MARIA ANTONIETA ALBANEZ ALBUQUERQUE DE MEDEIROS LOPES
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- Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification(2023) LOPES, Maria Antonieta Albanez A. de M.; CAMPOS, Carlos M.; ROSA, Vitor Emer Egypto; SAMPAIO, Roney O.; MORAIS, Thamara C.; BRITO JUNIOR, Fabio Sandoli de; VIEIRA, Marcelo L. C.; JR, Wilson Mathias; FERNANDES, Joao Ricardo Cordeiro; SANTIS, Antonio de; SANTOS, Luciano de Moura; ROCHITTE, Carlos E.; CAPODANNO, Davide; TAMBURINO, Corrado; ABIZAID, Alexandre; TARASOUTCHI, FlavioObjectivesThe aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS).BackgroundElevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS.MethodsProspective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (n = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 (n = 14) when BNP or hsTnI were higher than median; and Group 3 (n = 18) when both hsTnI and BNP were higher than median.Results49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (P = 0.03) and lower left ventricular ejection fraction (P = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31-47] vs. 32 [29-41] vs. 26 [19-33]%; p < 0.01) and right ventricular EF (62 [53-69] vs. 51 [35-63] vs. 30 [24-46]%; p < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8-30.7] vs. 28.2 [26.9-34.5] vs. 31.8 [28.9-35.5]%; p = 0.03) and indexed ECV (iECV) (28.7 [21.2-39.1] vs. 28.8 [25.4-39.9] vs. 44.2 [36.4-51.2] ml/m(2), respectively; p < 0.01) from Group 1 to Group 3.ConclusionsHigher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.
article Offline Assessment of the Quantitative Flow Ratio: Is it Useful in Clinical Practice?(2022) SANTOS, Luciano de Moura; CARVALHO JUNIOR, Wenderval Borges; RIBEIRO, Marcelo Harada; LOPES, Maria Antonieta A. A. Medeiros; SILVA, Eduardo Freitas da; FUKUSHIMA, Julia Tizue; ABIZAID, Alexandre Antonio Cunha; CAMPOS, Carlos M.Introduction. Fractional flow reserve (FFR) has been established as the gold standard in the physiological assessment of coronary obstructions severity. However, the need to insert an intracoronary pressure guidewire is a factor that limits its use. Quantitative flow ratio (QFR) is a method that infers the value of FFR from 3-dimensional quantitative coronary angiography (3D-QCA), eliminating the use of a pressure wire and coronary hyperemia. The present study aims to evaluate the diagnostic accuracy of QFR and 3D-QCA in comparison with FFR for the identification of significant obstructive coronary lesions (FFR <=.80) and the feasibility to assess QFR in a cohort of patients without dedicated angiographic acquisition. Methods. Consecutive patients with coronary angiography with moderate obstructive lesions that had previous FFR measurement were evaluated. Validation of QFR was assessed by the area under the curve (AUC) and other statistical tools, using FFR as the reference method. Results. Seventy-five arteries from 69 patients were evaluated. The accuracy of the QFR to detect FFR <=.80 was 84.0% (95% confidence interval, 75.6-92.4). The correlation and agreement between FFR and QFR were r=0.54 (P<.01) and mean difference was -0.02 +/- 0.09 (P=.09), respectively. The AUC of QFR and 3D-QCA identifying stenosis >50% was 0.854 and 0.755, respectively (P=.09). Conclusion. QFR demonstrated good accuracy compared with FFR for the assessment of moderate obstructive coronary lesions in an unselected clinical practice population. However, many patients were excluded from the analysis and there was no statistical difference between the receiver operator characteristic curves of the QFR and percent diameter stenosis.conferenceObject Validity of Coronary Angiography-Based Physiology in Clinical Practice(2021) SANTOS, Luciano de Moura; CARVALHO JR., Wenderval B.; RIBEIRO, Marcelo H.; LOPES, Maria Antonieta A.; FUKUSHIMA, Julia T.; ABIZAID, Alexandre A.; CAMPOS, Carlos M.