NELSON SAMESIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/65, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- 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
bookPart Eletrocardiograma(2016) PASTORE, Carlos Alberto; SAMESIMA, Nelson; MUNERATO, Rafael; PEREIRA FILHO, Horacio Gomes- Applicability of the Electro-Vectorcardiogram in Current Clinical Practice(2019) PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; TOBIAS, Nancy Maria Martins de Oliveira; MADALOSO, Bruna Affonso; FACIN, Mirella EsmanhottoThe electrocardiogram (ECG) has been reinvigorated by the identification of electrical alterations that were not definitely clarified before. In this context, and mainly regarding the definition of arrhythmogenic substrates, the association of the ECG with the vectorcardiogram (VCG) has gathered much more information about the cardiac electrical phenomena, thus allowing us to differentiate potentially fatal cases from benign ones. Obtaining a VCG concomitantly with the performance of an ECG has led to a significant gain in the definition of extremely sophisticated pathologies, which function suffer some type of structural or dynamic alterations, involving either the reduction or enhancement of ionic channels and currents. The classic aspects of the ECG/VCG association in the differential diagnosis of myocardial infarctions, conduction disorders, atrial and ventricular hypertrophies, and the correlations between these electrical disorders are still valid and assertive. The association of these pathologies is further clarified when they are seen through the ECG/VCG dyad. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the ECG linear form. The modern analysis of the ECG and its respective VCG, simultaneously obtained by the recent technique called electro-vectorcardiogram (ECG/VCG), brought a significant gain for the differential diagnosis of some pathologies. Therefore, we illustrate how this type of analysis can elucidate some of the most important diagnoses found in our daily clinical practice as cardiologists.
- Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up(2023) ANTUNES, Murillo Oliveira; ARTEAGA-FERNANDEZ, Edmundo; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; MADY, CharlesBackground: Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain. Objective: To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up. Avaliacao Prognostica da Microalternancia da onda T na Cardiomiopatia Hipertrofica em um Seguimento Clinico de 9 anos Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up Oliveira Antunes,1,2 Edmundo Arteaga-Fernandez,1 Nelson Samesima,1 Horacio Gomes Pereira Afonso Yoshikiro Matsumoto,3 Richard L. Verrier,4 Carlos Alberto Pastore,1 Charles Mady1 do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo,1 Sao Paulo, SP - Brasil Universidade Sao Francisco,2 Braganca Paulista, SP - Brasil Group,3 Sao Paulo, SP - Brasil Israel Deaconess Medical Center,4 Boston - EUA
- Rare Association: Chagas' Disease and Hypertrophic Cardiomyopathy(2015) PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; VARONI, Leonardo Paschoal Camacho; ROCHITTE, Carlos Eduardo; VIEIRA, Marcelo Luiz Campos; AVILA, Luiz Francisco Rodrigues de; MELO, Rodrigo de Jesus Louzeiro; PEREIRA, Alexandre da Costa; DAHEER, Julia; CARLO, Carlos Henrique delA woman (49 years) with Chagas' disease showed: ECG, right bundle-branch block and left anterior-superior fascicular block; V-1 has unusual R > R', and elevated ST segment from V-2 to V-6. Additional imaging revealed concomitant HCM and Chagas, which is uncommon. Overlapping of ECG findings can be explained by this rare association of diseases.
- Ventricular repolarization abnormalities: the electrocardiographic track of cardiac tumoural involvement in an infant with tuberous sclerosis complex. A case report(2020) FACIN, Mirella; PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio GomesBackground Primary cardiac tumours are rare in children. Against this backdrop, Doppler echocardiogram is the main diagnostic procedure, while electrocardiogram (ECG) usually plays a secondary role, by detecting tumoural consequences as cardiac arrhythmias and chambers overload. We describe a case where an electrocardiographic sign was the cornerstone to diagnosis and surveillance of an infant with a cardiac rhabdomyoma. Case summary A female infant was referred for cardiac evaluation to elucidate an electrocardiographic abnormality, detected during investigation of seizures. She had recently been diagnosed with epilepsy and was under three different anticonvulsants for appropriate control. Cardiovascular symptoms were absent. Skin inspection revealed hypochromic macules. Respiratory and cardiovascular examinations were normal, as well as laboratorial tests and chest radiography. Electrocardiogram (ECG) showed dome-shaped ST-segment elevation in V2 and V3. Transthoracic echocardiogram unveiled a single hyper-echogenic node (0.4 cm(2)) in the interventricular septum. Cardiac chambers had normal size and function and Doppler analysis was also normal. No specific medication was used to treat the tumour. During follow-up, she remained free of cardiac symptoms. Eighteen months after her first visit to the cardiologist, routine clinical assessment, ECG, and transthoracic Doppler echocardiogram normal results stated the spontaneous and complete involution of the tumoural lesion. Discussion Convex ST-segment elevation, generally related to myocardial injury, is unusual in paediatric patients. Once it occurs in asymptomatic individuals within this age bracket, exclusion of cardiac tumours is mandatory. However, data regarding the accuracy of such electrocardiographic marker in this clinical setting are still to be defined.
- Exercise-induced quantitative microvolt T-wave altemans in hypertrophic cardiomyopathy(2017) ANTUNES, Murillo de Oliveira; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; ARTEAGA-FERNANDEZ, Edmund; MADY, CharlesBackground/Purpose: Patients with hypertrophic cardiomyopathy (HCM) have elevated risk for sudden cardiac death (SCD). Our study aimed to quantitatively characterize microvolt T-wave alternans (TWA), a potential arrhythmia risk stratification tool, in this HCM patient population. Methods: TWA was analyzed with the quantitative modified moving average (MMA) in 132 HCM patients undergoing treadmill exercise testing, grouped according to Maron score risk factors as high-risk (H-Risk, n = 67,), or low-risk (L-Risk, n = 65, without these risk factors). Results: TWA levels were much higher for the H-Risk than for the L-Risk group (101.40 +/- 75.61 vs. 54.35 +/- 46.26 mu V; p < 0.0001). A 53 mu V cut point, set by receiver operator characteristic (ROC), identified H-Risk patients (82% sensitivity, 69% specificity). Conclusions: High TWA levels were found for hypertrophic cardiomyopathy patients. Abnormal TWA associated with major risk factors for SCD: non-sustained ventricular tachycardia on Holter (p = 0.001), family history of SCD (p = 0.006), septal thickness >= 30 mm (p < 0.001); and inadequate blood pressure response to effort (p = 0.04).
- Modified moving average methodology applied to the treadmill stress testing analysis of microvolt T-wave alternans(2022) PEREIRA FILHO, Horacio Gomes; SAMESIMA, Nelson; MADALOSO, Bruna Affonso; TOBIAS, Nancy Maria Martins de Oliveira; FACIN, Mirella; PASTORE, Carlos AlbertoSudden cardiac death is impactful. There has been an increase in the search for tools capable of identifying individuals who are most susceptible, such as the microvolt T-wave alternans. This study aims to analyze the applicability of the modified moving average methodology to obtain the microvolt T-wave alternans using treadmill specific protocols. Medical records of patients during the period August 2006-December 2014 were retrospectively analyzed. Five hundred and thirty nine exams were then included, divided into groups according to the protocol and updating factor used: Ellestad factor 8 or 32, Naughton factor 8 or 32. The topics for analysis were the alternans behavior, noise and confirmation according to the groups of leads analyzed (frontal, transversal and orthogonal planes). The greater microvolt T-wave alternans was found during the stress phase in most of the tests. Group Naughton 8 presented lower noise in this phase for the transverse and orthogonal planes (p=0.0082 and p<0.0001), with greater confirmation of frontal and orthogonal planes in comparison with group Ellestad 8 (p=0.0002 and 0.0008). The results indicate the viability of simultaneous performance of the stress test and measurement of the T wave alternans with Naughton protocol with 1/8 updating factor.
- Electrovectorcardiographic study of left ventricular aneurysm in ischemic heart disease(2023) VARONI, Leonardo Paschoal Camacho; SAMESIMA, Nelson; FACIN, Mirella; PEREIRA FILHO, Horacio Gomes; MADALOSO, Bruna Affonso; MATHIAS JUNIOR, Wilson; PASTORE, Carlos AlbertoThe aim was to characterize the electrovectorcardiographic pattern of ventricular aneurysms in ischemic cardiopathy by analyzing the cardiac ventricular repolarization. The medical records of 2,670 individuals were analyzed in this cross-sectional study. A test phase included 33 patients who underwent transthoracic echocardiogram with ultrasonic enhancing agent, electrocardiogram, and vectorcardiogram (aneurysm group - n = 22, and akinesia group - n = 11). In the validation phase, cardiac magnetic resonance imaging established the left ventricle segmental contractility in 16 patients who underwent electrocardiographic and vectorcardiographic tests (aneurysm group, n = 8, and akinesia group, n = 8). The variables studied were the presence of the T-wave plus-minus pattern and the T-wave loop anterior-posterior pattern in V2-V4. The diagnostic indices used were sensitivity, specificity, and predictive values, with their respective 95% confidence intervals. During the test and validation phases, the analysis of the presence of the T-wave plus-minus pattern identified the aneurysm group with a sensitivity of 91% vs. 87% and specificity of 91% vs. 87% (p < 0.0001 vs. p = 0.01), respectively. Meanwhile, the T-wave loop anterior-posterior pattern evidenced sensitivity of 95% vs. 77% and specificity of 91% vs. 87% (p < 0.0001 vs. p = 0.04), respectively. The electrovectorcardiographic parameters showed high accuracy for recognizing left ventricular aneurysms in ischemic heart disease.