THAMARA CARVALHO MORAIS

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LIM/65, Hospital das Clínicas, Faculdade de Medicina

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  • article 9 Citação(ões) na Scopus
    Diagnostic Performance of a Machine Learning-Based CT-Derived FFR in Detecting Flow-Limiting Stenosis
    (2021) MORAIS, Thamara Carvalho; ASSUNCAO-JR, Antonildes Nascimento; DANTAS JUNIOR, Roberto Nery; SILVA, Carla Franco Grego da; PAULA, Caroline Bastida de; TORRES, Roberto Almeida; MAGALHAES, Tiago Augusto; NOMURA, Cesar Higa; AVILA, Luiz Francisco Rodrigues de; PARGA FILHO, Jose Rodrigues
    Background: The non-invasive quantification of the fractional flow reserve (FFRCT) using a more recent version of an artificial intelligence-based software and latest generation CT scanner (384 slices) may show high performance to detect coronary ischemia. Objectives: To evaluate the diagnostic performance of FFRCT for the detection of significant coronary artery disease (CAD) in contrast to invasive FFR (iFFR) using previous generation CT scanners (128 and 256-detector rows). Methods: Retrospective study with patients referred to coronary artery CT angiography (CTA) and catheterization (iFFR) procedures. Siemens Somatom Definition Flash (256-detector rows) and AS+ (128-detector rows) CT scanners were used to acquire the images. The FFRCT and the minimal lumen area (MLA) were evaluated using a dedicated software (cFFR version 3.0.0, Siemens Healthineers, Forchheim, Germany). Obstructive CAD was defined as CTA lumen reduction >= 50%, and flow-limiting stenosis as iFFR <= 0.8. All reported P values are two-tailed, and when <0.05, they were considered statistically significant. Results: Ninety-three consecutive patients (152 vessels) were included. There was good agreement between FFRCT and iFFR, with minimal FFRCT overestimation (bias: -0.02; limits of agreement:0.14-0.09). Different CT scanners did not modify the association between FFRCT and FFRi (p for interaction=0.73). The performance of FFRCT was significantly superior compared to the visual classification of coronary stenosis (AUC 0.93vs.0.61, p<0.001) and to MLA (AUC 0.93vs.0.75, p<0.001), reducing the number of false-positive cases. The optimal cut-off point for FFRCT using a Youden index was 0.85 (87% Sensitivity, 86% Specificity, 73% PPV, 94% NPV), with a reduction of false-positives. Conclusion: Machine learning-based FFRCT using previous generation CT scanners (128 and 256-detector rows) shows good diagnostic performance for the detection of CAD, and can be used to reduce the number of invasive procedures.
  • conferenceObject
    Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis
    (2019) ROSA, V. Emer Egypto; RIBEIRO, H. B.; SAMAPIO, R. O.; MORAIS, T. C.; ROSA, M. E. E.; SANTIS, A. S. A. L. De; FERNANDES, J. R. C.; SPINA, G. S.; VIEIRA, M. L. C.; POMERANTZEFF, P. M. A.; ROCHITTE, C. E.; MATHIAS JR., W.; TARASOUTCHI, F.
  • article 0 Citação(ões) na Scopus
    Detection of Early Diffuse Myocardial Fibrosis and Inflammation in Chagas Cardiomyopathy with T1 Mapping and Extracellular Volume
    (2023) MELO, Rodrigo J. L.; ASSUNCAO, Antonildes N.; MORAIS, Thamara C.; NOMURA, Cesar H.; SCANAVACCA, Mauricio I.; MARTINELLI-FILHO, Martino; RAMIRES, Felix J. A.; FERNANDES, Fabio; IANNI, Barbara M.; MADY, Charles; ROCHITTE, Carlos E.
    Purpose: To evaluate myocardial T1 mapping and extracellular volume (ECV) parameters in different stages of Chagas cardiomyopathy and determine whether they are predictive of disease severity and prognosis.Materials and Methods: Prospectively enrolled participants (July 2013 to September 2016) underwent cine and late gadolinium enhancement (LGE) cardiac MRI and T1 mapping with a precontrast (native) or postcontrast modified Look-Locker sequence. The native T1 and ECV values were measured among subgroups that were based on disease severity (indeterminate, Chagas cardiomyopathy with preserved ejection fraction [CCpEF], Chagas cardiomyopathy with midrange ejection fraction [CCmrEF], and Chagas cardiomyopathy with reduced ejection fraction [CCrEF]). Cox proportional hazards regression and the Akaike information criterion were used to determine predictors of major cardiovascular events (cardioverter defibrillator implant, heart transplant, or death).Results: In 107 participants (90 participants with Chagas disease [mean age & PLUSMN; SD, 55 years & PLUSMN; 11; 49 men] and 17 age-and sex matched control participants), the left ventricular (LV) ejection fraction and the extent of focal and diffuse or interstitial fibrosis were correlated with disease severity. Participants with CCmrEF and participants with CCrEF showed significantly higher global native T1 and ECV values than participants in the indeterminate, CCpEF, and control groups (T1: 1072 msec & PLUSMN; 34 and 1073 msec & PLUSMN; 63 vs 1010 msec & PLUSMN; 41, 1005 msec & PLUSMN; 69, and 999 msec & PLUSMN; 46; ECV: 35.5% & PLUSMN; 3.6 and 35.0% & PLUSMN; 5.4 vs 25.3% & PLUSMN; 3.5, 28.2% & PLUSMN; 4.9, and 25.2% & PLUSMN; 2.2; both P < .001). Remote (LGE-negative areas) native T1 and ECV values were also higher (T1: 1056 msec & PLUSMN; 32 and 1071 msec & PLUSMN; 55 vs 1008 msec & PLUSMN; 41, 989 msec & PLUSMN; 96, and 999 msec & PLUSMN; 46; ECV: 30.2% & PLUSMN; 4.7 and 30.8% & PLUSMN; 7.4 vs 25.1% & PLUSMN; 3.5, 25.1% & PLUSMN; 3.7, and 25.0% & PLUSMN; 2.2; both P < .001). Abnormal remote ECV values (>30%) occurred in 12% of participants in the indeterminate group, which increased with disease severity. Nineteen combined outcomes were observed (median follow-up time: 43 months), and a remote native T1 value greater than 1100 msec was independently predictive of combined outcomes (hazard ratio, 12 [95% CI: 4.1, 34.2]; P < .001).Conclusion: Myocardial native T1 and ECV values were correlated with Chagas disease severity and may serve as markers of myocardial involvement in Chagas cardiomyopathy that precede LGE and LV dysfunction.
  • conferenceObject
    Post-Operative Prognostic Prediction of Different Myocardial Fibrosis Measures in Severe Aortic Valvular Heart Disease
    (2020) PIRES, Lucas J.; ROSA, Vitor E.; MORAIS, Thamara C.; SANTIS, Antonio S. de; FERNANDES, Joao Ricardo C.; BOER, Berta P.; ROSSI, Eduardo; LAVITOLA, Paulo D.; ROCHITTE, Carlos E.; NOMURA, Cesar H.; POMERANTZEFF, Pablo M.; TARASOUTCHI, Flavio
  • conferenceObject
    Impact of interstitial myocardial fibrosis measured by T1-mapping cardiac magnetic resonance on post-operative cardiac remodeling in patients with classical low-flow, low-gradient aortic stenosis
    (2018) ROSA, V. Emer Egypto; RIBEIRO, H. B.; SAMPAIO, R. O.; MORAIS, T. C.; ROSA, M. E. E.; SANTIS, A. S. A. L. De; FERNANDES, J. R. C.; VIEIRA, M. L. C.; POMERANTZEFF, P. M. A.; ROCHITTE, C. E.; MATHIAS JR., W.; TARASOUTCHI, F.
  • article 26 Citação(ões) na Scopus
    Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis Insights From a Cardiovascular Magnetic Resonance Study
    (2019) ROSA, Vitor E. E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E. E.; PIRES, Lucas J. T.; VIEIRA, Marcelo L. C.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; SANTIS, Antonio S. A. L. de; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A. D.; POMERANTZEFF, Pablo M. A.; RODES-CABAU, Josep; PIBAROT, Philippe; TARASOUTCHI, Flavio
    Background: Few data exist on the degree of interstitial myocardial fibrosis in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS) and its association with left ventricular flow reserve (FR) on dobutamine stress echocardiography. This study sought to evaluate the diffuse interstitial fibrosis measured by T1 mapping cardiac magnetic resonance technique in LFLG-AS patients with and without FR. Methods: Prospective study including 65 consecutive patients (41 LFLG-AS [mean age, 67.1 +/- 8.4 years; 83% men] and 24 high-gradient aortic stenosis used as controls) undergoing dobutamine stress echocardiography to assess FR and cardiac magnetic resonance to determine the extracellular volume (ECV) fraction of the myocardium, indexed ECV (iECV) to body surface area and late gadolinium enhancement. Results: Interstitial myocardial fibrosis measured by iECV was higher in patients with LFLG-AS with and without FR as compared with high-gradient aortic stenosis (35.25 +/- 9.75 versus 32.93 +/- 11.00 versus 21.19 +/- 6.47 mL/m(2), respectively; P<0.001). However, both ECV and iECV levels were similar between LFLG-AS patients with and without FR (P=0.950 and P=0.701, respectively). Also, FR did not correlate significantly with ECV (r=-0.16, P=0.31) or iECV (r=0.11, P=0.51). Late gadolinium enhancement mass was also similar in patients with versus without FR but lower in high-gradient aortic stenosis (13.3 +/- 10.2 versus 10.5 +/- 7.5 versus 4.8 +/- 5.9 g, respectively; P=0.018). Conclusions: Patients with LFLG-AS have higher ECV, iECV, and late gadolinium enhancement mass compared with high-gradient aortic stenosis. Moreover, among patients with LFLG-AS, the degree of myocardial fibrosis was similar in patients with versus those without FR. These findings suggest that diffuse myocardial fibrosis may not be the main factor responsible for the absence of FR in LFLG-AS patients.
  • conferenceObject
    Low-flow Low-gradient Aortic Stenosis With Low Ejection Fraction: Does Myocardial Fibrosis Predict Recovery of Postoperative Ventricular Function?
    (2016) ROSA, Vitor E.; SAMPAIO, Roney O.; SANTIS, Antonio S. de; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A.; ROSA, Marcela E.; VIEIRA, Marcelo L.; MORAIS, Thamara C.; BELLO, Juliana H.; MATHIAS, Wilson; ROCHITTE, Carlos E.; POMERANTZEFF, Pablo M.; TARASOUTCHI, Flavio
  • conferenceObject
    Short- and Long-term Outcomes After Surgical Aortic Valve Replacement in Patients With Classical Low-flow, Low-gradient Aortic Stenosis
    (2019) ROSA, Vitor E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E.; SANTIS, Antonio S. De; FERNANDES, Joao Ricardo C.; SPINA, Guilherme S.; VIEIRA, Marcelo L.; POMERANTZEFF, Pablo M.; ROCHITTE, Carlos E.; MATHIAS JR., Wilson; TARASOUTCHI, Flavio
  • conferenceObject
    EuroSCORE II, BNP, C-Reactive Protein, Creatinine and Delayed Myocardial Enhancement Imaging are Predictors of 1-Year Mortality in Patients with Low-Flow and Low-Gradient True Severe Aortic Stenosis with Low Ejection Fraction
    (2016) ROSA, Vitor E.; SAMPAIO, Roney O.; PAIXAO, Milena R.; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A.; SANTIS, Antonio S. de; SPINA, Guilherme S.; VIEIRA, Marcelo L.; MORAIS, Thamara C.; BELLO, Juliana H.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; BRANDAO, Carlos Manuel A.; TARASOUTCHI, Flavio
  • article 1 Citação(ões) na Scopus
    Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification
    (2023) LOPES, Maria Antonieta Albanez A. de M.; CAMPOS, Carlos M.; ROSA, Vitor Emer Egypto; SAMPAIO, Roney O.; MORAIS, Thamara C.; BRITO JUNIOR, Fabio Sandoli de; VIEIRA, Marcelo L. C.; JR, Wilson Mathias; FERNANDES, Joao Ricardo Cordeiro; SANTIS, Antonio de; SANTOS, Luciano de Moura; ROCHITTE, Carlos E.; CAPODANNO, Davide; TAMBURINO, Corrado; ABIZAID, Alexandre; TARASOUTCHI, Flavio
    ObjectivesThe aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS).BackgroundElevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS.MethodsProspective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (n = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 (n = 14) when BNP or hsTnI were higher than median; and Group 3 (n = 18) when both hsTnI and BNP were higher than median.Results49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (P = 0.03) and lower left ventricular ejection fraction (P = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31-47] vs. 32 [29-41] vs. 26 [19-33]%; p < 0.01) and right ventricular EF (62 [53-69] vs. 51 [35-63] vs. 30 [24-46]%; p < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8-30.7] vs. 28.2 [26.9-34.5] vs. 31.8 [28.9-35.5]%; p = 0.03) and indexed ECV (iECV) (28.7 [21.2-39.1] vs. 28.8 [25.4-39.9] vs. 44.2 [36.4-51.2] ml/m(2), respectively; p < 0.01) from Group 1 to Group 3.ConclusionsHigher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.