MARIA CLEMENTINA PINTO GIORGI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
9 resultados
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conferenceObject A decrease in glycolytic metabolism in noncompaction cardiomyopathy - Insights into pathophysiological mechanisms(2016) MELO, M. Dantas Tavares De; GIORGI, M. Clementina; DANTAS JUNIOR, R. Nery; LIMA, C. Rocon De; PARGA FILHO, J. Roberto; SOARES JUNIOR, J.; MENEGHETTI, J. Claudio; BIERRENBACH, A. Luiza; BOCCHI, E. Alcides; SALEMI, V. M. C.- Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study(2012) CONCEICAO-SOUZA, Germano Emilio; PEGO-FERNANDES, Paulo Manuel; CRUZ, Fatima das Dores; GUIMARAES, Guilherme Veiga; BACAL, Fernando; VIEIRA, Marcelo Luiz Campos; GRUPI, Cesar Jose; GIORGI, Maria Clementina Pinto; CONSOLIM-COLOMBO, Fernanda Marciano; NEGRAO, Carlos Eduardo; RONDON, Maria Urbana P.; MOREIRA, Luiz Felipe Pinho; BOCCHI, Edimar AlcidesTo evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) 40, sinus rhythm, and resting heart rate 65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 6.6 to 33 5.2 (P 0.03); 6 min walking distance improved from 167 35 to 198 47 m (P 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 5 to 15 7 (P 0.06). The remaining analysed variables were unchanged. During 848 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
- Case Report: Multivessel Coronary Disease Assessment with SPECT Tc-99m-Sestamibi and Rubidium-82 PET/CT(2017) PADILHA, Bruno Gomes; SABINO, Daniela; GIORGI, Maria Clementina; SOARES JR., Jose; IZAKI, Marisa; MENEGHETTI, Jose Claudio
- Low-carbohydrate diet versus euglycemic hyperinsulinemic clamp for the assessment of myocardial viability with F-18-fluorodeoxyglucose-PET: a pilot study(2014) SOARES JR., Jose; RODRIGUES FILHO, Filadelfo; IZAKI, Marisa; GIORGI, Maria Clementina P.; CATAPIRRA, Rosa M. A.; ABE, Rubens; VINAGRE, Carmen G. C. M.; CERRI, Giovanni G.; MENEGHETTI, Jose ClaudioPositron emission tomography with F-18-fluorodeoxyglucose (FDG-PET) is considered the gold standard for myocardial viability. A pilot study was undertaken to compare FDG-PET using euglycemic hyperinsulinemic clamp before F-18-fluorodeoxyglucose (F-18-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before F-18-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest Tc-99m-sestamibi-SPECT and two F-18-FDG studies (PET-CLAMP and PET-DIET). Myocardial tracer uptake was visually scored using a 5-point scale in a 17-segment model. Hibernating myocardium was defined as normal or mildly reduced metabolism (F-18-FDG uptake) in areas with reduced perfusion (Tc-99m-sestamibi uptake) since F-18-FDG uptake was higher than the degree of hypoperfusion-perfusion/metabolism mismatch indicating a larger flow defect. PET-DIET identified 79 segments and PET-CLAMP 71 as hibernating myocardium. Both methods agreed in 61 segments (agreement = 94.5 %, kappa = 0.78). PET-DIET identified 230 segments and PET-CLAMP 238 as nonviable. None of the patients had hypoglycemia after DIET, while 20 % had it during CLAMP. PET-DIET compared with PET-CLAMP had a good correlation for the assessment of hibernating myocardium. To our knowledge, these data provide the first evidence of the possibility of myocardial viability assessment with this technique.
- Decreased glycolytic metabolism in non-compaction cardiomyopathy by F-18-fluoro-2-deoxyglucose positron emission tomography: new insights into pathophysiological mechanisms and clinical implications(2017) MELO, Marcelo Dantas Tavares de; GIORGI, Maria Clementina Pinto; ASSUNCAO JR., Antonildes Nascimento; DANTAS JR., Roberto Nery; ARAUJO FILHO, Jose de Arimateia; PARGA FILHO, Jose Rodrigues; BIERRENBACH, Ana Luiza de Souza; LIMA, Camila Rocon de; SOARES JR., Jose; MENEGUETTI, Jose Claudio; MADY, Charles; HAJJAR, Ludhmila Abrahao; KALIL FILHO, Roberto; BOCCHI, Edimar Alcides; SALEMI, Vera Maria CuryAims The pathophysiological mechanisms of left ventricular non-compaction cardiomyopathy (LVNC) remain controversial. This study performed combined F-18-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 mu mol/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 < 0.001). Perfusion defects were also found in 15 (50%) patients (45 LV segments: 64.4% match, and 35.6% mismatch perfusion-metabolism pattern). Univariate and multivariate analyses showed that beta-blocker therapy was associated with increased MGU (beta coefficient = 10.1, P = 0.008). Moreover, a gradual increase occurred in MGU across the beta-blocker dose groups (P for trend = 0.01). Conclusion The reduction of MGU documented by FDG-PET in LVNC supports the hypothesis that a cellular metabolic pathway may play a role in the pathophysiology of LVNC. The beneficial effect of beta-blocker mediating myocardial.
conferenceObject Coronary flow reserve but not ischemia is a strong predictor of mortality in 551 outpatients referred for stress myocardial perfusion by Rubidium-82 PET imaging(2019) POPPI, N. Tavares; SOARES JUNIOR, J.; MENEGHETTI, J. C.; MIOTO, B. Mahler; GIORGI, M. C. P.; IZAKI, M.; CESAR, L. A. MachadoconferenceObject INFLUENCE OF LEFT BUNDLE BRANCH BLOCK IN ASSESSMENT OF MYOCARDIAL BLOOD FLOW FROM RUBIDIUM 82 POSITRON EMISSION TOMOGRAPHY IMAGING(2015) FALCAO, Andrea; CHALELA, William; GIORGI, Maria; IMADA, Rodrigo; SOARES JR., Jose; IZAKI, Marisa; KALIL-FILHO, Roberto; MENEGHETTI, Jose C.- Recurrent Angina Caused by Coronary Subclavian Steal Syndrome Confirmed by Positron Emission Tomography(2015) REZENDE, Paulo Cury; COSTA, Leandro Menezes Alves da; SCUDELER, Thiago Luis; NAKAMURA, Debora; GIORGI, Maria Clementina P.; HUEB, WhadyCoronary subclavian steal syndrome is a rare cause of recurrent angina after coronary artery bypass grafting. Identification of the myocardial ischemic region is crucial because it guides revascularization interventions to improve symptoms and myocardial ischemia. Positron emission computed tomography (PET) with rubidium might be a helpful tool because it identifies ischemia, localizes more precisely the ischemic region, and evaluates coronary flow reserve. Here, we report a case of recurrence of angina after coronary artery bypass grafting caused by an obstruction in the left subclavian artery and consequently by coronary steal syndrome confirmed by PET. (C) 2015 by The Society of Thoracic Surgeons
- Association between perivascular inflammation and downstream myocardial perfusion in patients with suspected coronary artery disease(2020) NOMURA, Cesar H.; ASSUNCAO-JR, Antonildes N.; GUIMARAES, Patricia O.; LIBERATO, Gabriela; MORAIS, Thamara C.; FAHEL, Mateus G.; GIORGI, Maria C. P.; MENEGHETTI, Jose C.; PARGA, Jose R.; DANTAS-JR, Roberto N.; CERRI, Giovanni G.Aims To investigate the association between pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary computed tomography angiography (CTA) and coronary flow reserve (CFR) by positron emission tomography (PET) in patients with suspected coronary artery disease (CAD). Methods and results PCAT CT attenuation was measured in proximal segments of all major epicardial coronary vessels of 105 patients with suspected CAD. We evaluated the relationship between PCAT CT attenuation and other quantitative/qualitative CT-derived anatomic parameters with CFR by PET. Overall, the mean age was 60 +/- 12 years and 93% had intermediate pre-test probability of obstructive CAD. Obstructive CAD (>= 50% stenosis) was detected in 37 (35.2%) patients and impaired CFR (<2.0) in 32 (30.5%) patients. On a per-vessel analysis (315 vessels), obstructive CAD, non-calcified plaque volume, and PCAT CT attenuation were independently associated with CFR. In patients with coronary calcium score (CCS) <100, those with high-PCAT CT attenuation presented significantly lower CFR values than those with low-PCAT CT attenuation (2.47 +/- 0.95 vs. 3.13 +/- 0.89, P = 0.003). Among those without obstructive CAD, CFR was significantly lower in patients with high-PCAT CT attenuation (2.51 +/- 0.95 vs. 3.02 +/- 0.84, P = 0.021). Conclusion Coronary perivascular inflammation by CTA was independently associated with downstream myocardial perfusion by PET. In patients with low CCS or without obstructive CAD, CFR was lower in the presence of higher perivascular inflammation. PCAT CT attenuation might help identifying myocardial ischaemia particularly among patients who are traditionally considered non-high risk for future cardiovascular events.