MARCIO SOMMER BITTENCOURT
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- Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected by Coronary Computed Tomography Angiography to Identify Cardiovascular Events(2014) BITTENCOURT, Marcio Sommer; HULTEN, Edward; GHOSHHAJRA, Brian; O'LEARY, Daniel; CHRISTMAN, Mitalee P.; MONTANA, Philip; TRUONG, Quynh A.; STEIGNER, Michael; MURTHY, Venkatesh L.; RYBICKI, Frank J.; NASIR, Khurram; GOWDAK, Luis Henrique W.; HAINER, Jon; BRADY, Thomas J.; CARLI, Marcelo F. Di; HOFFMANN, Udo; ABBARA, Suhny; BLANKSTEIN, RonBackground- The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. Methods and Results- All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (< 50% stenosis), or obstructive (>= 50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (<= 4 segments) or extensive (> 4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. Conclusions- Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.
- Association Between Smoking and Serum GlycA and High-Sensitivity C-Reactive Protein Levels: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2017) KIANOUSH, Sina; BITTENCOURT, Marcio S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; JONES, Steven R.; DEFILIPPIS, Andrew P.; TOTH, Peter P.; OTVOS, James D.; TIBUAKUU, Martin; HALL, Michael E.; HARADA, Paulo H. N.; BLAHA, Michael J.Background-Inflammation is suggested to be a central feature of atherosclerosis, particularly among smokers. We studied whether inflammatory biomarkers GlycA and high-sensitivity C-reactive protein are associated with cigarette smoking. Methods and Results-A total of 11 509 participants, 6774 from the MESA (Multi-Ethnic Study of Atherosclerosis) and 4735 from ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health) were included. We evaluated the cross-sectional association between multiple measures of smoking behavior and the inflammatory biomarkers, GlycA and high-sensitivity C-reactive protein, using regression models adjusted for demographic, anthropometric, and clinical characteristics. Participants were 57.7 +/- 11.1 years old and 46.4% were men. Never, former, and current smokers comprised 51.7%, 34.0%, and 14.3% of the population, respectively. Multivariable-adjusted mean absolute difference in GlycA levels (mu mol/L) with 95% confidence interval (CI) were higher for former (4.1, 95% CI, 1.7-6.6 mu mol/L) and current smokers (19.9, 95% CI, 16.6-23.2 mu mol/L), compared with never smokers. Each 5-unit increase in pack-years of smoking was associated with higher GlycA levels among former (0.7, 95% CI, 0.3-1.1 mu mol/L) and current smokers (1.6, 95% CI, 0.8-2.4 mu mol/L). Among former smokers, each 5-year increase in time since quitting smoking was associated with lower GlycA levels (-1.6, 95% CI, -2.4 to -0.8 lmol/L) and each 10-unit increase in number of cigarettes/day was associated with higher GlycA among current smokers (2.8, 95% CI, 0.5-5.2 mu mol/L). There were similar significant associations between all measures of smoking behavior, and both log-transformed GlycA and high-sensitivity C-reactive protein. Conclusions-Acute and chronic exposure to tobacco smoking is associated with inflammation, as quantified by both GlycA and high-sensitivity C-reactive protein. These biomarkers may have utility for the study and regulation of novel and traditional tobacco products.
- Race and Resting-State Heart Rate Variability in Brazilian Civil Servants and the Mediating Effects of Discrimination: An ELSA-Brasil Cohort Study(2016) KEMP, Andrew H.; KOENIG, Julian; THAYER, Julian F.; BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; SANTOS, Itamar S.; DANTAS, Eduardo M.; MILL, Jose G.; CHOR, Dora; RIBEIRO, Antonio L. P.; BENSENOR, Isabela M.; LOTUFO, Paulo A.Objectives African Americans are characterized by higher heart rate variability (HRV), a finding ostensibly associated with beneficial health outcomes. However, these findings are at odds with other evidence that blacks have worse cardiovascular outcomes. Here, we examine associations in a large cohort from the ELSA-Brasil study and determined whether these effects are mediated by discrimination. Methods Three groups were compared on the basis of self-declared race: black (n = 2,020), brown (n = 3,502), and white (n = 6,467). Perceived discrimination was measured using a modified version of the Everyday Discrimination Scale. Resting-state HRV was extracted from 10-minute resting-state electrocardiograms. Racial differences in HRV were determined by regression analyses weighted by propensity scores, which controlled for potentially confounding variables including age, sex, education, and other health-related information. Nonlinear mediation analysis quantified the average total effect, comprising direct (race-HRV) and indirect (race-discrimination-HRV) pathways. Results Black participants displayed higher HRV relative to brown (Cohen's d = 0.20) and white participants (Cohen's d = 0.31). Brown relative to white participants also displayed a small but significantly higher HRV (Cohen's d = 0.14). Discrimination indirectly contributed to the effects of race on HRV. Conclusions This large cohort from the Brazilian population shows that HRV is greatest in black, followed by brown, relative to white participants. The presence of higher HRV in these groups may reflect a sustained compensatory psychophysiological response to the adverse effects of discrimination. Additional research is needed to determine the health consequences of these differences in HRV across racial and ethnic groups.
- 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.
- Subclinical carotid artery atherosclerosis and performance on cognitive tests in middle-aged adults: Baseline results from the ELSA-Brasil(2015) SUEMOTO, Claudia K.; SANTOS, Itamar S.; BITTENCOURT, Marcio S.; PEREIRA, Alexandre C.; GOULART, Alessandra C.; RUNDEK, Tatjana; PASSOS, Valeria M.; LOTUFO, Paulo; BENSENOR, Isabela M.Background and aims: Carotid artery intima-media thickness (CIMT) may be used as a biomarker for early cognitive impairment. However, the results of the association between CIMT and cognitive function in middle-aged subjects are mixed. We aimed to investigate this association in a large Brazilian sample with no history of stroke at baseline. Additionally, we tested the effect of interactions between CIMT and cardiovascular risk factors on cognitive performance. Methods: In this cross-sectional study, cognition was evaluated using the delayed word recall (DWRT), the category fluency, and the trail making tests (TMT). CIMT was measured at the common carotid artery. The association between CIMT and cognitive tests was investigated using linear regression models, adjusted for an extensive set of possible confounding variables. We also included interaction terms with selected risk factors. Results: The mean age of the 8208 participants was 49.6 +/- 7.3 years, 44% were male, and 56% White. Increase in CIMT was associated with worse performance on the DWRT (beta = -0.433, 95% CI = -0.724; -0.142, p = 0.004). We found effect modification of the association between cognitive function and CMIT by self-reported heart failure and alcohol intake. Participants had worse performance in the TMT if they had greater CIMT and current alcohol use (p < 0.0001). The interaction between CIMT and heart failure on TMT performance was not significant after adjustment for multiple comparisons (p = 0.07). Conclusions: In this sample of middle-aged adults, CIMT was inversely associated with memory function. Additionally, the presence of alcohol use resulted in a stronger association of CIMT with worse performance on an executive function test.
- Coronary CTA in the Evaluation of Stable Chest Pain(2017) BLANKSTEIN, Ron; BITTENCOURT, Marcio Sommer; BHATT, Deepak L.
conferenceObject Long-Term Prognosticvalue of Coronary Computed Tomography Scores to Predict Cardiovascular Events: The CORE64 and CORE320 Studies(2018) LIMA, Thais P.; ASSUNCAO JR., Antonildes N.; BITTENCOURT, Marcio S.; LIBERATO, Gabriela; LIMA, Joao A.; ROCHITTE, Carlos E.- Coronary computed tomography angiography: How should we act on what we find?(2017) BITTENCOURT, Marcio Sommer; BLANKSTEIN, Ron
- Impact of Coronary Remodeling on Fractional Flow Reserve(2018) COLLET, Carlos; KATAGIRI, Yuki; MIYAZAKI, Yosuke; ASANO, Taku; SONCK, Jeroen; GEUNS, Robert-Jan van; ANDREINI, Daniele; BITTENCOURT, Marcio S.; KITSLAAR, Pieter; TENEKECIOUGLU, Erhan; TIJSSEN, Jan G. P.; PIEK, Jan J.; WINTER, Robbert J. de; COSYNS, Bernard; ROGERS, Campbell; ZARINS, Christopher K.; TAYLOR, Charles; ONUMA, Yoshinobu; SERRUYS, Patrick W.
- Sex-specific performance of the ASCVD pooled cohort equation risk calculator as a correlate of coronary artery calcium in Kampala, Uganda(2022) KENTOFFIO, Katherine; DURSTENFELD, Matthew S.; SIEDNER, Mark J.; KITYO, Cissy; EREM, Geoffrey; SSINABULYA, Isaac; GHOSHHAJRA, Brian; BITTENCOURT, Marcio S.; LONGENECKER, Chris T.Introduction: The prevalence of cardiovascular disease (CVD) is rising in Sub-Saharan Africa, but it is not known whether current risk assessment tools predict coronary atherosclerosis in the region. Furthermore, sex-specific performance and interaction with HIV serostatus has not been well studied. Methods: This cross-sectional study compared ASCVD risk scores and detectable coronary artery calcium (CAC>0) by sex in Kampala, Uganda (n = 200). The cohort was enriched for persons living with HIV, and all participants had at least one CVD risk factor. We fit log binomial regression models and constructed ROC curves to assess the correlation between ASCVD scores and CAC>0. Results: The mean age was 56. 62% were female and 50% of both men and women were living with HIV. The median 10-year ASCVD risk score was significantly higher in men (11.0%, IQR 7.6???19.4%) than in women (5.1%, IQR 3.2???8.7%), although the prevalence of CAC>0 was similar (8.1 vs 10.5%, p = 0.63). Each 10% increase in ASCVD risk was associated with increased risk of CAC>0 in men (PR 1.59, 95% CI 1.00???2.55, p = 0.05) but not women (PR 1.15, 95% CI 0.44???3.00, p = 0.77). ROC curves demonstrated an AUC of 0.57 for women vs 0.70 for men. Adjustment for HIV serostatus improved the predictive value of ASCVD in women only (AUC 0.78, p = 0.02). Conclusions: ASCVD risk score did not correlate with the presence of CAC in women. When HIV status was added to the ASCVD risk score, correlation with CAC was improved in women but not in men.