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Papers by Sergio Perez Melo

Journal of the American College of Cardiology, 2014

qTc dispersion on 12-lead elecTrocardiograM is inversely correlaTed wiTh T1 relaxaTion TiMes in p... more qTc dispersion on 12-lead elecTrocardiograM is inversely correlaTed wiTh T1 relaxaTion TiMes in paTienTs wiTh hyperTrophic cardioMyopaThy

Journal of Arrhythmia, 2017

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, ... more Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411 738 ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p o0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, p ¼0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

Stats, 2020

Ridge regression is a popular method to solve the multicollinearity problem for both linear and n... more Ridge regression is a popular method to solve the multicollinearity problem for both linear and non-linear regression models. This paper studied forty different ridge regression t-type tests of the individual coefficients of a linear regression model. A simulation study was conducted to evaluate the performance of the proposed tests with respect to their empirical sizes and powers under different settings. Our simulation results demonstrated that many of the proposed tests have type I error rates close to the 5% nominal level and, among those, all tests except one have considerable gain in powers over the standard ordinary least squares (OLS) t-type test. It was observed from our simulation results that seven tests based on some ridge estimators performed better than the rest in terms of achieving higher power gains while maintaining a 5% nominal size.

Journal of the American College of Cardiology, 2014

qTc dispersion on 12-lead elecTrocardiograM is inversely correlaTed wiTh T1 relaxaTion TiMes in p... more qTc dispersion on 12-lead elecTrocardiograM is inversely correlaTed wiTh T1 relaxaTion TiMes in paTienTs wiTh hyperTrophic cardioMyopaThy

Journal of Arrhythmia, 2017

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, ... more Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411 738 ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p o0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, p ¼0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

Stats, 2020

Ridge regression is a popular method to solve the multicollinearity problem for both linear and n... more Ridge regression is a popular method to solve the multicollinearity problem for both linear and non-linear regression models. This paper studied forty different ridge regression t-type tests of the individual coefficients of a linear regression model. A simulation study was conducted to evaluate the performance of the proposed tests with respect to their empirical sizes and powers under different settings. Our simulation results demonstrated that many of the proposed tests have type I error rates close to the 5% nominal level and, among those, all tests except one have considerable gain in powers over the standard ordinary least squares (OLS) t-type test. It was observed from our simulation results that seven tests based on some ridge estimators performed better than the rest in terms of achieving higher power gains while maintaining a 5% nominal size.