JOSE ANTONIO FRANCHINI RAMIRES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Myocardial injury in diabetic patients with multivessel coronary artery disease after revascularization interventions(2017) REZENDE, Paulo Cury; HUEB, Whady; RAHMI, Rosa Maria; SCUDELER, Thiago Luis; AZEVEDO, Diogo Freitas Cardoso de; GARZILLO, Cibele Larrosa; SEGRE, Carlos Alexandre Wainrober; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: Diabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD). Methods: Patients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI), off-pump or on-pump bypass surgery (CABG). Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72 h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c) levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI) on CMR. Results: Ninety (44.5%) of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14) and 2.24 (0.69, 5.42) ng/mL (P = 0.81), and median peak CK-MB was 14.1 (6.8, 31.7) and 14.0 (4.2, 29.8) ng/mL (P = 0.43), in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (P = 0.91), and myocardial edema in 15.5 and 22.9% (P = 0.39) in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (P = 0.98), and in the A1c tertiles was 19.1% versus 13.3% versus 22.2% (P = 0.88). Conclusions: In this study, diabetes mellitus did not add risk of myocardial injury after revascularization interventions in patients with multivessel coronary artery disease.
conferenceObject THE ROLE OF ORAL BETA BLOCKER IN A REAL-WORLD POPULATION WITH NON-ST SEGMENT ELEVATION ACUTE CORONARY SYNDROMES(2017) NICOLAU, Jose C.; FERRARI, Aline; COELHO, Gabriela M. M.; NAKASHIMA, Carlos A. K.; LIMA, Viviane M.; DALCOQUIO, Talia; FURTADO, Remo; MENEZES, Fernando; RAMIRES, Jose; KALIL-FILHO, Roberto; BARACIOLI, LucianoconferenceObject Influence of blood cell derived inflammatory markers on periprocedural myonecrosis in stable patients undergoing elective percutaneous coronary intervention(2017) GODOY, L. C.; DIAS NETO, V.; CASALE, G.; CHAVES, D. M.; ABUD, I. C. K.; GARZILLO, C. L.; FAVARATO, D.; LIMA, E. G.; LEMOS NETO, P. A.; SILVA, E. E. Ribeiro Da; PITTA, F. G.; RAMIRES, J. A. F.; KALIL FILHO, R.; SERRANO JR., C. V.- Significant elevation of biomarkers of myocardial necrosis after coronary artery bypass grafting without myocardial infarction established assessed by cardiac magnetic resonance(2017) COSTA, Leandro Menezes Alves da; HUEB, Whady; NOMURA, Cesar Higa; HUEB, Alexandre Ciappina; VILLA, Alexandre Volney; OIKAWA, Fernando Teiichi Costa; MELO, Rodrigo Morel Vieira de; REZENDE, Paulo Cury; SEGRE, Carlos Alexandre Wainrober; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoThe release of myocardial necrosis biomarkers after off-pump coronary artery bypass grafting (OPCAB) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedure-related myocardial infarction (MI) (type 5) has been controversial. This study aimed to evaluate the amount and pattern of cardiac biomarker release after elective OPCAB in patients without evidence of a new MI on cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). Patients with normal baseline cardiac biomarkers referred for elective OPCAB were prospectively included. CMR with LGE was performed in all patients before and after interventions. Measurements of troponin I (cTnI) and creatine kinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with new LGE on the postprocedure CMR were excluded. All of the 53 patients without CMR evidence of a procedure-related MI after OPCAB exhibited a cTnI elevation peak above the 99th percentile. In 48 (91%), the peak value was > 10 times this threshold. However, 41 (77%) had a CK-MB peak above the limit of the 99th percentile, and this peak was > 10 times the 99th percentile in only 7 patients (13%). The median peak release of cTnI was 0.290 (0.8-3.7) ng/mL, which is 50-fold higher than the 99th percentile. In contrast with CK-MB, considerable cTnI release often occurs after an elective OPCAB procedure, despite the absence of new LGE on CMR.
conferenceObject Impact of Syntax Score on Release of Cardiac Biomarkers in Post-revascularization Procedures Among Patients With Stable Multivessel Disease: Mass-v Insights(2017) AZEVEDO, Diogo F.; HUEB, Whady; TAKIUTI, Myrthes E.; LIMA, Eduardo G.; REZENDE, Paulo C.; GARZILLO, Cibele L.; SEGRE, Carlos A.; LINHARES FILHO, Jaime P.; GARCIA, Rosa M.; NOMURA, Cesar H.; RAMIRES, Jose A.; KALIL FILHO, Roberto- Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement(2017) MELO, Rodrigo Morel Vieira de; HUEB, Whady; NOMURA, Cesar Higa; SILVA, Expedito Eustaquio Ribeiro da; VILLA, Alexandre Volney; OIKAWA, Fernando Teiichi Costa; COSTA, Leandro Menezes Alves da; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoObjectivesThis study aimed to evaluate the amount and pattern of cardiac biomarker release after elective percutaneous coronary intervention (PCI) in patients without evidence of a new myocardial infarction (MI) after the procedure as assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). BackgroundThe release of myocardial necrosis biomarkers after PCI frequently occurs. However, the correlation between biomarker release and the diagnosis of procedure-related MI type 4a has been controversial. MethodsPatients with normal baseline cardiac biomarkers who were referred for elective PCI were prospectively included. CMR with LGE was performed in all of the patients before and after the intervention. Measurements of troponin I (TnI) and creatine kinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. ResultsOf the 56 patients with no evidence of a procedure-related MI as assessed by CMR after the PCI, 48 (85.1%) exhibited an elevation of TnI above the 99th percentile. In 32 patients (57.1%), the peak was greater than five times this limit. Additionally, 17 patients (30.4%) had a CK-MB peak above the 99th percentile limit, but this peak was greater than five times the 99th percentile in only two patients (3.6%). The median peak release of TnI was 0.290 (0.061-1.09) ng/mL, which was 7.25-fold higher than the 99th percentile. ConclusionsIn contrast to CK-MB, an abnormal release of TnI often occurs after an elective PCI procedure, despite the absence of a new LGE on CMR.
conferenceObject Impact of chronic kidney dysfunction among patients with stable coronary artery disease: ten-year follow-up of mass II trial(2017) LIMA, E. G.; HUEB, W.; GARZILLO, C. L.; FAVARATO, D.; SEGRE, C. A. W.; AZEVEDO, D. F. C.; HUEB, A. C.; REZENDE, P. C.; SILVA, E. E. R.; GARCIA, R. M. R.; SCUDELER, T. L.; RAMIRES, J. A. F.; KALIL FILHO, R.conferenceObject Quality of life and economic outcomes of on-pump and off-pump stable multivessel coronary artery bypass grafting - MASS III trial 5-year follow-up(2017) SCUDELER, T. L.; HUEB, W.; SOAREZ, P. C. De; CAMPOLINA, A. G.; REZENDE, P. C.; LIMA, E. G.; GARZILLO, C. L.; AZEVEDO, D. F. C.; COSTA, L. M. A.; OIKAWA, F. T. C.; RAMIRES, J. A. F.; KALIL FILHO, R.conferenceObject COST-EFFECTIVENESS ANALYSIS AND QUALITY OF LIFE OF ON-PUMP AND OFF-PUMP STABLE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTING: MASS III TRIAL 5-YEAR FOLLOW-UP(2017) SCUDELER, Thiago; HUEB, Whady; SOAREZ, Patricia Coelho De; CAMPOLINA, Alessandro G.; REZENDE, Paulo; LIMA, Eduardo; GARZILLO, Cibele Larrosa; FREITAS, Diogo Freitas Cardoso; COSTA, Leandro; OIKAWA, Fernando Teiichi; RAMIRES, Jose; KALIL FILHO, Roberto- Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve(2017) COSTANTINI, Costantino Roberto Frack; RAMIRES, Jose Antonio; COSTANTINI, Costantino Ortiz; DENK, Marcos Antonio; TARBINE, Sergio Gustavo; SANTOS, Marcelo de Freitas; ZANUTTINI, Daniel Anibal; SILVEIRA, Carmen Weigert; SOUZA, Admar Moraes de; MACEDO, Rafael Michel deBackground: Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. Objective: To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Methods: Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or >= 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. Results: All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values <= 0.80. On correlation analysis for FFR <= 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Conclusion: Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.