JEANE MIKE TSUTSUI
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- Evaluation of cardiac masses by real-time perfusion imaging echocardiography(2015) UENISHI, Eliza K.; CALDAS, Marcia A.; TSUTSUI, Jeane M.; ABDUCH, Maria C. D.; SBANO, Joao C. N.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackground: Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization. Methods: We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (beta), and microvascular blood flow (A x beta) were determined by quantitative RTPE. Results: Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1-7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x beta values were 0.0 dB/s(-1) (0.01-0.14), 2.00 dB/s(-1) (1-6), and 1.18 dB/s(-1) (0.52-3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Ax beta = 2.46 dB/s(-1) (1.42-4.59) versus Ax beta = 1.55 dB/s [1] (0.51-4.08); p=NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT. Conclusion: RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
- Prognostic Value of Coronary and Microvascular Flow Reserve in Patients with Nonischemic Dilated Cardiomyopathy(2013) LIMA, Marta F.; MATHIAS JR., Wilson; SBANO, Joao C. N.; CRUZ, Victoria Yezinia de la; ABDUCH, Maria Cristina; LIMA, Marcio S. M.; BOCCHI, Edmar A.; HAJJAR, Ludhmila A.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; TSUTSUI, Jeane M.Background: Coronary and microvascular blood flow reserve have been established as important predictors of prognosis in patients with cardiovascular disease. The aim of this study was to assess the value of coronary flow velocity reserve (CFVR) and real-time myocardial perfusion echocardiography (RTMPE) for predicting events in patients with nonischemic dilated cardiomyopathy. Methods: One hundred ninety-five patients (mean age 54 +/- 12 years; 66% men) with dilated cardiomyopathy (left ventricular ejection fraction < 35% and no obstructive coronary disease on invasive angiography or multi-detector computed tomography) who underwent dipyridamole stress (0.84 mg/kg over 10 min) RTMPE were prospectively studied. CFVR was calculated as the ratio of hyperemic to baseline peak diastolic velocities in the distal left anterior coronary artery. The replenishment velocity (beta), plateau of acoustic intensity (A(N)), and myocardial blood flow reserve were obtained from RTMPE. Results: Mean CFVR was 2.07 +/- 0.52, mean A(N) reserve was 1.05 +/- 0.09, mean beta reserve was 2.05 +/- 0.39, and mean myocardial blood flow reserve (A(N) x beta) was 2.15 +/- 0.48. During a median follow-up period of 29 months, 45 patients had events (43 deaths and two urgent transplantations). Independent predictors of events were left atrial diameter (relative risk, 1.16; 95% confidence interval, 1.08-1.26; P < .001) and beta reserve <= 2.0 (relative risk, 3.22; 95% confidence interval, 1.18-8.79; P < .001). After adjustment for beta reserve, CFVR and myocardial blood flow reserve no longer had predictive value. Left atrial diameter added prognostic value over clinical factors and left ventricular ejection fraction (chi(2) = 36.8-58.5, P < .001). Beta reserve added additional power to the model (chi(2) = 70.2, P < .001). Conclusions: Increased left atrial diameter and depressed beta reserve were independent predictors of cardiac death and transplantation in patients with nonischemic dilated cardiomyopathy. Beta reserve by RTMPE provided incremental predictive value beyond that provided by current known prognostic clinical and echocardiographic factors. (J Am Soc Echocardiogr 2013;26:278-87.)
conferenceObject Hypercholesterolemic diet worst left ventricular function evaluated by echocardiography in rats subjected to an experimental infarct model(2012) DOURADO, Paulo M.; TSUTSUI, Jeane M.; CASELLA FILHO, Antonio; LANDIM, Mauricio B.; GALVAO, Tatiana F.; AIELLO, Vera D.; LUZ, Protasio Da; MATHIAS JR., Wilson; CHAGAS, Antonio C.Introduction: A better comprehension of the hypercholesterolemic diet role in the set of acute myocardial infarct is fundamental. Objectives: Evaluation of the role of hypercholesterolemic diet in the determination of the hemodynamics patterns by echocardiography. Methods: Sixty three anesthetized rats were subjected to occlusion of the left anterior descending (LAD) coronary artery and divided in six groups: G1–just normal diet (ND); G2–ND and treatment with rosuvastatim for 30 days began after infarct and G3–ND and 30 days previously to infarct treated with rosuvastatim until 30 days after it; G4 –just hypercholesterolemic diet (HD); G5–HD and treatment with rosuvastatim for 30 days began after infarct and G6 –HD and 30 days previously to infarct treated with rosuvastatim until 30 days after it. Echocardiography was performed using bidimensional image in the paraesternal long axis. The planimetry of the left ventricle areas in the end of the diastole (LVEDA) and systole (LVESA) were realized before the infarct (pre) and 30 days after the infarct (post) . A p value<0.05 was considered significant. Conclusion: The hypercholesterolemic diet worst the hemodynamics parameters–LVEDA and LVESA - in comparison with the normocholesterolemic group treated with rosuvastatim.bookPart Ecocardiografia(2016) MATHIAS JUNIOR, Wilson; TSUTSUI, Jeane Mike- Rosuvastatin prevents myocardial necrosis in an experimental model of acute myocardial infarction(2011) DOURADO, P. M. M.; TSUTSUI, J. M.; LANDIM, M. B. P.; CASELLA FILHO, A.; GALVAO, T. F. G.; AIELLO, V. D.; MATHIAS JR., W.; LUZ, P. L. da; CHAGAS, A. C. P.Dyslipidemia is related to the progression of atherosclerosis and is an important risk factor for acute coronary syndromes. Our objective was to determine the effect of rosuvastatin on myocardial necrosis in an experimental model of acute myocardial infarction (AMI). Male Wistar rats (8-10 weeks old, 250-350 g) were subjected to definitive occlusion of the left anterior descending coronary artery to cause AMI. Animals were divided into 6 groups of 8 to 11 rats per group: G1, normocholesterolemic diet; G2, normocholesterolemic diet and rosuvastatin (1 mg.kg(-1).day(-1)) 30 days after AMI; G3, normocholesterolemic diet and rosuvastatin (1 mg.kg(-1).day(-1)) 30 days before and after AMI; G4, hypercholesterolemic diet; G5, hypercholesterolemic diet and rosuvastatin (1 mg.kg(-1).day(-1)) 30 days after AMI; G6, hypercholesterolemic diet and rosuvastatin (1 mg.kg(-1).day(-1)) 30 days before and after AMI. Left ventricular function was determined by echocardiography and percent infarct area by histology. Fractional shortening of the left ventricle was normal at baseline and decreased significantly after AMI (P < 0.05 in all groups), being lower in G4 and G5 than in the other groups. No significant difference in fractional shortening was observed between G6 and the groups on the normocholesterolemic diet. Percent infarct area was significantly higher in G4 than in G3. No significant differences were observed in infarct area among the other groups. We conclude that a hypercholesterolemic diet resulted in reduced cardiac function after AMI, which was reversed with rosuvastatin when started 30 days before AMI. A normocholesterolemic diet associated with rosuvastatin before and after AMI prevented myocardial necrosis when compared with the hypercholesterolemic condition.
bookPart Ecocardiografia(2016) MATHIAS JR., Wilson; TSUTSUI, Jeane MikebookPart Ecocardiografia(2013) MATHIAS JUNIOR, Wilson; TSUTSUI, Jeane MikeconferenceObject Prevalence of pulmonary hypertension among outpatients with sarcoidosis: An echocardiographic and pulmonary catheterization study(2012) MEDEIROS-NETO, Agostinho Hermes; RODRIGUES, Fabiola Gomes; TSUTSUI, Jean Mike; SOUZA, Rogerio; CARVALHO, Carlos Roberto Ribeiro; KAIRALLA, Ronaldo Adib- Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function(2017) MATTOSO, Angele A. A.; TSUTSUI, Jeane M.; KOWATSCH, Ingrid; CRUZ, Vitoria Y. L.; SBANO, Joao C. N.; RIBEIRO, Henrique B.; KALIL FILHO, Roberto; PORTER, Thomas R.; MATHIAS JR., WilsonObjective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (beta) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal beta reserve in >= 2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal beta reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WM and MP (chi(2) = 6.6 and chi(2) = 24.6, respectively; p = 0.001 and chi(2) = 6.6 and chi(2) = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, beta reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis of WM and MP, and coronary angiography in predicting acute coronary events.
- Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome(2015) ALDRIGHI, Jose M.; TSUTSUI, Jeane M.; KOWASTCH, Ingrid; RIBEIRO, Alessandra L.; SCAPINELLI, Alessandro; TAMANAHA, Sonia; OLIVEIRA, Ricardo M.; MATHIAS JR., WilsonObjectivePolycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS. MethodsWe studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE. Results reserve in group PCOS+IR was lower than control (2.340.55 vs. 3.60 +/- 0.6; P<0.001) and than PCOS without IR (2.34 +/- 0.55 vs. 3.17 +/- 0.65; P < 0.001). MBFR in patients with PCOS without IR did not differ from those of control (4.59 +/- 1.59 vs. 5.30 +/- 1.64; P =0.22) or from patients with PCOS+IR (4.59 +/- 1.59 vs. 3.70 +/- 1.47; P =0.07). When comparing with control group, patients with PCOS+IR had lower MBFR (5.30 +/- 1.64 vs. 3.70 +/- 1.47; P=0.01). No significant differences were found between control, PCOS without IR and PCOS+IR for FMD (0.18 +/- 0.05, 0.15 +/- 0.04 and 0.13 +/- 0.07; P =NS) or IMT (0.48 +/- 0.05, 0.47 +/- 0.05 and 0.49 +/- 0.07; P=NS). ConclusionWomen with PCOS and IR had depressed and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in reserve, probably an earlier marker of myocardial flow abnormality.