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
6 resultados
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conferenceObject Controversial and similar aspects of Brugada syndrome and J-wave patterns: the vectorcardiogram point of view(2016) PASTORE, C. A.; SAMESIMA, N.; PEREIRA FILHO, H. G.; MADALOSO, B. A.- Contribution of the vectorcardiogram in the differential diagnosis of Brugada electrocardiographic pattern(2022) MADALOSO, Bruna A.; SAMESIMA, Nelson; TOBIAS, Nancy M. M. O.; TAVARES, Caio A. M.; FILHO, Horacio G. Pereira; FACIN, Mirella E.; PASTORE, C. A.Background: The electrocardiogram (ECG) is a powerful tool for differential diagnosis among a group of pathologies with different therapeutic approaches/prognoses, the so-called J-wave syndrome. The vectorcardiogram (VCG) can be used as a complementary method to the ECG in several dubious electrocardiographic alterations. Objective: We carried out a VCG analysis alter conceiving and measuring a novel parameter (JT-distance) that allows diagnosis of the Brugada ECG pattern. Methods: A retrospective cohort study selected ninety-six ECGs with J-point elevation in V-1/V-2, ECG superior leads and VCGs, all performed on the same day. A new VCG measurement by Frank method (IT-distance) was conceived and designed in transverse and right sagittal planes by 3 lines drawn 1) at the final third of the QRS loop, comprehending the J-point; 2) at the initial portion of the T loop; 3) a parallel of the J-point line at the beginning of the T loop. JT measure was determined by the distance between parallels. A validation cohort was established in a new sample of thirty-five patients. Results: JT-distance >= 1.5 mm (tranverse plane) and JT-distance >1.25 mm, in the sagittal plane, differentiated Brugada type-1 from Brugada type-2, early repolarization and others, with 95% sensitivity and 68% specificity. JT-distance <1.5 mm (transverse plane) and JT >1.25 mm (sagittal plane) had 100% sensitivity and 85% specificity for Brugada type-1 diagnosis. A validation cohort showed very similar Cohen's kappa levels (0.65 and 0.77, test and validation cohorts, respectively), with overlapping 95% confidence intervals. Conclusions: The novel vectorcardiogram measurement (JT-distance) presented a new diagnostic criterion to identify Brugada pattern. Nevertheless, prospective studies should be performed by other centers to confirm these findings.
- 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
- Controversial and similar aspects of the Brugada and J wave patterns: The vectorcardiogram point of view(2016) PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio G.; MADALOSO, Bruna A.Background: The J-wave electrocardiographic patterns include early repolarization (ER) and Brugada syndrome; especially when ER is located in the anteroseptal leads (V1-V3), it can mimic the Brugada syndrome (BrS) ECG pattern and therefore mislead the diagnosis. We aimed to define the vectorcardiographic characteristics of BrS and ER using aspects of QRS complex loop, J-point and ST-segment. Methods/Results: Vectorcardiographic loops in the transverse plane (TP) of 14 BrS patients and 26 individuals with ER were analyzed and defined, and then a third group of 17 patients with non characteristic ECG patterns were analyzed and compared with. them. All QRS loops showed end conduction delay (ECD) located in the right posterior-to-anterior quadrant (BrS) or left posterior-to-anterior quadrant (ER). In 100% cases a ""break"" in the QRS loop end, resembling a ""nose"" identified BrS, and a ""fish-hook"" shape identified ER. Non-coincidental QRS complex onset-end defined J-point resulting vector. BrS showed a significantly longer end-conduction delay (100% right anterior quadrant), shorter 5 point amplitude oriented to the right, and ""nose-like"" QRS end loop. Analysis of group 3 confirmed the accuracy of the qualitative aspects to distinguish this ""atypical"" population: ""fish-hook"" shape of ER in the transverse plane in 6 individuals (one with both patterns seen in the sagittal plane); and the ""nose"" shape of BrS in 14 patients (two of which were diagnosed with both patterns in the transverse plane). Conclusions: Vectorcardiographic characteristics could clearly differentiate BrS from ER qualitatively and quantitatively even in atypical ECGs.
- 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.