CESAR HIGA NOMURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Brazilian Cardio-oncology Guideline-2020(2020) HAJJAR, Ludhmila Abrahao; COSTA, Isabela Bispo Santos da Silva da; LOPES, Marcelo Antonio Cartaxo Queiroga; HOFF, Paulo Marcelo Gehm; DIZ, Maria Del Pilar Estevez; FONSECA, Silvia Moulin Ribeiro; BITTAR, Cristina Salvadori; REHDER, Marilia Harumi Higuchi dos Santos; RIZK, Stephanie Itala; ALMEIDA, Dirceu Rodrigues; FERNANDES, Gustavo S. Santos; BECK-DA-SILVA, Luis; CAMPOS, Carlos Augusto Homem de Magalhaes; MONTERA, Marcelo Westerlund; ALVES, Silvia Marinho Martins; FUKUSHIMA, Julia Tizue; SANTOS, Maria Veronica Camara dos; NEGRAO, Carlos Eduardo; SILVA, Thiago Liguori Feliciano da; FERREIRA, Silvia Moreira Ayub; MALACHIAS, Marcus Vinicius Bolivar; MOREIRA, Maria da Consolacao Vieira; VALENTE NETO, Manuel Maria Ramos; FONSECA, Veronica Cristina Quiroga; SOEIRO, Maria da Carolina Feres de Almeida; ALVES, Juliana Barbosa Sobral; SILVA, Carolina Maria Pinto Domingues Carvalho; SBANO, Joao; PAVANELLO, Ricardo; PINTO, Ibraim Masciarelli F.; SIMAO, Antonio Felipe; DRACOULAKIS, Marianna Deway Andrade; HOFF, Ana Oliveira; ASSUNCAO, Bruna Morhy Borges Leal; NOVIS, Yana; TESTA, Laura; ALENCAR FILHO, Aristoteles Comte de; CRUZ, Cecilia Beatriz Bittencourt Viana; PEREIRA, Juliana; GARCIA, Diego Ribeiro; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; MACEDO, Ariane Vieira Scarlatelli; MARCATTI, Patricia Tavares Felipe; MATHIAS JUNIOR, Wilson; WIERMANN, Evanius Garcia; VAL, Renata do; FREITAS, Helano; COUTINHO, Anelisa; MATHIAS, Clarissa Maria de Cerqueira; VIEIRA, Fernando Meton de Alencar Camara; SASSE, Andre Deeke; ROCHA, Vanderson; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto
conferenceObject The Release of Cardiac Necrosis Biomarkers in Patients Without Myocardial Infarction After On-Pump Surgical Revascularization. A Study of Cardiac Magnetic Resonance Imaging(2016) OIKAWA, Fernando T.; HUEB, Whady; COSTA, Leandro M.; MELO, Rodrigo M. Vieira de; REZENDE, Paulo C.; GARZILLO, Cibele L.; LIMA, Eduardo G.; NOMURA, Cesar H.; VILLA, Alexandre V.; HUEB, Alexandre C.; RAMIRES, Jose A.; KALIL FILHO, Roberto- Long-term prognostic value of late gadolinium enhancement and periprocedural myocardial infarction after uncomplicated revascularization: MASS-V follow-up(2022) LINHARES-FILHO, Jaime; HUEB, Whady; LIMA, Eduardo; REZENDE, Paulo; AZEVEDO, Diogo; ROCHITTE, Carlos; NOMURA, Cesar; SERRANO-JUNIOR, Carlos; RAMIRES, Jose; KALIL-FILHO, RobertoAims Cardiac biomarkers elevation is common after revascularization, even in absence of periprocedural myocardial infarction (PMI) detection by imaging methods. Thus, late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We sought to evaluate long-term prognostic value of PMI and new LGE after revascularization. Methods and results Two hundred and two patients with multivessel coronary disease and preserved ventricular function who underwent elective revascularization were included, of whom 136 (67.3%) underwent coronary artery bypass grafting and 66 (32.7%) percutaneous coronary intervention. The median follow-up was 5 years (4.8-5.8 years). Cardiac biomarkers measurement and LGE-CMR were performed before and after procedures. The Society for Cardiovascular Angiography and Interventions definition was used to assess PMI. Primary endpoint was composed of death, infarction, additional revascularization, or cardiac hospitalization. Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%) had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9 (25.2%) in patients with it (P = 0.045). LGE was also associated to increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects without and with it (P = 0.02). LGE was the only independent predictor of primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass was estimated at 4.6 g. Patients with new LGE had a greater biomarkers release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P < 0.001 in both comparisons). Conclusions New LGE was shown to be better prognostic predictor than biomarker-only PMI definition after uncomplicated revascularization. Furthermore, new LGE was the only independent predictor of cardiovascular events and mortality.
conferenceObject ASSOCIATION BETWEEN ABNORMAL BIOMARKER RELEASE AND MYOCARDIAL EDEMA ASSESSED BY MAGNETIC RESONANCE IMAGING AFTER UNCOMPLICATED REVASCULARIZATION PROCEDURES(2020) RIBAS, Fernando Faglioni; HUEB, Whady; REZENDE, Paulo; ROCHITTE, Carlos; NOMURA, Cesar; MORAIS, Thamara; LIMA, Eduardo Gomes; BOROS, Gustavo; CARVALHO, Felipe Pereira Camara; RIBEIRO, Matheus; LINHARES FILHO, Jaime; DALLAZEN, Anderson Roberto; SILVA, Rafael; MOCHA, Mauricio; SERRANO, Carlos; RAMIRES, Jose; KALIL-FILHO, Roberto- Accuracy of Myocardial Biomarkers in the Diagnosis of Myocardial Infarction After Revascularization as Assessed by Cardiac Resonance: The Medicine, Angioplasty, Surgery Study V (MASS-V) Trial(2016) HUEB, Whady; GERSH, Bernard J.; COSTA, Leandro Menezes Alves da; OIKAWA, Fernando Teiichi Costa; MELO, Rodrigo Morel Vieira de; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; NOMURA, Cesar Higa; VILLA, Alexandre Volney; HUEB, Alexandre Ciappina; STRUNZ, Celia Maria Cassaro; FAVARATO, Desiderio; TAKIUTI, Myrthes Emy; ALBUQUERQUE, Cicero Piva de; SILVA, Expedito Eustaquio Ribeiro da; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground. The lack of a correlation between myocardial necrosis biomarkers and electrocardiographic abnormalities after revascularization procedures has resulted in a change in the myocardial infarction (MI) definition. Methods. Patients with stable multivessel disease who underwent percutaneous or surgical revascularization were included. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance and late gadolinium enhancement were performed before and after procedures. MI was defined as more than five times the 99th percentile upper reference limit for cTnI and 10 times for CK-MB in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), respectively, and new late gadolinium enhancement for cardiac magnetic resonance. Results. Of the 202 patients studied, 69 (34.1%) underwent on-pump CABG, 67 (33.2%) off-pump CABG, and 66 (32.7%) PCI. The receiver operating characteristic curve showed the accuracy of cTnI for on-pump CABG, off-pump CABG, and PCI patients was 21.7%, 28.3%, and 52.4% and for CK-MB was 72.5%, 81.2%, and 90.5%, respectively. The specificity of cTnI was 3.6%, 9.4%, and 42.1% and of CK-MB was 73.2%, 86.8%, and 96.4%, respectively. Sensitivity of cTnI was 100%, 100%, and 100% and of CK-MB was 69.2%, 64.3%, and 44.4%, respectively. The best cutoff of cTnI for on-pump CABG, off-pump CABG, and PCI was 6.5 ng/mL, 4.5 ng/mL, and 4.5 ng/mL (162.5, 112.5, and 112.5 times the 99th percentile upper reference limit) and of CK-MB was 37.5 ng/mL, 22.5 ng/mL, and 11.5 ng/mL (8.5, 5.1, and 2.6 times the 99th percentile upper reference limit), respectively. Conclusions. Compared with cardiac magnetic resonance, CK-MB was more accurate than cTnI for diagnosing MI. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI. (C) 2016 by The Society of Thoracic Surgeons
conferenceObject BIOMARKERS AND CMR WITH LATE GADOLINIUM ENHANCEMENT FOR DIAGNOSIS OF PROCEDURE-RELATED MYOCARDIAL NECROSIS: A PROSPECTIVE TRIAL USING THE THIRD UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION(2013) HUEB, Whady; NOMURA, Cesar; VILLA, Alexandre V.; PARGA, Jose; COSTA, Leandro; MELO, Rodrigo M. V.; OIKAWA, Fernando T. C.; STRUNZ, Celia; REZENDE, Paulo; LIMA, Eduardo; GARZILLO, Cibele L.; RIBEIRO, Expedito E.; HUEB, Alexandre; SERRANO, Carlos; RAMIRES, Jose; KALIL-FILHO, RobertoBackground: The elevation of cardiac biomarkers after percutaneous or surgical myocardial revascularization procedures is common. However, the correlation between the release and the diagnosis of procedure-related myocardial infarction (Ml) remains unknown. In this study we aim to compare the release of cardiac biomarkers after mechanical interventions with the presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). Methods: In this prospective study, we evaluated 64 stable multivessel coronary artery disease patients with preserved ventricular function and formal indication to revascularization. The release of troponin and CKMB for diagnosis of procedure-related Ml was defined as the third universal definition of Ml. CMR with LGE was performed in all patients before and after interventions. Measurements of cardiac biomarkers were performed before and after the procedure, every 6 hours until 48h after PCI and 72h after CABG. Results: Of 64 patients, 44 (68.8%) underwent CABG and 20 (31.2%) underwent PCI; 46 (72%) were male, 45 (70%) had 3-vessel disease, 33 (52%) had diabetes and 23 (36%) had class Ill/IV of angina. For CABG patients, injury occurred in 95.5% (troponin) and 25% (CKMB); for PCI patients injury occurred in 70% (troponin) and 5% (CKMB). From the initial 64 patients, 14 (21.9%) had new LGE on post-procedure CMR, 13 after CABG and 1 after PCI. From these 14 patients, 7 (50%) presented elevation of CKMB above the cutoffs and troponin was elevated in all patients. From the 50 patients with no new LGE on CMR, 5 (10%) presented CKMB elevation and 42 (84%) presented troponin elevation above the 99th percentile. Based on current cutoffs, troponin had a sensitivity of 100% and specificity of 16% (positive predictive value of 25% and negative predictive value of 100%). CKMB had a sensitivity of 50% and specificity of 90% (positive predictive value of 58% and negative predictive value of 87%). Conclusion: In this study, cardiac biomarkers had a low accuracy for the diagnosis of procedure-related myocardial infarction based on LGE CMR.- Myocardial microstructure assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting(2023) DALLAZEN, Anderson Roberto; REZENDE, Paulo Cury; HUEB, Whady; HLATKY, Mark Andrew; NOMURA, Cesar Higa; ROCHITTE, Carlos Eduardo; BOROS, Gustavo Andre Boeing; RIBAS, Fernando Faglioni; RIBEIRO, Matheus de Oliveira Laterza; SCUDELER, Thiago Luis; DANTAS, Roberto Nery; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: The correlation between the release of cardiac biomarkers after revascularization, in the absence of late gadolinium enhancement (LGE) or myocardial edema, and the development of myocardial tissue damage remains unclear. This study sought to identify whether the release of biomarkers is associated with cardiac damage by assessing myocardial microstructure on T1 mapping after on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB). Methods: Seventy-six patients with stable multivessel coronary artery disease (CAD) and preserved systolic ventricular function were included. T1 mapping, high-sensitive cardiac troponin I (cTnI), creatine kinase myocardial band (CK-MB) mass, and ventricular dimensions and function were measured before and after procedures. Results: Of the 76 patients, 44 underwent OPCAB, and 32 ONCAB; 52 were men (68.4%), and the mean age was 63 +/- 8.5 years. In both OPCAB and ONCAB the native T1 values were similar before and after surgeries. An increase in extracellular volume (ECV) values after the procedures was observed, due to the decrease in hematocrit levels during the second cardiac resonance. However, the lambda partition coefficient showed no significant difference after the surgeries. The median peak release of cTnI and CK-MB were higher after ONCAB than after OPCAB [3.55 (2.12-4.9) vs. 2.19 (0.69-3.4) ng/mL, P=0.009 and 28.7 (18.2-55.4) vs. 14.3 (9.3-29.2) ng/mL, P=0.009, respectively]. Left ventricular ejection fraction (LVEF) was similar in both groups before and after surgery. Conclusions: In the absence of documented myocardial infarction, T1 mapping did not identify structural tissue damage after surgical revascularization with or without cardiopulmonary bypass (CPB), despite the excessive release of cardiac biomarkers.
conferenceObject T1 MAPPING FOR MYOCARDIAL TISSUE EVALUATION IN PATIENTS WITH ISCHEMIA AND STABLE CORONARY ARTERY DISEASE: MASS V-TRIAL STUDY GROUP(2020) RIBEIRO, Matheus; HUEB, Whady; REZENDE, Paulo; ROCHITTE, Carlos; NOMURA, Cesar; MORAIS, Thamara; LIMA, Eduardo Gomes; BOROS, Gustavo; RIBAS, Fernando Faglioni; CARVALHO, Felipe Pereira Camara; CARVALHO, Guilherme; SERRANO, Carlos; RAMIRES, Jose; KALIL-FILHO, Roberto- Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease(2023) SEGRE, Carlos Alexandre W.; LEMOS, James A. de; ASSUNCAO, Antonildes Nascimento; NOMURA, Cesar Higa; FAVARATO, Desiderio; STRUNZ, Celia Maria Cassaro; VILLA, Alexandre Volney; PARGA FILHO, Jose Rodrigues; REZENDE, Paulo Cury; HUEB, Whady; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; SERRANO, Carlos VicenteBackground:Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. Methods:We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. Results:A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means +/- standard deviations) increased across tertiles: nativeT1 (1006 +/- 27 ms vs 1016 +/- 27 ms vs 1034 +/- 37 ms, ptrend = 0.006) and ECV (22 +/- 3% vs 23 +/- 1.9% vs 25 +/- 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. Conclusion:In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
conferenceObject Abnormal Release of Cardiac Biomarkers in the Presence of Myocardial Edema Evaluated by Cardiac Magnetic Resonance After Uncomplicated Revascularization Procedures(2018) RIBAS, Fernando F.; REZENDE, Paulo C.; BOROS, Gustavo A.; DALLAZEN, Anderson R.; LINHARES FILHO, Jaime P.; NOMURA, Cesar H.; ROCHITTE, Carlos E.; VILLA, Alexandre V.; LIMA, Eduardo G.; CARVALHO, Guilherme F.; HUEB, Whady; RAMIRES, Jose A.; KALIL FILHO, Roberto