HENRIQUE BARBOSA RIBEIRO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Left ventricular global longitudinal strain assessment in patients with takotsubo cardiomyopathy : a call for an echocardiography-based classification(2022) REDDIN, Gemma; FORRESTAL, Brian J.; GARCIA-GARCIA, Hector M.; MEDVEDOFSKY, Diego; SINGH, Manavotam; ASCH, Federico M.; RIBEIRO, Henrique B.; CAMPOS, Carlos M.BACKGROUND: Takotsubo cardiomyopathy (TTC) is classified into 4 types depending on the anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC. METHODS: We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient???s diagnosed classification and outcomes. RESULTS: Based on classification by traditional assessment the 92% (N.=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (N.=16) had abnormal strain (STE>-18) in all three LV regions (base, mid-ventricle and apex). Seventy-one percent of patients (N.=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, N.=8 Vs 30%, N.=4, respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three regions compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, P=0.02). CONCLUSIONS: A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance. (Cite this article as: Reddin G, Forrestal BJ, Garcia-Garcia HM, Medvedofsky D, Singh M, Asch FM, et al. Left ventricular global longitudinal strain assessment in patients with takotsubo cardiomyopathy: a call for an echocardiography-based classification. Minerva Cardiol Angiol 2022;70:321-8. DOI: 10.23736/S2724-5683.20.05386-4)
- Combined transcatheter aortic valve replacement and left atrial appendage occlusion in patients ineligible for oral anticoagulation: A case series(2022) FREIRE, A. F. D.; FILIPPINI, F. B.; BIGNOTO, T. C.; BRITO, P. H. F. de; NICZ, P. F. G.; MELO, P. H. M. C. D.; SILVA, R. C. e; QUEIROGA, M.; RIBEIRO, H. B.; PROCóPIO, A. G. M.; BEZERRA, C. G.; GRUBE, E.; ABIZAID, A.; FILHO, R. K.; BRITO JR., F. S. dePatients presenting with aortic stenosis and atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) are commonly at increased risk for stroke and bleeding complications. Concomitant left atrial appendage occlusion (LAAO) after TAVR may be an alternative to oral anticoagulation (OAC). Between 2018 and 2022, 7 consecutive patients who were ineligible for OAC underwent simultaneous TAVR and LAAO. The mean age was 84.9 ± 4.9 years. The mean CHA2DS2-VASc, HAS-BLED, and STS predicted risk of mortality scores were 5.9 ± 0.7, 3.9 ± 1.1, and 8.8 ± 3.4%, respectively. The median follow-up time was 23 (1 to 27) months. All procedures achieved technical success and no adverse events were observed during follow-up. This case series shows that concomitant TAVR and LAAO is feasible and safe among patients with severe aortic stenosis and AF who are deemed ineligible for OAC. Learning objectives: Atrial fibrillation is the most common arrhythmia in the transcatheter aortic valve replacement (TAVR) population. In those who experience major or life-threatening bleeding, mortality is doubled. We report a case series of 7 concomitant left atrial appendage occlusions (LAAO) after TAVR in patients ineligible for oral anticoagulation. All procedures achieved technical success and no adverse events were observed. The simultaneous approach with TAVR and LAAO was feasible and safe in this case series.
- Conduction Disturbances Associated with Transcatheter Aortic Valve Implantation: Challenge for another 20 Years?(2022) POZETTI, Antonio Helio; RIBEIRO, Henrique BarbosaTranscatheter aortic valve implantation (TAVI) is a well-established procedure for treating severe aortic stenosis in elderly patients, regardless of the surgical risk.(1) Since its introduction two decades ago, there have been major technological advances in devices, which, combined with new implantation techniques, have brought significant reductions in periprocedural complication rates, leading to their greater adoption worldwide. However, the incidence of conduction disorders showed a modest reduction, remaining the most frequent complication after TAVI,(2-4) which contributes to the increase in hospital stay, costs and the worsening of short and long-term clinical outcomes.(4.5) In addition, the approach to conduction disorders still varies greatly between centers, especially regarding the management of new left bundle branch block (LBBB), post-procedure advanced atrioventricular block (AVB) and previous right bundle branch block (RBBB), translated into variable rates of permanent pacemaker (PM) implantation.(3) Among patients who received PM after TAVI, there is also great variability regarding their dependence (ventricular pacing) at follow-up. In this journal edition, Pinto et al.(6) evaluated the incidence of conduction disorders, predictors and the rate of PM dependence in a population of 340 consecutive patients undergoing TAVI.(6) Conduction disorders occurred in more than 50% of post-procedure patients, with LBBB being the most frequent (32%), showing spontaneous resolution in 56% of them after 6 months. The overall PM implant rate was 18.5%, with prior RBBB being its main predictor. Among the patients who required PM, the main reasons were advanced AVB (60.3%), followed by LBBB with low-degree AVB (22%). Interestingly, there was a wide variation in the percentage of ventricular pacing among patients who received PM, being 83% in patients with advanced AVB (Advanced AVB and Mobitz Type II) and only 2% in those implanted with LBBB and low-degree AVB (first-degree AVB and Mobitz type I).(2-4.7) However, some aspects of this study deserve reflection.
- Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation(2022) COSTA, Giuliano; PILGRIM, Thomas; SANTOS, Ignacio J. Amat; BACKER, Ole De; KIM, Won-Keun; RIBEIRO, Henrique Barbosa; SAIA, Francesco; BUNC, Matjaz; TCHETCHE, Didier; GAROT, Philippe; RIBICHINI, Flavio Luciano; MYLOTTE, Darren; BURZOTTA, Francesco; WATANABE, Yusuke; MARCO, Federico De; TESORIO, Tullio; RHEUDE, Tobias; TOCCI, Marco; FRANZONE, Anna; VALVO, Roberto; SAVONTAUS, Mikko; WIENEMANN, Hendrik; PORTO, Italo; GANDOLFO, Caterina; IADANZA, Alessandro; BORTONE, Alessandro Santo; MACH, Markus; LATIB, Azeem; BIASCO, Luigi; TARAMASSO, Maurizio; ZIMARINO, Marco; TOMII, Daijiro; NUYENS, Philippe; SONDERGAARD, Lars; CAMARA, Sergio F.; PALMERINI, Tullio; ORZALKIEWICZ, Mateusz; STEBLOVNIK, Klemen; DEGRELLE, Bastien; GAUTIER, Alexandre; SOLE, Paolo Alberto Del; MAINARDI, Andrea; PIGHI, Michele; LUNARDI, Mattia; KAWASHIMA, Hideyuki; CRISCIONE, Enrico; CESARIO, Vincenzo; BIANCARI, Fausto; ZANIN, Federico; JONER, Michael; ESPOSITO, Giovanni; ADAM, Matti; GRUBE, Eberhard; BALDUS, Stephan; MARZO, Vincenzo De; PIREDDA, Elisa; CANNATA, Stefano; IACOVELLI, Fortunato; ANDREAS, Martin; FRITTITTA, Valentina; DIPIETRO, Elena; REDDAVID, Claudia; STRAZZIERI, Orazio; MOTTA, Silvia; ANGELLOTTI, Domenico; SGROI, Carmelo; KARGOLI, Faraj; TAMBURINO, Corrado; BARBANTI, MarcoBackground:The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. Methods:The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. Results:Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio, 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio, 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). Conclusions:The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
- Aortic Stiffness by Cardiac Magnetic Resonance: Prognostic tool or Bystander?(2022) CAMARA, Sergio Figueiredo; RIBEIRO, Henrique Barbosa
- Recent Developments and Current Status of Transcatheter Aortic Valve Replacement Practice in Latin America - the WRITTEN LATAM Study(2022) BERNARDI, Fernando Luiz de Melo; RIBEIRO, Henrique Barbosa; NOMBELA-FRANCO, Luis; CERRATO, Enrico; MALUENDA, Gabriel; NAZIF, Tamim; LEMOS, Pedro Alves; SZTEJFMAN, Matias; LAMELAS, Pablo; ECHEVERRI, Dario; LOPES, Marcelo Antonio Cartaxo Queiroga; BRITO, Fabio Sandoli de; ABIZAID, Alexandre A.; MANGIONE, Jose A.; ELTCHANINOFF, Helene; SONDERGAARD, Lars; RODES-CABAU, JosepBackground: Transcatheter aortic valve replacement (TAVR) is a worldwide adopted procedure with rapidly evolving practices. Regional and temporal variations are expected to be found. Objective: To compare TAVR practice in Latin America with that around the world and to assess its changes in Latin America from 2015 to 2020. Methods: A survey was applied to global TAVR centers between March and September 2015, and again to Latin-American centers between July 2019 and January 2020. The survey consisted of questions addressing: i) center's general information; ii) pre-TAVR evaluation; iii) procedural techniques; iv) post-TAVR management; v) follow-up. Answers from the 2015 survey of Latin-American centers (LATAM15) were compared with those of other centers around the world (WORLD15) and with the 2020 updated Latin-American survey (LATAM20). A 5% level of significance was adopted for statistical analysis. Results: 250 centers participated in the 2015 survey (LATAM15=29; WORLD15=221) and 46 in the LATAM20. Combined centers experience accounted for 73 707 procedures, with WORLD15 centers performing, on average, 6- and 3-times more procedures than LATAM15 and LATAM20 centers, respectively. LATAM centers performed less minimalistic TAVR than WORLD15 centers, but there was a significant increase in less invasive procedures after 5 years in Latin-American centers. For postprocedural care, a lower period of telemetry and maintenance of temporary pacing wire, along with less utilization of dual antiplatelet therapy was observed in LATAM20 centers. Conclusion: Despite still having a much lower volume of procedures, many aspects of TAVR practice in Latin-American centers have evolved in recent years, following the trend observed in developed country centers.
- 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.
- Infective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement(2022) VAL, David del; ABDEL-WAHAB, Mohamed; MANGNER, Norman; DURAND, Eric; IHLEMANN, Nikolaj; URENA, Marina; PELLEGRINI, Costanza; GIANNINI, Francesco; GASIOR, Tomasz; WOJAKOWSKI, Wojtek; LANDT, Martin; AUFFRET, Vincent; SINNING, Jan Malte; CHEEMA, Asim N.; NOMBELA-FRANCO, Luis; CHAMANDI, Chekrallah; CAMPELO-PARADA, Francisco; MUNOZ-GARCIA, Erika; HERRMANN, Howard C.; TESTA, Luca; WON-KEUN, K.; CASTILLO, Juan Carlos; ALPERI, Alberto; TCHETCHE, Didier; BARTORELLI, Antonio L.; KAPADIA, Samir; STORTECKY, Stefan; AMAT-SANTOS, Ignacio; WIJEYSUNDERA, Harindra C.; LISKO, John; GUTIERREZ-IBANES, Enrique; SERRA, Vicenc; SALIDO, Luisa; ALKHODAIR, Abdullah; VENDRAMIN, Igor; CHAKRAVARTY, Tarun; LERAKIS, Stamatios; VILALTA, Victoria; REGUEIRO, Ander; ROMAGUERA, Rafael; KAPPERT, Utz; BARBANTI, Marco; MASSON, Jean-Bernard; MAES, Frederic; FIORINA, Claudia; MICELI, Antonio; KODALI, Susheel; RIBEIRO, Henrique B.; MANGIONE, Jose Armando; JR, Fabio Sandoli de Brito; DATO, Guglielmo Mario Actis; ROSATO, Francesco; FERREIRA, Maria-Cristina; LIMA, Valter Corriea de; COLAFRANCESCHI, Alexandre Siciliano; ABIZAID, Alexandre; MARINO, Marcos Antonio; ESTEVES, Vinicius; ANDREA, Julio; GODINHO, Roger R.; ALFONSO, Fernando; ELTCHANINOFF, Helene; SONDERGAARD, Lars; HIMBERT, Dominique; HUSSER, Oliver; LATIB, Azeem; BRETON, Herve Le; SERVOZ, Clement; PASCUAL, Isaac; SIDDIQUI, Saif; OLIVARES, Paolo; HERNANDEZ-ANTOLIN, Rosana; WEBB, John G.; SPONGA, Sandro; MAKKAR, Raj; KINI, Annapoorna S.; BOUKHRIS, Marouane; GERVAIS, Philippe; LINKE, Axel; CRUSIUS, Lisa; HOLZHEY, David; RODES-CABAU, JosepBackground: Staphylococcus aureus (SA) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on SA IE after transcatheter aortic valve replacement (TAVR). Methods: Data were obtained from the Infectious Endocarditis After TAVR International Registry, including patients with definite IE after TAVR from 59 centres in 11 countries. Patients were divided into 2 groups according to microbiologic etiology: non-SA IE vs SA IE. Results: SA IE was identified in 141 patients out of 573 (24.6%), methicillin-sensitive SA in most cases (115/141, 81.6%). Self-expanding valves were more common than balloon-expandable valves in patients presenting with early SA IE. Major bleeding and sepsis complicating TAVR, neurologic symptoms or systemic embolism at admission, and IE with cardiac device involvement (other than the TAVR prosthesis) were associated with SA IE (P < 0.05 for all). Among patients with IE after TAVR, the likelihood of SA IE increased from 19% in the absence of those risk factors to 84.6% if > 3 risk factors were present. In-hospital (47.8% vs 26.9%; P < 0.001) and 2-year (71.5% vs 49.6%; P < 0.001) mortality rates were higher among patients with SA IE vs non-SA IE. Surgery at the time of index SA IE episode was associated with lower mortality at follow-up compared with medical therapy alone (adjusted hazard ratio 0.46, 95% CI 0.22-0.96; P = 0.038). Conclusions: SA IE represented approximately 25% of IE cases after TAVR and was associated with very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA IE and could help to orientate early antibiotic regimen selection. Surgery at index SA IE was associated with improved outcomes, and its role should be evaluated in future studies.
- MORBIDLY OBESE PATIENTS WITH SYMPTOMATIC SEVERE AORTIC STENOSIS, WHAT IS THE OPTIMAL TREATMENT STRATEGY? A PROPENSITY SCORE MATCHED ANALYSIS OF TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT(2022) MCINERNEY, A.; RODES-CABAU, J.; VEIGA, G.; LOPEZ-OTERO, D.; MUNOZ-GARCIA, E.; CAMPELO, F.; OTEO, J. F.; CARNERO, M.; SOTO, J. D. Tafur; AMAT-SANTOS, I.; TRAVIESO, A.; MOHAMMADI, S.; BARBANTI, M.; CHEEMA, A. N.; TOGGWEILER, S.; SAIA, F.; DABROWSKI, M.; SERRA, V.; ALFONSO, F.; BARBOSA, H.; REGUEIRO, A.; ALPERI, A.; ONGAY, A. G.; CEREIJO, J. M. Martinez; MUNOZ-GARCIA, A. J.; MATTA, A.; ARELLANO-SERRANO, C.; BARRERO, A.; TIRADO-CONTE, G.; GONZALO, N.; SANMARTIN, X. C.; HERNANDEZ, J. M. de la Torre; KALAVROUZIOTIS, D.; MAROTO, L.; FORTEZA-GIL, A.; COBIELLA, J.; ESCANED, J.; NOMBELA-FRANCO, L.
- Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis(2022) FUKUI, Miho; ANNABI, Mohamed-Salah; ROSA, Vitor E. E.; RIBEIRO, Henrique B.; I, Larissa Stanberry; CLAVEL, Marie-Annick; RODES-CABAU, Josep; TARASOUTCHI, Flavio; SCHELBERT, Erik B.; BERGLER-KLEIN, Jutta; BARTKO, Philipp E.; DONA, Carolina; MASCHERBAUER, Julia; DAHOU, Abdellaziz; ROCHITTE, Carlos E.; PIBAROT, Philippe; CAVALCANTE, Joao L.Aims This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS. Methods and results This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF >= 50%, and stroke volume index (SVi) < 35 ml/m(2)]; and normal-flow low-gradient (MG < 40 mmHg, LVEF >= 50%, and SVi >= 35 ml/m(2)). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment. Conclusions In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.