Marcos Denk - Academia.edu (original) (raw)

Papers by Marcos Denk

Research paper thumbnail of Decellularized Wharton’s Jelly: Biomaterial Potential for Regenerative Medicine Applications - A Mini-Review

Brazilian Archives of Biology and Technology

The use of Wharton's Jelly (WJ) as a biomaterial is currently undergoing an appearance in the reg... more The use of Wharton's Jelly (WJ) as a biomaterial is currently undergoing an appearance in the regenerative medicine field. The biomaterials applications focus on the aspects of cellular growth or delivery of proteins capable of stimulating cellular response. However, the basic knowledge about Wharton jelly and decellularization processing technology combined with understanding the physical-chemical properties of this biomaterial is necessary for proper application in regenerative medicine. This mini-review article summarizes information on the composition of WJ, application of drug delivery, in medicine and discusses recent HIGHLIGHTS • Wharton's Jelly (WJ) can stimulate cellular response. • WJ promotes cell proliferation, adhesion, differentiation, and migration. • WJ 3D printing scaffold can increase the healing tissue potential. • WJ contains a variety of growth factors that promote tissue regeneration.

Research paper thumbnail of Fractional Flow Reserve: Should be the Gold Standard for TherapeuticDefinition of Coronary Artery Disease?

The ideal Coronary Artery Disease (CAD) treatment strategy should be defined based on the results... more The ideal Coronary Artery Disease (CAD) treatment strategy should be defined based on the results from functional and anatomical examinations according to current guidelines [1]. However, this concept is apparently being overlooked by some centers, where percutaneous coronary intervention (PCI) is used to treat coronary lesions with ≤50% diameter stenosis, regardless of their functional repercussion [2-8]. Concern about the unnecessary revascularization of the myocardium motivated some cardiologists to develop the concept of functional PCI, where through the measurement of coronary fractional flow reserve (FFR) the therapeutic decision can be made [9]. Validated for clinical use in 1996 by Nico Pijls [10], FFR has gained popularity in interventional cardiology since then. It is important to note that its indications were strengthened by three studies with a small number of patients (1375 in total) and using different methods: the pioneering study by Nico Pijls the DEFER trial, and t...

Research paper thumbnail of The Evolution of Percutaneous Coronary Intervention in Latin America

Research paper thumbnail of Absorb bioresorbable vascular scaffold outcomes following implantation with routine intravascular imaging guidance

Catheterization and Cardiovascular Interventions

We sought to describe the outcomes of BVS use from a single‐center experience in which scaffold i... more We sought to describe the outcomes of BVS use from a single‐center experience in which scaffold implantation was guided by intravascular imaging (ultrasound and/or optical coherence tomography) to identify and treat mechanical factors potentially related to BVS failure.

Research paper thumbnail of Long Term Clinical Outcomes After Implantation of Absorb BVS in a Real World Setting, with Pre Dilatation and Guided by Intravascular Imaging

Journal of the American College of Cardiology

The safety and performance of the Absorb Bioresorbable Vascular Scaffold (BVS) has been previousl... more The safety and performance of the Absorb Bioresorbable Vascular Scaffold (BVS) has been previously demonstrated with clinical data. However, these trials included patients with simple lesions. The Absorb III trial demonstrated an excess of adverse events following BVS implantation. Aiming to

Research paper thumbnail of Correlação Entre as Lesões Coronarianas Diagnosticadas Pela Angiotomografia e as Diagnosticadas Pelo Método Visual Da Cineangiocoronariografia

Revista da Sociedade de Cardiologia do Estado de São Paulo

Research paper thumbnail of TCT-194 Impact of Intravascular Imaging Methods for Optimal Scaffold Implantation Reducing Thrombosis After Absorb BVS in a Real World Setting: Identification of Probable Factors Related to Stent Failure

Journal of the American College of Cardiology

Research paper thumbnail of Clinical Outcomes After Implantation of Absorb BVS in a Real World Setting, with Pre- and Post-Dilatation, Guided by Intravascular Ultrasound & Optical Coherence Tomography

Journal of the American College of Cardiology

Research paper thumbnail of Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

Arquivos Brasileiros de Cardiologia, 2016

Background: Functional assessment of coronary artery obstruction is used in cardiology practice t... more Background: 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 cutoff value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

Research paper thumbnail of Tratamento pecutâneo de pseudoaneurisma da zona fibrosa intervalvar mitroaórtica

Rev Bras Cardiol Invasiva, Sep 1, 2011

Research paper thumbnail of Clinical follow-up of patients with unprotected left main disease undergoing percutaneous coronary intervention with drug-eluting stents

BACKGROUND: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has... more BACKGROUND: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has proven to be a feasible option in selected patients with unprotected left main (LM) disease. This study was aimed at assessing the efficacy and safety of PCI with DES in LM lesions in the daily practice, analyzing the long-term occurrence of major adverse cardiac events (MACE). METHODS: A total of 142 consecutive patients were treated with a mean follow-up of 917 ± 743 days. The decision to use one or two stents or glycoprotein IIb/IIIa inhibitors was left to the operator's discretion. Coronary angiography was not performed routinely in the follow-up. RESULTS: Mean age was 67.5 ± 16 years, 75% of the patients were male, 29% had diabetes and 39% had unstable angina. A total of 2.75 ± 1.25 stents were implanted per patient. Bifurcation lesions were identified in 90.1% and the most frequent techniques were the provisional stent in 36% and small crush in 29% of the patients. Intravascul...

Research paper thumbnail of Aterectomia rotacional para o tratamento da reestenose intrastent

Revista Brasileira de Cardiologia Invasiva, 2009

Research paper thumbnail of Análise ultrassonográfica tardia do stent eluidor de sirolimus FirebirdTM

Revista Brasileira de Cardiologia Invasiva, 2011

Research paper thumbnail of Evolução clínica de pacientes com lesões de tronco de coronária esquerda não-protegido submetidos a angioplastia coronária com implante de stents farmacológicos

Revista Brasileira de Cardiologia Invasiva, 2011

Research paper thumbnail of TCTAP A-211 Diagnostic Accuracy of Fractional Flow Reserve to Detect Coronary Ischemic Lesions in Daily Practice

Journal of the American College of Cardiology, 2014

Clinical trials have shown low rates of clinical events in patients undergoing PCI of ischemic le... more Clinical trials have shown low rates of clinical events in patients undergoing PCI of ischemic lesions only as determined by a fractional flow reserve <0.8. However there is few data showing the diagnostic accuracy of FFR in real world practice. Since 3/11 until 7/13 a total of 324 coronary lesions

Research paper thumbnail of Rotational atherectomy for the treatment of in-stent restenosis

Research paper thumbnail of Percutaneous Left Atrial Appendage Occlusion: Feasibility, Safety and Effect on Echocardiographic Parameters of Cardiac Function and Anatomy

Received on 01/04/2013; accepted on 27/05/2013 Introduction Atrial Fibrillation (AF) is the most ... more Received on 01/04/2013; accepted on 27/05/2013 Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, associating with significant morbidity-mortality and cost1. AF increases the risk of cardiac thromboembolism, estimating 5% of the average annual rate of Ischemic Cerebral Vascular Accident (ICVA) in individuals with A of non-valvular origin1. Oral anticoagulation with vitamin K antagonists, especially warfarin, reduces the incidence of ICVA, but this treatment is underused for several reasons2.It is estimated that only 50% of the patients with indication are effectively treated with warfarine3. The recent introduction of new anticoagulant Percutaneous Left Atrial Appendage Occlusion: Feasibility, Safety and Effect on Echocardiographic Parameters of Cardiac Function and Anatomy

Research paper thumbnail of Percutaneous treatment of pseudoaneurysm of the mitral-aortic intervalvular fibrosa

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAF) is a rare disease, usually secon... more Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAF) is a rare disease, usually secondary to aortic valve endocarditis, particularly in prosthetic valves. Its clinical course is variable and may potentially cause serious complications, such as rupture into the pericardium, aorta or left atrium, systolic compression of the coronary arteries or systolic compression of the mitral valve, leading to severe mitral regurgitation, for which surgical treatment is recommended. This is a case report of a 69 year-old asymptomatic patient, with a prior history of two coronary artery bypass graft surgeries, the latter associated with aortic valve replacement. The PMAF was incidentally diagnosed in the late follow-up, and a decision was made to perform percutaneous therapy with the AmplatzerTM Muscular VSD Occluder.

Research paper thumbnail of Decellularized Wharton’s Jelly: Biomaterial Potential for Regenerative Medicine Applications - A Mini-Review

Brazilian Archives of Biology and Technology

The use of Wharton's Jelly (WJ) as a biomaterial is currently undergoing an appearance in the reg... more The use of Wharton's Jelly (WJ) as a biomaterial is currently undergoing an appearance in the regenerative medicine field. The biomaterials applications focus on the aspects of cellular growth or delivery of proteins capable of stimulating cellular response. However, the basic knowledge about Wharton jelly and decellularization processing technology combined with understanding the physical-chemical properties of this biomaterial is necessary for proper application in regenerative medicine. This mini-review article summarizes information on the composition of WJ, application of drug delivery, in medicine and discusses recent HIGHLIGHTS • Wharton's Jelly (WJ) can stimulate cellular response. • WJ promotes cell proliferation, adhesion, differentiation, and migration. • WJ 3D printing scaffold can increase the healing tissue potential. • WJ contains a variety of growth factors that promote tissue regeneration.

Research paper thumbnail of Fractional Flow Reserve: Should be the Gold Standard for TherapeuticDefinition of Coronary Artery Disease?

The ideal Coronary Artery Disease (CAD) treatment strategy should be defined based on the results... more The ideal Coronary Artery Disease (CAD) treatment strategy should be defined based on the results from functional and anatomical examinations according to current guidelines [1]. However, this concept is apparently being overlooked by some centers, where percutaneous coronary intervention (PCI) is used to treat coronary lesions with ≤50% diameter stenosis, regardless of their functional repercussion [2-8]. Concern about the unnecessary revascularization of the myocardium motivated some cardiologists to develop the concept of functional PCI, where through the measurement of coronary fractional flow reserve (FFR) the therapeutic decision can be made [9]. Validated for clinical use in 1996 by Nico Pijls [10], FFR has gained popularity in interventional cardiology since then. It is important to note that its indications were strengthened by three studies with a small number of patients (1375 in total) and using different methods: the pioneering study by Nico Pijls the DEFER trial, and t...

Research paper thumbnail of The Evolution of Percutaneous Coronary Intervention in Latin America

Research paper thumbnail of Absorb bioresorbable vascular scaffold outcomes following implantation with routine intravascular imaging guidance

Catheterization and Cardiovascular Interventions

We sought to describe the outcomes of BVS use from a single‐center experience in which scaffold i... more We sought to describe the outcomes of BVS use from a single‐center experience in which scaffold implantation was guided by intravascular imaging (ultrasound and/or optical coherence tomography) to identify and treat mechanical factors potentially related to BVS failure.

Research paper thumbnail of Long Term Clinical Outcomes After Implantation of Absorb BVS in a Real World Setting, with Pre Dilatation and Guided by Intravascular Imaging

Journal of the American College of Cardiology

The safety and performance of the Absorb Bioresorbable Vascular Scaffold (BVS) has been previousl... more The safety and performance of the Absorb Bioresorbable Vascular Scaffold (BVS) has been previously demonstrated with clinical data. However, these trials included patients with simple lesions. The Absorb III trial demonstrated an excess of adverse events following BVS implantation. Aiming to

Research paper thumbnail of Correlação Entre as Lesões Coronarianas Diagnosticadas Pela Angiotomografia e as Diagnosticadas Pelo Método Visual Da Cineangiocoronariografia

Revista da Sociedade de Cardiologia do Estado de São Paulo

Research paper thumbnail of TCT-194 Impact of Intravascular Imaging Methods for Optimal Scaffold Implantation Reducing Thrombosis After Absorb BVS in a Real World Setting: Identification of Probable Factors Related to Stent Failure

Journal of the American College of Cardiology

Research paper thumbnail of Clinical Outcomes After Implantation of Absorb BVS in a Real World Setting, with Pre- and Post-Dilatation, Guided by Intravascular Ultrasound & Optical Coherence Tomography

Journal of the American College of Cardiology

Research paper thumbnail of Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

Arquivos Brasileiros de Cardiologia, 2016

Background: Functional assessment of coronary artery obstruction is used in cardiology practice t... more Background: 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 cutoff value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

Research paper thumbnail of Tratamento pecutâneo de pseudoaneurisma da zona fibrosa intervalvar mitroaórtica

Rev Bras Cardiol Invasiva, Sep 1, 2011

Research paper thumbnail of Clinical follow-up of patients with unprotected left main disease undergoing percutaneous coronary intervention with drug-eluting stents

BACKGROUND: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has... more BACKGROUND: Recently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has proven to be a feasible option in selected patients with unprotected left main (LM) disease. This study was aimed at assessing the efficacy and safety of PCI with DES in LM lesions in the daily practice, analyzing the long-term occurrence of major adverse cardiac events (MACE). METHODS: A total of 142 consecutive patients were treated with a mean follow-up of 917 ± 743 days. The decision to use one or two stents or glycoprotein IIb/IIIa inhibitors was left to the operator's discretion. Coronary angiography was not performed routinely in the follow-up. RESULTS: Mean age was 67.5 ± 16 years, 75% of the patients were male, 29% had diabetes and 39% had unstable angina. A total of 2.75 ± 1.25 stents were implanted per patient. Bifurcation lesions were identified in 90.1% and the most frequent techniques were the provisional stent in 36% and small crush in 29% of the patients. Intravascul...

Research paper thumbnail of Aterectomia rotacional para o tratamento da reestenose intrastent

Revista Brasileira de Cardiologia Invasiva, 2009

Research paper thumbnail of Análise ultrassonográfica tardia do stent eluidor de sirolimus FirebirdTM

Revista Brasileira de Cardiologia Invasiva, 2011

Research paper thumbnail of Evolução clínica de pacientes com lesões de tronco de coronária esquerda não-protegido submetidos a angioplastia coronária com implante de stents farmacológicos

Revista Brasileira de Cardiologia Invasiva, 2011

Research paper thumbnail of TCTAP A-211 Diagnostic Accuracy of Fractional Flow Reserve to Detect Coronary Ischemic Lesions in Daily Practice

Journal of the American College of Cardiology, 2014

Clinical trials have shown low rates of clinical events in patients undergoing PCI of ischemic le... more Clinical trials have shown low rates of clinical events in patients undergoing PCI of ischemic lesions only as determined by a fractional flow reserve <0.8. However there is few data showing the diagnostic accuracy of FFR in real world practice. Since 3/11 until 7/13 a total of 324 coronary lesions

Research paper thumbnail of Rotational atherectomy for the treatment of in-stent restenosis

Research paper thumbnail of Percutaneous Left Atrial Appendage Occlusion: Feasibility, Safety and Effect on Echocardiographic Parameters of Cardiac Function and Anatomy

Received on 01/04/2013; accepted on 27/05/2013 Introduction Atrial Fibrillation (AF) is the most ... more Received on 01/04/2013; accepted on 27/05/2013 Introduction Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, associating with significant morbidity-mortality and cost1. AF increases the risk of cardiac thromboembolism, estimating 5% of the average annual rate of Ischemic Cerebral Vascular Accident (ICVA) in individuals with A of non-valvular origin1. Oral anticoagulation with vitamin K antagonists, especially warfarin, reduces the incidence of ICVA, but this treatment is underused for several reasons2.It is estimated that only 50% of the patients with indication are effectively treated with warfarine3. The recent introduction of new anticoagulant Percutaneous Left Atrial Appendage Occlusion: Feasibility, Safety and Effect on Echocardiographic Parameters of Cardiac Function and Anatomy

Research paper thumbnail of Percutaneous treatment of pseudoaneurysm of the mitral-aortic intervalvular fibrosa

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAF) is a rare disease, usually secon... more Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAF) is a rare disease, usually secondary to aortic valve endocarditis, particularly in prosthetic valves. Its clinical course is variable and may potentially cause serious complications, such as rupture into the pericardium, aorta or left atrium, systolic compression of the coronary arteries or systolic compression of the mitral valve, leading to severe mitral regurgitation, for which surgical treatment is recommended. This is a case report of a 69 year-old asymptomatic patient, with a prior history of two coronary artery bypass graft surgeries, the latter associated with aortic valve replacement. The PMAF was incidentally diagnosed in the late follow-up, and a decision was made to perform percutaneous therapy with the AmplatzerTM Muscular VSD Occluder.