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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 25
  • bookPart
    Teste ergométrico
    (2019) FALCãO, Andrea Maria Gomes Marinho; CHALELA, William Azem; MOFFA, Paulo Jorge
  • article 1 Citação(ões) na Scopus
    Chagas' Disease: Update on Current Diagnosis
    (2016) FALCAO, Andrea Marinho; GIORGI, Maria Clementina; VIEIRA, Marcelo L. Campos; CHALELA, William A.; BORGES-NETO, Salvador
    Purpose of Review Chagas' disease has become an emerging health problem due to increased migration. In the present review, we have summarized the usefulness of non-invasive imaging tools for the diagnosis of cardiac involvement in Chagas' disease, with emphasis on modern technologies. M-mode, bidimensional (2-D), and three-dimensional (3-D) echocardiographies may allow the evaluation of left ventricular (LV) regional and global contractile function, right ventricle (RV) impairment, evidence of aneurysms and thrombi, and assessment of diastolic function in any stage of the disease. Recent Findings New modalities such as strain and speckle-tracking imaging have brought non-invasive indices to the understanding of the mechanisms of cardiac dyssynchrony. The assessment of cardiac autonomic denervation using I-123-metaiodobenzylguanidine (I-123-MIBG), LV, and RV systolic function and the study of LV mechanical dyssynchrony by gated cardiac blood pool are available in current nuclear imaging for patients with Chagas' disease. The findings of myocardial fibrosis by cardiac magnetic resonance (CMR), mainly in inferolateral regions, are a marker of subclinical involvement and worse prognosis in Chagas' disease, even in patients with preserved ventricular function. Summary The detection and quantification of early signs of heart involvement by new technologies should be useful for risk stratification and in the clinical decision process for new therapeutic methods and could improve the natural history of the disease.
  • article 3 Citação(ões) na Scopus
    New Prognostic Score for Stable Coronary Disease Evaluation
    (2011) STORTI, Fernanda Coutinho; MOFFA, Paulo Jorge; UCHIDA, Augusto H.; HUEB, Whady Armindo; CESAR, Luiz Antonio Machado; FERREIRA, Beatriz Moreira Ayub; CAMARGO JR., Paulo Augusto de; CHALELA, William Azem
    Background: The need to improve the exercise testing accuracy, pushed the development of scores, whose applicability was already broadly recognized. Objective: Prognostic evaluation of stable coronary disease through a new simplified score. Methods: A new score was applied in 372 multivessel coronary patients with preserved ventricular function, 71.8% male, age: 59.5 (+/- 9.07) years old, randomized to medical treatment, surgery (CABG) or angioplasty (PTCA), with 5 years of follow-up. Cardiovascular death was considered the primary endpoint. Non-fatal myocardial infarction, death and re-intervention were considered for a combined secondary endpoint. The score was based on an equation previously validated, resulting from a sum of one point for: male gender, infarction history, angina, diabetes, insulin use and one point for each decade of life after 40 years old. Positive exercise testing summed one additional point. Results: Thirty six deaths was observed (10 in group PTCA, 15 in CABG and 11 in the clinical group), p = 0.61. We observed 93 combined events: 37 in PTCA group, 23 in CABG and 33 in the clinical group (p = 0.058). 247 patients presented clinical score >= 5 points and 216 >= 6 points. The cutoff point >= 5 or >= 6 points identified higher risk, p = 0.015 and p = 0.012, respectively. The survival curve showed a different death incidence after the randomization when score reached 06 points or more (p = 0.07), and a distinct incidence of combined events between the patients with score < 6 and >= 6 points (p = 0.02). Conclusion: The new score was consistent for multiarterial stable coronary disease risk stratification. (Arq Bras Cardiol 2011;96(5):411-419)
  • article 2 Citação(ões) na Scopus
    Non Electrocardiographic alterations in exercise testing in asymptomatic women. Associations with cardiovascular risk factors
    (2019) COUTINHO, Ricardo Quental; MONTARROYOS, Ulisses Ramos; BARROS, Isly Maria Lucena de; GUIMARAES, Maria Jose Bezerra; COSTA, Laura Olinda Bregieiro Fernandes; MEDEIROS, Ana Kelley de Lima; MONTEIRO, Maria de Fatima; FERREIRA, Moacir de Novaes Lima; CHALELA, William Azem; PEDROSA, Rodrigo
    OBJECTIVES: To estimate the prevalence of exercise testing alterations in middle-aged women without symptoms of heart disease and to verify the associations of functional capacity and heart rate behavior during and after exercise with cardiovascular risk factors. METHODS: A cross-sectional study was conducted with 509 asymptomatic women aged between 46 and 65 years who underwent clinical evaluations and exercise testing (Bruce protocol). The heart rate behavior was evaluated by the maximal predicted heart rate achieved, chronotropic index and recovery heart rate. RESULTS: The mean age was 56.4 +/- 4.8 years, and 13.4% of the patients had a Framingham risk score above 10%. In the exercise treadmill testing, 58.0% presented one or more of the following alterations (listed in order of ascending prevalence): symptoms (angina, dyspnea, and dizziness), ST-segment depression, arrhythmia, reduction in recovery heart rate of <= 12 bpm at 1 minute, altered maximal predicted heart rate achieved, abnormal blood pressure, functional capacity deficiency, and altered chronotropic index. In the multivariate analysis, the following associations (odds ratio) were observed for these alterations: chronotropic index was associated with obesity (2.08) and smoking (4.47); maximal predicted heart rate achieved was associated with smoking (6.45); reduction in the recovery heart rate at 1 minute was associated with age (1.09) and obesity (2.78); functional capacity was associated with age (0.92), an overweight status (2.29) and obesity (6.51). CONCLUSIONS: More than half of middle-aged women without cardiovascular symptoms present alterations in one or more exercise testing parameters. Alterations in the functional capacity or heart rate behavior, as verified by exercise testing, are associated with age, smoking, an overweight status and obesity.
  • article 6 Citação(ões) na Scopus
    Myocardial blood flow assessment with (82)rubidium-PET imaging in patients with left bundle branch block
    (2015) FALCAO, Andrea; CHALELA, William; GIORGI, Maria Clementina; IMADA, Rodrigo; SOARES JR., Jose; VAL, Renata Do; OLIVEIRA, Marco Antonio; IZAKI, Marisa; KALIL FILHO, Roberto; MENEGHETTI, Jose C.
    OBJECTIVES: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. OBJECTIVE: We sought to investigate rubidium-82 (Rb-82) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. METHODS: Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (>= 70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress Rb-82-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal (82) Rb-positron emission tomography studies and without left bundle branch block (GII). RESULTS: Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p<0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). CONCLUSION: The data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by Rb-82-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with left bundle branch block.
  • article 0 Citação(ões) na Scopus
    Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women
    (2021) COUTINHO, Ricardo Quental; MONTARROYOS, Ulisses Ramos; BARROS, Isly Maria Lucena de; GUIMARÃES, Maria José Bezerra; LEÃO, Ana Paula Dornelas; COSTA, Laura Olinda Bregieiro Fernandes; MEDEIROS, Ana Kelley de Lima; MONTEIRO, Maria de Fátima; FERREIRA, Moacir de Novaes Lima; CHALELA, William Azem; PEDROSA, Rodrigo Pinto
    Abstract Background Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable. Objective To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers. Methods This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05). Results According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (<5%), intermediate (5-10%), and high (>10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity <85% (22.2%), coronary calcium score >0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score. Conclusion Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.
  • bookPart
    O Papel Atual do Teste Ergométrico Associado a Métodos de Imagem na Avaliação do Risco
    (2018) CHALELA, William Azem; FALCãO, Andréa Marinho; MENEGHETTI, José Cláudio; TSUTSUI, Jeane
  • bookPart
    Cintilografia miocárdica
    (2018) LINHARES, Pedro Vieira; LINHARES FILHO, Jaime Paula Pessoa; FONSECA, Wallyson Pereira; GIORGI, Maria Clementina Pinto; CHALELA, William Azem
  • article 12 Citação(ões) na Scopus
    Update of the Brazilian Guideline on Nuclear Cardiology-2020
    (2020) MASTROCOLA, Luiz Eduardo; AMORIM, Barbara Juarez; VITOLA, Joao Vicente; BRANDAO, Simone Cristina Soares; GROSSMAN, Gabriel Blacher; LIMA, Ronaldo de Souza Leao; LOPES, Rafael Willain; CHALELA, William Azem; CARREIRA, Lara Cristiane Terra Ferreira; ARAUJO, Jose Roberto Nolasco de; MESQUITA, Claudio Tinoco; MENEGHETTI, Jose Claudio
  • conferenceObject
    Coronary flow reserve by PET 13N-ammonia in patients with hereditary transthyretin amyloidosis with and without cardiac involvement
    (2022) ALENCAR NETO, A. C.; CAFEZEIRO, C. R. F.; BUENO, B. V. K.; SOUZA, F. Ribeiro De; RISSATO, J. H. S. Henrique; BORGES, T. Souza; CARVALHAL, S. Freitas; LIMA, M. Santos; BUCHPIGUEL, C. Alberto; CHALELA, W. Azem; RAMIRES, F. J. Alvarez; SZOR, R. Shcolnik; KALIL FILHO, R.; ROCHITTE, C. E.; FERNANDES, F.