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Door-to-balloon time in patients undergoing primary angioplasty and therapeutic decision on acute myocardial infarction
CE Rochitte, R Kaneko, M Knobel, A Avezum, JAM Souza, FS Brito, E Knobel
Critical Care , 2001, DOI: 10.1186/cc1334
Abstract: We studied, retrospectively, 67 patients submitted to primary angioplasty, from January 1999 to November 2000. We divided our patient population into two groups. Group A (GA) included patients with DBT less than 120 min and group B (GB) patients with DBT greater or equal to 120 min. We evaluated several clinical variables, such as left ventricular ejection fraction (LVEF) on their first echocardiogram during hospitalization, admission Killip classification, in-hospital length of stay (LOS) and major cardiovascular events (MACE) during hospitalization and up to 6-month follow-up (in 23 patients).The median DBT was 132 min and the mean was 165 min, with a standard deviation of 137 min for all the cases. We had 32 patients in the GA and 35 patients (52%) in the GB. We observed four in-hospital deaths, all in GB. The mean LVEF was 53.1 ± 9% in GA and 46.1 ± 13% in GB (P = 0.059). Admission Killip class greater than 1 was noted in three patients of each group. The in-hospital LOS was similar for both groups (GA=8.35 ± 4 and GB=8.33 ± 4 days; NS). In-hospital events occurred in eight patients of GA (25%) and seven patients of GB (20%; NS). Only five follow-up events occurred during the first 6 months, three events in GA patients and two in GB patients (NS).DBT greater than or equal to 2 h are common and in our population it occurred in more than half of the primary angioplasties. Greater than 2 h DBTs were associated with a trend to larger left ventricular dysfunction early after MI. Monitoring and measures to reduce DBT are crucial for the potential prognosis improvement offered by primary angioplasty and for the broadening of its use in the management of acute MI.
Diltiazem como alternativa ao betabloqueador na angiotomografia de artérias coronárias
Rochitte, Carlos Eduardo;Azevedo, Guilherme Santana Antunes;Shiozaki, Afonso Akio;Azevedo, Clerio Francisco;Kalil Filho, Roberto;
Arquivos Brasileiros de Cardiologia , 2012, DOI: 10.1590/S0066-782X2012005000059
Abstract: background: reducing heart rate (hr) in ct angiography of the coronary arteries (ctacor) is critical to image quality. the effectiveness of calcium channel blockers as alternatives for patients with contraindications to beta-blockers has not been established. objectives: to compare the efficacy in the reduction of hr and rr variability of metoprolol and diltiazem in ctacor. methods: prospective, randomized, open study that included patients with clinical indication of ctacor in sinus rhythm with hr > 70 bpm and no use of agents that could interfere with hr. fifty patients were randomized to the groups: metoprolol iv 5-15 mg or up to hr ≤ 60 bpm (m), and diltiazem iv 0.25 to 0.60 mg/kg or up to hr ≤ 60 bpm (d). blood pressure (bp) and hr were measured at baseline, 1 minute, 3 minutes and 5 minutes after the agents, at the acquisition and after ctacor. results: hr reduction in absolute values was higher in group m than in group d (1, 3, 5 min, acquisition and post-test). the percentage reduction of hr was significantly higher in group m only 1 min and 3 min after the start of the agents. there was no difference in 5 min at acquisition and after examination. the percentage rr variability in group d was lower than that in group m during acquisition (rr variability/mean hr of acquisition). a single case of avb, 2:1 mobitz i occurred, which was spontaneously reverted (group d). conclusion: we conclude that diltiazem is an effective and safe alternative to beta-blockers in the reduction of hr when performing computed tomography angiography of coronary arteries. (arq bras cardiol. 2012; [online].ahead print, pp.0-0)
Miocardiopatia preponderante de ventrículo direito por miocardite prévia ou por displasia arritmogênica?
Atik, Edmar;Rochitte, Carlos Eduardo;ávila, Luis Francisco R. de;Kajita, Luiz J.;Palhares, Renata Bacic;
Arquivos Brasileiros de Cardiologia , 2005, DOI: 10.1590/S0066-782X2005001400014
Abstract: a clinical case of a 10-year-old male patient is reported. his dilated and prevailing right ventricular myocardiopathy shows diagnostic difficulties between previous myocarditis etiology and arrhythmogenic dysplasia. as the elements are not pathognomonic of one or other cause, the increase of cardiac enzymes in subacute stage maybe tends to the supposition of previous myocarditis. hence, the questioning that many cases labeled as arrhythmogenic dysplasia can truly correspond to the possibility of evolutional myocarditis. the controversial clinic management is disputable.
Ressonancia magnética cardíaca e seus planos anat?micos: como eu fa?o?
Nacif, Marcelo Souto;Oliveira Junior, Amarino Carvalho de;Carvalho, Antonio Carlos Pires;Rochitte, Carlos Eduardo;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010001600014
Abstract: due to the increasing use of the cardiac magnetic resonance (cmr) method and the frequent implementation of such method in new services, we describe herein, in a step-by-step format, the acquisition techniques that are necessary for a complete cardiac approach, of the main anatomical planes of the heart used by cmr.
Valvopatia aórtica cr nica grave sintomática: estudo comparado da ressonancia magnética cardíaca e ecocardiografia
Nigri Marcelo,Rochitte Carlos Eduardo,Tarasoutchi Flávio,Spina Guilherme S
Arquivos Brasileiros de Cardiologia , 2006,
Abstract: OBJETIVO: Mostrar o real valor da ressonancia magnética cardíaca (RMC) na avalia o dos portadores de valvopatia aórtica cr nica sintomática. MéTODOS: Foram estudados 70 pacientes, 35 com estenose aórtica (EAo) e 35 com insuficiência aórtica (IAo), com indica o cirúrgica, que realizaram ecocardiograma (ECO) e RMC pré-operatórios para avalia o da fun o ventricular, volumes e índice de massa ventricular esquerda por meio da cinerressonancia. RESULTADOS: Quando comparadas as variáveis do ECO e da RMC, nos grupos da EAo e da IAo n o houve diferen a estatística entre os dois métodos. Quando comparadas com o tipo de sintoma, as variáveis pelo ECO e pela RMC apresentam o mesmo comportamento. CONCLUS O: A RMC apresentou concordancia com o ECO na avalia o do volume ventricular esquerdo e fra o de eje o e com a clínica dos pacientes com valvopatia aórtica cr nica.
Miocardiopatia preponderante de ventrículo direito por miocardite prévia ou por displasia arritmogênica?
Atik Edmar,Rochitte Carlos Eduardo,ávila Luis Francisco R. de,Kajita Luiz J.
Arquivos Brasileiros de Cardiologia , 2005,
Abstract: é relatado o caso clínico de um paciente do sexo masculino com 10 anos de idade, cuja miocardiopatia dilatada e preponderante de ventrículo direito apresenta dificuldades diagnósticas entre a etiologia de miocardite prévia e a displasia arritmogênica. Como os elementos n o s o patognom nicos de uma ou de outra causa, a eleva o de enzimas cardíacas na fase subaguda talvez incline para a suposi o de miocardite prévia. Daí, o questionamento de que muitos casos rotulados como displasia arritmogênica poderem, verdadeiramente, corresponder à possibilidade de miocardite evolutiva. A controvertida conduta clínica é discutida.
Origem An?mala da Coronária (ALCAPA) em tomógrafo de 64 canais
Nacif, Marcelo Souto;Luz, José Hugo Mendes;Moreira, Denise Madeira;Rochitte, Carlos Eduardo;Oliveira Júnior, Amarino Carvalho de;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010000600022
Abstract: multidetector computed tomography (mdct) with 64 channels provides to clinical practice an excellent method to detect coronary artery anomalies. the diagnosis of coronary anomalies consisting of origin of left coronary artery in the pulmonary trunk in adults with no history of congenital disease has few reports in literature. we report a case in a 30-year old female patient complaining of fatigue on major efforts and positive scintigraphy for ischemia. the diagnosis was made through 64-channel mdct and thus it appears that the method can be used as baseline.
Comparison of non-invasive methods for the detection of coronary atherosclerosis
Bampi, Angela Bacelar Albuquerque;Rochitte, Carlos Eduardo;Favarato, Desiderio;Lemos, Pedro Alves;Luz, Protásio Lemos da;
Clinics , 2009, DOI: 10.1590/S1807-59322009000700012
Abstract: background: non-invasive detection of atherosclerosis is critical for its prevention. objective: to correlate non-invasively detectable indicators of coronary atherosclerosis, or coronary artery disease (i.e., classical risk factors, hs-crp test results, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography) with the extent of coronary disease assessed by the friesinger index from conventional coronary angiography. methods: we conducted a prospective study of 100 consecutive patients, mean age 55.1 ± 10.7 years, 55% men and 45% women. patients with acute coronary syndrome, renal dialytic insufficiency, collagen disease and cancer were not included. all patients were subjected to clinical evaluation and laboratory tests. endothelial function of the brachial artery and carotid artery were evaluated by high-resolution ultrasound; ankle-brachial index and computed tomography for coronary determination of calcium score were also performed, and non-hdl cholesterol and tg/hdl-c ratio were calculated. all patients were subjected to coronary angiography at the request of the assistant physician. we considered patients without an obstructive lesion (< 29% stenosis) demonstrated by coronary angiography to be normal. results: univariate analysis showed that calcium score, hdl-c, tg/hdl ratio and imt were significantly correlated with the friesinger index. however, multivariate analysis indicated that only calcium score and low hdl-c levels correlated significantly with the extension of cad. on the other hand, hs-crp, ldl-c, flow-mediated dilation, and framingham score did not correlate with the friesinger index. roc analysis showed that calcium score, hdl-c and tg-hdl ratio accurately predicted extensive cad in a statistically significant manner. conclusion: it is possible to approximately determine the presence and extent of cad by non-invasive methods, especially by calcium score, hdl-c and tg/hdl-c ratio assays.
Tratamento cirúrgico da coarcta o do arco aórtico em adulto: avalia o clínica e angiográfica tardia da técnica extra-anat mica
LISBOA Luiz Augusto F.,ABREU FILHO Carlos Alberto C.,DALLAN Luís Alberto O.,ROCHITTE Carlos E.
Revista Brasileira de Cirurgia Cardiovascular , 2001,
Abstract: OBJETIVO: Avaliar os resultados tardios da técnica extra-anat mica para corre o da coarcta o do arco aórtico em adultos. CASUíSTICA E MéTODOS: Entre 1979 e 2000, 15 pacientes foram submetidos à interposi o de tubo de Dacron entre a aorta ascendente e descendente para corre o da coarcta o do arco aórtico. Onze (73,3%) pacientes eram do sexo masculino e a média de idade foi de 30,8 ± 12,1 anos (18 a 61 anos). A esternotomia mediana, com abordagem do pericárdio posterior, foi utilizada em 13 (86,7%) pacientes e a toracotomia lateral esquerda em 2 (13,3%). Em 3 (20,0%) pacientes foram realizados procedimentos associados e 4 (26,7%) eram reopera es. Os pacientes foram acompanhados por um período de 30 dias a 21 anos (média de 6,9 ± 6,7 anos) com avalia o clínica, ecocardiográfica e estudo angiográfico com ressonancia magnética. RESULTADOS: N o ocorreram complica es neurológicas e nem mortalidade imediata ou tardia. N o houve necessidade de reopera es e nem complica es tardias com o enxerto. Todos os pacientes encontram-se assintomáticos e com o enxerto pérvio confirmado pelo ecocardiograma. Cinco (33,3%) pacientes apresentam hipertens o arterial sistêmica de grau leve. Em 11 (73,3%) pacientes foi realizado o estudo angiográfico com ressonancia magnética, mostrando enxerto com bom funcionamento a longo prazo. CONCLUS O: A técnica extra-anat mica, com interposi o de tubo de Dacron entre a aorta ascendente e descendente, para corre o da coarcta o do arco aórtico é uma opera o segura, com baixa morbidade e mortalidade. Os bons resultados a longo prazo mostram que esta técnica pode ser uma alternativa segura e menos invasiva, para a corre o de coarcta o do arco aórtico ou recoarcta o em adultos.
Compensatory enlargement of human coronary arteries identified by magnetic resonance imaging
Bertini P.J.,Parga J.R.,Chagas A.C.P.,Rochitte C.E.
Brazilian Journal of Medical and Biological Research , 2005,
Abstract: The aim of the present study was to evaluate the role of magnetic resonance imaging (MRI) for the non-invasive detection of coronary abnormalities and specifically the remodeling process in patients with coronary artery disease (CAD). MRI was performed in 10 control healthy subjects and 26 patients with angiographically proven CAD of the right coronary (RCA) or left anterior descending (LAD) artery; 23 patients were within two months of acute coronary syndromes, and 3 had stable angina with a positive test for ischemia. Wall thickness (WT), vessel wall area (VWA), total vessel area (TVA), and luminal area (LA) were measured. There were significant increases in WT (mean ± SEM, RCA: 2.62 ± 0.75 vs 0.53 ± 0.15 mm; LAD: 2.21 ± 0.69 vs 0.62 ± 0.24 mm) and in VWA (RCA: 30.96 ± 17.57 vs 2.1 ± 1.2 mm2; LAD: 19.53 ± 7.25 vs 3.6 ± 2.0 mm2) patients compared to controls (P < 0.001 for each variable). TVA values were also greater in patients compared to controls (RCA: 44.56 ± 21.87 vs 12.3 ± 4.2 mm2; LAD: 31.89 ± 11.31 vs 17.0 ± 6.2 mm2; P < 0.001). In contrast, the LA did not differ between patients and controls for RCA or LAD. When the LA was adjusted for vessel size using the LA/TVA ratio, a significant difference was found: 0.33 ± 0.16 in patients vs 0.82 ± 0.09 in controls (RCA) and 0.38 ± 0.13 vs 0.78 ± 0.06 (LAD) (P < 0.001). As opposed to normal controls, positive remodeling was present in all patients with CAD, as indicated by larger VWA. We conclude that MRI detected vessel wall abnormalities and was an effective tool for the noninvasive evaluation of the atherosclerotic process and coronary vessel wall modifications, including positive remodeling that frequently occurs in patients with acute coronary syndromes.
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