CARLOS ALBERTO PASTORE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
65 resultados
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conferenceObject Controversial and similar aspects of Brugada syndrome and J-wave patterns: the vectorcardiogram point of view(2016) PASTORE, C. A.; SAMESIMA, N.; PEREIRA FILHO, H. G.; MADALOSO, B. A.- Contribution of the vectorcardiogram in the differential diagnosis of Brugada electrocardiographic pattern(2022) MADALOSO, Bruna A.; SAMESIMA, Nelson; TOBIAS, Nancy M. M. O.; TAVARES, Caio A. M.; FILHO, Horacio G. Pereira; FACIN, Mirella E.; PASTORE, C. A.Background: The electrocardiogram (ECG) is a powerful tool for differential diagnosis among a group of pathologies with different therapeutic approaches/prognoses, the so-called J-wave syndrome. The vectorcardiogram (VCG) can be used as a complementary method to the ECG in several dubious electrocardiographic alterations. Objective: We carried out a VCG analysis alter conceiving and measuring a novel parameter (JT-distance) that allows diagnosis of the Brugada ECG pattern. Methods: A retrospective cohort study selected ninety-six ECGs with J-point elevation in V-1/V-2, ECG superior leads and VCGs, all performed on the same day. A new VCG measurement by Frank method (IT-distance) was conceived and designed in transverse and right sagittal planes by 3 lines drawn 1) at the final third of the QRS loop, comprehending the J-point; 2) at the initial portion of the T loop; 3) a parallel of the J-point line at the beginning of the T loop. JT measure was determined by the distance between parallels. A validation cohort was established in a new sample of thirty-five patients. Results: JT-distance >= 1.5 mm (tranverse plane) and JT-distance >1.25 mm, in the sagittal plane, differentiated Brugada type-1 from Brugada type-2, early repolarization and others, with 95% sensitivity and 68% specificity. JT-distance <1.5 mm (transverse plane) and JT >1.25 mm (sagittal plane) had 100% sensitivity and 85% specificity for Brugada type-1 diagnosis. A validation cohort showed very similar Cohen's kappa levels (0.65 and 0.77, test and validation cohorts, respectively), with overlapping 95% confidence intervals. Conclusions: The novel vectorcardiogram measurement (JT-distance) presented a new diagnostic criterion to identify Brugada pattern. Nevertheless, prospective studies should be performed by other centers to confirm these findings.
- Brazilian Society of Cardiology Guidelines on the Analysis and Issuance of Electrocardiographic Reports-2022(2022) SAMESIMA, Nelson; GOD, Epotamenides Good; KRUSE, Jose Claudio Lupi; LEAL, Marcelo Garcia; PINHO, Claudio; FRANCA, Francisco Faustino de A. C.; PIMENTA, Joao; CARDOSO, Acacio Fernandes; PAIXAO, Adail; FONSECA, Alfredo; PEREZ-RIERA, Andres R.; RIBEIRO, Antonio Luiz Pinho; MADALOSO, Bruna Affonso; LUNA FILHO, Braulio; OLIVEIRA, Carlos Alberto Rodrigues de; GRUPI, Cesar Jose; MOREIRA, Dalmo Antonio Ribeiro; KAISER, Elisabeth; PAIXAO, Gabriela Miana de Mattos; FEITOSA FILHO, Gilson; PEREIRA FILHO, Horacio Gomes; GRINDLER, Jose; AZIZ, Jose Luiz; MOLINA, Marcos Sleiman; FACIN, Mirella; TOBIAS, Nancy M. M. de Oliveira; OLIVEIRA, Patricia Alves de; SANCHES, Paulo Cesar R.; TEIXEIRA, Ricardo Alkmin; ATANES, Severiano Melo; PASTORE, Carlos Alberto
- Autonomic nervous system in individuals with cerebral palsy: a controlled study(2011) FERREIRA, Maria C.; PASTORE, Carlos; IMADA, Rodrigo; GUARE, Renata; LEITE, Mariana; POYARES, Dalva; SANTOS, Maria T.BACKGROUND: Disturbances in homeostatic functions have been observed in individuals with cerebral palsy (CP), possibly resulting from autonomic dysfunction. Salivary flow rate and saliva composition are controlled by the autonomic nervous system, and CP individuals exhibit alterations in salivary parameters that suggest autonomic impairment. This study aimed to investigate cardiac parameters as indicative of autonomic disturbances, possibly associated with salivary changes observed in CP individuals. METHODS: Ninety individuals with CP were compared with 35 sibling volunteers with no neurological damage (CG). Twenty-four-hour ECG/Holter monitoring (SEER (R) Light; GE Medical Systems, Milwaukee, WI, USA) and 12-lead electrocardiographic recordings were performed on the CP and control groups. Total saliva was collected, and the salivary flow rate and total protein concentration were determined. RESULTS: Cerebral palsy (CP) individuals presented a significant reduction in salivary flow rate (P < 0.01) and increased protein concentrations (P < 0.01) compared to CG. Twenty-four-hour Holter ECG analysis showed differences for high frequency (HF), low frequency (LF) and LF/HF ratio between the groups, with the CP group presenting higher HF and LF values and lower LF/HF. Electrocardiographic parameters showed a statistically significant difference for heart rate, and its correlates, and mean corrected QT interval between the groups studied (P < 0.05). Snoring was frequent among CP patients. ECG and autonomic changes were independently associated with CP. CONCLUSION: Individuals with cerebral palsy present cardiovascular changes principally manifested as disturbed sympathovagal balance. These autonomic dysfunctions could contribute to the salivary changes observed. J Oral Pathol Med (2011) 40: 576-581
conferenceObject The Peguero-Lo Presti criteria has the highest diagnostic accuracy for the diagnosis of left ventricular hypertrophy in the elderly(2020) TAVARES, C. A. M.; SAMESIMA, N.; HAJJAR, L. A.; GODOY, L. C.; HIRANO, E. M. P.; FACIN, M.; JACOB FILHO, W.; FARKOUH, M. E.; PASTORE, C. A.bookPart Eletrocardiograma de repouso e vetocardiograma(2013) SANCHES, Paulo César; MOFFA, Paulo Jorge; PASTORE, Carlos Alberto- One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study(2015) SANTOS, Itamar Souza; GOULART, Alessandra Carvalho; BRANDAO, Rodrigo Martins; SANTOS, Rafael Caire de Oliveira; BITTENCOURT, Marcio Sommer; SITNIK, Debora; PEREIRA, Alexandre Costa; PASTORE, Carlos Alberto; SAMESIMA, Nelson; LOTUFO, Paulo Andrade; BENSENOR, Isabela MartinsBackground: Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers. Objectives: To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors. Methods: We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality. Results: We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95% CI) = 1.75-2.38], non-ST elevation myocardial infarction (HR = 3.82; 95% CI = 2.21-6.60) or ST elevation myocardial infarction (HR = 2.59; 95% CI = 1.38-4.89) diagnoses, and diabetes (HR = 1.78; 95% CI = 1.20-2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95% CI = 1.04-2.50), but not for cardiovascular mortality. Conclusions: We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in Sao Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one-year survival for overall and cardiovascular-related causes.
bookPart Eletrocardiograma(2016) PASTORE, Carlos Alberto; SAMESIMA, Nelson; MUNERATO, Rafael; PEREIRA FILHO, Horacio Gomes- Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms(2015) KAISER, Elisabeth; DARRIEUX, Francisco C. C.; BARBOSA, Silvio A.; GRINBERG, Rodrigo; ASSIS-CARMO, Andre; SOUSA, Julio C.; HACHUL, Denise; PISANI, Cristiano F.; KOSA, Eva; PASTORE, Carlos A.; SCANAVACCA, Mauricio I.This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): Brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.
- Artificial Intelligence-Driven Screening System for Rapid Image-Based Classification of 12-Lead ECG Exams: A Promising Solution for Emergency Room Prioritization(2023) DIAS, Felipe Meneguitti; RIBEIRO, Estela; MORENO, Ramon Alfredo; RIBEIRO, Adele Helena; SAMESIMA, Nelson; PASTORE, Carlos Alberto; KRIEGER, Jose Eduardo; GUTIERREZ, Marco AntonioThe electrocardiogram (ECG) serves as a valuable diagnostic tool, providing crucial information about life-threatening cardiac conditions such as atrial fibrillation and myocardial infarction. A prompt and efficient assessment of ECG exams in environments such as Emergency Rooms (ERs) can significantly enhance the chances of survival for high-risk patients. Despite the presence of numerous works on ECG classification, most of these studies have concentrated on one-dimensional ECG signals, which are commonly found in publicly available ECG datasets. Nevertheless, the practical relevance of such methods is limited in hospital settings, where ECG exams are usually stored as images. In this study, we have developed an artificial intelligence-driven screening system specifically designed to analyze 12-lead ECG images. Our proposed method has been trained on an extensive dataset comprising 99,746 12-lead ECG exams collected from the ambulatory section of a tertiary hospital. The primary goal was to precisely classify the exams into three classes: Normal (N), Atrial Fibrillation (AFib), and Other (O). The evaluation of our approach yielded AUROC scores of 93.2%, 99.2%, and 93.1% for N, AFib, and O, respectively. To further validate our approach, we conducted evaluations using the 2018 China Physiological Signal Challenge (CPSC) database. In this evaluation, we achieved AUROC scores of 91.8%, 97.5%, and 70.4% for the classes N, AFib, and O, respectively. Additionally, we assessed our method using 1,074 exams acquired in the ER and obtained AUROC values of 98.3%, 98.0%, and 97.7% for the classes N, AFib, and O, respectively. Furthermore, we developed and deployed a system with a trained model within the ER of a tertiary hospital for research purposes. This system automatically retrieves newly captured ECG chart images from the Picture Archiving and Communication System (PACS) within the ER. These images undergo necessary preprocessing steps and serve as input for our proposed classification method. This comprehensive approach established an efficient and versatile end-to-end framework for ECG classification. The results of our study highlight the potential of leveraging artificial intelligence in the screening of ECG exams, offering a promising solution for the rapid assessment and prioritization of patients in the ER.