JEANE MIKE TSUTSUI
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bookPart Ecocardiografia(2016) MATHIAS JUNIOR, Wilson; TSUTSUI, Jeane MikebookPart Ecocardiografia(2016) MATHIAS JR., Wilson; TSUTSUI, Jeane MikeconferenceObject Effects of High Mechanical Index Impulses From a Diagnostic Ultrasound Transducer During an Intravenous Ultrasound Contrast Infusion in Preventing Adverse Left Ventricular Remodeling in Acute ST Segment Myocardial Infarction(2016) MATHIAS, Wilson; TSUTSUI, Jeane M.; TAVARES, Bruno G.; AGUIAR, Miguel O.; OLIVEIRA, Mucio T.; SOEIRO, Alexandre; LEMOS, Pedro A.; RAMIRES, Jose; KALIL, Roberto; PORTER, Thomas R.- Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles(2016) MATHIAS JR., Wilson; TSUTSUI, Jeane M.; TAVARES, Bruno G.; XIE, Feng; AGUIAR, Miguel O. D.; GARCIA, Diego R.; OLIVEIRA JR., Mucio T.; SOEIRO, Alexandre; NICOLAU, Jose C.; LEMOS NETO, Pedro A.; ROCHITTE, Carlos E.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; PORTER, Thomas R.BACKGROUND Pre-clinical trials have demonstrated that, during intravenous microbubble infusion, high mechanical index (HMI) impulses from a diagnostic ultrasound (DUS) transducer might restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES The purpose of this study was to test the safety and efficacy of this adjunctive approach in humans. METHODS From May 2014 through September 2015, patients arriving with their first STEMI were randomized to either DUS intermittent HMI impulses (n = 20) just prior to emergent percutaneous coronary intervention (PCI) and for an additional 30 min post-PCI (HMI + PCI), or low mechanical index (LMI) imaging only (n = 10) for perfusion assessments before and after PCI (LMI + PCI). All studies were conducted during an intravenous perflutren lipid microsphere infusion. A control reference group (n = 70) arrived outside of the time window of ultrasound availability and received emergent PCI alone (PCI only). Initial epicardial recanalization rates prior to emergent PCI and improvements in microvascular flow were compared between ultrasound-treated groups. RESULTS Median door-to-dilation times were 82 +/- 26 min in the LMI + PCI group, 72 +/- 15 min in the HMI + PCI group, and 103 +/- 42 min in the PCI-only group (p = NS). Angiographic recanalization prior to PCI was seen in 12 of 20 HMI + PCI patients (60%) compared with 10% of LMI + PCI and 23% of PCI-only patients (p = 0.002). There were no differences in microvascular obstructed segments prior to treatment, but there were significantly smaller proportions of obstructed segments in the HMI + PCI group at 1 month (p = 0.001) and significant improvements in left ventricular ejection fraction (p < 0.005). CONCLUSIONS HMI impulses from a diagnostic transducer, combined with a commercial microbubble infusion, can prevent microvascular obstruction and improve functional outcome when added to the contemporary PCI management of acute STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330) (C) 2016 by the American College of Cardiology Foundation.
- Comprehensive left ventricular mechanics analysis by speckle tracking echocardiography in Chagas disease(2016) LIMA, Marcio Silva Miguel; VILLARRAGA, Hector R.; ABDUCH, Maria Cristina Donadio; LIMA, Marta Fernandes; CRUZ, Cecilia Beatriz Bittencourt Viana; BITTENCOURT, Marcio Sommer; VOOS, Mariana Callil; SBANO, Joao Cesar Nunes; MATHIAS JR., Wilson; TSUTSUI, Jeane MikeBackground: Chagas disease (CD) is a frequent cause of dilated cardiomyopathy (CMP) in developing countries, leading to clinical heart failure and worse prognosis. Therefore, the development and evolution of this CMP has always been a major topic in numbers of previous studies. A comprehensive echocardiographic study of left ventricular (LV) mechanics, fully assessing myocardial contraction, has never been done before. This could help characterize and improve the understanding of the evolution of this prevalent CMP. Methods: A total of 47 chagasic and 84 control patients were included in this study and allocated in groups according to LV ejection fraction. 2D-Echocardiogram was acquired for LV mechanics analysis by speckle tracking echocardiography. Results: Mean age of chagasic individuals was 55y and 16 (34 %) were men. Significant difference was found in global longitudinal velocity analysis, with lower values in indeterminate form. In the group with severe systolic dysfunction, a paradoxical increase in longitudinal and apical radial displacements were demonstrated. In parallel, segmental analyzes highlighted lower values of radial displacement, strain and strain rate into inferior and inferolateral walls, with increase of these values in septal and anterior walls. Conclusion: Chagasic CMP has a vicarious pattern of contraction in the course of its evolution, defined by reduced displacement and strain into inferior and posterior walls with paradoxical increase in septal and anterior segments. Also, lower longitudinal velocities were demonstrated in CD indeterminate form, which may indicate an incipient myocardial injury.
- The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography(2016) LANCELLOTTI, Patrizio; PELLIKKA, Patricia A.; BUDTS, Werner; CHAUDHRY, Farooq A.; DONAL, Erwan; DULGHERU, Raluca; EDVARDSEN, Thor; GARBI, Madalina; HA, Jong-Won; KANE, Garvan C.; KREEGER, Joe; MERTENS, Luc; PIBAROT, Philippe; PICANO, Eugenio; RYAN, Thomas; TSUTSUI, Jeane M.; VARGA, AlbertA unique and highly versatile technique, stress echocardiography (SE) is increasingly recognized for its utility in the evaluation of non-ischaemic heart disease. SE allows for simultaneous assessment of myocardial function and haemodynamics under physiological or pharmacological conditions. Due to its diagnostic and prognostic value, SE has become widely implemented to assess various conditions other than ischaemic heart disease. It has thus become essential to establish guidance for its applications and performance in the area of non-ischaemic heart disease. This paper summarizes these recommendations.
- The impact of ligation of proximal side branches on blood flow and functional status of the internal thoracic artery in coronary anastomosis(2016) ABREU, Jose Sebastiao; TSUTSUI, Jeane Mike; FALCAO, Sandra Nivea R.; FEITOSA, Jose Acacio; ROCHA, Eduardo Arraes; OLIVEIRA, Italo Martins; DIOGENES, Teresa Cristina; PAES JR., Jose N.; SBANO, Joao C.; DALLAN, Luis A.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackgroundThe effect of proximal side branches on the patency of the internal thoracic artery (ITA) is controversial. We used echocardiography and Doppler to verify the effect of ligation of branches on the flow and coronary flow reserve (CFR) of the grafted ITA in patients after coronary artery bypass grafting (CABG). MethodsWe prospectively investigated 53 patients with preserved left ventricular ejection fraction (LVEF >50%) who underwent CABG of the ITA. In Group I (25 patients), major branches were ligated during ITA anastomosis to the left anterior descending (LAD) coronary artery, whereas no ligation was performed in Group II (28 patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF = SF + DF) were measured by Doppler echocardiography at the proximal level of the ITA preoperatively, at early postoperative stage, and 6months after surgery. Dobutamine stress echocardiography (DSE) was performed at 6months to determine CFR. ResultsThe ITA flow was predominantly systolic before surgery and diastolic in the postoperative period. We found no differences between the groups in DF. On DSE, SF (19.59mL/min vs 32.7 +/- 19mL/min; P=.003) and TF (79 +/- 21mL/min vs 101 +/- 47mL/min; P=.037) were higher in Group II. There were no differences in CFR (1.9 +/- 0.46 vs 2.11 +/- 0.56; P=.143). ConclusionIn patients with preserved LVEF, ligation of major side branches during anastomosis to the LAD does not alter ITA flow or CFR.
conferenceObject Effects of High Mechanical Index Impulses From a Diagnostic Ultrasound Transducer During an Intravenous Ultrasound Contrast Infusion in Preventing Adverse Left Ventricular Remodeling in Acute ST Segment Myocardial Infarction(2016) MATHIAS, Wilson; TSUTSUI, Jeane M.; TAVARES, Bruno G.; AGUIAR, Miguel O.; OLIVEIRA, Mucio T.; SOEIRO, Alexandre; LEMOS, Pedro A.; RAMIRES, Jose; KALIL, Roberto; PORTER, Thomas R.- Predominance of Intrinsic Mechanism of Resting Heart Rate Control and Preserved Baroreflex Sensitivity in Professional Cyclists after Competitive Training(2016) AZEVEDO, Luciene Ferreira; PERLINGEIRO, Patricia; HACHUL, Denise Tessariol; GOMES-SANTOS, Igor Lucas; TSUTSUI, Jeane Mike; NEGRAO, Carlos Eduardo; MATOS, Luciana D. N. J. DeDifferent season trainings may influence autonomic and non-autonomic cardiac control of heart rate and provokes specific adaptations on heart's structure in athletes. We investigated the influence of transition training (TT) and competitive training (CT) on resting heart rate, its mechanisms of control, spontaneous baroreflex sensitivity (BRS) and relationships between heart rate mechanisms and cardiac structure in professional cyclists (N = 10). Heart rate (ECG) and arterial blood pressure (Pulse Tonometry) were recorded continuously. Autonomic blockade was performed (atropine-0.04 mg.kg(-1); esmolol-500 mu g.kg(-1) = 0.5 mg). Vagal effect, intrinsic heart rate, parasympathetic (n) and sympathetic (m) modulations, autonomic influence, autonomic balance and BRS were calculated. Plasma norepinephrine (high-pressure liquid chromatography) and cardiac structure (echocardiography) were evaluated. Resting heart rate was similar in TT and CT. However, vagal effect, intrinsic heart rate, autonomic influence and parasympathetic modulation (higher n value) decreased in CT (P <= 0.05). Sympathetic modulation was similar in both trainings. The autonomic balance increased in CT but still showed parasympathetic predominance. Cardiac diameter, septum and posterior wall thickness and left ventricular mass also increased in CT (P<0.05) as well as diastolic function. We observed an inverse correlation between left ventricular diastolic diameter, septum and posterior wall thickness and left ventricular mass with intrinsic heart rate. Blood pressure and BRS were similar in both trainings. Intrinsic heart rate mechanism is predominant over vagal effect during CT, despite similar resting heart rate. Preserved blood pressure levels and BRS during CT are probably due to similar sympathetic modulation in both trainings.
- Untitled Reply(2016) GUERRA, Vitor C.; TSUTSUI, Jeane M.; MATHIAS JR., Wilson