MIRELLA ESMANHOTTO FACIN SAMESIMA
Projetos de Pesquisa
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
8 resultados
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- Brazilian Society of Cardiology Guidelines on the Analysis and Issuance of Electrocardiographic Reports-2022(2022) SAMESIMA, Nelson; GOD, Epotamenides Good; KRUSE, Jose Claudio Lupi; LEAL, Marcelo Garcia; PINHO, Claudio; FRANCA, Francisco Faustino de A. C.; PIMENTA, Joao; CARDOSO, Acacio Fernandes; PAIXAO, Adail; FONSECA, Alfredo; PEREZ-RIERA, Andres R.; RIBEIRO, Antonio Luiz Pinho; MADALOSO, Bruna Affonso; LUNA FILHO, Braulio; OLIVEIRA, Carlos Alberto Rodrigues de; GRUPI, Cesar Jose; MOREIRA, Dalmo Antonio Ribeiro; KAISER, Elisabeth; PAIXAO, Gabriela Miana de Mattos; FEITOSA FILHO, Gilson; PEREIRA FILHO, Horacio Gomes; GRINDLER, Jose; AZIZ, Jose Luiz; MOLINA, Marcos Sleiman; FACIN, Mirella; TOBIAS, Nancy M. M. de Oliveira; OLIVEIRA, Patricia Alves de; SANCHES, Paulo Cesar R.; TEIXEIRA, Ricardo Alkmin; ATANES, Severiano Melo; PASTORE, Carlos Alberto
- Applicability of the Electro-Vectorcardiogram in Current Clinical Practice(2019) PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio Gomes; TOBIAS, Nancy Maria Martins de Oliveira; MADALOSO, Bruna Affonso; FACIN, Mirella EsmanhottoThe electrocardiogram (ECG) has been reinvigorated by the identification of electrical alterations that were not definitely clarified before. In this context, and mainly regarding the definition of arrhythmogenic substrates, the association of the ECG with the vectorcardiogram (VCG) has gathered much more information about the cardiac electrical phenomena, thus allowing us to differentiate potentially fatal cases from benign ones. Obtaining a VCG concomitantly with the performance of an ECG has led to a significant gain in the definition of extremely sophisticated pathologies, which function suffer some type of structural or dynamic alterations, involving either the reduction or enhancement of ionic channels and currents. The classic aspects of the ECG/VCG association in the differential diagnosis of myocardial infarctions, conduction disorders, atrial and ventricular hypertrophies, and the correlations between these electrical disorders are still valid and assertive. The association of these pathologies is further clarified when they are seen through the ECG/VCG dyad. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the ECG linear form. The modern analysis of the ECG and its respective VCG, simultaneously obtained by the recent technique called electro-vectorcardiogram (ECG/VCG), brought a significant gain for the differential diagnosis of some pathologies. Therefore, we illustrate how this type of analysis can elucidate some of the most important diagnoses found in our daily clinical practice as cardiologists.
- Ventricular repolarization abnormalities: the electrocardiographic track of cardiac tumoural involvement in an infant with tuberous sclerosis complex. A case report(2020) FACIN, Mirella; PASTORE, Carlos Alberto; SAMESIMA, Nelson; PEREIRA FILHO, Horacio GomesBackground Primary cardiac tumours are rare in children. Against this backdrop, Doppler echocardiogram is the main diagnostic procedure, while electrocardiogram (ECG) usually plays a secondary role, by detecting tumoural consequences as cardiac arrhythmias and chambers overload. We describe a case where an electrocardiographic sign was the cornerstone to diagnosis and surveillance of an infant with a cardiac rhabdomyoma. Case summary A female infant was referred for cardiac evaluation to elucidate an electrocardiographic abnormality, detected during investigation of seizures. She had recently been diagnosed with epilepsy and was under three different anticonvulsants for appropriate control. Cardiovascular symptoms were absent. Skin inspection revealed hypochromic macules. Respiratory and cardiovascular examinations were normal, as well as laboratorial tests and chest radiography. Electrocardiogram (ECG) showed dome-shaped ST-segment elevation in V2 and V3. Transthoracic echocardiogram unveiled a single hyper-echogenic node (0.4 cm(2)) in the interventricular septum. Cardiac chambers had normal size and function and Doppler analysis was also normal. No specific medication was used to treat the tumour. During follow-up, she remained free of cardiac symptoms. Eighteen months after her first visit to the cardiologist, routine clinical assessment, ECG, and transthoracic Doppler echocardiogram normal results stated the spontaneous and complete involution of the tumoural lesion. Discussion Convex ST-segment elevation, generally related to myocardial injury, is unusual in paediatric patients. Once it occurs in asymptomatic individuals within this age bracket, exclusion of cardiac tumours is mandatory. However, data regarding the accuracy of such electrocardiographic marker in this clinical setting are still to be defined.
- 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.
conferenceObject THE ASSOCIATION OF ELECTRICAL LEFT AXIS DEVIATION WITH CARDIAC STRUCTURAL ABNORMALITIES IN PATIENTS WITH ADVANCED AGE: AN OBSERVATIONAL STUDY.(2023) TAVARES, Caio A. M.; SAMESIMA, Nelson; GUIMARAES, Patricia; PADRAO, Eduardo; FACIN, Mirella Esmanhotto; NETO, Felippe Lazar; FERREIRA, Elisa; HAJJAR, Ludhmila; PASTORE, Carlos Alberto- Modified moving average methodology applied to the treadmill stress testing analysis of microvolt T-wave alternans(2022) PEREIRA FILHO, Horacio Gomes; SAMESIMA, Nelson; MADALOSO, Bruna Affonso; TOBIAS, Nancy Maria Martins de Oliveira; FACIN, Mirella; PASTORE, Carlos AlbertoSudden cardiac death is impactful. There has been an increase in the search for tools capable of identifying individuals who are most susceptible, such as the microvolt T-wave alternans. This study aims to analyze the applicability of the modified moving average methodology to obtain the microvolt T-wave alternans using treadmill specific protocols. Medical records of patients during the period August 2006-December 2014 were retrospectively analyzed. Five hundred and thirty nine exams were then included, divided into groups according to the protocol and updating factor used: Ellestad factor 8 or 32, Naughton factor 8 or 32. The topics for analysis were the alternans behavior, noise and confirmation according to the groups of leads analyzed (frontal, transversal and orthogonal planes). The greater microvolt T-wave alternans was found during the stress phase in most of the tests. Group Naughton 8 presented lower noise in this phase for the transverse and orthogonal planes (p=0.0082 and p<0.0001), with greater confirmation of frontal and orthogonal planes in comparison with group Ellestad 8 (p=0.0002 and 0.0008). The results indicate the viability of simultaneous performance of the stress test and measurement of the T wave alternans with Naughton protocol with 1/8 updating factor.
- 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.
- Electrovectorcardiographic study of left ventricular aneurysm in ischemic heart disease(2023) VARONI, Leonardo Paschoal Camacho; SAMESIMA, Nelson; FACIN, Mirella; PEREIRA FILHO, Horacio Gomes; MADALOSO, Bruna Affonso; MATHIAS JUNIOR, Wilson; PASTORE, Carlos AlbertoThe aim was to characterize the electrovectorcardiographic pattern of ventricular aneurysms in ischemic cardiopathy by analyzing the cardiac ventricular repolarization. The medical records of 2,670 individuals were analyzed in this cross-sectional study. A test phase included 33 patients who underwent transthoracic echocardiogram with ultrasonic enhancing agent, electrocardiogram, and vectorcardiogram (aneurysm group - n = 22, and akinesia group - n = 11). In the validation phase, cardiac magnetic resonance imaging established the left ventricle segmental contractility in 16 patients who underwent electrocardiographic and vectorcardiographic tests (aneurysm group, n = 8, and akinesia group, n = 8). The variables studied were the presence of the T-wave plus-minus pattern and the T-wave loop anterior-posterior pattern in V2-V4. The diagnostic indices used were sensitivity, specificity, and predictive values, with their respective 95% confidence intervals. During the test and validation phases, the analysis of the presence of the T-wave plus-minus pattern identified the aneurysm group with a sensitivity of 91% vs. 87% and specificity of 91% vs. 87% (p < 0.0001 vs. p = 0.01), respectively. Meanwhile, the T-wave loop anterior-posterior pattern evidenced sensitivity of 95% vs. 77% and specificity of 91% vs. 87% (p < 0.0001 vs. p = 0.04), respectively. The electrovectorcardiographic parameters showed high accuracy for recognizing left ventricular aneurysms in ischemic heart disease.