Antonio Luiz Pinho Ribeiro

Federal University of Minas Gerais | UFMG · Hospital das Clínicas

Background Individuals in the indeterminate phase of Chagas disease are considered to have mortality rates similar to those of the overall population. This study compares mortality rates among blood donors seropositive for Chagas disease and negative controls in the city of São Paulo, Brazil. Methodology/principal findings This is a retrospective...

The electrocardiogram (ECG) is a simple and useful clinical tool; nevertheless, few studies have evaluated the prevalence of electrocardiographic abnormalities in the Latin American population. This study aims to evaluate the major electrocardiographic abnormalities according to the Minnesota coding system in Brazilian adults, stratified by sex, ag...

Background Microvascular dysfunction is a marker of early vascular disease that predicts cardiovascular events. Whether metabolically healthy obese individuals have impaired microvascular function remains unclear. The aim of this study was to evaluate the relation of obesity phenotypes stratified by metabolic status to microvascular function. Meth...

In patients with cardiovascular diseases, comprehensive risk factor control and lifestyle modification reduce the risk of recurrent events and the need for revascularisation procedures, and improve survival and quality of life.1 Despite this convincing evidence, in the real world, there are several barriers that hamper the application of such measu...

Brazil is a large country, with an evolving economy, but marked social inequalities. The population is formed by an admixture of native Brazilians, Europeans, and Africans; is predominantly urban; and faces rapid aging. Time trends related to health behaviors show a substantial reduction in smoking rates, but a rising prevalence of overweight and o...

The electrocardiogram (ECG) can capture obesity-related cardiac changes. Artificial intelligence-enhanced ECG (AI-ECG) can identify subclinical disease. We trained an AI-ECG model to predict body mass index (BMI) from the ECG alone. Developed from 512,950 12-lead ECGs from the Beth Israel Deaconess Medical Center (BIDMC), a secondary care cohort, a...

Aims Despite notable population differences in high-income and low- and middle-income countries (LMICs), national guidelines in LMICs often recommend using US-based cardiovascular disease (CVD) risk scores for treatment decisions. We examined the performance of widely used international CVD risk scores within the largest Brazilian community-based c...

Background Hypertension underpins significant global morbidity and mortality. Hypertension-mediated organ damage is an early indicator of serious cardiovascular sequelae, with multinational guidelines advocating aggressive treatment where detected. Artificial intelligence-enabled electrocardiogram (AI-ECG) offers novel strategies to facilitate pers...

Importance Despite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) can enable large-scale community-based risk assessment. Objective To evaluate an artificial intelligence (AI) algorithm to pre...

Background: Current risk stratification strategies for heart failure (HF) risk require either specific blood-based biomarkers or comprehensive clinical evaluation. In this study, we evaluated the use of artificial intelligence (AI) applied to images of electrocardiograms (ECGs) to predict HF risk. Methods: Across multinational longitudinal cohorts...

Aims Electrocardiogram (ECG) is widely considered the primary test for evaluating cardiovascular diseases. However, the use of artificial intelligence (AI) to advance these medical practices and learn new clinical insights from ECGs remains largely unexplored. We hypothesize that AI models with a specific design can provide fine-grained interpretat...

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determ...

Introduction Despite advancements in implantable cardioverter‐defibrillator (ICD) technology, sudden cardiac death (SCD) remains a persistent public health concern. Chagas disease (ChD), prevalent in Brazil, is associated with increased ventricular tachycardia (VT) and ventricular fibrillation (VF) events and SCD compared to other cardiomyopathies....

Parasitemia and inflammatory markers are cross-sectionally associated with chronic Chagas cardiomyopathy (CCC) among patients with Trypanosoma cruzi. However, the prospective association of the parasite load and host immune response-related characteristics with CCC (that is, progressors) among T. cruzi seropositive individuals has only been partial...

The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Repor...

Introduction: Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospita...

Introduction: Tele-cardiology tools are valuable strategies to improve risk stratification, especially in low-resourced settings. We aimed to evaluate the accuracy of tele-electrocardiography (ECG) in remote sites to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 healthcare workers at 16 PC...

Introduction: Chagas disease (CD) is a neglected disease caused by Trypanosoma cruzi ( T. cruzi ), and benznidazole (BZN) is the most prescribed trypanocidal drug in Brazil in function of its best tolerability profile. While treatment with this drug is effective in acute disease, there is no consensus on its effectiveness in adults with chronic inf...

Introduction: The COVID-19 pandemic led to a reduction in cardiovascular (CVD) hospital admissions in many countries. We aimed to assess the effect of the COVID-19 pandemic on CVD hospitalizations, management, and mortality in Brazil. Methods: Hospitalization data for the years 2020 and 2021 for Brazil and regions were analyzed using the Datasus ho...

Background: Handheld echocardiography (echo) is the tool of choice for Rheumatic Heart Disease (RHD) screening, based on the 2012 World Heart Federation (WHF) Criteria. We aimed to assess the agreement between screening and standard echo for diagnosis of latent RHD in schoolchildren from an endemic setting. Methods: Over 14 months, 3 non-physicians...

Background: Direct oral anticoagulants (DOACs) have progressively replaced vitamin K antagonists (VKAs). However, in certain conditions, especially antiphospholipid syndrome, mechanical heart valves and rheumatic mitral stenosis, VKAs remain the only drugs with established safety and efficacy. In low-income contexts, they are frequently the preferr...

Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC...

Background Deep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an ECG-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aim...

Introduction: Even with the increased use of telehealth from the COVID-19 pandemic onward, there needs to be more knowledge about its usability for patients with non-communicable diseases from the point of view of the health professional, which is the main objective of this study. The secondary objectives will be to describe the user’s profile, dis...

Background: Worldwide, it is estimated that over 6 million people are infected with Chagas disease (ChD). It is a neglected disease that can lead to severe heart conditions in its chronic phase. While early treatment can avoid complications, the early-stage detection rate is low. We explore the use of deep neural networks to detect ChD from electr...

Background: Deep neural networks have been used to estimate age from ECGs, the electrocardiographic age (ECG-age), which predicts adverse outcomes. However, this prediction ability has been restricted to clinical settings or relatively short periods. We hypothesized that ECG-age is associated with death and cardiovascular outcomes in the long-stan...

Background Subtle, prognostically-meaningful ECG features may not be apparent to physicians. In the course of supervised machine learning ML training, many thousands of ECG features are identified. These are not limited to conventional ECG parameters and morphology. These novel neural network (NN)-derived ECG features may have clinical, phenotypic,...

Background: People age at different rates. Biological age is a risk factor for many chronic diseases independent of chronological age. A good lifestyle is known to improve overall health, but its association with biological age is unclear. Methods: This study included participants from the UK Biobank who had undergone 12-lead resting electrocard...

Background: During the COVID-19 pandemic, telehealth was expanded without the opportunity to evaluate the adopted technology's usability extensively. Objective: To synthesize evidence on health professionals' perceptions regarding the usability of telehealth systems in the primary care of individuals with non-communicable diseases (NCDs) (hypert...

The 3-dimensional spatial and 2-dimensional frontal QRS-T angles are measures derived from the vectorcardiogram. They are independent risk predictors for arrhythmia, but the underlying biology is unknown. Using multi-ancestry genome-wide association studies we identify 61 (58 previously unreported) loci for the spatial QRS-T angle (N = 118,780) and...

Objective. Automatic detection of Electrocardiograms (ECG) quality is fundamental to minimize costs and risks related to delayed diagnosis due to low ECG quality. Most algorithms to assess ECG quality include non-intuitive parameters. Also, they were developed using data non-representative of a real-world scenario, in terms of pathological ECGs and...

Background: Statins are an effective strategy to reduce CVD risk, however, treatment goals are not achieved especially among Blacks and “Pardos” in Brazil. Hypothesis: Socioeconomic differences and lack of statin treatment for primary CVD prevention can explain part of the elevated mortality risk of Blacks and “Pardos”. Methods: Data from the ELSA-...

Aims To evaluate clinical and electrocardiographic outcomes of patients with COVID-19, comparing those using chloroquine compounds (chloroquine) to individuals without specific treatment. Methods Outpatients with suspected COVID-19 in Brazil who had at least one tele-electrocardiography (ECG) recorded in a telehealth system were enrolled in two ar...

Background: The Good Practices in Cardiology Program is an initiative created by the Brazilian Society of Cardiology (SBC) to improve the quality of care of cardiovascular disease patients in Brazilian public hospitals. Objectives: To characterize patients admitted to a tertiary public hospital with diagnosis of acute coronary syndrome (ACS) or...

The COVID-19 pandemic has profoundly influenced the effort to achieve global health equity. This has been particularly the case for HIV/AIDS, tuberculosis, and malaria control initiatives in low- and middle-income countries, with significant outcome setbacks seen for the first time in decades. Lost in the calls for compensatory funding increases fo...

Background. Worldwide it is estimated that more than 6 million people are infected with Chagas disease (ChD). It is considered one of the most important neglected diseases and, when it reaches its chronic phase, the infected person often develops serious heart conditions. While early treatment can avoid complications, the condition is often not det...

Objective: Over the past few years, deep learning (DL) has been used extensively in research for 12-lead electrocardiogram (ECG) analysis. However, it is unclear whether the explicit or implicit claims made on DL superiority to the more classical feature engineering (FE) approaches, based on domain knowledge, hold. In addition, it remains unclear w...

We aimed to evaluate the reasons for disagreement between screening echocardiography (echo), acquired by nonexperts, and standard echo in the Brazilian primary care (PC). Over 20 months, 22 PC workers were trained on simplified handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years, and patien...

Background COVID-19 affects the cardiovascular system and ECG abnormalities may be associated with worse prognosis. We evaluated the prognostic value of ECG abnormalities in individuals with COVID-19. Methods Multicentre cohort study with adults hospitalised with COVID-19 from 40 hospitals across 23 countries. Patients were followed-up from admiss...

Introduction: Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service. Methods: From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs...

Introduction: The COVID-19 pandemic prompted policies that limited direct human interactions globally. Due to this, healthcare systems worldwide have witnessed unprecedented challenges in providing adequate and continuous healthcare for patients with Non-Communicable Diseases (NCDs), among them hypertension and diabetes. The pandemic promoted the e...

BACKGROUND Telehealth has been established as a strategy to provide health care for patients with hypertension and diabetes from the COVID-19 pandemic onward. However, little is known about its usability from a healthcare professional's perspective. OBJECTIVE To assess evidence on health professionals’ perceptions of the usability of telehealth sy...

[This corrects the article DOI: 10.5334/gh.1128.].

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it. Chagas disease in the 21st century maintains an epidemiological pattern of ende...

Importance: Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID). Objective: To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration. Design,...

Background: Chronic Chagas Cardiomyopathy (CCC) usually develops between 10 and 20 years after the first parasitic infection and is one of the leading causes of end-stage heart failure in Latin America. Despite the great inter-individual variability in CCC susceptibility (only 30% of infected individuals ever present CCC), there are no known predi...

Background: The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs fur...

Background and Aims Food intake influences uric acid (UA) levels and hyperuricemia (HU), but evidence on the role of ultra-processed foods (UPFs) are scarce. The association between UPFs consumption with (1) HU prevalence and UA levels; (2) HU incidence; and (3) UA level change over a 4-year period was investigated. Methods and Results Cross-secti...

Background: The potential of chatbots for screening and monitoring COVID-19 was envisioned since the very outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior and support the provision of healthcare services safely and at scale. In this scenario and in view of its far-reachi...

We analyzed epidemiologic characteristics and distribution of 492 deaths related to Chagas disease and coronavirus disease (COVID-19) co-infection in Brazil during March‒December 2020. Cumulative co-infected death rates were highest among advanced age groups, persons of Afro-Brazilian ethnicity and with low education levels, and geographically dist...

Objectives Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. Methods This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the...

This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publi...

Background: The effective management of patients with acute myocardial infarction (AMI) is time-dependent. Objectives: To assess the impacts of the implementation of prehospital care on admission rates and mortality associated with AMI. Methods: Retrospective, ecological study, which assessed data from the Brazilian Universal Health System, fr...

Background: The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective: To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)...

TRANSFUSÕES DE HEMOCOMPONENTES POR INTERNAÇÃO HOSPITALAR NA REDE PÚBLICA MUNICIPAL DE BELO HORIZONTE ENTRE 2008 E 2021: UMA ANÁLISE DE SÉRIE TEMPORAL ABSTRACT Background: Blood transfusion rates are increasing worldwide. This work was a longitudinal retrospective study conducted with data referent to the use of blood components between January 200...

The QT interval is an electrocardiographic measure representing the sum of ventricular depolarization and repolarization, estimated by QRS duration and JT interval, respectively. QT interval abnormalities are associated with potentially fatal ventricular arrhythmia. Using genome-wide multi-ancestry analyses (>250,000 individuals) we identify 177, 1...

Purpose: To evaluate the reasons for disagreement between screening echocardiography (echo), acquired by non-experts, and standard echo in the Brazilian primary care (PC). Methods: Over 20 months, 22 PC workers were trained on simplified handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years,...

Background People with severe mental illness have a mortality rate higher than the general population, living an average of 10–20 years less. Most studies of mortality among people with severe mental illness have occurred in high-income countries (HICs). We aimed to estimate all-cause and cause-specific relative risk (RR) and excess mortality rate...

Aim To investigate whether serum uric acid (SUA) levels and hyperuricemia can be predictive biomarkers of incident metabolic syndrome(MS) among different body mass index(BMI) categories, and to investigate SUA cutoffs that best discriminate individuals with incident MS. Methods We analyzed 7,789 participants without MS at baseline of ELSA-Brasil s...

Objective: Machine learning techniques have been used extensively for 12-lead electrocardiogram (ECG) analysis. For physiological time series, deep learning (DL) superiority to feature engineering (FE) approaches based on domain knowledge is still an open question. Moreover, it remains unclear whether combining DL with FE may improve performance. M...

Background: Atrioventricular block (AVB) describes an impairment of conduction from the atria to the ventricles. Although the clinical course of AVB has been evaluated, the findings are from high-income countries and, therefore, cannot be extrapolated to the Latinx population. Objective: Evaluate the association between AVB and mortality. Metho...

Cardiomyopathy is a major cause of death in Chagas disease and early detection of cardiac involvement is essential. Myocardial strain is a reliable technique for assessment of subtle left ventricular (LV) contractility alterations. This study assessed LV global longitudinal strain (GLS) in a large Chagas disease population living in remote areas. B...

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalen...

O SaMi-Trop é um estudo de coorte que acompanha pacientes com doença de Chagas, desenvolvido em 21 municípios endêmicos. Objetivo: Realizar o consolidado das publicações produzidas pela coorte. Metodologia: Trata-se de uma revisão narrativa dos artigos publicados com dados da coorte. Resultados: Foram identificados 18 estudos, sendo 17 publicados e...

Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low-and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle-and high-...

Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and hi...

Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low-and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle-and high-...

Background Left ventricular (LV) systolic dysfunction is associated with over 8-fold increased risk of heart failure and a 2-fold risk of premature death. The use of electrocardiogram (ECG) signals in screening for LV systolic dysfunction is limited by their availability to clinicians. We developed a novel deep learning-based approach that can use...