MATEUS GUIMARAES FAHEL
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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- Myocardial perfusion in patients with suspected coronary artery disease: comparison between 320-MDCT and rubidium-82 PET(2018) DANTAS JR., Roberto Nery; ASSUNCAO JR., Antonildes Nascimento; MARQUES FILHO, Ismar Aguiar; FAHEL, Mateus Guimaraes; NOMURA, Cesar Higa; AVILA, Luiz Francisco Rodrigues; GIORGI, Maria Clementina Pinto; SOARES JR., Jose; MENEGHETTI, Jose Claudio; PARGA, Jose RodriguesDespite advances in non-invasive myocardial perfusion imaging (MPI) evaluation, computed tomography (CT) multiphase MPI protocols have not yet been compared with the highly accurate rubidium-82 positron emission tomography ((RbPET)-Rb-82) MPI. Thus, this study aimed to evaluate agreement between (RbPET)-Rb-82 and 320-detector row CT (320-CT) MPI using a multiphase protocol in suspected CAD patients. Forty-four patients referred for MPI evaluation were prospectively enrolled and underwent dipyridamole stress (RbPET)-Rb-82 and multiphase 320-CT MPI (five consecutive volumetric acquisitions during stress). Statistical analyses were performed using the R software. There was high agreement for recognizing summed stress scores 4 (kappa 0.77, 95% CI 0.55-0.98, p < 0.001) and moderate for detecting SDS 2 (kappa 0.51, 95% CI 0.23-0.80, p < 0.001). In a per segment analysis, agreement was high for the presence of perfusion defects during stress and rest (kappa 0.75 and 0.82, respectively) and was moderate for impairment severity (kappa 0.58 and 0.65, respectively). The 320-CT protocol was safe, with low radiation burden (9.3 +/- 2.4 mSv). There was a significant agreement between dipyridamole stress 320-CT MPI and (RbPET)-Rb-82 MPI in the evaluation of suspected CAD patients of intermediate risk. The multiphase 320-CT MPI protocol was feasible, diagnostic and with relatively low radiation exposure. aEuro cent Rubidium-82 PET and 320-MDCT can perform MPI studies for CAD investigation. aEuro cent There is high agreement between rubidium-82 PET and 320-MDCT for MPI assessment. aEuro cent Multiphase CT perfusion protocols are feasible and with low radiation. aEuro cent Multiphase CT perfusion protocols can identify image artefacts.
- 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.
- 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.