CAIO DE ASSIS MOURA TAVARES
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Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/65, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject The Peguero-Lo Presti criteria has the highest diagnostic accuracy for the diagnosis of left ventricular hypertrophy in the elderly(2020) TAVARES, C. A. M.; SAMESIMA, N.; HAJJAR, L. A.; GODOY, L. C.; HIRANO, E. M. P.; FACIN, M.; JACOB FILHO, W.; FARKOUH, M. E.; PASTORE, C. A.- Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus(2020) GODOY, Lucas C.; TAVARES, Caio A. M.; FARKOUH, Michael E.Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2- or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the post-revascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure. (C) 2019 Canadian Diabetes Association.
- Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study(2021) TAVARES, Caio Assis Moura; SAMESIMA, Nelson; NETO, Felippe Lazar; HAJJAR, Ludhmila Abrahao; GODOY, Lucas C.; PADRAO, Eduardo Messias Hirano; FACIN, Mirella; FILHO, Wilson Jacob; FARKOUH, Michael E.; PASTORE, Carlos AlbertoBackground Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3-83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10-60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed.
- Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults(2021) TAVARES, Caio de Assis Moura; SAMESIMA, Nelson; HAJJAR, Ludhmila Abrahao; GODOY, Lucas C.; PADRAO, Eduardo Messias Hirano; LAZAR NETO, Felippe; FACIN, Mirella; JACOB-FILHO, Wilson; FARKOUH, Michael E.; PASTORE, Carlos AlbertoRecently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)-compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4-58.3%] vs 28.2% [95% CI 22.6-34.4%], p<0.0001; vs 35.3% [95% CI 29.2-41.7%], p<0.0001; vs 44.4% [95% CI 38.0-50.9%], p=0.042), highest F1 score (58.3%) and net benefit for most of the 20-60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.