PABLO MARIA ALBERTO POMERANTZEFF

(Fonte: Lattes)
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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/65, Hospital das Clínicas, Faculdade de Medicina

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  • article 26 Citação(ões) na Scopus
    Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis Insights From a Cardiovascular Magnetic Resonance Study
    (2019) ROSA, Vitor E. E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E. E.; PIRES, Lucas J. T.; VIEIRA, Marcelo L. C.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; SANTIS, Antonio S. A. L. de; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A. D.; POMERANTZEFF, Pablo M. A.; RODES-CABAU, Josep; PIBAROT, Philippe; TARASOUTCHI, Flavio
    Background: Few data exist on the degree of interstitial myocardial fibrosis in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS) and its association with left ventricular flow reserve (FR) on dobutamine stress echocardiography. This study sought to evaluate the diffuse interstitial fibrosis measured by T1 mapping cardiac magnetic resonance technique in LFLG-AS patients with and without FR. Methods: Prospective study including 65 consecutive patients (41 LFLG-AS [mean age, 67.1 +/- 8.4 years; 83% men] and 24 high-gradient aortic stenosis used as controls) undergoing dobutamine stress echocardiography to assess FR and cardiac magnetic resonance to determine the extracellular volume (ECV) fraction of the myocardium, indexed ECV (iECV) to body surface area and late gadolinium enhancement. Results: Interstitial myocardial fibrosis measured by iECV was higher in patients with LFLG-AS with and without FR as compared with high-gradient aortic stenosis (35.25 +/- 9.75 versus 32.93 +/- 11.00 versus 21.19 +/- 6.47 mL/m(2), respectively; P<0.001). However, both ECV and iECV levels were similar between LFLG-AS patients with and without FR (P=0.950 and P=0.701, respectively). Also, FR did not correlate significantly with ECV (r=-0.16, P=0.31) or iECV (r=0.11, P=0.51). Late gadolinium enhancement mass was also similar in patients with versus without FR but lower in high-gradient aortic stenosis (13.3 +/- 10.2 versus 10.5 +/- 7.5 versus 4.8 +/- 5.9 g, respectively; P=0.018). Conclusions: Patients with LFLG-AS have higher ECV, iECV, and late gadolinium enhancement mass compared with high-gradient aortic stenosis. Moreover, among patients with LFLG-AS, the degree of myocardial fibrosis was similar in patients with versus those without FR. These findings suggest that diffuse myocardial fibrosis may not be the main factor responsible for the absence of FR in LFLG-AS patients.
  • article 2 Citação(ões) na Scopus
    Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial
    (2024) RODES-CABAU, Josep; RIBEIRO, Henrique Barbosa; MOHAMMADI, Siamak; SERRA, Vicenc; AL-ATASSI, Talal; INIGUEZ, Andres; VILALTA, Victoria; NOMBELA-FRANCO, Luis; SANCHEZ, Jose Ignacio Saez de Ibarra; AUFFRET, Vincent; FORCILLO, Jessica; CONRADI, Lenard; URENA, Marina; MORIS, Cesar; MUNOZ-GARCIA, Antonio; PARADIS, Jean-Michel; DUMONT, Eric; KALAVROUZIOTIS, Dimitri; POMERANTZEFF, Pablo Maria; ROSA, Vitor Emer Egypto; LOPES, Mariana Pezzute; SUREDA, Carles; DIAZ, Victor Alfonso Jimenez; GIULIANI, Carlos; AVVEDIMENTO, Marisa; PELLETIER-BEAUMONT, Emilie; PIBAROT, Philippe
    BACKGROUND: The optimal treatment in patients with severe aortic stenosis and small aortic annulus (SAA) remains to be determined. This study aimed to compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with a SAA. METHODS: This prospective multicenter international randomized trial was performed in 15 university hospitals. Participants were 151 patients with severe aortic stenosis and SAA (mean diameter <23 mm) randomized (1:1) to TAVR (n=77) versus SAVR (n=74). The primary outcome was impaired valve hemodynamics (ie, severe prosthesis patient mismatch or moderate-severe aortic regurgitation) at 60 days as evaluated by Doppler echocardiography and analyzed in a central echocardiography core laboratory. Clinical events were secondary outcomes. RESULTS: The mean age of the participants was 75.5 +/- 5.1 years, with 140 (93%) women, a median Society of Thoracic Surgeons predicted risk of mortality of 2.50% (interquartile range, 1.67%-3.28%), and a median annulus diameter of 21.1 mm (interquartile range, 20.4-22.0 mm). There were no differences between groups in the rate of severe prosthesis patient mismatch (TAVR, 4 [5.6%]; SAVR, 7 [10.3%]; P=0.30) and moderate-severe aortic regurgitation (none in both groups). No differences were found between groups in mortality rate (TAVR, 1 [1.3%]; SAVR, 1 [1.4%]; P=1.00) and stroke (TAVR, 0; SAVR, 2 [2.7%]; P=0.24) at 30 days. After a median follow-up of 2 (interquartile range, 1-4) years, there were no differences between groups in mortality rate (TAVR, 7 [9.1%]; SAVR, 6 [8.1%]; P=0.89), stroke (TAVR, 3 [3.9%]; SAVR, 3 [4.1%]; P=0.95), and cardiac hospitalization (TAVR, 15 [19.5%]; SAVR, 15 [20.3%]; P=0.80). CONCLUSIONS: In patients with severe aortic stenosis and SAA (women in the majority), there was no evidence of superiority of contemporary TAVR versus SAVR in valve hemodynamic results. After a median follow-up of 2 years, there were no differences in clinical outcomes between groups. These findings suggest that the 2 therapies represent a valid alternative for treating patients with severe aortic stenosis and SAA, and treatment selection should likely be individualized according to baseline characteristics, additional anatomical risk factors, and patient preference. However, the results of this study should be interpreted with caution because of the limited sample size leading to an underpowered study, and need to be confirmed in future larger studies.