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
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- 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.
- The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper(2015) DIGBY, Genevieve C.; KUKLA, Piotr; ZHAN, Zhong-Qun; PASTORE, Carlos A.; PIOTROWICZ, Ryszard; SCHAPACHNIK, Edgardo; ZAREBA, Wojciech; LUNA, Antonio Bayes de; PRUSZCZYK, Piotr; BARANCHUK, Adrian M.Electrocardiographic (ECG) abnormalities in the setting of acute pulmonary embolism (PE) are being increasingly characterized and mounting evidence suggests that ECG plays a valuable role in prognostication for PE. We review the historical 21-point ECG prognostic score for the severity of PE and examine the updated evidence surrounding the utility of ECG abnormalities in prognostication for severity of acute PE. We performed a literature search of MEDLINE, EMBASE, and PubMed up to February 2015. Article titles and abstracts were screened, and articles were included if they were observational studies that used a surface 12-lead ECG as the instrument for measurement, a diagnosis of PE was confirmed by imaging, arteriography or autopsy, and analysis of prognostic outcomes was performed. Thirty-six articles met our inclusion criteria. We review the prognostic value of ECG abnormalities included in the 21-point ECG score, including new evidence that has arisen since the time of its publication. We also discuss the potential prognostic value of several ECG abnormalities with newly identified prognostic value in the setting of acute PE.
- A 64-lead Body Surface Potential Mapping System(2017) SALINET, Joao L.; MARQUES, Victor G.; MAZZETTO, Marcelo; CAMARGO, Erick D. L. B.; PASTORE, Carlos A.; CESTARI, Idagene A.Non-invasive acquisition of the electrical heart activity through high density mapping might allow early diagnosis of heart diseases overcoming the limitations of the traditional ECG method. This study presents a BSPM system (hardware and platform) to allow users to analyze the characteristics of morphology in up to 64 simultaneous body surface potentials (BSPs) including the 12-lead ECG and vectocardiogram (VCG). The signals undergo a preprocessing step followed by the R peak detection using previously validated techniques for heart rate variability studies. In addition, embedded 3D isopotential, 3D isochrone maps and VCG planes allow researchers to investigate the heart's the electrical activity and its patterns under different heart rhythm disorders in clinical practice.
- 2D Image-Based Atrial Fibrillation Classification(2021) DIAS, Felipe M.; SAMESIMA, Nelson; RIBEIRO, Adele; MORENO, Ramon A.; PASTORE, Carlos A.; KRIEGER, Jose E.; GUTIERREZ, Marco A.Atrial fibrillation (AF) is a common arrhythmia (0.5% worldwide prevalence) associated with an increased risk of various cardiovascular disorders, including stroke. Automated routine AF detection by Electrocardiogram (ECG) is based on the analysis of one-dimensional ECG signals and requires dedicated software for each type of device, limiting its wide use, especially with the rapid incorporation of telemedicine into the healthcare system. Here, we implement a machine learning method for AF classification using the region of interest (ROI) corresponding to the long DII lead automatically extracted from DICOM 12-lead ECG images. We observed 94.3%, 98.9%, 99.1%, and 92.2% for sensitivity, specificity, AUC, and F1 score, respectively. These results indicate that the proposed methodology performs similar to one-dimensional ECG signals as input, but does not require a dedicated software facilitating the integration into clinical practice, as ECGs are typically stored in PACS as 2D images.
- Global and Regional Ventricular Repolarization Study by Body Surface Potential Mapping in Patients with Left Bundle-Branch Block and Heart Failure Undergoing Cardiac Resynchronization Therapy(2012) DOUGLAS, Roberto A. G.; SAMESIMA, Nelson; FILHO, Martino M.; PEDROSA, Anisio A.; NISHIOKA, Silvana A. D.; PASTORE, Carlos A.Background: The controversial effects promoted by cardiac resynchronization therapy (CRT) on the ventricular repolarization (VR) have motivated VR evaluation by body surface potential mapping (BSPM) in CRT patients. Methods: Fifty-two CRT patients, mean age 58.8 +/- 12.3 years, 31 male, LVEF 27.5 +/- 9.2, NYHA III-IV heart failure with QRS181.5 +/- 14.2 ms, underwent 87-lead BSPM in sinus rhythm (BASELINE) and biventricular pacing (BIV). Measurements of mean and corrected QT intervals and dispersion, mean and corrected T peak end intervals and their dispersion, and JT intervals characterized global and regional (RV, Intermediate, and LV regions) ventricular repolarization response. Results: Global QTm (P < 0.001) and QTcm (P < 0.05) were decreased in BIV; QTm was similar across regions in both modes (P = ns); QTcm values were lower in RV/LV than in Intermediate region in BASELINE and BIV (P < 0.001); only RV/Septum showed a significant difference (P < 0.01) in the BIV mode. QTD values both of BASELINE (P < 0.01) and BIV (P < 0.001) were greater in the Intermediate than in the LV region. CRT effect significantly reduced global/regional QTm and QTcm values. QTD was globally decreased in RV/LV (Intermediate: P = ns). BIV mode significantly reduced global T peak end mean and corrected intervals and their dispersion. JT values were not significant. Conclusions: Ventricular repolarization parameters QTm, QTcm, and QTD global/regional values, as assessed by BSPM, were reduced in patients under CRT with severe HF and LBBB. Greater recovery impairment in the Intermediate region was detected by the smaller variation of its dispersion.
conferenceObject J-Point Syndromes From the Vectorcardiogram Point of View(2014) PASTORE, Carlos A.; SAMESIMA, Nelson; PEREIRA, Horacio G.- ST-segment abnormalities are associated with long-term prognosis in non-ST-segment elevation acute coronary syndromes: The ERICO-ECG study(2016) BRANDAO, Rodrigo M.; SAMESIMA, Nelson; PASTORE, Carlos A.; STANIAK, Henrique L.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.; SANTOS, Itamar S.Introduction: We aimed to identify whether ST-segment abnormalities, in the admission or during in-hospital stay, are associated with survival and/or new incident myocardial infarction (MI) in 623 non-ST-elevation acute coronary syndrome participants of the Strategy of Registry of Acute Coronary Syndrome (ERICO) study: Materials and methods: ERICO is conducted in a community-based hospital. ST-segment analysis was based on the Minnesota Code. We built Cox regression models to study whether ECG was an independent predictor for clinical outcomes. Results: Median follow-up was 3 years. We found higher risk of death due to MI in individuals with ST-segment abnormalities in the final ECG (adjusted hazard ratio: 2.68; 95% confidence interval: 1.14-6.28). Individuals with ST-segment abnormalities in any tracing had a non-significant trend toward a higher risk of fatal or new non-fatal MI (p = 0.088). Conclusions: ST-segment abnormalities after the initial tracing added long-term prognostic information.
- Left Atrium Reverse Remodeling in Patients With Mitral Valve Stenosis After Percutaneous Valvuloplasty: A 2-and 3-Dimensional Echocardiographic Study(2013) VIEIRA, Marcelo L. Campos; SILVA, Murilo C.; WAGNER, Camila R.; DALLAN, Luis A.; KAJITA, Luis J.; OLIVEIRA, Wercules A.; SAMESINA, Nelson; HOTTA, Viviane T.; MATHIAS JR., Wilson; SPINA, Guilherme; CARDOSO, Luis; PASTORE, Carlos A.; TARASOUTCHI, Flavio; GRINBERG, MaxIntroduction and objectives: The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3 -dimensional transthoracic echocardiography. Methods: We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 [11.5]) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72 h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemodynamic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. Results: The 3-dimensional parameters of the mitral valve stenosis patients before and 72 h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm(2); 1.8 (0.2) cm(2) (P<.001); 1.7 (0.2) cm(2) (P<.001); b) left atrium maximum volumes: 49.9 (12) mL/m(2); 42 (11.4) mL/m(2) (P<.001); 40.3 (10.2) mL/m(2)(P<.001), and c) left atrium emptying fraction: 30.1 (9.4%); 40.6 (7.4%) (P<.001); 44.1 (8%) (P<.001), respectively. Conclusions: In symptomatic mitral valve stenosis patients who underwent percutaneous balloon valvuloplasty analysis by 2- and 3-dimensional echocardiography, improvements in left atrium reverse remodeling and left atrium emptying fraction were observed 72 h and 12 months after the procedure. Full English text available from: www.revespcardiol.org/en (C) 2012 Sociedad Espanola de Cardiologia.