CARLOS AUGUSTO HOMEM DE MAGALHAES CAMPOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
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- Seattle Angina Pectoris Questionnaire and Canadian Cardiovascular Society Angina Categories in the Assessment of Total Coronary Atherosclerotic Burden(2021) GUIMARAES, Welingson Vanucci Negreiros; NICZ, Pedro Felipe Gomes; GARCIA-GARCIA, Hector M.; ABIZAID, Alexandre; SANTOS, Luciano de Moura; ROSA, Vitor E.; RIBEIRO, Marcelo Harada; MEHTA, Sameer; RIBEIRO, Expedito; LEMOS, Pedro A.; BRITO JR., Fabio S.; HAJJAR, Ludhmila; KALIL FILHO, Roberto; CAMPOS, Carlos M.The patient reported angina measurement with the Seattle Angina Questionnaire (SAQ) has shown to have prognostic implications and became an endpoint in clinical trials. Our objective was to study physician-reported and SAQ severity with the total coronary atherosclerotic burden as assessed by 4 angiographic scores. We prospectively analyzed data of consecutive patients scheduled for coronary angiography or percutaneous coronary intervention. The Canadian Cardiovascular Society (CCS) angina categories was used as physician-reported angina. SAQ domains were categorized as severe (0 to 24), moderate 25 to 75 and mild angina (>75). All angina assessments were done before coronary angiography. Gensini, Syntax, Friesinger, and Sullivan angiographic scores were used for total atherosclerotic burden quantification: 261 patients were included in the present analysis. The median age was 66.0 (59.0 to 71.8) years, 53.6% were male and 43.7% had diabetes. The median SYNTAX score was 6.0 (0 to 18.0). The worse the symptoms of CCS categories, the more severe was the atherosclerotic burden in all angiographic scores: SYNTAX (p = 0.01); Gensini (p<0.01); Friesinger (p = 0.02) and Sullivan (p = 0.03). Conversely, SAQ domains were not able to discriminate the severity of CAD in any of the scores. The only exception was the severe SAQ quality of life that had worse Gensini score than the mild SAQ quality of life (p = 0.04). In conclusion, CCS angina categories are related to the total atherosclerotic burden in coronary angiography, by all angiographic scores. SAQ domains should be used as a measure of patient functionality and quality of life but not as a measure of CAD severity. (C) 2021 Published by Elsevier Inc.
- Challenges and Management of Acute Coronary Syndrome in Cancer Patients(2021) COSTA, Isabela Bispo Santos da Silva; ANDRADE, Fernanda Thereza de Almeida; CARTER, Diego; SELEME, Vinicius B.; COSTA, Maycon Santos; CAMPOS, Carlos M.; HAJJAR, Ludhmila AbrahaoCancer and cardiovascular disease are the leading causes of mortality in the world. The prevalence of cardiovascular risk factors and coronary artery disease in cancer patients is elevated, and it is associated with high mortality. Several mechanisms, such as the proinflammatory and procoagulant states present in cancer patients, may contribute to these scenarios. Oncological therapy can predispose patients to acute thrombosis, accelerated atherosclerosis and coronary spasm. Treatment decisions must be individualized and based on the cancer history and balancing bleeding and thrombosis risks.
- Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease(2021) SILVA, Michel V. Lemes da; NUNES FILHO, Antonio C. B.; ROSA, Vitor E. E.; CAIXETA, Adriano; LEMOS NETO, Pedro A.; RIBEIRO, Henrique B.; ALMEIDA, Breno O.; MARIANI JR., Jose; CAMPOS, Carlos M.; ABIZAID, Alexandre A. C.; MANGIONE, Jose A.; SAMPAIO, Roney O.; CARAMORI, Paulo; SARMENTO-LEITE, Rogerio; TARASOUTCHI, Flavio; FRANKEN, Marcelo; BRITO JR., Fabio S. deBackground Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m(2)) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m(2)) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48-0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97-1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.
conferenceObject CLINICAL IMPACT OF CORONARY PERFORATIONS DURING CHRONIC TOTAL OCCLUSION RECANALIZATION: A 2.566 PATIENT POOLED ANALYSIS FROM A LATIN AMERICAN (LATAM) REGISTRY(2021) RIBEIRO, Marcelo Harada; QUADROS, Alexandre; GALASSI, Alfredo; ARAUJO, Gustavo; PADILLA, Lucio; OLIVEIRA, Pedro; HANNA, Franklin; SANTIAGO, Ricardo; BOTELHO, Antonio; DALLAN, Luis; AZZALINI, Lorenzo; BOUKHRIS, Marouane; SANTOS, Luciano; BELLI, Karlyse; SELEME, Vinicius; ALBANEZ, Maria Antonieta; ALCANTRA, Marco; ABIZAID, Alexandre; CAMPOS, Carlos- Comparative clinical performance of two types of drug-eluting stents with abluminal biodegradable polymer coating: Five-year results of the DESTINY randomized trial(2021) JR, Guy F. A. Prado; ABIZAID, Alexandre A. C.; MEIRELES, George C.; SARMENTO-LEITE, Rogerio; PRUDENTE, Mauricio; CANTARELLI, Marcelo; DOURADO, Adriano D.; JR, Jose Mariani; PERIN, Marco A.; COSTANTINI, Costantino; COSTA, Ricardo; COSTA, J. Ribamar; CHAMIE, Daniel; CAMPOS, Carlos M.; RIBEIRO, Expedito E.; LEMOS, Pedro A.Introduction and Objectives: The Stents Coated With the Biodegradable Polymer on Their Abluminal Faces and Elution of Sirolimus Versus Biolimus Elution for the Treatment of de Novo Coronary Lesions - DESTINY Trial is a non-inferiority randomized study that compared the Inspiron (TM) sirolimus-eluting stent (SES) with the control Biomatrix (TM) Flex biolirms-eluting stent (BES). Previous reports in the first year showed similar outcomes for both stents, in clinical, angiographic, optical coherence tomography, and intravascular ultrasound assessments. The present analysis aims to compare the clinical performance of these two biodegradable polymer drug-eluting stents five years after the index procedure. Methods: A total of 170 patients (194 lesions) were randomized in a 2:1 ratio for treatment with SES or BES, respectively. The primary endpoint for the present study was the five-year rate of combined major adverse cardiac events, defined as cardiac death, myocardial infarction, or target lesion revascularization. Results: At five years, the primary endpoint occurred in 12.5% and 17.9% of the SES and BES groups, respectively (p=0.4). There was no definite or probable stent thrombosis among patients treated with the novel SES stent during the five years of follow-up, and no stent thrombosis after the first year in the BES group. Conclusions: The novel Inspiron (TM) stent had similar good clinical performance in long-term follow-up when compared head-to-head with the control latest-generation Biomatrix (TM) Flex biolimus-eluting stent. (C) 2020 Sociedade Portuguesa de Cardiologia.
- Comparison of Contractility Patterns on Left Ventriculogram Versus Longitudinal Strain by Echocardiography in Patients With Takotsubo Cardiomyopathy(2021) SINGH, Manavotam; REDDIN, Gemma; GARCIA-GARCIA, Hector M.; MEDVEDOFSKY, Diego; ASCH, Federico M.; KUMAR, Preetham; FRANKEN, Marcelo; CAMPOS, Carlos M.Background: Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular (LV) dysfunction, electrocardiographic changes that can mimic acute myocardial infarction (MI), and release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Conventionally, gross visual assessment of LV angiogram has been used to classify ITC. We aim to compare quantitative assessment of different regions of LV on angiogram and segmental strain on transthoracic echo to determine a better way to classify ITC rather than conventional qualitative visual assessment. Methods: We conducted a retrospective observational study of 20 patients diagnosed with ITC who had LV angiogram and transthoracic echocardiograms performed on presentation that were suitable for analysis. Twenty LV angiograms were analyzed using Rubo DICOM viewer software. Areas of different LV regions were measured in diastole and systole, and percentage changes in area of these regions were calculated. Percentage changes in area of less than 10% was considered ""akinetic."" On the other hand, using echocardiograms of these patients, LV regional longitudinal strain (LS) was derived from speckle-tracking analysis. These findings were compared to determine concordance between both modalities. Results: On quantitative analysis of 20 LV angiograms, the area of all the three LV regional (apex, mid ventricle, and base) shortening (>10%) was observed in 16 patients (80%) during systole as compared to diastole. However, only 4 out of 20 patients (20%) were noted to have apical region area change of <10% between diastole and systole. Analysis of LV regional LS patterns of 20 patients showed that 14 patients had abnormal values (> - 18%) in all three LV regions: apex, mid ventricle, and base. The apical region was the most severely affected region (mean LS -13.9%), followed by the basal region (mean -14.7%) and the mid ventricular region (mean - 15.1%). Comparing the results of both modalities showed that there was 35% (n = 7) concordance in the results noted for base and apical regions of the LV, whereas only 20% (n = 4) concordance was noted in mid ventricular region. Conclusion: Contractility (shortening) on LV angiogram is present in a majority of patients in the three LV regions, but contractility assessed by LS is impaired in most of them. The concordance in both quantitative assessment modalities was low. LV angiogram may not be an accurate imaging modality to assess contractility patterns in Takotsubo patients, and echocardiographic LS analysis should be taken as the preferred imaging modality.
- Excimer laser atherectomy in an uncrossable long chronic total occlusion through the subintimal space(2021) RIBEIRO, Marcelo Harada; DALLAN, Luis Augusto Palma; BOUKHRIS, Marouane; CAMPOS, Carlos Augusto H. M.; BEZERRA, Hiram Grando; QUESADA, Franklin Hanna; BEZERRA, Cristiano Guedes; AGOSTONI, Pierfrancesco; AZZALINI, Lorenzo; GALASSI, Alfredo R.
- Late clinical outcomes of myocardial hybrid revascularization versus coronary artery bypass grafting for complex triple-vessel disease: Long-term follow-up of the randomized MERGING clinical trial(2021) ESTEVES, Vinicius; OLIVEIRA, Marco A. P.; FEITOSA, Fernanda S.; MARIANI JR., Jose; CAMPOS, Carlos M.; HAJJAR, Ludhmila A.; LISBOA, Luiz A.; JATENE, Fabio B.; FILHO, Roberto K.; LEMOS NETO, Pedro A.Objectives This article aimed to compare the outcomes after hybrid revascularization with conventional coronary artery bypass grafting (CABG) surgery. Background The concept of hybrid coronary revascularization combines the advantages of CABG and percutaneous coronary intervention to improve the treatment of patients with complex multivessel disease. Methods The Myocardial hybrid revascularization versus coronary artERy bypass GraftING for complex triple-vessel disease-MERGING study is a pilot randomized trial that allocated 60 patients with complex triple-vessel disease to treatment with hybrid revascularization or conventional CABG (2:1 ratio). The primary outcome was the composite of all-cause death, myocardial infarction, stroke, or unplanned repeat revascularization at 2 years. Results Clinical and anatomical characteristics were similar between groups. After a mean follow-up of 802 +/- 500 days, the primary endpoint rate was 19.3% in the hybrid arm and 5.9% in the CABG arm (p = NS). The incidence of unplanned revascularization increased over time in both groups, reaching 14.5 versus 5.9% in the hybrid and in the CABG groups, respectively (p = .4). Of note, in the hybrid group, there were no reinterventions driven by the occurrence of stent restenosis. Conclusions Hybrid myocardial was feasible but associated with increasing rates of major adverse cardiovascular events during 2 years of clinical follow-up, while the control group treated with conventional surgery presented with low rates of complications during the same period. In conclusion, before more definitive data arise, hybrid revascularization should be applied with careful attention in practice, following a selective case-by-case indication.
conferenceObject Coronary perforations and its clinical impact during CTO recanalization: a 2054 patients pooled analysis from the Latin American (LATAM) CTO registry(2021) RIBEIRO, M. Harada; QUADROS, A.; PADILLA, L. T.; BELLI, K. C.; PICCARO, P.; DALLAN, L. A.; SILVEIRA, C. E.; QUESADA, F. H.; MORALES, N.; SANTIAGO, R.; MASHAYEKHI, K. C.; AZZALINI, L. A.; GALASSI, A. R.; CAMPOS, C. M.- Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study(2021) ABIZAID, Alexandre; CAMPOS, Carlos M.; GUIMARAES, Patricia O.; JR, Jose de Ribamar Costa; FALCAO, Breno A. A.; MANGIONE, Fernanda; CAIXETA, Adriano; LEMOS, Pedro A.; BRITO, Fabio S. de; CAVALCANTE, Ricardo; BEZERRA, Cristiano Guedes; CORTES, Leandro; RIBEIRO, Henrique B.; SOUZA, Francis R. de; HUEMER, Natassja; VAL, Renata M. do; CARAMELLI, Bruno; CALDERARO, Daniela; LIMA, Felipe G.; HAJJAR, Ludhmila A.; MEHRAN, Roxana; KALIL FILHO, RobertoObjectives We aimed to explore angiographic patterns and in-hospital outcomes of patients with concomitant coronavirus disease-19 (COVID-19) and myocardial infarction (MI). Background Patients with COVID-19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID-19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID-19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1-10) days. A total of 83 (54.6%) patients presented with ST-elevation MI. The median angiographic Syntax score was 16 (9.0-25.3) and 69.0% had multi-vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in-hospital mortality was 23.7%. ST-segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30-5.80 and HR 3.73, 95%CI 1.61-8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID-19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in-hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.