CARLOS HENRIQUE REIS ESSELIN RASSI
Projetos de Pesquisa
Unidades Organizacionais
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
conferenceObject Yield of Different Approaches for Screening for Cardiovascular Disease in Asymptomatic Diabetics(2014) CHURCHILL, Timothy W.; RASSI, Carlos H.; TAVARES, Carlos A. Fernandes; FAHEL, Mateus G.; RASSI, Fabricia P.; UCHIDA, Augusto H.; WAJCHENBERG, Bernardo L.; LERARIO, Antonio C.; HULTEN, Edward; BITTENCOURT, Marcio S.; BLANKSTEIN, Ron- Relationship between glycemic control and coronary artery disease severity, prevalence and plaque characteristics by computed tomography coronary angiography in asymptomatic type 2 diabetic patients(2016) TAVARES, C. A. F.; RASSI, C. H. R. E.; FAHEL, M. G.; WAJCHENBERG, B. L.; ROCHITTE, C. E.; LERARIO, A. C.Evaluate whether glycemic control in type 2 diabetes (DM2) asymptomatic for coronary artery disease (CAD) affects not only the presence and magnitude of CAD but also the characteristics of plaque vulnerability using multidetector row computed coronary tomography (MDCT). Acute coronary syndrome (ACS) is frequently observed in asymptomatic DM2 patients. Positive vessel remodeling (PR) and low-attenuation plaques (LAP) identified by MDCT have been demonstrated to be characteristics of subsequent culprit lesions of ACS. However, little is known regarding plaque characteristics in asymptomatic diabetic patients and their relationship with glycemic control. Ninety asymptomatic DM2 patients, aged 40-65 years old, underwent MDCT. The presence of atherosclerotic obstruction, defined as coronary stenosis aeyen50 %, and plaque characteristics were compared between two groups of patients with A1c < 7 and A1c aeyenaEuroe7 %. Of the 90 patients, 38 (42.2 %) presented with coronary atherosclerotic plaques, 11 had A1c < 7 % and 27 had A1c aeyenaEuroe7 % (p = 0.0006). Fourteen patients had significant lumen obstruction higher than 50 %: 3 in the A1c < 7 % group and 11 in the A1c aeyenaEuroe7 % group (p = 0.02). Non-calcified plaque was more prevalent in the A1c aeyenaEuroe7 % group (p = 0.005). In eleven patients, the simultaneous presence of two vulnerability plaque characteristics (PR and LAP) were observed more frequently in the A1c aeyenaEuroe7 group (n = 8) than in the A1c < 7 group (n = 3) (p = 0.04). Asymptomatic DM2 patients with A1c aeyenaEuroe7 % have a higher frequency of CAD and a higher proportion of vulnerable atherosclerotic coronary plaque by MDCT compared to patients with DM2 with A1c < 7 in our study.
- Myocardial tissue characterization in Chagas' heart disease by cardiovascular magnetic resonance(2015) TORREAO, Jorge A.; IANNI, Barbara M.; MADY, Charles; NAIA, Evandro; RASSI, Carlos H.; NOMURA, Cesar; PARGA, Jose R.; AVILA, Luis F.; RAMIRES, Jose A. F.; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.Background: Chagas' heart disease is an important public health problem in South America. Several aspects of the pathogenesis are not fully understood, especially in its subclinical phases. On pathology Chagas' heart disease is characterized by chronic myocardial inflammation and extensive myocardial fibrosis. The latter has also been demonstrated by late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). In three clinical phases of this disease, we sought to investigate the presence of LGE, myocardial increase in signal intensity in T2-weighted images (T2W) and in T1-weighted myocardial early gadolinium enhancement (MEGE), previously described CMR surrogates for myocardial fibrosis, myocardial edema and hyperemia, respectively. Methods: Fifty-four patients were analyzed. Sixteen patients with the indeterminate phase (IND), seventeen patients with the cardiac phase with no left ventricular systolic dysfunction (CPND), and twenty-one patients with the cardiac phase with left ventricular systolic dysfunction (CPD). All patients underwent 1.5 T CMR scan including LGE, T2W and MEGE image sequences to evaluate myocardial abnormalities. Results: Late gadolinium enhancement was present in 72.2 % of all patients, in 12.5 % of IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). Myocardial increase in signal intensity in T2-weighted images (T2W) was present in 77.8 % of all patients, in 31.3 % of the IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). T1-weighted myocardial early gadolinium enhancement (MEGE) was present in 73.8 % of all patients, in 25.0 % of the IND, 92.3 % of the CPND and 94.1 % of the CPD (p < 0.0001). A good correlation between LGE and T2W was observed (r = 0.72, and p < 0.001). Conclusions: Increase in T2-weighted (T2W) myocardial signal intensity and T1-weighted myocardial early gadolinium enhancement (MEGE) can be detected by CMR in patients throughout all phases of Chagas' heart disease, including its subclinical presentation (IND). Moreover, those findings were parallel to myocardial fibrosis (LGE) in extent and location and also correlated with the degree of Chagas' heart disease clinical severity. These findings contribute to further the knowledge on pathophysiology of Chagas' heart disease, and might have therapeutic and prognostic usefulness in the future.
- Myocardial Fibrosis Progression in Duchenne and Becker Muscular Dystrophy A Randomized Clinical Trial(2017) SILVA, Marly Conceicao; MAGALHAES, Tiago Augusto; MEIRA, Zilda Maria Alves; RASSI, Carlos Henrique Reis Esselin; ANDRADE, Amanda Cristina de Souza; GUTIERREZ, Paulo Sampaio; AZEVEDO, Clerio Francisco; GURGEL-GIANNETTI, Juliana; VAINZOF, Mariz; ZATZ, Mayana; KALIL-FILHO, Roberto; ROCHITTE, Carlos EduardoIMPORTANCE In Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), interventions reducing the progression of myocardial disease could affect survival. OBJECTIVE To assess the effect of early angiotensin-converting enzyme (ACE) inhibitor therapy in patients with normal left ventricular function on the progression of myocardial fibrosis (MF) identified on cardiovascular magnetic resonance (CMR). DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial conducted in 2 centers included 76 male patients with DMD or BMD undergoing 2 CMR studies with a 2-year interval for ventricular function and MF assessment. In a non-intent-to-treat trial, 42 patients with MF and normal left ventricular ejection fraction (LVEF) were randomized (1: 1) to receive or not receive ACE inhibitor therapy. The study was conducted from June 26, 2009, to June 30, 2012. Data analysis was performed from June 30, 2013, to October 3, 2016. INTERVENTIONS Randomization (1: 1) to receive or not receive ACE inhibitor therapy. MAIN OUTCOMES AND MEASURES Primary outcome was MF progression from baseline to the 2-year CMR study. RESULTS Of the 76 male patients included in the study, 70 had DMD (92%) and 6 had BMD (8%); mean (SD) age at baseline was 13.1 (4.4) years. Myocardial fibrosis was present in 55 patients (72%) and LV systolic dysfunction was identified in 13 patients (24%). Myocardial fibrosis at baseline was an independent indicator of lower LVEF at follow-up (coefficient [SE], -0.16 [0.07]; P = .03). Among patients with MF and preserved LVEF (42 [55%]), those randomized (21 patients in each arm) to receive ACE inhibitors demonstrated slower MF progression compared with the untreated group (mean [SD] increase of 3.1% [7.4%] vs 10.0% [6.2%] as a percentage of LV mass; P = .001). In multivariate analysis, ACE inhibitor therapy was an independent indicator of decreased MF progression (coefficient [SE], -4.51 [2.11]; P = .04). Patients with MF noted on CMR had a higher probability of cardiovascular events (event rate, 10 of 55 [18.2%] vs 0 of 21 [0%]; log-rank P = .04). CONCLUSIONS AND RELEVANCE In this 2-year, follow-up, randomized clinical trial of patients with Duchenne or Becker muscular dystrophy whose LVEF was preserved and MF was present as determined on CMR, ACE inhibitor therapy was associated with significantly slower progression of MF. The presence of MF was associated with worse patient prognosis.
- Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics(2016) RASSI, Carlos Henrique Reis Esselin; CHURCHILL, Timothy W.; TAVARES, Carlos A. Fernandes; FAHEL, Mateus Guimaraes; RASSI, Fabricia P. O.; UCHIDA, Augusto H.; WAJCHENBERG, Bernardo L.; LERARIO, Antonio C.; HULTEN, Edward; NASIR, Khurram; BITTENCOURT, Marcio S.; ROCHITTE, Carlos Eduardo; BLANKSTEIN, RonBackground: There is increasing evidence to suggest that not all individuals with type 2 diabetes mellitus (T2DM) have equal risk for developing cardiovascular disease. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches. Methods: 98 asymptomatic individuals with T2DM without known coronary artery disease (CAD) were enrolled in a prospective study and underwent carotid ultrasound, exercise treadmill testing (ETT), coronary artery calcium (CAC) scoring, and coronary computed tomography angiography (CTA). Results: Of 98 subjects (average age 55 +/- 6, 64 % female), 43 (44 %) had coronary plaque detectable on CTA, and 38 (39 %) had CAC score >0. By CTA, 16 (16 %) had coronary stenosis >= 50 %, including three subjects with CAC = 0. Subjects with coronary plaque had greater prevalence of carotid plaque (58 % vs. 38 %, p = 0.01) and greater carotid intima media thickness (0.80 +/- 0.20 mm vs. 0.70 +/- 0.11 mm, p = 0.02). Notably, 18 of 55 subjects (33 %) with normal CTA had carotid plaque. Eight subjects had a positive ETT, of whom five had = 50 % coronary stenosis, two had <50 % stenosis, and one had no CAD. Among these tests, CAC scoring had the highest sensitivity and specificity for prediction of CAD. Conclusion: Among asymptomatic subjects with T2DM, a majority (56 %) had no CAD by CTA. When compared to CTA, CAC was the most accurate screening modality for detection of CAD, while ETT and carotid ultrasound were less sensitive and specific. However, 33 % of subjects with normal coronary CTA had carotid plaque, suggesting that screening for carotid plaque might better characterize stroke risk in such patients.