MARCIO SOMMER BITTENCOURT

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  • article 22 Citação(ões) na Scopus
    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.
  • article 13 Citação(ões) na Scopus
    In vitro validation of coronary CT angiography for the evaluation of complex lesions
    (2018) COLLET, Carlos; ONUMA, Yoshinobu; GRUNDEKEN, Maik J.; MIYAZAKI, Yosuke; BITTERCOURT, Marcio; KITSLAAR, Pieter; MOTOYAMA, Sadako; OZAKI, Yukio; ASANO, Taku; WENTZEL, Jolanda J.; STREEKSTRA, Geert J.; SERRUYS, Patrick W.; WINTER, Robbert J. de; PLANKEN, R. Nils
    AIMS: The aim of this study was to assess in vitro the diagnostic accuracy of computed tomography angiography (CTA) for the evaluation of complex coronary lesions. METHODS AND RESULTS: Five Plexiglas phantoms with three bifurcation lesions each were designed to mimic the anatomic variations and fractal phenomena of the coronary tree. In addition, luminal stenoses were scaled up with increases of 10% from 40% to 80%, corresponding to luminal areas ranging from 3.0 mm2 to 0.22 mm2. Third-generation dual-source computed tomography was used. Automated quantitative CTA analysis was performed according to the bifurcation segment model. The primary objective was to determine the diagnostic accuracy of quantitative CTA in assessing bifurcation lesions with the phantoms as a reference. The accuracy of CTA for the assessment of minimal luminal diameter was -0.07 mm (limits of agreement -0.75 to 0.61), for reference vessel diameter 0.19 mm (limits of agreement -0.25 to 0.63) and diameter stenosis 8.2% (limits of agreement -13.2 to 29.5) with no difference regarding the location within the bifurcation (i.e., proximal and distal main vessel and side branch). In stenosis with minimal luminal diameter <= 1 mm, CTA overestimated the lesion severity (bias 0.19 mm, limits of agreement -0.09 to 0.47), whereas in lesions with severe stenosis and minimal luminal diameter >= 1 mm, CTA underestimated the lesion severity (bias -0.48 mm, limits of agreement -0.55 to -0.41). CTA was able to identify the contrast-filled lumen in all degrees of lesion severity. CONCLUSIONS: In vitro, CTA is accurate for the evaluation of bifurcation lesions. CTA was able to distinguish contrast-filled lumen even in severe obstructive lesions. These findings require further validation in the clinical setting.
  • article 10 Citação(ões) na Scopus
    Prospective associations between multiple lifestyle behaviors and depressive symptoms
    (2022) WERNECK, Andre O.; VANCAMPFORT, Davy; STUBBS, Brendon; SILVA, Danilo R.; CUCATO, Gabriel G.; CHRISTOFARO, Diego G. D.; SANTOS, Raul D.; RITTI-DIAS, Raphael M.; BITTENCOURT, Marcio S.
    Background: Our aim was to analyze the associations between multiple lifestyle behaviors and depressive symptoms. Methods: We included 4,725 adults (18-59y), that provided data in routine health evaluations of a hospital in Brazil, followed for a mean period of 3.1 +/- 1.6 years. Physical activity, alcohol consumption (measured using Alcohol Use Disorders Identification Test) and tobacco smoking were categorized as: (1) absence of the behavior (inactivity i.e. not complying with 150 min of moderate-to-vigorous PA/week, not smoking, no risky drinking, i. e. AUDIT<5) during baseline and follow-up; (2) Absence during baseline and presence during follow-up; (3) Presence during baseline and absence during follow-up; (4) Presence during both time points. Depressive symptoms were measured with the Beck Inventory was adopted to analyze patterns of depressive symptoms over time (as exposure). C-reactive protein [HS-CRP]) was assessed and its role in the association was tested. Incidence indicators of behaviors and depressive symptoms were created and used as outcomes. We used crude and adjusted Poisson regression analysis. Results: Fully adjusted models revealed that persistently physical inactive participants (RR:1.71;95% CI:1.33-2.21), those who became physically inactive (1.68;1.19-2.26), with consistently risky drinking (1.62;1.15-2.30), and who became risky drinkers (1.62;1.15-2.30) had higher risk for incidence of elevated depressive symptoms. Vice versa participants with incidence of depressive symptoms over time presented higher risk for physical inactivity (1.44;1.11-1.87) and risky drinking (1.65;1.16-2.34) incidence. HS-CRP did not influence the associations. Limitations: Self-reported physical activity, binary tobacco smoking, and non-probabilistic sampling. Conclusions: There is a prospective relationship between elevated depressive symptoms and adverse lifestyle behaviors.
  • article 7 Citação(ões) na Scopus
    Does physical activity influence the association between depressive symptoms and low-grade inflammation in adults? A study of 8,048 adults
    (2020) WERNECK, Andre O.; CHRISTOFARO, Diego G. D.; RITTI-DIAS, Raphael M.; CUCATO, Gabriel G.; STUBBS, Brendon; OYEYEMI, Adewale L.; CONCEICAO, Raquel D. O.; SANTOS, Raul D.; BITTENCOURT, Marcio S.
    This study investigated whether physical activity (PA) influences the association between depression risk and low-grade inflammation. This was a cross-sectional study including 8,048 adults (18-59y). Depression symptoms were evaluated with the Beck depression inventory (BDI) and physical activity through the international physical activity questionnaire. Adults with infectious and inflammatory diseases were excluded. Blood samples were collected, including high sensitivity C-reactive protein (CRP), a marker of low-grade inflammation when >= 3mg/L. Additional measures of LDL-C, HDL-C, triglycerides and fasting glucose were also determined. Sex, chronological age, tobacco smoking, alcohol drinking, body mass index, dyslipidemia, high blood pressure and fasting glucose were used as covariates. Mediation models were conducted using the procedures of Karlson Holm Breen. Adults with elevated CRP (>= 3mg/L) compared to those with low CRP (<3mg/L) presented with higher BDI scores [8.5%(95%CI:7.2%-10.1%) vs. 5.8%(95%CI:5.2-6.4)] as well as higher prevalence of physical inactivity 67.4% (95%CI:64.9-69.9) vs. 59.7% (95%CI:58.4-60.9). The prevalence of elevated CRP was highest in physically inactive adults with greater depression risk. Models revealed that physical activity risk explained 13% of the association between depression risk and elevated CRP (p=0.035), independently of potential confounders. Physical activity may reduce the association between depression symptoms and elevated CRP. Future longitudinal research is required to determine the directionality of the relationships observed.
  • article 19 Citação(ões) na Scopus
    Coronary Artery Calcium to Improve the Efficiency of Randomized Controlled Trials in Primary Cardiovascular Prevention
    (2021) CAINZOS-ACHIRICA, Miguel; BITTENCOURT, Marcio Sommer; OSEI, Albert D.; HAQUE, Waqas; BHATT, Deepak L.; BLUMENTHAL, Roger S.; BLANKSTEIN, Ron; RAY, Kausik K.; BLAHA, Michael J.; NASIR, Khurram
    OBJECTIVES This study sought to assess the value, in terms of sample size and cost, of using the coronary artery calcium (CAC) score to enrich the study population of primary prevention randomized controlled trials (RCTs) with participants at high absolute risk of atherosclerotic cardiovascular disease (ASCVD) events. BACKGROUND The feasibility of RCTs assessing the efficacy of novel add-on therapies for primary prevention among high-risk individuals treated with statins may be limited by sample size and cost. METHODS We evaluated 3,075 statin-naive participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with estimated 10-year ASCVD risk of >_7.5%. CAC of >100, CAC of >400, high sensitivity C-reactive protein levels of >2 and >3 mg/l, ankle-brachial index of <0.9, and triglyceride levels of >175 mg/dl were each evaluated as enrichment criteria on top of estimated ASCVD risk of >_7.5%, >_10%, >_15% and >_20%. For each criterion, using the observed 5-year incidence of CVD, we projected the incidence of CVD assuming a 28% relative risk reduction with high-intensity statin therapy and after addition of novel therapy with additive relative risk reductions of 15% and 25%. Sample size and cost of a hypothetical primary prevention 5-year RCT of a novel therapy on top of statins versus statins alone were then computed by using the projected incidences. Yearly costs per included participant of $6,000 to $9,000 and of $500/ $600 per screened nonparticipant were assumed. RESULTS CAC of >400, present in 15% to 23% participants, consistently identified the subgroups with highest 5-year incident events and outperformed the other features yielding the smallest projected sample size, ranging 33% to 58% lower than using risk estimations alone for participant selection. CAC of >400 also yielded the lowest projected RCT costs, at least $40 million lower than using risk estimations alone. CAC of >100 showed the second-best performance in most scenarios. CONCLUSIONS High CAC scores used as study entry criteria can improve the efficiency and feasibility of primary prevention RCTs evaluating the incremental efficacy of novel add-on therapies. (J Am Coll Cardiol Img 2021;14:1005 & ndash;16) (c) 2021 by the American College of Cardiology Foundation.
  • article 26 Citação(ões) na Scopus
    Relation of Fasting Triglyceride-Rich Lipoprotein Cholesterol to Coronary Artery Calcium Score (from the ELSA-Brasil Study)
    (2017) BITTENCOURT, Marcio S.; SANTOS, Raul D.; STANIAK, Henrique; SHAROVSKY, Rodolfo; KONDAPALLY, Rao; VALLEJO-VAZ, Antonio J.; RAY, Kausik K.; BENSENOR, Isabela; LOTUFO, Paulo
    Although low-density lipoprotein cholesterol (LDL-C) is widely accepted as the principal lipid fraction associated with atherosclerosis, emerging evidence suggests a causal relation between lifelong elevations in triglyceride-rich lipoprotein cholesterol (TRL-C) and cardiovascular disease (CVD) in genetic studies. To provide further evidence for the potential relevance of TRL-C and atherosclerosis, we have evaluated the relation between TRL-C and coronary artery calcium (CAC) score. We included 3,845 subjects (49.9 +/- 8.4 years, 54% women) who had no history of CVD, were not using lipid-lowering medications, and underwent CAC evaluation. We assessed the relation between increasing fasting TRL-C and the graded increase in CAC and to what extent TRL-C were independently associated with CAC over and above LDL-C using logistic regression models. Overall, 973 (25%) of the participants had a CAC >0 and 308 (8%) had a CAC >100. The median TRL-C level was 22 mg/dL (IQR 16 to 32). Subjects with CAC >0 had higher TRL-C levels than those with CAC = 0 (p <0.001). Similarly, subjects with CAC >0 had higher levels of LDL-C, non high-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (all p <0.001). After multivariate adjustment, log-transformed TRL-C remained associated with the presence and severity of CAC (all p <0.05). When TRL-C was added to models that contained demographic factors and conventional lipids, it significantly improved the model to predict the presence of CAC >0 (p = 0.01). In conclusion, in a large cohort of asymptomatic subjects, TRL-C was associated with sub clinical atherosclerosis supporting a potentially causal role in CVD.
  • article 28 Citação(ões) na Scopus
    Post-TB health and wellbeing
    (2023) NIGHTINGALE, R.; CARLIN, F.; MEGHJI, J.; MCMULLEN, K.; EVANS, D.; ZALM, M. M. van der; ANTHONY, M. G.; BITTENCOURT, M.; BYRNE, A.; PREEZ, K. du; COETZEE, M.; FERIS, C.; GOUSSARD, P.; HIRASEN, K.; BOUWER, J.; HODDINOTT, G.; HUAMAN, M. A.; INGLIS-JASSIEM, G.; IVANOVA, O.; KARMADWALA, F.; SCHAAF, H. S.; SCHOEMAN, I.; SEDDON, J. A.; SINEKE, T.; SOLOMONS, R.; THIART, M.; TOORN, R. van; FUJIWARA, P. I.; ROMANOWSKI, K.; MARAIS, S.; HESSELING, A. C.; JOHNSTON, J.; ALLWOOD, B.; MUHWA, J. C.; MORTIMER, K.
    TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post -Tuberculosis Symposium' called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
  • article 1629 Citação(ões) na Scopus
    Atherosclerosis
    (2019) LIBBY, Peter; BURING, Julie E.; BADIMON, Lina; HANSSON, Carom K.; DEANFIELD, John; BITTENCOURT, Marcio Sommer; TOKGOZOGLU, Lale; LEWIS, Eldrin F.
    Atherosclerosis, the formation of fibrofatty lesions in the artery wall, causes much morbidity and mortality worldwide, including most myocardial infarctions and many strokes, as well as disabling peripheral artery disease. Development of atherosclerotic lesions probably requires low-density lipoprotein, a particle that carries cholesterol through the blood. Other risk factors for atherosclerosis and its thrombotic complications include hypertension, cigarette smoking and diabetes mellitus. Increasing evidence also points to a role of the immune system, as emerging risk factors include inflammation and clonal haematopoiesis. Studies of the cell and molecular biology of atherogenesis have provided considerable insight into the mechanisms that link all these risk factors to atheroma development and the clinical manifestations of this disease. An array of diagnostic techniques, both invasive (such as selective coronary arteriography) and noninvasive (such as blood biomarkers, stress testing, CT and nuclear scanning), permit assessment of cardiovascular disease risk and targeting of therapies. An expanding armamentarium of therapies that can modify risk factors and confer clinical benefit is available; however, we face considerable challenge in providing equitable access to these treatments and in maximizing adherence. Yet, the clinical application of the fruits of research has advanced preventive strategies, enhanced clinical outcomes in affected individuals, and improved their quality of life. Rapidly accelerating knowledge and continued research promise to provide further progress in combating this common chronic disease.
  • article 64 Citação(ões) na Scopus
    The Role of F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis of Left-sided Endocarditis: Native vs Prosthetic Valves Endocarditis
    (2020) CAMARGO, Raphael Abegao de; BITENCOURT, Marcio Sommer; MENEGHETTI, Jose Claudio; JR, Jose Soares; GONCALVES, Luis Fernando Tonello; BUCHPIGUEL, Carlos Alberto; PAIXAO, Milena Ribeiro; FELICIO, Marilia Francesconi; SOEIRO, Alexandre de Matos; STRABELLI, Tania Mara Varejao; MANSUR, Alfredo Jose; TARASOUTCHI, Flavio; JR, Mucio Tavares de Oliveira; CASTELLI, Jussara Bianchi; GUALANDRO, Danielle Menosi; POCEBON, Lucas Zoboli; BLANKSTEIN, Ron; ALAVI, Abass; MOORE, John Edmund; MILLAR, Beverley Cherie; SICILIANO, Rinaldo Focaccia
    Background: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of F-18-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). Methods: Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. F-18-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and F-18-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. Results: Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of F-18-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal F-18-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as ""possible"" to ""definite"" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only. Conclusions: Use of F-18-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of F-18-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.
  • article 6 Citação(ões) na Scopus
    Sex-specific associations between alcohol consumption, cardiac morphology, and function as assessed by magnetic resonance imaging: insights form the UK Biobank Population Study
    (2021) SIMON, Judit; FUNG, Kenneth; KOLOSSVARY, Marton; SANGHVI, Mihir M.; AUNG, Nay; PAIVA, Jose Miguel; LUKASCHUK, Elena; CARAPELLA, Valentina; MERKELY, Bela; BITTENCOURT, Marcio S.; KARADY, Julia; LEE, Aaron M.; PIECHNIK, Stefan K.; NEUBAUER, Stefan; MAUROVICH-HORVAT, Pal; PETERSEN, Steffen E.
    Aims Data regarding the effects of regular alcohol consumption on cardiac anatomy and function are scarce. Therefore, we sought to determine the relationship between regular alcohol intake and cardiac structure and function as evaluated with cardiac magnetic resonance imaging. Methods and results Participants of the UK Biobank who underwent cardiac magnetic resonance were enrolled in our analysis. Data regarding regular alcohol consumption were obtained from questionnaires filled in by the study participants. Exclusion criteria were poor image quality, missing, or incongruent data regarding alcohol drinking habits, prior drinking, presence of heart failure or angina, and prior myocardial infarction or stroke. Overall, 4335 participants (61.57.5years, 47.6% male) were analysed. We used multivariate linear regression models adjusted for age, ethnicity, body mass index, smoking, hypertension, diabetes mellitus, physical activity, cholesterol level, and Townsend deprivation index to examine the relationship between regular alcohol intake and cardiac structure and function. In men, alcohol intake was independently associated with marginally increased left ventricular end-diastolic volume [beta = 0.14; 95% confidence interval (CI) = 0.05-0.24; P = 0.004], left ventricular stroke volume (beta = 0.08; 95% CI = 0.03-0.14; P = 0.005), and right ventricular stroke volume (beta = 0.08; 95% CI = 0.02-0.13; P = 0.006). In women, alcohol consumption was associated with increased left atrium volume (beta = 0.14; 95% CI = 0.04-0.23; P = 0.006). Conclusion Alcohol consumption is independently associated with a marginal increase in left and right ventricular volumes in men, but not in women, whereas alcohol intake showed an association with increased left atrium volume in women. Our results suggest that there is only minimal relationship between regular alcohol consumption and cardiac morphology and function in an asymptomatic middle-aged population.