RAFAEL ALMEIDA FONSECA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/64, Hospital das Clínicas, Faculdade de Medicina

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  • article 3 Citação(ões) na Scopus
    Decreased Native T1 Values and Impaired Myocardial Contractility in Anabolic Steroid Users
    (2022) SOUZA, Francis Ribeiro de; SANTOS, Marcelo Rodrigues dos; ROCHITTE, Carlos Eduardo; SANTOS, Rafael Parenquine dos; JORDAO, Camila Paixao; LEITE, Ivanhoe Stuart; FONSECA, Guilherme Wesley Peixoto da; FONSECA, Rafael Almeida; OLIVEIRA, Tiago Franco de; YONAMINE, Mauricio; PEREIRA, Rosa Maria Rodrigues; NEGRAO, Carlos Eduardo; ALVES, de Nazare Nunes Maria Janieire
    Anabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29 +/- 5yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888 +/- 162 vs. 1020 +/- 179ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30 +/- 8 vs. 38 +/- 6%, p<0.01), LV circumferential strain (-17 +/- 3 vs. -20 +/- 2%, p<0.01), and LV global longitudinal strain (-17 +/- 3 vs. -20 +/- 3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (-15 +/- g3 vs. -18 +/- 2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28 +/- 10 vs. 28 +/- 7 vs. 30 +/- 7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85 +/- 14 vs. 64 +/- 8 vs. 58 +/- 5g/m(2), respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users.
  • article 0 Citação(ões) na Scopus
    The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis
    (2023) SOEIRO, Alexandre M.; BOSSA, Aline S.; CESAR, Maria C.; LEAL, Tatiana C. A. T.; GARCIA, Guilherme; FONSECA, Rafael A.; NAKAMURA, Debora; GUIMARAES, Patricia O.; SOEIRO, Maria C. F. A.; JR, Carlos V. Serrano; SOARES, Paulo R.; MUELLER, Christian; MEBAZAA, Alexandre; FERNANDES, Fabio; NOMURA, Cesar H.; ROCHITTE, Carlos E.; JR, Mucio T. de Oliveira
    IntroductionThe role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methodsThis was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. ResultsThe mean follow-up was 18.7 & PLUSMN; 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. ConclusionMeasurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
  • article 1 Citação(ões) na Scopus
    Myocardial Injury in Patients With Acute and Subacute Chagas Disease in the Brazilian Amazon Using Cardiovascular Magnetic Resonance
    (2022) COUCEIRO, Katia do Nascimento; ORTIZ, Jessica Vanina; SILVA, Monica Regina Hosannah da Silva e; SOUSA, Debora Raysa Teixeira de; JR, Rubens Celso Andrade; BRANDAO, Alba Regina Jorge; MORAIS, Romulo Freire de; DORIA, Susan Smith; FONSECA, Rafael Almeida; SILVA, Paula Rita Leite da; FERNANDES, Fabio; GUERRA, Maria das Gracas Vale Barbosa; ROCHITTE, Carlos Eduardo; FERREIRA, Joao Marcos Bemfica Barbosa; GUERRA, Jorge Augusto de Oliveira
    Background Chagas disease is a neglected tropical disease that is still considered a global health emergency. In the Amazon region, most of the reports are of acute cases that are associated with oral transmission. This study aimed to evaluate myocardial injury in patients with acute Chagas disease before and after treatment. Methods and Results We evaluated 23 patients with acute Chagas disease in 3 different stages of progression. Group 1 had 12 patients evaluated during the acute phase, at the time of diagnosis, and 1 year after treatment, and Group 2 had 11 patients in the late postacute phase who were evaluated 5.2 years on average after diagnosis and treatment. ECGs with the Selvester score, 24-hour Holter exam, and cardiovascular magnetic resonance imaging were performed. The mean age of the 23 patients was 44.3 +/- 18.9 years, and they were mostly men (15/65.24%) from Amazonas state (22/95.6%). In 69.6% (n=16) of the patients, some ECG alterations were found, the most frequent being left anterior fascicular block and ventricular repolarization. In Group 1, the 24-hour Holter exam showed atrial tachycardia in 3 (25%) patients and ventricular extrasystoles in 2 (16.7%) patients. In Group 2, 1 patient had ventricular extrasystoles. Myocardial injury was observed in 7 patients (58.3%) at the acute phase and in 5 (50%) patients at the 1-year follow-up in Group 1 and in 2 (18.2%) patients in Group 2. Conclusions This article describes, for the first time, myocardial injury shown by cardiovascular magnetic resonance imaging in a group of patients with acute Chagas disease and reveals the importance of early detection and follow-up of the cardiac impairment in these patients.
  • conferenceObject
    Myocardial tissue function and characterization in patients with idiopathic cardiac magnetic resonance myopericarditis: evolutionary analysis
    (2021) SOEIRO, A.; BOSSA, A. S.; CESAR, M. C.; LEAL, T. C. A. T.; GARCIA, G.; FONSECA, R. A.; NAKAMURA, D.; GUIMARAES, P. O.; SOARES, P. R.; MUELLER, C.; MEBAZAA, A.; FERNANDES, F.; NOMURA, C. H.; ROCHITTE, C. E.; OLIVEIRA JR., M. T.