WILSON MATHIAS JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
28 resultados
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- Cardiovascular Sonothrombolysis(2019) PORTER, Thomas R.; MATHIAS JR., WilsonPurpose of ReviewThis review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes.Recent FindingsThe initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have confirmed that in patients with acute STEMI receiving an intravenous microbubble infusion, diagnostic high mechanical index impulses applied in the apical windows pre- and post-percutaneous coronary intervention have reduced myocardial infarction size, as assessed by magnetic resonance imaging at 72h following presentation, and have been associated with better left ventricular systolic function at 6month follow-up.SummarySonothrombolysis has potential for improving early epicardial coronary artery patency and reduce left ventricular remodeling when added to current interventional strategies in STEMI.
conferenceObject Quality of life and physical capacity after long-term right ventricular pacing in young adults with congenital atrioventricular block(2012) SILVA, K. R.; COSTA, R.; OLIVEIRA JR., R. M.; MARTINELLI FILHO, M.; LACERDA, M. S.; HUANG, A.; ROSSI, M. B.; MATHIAS JR., W.; PIETROBON, R.; STOLF, N. A. G.Background: Although several studies have demonstrated the deleterious consequences of chronic right ventricular (RV) pacing on ventricular function and synchronicity, its effects on health-related quality of life (HRQL) and physical capacity remains uncertain. Objectives: To evaluate the effect of RV pacing on HRQL and physical capacity of children and young adults with congenital complete atrioventricular (AV) block. Methods: Fifty consecutive patients with permanent RV cardiac pacing due to congenital AV block and under clinical follow-up for more than one year were enrolled. Multidimensional HRQL was assessed with the Short Form-36 Health Survey (SF-36) and Child Health Questionnaire (CHQ-PF50). Physical capacity was tested by the 6-minute walk distance test (6MWD). The scores for each domain and the distance performed at the 6MWD test were compared with demographic and clinical characteristics of patients, using the Student’s t-test and Qui-squaretest. Results: Domains presenting lower scores were Vitality (63.0±20.6), Pain(66.5±25.1) and Mental Health (67.3±20.4) in the SF-36 questionnaire; General Health Perceptions (64.0±15.0) and Parental Impact-Emotional (69.0±30.0) in the CHQ-PF50. Female gender (P=0.026), DDD pacing mode (0.008) and normal left ventricular ejection fraction (0.002) were associated with higher quality of life scores. The average distance performed at the 6MWD test was 677,2 meters (454,5 to 852,8). The 6MWD showed significant association with age (P=0.004), normal ventricular function (P= 0.031) and the absence of cardiovascular drugs use (P= 0.018). Conclusions: The results of this analysis indicated that chronic RV pacing did not affect the HRQL and physical capacity of young patients. Female gender, DDD pacing, normal ventricular function and the absence of cardiovascular medications were associated with better HRQL scores and with better results at 6MWD test.- Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction(2021) MARIA, Giovanni Luigi De; GARCIA-GARCIA, Hector M.; SCARSINI, Roberto; FINN, Aloke; SATO, Yu; VIRMANI, Renu; BHINDI, Ravinay; CIOFANI, Jonathan L.; NUCHE, Jorge; RIBEIRO, Henrique B.; MATHIAS JR., Wilson; YERASI, Charan; FISCHELL, Tim A.; OTTERSPOOR, Luuk; RIBICHINI, Flavio; IBANEZ, Borja; PIJLS, Nico H. J.; SCHWARTZ, Robert S.; KAPUR, Navin K.; STONE, Gregg W.; BANNING, Adrian P.Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia-reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.
- Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update(2018) PORTER, Thomas R.; MULVAGH, Sharon L.; ABDELMONEIM, Sahar S.; BECHER, Harald; BELCIK, J. Todd; BIERIG, Michelle; CHOY, Jonathan; GAIBAZZI, Nicola; GILLAM, Linda D.; JANARDHANAN, Rajesh; KUTTY, Shelby; LEONG-POI, Howard; LINDNER, Jonathan R.; MAIN, Michael L.; MATHIAS JR., Wilson; PARK, Margaret M.; SENIOR, Roxy; VILLANUEVA, FlordelizaThis document is endorsed by the following American Society of Echocardiography International Alliance Partners: the Argentinian Federation of Cardiology, the British Society of Echocardiography, the Canadian Society of Echocardiography, the Chinese Society of Echocardiography, the Echocardiography Section of the Cuban Society of Cardiology, the Indian Academy of Echocardiography, the Indian Association of Cardiovascular Thoracic Anaesthesiologists, the Iranian Society of Echocardiography, the Japanese Society of Echocardiography, the Korean Society of Echocardiography, the Saudi Arabian Society of Echocardiography, and the Vietnamese Society of Echocardiography.
- Myocardial function reclassification: Echocardiographic strain patterns in patients with chronic Chagas cardiomyopathy and intraventricular dyssynchrony(2022) ATHAYDE, Guilherme A. T.; BORGES, Bruno C. C.; PINHEIRO, Andreia O.; SOUZA, Aline L.; OLIVEIRA, Camila P.; MARTINS, Sergio A. M.; TEIXEIRA, Ricardo A.; SIQUEIRA, Sergio F.; PORTER, Thomas Richard; MATHIAS JR., Wilson; MARTINELLI FILHO, MartinoBackground: We aimed to identify, among Chronic Chagas Cardiomyopathy (CCC) patients with left ventricular dysfunction (LVD) and non-left bundle branch block (non-LBBB), subgroups with different functional and mechanical patterns of global longitudinal strain (GLS) and intraventricular dyssynchrony (IVD) at rest and after exercise stress test, and reclassify them using a new echocardiographic approach. Methodology: In this single-center cross-sectional study, 40 patients with CCC, left ventricular ejection fraction (LVEF) <= 35% and non-LBBB underwent rest echocardiography and then treadmill exercise stress echocardiography with GLS and IVD analysis. The sample was divided into four groups, based on GLS and IVD significant variation between rest and exercise: GLS + IVD+ (9 patients); GLS + IVD- (9 patients); GLS-IVD+ (10 patients); GLS-IVD- (10 patients). Results: At rest, median LVEF was 28% (21.3%-33%) and GLS (-7% (-5%/-9.3%), were not different among groups. The average response of GLS was an increase of 0.74% over rest values, and the average response of IVD was a decrease of 6.9 ms. Group GLS-IVD+ presented more dyssynchrony at rest (p = 0.01). Left atrial (LA) volume (higher in GLS-IVD-) (p = 0.022) and TAPSE (higher in GLS + IVD+) (p = 0.015) were also different among groups at baseline. Of the 40 patients evaluated, 27 (67.5%) had very severe LVD (GLS < -8%). In addition, among these patients, 11 patients had contractile reserve after undergoing stress echocardiography. Conclusions: In patients with CCC, severe LVD and non-LBBB, the evaluation of GLS and IVD between rest and exercise was able to reclassify myocardial function and to identify subgroups with contractile reserve and significant dyssynchronopathy.
conferenceObject Myocardial strain as a noninvasive measure of circulatory dysfunction and systolic function in liver cirrhosis.(2015) PIMENTEL, Carolina F.; FERRAZ, Maria Lucia; AGUIAR, Miguel Osman D.; GONZALEZ, Adriano M.; BRANCO, Gabriel D.; SUPERBIA, Marcel; FELDNER, Ana Cristina A.; LAI, Michelle; MATHIAS, Wilson; KONDO, MarioconferenceObject Exercise Training Restores Muscle Mechano and Metaboreflex Sensitivity in Heart Failure Patients(2013) ANTUNES-CORREA, Ligia M.; NOBRE, Thais S.; GROEHS, Raphaela V.; ALVES, Maria Janieire N. N.; RONDON, Maria Urbana P. B.; MADY, Charles; ALMEIDA, Dirceu R.; OLIVEIRA, Patricia; LIMA, Marta F.; MATHIAS, Wilson; BRUM, Patricia C.; ROSSONI, Luciana V.; OLIVEIRA, Edilamar M.; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos EduardoIncreased sympathetic muscle mechanoreflex sensitivity and attenuated sympathetic muscle metaboreflex sensitivity have been described in heart failure (HF) patients. We tested the hypothesis that exercise training (ET) would improve sympathetic mechano and metaboreflex sensitivity in HF patients. 24 consecutive, randomized, HF patients, Functional Class II-III NYHA, EF≤40% were divided into two groups: Exercise-trained (n=12, 55±2 years) and untrained (n=12, 54±2 years). 10 normal controls (NC) were also studied. Muscle sympathetic nerve activity (MSNA) was directly recorded from the peroneal nerve. Mechanoreceptors were activated by passive exercise. Metaboreceptors were activated by post-exercise circulatory arrest. ET consisted of three 60-minutes exercise sessions per week for 4 months. ET significantly reduced MSNA in HF patients (34 vs. 40 bursts/min, P<0.05). ET significantly reduced MSNA responses to passive exercise ({Delta} = 2 vs. 5 bursts/min, P<0.05) and increased MNSA responses during post-exercise circulatory arrest ({Delta} = 5 vs. –1 bursts/min, P<0.0 5). These changes were so dramatic that the difference between HF patients and NC were no longer observed. No changes in untrained HF patients were found. In conclusion, ET restores sympathetic muscle mechano and metaboreflex sensitivity in HF patients, which may contribute to the reduction in MSNA and clinical outcomes in these patients.- Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function(2017) MATTOSO, Angele A. A.; TSUTSUI, Jeane M.; KOWATSCH, Ingrid; CRUZ, Vitoria Y. L.; SBANO, Joao C. N.; RIBEIRO, Henrique B.; KALIL FILHO, Roberto; PORTER, Thomas R.; MATHIAS JR., WilsonObjective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (beta) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal beta reserve in >= 2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal beta reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WM and MP (chi(2) = 6.6 and chi(2) = 24.6, respectively; p = 0.001 and chi(2) = 6.6 and chi(2) = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, beta reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis of WM and MP, and coronary angiography in predicting acute coronary events.
- Myocardial Deformation by Speckle Tracking in Severe Dilated Cardiomyopathy(2012) ABDUCH, Maria Cristina Donadio; SALGO, Ivan; TSANG, Wendy; VIEIRA, Marcelo Luiz Campos; CRUZ, Victoria; LIMA, Marta; TSUTSUI, Jeane Mike; MOR-AVI, Victor; LANG, Roberto M.; MATHIAS JR., WilsonBackground: The high and increasing prevalence of Dilated Cardiomyopathy (DCM) represents a serious public health issue. Novel technologies have been used aiming to improve diagnosis and the therapeutic approach. In this context, speckle tracking echocardiography (STE) uses natural myocardial markers to analyze the systolic deformation of the left ventricle (LV). Objective: Measure the longitudinal transmural global strain (GS) of the LV through STE in patients with severe DCM, comparing the results with normal individuals and with echocardiographic parameters established for the analysis of LV systolic function, in order to validate the method in this population. Methods: Seventy-one patients with severe DCM (53 +/- 12 years, 72% men) and 20 controls (30 +/- 8 years, 45% men) were studied. The following variables were studied: LV volumes and ejection fraction calculated by two and three-dimensional echocardiography, Doppler parameters, Tissue Doppler Imaging systolic and diastolic LV velocities and GS obtained by STE. Results: Compared with controls, LV volumes were higher in the DCM group; however, LVEF and peak E-wave velocity were lower in the latter. The myocardial performance index was higher in the patient group. Tissue Doppler myocardial velocities (S', e', a') were significantly lower and E/e' ratio was higher in the DCM group. GS was decreased in the DCM group (-5.5% +/- 2.3%) when compared with controls (-14.0% +/- 1.8%). Conclusion: In this study, GS was significantly lower in patients with severe DCM, bringing new perspectives for therapeutic approaches in this specific population. (Arq Bras Cardiol 2012;99(3):834-842)
conferenceObject Autonomic cardiac dysfunctions are common in cirrhotic patients and may be associated with an increased mortality.(2015) PIMENTEL, Carolina F.; SALVADORI, Ricardo; FELDNER, Ana Cristina A.; GONZALEZ, Adriano M.; AGUIAR, Miguel Osman D.; BRANCO, Gabriel D.; SUPERBIA, Marcel; LAI, Michelle; FERRAZ, Maria Lucia; MATHIAS, Wilson; KONDO, Mario
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