JEANE MIKE TSUTSUI
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- Evaluation of cardiac masses by real-time perfusion imaging echocardiography(2015) UENISHI, Eliza K.; CALDAS, Marcia A.; TSUTSUI, Jeane M.; ABDUCH, Maria C. D.; SBANO, Joao C. N.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackground: Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization. Methods: We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (beta), and microvascular blood flow (A x beta) were determined by quantitative RTPE. Results: Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1-7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x beta values were 0.0 dB/s(-1) (0.01-0.14), 2.00 dB/s(-1) (1-6), and 1.18 dB/s(-1) (0.52-3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Ax beta = 2.46 dB/s(-1) (1.42-4.59) versus Ax beta = 1.55 dB/s [1] (0.51-4.08); p=NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT. Conclusion: RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
- Prognostic Value of Coronary and Microvascular Flow Reserve in Patients with Nonischemic Dilated Cardiomyopathy(2013) LIMA, Marta F.; MATHIAS JR., Wilson; SBANO, Joao C. N.; CRUZ, Victoria Yezinia de la; ABDUCH, Maria Cristina; LIMA, Marcio S. M.; BOCCHI, Edmar A.; HAJJAR, Ludhmila A.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; TSUTSUI, Jeane M.Background: Coronary and microvascular blood flow reserve have been established as important predictors of prognosis in patients with cardiovascular disease. The aim of this study was to assess the value of coronary flow velocity reserve (CFVR) and real-time myocardial perfusion echocardiography (RTMPE) for predicting events in patients with nonischemic dilated cardiomyopathy. Methods: One hundred ninety-five patients (mean age 54 +/- 12 years; 66% men) with dilated cardiomyopathy (left ventricular ejection fraction < 35% and no obstructive coronary disease on invasive angiography or multi-detector computed tomography) who underwent dipyridamole stress (0.84 mg/kg over 10 min) RTMPE were prospectively studied. CFVR was calculated as the ratio of hyperemic to baseline peak diastolic velocities in the distal left anterior coronary artery. The replenishment velocity (beta), plateau of acoustic intensity (A(N)), and myocardial blood flow reserve were obtained from RTMPE. Results: Mean CFVR was 2.07 +/- 0.52, mean A(N) reserve was 1.05 +/- 0.09, mean beta reserve was 2.05 +/- 0.39, and mean myocardial blood flow reserve (A(N) x beta) was 2.15 +/- 0.48. During a median follow-up period of 29 months, 45 patients had events (43 deaths and two urgent transplantations). Independent predictors of events were left atrial diameter (relative risk, 1.16; 95% confidence interval, 1.08-1.26; P < .001) and beta reserve <= 2.0 (relative risk, 3.22; 95% confidence interval, 1.18-8.79; P < .001). After adjustment for beta reserve, CFVR and myocardial blood flow reserve no longer had predictive value. Left atrial diameter added prognostic value over clinical factors and left ventricular ejection fraction (chi(2) = 36.8-58.5, P < .001). Beta reserve added additional power to the model (chi(2) = 70.2, P < .001). Conclusions: Increased left atrial diameter and depressed beta reserve were independent predictors of cardiac death and transplantation in patients with nonischemic dilated cardiomyopathy. Beta reserve by RTMPE provided incremental predictive value beyond that provided by current known prognostic clinical and echocardiographic factors. (J Am Soc Echocardiogr 2013;26:278-87.)
conferenceObject Sonothrombolysis Improves Left Atrial Pressure and Volume in Patients With ST Elevation Acute Myocardial Infarction(2020) CHIANG, Hsu Po; AGUIAR, Miguel; TAVARES, Bruno; MATHIAS, Wilson; BORGES, Bruno C.; OLIVEIRA, Mucio; SOEIRO, Alexandre D.; NICOLAU, Jose C.; SBANO, Joao; GOLDSWEIG, Andrew M.; KALIL FILHO, Roberto; RAMIRES, Jose A.; PORTER, Thomas R.; TSUTSUI, Jeane M.conferenceObject THE IMPACT OF SONOTHROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND LEFT ATRIAL MECHANICS IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION(2020) CHIANG, Hsu; AGUIAR, Miguel Osman; TAVARES, Bruno Garcia; MATHIAS JR., Wilson; BORGES, Bruno Carter; AZEVEDO, Luciene; OLIVEIRA, Mucio; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; SBANO, Joao Cesar; GOLDSWEIG, Andrew; KALIL-FILHO, Roberto; RAMIRES, Jose; PORTER, Thomas; TSUTSUI, Jeane- Sonothrombolysis Promotes Improvement in Left Ventricular Wall Motion and Perfusion Scores after Acute Myocardial Infarction(2022) TAVARES, Bruno G.; AGUIAR, Miguel Osman; TSUTSUI, Jeane; OLIVEIRA, Mucio; SOEIRO, Alexandre de Matos; NICOLAU, Jose; RIBEIRO, Henrique; POCHIANG, Hsu; SBANO, Joao; ROCHITTE, Carlos Eduardo; LOPES, Bernardo; RAMIREZ, Jose; KALIL FILHO, Roberto; MATHIAS, WilsonBackground: It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI). Objective: To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods: One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results: Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% +/- 10% versus 44% +/- 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% +/- 10% versus 48% +/- 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 +/- 0.39 versus 1.75 +/- 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 +/- 0.36 versus 1.64 +/- 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 +/- 3.47 versus 6.94 +/- 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 +/- 3.31 versus 6.57 +/- 4.29; p = 0.01). Conclusion: Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.
- The impact of ligation of proximal side branches on blood flow and functional status of the internal thoracic artery in coronary anastomosis(2016) ABREU, Jose Sebastiao; TSUTSUI, Jeane Mike; FALCAO, Sandra Nivea R.; FEITOSA, Jose Acacio; ROCHA, Eduardo Arraes; OLIVEIRA, Italo Martins; DIOGENES, Teresa Cristina; PAES JR., Jose N.; SBANO, Joao C.; DALLAN, Luis A.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackgroundThe effect of proximal side branches on the patency of the internal thoracic artery (ITA) is controversial. We used echocardiography and Doppler to verify the effect of ligation of branches on the flow and coronary flow reserve (CFR) of the grafted ITA in patients after coronary artery bypass grafting (CABG). MethodsWe prospectively investigated 53 patients with preserved left ventricular ejection fraction (LVEF >50%) who underwent CABG of the ITA. In Group I (25 patients), major branches were ligated during ITA anastomosis to the left anterior descending (LAD) coronary artery, whereas no ligation was performed in Group II (28 patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF = SF + DF) were measured by Doppler echocardiography at the proximal level of the ITA preoperatively, at early postoperative stage, and 6months after surgery. Dobutamine stress echocardiography (DSE) was performed at 6months to determine CFR. ResultsThe ITA flow was predominantly systolic before surgery and diastolic in the postoperative period. We found no differences between the groups in DF. On DSE, SF (19.59mL/min vs 32.7 +/- 19mL/min; P=.003) and TF (79 +/- 21mL/min vs 101 +/- 47mL/min; P=.037) were higher in Group II. There were no differences in CFR (1.9 +/- 0.46 vs 2.11 +/- 0.56; P=.143). ConclusionIn patients with preserved LVEF, ligation of major side branches during anastomosis to the LAD does not alter ITA flow or CFR.
- Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention(2019) JR, Wilson Mathias; TSUTSUI, Jeane M.; TAVARES, Bruno G.; FAVA, Agostina M.; AGUIAR, Miguel O. D.; BORGES, Bruno C.; JR, Mucio T. Oliveira; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; CHIANG, Hsu Po; SBANO, Joao C. N.; MORAD, Abdulrahman; GOLDSWEIG, Andrew; ROCHITTE, Carlos E.; LOPES, Bernardo B. C.; RAMIREZ, Jose A. F.; KALIL FILHO, Roberto; PORTER, Thomas R.BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 +/- 22 g high MI/PCI vs. 40 +/- 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 +/- 11% vs. 43 +/- 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF <= 30%) was reducedin the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (C) 2019 by the American College of Cardiology Foundation.
- THE EFFECTIVENESS OF MICROBUBBLE-MEDIATED SONOTHROMBOLYSIS FOR INDUCING EARLY RECANALIZATION OF DIFFERENT CULPRIT CORONARY ARTERIES IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION(2018) MATHIAS, Wilson; TAVARES, Bruno G.; AGUIAR, Miguel Osman; TSUTSUI, Jeane; CHIANG, Hsu; SOEIRO, Alexandre; OLIVEIRA, Mucio; NICOLAU, Jose; LEMOS, Pedro; LOPES, Bernardo; ROCHITTE, Carlos; VIANA, Erica; SBANO, Joao; KALIL-FILHO, Roberto; PORTER, Thomas
conferenceObject Microbubble-Mediated Sonothrombolysis for Treatment of Patients With Acute St-Segment Elevation Myocardial Infarction: Improvement in Recanalization Rate, Systolic Function and Microvascular Perfusion(2017) MATHIAS, Wilson; TSUTSUI, Jeane M.; AGUIAR, Miguel O.; TAVARES, Bruno; NICOLAU, Jose; VIANA, Erica P.; OLIVEIRA, Mucio T.; SOEIRO, Alexandre; LEMOS, Pedro; LOPES, Bernardo; SBANO, Joao; KALIL, Roberto; PORTER, Thomas- Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis(2013) LARIO, Fabio C.; MINAME, Marcio H.; TSUTSUI, Jeane M.; SANTOS, Raul D.; KOWATSCH, Ingrid; SBANO, Joao C. N.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackground: Hypercholesterolemia induces early microcirculatory functional and structural alterations that are reversible by cholesterol reduction. Real time myocardial contrast echocardiography (RTMCE) and vascular ultrasound evaluate the effects of hyperlipidemia on peripheral and central blood flow reserve. This study investigated the effects of lipid-lowering therapy on coronary and peripheral artery circulation in patients with familial hypercholesterolemia (FH). Methods: RTMCE and vascular ultrasound were performed in 10 healthy volunteers (validation group) at baseline and after 12-week clinical observation, and in 16 age-and sex-matched FH patients without obstructive coronary artery disease (CAD) by computed tomography angiography at baseline and after 12-week atorvastatin treatment. Indexes of relative myocardial blood flow (MBF) were obtained at rest and during adenosine infusion. Results: In validation group, there was no significant difference between flow-mediated dilation (FMD) at baseline and after 12 weeks (0.15 +/- 0.02 vs. 0.14 +/- 0.03; P = 0.39). Similarly, no differences were observed in MBF reserve at baseline and after 12 weeks (3.31 +/- 0.63 vs. 3.48 +/- 0.89; P = 0.89). FMD was blunted in FH patients, at baseline, as compared with validation group (0.08 +/- 0.04 vs. 0.15 +/- 0.02; P < 0.001) and became similar to that group (0.13 +/- 0.05 vs. 0.14 +/- 0.03; P = 0.07) after treatment. MBF reserve was blunted at baseline in FH patients in comparison with the validation group (2.78 +/- 0.71 vs. 3.31 +/- 0.63; P = 0.003). After treatment, MBF reserve values were no longer different (3.43 +/- 0.66 and 3.48 +/- 0.89; P = 0.84, respectively, for FH and validation groups). Conclusion: Patients with FH and no obstructive CAD have blunted MBF reserve and lower FMD values as compared with healthy volunteers. Both FMD and MBF reserve were normalized after atorvastatin treatment. (Echocardiography 2013;30:64-71)