CARLOS EDUARDO ROCHITTE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder
25 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 25
- Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stents(2011) MAGALHAES, Tiago A.; CURY, Roberto C.; PEREIRA, Alexandre C.; MOREIRA, Valeria de Melo; LEMOS, Pedro A.; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.BACKGROUND: Coronary computed tomography angiography (CTA) is a well-established diagnostic tool for coronary artery disease (CAD). However, coronary segments with prior stent implantation visualized with CIA may have limited evaluation and reduced accuracy. OBJECTIVE: We assessed the incremental value of stress myocardial CT perfusion (CTP) over anatomical assessment by coronary CIA alone in patients with stents, using quantitative invasive coronary angiography (>= 50%) as reference. METHODS: Forty-six patients (56.9 +/- 7.2 years; 28 men) referred to invasive coronary angiography were evaluated, combining coronary CIA and dipyridamole stress myocardial CTP with 64 detector-row CT. Coronary CTA was evaluated for >= 50% coronary stenosis, and myocardial CTP was used to potentially reclassify coronary territories, including those with stents and poorly evaluated stents because of artifacts. RESULTS: We evaluated 138 coronary territories, 62 with >= 1 stent. From these, 21(34%) territories had adequately evaluated stents, 28 (45%) had limitedly evaluated stents still allowing diagnosis, and 13 (21%) had inadequately evaluated stents (no luminal assessment possible). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for coronary CTA in stent territories were, respectively, 85%, 77%, 87%, 74%, and 81%, and the combined use of coronary CTA and myocardial CTP were 88%, 95%, 97%, 81%, and 91% (P = 0.0292). In territories with impaired stent evaluation (limited or inadequate), the diagnostic performance of coronary CIA alone was 83%, 72%, 79%, 76% and 77%, and combined with myocardial CTP were 87%, 94%, 95%, 85%, and 91% (P = 0.036). CONCLUSION: The combined evaluation of coronary CTA and stress myocardial CTP improved the diagnostic accuracy for the detection of significant obstructive CAD in patients with stents.
conferenceObject Natural History of Adapted Leaman Score Assessing Coronary Artery Disease Progression Over 7 Years by Computed Tomography Angiography(2020) HIDEO-KAJITA, Alexandre; GARCIA-GARCIA, Hector M.; FREIRE, Antonio Fernando Diniz; OZAKI, Yuichi; CAVALCANTE, Rafael; BITTENCOURT, Marcio Sommer; DAN, Kazuhiro; SOUD, Mohamad; FALCAO, Breno; FALCAO, Joao Luis; SOARES, Paulo Rogerio; RIBEIRO, Expedito; ROCHITTE, Carlos E.; LEMOS, Pedro A.- Phosphorus Is Associated with Coronary Artery Disease in Patients with Preserved Renal Function(2012) CANCELA, Ana Ludimila; SANTOS, Raul Dias; TITAN, Silvia Maria; GOLDENSTEIN, Patricia Taschner; ROCHITTE, Carlos Eduardo; LEMOS, Pedro Alves; REIS, Luciene Machado dos; GRACIOLLI, Fabiana Giorgetti; JORGETTI, Vanda; MOYSES, Rosa MariaHigh serum phosphorus levels have been associated with mortality and cardiovascular events in patients with chronic kidney disease and in the general population. In addition, high phosphorus levels have been shown to induce vascular calcification and endothelial dysfunction in vitro. The aim of this study was to evaluate the relation of phosphorus and coronary calcification and atherosclerosis in the setting of normal renal function. This was a cross-sectional study involving 290 patients with suspected coronary artery disease and undergoing elective coronary angiography, with a creatinine clearance >60 ml/min/1.73 m(2). Coronary artery obstruction was assessed by the Friesinger score and coronary artery calcification by multislice computed tomography. Serum phosphorus was higher in patients with an Agatston score >10 than in those with an Agatston score <= 10 (3.63 +/- 0.55 versus 3.49 +/- 0.52 mg/dl; p = 0.02). In the patients with Friesinger scores >4, serum phosphorus was higher (3.6 +/- 0.5 versus 3.5 +/- 0.6 mg/dl, p = 0.04) and median intact fibroblast growth factor 23 was lower (40.3 pg/ml versus 45.7 pg/ml, p = 0.01). Each 0.1-mg/dl higher serum phosphate was associated with a 7.4% higher odds of having a Friesinger score >4 (p = 0.03) and a 6.1% greater risk of having an Agatston score >10 (p = 0.01). Fibroblast growth factor 23 was a negative predictor of Friesinger score ( p = 0.002). In conclusion, phosphorus is positively associated with coronary artery calcification and obstruction in patients with suspected coronary artery disease and preserved renal function.
- Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: A CORE64 multicenter trial substudy(2014) SARA, Leonardo; ROCHITTE, Carlos E.; LEMOS, Pedro A.; NIINUMA, Hiroyuki; DEWEY, Marc; SHAPIRO, Edward P.; GOTTLIEB, Ilan; MANSUR, Antonio P.; NICOLAU, Jose C.; LARDO, Albert C.; AZEVEDO, Clerio F.; KALIL-FILHO, Roberto; VAVERE, Andrea L.; COHN, Silvia; COX, Christopher; BRINKER, Jeffrey; MILLER, Julie M.; LIMA, Joao A. C.Background: Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS). Methods: Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories. Results: From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting >= 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P = 0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 +/- 449 in suspected ACS and 435 +/- 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients. Conclusions: The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.
- Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer(2022) DALLAN, Luis Augusto Palma; DAE, Michael; GIANNETTI, Natali Schiavo; POLASTRI, Tathiane Facholi; LIMA, Marian Keiko Frossard; ROCHITTE, Carlos Eduardo; HAJJAR, Ludhmila Abrahao; MARTIN, Claudia Yanet Bernoche San; LIMA, Felipe Gallego; NICOLAU, Jose Carlos; JR, Mucio Tavares de Oliveira; DALLAN, Luis Alberto Oliveira; SILVA, Expedito Eustaquio Ribeiro da; FILHO, Roberto Kalil; ABIZAID, Alexandre; LEMOS NETO, Pedro Alves; TIMERMAN, SergioBackground: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETU and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. Methods and results: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEN s starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus (R) Endovascular System (loll Circulation Inc (TM), San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewanning during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 +/- 1.0 degrees C or PCI-only. A total of 35 patients underwent FM (85.7% [30/35] in 90 +/- 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). Conclusions: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEM.
- Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound(2016) CAVALCANTE, Rafael; BITTENCOURT, Marcio S.; PINHEIRO, Thais L.; FALCAO, Breno A. A.; MORAIS, Gustavo R.; SOARES, Paulo; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.Aims: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. Methods and results: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 +/- 0.7 vessels, comprising 123.8 +/- 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. Conclusions: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.
conferenceObject Training, Simulation and Validation of Therapeutic Hypothermia as an Adjuvant Treatment in St Segment Elevation Myocardial Infarction(2018) DALLAN, Luis Augusto; RIBEIRO, Marcelo; GIANNETTI, Natali; ROCHITTE, Carlos; NOMURA, Cesar H.; HAJJAR, Ludhmila A.; BERNOCHE, Claudia Y.; LAGE, Silvia G.; NICOLAU, Jose Carlos; OLIVEIRA, Mucio T.; POLASTRI, Thatiane F.; RIBEIRO, Expedito E.; KALIL FILHO, Roberto; LEMOS NETO, Pedro A.; TIMERMAN, Sergio- Natural History of Adapted Leaman Score Assessing Coronary Artery Disease Progression by Computed Tomography Angiography: A 7-Year Follow-Up Report(2021) HIDEO-KAJITA, Alexandre; GARCIA-GARCIA, Hector M.; RUBARTH, Rodrigo; WOPPERER, Samuel; OZAKI, Yuichi; FREIRE, Antonio Fernando Diniz; CAVALCANTE, Rafael; BITTENCOURT, Marcio; DAN, Kazuhiro; PINHEIRO, Thais L.; FALCAO, Breno A. A.; FALCAO, Joao Luis A.; SOARES, Paulo; RIBEIRO, Expedito; ROCHITTE, Carlos E.; LEMOS, Pedro AlvesBackground: Coronary computed tomographic angiography (CCTA) provides a non-invasive assessment of the coronary artery tree. Computed Tomography - adapted Leaman Score (CT-LeSc) has been shown to be an independent predictor of cardiac events in coronary artery disease (CAD) patients with a score greater than 5 (high). Purpose: To investigate the relationship between CT-LeSc and the progression of CAD and to provide vessel- and segment-level CAD qualification and quantification at baseline and 7-year follow-up. Methods: Patients with multivessel CAD and CCTA assessments at baseline and follow-up were included. The CT-LeSc analysis was performed in a paired fashion. The patient-level scores and the differences between each phase were assessed by 2 analysts in an independent core laboratory. Results: This study analyzed 248 coronary segments from 17 patients with a mean follow-up interval of 75 +/- 0.6 years. The mean CT-LeSc at baseline and follow-up were 14.6 +/- 42 and 16.9 +/- 15, respectively, with an absolute increase of 2.3 +/- 1.8. The mean cumulative increase of new lesions was 0.2 = 02 per year. Over time, 14.6% of the non-obstructive lesions became obstructive, and 15.0% of the non-calcified plaques became calcified. There were 29 new lesions found at follow-up, and out of these, 16 were obstructive and 19 were non-calcified. Conclusion: In patients at high risk for cardiac events, as determined by CT-LeSc, there was an increase in CT-LeSc, obstructive lesions, and calcified plaques over the 7-year follow-up period. Most of the new lesions were obstructive and non-calcified. This is the first report showing long-term serial imaging CCTA changes in a high-risk population.
conferenceObject Safety of Endovascular Therapeutic Hypothermia as an Adjuvant Therapy in Acute ST Segment Elevation Myocardial Infarction(2017) DALLAN, Luis A.; RIBEIRO, Marcelo; GIANNETTI, Natali; ROCHITTE, Carlos; NOMURA, Cesar; HAJJAR, Ludhmila; LAGE, Silvia; LIMA, Felipe G.; SOEIRO, Alexandre; NICOLAU, Jose C.; TAVARES, Mucio; NETO, Pedro A. Lemos; TIMERMAN, Sergio; KALIL, Roberto- Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST (II Edição, 2007) - Atualização 2013/2014(2014) NICOLAU, JC; TIMERMAN, A; MARIN-NETO, JA; PIEGAS, LS; BARBOSA, CJDG; FRANCI, A; AVEZUM JR., A; CARVALHO, ACC; MARKMAN FILHO, B; POLANCZYK, CA; ROCHITTE, CE; SERRANO JÚNIOR, CV; PRECOMA, DB; SILVA JUNIOR, DG; ALBUQUERQUE, DC; STEFANINI, E; KNOBEL, E; JATENE, FB; FERES, F; MORCERF, FAP; GANEM, F; LIMA FILHO, FA; FEITOSA FILHO, GS; FERREIRA, JFM; MENEGHETTI, JC; SARAIVA, JFK; SILVA, LS; MAIA, LN; BARACIOLI, LM; LISBOA, LAF; DALLAN, LAO; BODANESE, LC; ANDRADE, MD; OLIVEIRA JÚNIOR, M; DUTRA, OP; COELHO, OR; LEÃES, PE; ALBUQUERQUE, PF; LEMOS, P; KALIL, R; COSTA, RVC; ESPORCATE, R; MARINO, RL; BOTELLHO, RV; MENEGHELO, RS; SPROVIERI, SR; TIMERMAN, S; MATHIAS JÚNIOR, W
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