from LVNC were compared with the segments from control subjects (P
- Published
- 2017
23. Epipericardial Fat Necrosis: Who Should Be a Candidate?
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José Rodrigues Parga Filho, Guilherme Hipolito Bachion, Karina de Souza Giassi, André Nathan Costa, and Ronaldo Adib Kairalla
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medicine.medical_specialty ,Retrospective review ,business.industry ,Patient demographics ,General Medicine ,Emergency department ,030204 cardiovascular system & hematology ,medicine.disease ,Chest pain ,Control subjects ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,medicine ,Radiology, Nuclear Medicine and imaging ,Fat necrosis ,Radiology ,Patient group ,medicine.symptom ,business - Abstract
The objectives of the present study were to estimate the frequency of epipericardial fat necrosis among patients undergoing chest CT for chest pain and to compare the clinical and laboratory data between patients with epipericardial fat necrosis and control subjects.A retrospective review of 7463 chest CT studies performed in the emergency department from July 2011 to December 2014 was conducted to collect data regarding patient demographic characteristics and CT findings. Twenty patients who had epipericardial fat necrosis diagnosed were defined as the main patient group. An age- and sex-matched control group was selected from patients with chest pain who underwent chest CT during the same period. Linear regression models were used to assess data, and statistical significance was expressed as p values and 95% CIs.We found that the frequency of epipericardial fat necrosis was 2.15% among patients who underwent chest CT for chest pain. Epipericardial fat necrosis was statistically significantly associated with a lack of medication use (p = 0.01; 95% CI, -3.33 to -0.40) and the absence of other symptoms (p = 0.005; 95% CI, -5.83 to -1.27). Epipericardial fat necrosis was most often observed as an ovoid lesion with mixed fat attenuation with little stranding in the left paracardiac region accompanied by pleural effusion.Epipericardial fat necrosis is a significant clinical condition. For patients seen in the emergency department with isolated acute chest pain but no additional clinical history, no medication history, and normal laboratory results, chest CT is recommended to support a diagnosis of epipericardial fat necrosis.
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- 2016
24. Avaliação da Perfusão Miocárdica por Tomografia Computadorizada - Princípios, Fundamentação Técnica e Recomendações
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Tiago A. Magalhães, Fábio Vilas-Boas, Rodrigo Cerci, Marcelo Souto Nacif, José Rodrigues Parga Filho, Carlos E. Rochitte, Paulo Roberto Schvartzman, Ibraim Pinto, Roberto Caldeira Cury, and Ilan Gottlieb
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medicine.medical_specialty ,Adenosine ,Myocardial ischemia ,Computed Tomography Angiography ,medicine.medical_treatment ,Adenosina ,Myocardial Ischemia ,Vasodilatation ,Contrast Media ,Computed tomography ,Review Article ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Dipiridamol ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Angiografia por Tomografia Computadorizada/métodos ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Cardiac catheterization ,Computed Tomography Angiography/methods ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Dipyridamole ,Vasodilatação ,medicine.disease ,Myocardial Perfusion Imaging/methods ,Coronary arteries ,medicine.anatomical_structure ,RC666-701 ,Cardiology ,Imagem de Perfusão/métodos ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Doença Arterial Coronariana ,medicine.drug - Abstract
Coronary computed tomography angiography (CCTA) has gained a prominent role in the evaluation of coronary artery disease. However, its anatomical nature does not allow the evaluation of the functional repercussion of coronary obstructions. It has been made possible to evaluate Myocardial computed tomography perfusion (Myocardial CTP) recently, based on myocardial contrast changes related to coronary stenoses. Several studies have validated this technique against the anatomical reference method (cardiac catheterization) and other functional methods, including myocardial perfusion scintigraphy and fractional flow reserve. The Myocardial CTP is performed in conjunction with the CCTA, a combined analysis of anatomy and function. The stress phase (with assessment of myocardial perfusion) can be performed before or after the resting phase (assessment of resting perfusion and coronary arteries), and different acquisition parameters are proposed according to the protocol and type of equipment used. Stressors used are based on coronary vasodilation (e.g. dipyridamole, adenosine). Image interpretation, similar to other perfusion assessment methods, is based on the identification and quantification of myocardial perfusion defects. The integration of both perfusion and anatomical findings is fundamental for the examination interpretation algorithm, allowing to define if the stenoses identified are hemodynamically significant and may be related to myocardial ischemia. Resumo A angiografia coronariana por tomografia computadorizada (ACTC) assumiu um papel de destaque na avaliação da doença arterial coronariana. Entretanto, sua natureza anatômica não permitia a avaliação da repercussão funcional das obstruções coronarianas. Recentemente, tornou-se possível a avaliação da perfusão miocárdica por tomografia computadorizada (PMTC), baseando-se nas alterações de contrastação miocárdicas relacionadas às estenoses coronarianas. Diversos estudos permitiram validar esta técnica perante o método anatômico de referência (cateterismo cardíaco) e outros métodos funcionais, incluindo cintilografia de perfusão miocárdica e a reserva de fluxo fracionada. A PMTC é realizada conjuntamente com a ACTC, em uma análise combinada de anatomia e função. A fase de estresse (com avaliação da perfusão miocárdica) pode ser realizada antes ou depois da fase de repouso (avaliação da perfusão de repouso e artérias coronárias), e diferentes parâmetros de aquisição são propostos conforme o protocolo e o tipo de equipamento utilizados. Os agentes estressores utilizados baseiam-se na vasodilatação coronariana (ex: dipiridamol, adenosina). A interpretação das imagens, semelhante a outros métodos de avaliação perfusional, baseia-se na identificação e quantificação de defeitos de perfusão miocárdicos. A integração dos achados perfusionais e anatômicos é parte fundamental do algoritmo de interpretação do exame, permitindo definir se as estenoses identificadas são hemodinamicamente significativas, podendo se relacionar com isquemia miocárdica.
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- 2019
25. Epipericardial fat necrosis: increasing the rate of diagnosis by disseminating knowledge within a single institution
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Karina de Souza Giassi, José Rodrigues Parga Filho, André Nathan Costa, and Ronaldo Adib Kairalla
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,business.industry ,General surgery ,lcsh:R895-920 ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Fat necrosis ,Single institution ,business ,Letters to the Editor ,IMAGEM POR RESSONÂNCIA MAGNÉTICA - Published
- 2018
26. Desenvolvimento de modelo clínico para predição da possibilidade de identificação da artéria de Adamkiewicz por angiotomografia
- Author
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Alexandre Campos Moraes Amato, Noedir Antônio Groppo Stolf, and José Rodrigues Parga Filho
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spinal column ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,lcsh:Surgery ,spinal marrow ,lcsh:RD1-811 ,030204 cardiovascular system & hematology ,Adamkiewicz ,030218 nuclear medicine & medical imaging ,aorta ,03 medical and health sciences ,0302 clinical medicine ,medula espinhal ,lcsh:RC666-701 ,coluna vertebral ,Medicine ,MODELOS MATEMÁTICOS ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Resumo Contexto Diferenças morfológicas da artéria de Adamkiewicz (AKA) entre a população portadora e não portadora de doença aórtica têm importância clínica, influenciando as complicações neuroisquêmicas da medula espinhal em procedimentos operatórios. Ainda não é conhecida a correlação entre parâmetros clínicos e a previsibilidade da identificação dessa artéria pela angiotomografia. Objetivo Desenvolver um modelo matemático que, através de parâmetros clínicos correlacionados com aterosclerose, possa prever a probabilidade de identificação da AKA em pacientes submetidos a angiotomografias. Método Estudo observacional transversal utilizando banco de imagens e dados de pacientes. Foi feita análise estatística multivariada e criado modelo matemático logit de predição para identificação da AKA. Variáveis significativas foram utilizadas na montagem da fórmula para cálculo da probabilidade de identificação. O modelo foi calibrado, e a discriminação foi avaliada pela curva receiver operating characteristic (ROC). A seleção das variáveis explanatórias foi guiada pela maior área na curva ROC (p = 0,041) e pela significância combinada das variáveis. Resultados Foram avaliados 110 casos (54,5% do sexo masculino, com idade média de 60,97 anos e etnia com coeficiente B -2,471, M -1,297, N -0,971), com AKA identificada em 60,9%. Índice de massa corporal: 27,06 ± 0,98 (coef. -0,101); fumantes: 55,5% (coef. -1,614/-1,439); diabéticos: 13,6%; hipertensos: 65,5% (coef. -1,469); dislipidêmicos: 58,2%; aneurisma aórtico: 38,2%; dissecção aórtica: 12,7%; e trombo mural: 24,5%. Constante de 6,262. Fórmula para cálculo da probabilidade de detecção: ( e − ( C o e f . E t n i a + ( C o e f . I M C × I M C ) + C o e f . f u m a n t e + C o e f . H A S + C o e f . d i s l i p + C o n s tan t e ) + 1 ) − 1 . O modelo de predição foi criado e disponibilizado no link https://vascular.pro/aka-model . Conclusão Com as covariáveis etnia, índice de massa corporal, tabagismo, hipertensão arterial e dislipidemia, foi possível criar um modelo matemático de predição de identificação da AKA com significância combinada de nove coeficientes (p = 0,042). Abstract Background There are clinically important morphological differences in the Adamkiewicz artery (AKA) between populations that do and do not have aortic disease and they have an influence on the neuroischemic complications involving the spinal cord during surgical operations. It is not yet known whether clinical parameters correlate with the predictability of identification of the artery using angiotomography. Objective To develop a mathematical model that by correlating clinical parameters with atherosclerosis enables prediction of the probability of identification of the AKA in patients examined with angiotomography. Method This is a cross-sectional, observational study using a patient database and image bank. A multivariate statistical analysis was conducted and a logit mathematical model was constructed to predict AKA identification. Significant variables were used to build a formula for calculation of the probability of identification. This model was calibrated and its power of discrimination was assessed using receiver operating characteristic (ROC) curves. Selection of explanatory variables was based on largest area under the ROC curve (p = 0.041) and combined significance of variables. Results A total of 110 cases were analyzed (54.5% were male, mean age was 60.97 years, and ethnicity coefficients were white -2.471, brown -1.297, and black -0.971) and the AKA was identified in 60.9%. Body mass index: 27.06 ± 0.98 (coef. -0.101); smokers: 55.5% (coef. -1.614/-1.439); diabetes: 13.6%; hypertension: 65.5% (coef. -1.469); dyslipidemia: 58.2%; aortic aneurysm: 38.2%; aortic dissection: 12.7%; and mural thrombus: 24.5%. The constant was 6.262. The formula for calculating the probability of detection is as follows: ( e − ( C o e f . E t n i c i t y + ( C o e f . B M I × B M I ) + C o e f . s m o ker + C o e f . S A H + C o e f . d y s l i p + C o n s tan t ) + 1 ) − 1 . The prediction model was constructed and made available at: https://vascular.pro/aka-model . Conclusions Using the covariates ethnicity, body mass index, smoking, arterial hypertension, and dyslipidemia, it proved possible to create a mathematical model for predicting identification of the AKA with a combined significance of nine coefficients (p = 0.042).
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- 2018
27. Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography
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Alexandre Campos Moraes Amato, Noedir Antônio Groppo Stolf, and José Rodrigues Parga Filho
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medicine.medical_specialty ,Arterial disease ,Anterior spinal artery ,030204 cardiovascular system & hematology ,arterial disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,anterior spinal artery ,Computed tomography angiography ,lcsh:R5-920 ,medicine.diagnostic_test ,business.industry ,Adamkiewicz artery ,General Medicine ,Surgical procedures ,Spinal cord ,medicine.anatomical_structure ,Angiography ,Original Article ,Radiology ,lcsh:Medicine (General) ,business ,computed tomography angiography ,030217 neurology & neurosurgery - Abstract
Background: The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability. Aims: To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography. Methods: We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software. Results: A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor. Conclusion: Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.
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- 2017
28. Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy
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Roberto Kalil-Filho, Martino Martinelli Filho, David A. Bluemke, Afonso Akio Shiozaki, Charles Mady, Tiago Senra, Luis F. Avila, Carlos E. Rochitte, Edmundo Arteaga, Cristiane Guedes Pita, and José Rodrigues Parga Filho
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Adult ,Male ,DOENÇAS GENITAIS (ANORMALIDADES) ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Contrast Media ,Ventricular tachycardia ,Sudden death ,Article ,Sudden cardiac death ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Proportional Hazards Models ,Fibrillation ,biology ,business.industry ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,Endomyocardial Fibrosis ,Implantable cardioverter-defibrillator ,medicine.disease ,Troponin ,Defibrillators, Implantable ,Iopamidol ,ROC Curve ,Ventricular Fibrillation ,Ventricular fibrillation ,Tachycardia, Ventricular ,cardiovascular system ,biology.protein ,Cardiology ,Radiographic Image Interpretation, Computer-Assisted ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. Objective The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. Methods Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. Results MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 ± 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 ± 19.13 g vs 13.57 ± 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%–88%) and 71% (95% CI, 56%–81%), respectively. Kaplan–Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass ≥18 g than in patients with MF P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. Conclusion The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
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- 2013
29. Influential Factors on the Evaluation of Adamkiewicz Artery Using a 320-Detector Row Computed Tomography Device
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Alexandre Campos Moraes Amato, José Rodrigues Parga Filho, and Noedir Antônio Groppo Stolf
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Adult ,Male ,medicine.medical_specialty ,Tomography Scanners, X-Ray Computed ,Cross-sectional study ,Computed Tomography Angiography ,Aortic Diseases ,Computed tomography ,030204 cardiovascular system & hematology ,Aortography ,Group B ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Predictive Value of Tests ,Multidetector Computed Tomography ,Medicine ,Humans ,Diagnostic Errors ,Aged ,medicine.diagnostic_test ,business.industry ,Tobacco Smokers ,Case-control study ,General Medicine ,Arteries ,Equipment Design ,Multiplanar reconstruction ,Middle Aged ,Adamkiewicz artery ,Surgery ,Cross-Sectional Studies ,Spinal Cord ,Predictive value of tests ,Case-Control Studies ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Understanding the difference of Adamkiewicz artery (AKA) presentation in healthy and diseased subjects, and the influence of atherosclerotic factors prevalent in aortic disease patients, are important for aortic disease therapeutic planning. This study used a 320-detector row computed tomography (CT) device to examine the impact of clinical aspects of AKA identification in individuals with and without aortic disease. Methods Angio-CTs obtained from 115 patients were assessed and the individuals grouped according to the presence or absence of aortic disease. Datasets were analyzed using OsiriX software, and AKA was identified by three-dimensional multiplanar reconstruction. Results The group without aortic disease (Group A) comprised 32 (52.5%) men and 29 women, with a mean age of 53.7 ± 16.8 years. The group with aortic disease (Group B) comprised 31 (57.4%) men and 23 women, with a mean age of 64.8 ± 11.6 years. AKA was identified in 49 (80.3%) participants of Group A and 23 (42.6%) individuals of Group B (P ≤ 0.0001). In 53 cases (73.6%), AKA originated on the left side. AKA was mainly detected on the left side (73.6%), at the level of T10 to T12 (70%). Tobacco smokers, former smokers, and hypertensive patients had increased odds of having undetected AKA. Conclusions Using the method described and a state of the art 320-detector row CT device, AKA was detected more frequently among individuals without aortic disease. Thus, aortic disease and atherosclerotic risk factors hindered AKA detection.
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- 2016
30. Fibrose miocárdica em pacientes com cardiomiopatia hipertrófica com alto risco para morte súbita cardíaca Fibrosis miocárdica en pacientes con cardiomiopatía hipertrófica con alto riesgo para muerte súbita cardíaca Myocardial fibrosis in patients with hypertrophic cardiomyopathy and high risk for sudden death
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Afonso Akio Shiozaki, Tiago Senra, Edmundo Arteaga, Cristiane Guedes Pita, Martino Martinelli Filho, Luis Francisco R. Ávila, José Rodrigues Parga Filho, Charles Mady, and Carlos Eduardo Rochitte
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,multidetector computed tomography ,realce tardío y cardiodesfibrilador implantable ,fibrose miocárdica ,Hypertrophic cardiomyopathy ,tomografia computadorizada com múltiplos destectores ,Cardiomiopatia hipertrófica ,Cardiomiopatía hipertrófica ,lcsh:RC666-701 ,cardiodesfibrilador implantável ,realce tardio ,myocardial fibrosis ,tomografía computarizada con múltiples detectores ,fibrosis miocárdica - Abstract
FUNDAMENTO: A estratificação de risco para morte súbita na cardiomiopatia hipertrófica (CMH), continua a ser um verdadeiro desafio devido à grande heterogeneidade da sua apresentação, em que a maioria dos indivíduos permanecem assintomáticos por toda sua vida e outros apresentam a morte súbita como primeiro sintoma. Recentes trabalhos vêm sugerindo que a fibrose miocárdica pode constituir-se em um importante substrato para as arritmias ventriculares malignas, responsáveis pela morte súbita nesta doença. OBJETIVO: Avaliação da prevalência e quantificação da fibrose miocárdica (FM), em pacientes com CMH com alto risco ou recuperados de morte súbita, portadores de cardiodesfibrilador implantável (CDI). MÉTODOS: Vinte e oito pacientes com CMH portadores de CDI foram submetidos à tomografia computadorizada com múltiplos detectores, para realização da técnica de realce tardio, e avaliação da fibrose miocárdica. RESULTADOS: 96% dos pacientes apresentavam fibrose miocárdica (20,38 ± 15,55 gramas) correspondendo a 15,96 ± 10,20% da massa miocárdica total. A FM foi significativamente mais prevalente que os demais fatores de risco clássicos para morte súbita. CONCLUSÃO: Concluímos que existe uma alta prevalência de fibrose miocárdica em pacientes com cardiomiopatia hipertrófica de alto risco ou recuperados de morte súbita, como neste grupo - portadores de cardiodesfibrilador implantável. A maior prevalência da fibrose miocárdica comparada aos fatores de risco de pior prognóstico levantam a hipótese de que a fibrose miocárdica possa ser um importante substrato potencialmente necessário na gênese das arritmias desencadeadoras da morte súbita.FUNDAMENTO: La estratificación de riesgo para muerte súbita en la cardiomiopatía hipertrófica (CMH), sigue siendo un verdadero reto debido a la gran heterogeneidad de su presentación, cuya mayoría de los individuos permanecen asintomáticos por toda su vida y otros expresan la muerte súbita como primer síntoma. Trabajos recientes vienen sugiriendo que la fibrosis miocárdica puede constituirse en un importante sustrato para las arritmias ventriculares malignas, responsables de la muerte súbita en esta enfermedad. OBJETIVO: Evaluación de la prevalencia y cuantificación de la fibrosis miocárdica (FM), en pacientes con CMH con alto riesgo o recuperados de muerte súbita, portadores de cardiodesfibrilador implantable (CDI). MÉTODOS: Un total de 28 pacientes con CMH portadores de CDI fueron sometidos a la tomografía computadorizada con múltiples detectores, para la realización de la técnica de realce tardío, y evaluación de la fibrosis miocárdica. RESULTADOS: El 96% de los pacientes presentaba fibrosis miocárdica (20,38 ± 15,55 gramos) y correspondía a 15,96 ± 10,20% de la masa miocárdica total. La FM fue significativamente más prevalente que los demás factores de riesgo clásicos para muerte súbita. CONCLUSIÓN: Concluimos que existe una alta prevalencia de fibrosis miocárdica en pacientes con cardiomiopatía hipertrófica de alto riesgo o recuperados de muerte súbita, como en este grupo - portadores de cardiodesfibrilador implantable. La mayor prevalencia de la fibrosis miocárdica comparada a los factores de riesgo de peor pronóstico levanta la hipótesis de que la fibrosis miocárdica pueda ser un importante sustrato potencialmente necesario en la génesis de las arritmias desencadenadoras de la muerte súbita.BACKGROUND: The stratification of risk for sudden death in hypertrophic cardiomyopathy (HCM) continues to be a true challenge due to the great heterogeneity of this disease's presentation, as most individuals remain asymptomatic during their entire lives and others present sudden death as first symptom. Recent studies have suggested that myocardial fibrosis may represent an important substrate for the malignant ventricular arrhythmias, that are responsible for the cases of sudden death related to this disease. OBJECTIVE: To assess the prevalence and quantification of myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with implantablecardioverter - defibrillator (ICD) indicated due to their high risk or recovered from cardiac sudden death. METHODS: Twenty-eight HCM patients with ICD were submitted to multidetector computed tomography to assess myocardial fibrosis by delayed enhancement technique. RESULTS: Myocardial fibrosis was present in 96% of these HCM patients with (20.38 ± 15.55 g) comprising 15.96 ± 10.20% of the total myocardial mass. MF was observed in a significantly higher prevalence as compared to other classical risk factors for sudden death. CONCLUSION: It is possible to conclude that there is a high prevalence of myocardial fibrosis in hypertrophic cardiomyopathy patients with high-risk or recovered from cardiac sudden death, like those with clinical indication to implantable cardioverter -defibrillator. The higher prevalence of myocardial fibrosis in comparison to classical risk factors of worse prognosis raise the hypothesis that the myocardial fibrosis may be an important substrate in the genesis of lifethreatening arrhythmias in these high risk HCM population.
- Published
- 2010
31. Ressonância magnética vs cintilografia com pirofosfato marcado com tecnécio-99m para a detecção de necrose miocárdica perioperatória
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Roberto Kalil Filho, José Rodrigues Parga Filho, Fábio Solano de Freitas Souza, Luiz Francisco Rodrigues de Ávila, José Cláudio Meneghetti, Luciano F. Drager, Luiz Antonio Machado César, M Izaki, Guilherme Urpia Monte, and Carlos E. Rochitte
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,imagem por ressonância magnética ,pirofosfato de Tecnécio Tc 99 m ,infarto do miocárdio/cirurgia ,Magnetic resonance imaging ,Perioperative ,miocárdio/cintilografia ,medicine.disease ,Scintigraphy ,revascularização miocárdica ,Coronary artery disease ,medicine.anatomical_structure ,Internal medicine ,Troponin I ,Estudo comparativo ,medicine ,Cardiology ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Technetium-99m ,Artery - Abstract
BACKGROUND: Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis. OBJECTIVE: To compare CMRI and MS for the detection of POMI after CABG. METHODS: A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery. RESULTS: Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed. CONCLUSION: Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.
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- 2008
32. Epipericardial Fat Necrosis: Who Should Be a Candidate?
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Giassi, Karina de Souza, primary, Costa, Andre Nathan, additional, Bachion, Guilherme Hipolito, additional, Kairalla, Ronaldo Adib, additional, and Filho, José Rodrigues Parga, additional
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- 2016
- Full Text
- View/download PDF
33. [II Guidelines on Cardiovascular Magnetic Resonance and Computed Tomography of the Brazilian Society of Cardiology and the Brazilian College of Radiology]
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Leonardo, Sara, Gilberto, Szarf, Adriano, Tachibana, Afonso Akio, Shiozaki, Alexandre Volney, Villa, Amarino Carvalho, de Oliveira, Andrei Skromov, de Albuquerque, Carlos Eduardo, Rochitte, César Higa, Nomura, Clerio Francisco, Azevedo, Dany, Jasinowodolinski, Eduardo Marinho, Tassi, Fabio de Morais, Medeiros, Fernando Uliana, Kay, Flávia Pegado, Junqueira, Guilherme S A, Azevedo, Guilherme Urpia, Monte, Ibraim Masciarelli Francisco, Pinto, Ilan, Gottlieb, Joalbo, Andrade, João A C, Lima, José Rodrigues, Parga Filho, Juliana, Kelendjian, Juliano Lara, Fernandes, Leonardo, Iquizli, Luis C L, Correia, Luiz Augusto, Quaglia, Luiz Flavio Galvão, Gonçalves, Luiz Francisco, Ávila, Marcello, Zapparoli, Marcelo, Hadlich, Marcelo Souto, Nacif, Márcia de Melo, Barbosa, Márcio Hiroshi, Minami, Marcio Sommer, Bittencourt, Maria Helena Albernaz, Siqueira, Marly Conceição, Silva, Marly Maria Uellendahl, Lopes, Mateus Diniz, Marques, Mônica La Rocca, Vieira, Otávio Rizzi, Coellho Filho, Paulo R, Schvartzman, Raul D, Santos, Ricardo C, Cury, Ricardo, Loureiro, Roberto Caldeira, Cury, Roberto, Sasdelli Neto, Robson, Macedo, Rodrigo Julio, Cerci, Rui Alberto, de Faria Filho, Sávio, Cardoso, Thiago, Naves, Tiago Augusto, Magalhães, Tiago, Senra, Ursula Maria Moreira Costa, Burgos, Valéria de Melo, Moreira, and Walther Yoshiharu, Ishikawa
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Male ,Cardiovascular Diseases ,Predictive Value of Tests ,Angiocardiography ,Humans ,Female ,Prognosis ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Brazil ,Societies, Medical - Published
- 2015
34. I Diretriz de Ressonância e Tomografia Cardiovascular da Sociedade Brasileira de Cardiologia Sumário Executivo
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Marcelo Hadlich, César Augusto Mastrofrancisco Cattani, Fábio Berezowsky Rocha, Iugiro Roberto Kuroki, Marly Maria Uellendhal, Ricardo Loureiro, Fátima Cristina Monteiro Pedroti, Robson de Macedo Vieira, Paulo R Schwarzman, Dany Jasinowodolinsk, Luiz Francisco Rodrigues de Ávila, Miguel Abraão Rosário Neto, Gilberto Szarf, José Rodrigues Parga Filho, Márcia Lima Mugnaini, Maria Helena Albernaz Siqueira, Joalbo M. Andrade, Marcia M. Barbosa, Marcelo Zapparoli, Luis C. L. Correia, Raul Dias dos Santos Filho, Guilherme Urpia Monte, Fabiano Lucchesi, and Roberto Kalil Filho
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lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,tomografia ,lcsh:RC666-701 ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities ,Imagem por ressonância magnética ,técnicas de diagnóstico cardiovascular - Abstract
Cesar Augusto Mastrofrancisco Cattani, Dany Jasinowodolinsk, Fabiano Lucchesi, Fabio Berezowsky Rocha, Fatima Cristina Pedroti, Gilberto Szarf, Guilherme Urpia Monte, Iugiro Roberto Kuroki , Joalbo Andrade, Jose Rodrigues Parga Filho, Luis Claudio Correia, Luiz Francisco Avila, Marcelo Hadlich, Marcelo Zapparoli, Marcia Barbosa, Marcia Lima Mugnaini, Maria Helena Albernaz Siqueira, Marly Maria Uellendhal, Miguel Abraao Rosario Neto, Paulo R. Schwarzman, Raul Dias dos Santos Filho, Ricardo Loureiro, Roberto Kalil Filho, Robson de Macedo Vieira
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- 2006
35. Diretrizes SBC: ressonância e tomografia cardiovascular
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Fábio Berezowsky Rocha, Dany Jasinowodolinsk, Marcelo Hadlich, Miguel Abraão Rosário Neto, Iugiro Roberto Kuroki, Fabiano Lucchesi, Luiz Francisco Rodrigues de Ávila, Anis Rassi, Jorge Pinto Ribeiro, Márcia Lima Mugnaini, Gilberto Szarf, Roberto Kalil Filho, Carlos E. Rochitte, Ricardo Loureiro, Clerio Francisco de Azevedo Filho, Fátima Cristina Monteiro Pedroti, Paulo R Schwarzman, Juliano L Fernandes, Joalbo M. Andrade, Guilherme Urpia Monte, Ibraim Pinto, César Augusto Mastrofrancisco Cattani, Adib D Jatene, Maria Helena Albernaz Siqueira, José Antonio Franchini Ramires, Robson de Macedo Vieira, Marcia M. Barbosa, Antonio Carlos de Camargo Carvalho, Marcelo Zapparoli, José Rodrigues Parga Filho, Marly Maria Uellendhal, Sérgio Almeida de Oliveira, Luis C. L. Correia, and Raul Dias dos Santos Filho
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine ,Medical physics ,Magnetic resonance imaging ,Computed tomography ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2006
36. I Diretriz de Ressonância e Tomografia Cardiovascular da Sociedade Brasileira de Cardiologia: sumário executivo
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Robson de Macedo Vieira, Gilberto Szarf, José Antonio Franchini Ramires, Paulo R Schwarzman, Maria Helena Albernaz Siqueira, Guilherme Urpia Monte, Antonio Carlos de Camargo Carvalho, Marcia M. Barbosa, Fábio Berezowsky Rocha, Marly Maria Uellendhal, Roberto Kalil Filho, Clerio Francisco de Azevedo Filho, Ricardo Loureiro, Fátima Cristina Monteiro Pedroti, Juliano L Fernandes, Joalbo M. Andrade, Dany Jasinowodolinsk, Márcia Lima Mugnaini, Ibraim Pinto, Marcelo Hadlich, José Rodrigues Parga Filho, César Augusto Mastrofrancisco Cattani, Luiz Francisco Rodrigues de Ávila, Jorge Pinto Ribeiro, Carlos E. Rochitte, Iugiro Roberto Kuroki, Fabiano Lucchesi, Miguel Abraão Rosário Neto, Marcelo Zapparoli, Adib D Jatene, Sérgio Almeida de Oliveira, Luis C. L. Correia, and Raul Dias dos Santos Filho
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medicine.medical_specialty ,Executive summary ,medicine.diagnostic_test ,business.industry ,Medicine ,Medical physics ,Magnetic resonance imaging ,Computed tomography ,Cardiology and Cardiovascular Medicine ,business - Published
- 2006
37. Perfusion Impairment in Patients with Normal-appearing Coronary Arteries: Identification with Contrast-enhanced MR Imaging
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Luiz Francisco Rodrigues de Ávila, José Rodrigues Parga Filho, Carlos E. Rochitte, Giovanni Guido Cerri, and Juliano L Fernandes
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Male ,media_common.quotation_subject ,Coronary Artery Disease ,Coronary artery disease ,Coronary Circulation ,Humans ,Medicine ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,In patient ,Prospective Studies ,media_common ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Coronary Vessels ,Magnetic Resonance Imaging ,Radiography ,Coronary arteries ,Dipyridamole ,medicine.anatomical_structure ,Feasibility Studies ,Female ,business ,Nuclear medicine ,Perfusion ,medicine.drug ,Artery - Abstract
To prospectively determine the feasibility of using first-pass magnetic resonance (MR) imaging to distinguish between myocardial segments in patients with coronary artery disease (CAD) of different degrees of obstruction and those in patients with normal-appearing coronary arteries.The study was approved by the institutional ethics committee, and all patients provided informed consent. First-pass contrast material-enhanced MR imaging was performed at rest and after the infusion of dipyridamole in 37 patients (29 men, eight women; mean age, 57.2 years +/- 10.5 [standard deviation]) who had positive exercise test results or a clinical history of CAD. Myocardial segments were divided into five groups according to the degree of obstruction in the supplying artery. Signal intensity upslope, peak signal intensity, and time to peak signal intensity, as well as hyperemia-to-rest (HR) ratios for each of these three variables, were analyzed for each segment by using a generalized linear model.Signal intensity upslope in patients with normal coronary arteries at angiography was significantly higher than that in patients with CAD (P.001). Signal intensity upslope for segments in patients without CAD was significantly different from that for normal-appearing segments in patients with CAD (P.001). Signal intensity upslope (P.05) and peak signal intensity (P.01) enabled the differentiation of segments with more than 70% reduction in luminal diameter from those in all other groups. HR ratios demonstrated findings that were similar to those obtained by using each signal intensity variable alone.First-pass MR imaging can be used to distinguish segments with different degrees of obstructive CAD. Importantly, MR imaging can help identify segments with impaired perfusion and normal-appearing coronary arteries in patients with CAD and can demonstrate obstructive lesions in other territories.
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- 2006
38. Normalization of Right Ventricular Performance and Remodeling Evaluated by Magnetic Resonance Imaging at Late Follow-up of Heart Transplantation: Relationship Between Function, Exercise Capacity and Pulmonary Vascular Resistance
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Noedir Antônio Groppo Stolf, Luiz Felipe P. Moreira, Fernando Bacal, José Rodrigues Parga Filho, S.A. Ferreira, Fátima das Dores Cruz, José Antonio Franchini Ramires, Victor Sarli Issa, Edimar Alcides Bocchi, Guilherme Veiga Guimarães, Ursula M. Costa, Philippe Vieira Pires, Christiano Pereira Silva, Veridiana M. D´Ávila, and Miguel A. Rosário-Neto
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hemodynamics ,Internal medicine ,medicine ,Humans ,Ventricular Function ,Prospective Studies ,Ventricular remodeling ,Lung ,End-systolic volume ,Transplantation ,Exercise Tolerance ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Stroke volume ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Blood pressure ,Case-Control Studies ,Exercise Test ,Cardiology ,Vascular resistance ,Heart Transplantation ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Right ventricular (RV) dysfunction remains one of the most prominent complications during the period immediately after heart transplantation (HT); however, late adaptation of the RV has not been well described. The aim of our study was to evaluate RV function and remodeling using magnetic resonance imaging (MRI) and to correlate it with exercise capacity and also with hemodynamic data obtained before HT. Methods We prospectively evaluated RV function of 25 heart-transplanted patients, without cardiac allograft vasculopathy, who were documented by negative dobutamine stress echocardiography during late follow-up (Group 1, 6 ± 4.3 years) using MRI. We then compared Group 1 with a control group consisting of 10 patients, who were ≤1 year post-HT (Group 2), hemodynamically stable, and with the same pre-operative hemodynamic features as Group 1. Their pulmonary arterial systolic blood pressure (PSBP) varied from 17 to 67 mm Hg (43.2 ± 15.3) and pulmonary vascular resistance (PVR) from 1.0 to 5.4 Wood units (2.5 ± 1.12). The following parameters were studied: RV end-diastolic volume (EDV) and systolic volume (ESV); stroke volume (SV); ejection fraction (EF); and mass (M). We also evaluated the Vo 2 peak and slope Ve/Vco 2 values during a treadmill test. Data were analyzed and correlated with the hemodynamic values of PVR and PSBP obtained pre-HT. Results In Group 1, treadmill evaluation data showed exercise Vo 2 peak (19.9 ± 3.19 ml/kg/min) and slope Ve/Vco 2 (36.9 ± 4.5) values comparable to those of sedentary individuals; RV variables according to MRI were within normal ranges, with the following mean values for Groups 1 and 2, respectively: RVEDV, 99.6 ± 4.0 ml vs 127 ± 16 ml ( p = 0.03); RVESV, 42 ± 2 ml vs 58.5 ± 9 ml ( p = 0.01); RVSV, 57 ± 3 ml vs 71 ± 10 ml ( p = 0.1); RVEF, 58 ± 1.4% vs 54 ± 3.8% ( p = 0.29); and RVM, 43.4 ± 1.9 g vs 74 ± 8.8 g ( p = 0.001). There was no correlation between hemodynamic pulmonary values before HT or any other index of late RV performance, including RV remodeling and hypertrophy, in our study population ( p = not significant). Conclusions In contrast to what we would expect for heart transplant patients at late follow-up, the RV may adapt to pulmonary pressure and resistance, with reverse remodeling characterized by volume and mass reduction, leading to normalization of RV function despite abnormal hemodynamic pulmonary values being measured before HT. There was no influence on the low exercise capacity observed in these patients, in the absence of cardiac allograft vasculopathy.
- Published
- 2005
39. Epipericardial fat necrosis: an underdiagnosed condition
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K de S Giassi, André Nathan Costa, Guilherme Hipolito Bachion, D A Lynch, Ronaldo Adib Kairalla, José Rodrigues Parga Filho, and Andre Apanavicius
- Subjects
Adult ,Male ,medicine.medical_specialty ,Chest Pain ,Adolescent ,Pleural effusion ,Atelectasis ,Chest pain ,Lesion ,Diagnosis, Differential ,Fibrin Fibrinogen Degradation Products ,medicine ,Pericardium ,Humans ,Radiology, Nuclear Medicine and imaging ,Fat necrosis ,Fat Necrosis ,Aged ,Pain Measurement ,Aged, 80 and over ,Full Paper ,business.industry ,Emergency department ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Female ,Radiology ,medicine.symptom ,Differential diagnosis ,business ,Emergency Service, Hospital ,Tomography, X-Ray Computed - Abstract
Epipericardial fat necrosis (EFN) is an uncommon benign and self-limited condition that leads patients to the emergency department (ED) owing to the onset of acute pleuritic chest pain. The aim of this study was to describe the cases of this disease in our institution and to illustrate the associated clinical and radiological findings.We reviewed 3604 chest scans referred by the ED from November 2011 to July 2013. Patients diagnosed with epipericardial necrosis had their medical records and original tomography reports analysed.Chest pain was the primary complaint in 426 patients; 11 of them had definitive EFN findings characterized by a round soft-tissue attenuation lesion with a varying degree of strands. All patients presented with pleuritic chest pain on the same side as the lesion. Pericardial thickening, pleural effusion and mild atelectasis were the associated tomography findings. Cardiac enzyme and D-dimer tests performed during the episode were normal in all cases. 27% of the cases only were correctly diagnosed with EFN at the time of presentation.EFN is a benign inflammatory condition frequently overlooked in the ED by physicians and radiologists but is an important factor in the differential diagnosis of patients with acute chest pain.The article adds clinically and radiologically useful information about the condition and displays the importance of making the correct diagnosis to avoid unnecessary examinations.
- Published
- 2014
40. II Diretriz de Ressonância Magnética e Tomografia Computadorizada Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia
- Author
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Valéria de Melo Moreira, Marly Maria Uellendahl Lopes, Marcelo Hadlich, Paulo Roberto Schvartzman, Rui Alberto de Faria Filho, Ricardo Loureiro, Fabio de Morais Medeiros, Rodrigo Cerci, Cesar Higa Nomura, Marcello Zapparoli, Adriano Tachibana, Andrei Skromov de Albuquerque, Márcio Hiroshi Minami, Luiz Flávio Galvão Gonçalves, Walther Yoshiharu Ishikawa, Raul D. Santos, Marcia M. Barbosa, Juliana Fernandes Kelendjian, Ilan Gottlieb, Luiz Augusto Quaglia, Guilherme Urpia Monte, Alexandre Volney Villa, Tiago A. Magalhães, Sávio Cardoso, Otávio Rizzi Coellho Filho, Gilberto Szarf, Roberto Caldeira Cury, Leonardo Iquizli, Roberto Sasdelli Neto, Ricardo C. Cury, Afonso Akio Shiozaki, Flávia Pegado Junqueira, Robson Macedo, Maria Helena Albernaz Siqueira, Marcelo Souto Nacif, Clerio F. Azevedo, Juliano L Fernandes, Joalbo M. Andrade, Dany Jasinowodolinski, Tiago Senra, Amarino C. Oliveira, Ibraim Pinto, Carlos E. Rochitte, Mateus Diniz Marques, Fernando Uliana Kay, Ursula Maria Moreira Costa Burgos, Márcio Sommer Bittencourt, Leonardo Sara, Marly Conceição Silva, José Rodrigues Parga Filho, Joao A.C. Lima, Eduardo Marinho Tassi, Thiago Marchini Naves, Mônica La Rocca Vieira, Guilherme Santana Antunes Azevedo, Luis C. L. Correia, and Luiz Francisco Rodrigues de Ávila
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,lcsh:RC666-701 ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Published
- 2014
41. FT17. Computed Tomography Evaluation of Adamkiewicz Artery in Patients With and Without Aortic Disease
- Author
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José Rodrigues Parga Filho, Noedir Antônio Groppo Stolf, and Alexandre Campos Moraes Amato
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medicine ,Surgery ,Computed tomography ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Adamkiewicz artery ,Aortic disease - Published
- 2016
42. Dynamic myocardial perfusion imaging by dual-source computed tomography
- Author
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José Rodrigues, Parga Filho, Cintia Souza Lima Moraes, Lima, Felipe Gallego, Lima, Tiago da Silveira, Jaques, Luiz Francisco Rodrigues de, Avila, and Roberto, Kalil Filho
- Subjects
Adult ,Male ,Tissue Survival ,Coronary Stenosis ,Myocardial Ischemia ,Myocardial Perfusion Imaging ,Humans ,Dipyridamole ,Radiopharmaceuticals ,Tomography, X-Ray Computed - Abstract
We report a dual-source computed tomography study of dynamic and quantitative myocardial perfusion in a 44-year-old patient with previous documented coronary artery disease. Quantitatively, the tomography showed myocardial perfusion deficit in the territories with significant coronary stenosis, confirmed by computed tomography angiography and conventional angiography. Dual-source computed tomography allowed dynamic perfusion and anatomic evaluation in a single study during the follow-up of this patient.
- Published
- 2011
43. Evaluation of subclinical atherosclerosis by computed tomography coronary angiography and its association with risk factors in familial hypercholesterolemia
- Author
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Mario S. Ribeiro, Raul D. Santos, José Rodrigues Parga Filho, L. Martinez, Luiz Aparecido Bortolotto, Marcio H. Miname, Carlos E. Rochitte, and Luis F. Avila
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Familial hypercholesterolemia ,Coronary Artery Disease ,Coronary Angiography ,Asymptomatic ,Hyperlipoproteinemia Type II ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Risk factor ,education ,Coronary atherosclerosis ,Computed tomography angiography ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Age Factors ,Calcinosis ,Cholesterol, LDL ,Middle Aged ,medicine.disease ,Coronary Calcium Score ,Stenosis ,Cardiology ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Increasing age and cholesterol levels, male gender, and family history of early coronary heart disease (CHD) are associated with early onset of CHD in familial hypercholesterolemia (FH).Assess subclinical atherosclerosis by computed tomography coronary angiography (CTCA) and its association with clinical and laboratorial parameters in asymptomatic FH subjects.102 FH subjects (36% male, 45 ± 13 years, LDL-c 280 ± 54 mg/dL) and 35 controls (40% male, 46 ± 12 years, LDL-c 103 ± 18 mg/dL) were submitted to CTCA. Plaques were divided into calcified, mixed and non-calcified; luminal stenosis was characterized as50% obstruction.FH had a greater atherosclerotic burden represented by higher number of patients with: plaques (48% vs. 14%, p=0.0005), stenosis (19% vs. 3%, p=0.015), segments with plaques (2.05 ± 2.85 vs.0.43 ± 1.33, p=0.0016) and calcium scores (55 ± 129 vs. 38 ± 140, p=0.0028). After multivariate analysis, determinants of plaque presence were increasing age (OR=2.06, for age change of 10 years, CI95%: 1.38-3.07, p0.001) and total cholesterol (OR=1.86, for cholesterol change by 1 standard deviation, CI95%: 1.09-3.15, p=0.027). Coronary calcium score was associated with the presence of stenosis (OR=1.54; CI95%: 1.27-1.86, p0.001, for doubling the calcium score). Male gender was directly associated with the presence of non-calcified plaques (OR: 15.45, CI95% 1.72-138.23, p=0.014) and inversely with calcified plaques (OR=0.21, CI95%: 0.05-0.84, p=0.027). Family history of early CHD was associated with the presence of mixed plaques (OR=4.90, CI95%: 1.32-18.21, p=0.018).Patients with FH had an increased burden of coronary atherosclerosis by CTCA. The burden of atherosclerosis and individual plaque subtypes differed with the presence of other associated risk factors, with age and cholesterol being most important. A coronary calcium score of zero ruled out obstructive disease in this higher risk population.
- Published
- 2010
44. Echocardiographic diagnosis of rheumatic fever and rheumatic valvar disease
- Author
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Alvaro Moraes, José Albuquerque de Figueiredo Neto, R Snitcowsky, José Rodrigues Parga Filho, Caio Cesar Jorge Medeiros, Fulvio Pileggi, Giovanni Bellotti, and P Graziosi
- Subjects
Mitral regurgitation ,medicine.medical_specialty ,Myocarditis ,business.industry ,Carditis ,General Medicine ,Regurgitation (circulation) ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Mitral valve ,Heart failure ,Internal medicine ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine ,Cardiology ,Rheumatic fever ,Cardiology and Cardiovascular Medicine ,business - Abstract
SummaryWe studied 56 children echocardiographically, ages four to 15 years (mean nine years) with acute rheumatic fever to determine the extent of cardiac involvement. All had a clinical diagnosis of carditis. Mitral regurgitation was always present and was associated with aortic regurgitation in 53.6% and tricuspid regurgitation in 32.1%. Mitral valvar prolapse was observed in 18 patients 5(32.1%) and could not be differentiated from myxomatous prolapse in 10 (17.8%). Cordal rupture was detected in seven patients (12.5%), three of whom required surgical treatment. Other findings concerning the mitral valve were vegetations in two patients (3.6%), commissural fusion without stenosis in 36(64.3%), and mitral stenosis in four (7.1%). Heart failure was usually secondary to valvitis rather than myocarditis, and led to surgical treatment in seven patients. The myocardial function was depressed in only two patients. In both, the ejection function returned to normal after medical treatment. Echocardiography provides important information on the involvement of the heart in acute rheumatic fever, helping to determine prognosis and the results of treatment.
- Published
- 1992
45. Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison betw een groups)
- Author
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Clarissa Almeida Sarmento Barbosa, José Rodrigues Parga Filho, Edmundo Arteaga Fernández, Luiz Francisco Rodrigues de Ávila, Domingos Mohanad Hattem, and Cláudio Campi de Castro
- Subjects
Gynecology ,medicine.medical_specialty ,resonance imaging ,business.industry ,Perfusión miocárdica ,Perfusão miocárdica ,hypertrophic cardiomyopathy ,imagen de resonancia magnética ,imagem de ressonância magnética ,cardiomiopatia hipertrófica ,Myocardial perfusion ,cardiomiopatía hipertrófica ,estudo comparativo ,estudio comparativo ,medicine ,Cardiology and Cardiovascular Medicine ,business ,comparative study - Abstract
FUNDAMENTO: A ressonância magnética é um método eficaz para estudo da cardiomiopatia hipertrófica. OBJETIVO: Avaliar, pela ressonância magnética, os parâmetros de função sistólica, perfusão e viabilidade miocárdica em pacientes portadores de cardiomiopatia hipertrófica, comparando os grupos com e sem obstrução na via de saída do ventrículo esquerdo. MÉTODO: Vinte e um pacientes com diagnóstico de cardiomiopatia hipertrófica realizaram estudos de função, viabilidade e perfusão miocárdica nas fases de estresse e de repouso pela ressonância magnética. RESULTADOS: Os segmentos ventriculares mais comprometidos pela hipertrofia foram os da região septal. O grupo obstrutivo apresentou distribuição segmentar de espessura miocárdica semelhante ao não-obstrutivo, porém com maiores médias que o primeiro grupo. A média da fração de ejeção dos pacientes do grupo obstrutivo foi maior que o grupo não-obstrutivo, enquanto as médias dos volumes sistólico e diastólico finais foram menores no grupo obstrutivo. Houve correlação positiva entre a espessura segmentar do ventrículo e a massa segmentar do realce tardio. A indução de estresse determinou aumento do número de segmentos com alteração de perfusão e essa alteração foi mais evidente no grupo obstrutivo. CONCLUSÃO: Os segmentos ventriculares com maior espessura são os septais. As regiões hipertróficas estão associadas à maior extensão de realce tardio. Houve correlação positiva entre as áreas de hipertrofia ventricular e perfusão miocárdica alterada, e esses achados foram mais evidentes no grupo obstrutivo. BACKGROUND: The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE: To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS: Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS: The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION: The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group. FUNDAMENTO: La resonancia magnética es un método eficaz para estudio de la cardiomiopatía hipertrófica. OBJETIVO: Evaluar, por la resonancia magnética, los parámetros de función sistólica, perfusión y viabilidad miocárdica en pacientes portadores de cardiomiopatía hipertrófica, comparando los grupos con y sin obstrucción en la vía de salida del ventrículo izquierdo. MÉTODO: Veinte y un pacientes con diagnóstico de cardiomiopatía hipertrófica realizaron estudios de función, viabilidad y perfusión miocárdica en las fases de estrés y de reposo por la resonancia magnética. RESULTADOS: Los segmentos ventriculares más comprometidos por la hipertrofia fueron los de la región septal. El grupo obstructivo presentó distribución segmental de espesor miocárdico semejante al no obstructivo, pero con mayores promedios que el primer grupo. El promedio de la fracción de eyección de los pacientes del grupo obstructivo fue mayor que el grupo no obstructivo, mientras que los promedios de los volúmenes sistólico y diastólico finales se hallaron menores en el grupo obstructivo. Hubo correlación positiva entre el espesor de los segmentos del ventrículo y la masa segmental del realce tardío. La inducción de estrés determinó aumento del número de segmentos con alteración de perfusión, y esa alteración fue más evidente en el grupo obstructivo. CONCLUSIÓN: Los segmentos ventriculares con mayor espesor son los septales. Las regiones hipertróficas están asociadas a la mayor extensión de realce tardío. Hubo correlación positiva entre las áreas de hipertrofia ventricular y perfusión miocárdica alterada, y estos hallazgos fueron más evidentes en el grupo obstructivo.
- Published
- 2009
46. Evaluation of the metabolism of high energy phosphates in patients with Chagas' disease
- Author
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Ana Maria Betim Paes, Leme, Vera Maria Cury, Salemi, José Rodrigues, Parga, Bárbara Maria, Ianni, Charles, Mady, Robert G, Weiss, and Roberto, Kalil-Filho
- Subjects
Adult ,Cardiomyopathy, Dilated ,Chagas Cardiomyopathy ,Heart Failure ,Male ,Magnetic Resonance Spectroscopy ,Myocardium ,Phosphorus ,Middle Aged ,Severity of Illness Index ,Phosphates ,Adenosine Triphosphate ,Humans ,Ventricular Function ,Chagas Disease ,Female ,Prospective Studies ,Energy Metabolism ,Aged - Abstract
Abnormalities in myocardial metabolism have been observed in patients with heart failure of different etiologies. Magnetic resonance spectroscopy (MRS) with phosphorus-31 is a noninvasive technique that allows detection of myocardial metabolic changes.To determine the resting metabolism of high-energy phosphates in patients with Chagas' disease (CD) by MRS with phosphorus-31.We studied 39 patients with CD, 23 with preserved ventricular function (PF Group) and 16 with ventricular dysfunction (VD Group), assessed by Doppler echocardiography. MRS of the anterosseptal region was performed in 39 patients and 8 normal subjects (C Group) through a Phillips 1.5 Tesla device, obtaining the phosphocreatine/beta-adenosine triphosphate myocardial ratio (PCr/β-ATP).The levels of cardiac PCr/β-ATP were reduced in VD Group in relation to PF Group, and the latter presented reduced levels compared to C Group (VD Group: 0.89 ± 0.31 vs PF Group: 1.47 ± 0.34 vs C Group: 1.88 ± 0.08, p0.001). A correlation was found between left ventricular ejection fraction and PCr/β-ATP in 39 patients (r = 0.64, p0.001). Patients under functional class I (n = 22) presented PCr/β-ATP of 1.45 ± 0.35, and those in functional classes II and III (n = 17), PCr/β-ATP of 0.94 ± 0.36 (p0.001).The 31-phosphorus MRS was able to detect non-invasively changes in the rest energy metabolism of patients with Chagas' disease, with and without systolic dysfunction. These changes were related to the severity of heart impairment.
- Published
- 2009
47. [Myocardial fibrosis in patients with hypertrophic cardiomyopathy and high risk for sudden death]
- Author
-
Afonso Akio, Shiozaki, Tiago, Senra, Edmundo, Arteaga, Cristiane Guedes, Pita, Martino, Martinelli Filho, Luis Francisco R, Avila, José Rodrigues, Parga Filho, Charles, Mady, and Carlos Eduardo, Rochitte
- Subjects
Adult ,Male ,Chi-Square Distribution ,Death, Sudden, Cardiac ,Risk Factors ,Myocardium ,Humans ,Female ,Cardiomyopathy, Hypertrophic ,Tomography, X-Ray Computed ,Fibrosis ,Defibrillators, Implantable ,Electrodes, Implanted - Abstract
The stratification of risk for sudden death in hypertrophic cardiomyopathy (HCM) continues to be a true challenge due to the great heterogeneity of this disease's presentation, as most individuals remain asymptomatic during their entire lives and others present sudden death as first symptom. Recent studies have suggested that myocardial fibrosis may represent an important substrate for the malignant ventricular arrhythmias, that are responsible for the cases of sudden death related to this disease.To assess the prevalence and quantification of myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with implantablecardioverter - defibrillator (ICD) indicated due to their high risk or recovered from cardiac sudden death.Twenty-eight HCM patients with ICD were submitted to multidetector computed tomography to assess myocardial fibrosis by delayed enhancement technique.Myocardial fibrosis was present in 96% of these HCM patients with (20.38 +/- 15.55 g) comprising 15.96 +/- 10.20% of the total myocardial mass. MF was observed in a significantly higher prevalence as compared to other classical risk factors for sudden death.It is possible to conclude that there is a high prevalence of myocardial fibrosis in hypertrophic cardiomyopathy patients with high-risk or recovered from cardiac sudden death, like those with clinical indication to implantable cardioverter -defibrillator. The higher prevalence of myocardial fibrosis in comparison to classical risk factors of worse prognosis raise the hypothesis that the myocardial fibrosis may be an important substrate in the genesis of lifethreatening arrhythmias in these high risk HCM population.
- Published
- 2008
48. Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison between groups)
- Author
-
Clarissa Almeida Sarmento, Barbosa, Cláudio Campi de, Castro, Luiz Francisco Rodrigues de, Avila, José Rodrigues, Parga Filho, Domingos Mohanad, Hattem, and Edmundo Arteaga, Fernandez
- Subjects
Adult ,Male ,Young Adult ,Adolescent ,Humans ,Female ,Hypertrophy, Left Ventricular ,Stroke Volume ,Cardiomyopathy, Hypertrophic ,Middle Aged ,Epidemiologic Methods ,Magnetic Resonance Imaging ,Myocardial Contraction - Abstract
The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM).To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract.Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI.The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group.The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.
- Published
- 2007
49. Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis
- Author
-
Guilherme Urpia, Monte, Luciano Ferreira, Drager, Fábio Solano de Freitas, Souza, Luiz Francisco Rodrigues de, Avila, José Rodrigues, Parga Filho, Luiz Antônio Machado, César, Marisa, Izaki, José Cláudio, Meneghetti, Carlos Eduardo, Rochitte, and Roberto, Kalil Filho
- Subjects
Male ,Technetium Tc 99m Pyrophosphate ,Troponin I ,Myocardial Infarction ,Coronary Disease ,Middle Aged ,Magnetic Resonance Imaging ,Sensitivity and Specificity ,Necrosis ,Chronic Disease ,Myocardial Revascularization ,Creatine Kinase, MB Form ,Humans ,Female ,Radiopharmaceuticals ,Intraoperative Complications ,Radionuclide Imaging ,Biomarkers - Abstract
Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis.To compare CMRI and MS for the detection of POMI after CABG.A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery.Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed.Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.
- Published
- 2007
50. [Cardiovascular magnetic resonance and computed tomography imaging guidelines of the Brazilian Society of Cardiology]
- Author
-
Carlos Eduardo, Rochitte, Ibraim Masciarelli Francisco, Pinto, Juliano Lara, Fernandes, Clério Francisco Azevedo, Filho, Adib, Jatene, Antonio Carlos de Camargo, Carvalho, Jorge Pinto, Ribeiro, José Antonio Franchini, Ramires, Sergio Almeida, Oliveira, César Augusto Mastrofrancisco, Cattani, Dany, Jasinowodolinsk, Fabiano, Lucchesi, Fábio Berezowsky, Rocha, Fátima Cristina, Pedroti, Gilberto, Szarf, Guilherme Urpia, Monte, Iugiro Roberto, Kuroki, Joalbo, Andrade, José Rodrigues Parga, Filho, Luis Cláudio, Correia, Luiz Francisco, Avila, Marcelo, Hadlich, Marcelo, Zapparoli, Marcia, Barbosa, Márcia Lima, Mugnaini, Maria Helena Albernaz, Siqueira, Marly Maria, Uellendhal, Miguel Abraão Rosário, Neto, Paulo R, Schwarzman, Raul Dias dos Santos, Filho, Ricardo, Loureiro, Roberto, Kalil Filho, Robson de Macedo, Vieira, and Anis, Rassi
- Subjects
Cardiovascular Diseases ,Cardiology ,Humans ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Brazil ,Societies, Medical - Published
- 2006
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