SBC -DCC October, 2019departamentos.cardiol.br/sbc-dcc/congresso2019/congresso... · 2019. 10....
Transcript of SBC -DCC October, 2019departamentos.cardiol.br/sbc-dcc/congresso2019/congresso... · 2019. 10....
SBC -DCC
October, 2019
Rio de Janeiro – RJ - Brazil
RM Cardiovascular
Cine-RM
FSE-T1
Tagging
FSE-T1 FSE-FatSat
Perfusão Cine-RM
Cine-RM
FLUXO
Perfusão Estresse
Realce Tardio
Realce Tardio
Realce Tardio
FSE-T2-Edema
Angio-RM
Mapa T1
DE-CMR↑↑↑↑ EC volume
Ischemic
- Always involvesubendocardium
-Related to coronary
territories
NonIschemic
-Probably will Notinvolve
subendocardium
-Not restricted to coronary
territories
Mahrholdt H et al European Heart Journal (2005) 26, 1461–1474
Kim et al., Circulation 1999;100:1992-2002.
Lima et al Circulation 1995;92:1117-1125
Rochitte, CE Circulation 1998; 98:1006-1014
Mewton . JACC 2011;57:891–903
DIFFUSE FIBROSIST1 Mapping and ECV
ECV= 26.7%
Magn Reson Imaging Clin N Am. 2015 Feb;23(1):25-34
DIFFUSE FIBROSIST1 Mapping and ECV
ECV= 26.7%
Fernandes and Rochitte. Reson Imaging Clin N Am. 2015 Feb;23(1):25-34
Puntmann V et al. Circ Res. 2016;119:277-299
CAD vs. Non Ischemic CMP
Puntmann V et al. Circ Res. 2016;119:277-299
DIFFUSE FIBROSIST1 Mapping and ECV
ECV= 26.7%
Magn Reson Imaging Clin N Am. 2015 Feb;23(1):25-34
Tang CX et al. Trends in Cardiovascular Medicine 0 0 0 (2018) 1–12
Kellman et al. Journal of Cardiovascular Magnetic Resonance 2012, 14:63
Liu et al. Journal of Cardiovascular Magnetic Resonance (2017) 19:74
T1 Map
Sado DM et al. Circ Cardiovasc Imaging. 2013;6:392-398
CMR in Hypertension Indications
Assess target organ damage Detect identifiable causes
Not in the guidelines Cardiac MR
LVH LA dilatation Myocardial Fibrosis Diastolic dysfunction Higher risk for CAD
Maceira and Mohiaddin JCMR 2012, 14:28
LVH Regression
Maceira and Mohiaddin JCMR 2012, 14:28
LV Dimension, Geometry and Function
Accurate and Precise for LV mass Gold-Standard for Volumes, Mass and Function Lower Intraobserver and Interobserver variablity
2.0-7.4% and 3.3 – 7.7%
LVH differential diagnosis HCM, infiltrative disease, Fabry´s, sarcoidosis,
aortic stenosis, exercise-induced, athlete´s heart
Maceira and Mohiaddin JCMR 2012, 14:28
Khan et al. Journal of Cardiovascular Magnetic Resonance (2019) 21:4
LA Volume Mortality
Khan et al. Journal of Cardiovascular Magnetic Resonance (2019) 21:4
LVH Differential Diagnosis
Maceira and Mohiaddin JCMR 2012, 14:28
Detection of Myocardial Fibrosis
Serum markers of fibrosis carboxyterminal propeptide of
procollagen type I (PIP), a marker of collagen synthesis
Querejeta R et al. Circulation 2000;101:1729–35.Maceira and Mohiaddin JCMR 2012, 14:28
Hemochromatosis-related hypertension
Nunez OC et al. ,Rev Esp Cardiol. 2017;70(12):1135
Cardiac T2* CMR identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major and is superior to serum ferritin and liver iron.Kirk P et al. C irculation. 2009;120:1961-1968
Modell B et al. JCMR 2008, 10:42Anderson LJ et al . 2001 Eur Heart J; 22: 2171–2179
Cardiac Siderosis
MF Histopathology Histological basis of myocardial LGE in patients with systemic hypertension:
localized myocardial interstitial fibrosis in the midwall (or outer myocardium) and replacement fibrosis in the subendocardium.
Chaowu Y et al. Circulation. 2014;130:2210-2212
MF in Arterial Hypertension
45% of patients with arterial hypertension showed DE on cardiac MRI
K. Andersen et al. European Journal of Radiology 71 (2009) 75–81
Tahir E et al.J Am Coll Cardiol Img 2018;11:1260–70
dsf
Rudolph A. et al.J Am Coll Cardiol 2009;53:284–91
Heart 2011;97:1257-1261.
Cardiopatia Congênita - VD
DAC - IsquemiaMiocárdica
Lockie T et al. J Am Coll Cardiol 2011;57:70–5
(%) RMC SPECT
Sens 86.5 66.5
Espec 83.4 82.6
VPP 77.2 71.4
VPN 90.5 79.1
Greenwood JP et. al. Lancet. 2012;379:453-60
TC Cardiovascular
Aorta torácica e abdominal
Maceira and Mohiaddin JCMR 2012, 14:28
Preditor de Eventos Coronários
Escore de Risco de Framingham
Greenland et al. JAMA 2004; 291:210-5
Escore de Risco de Framingham
Mohlenkamp et al. JACC 2011; 57:1455-64
Risk Markers Accuracy
Intermediate risk:
YEBOAH, J. et al. JAMA, 2012.
AUC FRS + CAC = 0,784AUC FRS + HF = 0,675
Thomas DM et al. Curr Cardiovasc Imaging Rep. 2015;8(6):18
O Que Fazer Depois
Grundy SM, et al.2018 Cholesterol Clinical Practice Guidelineshttps://doi.org/10.1016/j.jacc.2018.11.003
J Am Coll Cardiol 2009;54:49–57
15/02/2013 25/03/2014
Plaque Burden and Prognosis
Bittencourt MS et al . Circ Cardiovasc Imaging. 2014;7:282-291
Non Obstructive Extensive CAD
Obstructive Less Extensive CAD
O Que Fazer Depois
Thomas DM et al. Curr Cardiovasc Imaging Rep. 2015;8(6):18
Newby DE et al. N Engl J Med 2018;379:924-33.
A
B
C
D F
E
Cury, Rochitte et al . Am J Cardiol 2010:106:310-315
Single Center Study
Multi-Center Trial comparing 320 x 0.5mm CT & CTP to cath & SPECT
JHUJHU
BIDBID
INCORINCOR
LUMCLUMCChariteCharite IwateIwate
TGHTGH
Mt EMt E
MieMie
BWHBWHNIHNIH KeioKeio
EinsteinEinstein
NHCNHC
RigsRigs
St LukeSt Luke
Rochitte et al. European Heart Journal (2014) 35, 1120–1130
Rochitte et al. European Heart Journal (2014) 35, 1120–1130
FFRct vs. FFR
Discovery-Flow
J Am Coll Cardiol. 2011 Nov 1;58(19):1989-97.
DeFacto
Min JK et al. JAMA. 2012;308(12):1237-1245
NXT
Norgaard B, et al. J Am Coll Cardiol. 2014 Apr 1;63(12):1145-55
DIC 2018 – PREMIO MELHOR TRABALHO, HCOR
r=0,77p=0,0007
AcuráciaTCCor 53%
AcuráciaFFRct 80%
P=0,003
Média da diferença: -0,033
Limites de concordância: -0,176 – 0,111
Conclusões HAS Lesão de Órgão Alvo
Coração e Vasos (CoAo, Renovasc, Adrenais)
RMC Fibrose miocárdica
focal – RT difusa – Mapa T1 e ECV
Infarto e isquemia
TCC Estratificação de Risco Cardiovascular
Escore de Cálcio DAC não obstrutiva Placa Vulnerável
DAC obstrutiva Avaliação anatômica – angioTC de Coronárias Avaliação funcional Perfusão, CTP e FFRct
Instituto do Coração - InCor
Dr. Clério AzevedoDr. Guilherme AzevedoDr. Leonardo SaraDr. Afonso A. ShiozakiDr. Tiago SenraDra. Marly SilvaDr. Jorge A TorreãoDr. Joalbo AndradeDr. Marcelo NacifDr. Alexandre Volney Villa
Dr Adriano CarneiroDra. Valéria Melo MoreiraDr. Tiago MagalhãesDra. Juliana BelloDr. Carlos Prazeres
Hospital do Coração - HCor
Dr. Leonardo ZancanerDra. Roberta Iki MochidukyDr. Ricardo RochaDr. Roberto NeryDr. Mateus FahelDr. Carlos Henrique RassiDr. Fabio Petrucci
Dr. Bernardo AbreuDr. Fábio V. FernandesDra. Mariana LamaciéDr. Helder GomesDr. Matheus FreitasDr. Paulo Ferraz DiasDra. Natália AthaydeDra. Mariana BaptistaDr. Jasvan Leite de OliveiraDr. Jamil Calil NetoDr. Dário Quirino FirminoDr. Flavio Magnani LauandDr. Matheus L M GodoiDr. Issac Torquato Q e SilvaDra. Natália B SaçvattiiDra. Hilka CarvalhoDr. Pedro Macedo BarbosaDra. Paula Rodrigues CostaDra Fernanda Soares Rêgo
Dr. Pedro LemosDr. Amarino OliveiraDr. David BluemkeDr. João AC LimaProf. Dr. Roberto Kalil FilhoProf. Dr. Giovanni G. Cerri
Thank you for your Attention!!!
Dra. Simone C. S. CostaDra. Thais Pinheiro LimaDra. Renata Ávila CintraDr. Marcus PicoralDr. Ismar MarquesDr . Raphael Scoppetta
Dra. Jacob Sessim FilhoDra. Ariane PachecoDra. Gabriela SouzaDr. Ari AraújoDra. Carol ReiserDr. Antonildes Assunção Jr.Dra. Débora NakamuraDra. Alejandra VilanuevaDr. Bernardo LopesDr. Rodrigo MeloDra Liliane RochaDr. Ricardo OguroDra. Solange Ayala
Dra. Thamara C. MoraisDra. Elissa IshieDr. Marcelo M.CastroDra. Ana Carolina P. CostaDra. Bruna MS. AndradeDra. Giovanna AbdallaDra. Pricilla GianottoDra. Thalita CanevariDra. Andrea BerchtDr. Ivanhoé LeiteDr. Rosse OsórioDr. José Henrique de AndradeDr. José Roberto P da FonsecaDr. Marcelo MontemorDra Naiana ZaminDra. Renata M de SouzaDr. Nevelton Heringer Filho