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
4 resultados
Resultados de Busca
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- Cardiac Mean Electrical Axis in Thoroughbreds-Standardization by the Dubois Lead Positioning System(2017) COSTA, Cassia Fre da; SAMESIMA, Nelson; PASTORE, Carlos AlbertoBackground Different methodologies for electrocardiographic acquisition in horses have been used since the first ECG recordings in equines were reported early in the last century. This study aimed to determine the best ECG electrodes positioning method and the most reliable calculation of mean cardiac axis (MEA) in equines. Materials and Methods We evaluated the electrocardiographic profile of 53 clinically healthy Thoroughbreds, 38 males and 15 females, with ages ranging 2-7 years old, all reared at the Sao Paulo Jockey Club, in Brazil. Two ECG tracings were recorded from each animal, one using the Dubois lead positioning system, the second using the base-apex method. QRS complex amplitudes were analyzed to obtain MEA values in the frontal plane for each of the two electrode positioning methods mentioned above, using two calculation approaches, the first by Tilley tables and the second by trigonometric calculation. Results There were compared between the two methods. Results There was significant difference in cardiac axis values: MEA obtained by the Tilley tables was +135.1 degrees +/- 90.9 degrees vs. -81.1 degrees +/- 3.6 degrees (p<0.0001), and by trigonometric calculation it was -15.0 degrees +/- 11.3 degrees vs. -79.9 degrees +/- 7.4 degrees (p<0.0001), base-apex and Dubois, respectively. Furthermore, Dubois method presented small range of variation without statistical or clinical difference by either calculation mode, while there was a wide variation in the base-apex method. Conclusion Dubois improved centralization of the Thoroughbreds' hearts, engendering what seems to be the real frontal plane. By either calculation mode, it was the most reliable methodology to obtain cardiac mean electrical axis in equines.
- 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.
- Comparison of Electrocardiographic Criteria for Identifying Left Ventricular Hypertrophy in Athletes from Different Sports Modalities(2017) SAMESIMA, Nelson; AZEVEDO, Luciene Ferreira; MATOS, Luciana Diniz Nagem Janot De; ECHENIQUE, Leandro Santini; NEGRAO, Carlos Eduardo; PASTORE, Carlos AlbertoOBJECTIVES: In athletes, isolated electrocardiogram high voltage criteria are widely used to evaluate left ventricular hypertrophy, but positive findings are thought to represent normal electrocardiogram alterations. However, which electrocardiogram criterion can best detect left ventricular hypertrophy in athletes of various sport modalities remains unknown. METHODS: Five electrocardiogram criteria used to detect left ventricular hypertrophy were tested in 180 male athletes grouped according to their sport modality: 67% low-static and high-dynamic components and 33% high-static and high-dynamic components of exercise. The following echocardiogram parameters are the gold standard for diagnosing left ventricular hypertrophy: left ventricular mass index >= 34 g.m(-2), relative wall thickness >= 0.42 mm, left ventricular diastolic diameter index >= 32 m.m(-2), septum wall thickness >= 13 mm, and posterior wall thickness >= 13 mm. Results for the various criteria were compared using the kappa coefficient. Significance was established at p < 0.05. RESULTS: Fifty athletes (28%) presented with left ventricular hypertrophy according to electrocardiogram findings, with the following sensitivities and specificities, respectively: 38-53% and 79-83% (Perugia), 22-40% and 89-91% (Cornell), 24-29% and 90% (Romhilt-Estes), 68-87% and 20-23% (Sokolow-Lyon), and 0% and 99% (Gubner). The Perugia and Cornell criteria had higher negative predictive values for the low-static and high-dynamic subgroup. Kappa coefficients were higher for Romhilt-Estes, Cornell and Perugia criteria than for Sokolow-Lyon and Gubner criteria. CONCLUSION: All five evaluated criteria are inadequate for detecting left ventricular hypertrophy, but the Perugia, Cornell and Romhilt-Estes criteria are useful for excluding its presence. The Perugia and Cornell criteria were more effective at excluding left ventricular hypertrophy in athletes involved in a sport modality with low-static and high-dynamic component predominance.
- 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).