INGRID KOWATSCH
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function(2017) MATTOSO, Angele A. A.; TSUTSUI, Jeane M.; KOWATSCH, Ingrid; CRUZ, Vitoria Y. L.; SBANO, Joao C. N.; RIBEIRO, Henrique B.; KALIL FILHO, Roberto; PORTER, Thomas R.; MATHIAS JR., WilsonObjective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (beta) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal beta reserve in >= 2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5-99; p<0.001). Both, abnormal beta reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WM and MP (chi(2) = 6.6 and chi(2) = 24.6, respectively; p = 0.001 and chi(2) = 6.6 and chi(2) = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, beta reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5-99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis of WM and MP, and coronary angiography in predicting acute coronary events.
conferenceObject Pulmonary Complications in Right Sided Endocarditis(2013) RODRIGUES, Ana Clara T.; KAY, Fernando U.; OGAWA, Andrea; NISHIYAMA, Katia; ARRUDA, Ana Lucia; LIRA FILHO, Edgar; KOWATSCH, Ingrid; FURTADO, Meive; CERRI, Glovanni G.; ANDRADE, Jose L.- Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome(2015) ALDRIGHI, Jose M.; TSUTSUI, Jeane M.; KOWASTCH, Ingrid; RIBEIRO, Alessandra L.; SCAPINELLI, Alessandro; TAMANAHA, Sonia; OLIVEIRA, Ricardo M.; MATHIAS JR., WilsonObjectivePolycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS. MethodsWe studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE. Results reserve in group PCOS+IR was lower than control (2.340.55 vs. 3.60 +/- 0.6; P<0.001) and than PCOS without IR (2.34 +/- 0.55 vs. 3.17 +/- 0.65; P < 0.001). MBFR in patients with PCOS without IR did not differ from those of control (4.59 +/- 1.59 vs. 5.30 +/- 1.64; P =0.22) or from patients with PCOS+IR (4.59 +/- 1.59 vs. 3.70 +/- 1.47; P =0.07). When comparing with control group, patients with PCOS+IR had lower MBFR (5.30 +/- 1.64 vs. 3.70 +/- 1.47; P=0.01). No significant differences were found between control, PCOS without IR and PCOS+IR for FMD (0.18 +/- 0.05, 0.15 +/- 0.04 and 0.13 +/- 0.07; P =NS) or IMT (0.48 +/- 0.05, 0.47 +/- 0.05 and 0.49 +/- 0.07; P=NS). ConclusionWomen with PCOS and IR had depressed and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in reserve, probably an earlier marker of myocardial flow abnormality.
- 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 MikeBackground: 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)
- Atorvastatin Treatment Improves Myocardial and Peripheral Blood Flow in Familial Hypercholesterolemia Subjects without Evidence of Coronary Atherosclerosis(2013) LARIO, Fabio C.; MINAME, Marcio H.; TSUTSUI, Jeane M.; SANTOS, Raul D.; KOWATSCH, Ingrid; SBANO, Joao C. N.; RAMIRES, Jose A. F.; KALIL FILHO, Roberto; MATHIAS JR., WilsonBackground: Hypercholesterolemia induces early microcirculatory functional and structural alterations that are reversible by cholesterol reduction. Real time myocardial contrast echocardiography (RTMCE) and vascular ultrasound evaluate the effects of hyperlipidemia on peripheral and central blood flow reserve. This study investigated the effects of lipid-lowering therapy on coronary and peripheral artery circulation in patients with familial hypercholesterolemia (FH). Methods: RTMCE and vascular ultrasound were performed in 10 healthy volunteers (validation group) at baseline and after 12-week clinical observation, and in 16 age-and sex-matched FH patients without obstructive coronary artery disease (CAD) by computed tomography angiography at baseline and after 12-week atorvastatin treatment. Indexes of relative myocardial blood flow (MBF) were obtained at rest and during adenosine infusion. Results: In validation group, there was no significant difference between flow-mediated dilation (FMD) at baseline and after 12 weeks (0.15 +/- 0.02 vs. 0.14 +/- 0.03; P = 0.39). Similarly, no differences were observed in MBF reserve at baseline and after 12 weeks (3.31 +/- 0.63 vs. 3.48 +/- 0.89; P = 0.89). FMD was blunted in FH patients, at baseline, as compared with validation group (0.08 +/- 0.04 vs. 0.15 +/- 0.02; P < 0.001) and became similar to that group (0.13 +/- 0.05 vs. 0.14 +/- 0.03; P = 0.07) after treatment. MBF reserve was blunted at baseline in FH patients in comparison with the validation group (2.78 +/- 0.71 vs. 3.31 +/- 0.63; P = 0.003). After treatment, MBF reserve values were no longer different (3.43 +/- 0.66 and 3.48 +/- 0.89; P = 0.84, respectively, for FH and validation groups). Conclusion: Patients with FH and no obstructive CAD have blunted MBF reserve and lower FMD values as compared with healthy volunteers. Both FMD and MBF reserve were normalized after atorvastatin treatment. (Echocardiography 2013;30:64-71)
- Myeloperoxidases and polycystic ovary syndrome(2012) RIBEIRO, Alessandra Lorenti; SCAPINELLI, Alessandro; TAMANAHA, Sonia; OLIVEIRA, Ricardo Manoel de; KOWASTCH, Ingrid; MATHIAS JUNIOR, Wilson; AOKI, Tsutomu; ALDRIGHI, Jose MendesNew biological markers are emerging trying to identify earlier cardiovascular high risk subjects. Myeloperoxidases have been involved in the role of atherosclerosis process, by the beginning of the endothelial dysfunction up to the plaque rupture and clinical manifestation, and it has been demonstrated that this enzyme has also a prognostic value. We aimed to assess myeloperoxidases levels in patients with polycystic ovary syndrome (PCOS) with insulin resistance (IR), considering that these women represent a high risk group for cardiovascular disease. We developed a transversal study, comprising 26 patients with PCOS and IR and 30 controls (PCOS without IR). IR was considered with HOMA-IR >= 3.0. IR absence was considered when HOMA-IR <3.0, triglycerides <200, BMI <28.7, and BMI <27.8 in patients with familial history of type 2 diabetes. All patients went through anamnesis, physical examination, transvaginal ultrasound, and blood samples. IR PCOS patients had higher levels of myeloperoxidase (22.3 x 18.1, p = 0.047), and also higher BMI. Myeloperoxidase levels correlated directly with insulin. In conclusion, IR PCOS young patients have higher myeloperoxidase levels.