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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- 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.
- Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report(2012) LUNA, Antonio Bayes de; BRUGADA, Josep; BARANCHUK, Adrian; BORGGREFE, Martin; BREITHARDT, Guenter; GOLDWASSER, Diego; LAMBIASE, Pier; RIERA, Andres Perez; GARCIA-NIEBLA, Javier; PASTORE, Carlos; ORETO, Giuseppe; MCKENNA, William; ZAREBA, Wojciech; BRUGADA, Ramon; BRUGADA, PedroBrugada syndrome is an inherited heart disease without structural abnormalities that is thought to arise as a result of accelerated inactivation of Na channels and predominance of transient outward K current (I-to) to generate a voltage gradient in the right ventricular layers. This gradient triggers ventricular tachycardia/ventricular fibrillation possibly through a phase 2 reentrant mechanism. The Brugada electrocardiographic (ECG) pattern, which can be dynamic and is sometimes concealed, being only recorded in upper precordial leads, is the hallmark of Brugada syndrome. Because of limitations of previous consensus documents describing the Brugada ECG pattern, especially in relation to the differences between types 2 and 3, a new consensus report to establish a set of new ECG criteria with higher accuracy has been considered necessary. In the new ECG criteria, only 2 ECG patterns are considered: pattern 1 identical to classic type 1 of other consensus (coved pattern) and pattern 2 that joins patterns 2 and 3 of previous consensus (saddleback pattern). This consensus document describes the most important characteristics of 2 patterns and also the key points of differential diagnosis with different conditions that lead to Brugada-like pattern in the right precordial leads, especially right bundle-branch block, athletes, pectus excavatum, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Also discussed is the concept of Brugada phenocopies that are ECG patterns characteristic of Brugada pattern that may appear and disappear in relation with multiple causes but are not related with Brugada syndrome.
- Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up(2023) ANTUNES, Murillo Oliveira; ARTEAGA-FERNANDEZ, Edmundo; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; MADY, CharlesBackground: Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain. Objective: To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up. Avaliacao Prognostica da Microalternancia da onda T na Cardiomiopatia Hipertrofica em um Seguimento Clinico de 9 anos Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up Oliveira Antunes,1,2 Edmundo Arteaga-Fernandez,1 Nelson Samesima,1 Horacio Gomes Pereira Afonso Yoshikiro Matsumoto,3 Richard L. Verrier,4 Carlos Alberto Pastore,1 Charles Mady1 do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo,1 Sao Paulo, SP - Brasil Universidade Sao Francisco,2 Braganca Paulista, SP - Brasil Group,3 Sao Paulo, SP - Brasil Israel Deaconess Medical Center,4 Boston - EUA
- Interatrial blocks. A separate entity from left atrial enlargement: a consensus report(2012) LUNA, Antonio Bayes de; PLATONOV, Pyotr; COSIO, Francisco G.; CYGANKIEWICZ, Iwona; PASTORE, Carlos; BARANOWSKI, Rafa; BAYES-GENIS, Antoni; GUINDO, Josep; VINOLAS, Xavier; GARCIA-NIEBLA, Javier; BARBOSA, Raimundo; STERN, Shlomo; SPODICK, DavidImpaired interatrial conduction or interatrial block is well documented but is not described as an individual electrocardiographic (ECG) pattern in most of ECG books, although the term atrial abnormalities to encompass both concepts, left atrial enlargement (LAE) and interatrial block, has been coined. In fact, LAE and interatrial block are often associated, similarly to what happens with ventricular enlargement and ventricular block. The interatrial blocks, that is, the presence of delay of conduction between the right and left atria, are the most frequent atrial blocks. These may be of first degree (P-wave duration > 120 milliseconds), third degree (longer P wave with biphasic [+/-] morphology in inferior leads), and second degree when these patterns appear transiently in the same ECG recording (atrial aberrancy). There are evidences that these electrocardiographic P-wave patterns are due to a block because they may (a) appear transiently, (b) be without associated atrial enlargement, and (c) may be reproduced experimentally. The presence of interatrial blocks may be seen in the absence of atrial enlargement but often are present in case of LAE. The most important clinical implications of interatrial block are the following: (a) the first degree interatrial blocks are very common, and their relation with atrial fibrillation and an increased risk for global and cardiovascular mortality has been demonstrated; (b) the third degree interatrial blocks are less frequent but are strong markers of LAE and paroxysmal supraventricular tachyarrhythmias. Their presence has been considered a true arrhythmological syndrome.
- Exercise-induced quantitative microvolt T-wave altemans in hypertrophic cardiomyopathy(2017) ANTUNES, Murillo de Oliveira; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; MATSUMOTO, Afonso Yoshikiro; VERRIER, Richard L.; PASTORE, Carlos Alberto; ARTEAGA-FERNANDEZ, Edmund; MADY, CharlesBackground/Purpose: Patients with hypertrophic cardiomyopathy (HCM) have elevated risk for sudden cardiac death (SCD). Our study aimed to quantitatively characterize microvolt T-wave alternans (TWA), a potential arrhythmia risk stratification tool, in this HCM patient population. Methods: TWA was analyzed with the quantitative modified moving average (MMA) in 132 HCM patients undergoing treadmill exercise testing, grouped according to Maron score risk factors as high-risk (H-Risk, n = 67,), or low-risk (L-Risk, n = 65, without these risk factors). Results: TWA levels were much higher for the H-Risk than for the L-Risk group (101.40 +/- 75.61 vs. 54.35 +/- 46.26 mu V; p < 0.0001). A 53 mu V cut point, set by receiver operator characteristic (ROC), identified H-Risk patients (82% sensitivity, 69% specificity). Conclusions: High TWA levels were found for hypertrophic cardiomyopathy patients. Abnormal TWA associated with major risk factors for SCD: non-sustained ventricular tachycardia on Holter (p = 0.001), family history of SCD (p = 0.006), septal thickness >= 30 mm (p < 0.001); and inadequate blood pressure response to effort (p = 0.04).
- Diagnostic Accuracy of ECG to Detect Left Ventricular Hypertrophy in Patients with Left Bundle Branch Block A Systematic Review and Meta-analysis(2023) SOUZA, Isabela A. F. de; PADRAO, Eduardo M. H.; MARQUES, Isabela R.; MIYAWAKI, Isabele A.; LOYOLA JUNIOR, Jose Eduardo Riceto; MOREIRA, Vittoria Caporal S.; GOMES, Cintia; SILVA, Caroliny H. A.; OPRYSKO, Carson; NETO, Augusto Barreto do Amaral; CARDOSO, Rhanderson; SAMESIANA, Nelson; PASTORE, Carlos Alberto; TAVARES, Caio A. M.Background: Electrocardiographic (ECG) criteria to detect left ventricular hypertrophy (LVH) in patients with left bundle branch block (LBBB) remain under debate. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of different ECG criteria for diagnosing LVH in patients with LBBB.Methods: We searched PubMed, Embase, Cochrane, and LILACS for articles evaluating the diagnostic accuracy of ECG criteria for LVH in patients with LBBB published between 1984 and 2023. Echocardiogram, magnetic resonance imaging, or autopsy were used as the reference standard for diagnosis of LVH. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The co-primary outcomes were sensitivity, specificity, the diagnostic odds ratio, and likelihood ratios, estimated using a bivariate generalized linear mixed model for each ECG criterion. The prespecified protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO).Results: We included 12 studies with a total of 1023 patients. We analyzed 10 criteria for LVH on ECG, including the Sokolow-Lyon criterion, the Cornell criterion, the RaVL (R wave in aVL) criterion, the Gubner-Ungerleider criterion, and the Dalfo criterion, among others. The Dalfo criterion was used for 487 patients and had the highest pooled sensitivity of 86% (95% confidence interval [CI] 57%-97%). All the other criteria had poor sensitivities. The Gubner-Ungerleider criterion and the RV5 or RV6 > 25 mm criterion had the highest specificities, with the former being used for 805 patients, obtaining a specificity of 99% (95% CI 80%-100%) and the latter being used for 355 patients, obtaining a specificity of 99% (95% CI 94%-100%). Conclusions: In patients with LBBB, the use of ECG criteria had poor performance for ruling out LVH, mostly due to low sensitivities. None of the criteria analyzed demonstrated a balanced tradeoff between sensitivity and specificity, suggesting that ECG should not be used routinely to screen for LVH.