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Article ; Online: Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up.

Kochi, Adriano Nunes / Vettor, Giulia / Dessanai, Maria Antonietta / Pizzamiglio, Francesca / Tondo, Claudio

2021 Volume 57, Issue 2

Abstract: Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the ... ...

Abstract	Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach.
MeSH term(s)	Athletes ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Electrocardiography ; Humans ; Mass Screening
Language	English
Publishing date	2021-02-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina57020168
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Article ; Online: Sudden Cardiac Death in Athletes

Adriano Nunes Kochi / Giulia Vettor / Maria Antonietta Dessanai / Francesca Pizzamiglio / Claudio Tondo

Medicina, Vol 57, Iss 168, p

From the Basics to the Practical Work-Up

2021 Volume 168

Abstract	Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach.
Keywords	sudden cardiac death ; athletes ; ventricular arrhythmias ; hypertrophic cardiomyopathy ; myocarditis ; arrhythmogenic right ventricular cardiomyopathy ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictors of Total Mortality and Serious Arrhythmic Events in Non-Ischemic Heart Failure Patients: The Role of Galectin-3.

Kochi, Adriano Nunes / Pimentel, Mauricio / Andrades, Michael / Zimerman, Tiago / Zimerman, Leandro Ioschpe / Rohde, Luis Eduardo

Arquivos brasileiros de cardiologia

2021 Volume 117, Issue 3, Page(s) 531–541

Abstract: Background: Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication.: Objective: To determine the role of galectin-3 ... ...

Title translation	Preditores de Mortalidade Total e Eventos Arrítmicos Graves em Pacientes com Insuficiência Cardíaca Não Isquêmica: O Papel da Galectina-3.
Abstract	Background: Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication. Objective: To determine the role of galectin-3 as a predictor of major arrhythmic events and overall mortality. Methods: We conducted a prospective cohort study that enrolled 148 non-ischemic HF patients. All patients underwent a comprehensive baseline clinical and laboratory assessment, including levels of serum galectin-3. The primary outcome was the occurrence of arrhythmic syncope, appropriate implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, or sudden cardiac death. The secondary outcome was all-cause death. For all statistical tests, a two-tailed p-value<0.05 was considered significant. Results: In a median follow-up of 941 days, the primary and secondary outcomes occurred in 26 (17.5%) and 30 (20%) patients, respectively. Serum galectin-3>22.5 ng/mL (highest quartile) did not predict serious arrhythmic events (HR: 1.98, p=0.152). Independent predictors of the primary outcome were left ventricular end-diastolic diameter (LVEDD)>73mm (HR: 3.70, p=0.001), exercise periodic breathing (EPB) on cardiopulmonary exercise testing (HR: 2.67, p=0.01), and non-sustained ventricular tachycardia (NSVT)>8 beats on Holter monitoring (HR: 3.47, p=0.027). Predictors of all-cause death were galectin-3>22.5 ng/mL (HR: 3.69, p=0.001), LVEDD>73mm (HR: 3.35, p=0.003), EPB (HR: 3.06, p=0.006), and NSVT>8 beats (HR: 3.95, p=0.007). The absence of all risk predictors was associated with a 91.1% negative predictive value for the primary outcome and 96.6% for total mortality. Conclusions: In non-ischemic HF patients, elevated galectin-3 levels did not predict major arrhythmic events but were associated with total mortality. Absence of risk predictors revealed a prevalent subgroup of HF patients with an excellent prognosis.
MeSH term(s)	Death, Sudden, Cardiac ; Defibrillators, Implantable ; Galectin 3/blood ; Heart Failure ; Humans ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Factors
Chemical Substances	Galectin 3
Language	Portuguese
Publishing date	2021-09-20
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	730261-7
ISSN	1678-4170 ; 0066-782X
ISSN (online)	1678-4170
ISSN	0066-782X
DOI	10.36660/abc.20200353
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Article ; Online: Cardiomyopathy Induced by Artificial Cardiac Pacing: To Whom, When, Why, and How? Insights on Heart Failure Development.

Ferrari, Andres Di Leoni / Oliveira, Eduardo Bartholomay / Tagliari, Ana Paula / Kochi, Adriano Nunes / Beuren, Thaís Mariel Andara / Cabral, Gustavo Chiari / Ferreira, Flávio Vinicius Costa / Danzmann, Luiz Cláudio

Brazilian journal of cardiovascular surgery

2023 Volume 38, Issue 2, Page(s) 278–288

Abstract: Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to ... ...

Abstract	Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical "dyssynchronopathy" with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chronic effect of abnormal impulse conduction and nonphysiological ectopic activation by artificial cardiac pacing is suspected to affect metabolism and myocardial perfusion, triggering regional differences in the activation/contraction processes that cause electrical and structural remodeling due to damage, inflammation, and fibrosis of the cardiac tissue. The effect of artificial cardiac pacing on ventricular function and structure can be multifactorial, and biological factors underlying PiCM could affect the time and probability of developing the condition. PiCM has not been included in the traditional classification of cardiomyopathies, which can hinder detection. This article reviews the available evidence for pacing-induced cardiovascular disease, the current understanding of its pathophysiology, and reinforces the adverse effects of right ventricular pacing, especially right ventricular pacing burden (commonly measured in percentage) and its repercussion on ventricular contraction (reflected by the impact on left ventricular systolic function). These effects might be the main defining criteria and determining mechanisms of the pathophysiology and the clinical repercussion seen on patients.
MeSH term(s)	Humans ; Cardiomyopathies/etiology ; Cardiomyopathies/therapy ; Heart Failure/etiology ; Heart Failure/therapy ; Cardiac Pacing, Artificial/adverse effects ; Ventricular Function, Left ; Arrhythmias, Cardiac
Language	English
Publishing date	2023-04-23
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2031026-2
ISSN	1678-9741 ; 1678-9741
ISSN (online)	1678-9741
ISSN	1678-9741
DOI	10.21470/1678-9741-2021-0629
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Article ; Online: Insights from the axillary vein puncture guided by ultrasound versus cephalic vein dissection trial.

Tagliari, Ana Paula / Kochi, Adriano Nunes / Saadi, Rodrigo Petersen / Mastella, Bernardo / Saadi, Eduardo Keller / Polanczyk, Carisi Anne

Future cardiology

2021 Volume 17, Issue 6, Page(s) 923–929

Abstract: Axillary vein puncture guided by ultrasound (US-Ax) versus cephalic vein dissection in pacemaker and defibrillator implant: a multicenter randomized clinical trial is a recently published study in which 88 patients were randomized in a 1:1 fashion to one ...

Abstract	Axillary vein puncture guided by ultrasound (US-Ax) versus cephalic vein dissection in pacemaker and defibrillator implant: a multicenter randomized clinical trial is a recently published study in which 88 patients were randomized in a 1:1 fashion to one of the two methods. Even being performed by operators with not previous ultrasound-guided axillary vein puncture experience, this group presented a higher success rate, lower procedural time and comparable complication incidence.
MeSH term(s)	Axillary Vein/diagnostic imaging ; Axillary Vein/surgery ; Defibrillators, Implantable ; Dissection ; Humans ; Phlebography ; Punctures ; Ultrasonography, Interventional
Language	English
Publishing date	2021-02-18
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2274267-0
ISSN	1744-8298 ; 1479-6678
ISSN (online)	1744-8298
ISSN	1479-6678
DOI	10.2217/fca-2020-0190
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Article ; Online: Cardiac and arrhythmic complications in patients with COVID-19.

Kochi, Adriano Nunes / Tagliari, Ana Paula / Forleo, Giovanni Battista / Fassini, Gaetano Michele / Tondo, Claudio

Journal of cardiovascular electrophysiology

2020 Volume 31, Issue 5, Page(s) 1003–1008

Abstract: In December 2019, the world started to face a new pandemic situation, the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Although coronavirus disease (COVID-19) clinical manifestations are mainly respiratory, major cardiac complications ... ...

Abstract	In December 2019, the world started to face a new pandemic situation, the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Although coronavirus disease (COVID-19) clinical manifestations are mainly respiratory, major cardiac complications are being reported. Cardiac manifestations etiology seems to be multifactorial, comprising direct viral myocardial damage, hypoxia, hypotension, enhanced inflammatory status, ACE2-receptors downregulation, drug toxicity, endogenous catecholamine adrenergic status, among others. Studies evaluating patients with COVID-19 presenting cardiac injury markers show that it is associated with poorer outcomes, and arrhythmic events are not uncommon. Besides, drugs currently used to treat the COVID-19 are known to prolong the QT interval and can have a proarrhythmic propensity. This review focus on COVID-19 cardiac and arrhythmic manifestations and, in parallel, makes an appraisal of other virus epidemics as SARS-CoV, Middle East respiratory syndrome coronavirus, and H1N1 influenza.
MeSH term(s)	Arrhythmias, Cardiac/complications ; Arrhythmias, Cardiac/virology ; Betacoronavirus ; COVID-19 ; Cardiomyopathies/complications ; Cardiomyopathies/virology ; Coronavirus ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Humans ; Male ; Myocarditis/complications ; Myocarditis/virology ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.14479
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Article ; Online: Cardiac and arrhythmic complications in patients with COVID‐19

Kochi, Adriano Nunes / Tagliari, Ana Paula / Forleo, Giovanni Battista / Fassini, Gaetano Michele / Tondo, Claudio

Journal of Cardiovascular Electrophysiology

2020 Volume 31, Issue 5, Page(s) 1003–1008

Keywords	Physiology (medical) ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.14479
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Article ; Online: Infective endocarditis profile, prognostic factors and in-hospital mortality: 6-year trends from a tertiary university center in South America.

Tagliari, Ana Paula / Steckert, Gabriela Vieira / da Silveira, Lucas Molinari Veloso / Kochi, Adriano Nunes / Wender, Orlando Carlos Belmonte

Journal of cardiac surgery

2020 Volume 35, Issue 8, Page(s) 1905–1911

Abstract: Background: Infective endocarditis (IE) remains an expressive health problem with high morbimortality rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries.: Aim: This study aims to ... ...

Abstract	Background: Infective endocarditis (IE) remains an expressive health problem with high morbimortality rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries. Aim: This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors. Methods: An observational, retrospective study of 167 patients, who fulfilled modified Duke's criteria during a six-year enrollment period, from January 2010 to December 2015. The primary outcome was defined as in-hospital mortality analyzed according to treatment received (clinical vs surgical). Multivariate analysis identified mortality predictors. Results: The median age was 60 years (Q Conclusion: This study presents IE profile and all-cause mortality in a large patient's cohort, comprising a 6-years' time window, a rare initiative in developing countries. Elderly and male patients predominated, while S. aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.
MeSH term(s)	Cohort Studies ; Endocarditis/epidemiology ; Endocarditis/microbiology ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; South America/epidemiology ; Time Factors
Language	English
Publishing date	2020-06-29
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.14787
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Article ; Online: Update in Heart Rhythm Abnormalities and Indications for Pacemaker After Transcatheter Aortic Valve Implantation.

Saadi, Marina / Tagliari, Ana Paula / Danzmann, Luiz Cláudio / Bartholomay, Eduardo / Kochi, Adriano Nunes / Saadi, Eduardo Keller

Brazilian journal of cardiovascular surgery

2018 Volume 33, Issue 3, Page(s) 286–290

Abstract: Objective: Rhythm abnormalities following transcatheter aortic valve implantation (TAVI) and indications for permanent pacemaker implantation (PPI) were reviewed, which aren't well established in the current guidelines. New left bundle branch block and ... ...

Abstract	Objective: Rhythm abnormalities following transcatheter aortic valve implantation (TAVI) and indications for permanent pacemaker implantation (PPI) were reviewed, which aren't well established in the current guidelines. New left bundle branch block and atrioventricular block are the most common electrocardiographic changes after TAVI. PPI incidence ranges from 9-42% for self-expandable and 2.5-11.5% for balloon expandable devices. Not only anatomical variations in conduction system have an important role in conduction disorders, but different valve characteristics and their relationship with cardiac structures as well. Previous right bundle branch block has been confirmed as one of the most significant predictors for PPI.
MeSH term(s)	Arrhythmias, Cardiac/etiology ; Arrhythmias, Cardiac/therapy ; Cardiac Pacing, Artificial/methods ; Humans ; Pacemaker, Artificial ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome
Language	English
Publishing date	2018-07-25
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2031026-2
ISSN	1678-9741 ; 0102-7638
ISSN (online)	1678-9741
ISSN	0102-7638
DOI	10.21470/1678-9741-2017-0206
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Article ; Online: Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: A multicenter randomized clinical trial.

Tagliari, Ana Paula / Kochi, Adriano Nunes / Mastella, Bernardo / Saadi, Rodrigo Petersen / di Leoni Ferrari, Andres / Saadi, Eduardo Keller / Polanczyk, Carisi Anne

Heart rhythm

2020 Volume 17, Issue 9, Page(s) 1554–1560

Abstract: Background: Axillary vein puncture guided by ultrasound (US-Ax) has emerged as a valid alternative access route to pacemaker and defibrillator lead insertion.: Objective: The purpose of this study was to evaluate whether US-Ax compared to cephalic ... ...

Abstract	Background: Axillary vein puncture guided by ultrasound (US-Ax) has emerged as a valid alternative access route to pacemaker and defibrillator lead insertion. Objective: The purpose of this study was to evaluate whether US-Ax compared to cephalic vein dissection (CV) improves success and early complications in pacemaker or defibrillator implant. Methods: This prospective, multicenter clinical trial included 88 adult patients randomized 1:1 to US-Ax (n = 44) or CV (n = 44). All procedures were performed by operators with no previous experience in axillary approach. Primary endpoint was defined as success rate. Secondary endpoints were venous access site change, time to obtain venous access, total procedural time, and early complication rate. Analyses were performed using the intention-to-treat principle. Results: Median age was 70.5 years (58.2-79.7), and 60.2% were male. For the primary outcome, a higher success rate was observed in the axillary group (97.7% vs 54.5%; P <.001), as well as a lower rate of venous access site change (2.3% vs 40.9%; P <.001) and shorter time to obtain venous access (5 vs 15 minutes; P <.001) and procedural time (40 vs 51 minutes; P = .010), with no difference in complication rate (2.3% vs 11.4%; P =.20). In multivariate analysis, US-Ax (P <.001), single-chamber device (P = .015), and body mass index (P = .015) were independent predictors of overall success. Conclusion: This is the first randomized trial comparing self-learned US-Ax to CV in cardiac lead implantation. Our results indicate that the axillary approach was superior in terms of success rate, time to obtain venous access and procedural time, with similar complication rate.
MeSH term(s)	Aged ; Aged, 80 and over ; Arrhythmias, Cardiac/diagnosis ; Arrhythmias, Cardiac/therapy ; Axillary Vein/diagnostic imaging ; Axillary Vein/surgery ; Catheterization, Peripheral/methods ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; Phlebography ; Prospective Studies ; Prosthesis Implantation/methods ; Punctures/methods ; Surgery, Computer-Assisted/methods ; Ultrasonography
Language	English
Publishing date	2020-04-29
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2020.04.030
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