JOAO CESAR NUNES SBANO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Assunto: coronary-artery-disease ×

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Agora exibindo 1 - 6 de 6
  • article 17 Citação(ões) na Scopus
    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
  • article 22 Citação(ões) na Scopus
    Evaluation of cardiac masses by real-time perfusion imaging echocardiography
    (2015) UENISHI, Eliza K.; CALDAS, Marcia A.; TSUTSUI, Jeane M.; ABDUCH, Maria C. D.; SBANO, Joao C. N.; KALIL FILHO, Roberto; MATHIAS JR., Wilson
    Background: Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization. Methods: We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (beta), and microvascular blood flow (A x beta) were determined by quantitative RTPE. Results: Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1-7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x beta values were 0.0 dB/s(-1) (0.01-0.14), 2.00 dB/s(-1) (1-6), and 1.18 dB/s(-1) (0.52-3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Ax beta = 2.46 dB/s(-1) (1.42-4.59) versus Ax beta = 1.55 dB/s [1] (0.51-4.08); p=NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT. Conclusion: RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
  • article 5 Citação(ões) na Scopus
    Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with refractory angina: A study with speckle tracking echocardiography
    (2018) DUQUE, Anderson S.; CECCON, Conrado L.; JR, Wilson Mathias; MAJESKY, Joana Diniz; GOWDAK, Luis H.; SBANO, Joao C. N.; CESAR, Luis Antonio Machado; ABDUCH, Maria Cristina; LIMA, Marcio S. M.; DOURADO, Paulo M. M.; V, Cecilia B. B. Cruz; TSUTSUI, Jeane M.
    BackgroundCardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA. MethodWe prospectively studied 19 patients who underwent CSWT. Left ventricular mechanics were evaluated by speckle tracking echocardiography (STE), and myocardial perfusion by single-photon emission computed tomography, using stress/rest-Technetium-99m Sestamibi, for determination of summed stress score (SSS). Canadian Cardiac Society (CCS), New York Heart Association (NYHA), and quality of life by Seattle Angina Questionnaire (SAQ) were assessed at baseline and 6months after therapy. ResultsCSWT therapy was applied without major side effects. At baseline, 18 patients (94.7%) had CCS class III or IV, and after CSWT there was reduction to 3 (15.8%), P=.0001, associated with improvement in SAQ (38.5%; P<.001). Thirteen (68.4%) had class NYHA III or IV before treatment, with significant reduction to 7 (36.8%); P=.014. No change was observed in the global SSS from baseline to 6-month follow-up (15.338.60 vs 16.60 +/- 8.06; P=.157). However, there was a significant reduction in the average SSS of the treated ischemic segments (2.1 +/- 0.87 pre vs 1.6 +/- 1.19 post CSWT; P=.024). Global longitudinal strain by STE remained unaltered (-13.03 +/- 8.96 pre vs -15.88 +/- 3.43 6-month post CSWT; P=.256). ConclusionCSWT is a safe procedure for the treatment of patients with RA that results in better quality of life, improvement in myocardial perfusion of the treated segments with preservation of left ventricular mechanics.
  • article 14 Citação(ões) na Scopus
    Qualitative and Quantitative Real Time Myocardial Contrast Echocardiography for Detecting Hibernating Myocardium
    (2011) FERNANDES, Daniela Ribeiro Aleixo; TSUTSUI, Jeane Mike; BOCCHI, Edimar Alcides; CESAR, Luiz Antonio Machado; SBANO, Joao Cesar Nunes; RAMIRES, Jose Antonio Franchini; MATHIAS JR., Wilson
    Background: Real time myocardial contrast echocardiography (RTMCE) is an emerging imaging modality for assessing myocardial perfusion that allows for noninvasive quantification of regional myocardial blood flow (MBF). Aim: We sought to assess the value of qualitative analysis of myocardial perfusion and quantitative assessment of myocardial blood flow (MBF) by RTMCE for predicting regional function recovery in patients with ischemic heart disease who underwent coronary artery bypass grafting (CABG). Methods: Twenty-four patients with coronary disease and left ventricular systolic dysfunction (ejection fraction < 45%) underwent RTMCE before and 3 months after CABG. RTMCE was performed using continuous intravenous infusion of commercially available contrast agent with low mechanical index power modulation imaging. Viability was defined by qualitative assessment of myocardial perfusion as homogenous opacification at rest in >= 2 segments of anterior or >= 1 segment of posterior territory. Viability by quantitative assessment of MBF was determined by receiver-operating characteristics curve analysis. Results: Regional function recovery was observed in 74% of territories considered viable by qualitative analysis of myocardial perfusion and 40% of nonviable (P = 0.03). Sensitivity, specificity, positive and negative predictive values of qualitative RTMCE for detecting regional function recovery were 74%, 60%, 77%, and 56%, respectively. Cutoff value of MBF for predicting regional function recovery was 1.76 (AUC = 0.77; 95% CI = 0.62-0.92). MBF obtained by RTMCE had sensitivity of 91%, specificity of 50%, positive predictive value of 75%, and negative predictive value of 78%. Conclusion: Qualitative and quantitative RTMCE provide good accuracy for predicting regional function recovery after CABG. Determination of MBF increases the sensitivity for detecting hibernating myocardium. (Echocardiography 2011;28:342-349).
  • article 3 Citação(ões) na Scopus
    Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography
    (2011) MATHIAS JR., Wilson; KOWATSCH, Ingrid; SAROUTE, Ally Nader; OSORIO, Altamiro Filho Ferraz; SBANO, Joao Cesar Nunes; DOURADO, Paulo Magno Martins; RAMIRES, Jose Antonio Franchini; TSUTSUI, Jeane Mike
    Background: Although dobutamine-atropine stress echocardiography (DASE) has been widely used for evaluating patients with coronary artery disease (CAD), dynamic changes that occur at microcirculatory level during each stage of stress have not been demonstrated in humans. Aim: We sought to determine variations in myocardial blood flow (MBF) during DASE using quantitative real time myocardial contrast echocardiography (RTMCE). Methods: We studied 45 patients who underwent coronary angiography and RTMCE. Replenishment velocity of microbubbles in the myocardium (beta) and MBF reserves were obtained at baseline, intermediate stage (70% of maximal predicted heart rate), peak stress, and recovery phase. Results: beta and MBF reserves were lower in patients with than without CAD at intermediate (1.65 vs. 2.10; P = 0.001 and 2.44 vs. 3.23; P = 0.004) and peak (1.63 vs. 3.00; P < 0.001 and 2.14 vs. 3.98; P < 0.001, respectively). In patients without CAD, beta, and MBF reserves increased from intermediate to peak and decreased at recovery, while in those without CAD reserves did not change significantly. Optimal cutoff values of beta reserve at intermediate, peak, and recovery were 1.78, 2.09, and 1.70, with areas under the curves of 0.80 (95%CI = 0.67-0.94), 0.89 (95%CI = 0.79-0.99), and 0.69 (95%CI = 0.53-0.85). Sensitivity, specificity and accuracy for detecting CAD at intermediate stage were 68% (95%CI = 48-89), 85% (95%CI = 71-98), and 78% (95%CI = 66-90), at peak stress were 79% (95%CI = 61-97), 96% (95%CI = 89-100), and 89% (95%CI = 80-98), and at recovery were 74% (95%CI = 54-93), 65% (95%CI = 47-84), and 69% (95%CI = 55-82), respectively. Conclusion: RTMCE allows for quantification of dynamic changes in microcirculatory blood flow at each stage of DASE. The best parameter for detecting CAD in all stages was beta reserve. (Echocardiography 2011;28:993-1001)
  • article 7 Citação(ões) na Scopus
    Shock-Wave Therapy Improves Myocardial Blood Flow Reserve in Patients with Refractory Angina: Evaluation by Real-Time Myocardial Perfusion Echocardiography
    (2019) CECCON, Conrado L.; DUQUE, Anderson S.; GOWDAK, Luis H.; MATHIAS JR., Wilson; CHIANG, Hsu Po; SBANO, Joao C. N.; LIMA, Marta F.; CESAR, Luis Antonio Machado; CRUZ, Cecilia B. B. V.; DOURADO, Paulo M. M.; MENEGHETTI, Claudio; TSUTSUI, Jeane M.
    Background: Cardiac shock-wave therapy (CSWT) has been demonstrated as an option for the treatment of patients with refractory angina (RA), promoting immediate vasodilatory effects and, in the long-term, neoangiogenic effects that would be responsible for reducing the myocardial ischemic load. The aim of this study was to determine the effects of CSWT on myocardial blood flow reserve (MBFR) assessed by quantitative real-time myocardial perfusion echocardiography in patients with RA. Methods: Fifteen patients (mean age 61.5 +/- 12.8 years) with RA who underwent CSWT during nine sessions, over 3 months of treatment, were prospectively studied. A total of 32 myocardial segments with ischennia were treated, while another 31 did not receive therapy because of technical limitations. Myocardial perfusion was evaluated at rest and after dipyridamole stress (0.84 mg/kg) before and 6 months after CSWT, using quantitative real-time myocardial perfusion echocardiography. Clinical effects were evaluated using Canadian Cardiovascular Society grading of angina and the Seattle Angina Questionnaire. Results: The ischemic segments treated with CSWT had increased MBFR (from 1.33 +/- 0.22 to 1.74 +/- 0.29, P < .001), a benefit that was not observed in untreated ischemic segments (1.51 +/- 0.29 vs 1.54 +/- 0.28, P = .47). Patients demonstrated increased global MBFR (from 1.78 +/- 0.54 to 1.89 +/- 0.49, P = .017). Senn iquantitative single-photon emission computed tomographic analysis of the treated ischemic segments revealed a score reduction from 2.10 +/- 0.87 to 1.68 +/- 1.19 (P = .024). There was improvement in Canadian Cardiovascular Society score (from 3.20 +/- 0.56 to 1.93 +/- 0.70, P < .05) and in Seattle Angina Questionnaire score (from 42.3 +/- 12.99 to 71.2 +/- 14.29, P < .05). No major cardiovascular events were recorded during follow-up. Conclusions: CSWT improved MBFR in ischemic segments, as demonstrated by quantitative real-time myocardial perfusion echocardiography. These results suggest that CSWT has the potential to increase myocardial blood flow, with an impact on symptoms and quality of life in patients with RA.