WHADY ARMINDO HUEB
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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- Cardiac Troponin I in Patients Undergoing Percutaneous and Surgical Myocardial Revascularization: Comparison of Analytical Methods(2023) VENDRAMINI, Sabrina Pacheco do Amaral; STRUNZ, Celia Maria Cassaro; HUEB, Whady Armindo; MANSUR, Antonio de PaduaThe myocardial infarction (MI) types 4a and 5 guidelines recommend cardiac troponin (cTn) diagnostic decision limits of 5 and 10 times the 99th percentile, respectively. Different cTn kits elicit different responses, so the MI diagnosis is still challenging. The study aimed to establish the cutoff values and the accuracy of three different cTnI kits in the diagnosis of post-procedural MI. We analyzed 115 patients with multivessel stable chronic coronary artery disease; 26 underwent percutaneous coronary intervention, and 89 underwent coronary artery bypass graft. Delayed-enhancement magnetic resonance imaging was performed before and after each intervention for definitive MI diagnoses. Two contemporary and one high-sensitivity cTnI immunoassays were used. ROC curves determined the accuracy of each assay. Low accuracy was observed after applying the current guidelines recommendations. The three cTnI assays accuracies improved when adjusted by the new ROC cutoffs, reaching 82% for MI type 5 for all assays, and 78%, 88%, and 87% for MI type 4 for Siemens, Beckman, and Abbott, respectively. The ultrasensitive and contemporary tests' accuracy for MI types 4a and 5 diagnoses are equivalent when adjusted for these new cutoffs. The hs-cTnI assays had lower accuracy than contemporary tests for MI types 4a and 5 diagnoses.
- Myocardial microstructure assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting(2023) DALLAZEN, Anderson Roberto; REZENDE, Paulo Cury; HUEB, Whady; HLATKY, Mark Andrew; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; BOROS, Gustavo Andre Boeing; RIBAS, Fernando Faglioni; RIBEIRO, Matheus de Oliveira Laterza; SCUDELER, Thiago Luis; DANTAS, Roberto Nery; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: The correlation between the release of cardiac biomarkers after revascularization, in the absence of late gadolinium enhancement (LGE) or myocardial edema, and the development of myocardial tissue damage remains unclear. This study sought to identify whether the release of biomarkers is associated with cardiac damage by assessing myocardial microstructure on T1 mapping after on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB). Methods: Seventy-six patients with stable multivessel coronary artery disease (CAD) and preserved systolic ventricular function were included. T1 mapping, high-sensitive cardiac troponin I (cTnI), creatine kinase myocardial band (CK-MB) mass, and ventricular dimensions and function were measured before and after procedures. Results: Of the 76 patients, 44 underwent OPCAB, and 32 ONCAB; 52 were men (68.4%), and the mean age was 63 +/- 8.5 years. In both OPCAB and ONCAB the native T1 values were similar before and after surgeries. An increase in extracellular volume (ECV) values after the procedures was observed, due to the decrease in hematocrit levels during the second cardiac resonance. However, the lambda partition coefficient showed no significant difference after the surgeries. The median peak release of cTnI and CK-MB were higher after ONCAB than after OPCAB [3.55 (2.12-4.9) vs. 2.19 (0.69-3.4) ng/mL, P=0.009 and 28.7 (18.2-55.4) vs. 14.3 (9.3-29.2) ng/mL, P=0.009, respectively]. Left ventricular ejection fraction (LVEF) was similar in both groups before and after surgery. Conclusions: In the absence of documented myocardial infarction, T1 mapping did not identify structural tissue damage after surgical revascularization with or without cardiopulmonary bypass (CPB), despite the excessive release of cardiac biomarkers.
- Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease(2023) SEGRE, Carlos Alexandre W.; LEMOS, James A. de; ASSUNCAO, Antonildes Nascimento; NOMURA, Cesar Higa; FAVARATO, Desiderio; STRUNZ, Celia Maria Cassaro; VILLA, Alexandre Volney; PARGA FILHO, Jose Rodrigues; REZENDE, Paulo Cury; HUEB, Whady; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; SERRANO, Carlos VicenteBackground:Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. Methods:We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. Results:A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means +/- standard deviations) increased across tertiles: nativeT1 (1006 +/- 27 ms vs 1016 +/- 27 ms vs 1034 +/- 37 ms, ptrend = 0.006) and ECV (22 +/- 3% vs 23 +/- 1.9% vs 25 +/- 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. Conclusion:In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
- Long-term analysis of ventricular function in patients with symptomatic coronary disease who underwent on-pump or off-pump coronary artery bypass grafting(2022) SILVA, Rafael Rocha Mol; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; SOARES, Paulo Rogerio; RAMIRES, Jose Antonio Franchini; FILHO, Roberto KalilBackground: Systemic deleterious effects of cardiopulmonary bypass have been observed in the postprocedural period. Long-term assessment, including ventricular function (VF), is unclear. The objective of this study was to compare the change of left ventricular ejection fractions (LVEFs) during a long-term follow-up of coronary artery disease (CAD) patients who underwent off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Methods: This study is a prespecified analysis of the MASS III trial, which was a single-center and prospective study that enrolled stable CAD patients with preserved VF. The CAD patients in our study were randomized to OPCAB or ONCAB. A transthoracic echocardiogram was performed during follow-up and a LVEF value was obtained. The primary endpoint was the difference between the final LVEF and the baseline LVEF. Results: Of the 308 randomized patients, ventricular function were observed in 225 over a mean of 5.9 years of follow-up: 113 in the ONCAB group and 112 in the OPCAB group. Baseline characteristics were similar between the two groups, but there was a larger proportion of subjects with 3-vessel disease in the ONCAB group. There was no difference in the LVEF at the beginning (P= 0.08), but there was a slight decrease in the LVEF in the ONCAB and OPCAB groups (P< 0.001 in both groups) at 5.9 years. The decline was not significantly different between the two groups (delta of-6% for ONCAB and -5% for OPCAB; P= 0.78). In a multivariate analysis, myocardial infarction in the follow-up was a predictor of an LVEF <40%. Conclusions: There was no difference in the long-term development of ventricular function between the surgical techniques, despite a decline in the LVEF in both groups.
- Coronary artery bypass grafting versus medical therapy in patients with stable coronary artery disease: An individual patient data pooled meta-analysis of randomized trials(2024) GAUDINO, Mario; AUDISIO, Katia; HUEB, Whady A.; STONE, Gregg W.; FARKOUH, Michael E.; FRANCO, Antonino Di; RAHOUMA, Mohamed; SERRUYS, Patrick W.; BHATT, Deepak L.; ZOCCAI, Giuseppe Biondi; YUSUF, Salim; GIRARDI, Leonard N.; FREMES, Stephen E.; RUEL, Marc; REDFORS, BjornObjectives: It is unclear whether coronary artery bypass grafting (CABG) improves survival compared with medical therapy (MT) in patients with stable coronary artery disease (CAD). The aim of this analysis was to perform an individual-patient data-pooled meta-analysis of contemporary randomized controlled trials that compared CABG and MT in patients with stable CAD. Methods: A systematic search was performed in January 2021 to identify randomized controlled trials enrolling adult patients with stable CAD, randomized to CABG or MT. Only trials using at least aspirin, beta-blockers, and statins in the MT arm were included. Individual patient data were obtained from all eligible studies and pooled. The primary outcome was all-cause mortality. Results: Four trials involving 2523 patients (1261 CABG; 1262 MT) were included with a median follow-up of 5.6 (4.0-9.2) years. CABG was associated with increased risk of all-cause mortality within 30 days (hazard ratio [HR], 4.81; 95% confidence interval [CI], 1.95-11.83) but subsequent reduction in the long-term risk of death (HR, 0.79; 95% CI, 0.69-0.89). As such, the cumulative 10-year mortality rate was lower in patients treated with CABG compared with MT (45.1% vs 51.7%, respectively; odds ratio, 0.70; 95% CI, 0.58-0.85). Age and race were significant treatment effect modifier (interaction P 1/4 .003 for both). Conclusions: In patients with stable CAD, initial allocation to CABG was associated with greater periprocedural risk of death but improved long-term survival compared with MT. The survival advantage for CABG became significant after the fourth postoperative year and was particularly pronounced in younger and non-White patients. (J Thorac Cardiovasc Surg 2024;167:1022-32)
- Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil(2023) MOREIRA, Eduardo Martelli; PINESI, Henrique Trombini; MARTINS, Eduardo Bello; PITTA, Fabio Grunspun; BOLTA, Paula Mathias Paulino; SEGRE, Carlos Alexandre Wainrober; FAVARATO, Desiderio; RACHED, Fabiana Hanna; HUEB, Whady Armindo; LIMA, Eduardo Gomes; FILHO, Roberto Kalil; GARZILLO, Cibele Larrosa; JR, Carlos Vicente SerranoBackground: The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records.Objectives: This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil.Methods: Patients with CIHD who reported for clinical evaluation at Instituto do Coracao (Sao Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted.Results: From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 - 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. Conclusion: This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.
- Cardiovascular events in patients with coronar y ar ter y disease with and without myocardial ischemia: Long-term follow-up(2023) CARVALHO, Felipe Pereira Camara de; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; LINHARES FILHO, Jaime Paula Pessoa; GARCIA, Rosa Maria Rahmi; SOARES, Paulo Rogerio; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground After the results of the ISCHEMIA Trial, the role of myocardial ischemia in the prognosis of coronary artery disease (CAD) was under debate. We sought to comparatively evaluate the long-term prognosis of patients with multivessel CAD with or without documented myocardial ischemia.Methods This is a single-center, retrospective, observational cohort study that included patients with CAD obtained from the research protocols database of ""The Medicine, Angioplasty or Surgery Study,"" the MASS Study Group. Patients were stratified according to the presence or absence of myocardial ischemia. Cardiovascular events (overall mortality and myocardial infarction) were tracked from the registry entry up to a median follow-up of 8.7 years. Myocardial ischemia was assessed at baseline by a functional test with or without imaging.Results From 1995 to 2018, 2015 patients with multivessel CAD were included. Of these, 1001 presented with conclu-sive tests at registry entry, 790 (79%) presenting with ischemia and 211 (21%) without ischemia. The median follow-up was 8.7 years (IQR 4.04 to 10.07). The primary outcome occurred in 228 (28.9%) patients with ischemia and in 64 (30.3%) patients without ischemia (plog-rank = 0.60). No significant interaction was observed with the presence of myocardial ischemia and treatment strategies in the occurrence of the combined primary outcome (pinteration= 0.14).Conclusions In this sample, myocardial ischemia was not associated with a worse prognosis compared with no is-chemia in patients with multivessel CAD. These results refer to debates about the role of myocardial ischemia in the occurrence of cardiovascular events.
- Myocardial tissue microstructure with and without stress-induced ischemia assessed by T1 mapping in patients with stable coronary artery disease(2023) RIBEIRO, Matheus de Oliveira Laterza; HUEB, Whady; REZENDE, Paulo Cury; LIMA, Eduardo Gomes; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; SELISTRE, Luciano da Silva; BOROS, Gustavo Andre Boeing; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: Stress-induced myocardial ischemia seems not to be associated with cardiovascular events. How-ever, its effects on myocardial tissue characteristics remain under debate. Thus, we sought to assess whether documented stress-induced ischemia is associated with changes in myocardial microstructure evaluated by magnetic resonance native T1 map and extracellular volume fraction (ECV).Methods: This is a single-center, analysis of the previously published MASS V Trial. Multivessel patients with a formal indication for myocardial revascularization and with documented stress-induced ischemia were included in this study. Native T1 and ECV values evaluated by cardiac magnetic resonance imaging of ischemic and nonischemic myocardial segments at rest and after stress were compared. Myocardial ischemia was detected by either nuclear scintigraphy or stress magnetic cardiac resonance protocol.Results: Between May 2012 and March 2014, 326 prospective patients were eligible for isolated CABG or PCI and 219 were included in the MASS V trial. All patients underwent resting cardiac magnetic resonance imaging. Of a total of 840 myocardial segments, 654 were nonischemic segments and 186 were ischemic segments. Native T1 and ECV values of ischemic segments were not significantly different from nonischemic segments, both at rest and after stress induction. In addition, native T1 and ECV values of myocardial segments supplied by vessels with obstructive lesions were similar to those supplied by nonobstructive ones.Conclusion and relevance: In this study, cardiac magnetic resonance identified similar T1 mapping values between ischemic and nonischemic myocardial segments. This finding suggests integrity and stability of myocardial tissue in the presence of stress-induced ischemia.
- Abnormal release of cardiac biomarkers in the presence of myocardial oedema evaluated by cardiac magnetic resonance after uncomplicated revascularization procedures(2023) RIBAS, Fernando Faglioni; HUEB, Whady; REZENDE, Paulo Cury; ROCHITTE, Carlos Eduardo; NOMURA, Cesar Higa; VILLA, Alexandre Volney; MORAIS, Thamara Carvalho; LIMA, Eduardo Gomes; BOROS, Gustavo Andre Boeing; RIBEIRO, Matheus de Oliveira Laterza; LINHARES-FILHO, Jaime Paula Pessoa; DALLAZEN, Anderson Roberto; SILVA, Rafael Rocha Mol; RAMIRES, Jose Antonio Franchini; KALIL-FILHO, RobertoAims To analyse the association of myocardial oedema (ME), observed as high T2 signal intensity (HT2) in cardiac magnetic resonance imaging, with the release of cardiac biomarkers, ventricular ejection, and clinical outcomes after revascularization. Methods and results Patients with stable coronary artery disease with the indication for revascularization were included. Biomarker levels [troponin I (cTnI) and creatine kinase MB (CK-MB)] and T2-weighted and late gadolinium enhancement (LGE) images were obtained before and after the percutaneous or surgical revascularization procedures. The association of HT2 with the levels of biomarkers, with and without LGE, evolution of left ventricular ejection fraction (LVEF), and 5-year clinical outcomes were assessed. A total of 196 patients were divided into 2 groups: Group 1 (HT2, 40) and Group 2 (no HT2, 156). Both peak cTnI (8.9 and 1.6 ng/mL) and peak CK-MB values (44.7 and 12.1 ng/mL) were significantly higher in Group 1. Based on the presence of new LGE, patients were stratified into Groups A (no HT2/LGE, 149), B (HT2, 9), C (LGE, 7), and D (both HT2/LGE, 31). The peak cTnI and CK-MB values were 1.5 and 12.0, 5.4 and 44.7, 5.0 and 18.3, and 9.8 and 42.8 ng/mL in Groups A, B, C, and D, respectively, and were significantly different. The average LVEF decreased by 4.4% in Group 1 and increased by 2.2% in Group 2 (P = 0.057). Conclusion ME after revascularization procedures was associated with increased release of cardiac necrosis biomarkers, and a trend towards a difference in LVEF, indicating a role of ME in cardiac injury after interventions.
- High-Sensitivity Troponin I and Cardiovascular Events in Stable Coronary Artery Disease: Insights from a Longitudinal Outpatient Study(2023) STRUNZ, Celia Maria Cassaro; HUEB, Whady; REZENDE, Paulo Cury; VENDRAMINI, Sabrina Pacheco do Amaral; ASSIS, Arthur Cicupira Rodrigues de; ROGGERIO, Alessandra; TAIROVA, Maria Stanislavovna; SILVA, Marcela Francisca; OLIVEIRA, Senili Avila; KISSER, Gyovanna de Cassia Agreste; FILHO, Roberto KalilNumerous studies have been published suggesting that troponin levels are related to adverse outcomes in chronic cardiac and non-cardiac conditions. Our study investigated whether troponin levels gathered from unselected blood samples taken during outpatient care are associated with adverse outcomes in a population with stable coronary artery disease. In a cohort of 949 patients with stable coronary artery disease, an average age of 67.5 +/- 9.5 years, 69.5% male, 52.1% diabetics, 51.6% with previous myocardial infarction, and 57.9% with triple-vessel disease, 21.7% of patients encountered new events during an average period of monitoring of 2.07 +/- 0.81 years. Troponin I/99th percentile categorized into tertiles emerged as an independent predictor of death and combined events risk (hazard ratio: 2.02 (1.13-3.60), p = 0.017; 2.30 (1.37-3.88, p = 0.002, respectively). A troponin ratio > 0.24 was able to identify 53.3% of patients at risk of death and heart failure hospitalization. In patients with stable coronary artery disease who are adherent to treatment, troponin levels are independently associated with death and heart failure hospitalization in a medium-term follow-up.