CARLOS EDUARDO ROCHITTE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
25 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 25
- Clinical Outcomes After Evaluation of Stable Chest Pain by Coronary Computed Tomographic Angiography Versus Usual Care: A Meta-Analysis(2016) BITTENCOURT, Marcio Sommer; HULTEN, Edward A.; MURTHY, Venkatesh L.; CHEEZUM, Michael; ROCHITTE, Carlos E.; CARLI, Marcelo F. Di; BLANKSTEIN, RonBackground Limited data exist on how noninvasive testing options compare for evaluating patients with suspected stable coronary artery disease. In this study, we have performed a meta-analysis of randomized controlled trials comparing the use of coronary computed tomographic angiography (CTA) with usual care. Methods and Results We systematically searched databases for randomized clinical trials comparing coronary CTA with usual care for the evaluation of stable chest pain with follow-up for cardiovascular outcomes. The primary outcomes were myocardial infarction and all-cause mortality. We identified 4 randomized clinical trials, including a total of 7403 patients undergoing coronary CTA and 7414 patients undergoing usual care with various functional testing approaches. When compared with usual care, the use of coronary CTA was associated with a significant reduction in the annual rate of myocardial infarction (rate ratio, 0.69; 95% confidence interval, 0.49-0.98; P=0.038), but no difference was found in all-cause mortality. There was a trend toward more invasive coronary angiographies among patients undergoing coronary CTA (odds ratio, 1.33; 95% confidence interval, 0.95-1.84; P=0.09) and higher use of coronary revascularizations (odds ratio, 1.77; 95% confidence interval, 1.14-2.75). Significant heterogeneity for invasive coronary angiography and revascularization was noted, which was attributable to the Scottish Computed Tomography of the HEART (SCOT-HEART) study. We found no difference in the rate of admission for cardiac chest pain (rate ratio, 1.21; 95% confidence interval, 0.95-1.54). Conclusions In comparison to usual care, an initial investigation of suspected stable coronary artery disease using coronary CTA resulted in a significant reduction in myocardial infarction, an increased incidence of coronary revascularization, and no effect in all-cause mortality. Future studies should further define whether the potential reduction in myocardial infarction identified justifies the increased resource utilization associated with coronary CTA.
- Chagas' heart disease: gender differences in myocardial damage assessed by cardiovascular magnetic resonance(2016) ASSUNCAO JR., Antonildes N.; JEROSCH-HEROLD, Michael; MELO, Rodrigo L.; MAURICIO, Alejandra V.; ROCHA, Liliane; TORREAO, Jorge A.; FERNANDES, Fabio; IANNI, Barbara M.; MADY, Charles; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.Background: Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas' heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR). Methods and results: Retrospectively, 62 seropositive Chagas' heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003). Conclusions: We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas' heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas' disease.
conferenceObject Low-flow Low-gradient Aortic Stenosis With Low Ejection Fraction: Does Myocardial Fibrosis Predict Recovery of Postoperative Ventricular Function?(2016) ROSA, Vitor E.; SAMPAIO, Roney O.; SANTIS, Antonio S. de; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A.; ROSA, Marcela E.; VIEIRA, Marcelo L.; MORAIS, Thamara C.; BELLO, Juliana H.; MATHIAS, Wilson; ROCHITTE, Carlos E.; POMERANTZEFF, Pablo M.; TARASOUTCHI, Flavio- Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis(2016) SORGAARD, Mathias Holm; KOFOED, Klaus Fuglsang; LINDE, Jesper James; GEORGE, Richard Thomas; ROCHITTE, Carlos Eduardo; FEUCHTNER, Gudrun; LIMA, Joao A. C.; ABDULLA, JawdatObjectives: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results: The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CFA.
- Epicardial fat is associated with severity of subclinical coronary atherosclerosis in familial hypercholesterolemia(2016) MANGILI, Leonardo C.; MANGILI, Otavio C.; BITTENCOURT, Marcio S.; MINAME, Marcio H.; HARADA, Paulo H.; LIMA, Leonardo M.; ROCHITTE, Carlos E.; SANTOS, Raul D.Background and aims: Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated blood cholesterol, increased prevalence of subclinical atherosclerosis and high risk of premature coronary heart disease. However, this risk is not explained solely by elevated LDL-cholesterol concentrations, and other factors may influence atherosclerosis development. There is evidence that increased adiposity may predispose to atherosclerosis in FH. Epicardial fat has been associated with subclinical coronary atherosclerosis in the general population. This study evaluated the association of epicardial fat (EFV) volume with the presence and extent of subclinical coronary atherosclerosis detected by computed tomography angiography in FH patients. Methods: Ninety-seven FH subjects (35% male, mean age 45 +/- 13 years, LDL-C 281 +/- 56 mg/dL, 67% with proven molecular defects) underwent computed tomography angiography and coronary artery calcium (CAC) scoring. EFV was measured in non-contrast images using a semi-automated method. Segment-stenosis score (SSS) and segment-involvement score (SIS) were calculated. Multivariate Poisson regression was utilized to assess an independent association of EFV with coronary atherosclerotic burden. Results: EFV was positively associated with age, body mass index, waist circumference, blood glucose, the presence of the metabolic syndrome components, but not with LDL-C. After adjusting for confounders and abdominal circumference, an independent association (shown as beta coefficients and 95% confidence intervals) of EVF with CAC scores [beta = 0.263 (0.234; 0.292), p = 0.000], SIS [beta = 0.304 (0.141; 0.465) p = 0.000] and SSS [beta = 0.296 (0.121; 0.471), p = 0.001] was found. Conclusions: In FH, EFV was independently associated with coronary atherosclerotic presence and severity.
- The role of cardiovascular magnetic resonance in takotsubo syndrome(2016) PLACIDO, Rui; LOPES, Bernardo Cunha; ALMEIDA, Ana G.; ROCHITTE, Carlos E.Takotsubo syndrome (TS) is a transient form of left ventricular dysfunction associated with a distinctive contraction pattern in the absence of significant coronary artery disease triggered by stressful events. Several aspects of its clinical profile have been described but it still remains difficult to quickly establish the diagnosis at admission. Cardiovascular magnetic resonance (CMR) has achieved great improvements in the last years, which in turn has made this imaging technology more attractive in the diagnosis and evaluation of TS. With its superior tissue resolution and dynamic imaging capabilities, CMR is currently the most useful imaging technique in this setting. In this review, we propose to comprehensively define the role of CMR in the evaluation of patients with TS and to summarize a set of criteria suitable for diagnostic decision making in this clinical setting.
- Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound(2016) CAVALCANTE, Rafael; BITTENCOURT, Marcio S.; PINHEIRO, Thais L.; FALCAO, Breno A. A.; MORAIS, Gustavo R.; SOARES, Paulo; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.Aims: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. Methods and results: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 +/- 0.7 vessels, comprising 123.8 +/- 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. Conclusions: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.
conferenceObject EuroSCORE II, BNP, C-Reactive Protein, Creatinine and Delayed Myocardial Enhancement Imaging are Predictors of 1-Year Mortality in Patients with Low-Flow and Low-Gradient True Severe Aortic Stenosis with Low Ejection Fraction(2016) ROSA, Vitor E.; SAMPAIO, Roney O.; PAIXAO, Milena R.; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A.; SANTIS, Antonio S. de; SPINA, Guilherme S.; VIEIRA, Marcelo L.; MORAIS, Thamara C.; BELLO, Juliana H.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; BRANDAO, Carlos Manuel A.; TARASOUTCHI, Flavio- 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.
bookPart Ressonância magnética cardíaca(2016) AZEVEDO FILHO, Clerio Francisco de; ROCHITTE, Carlos Eduardo; LIMA, João Augusto Costa
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