ANTONIO EDUARDO ZERATI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Effect of Creatine Supplementation on Functional Capacity and Muscle Oxygen Saturation in Patients with Symptomatic Peripheral Arterial Disease: A Pilot Study of a Randomized, Double-Blind Placebo-Controlled Clinical Trial(2021) DOMINGUES, Wagner Jorge Ribeiro; RITTI-DIAS, Raphael Mendes; CUCATO, Gabriel Grizzo; WOLOSKER, Nelson; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; COELHO, Daniel Boari; NUNHES, Pollyana Mayara; MOLITERNO, Andre Alberto; AVELAR, AdemarThe aim of the study was to verify the effects of creatine (Cr) supplementation on functional capacity (walking capacity; primary outcome) and calf muscle oxygen saturation (StO(2)) (secondary outcome) in symptomatic peripheral arterial disease (PAD) patients. Twenty-nine patients, of both sexes, were randomized (1:1) in a double-blind manner for administration of placebo (PLA, n = 15) or creatine monohydrate (Cr, n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into four equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Functional capacity (total walking distance) was assessed by the 6 min walk test, and calf muscle StO(2) was assessed through near infrared spectroscopy. The measurements were collected before and after loading and after the maintenance phase. The level of significance was p < 0.05. No significant differences were found for function capacity (total walking distance (PLA: pre 389 +/- 123 m vs. post loading 413 +/- 131 m vs. post maintenance 382 +/- 99 m; Cr: pre 373 +/- 149 m vs. post loading 390 +/- 115 m vs. post maintenance 369 +/- 115 m, p = 0.170) and the calf muscle StO(2) parameters (p > 0.05). Short- and long-term Cr supplementation does not influence functional capacity and calf muscle StO(2) parameters in patients with symptomatic PAD.
- Does Creatine Supplementation Affect Renal Function in Patients with Peripheral Artery Disease? A Randomized, Double Blind, Placebo-controlled, Clinical Trial(2020) DOMINGUES, Wagner Jorge Ribeiro; RITTI-DIAS, Raphael Mendes; CUCATO, Gabriel Grizzo; WOLOSKER, Nelson; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; NUNHES, Pollyana Mayara; MOLITERNO, Andre Alberto; AVELAR, AdemarBackground: Case studies and reviews have shown that creatine supplementation can affect kidney function. The objective of this study is to verify the effects of 8 weeks of creatine supplementation on renal function (creatinine clearance: primary outcome) in patients with symptomatic peripheral arterial disease. Methods: Twenty-nine patients, of both genders, were randomized (1:1) in a double-blind manner for administration of Placebo (PLA; n = 15) or creatine monohydrate (Cr; n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into 4 equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Before and after the supplementation period, markers of renal function, serum creatinine, creatinine excretion rate, and creatinine clearance were evaluated. The Generalized Estimation Equation Model was used for comparison between groups. The level of significance was P < 0.05. Results: No significant differences were found between groups before and after the intervention for serum creatinine (Cr: pre 1.00 +/- 0.15 mL/dL vs. post 1.07 +/- 0.16 mL/dL; PLA: pre 1.30 +/- 0.53 mL/dL vs. post 1.36 +/- 0.47 mL/dL, P = 0.590), creatinine excretion rate (Cr: pre 81.73 +/- 43.80 mg/dL vs. post 102.92 +/- 59.57 mg/dL; PLA: pre 74.37 +/- 38.90 mg/dL vs. post 86.22 +/- 39.94 mg/dL, P = 0.560), or creatinine clearance (Cr; pre 108 +/- 59 mL/min/1.73 m(2) vs. post 117 +/- 52 mL/min/1.73 m(2); PLA: pre 88 +/- 49 mL/min/1.73 m(2) vs. post 82 +/- 47 mL/ min/1.73 m(2), P = 0.366). Conclusions: Eight weeks of creatine supplementation is safe and does not compromise the renal function of patients with peripheral arterial disease.
- Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease(2019) CORREIA, Marilia de Almeida; CUCATO, Gabriel Grizzo; LANZA, Fernanda Cordoba; PEIXOTO, Roger Andre Oliveira; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; WOLOSKER, Nelson; RITTI-DIAS, Raphael MendesOBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6 +/- 9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r < 0.55, p < 0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (beta=0.001, p<0.001), sit-to-stand test score (beta=-0.005, p=0.012), and WIQ stairs score (beta=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (beta=0.002, p < 0.001), WIQ stairs score (beta=0.003, p=0.010), and WELCH total score (beta=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.
- Graduated Compression Stockings Does Not Decrease Walking Capacity and Muscle Oxygen Saturation during 6-Minute Walk Test in Intermittent Claudication Patients(2017) CAVALCANTE, Bruno Remigio; RITTI-DIAS, Raphael Mendes; SOARES, Antonio Henrique Germano; DOMINGUES, Wagner Jorge Ribeiro; SAES, Glauco Fernandes; DUARTE, Flavio Henrique; CRUZ, Aline de Paula da; WOLOSKER, Nelson; PUECH-LEAO, Pedro; CUCATO, Gabriel Grizzo; ZERATI, Antonio EduardoBackground: We analyze the effects of graduated compression stoking (GCS) on walking capacity and oxygen saturation in intermittent claudication (IC) patients. Methods: Eighteen patients with IC performed the 6-minute walking test in 2 conditions in random order: GCS or placebo sock. Onset claudication distance and total walking distance were obtained. The calf muscle oxygen saturation was continuously monitored before, during, and after 6-minute walk test. Comparisons of the walking capacity and StO(2) parameters between GCS and placebo conditions were analyzed by Wilcoxon rank-sum test. Results: The onset claudication distance (GCS: 120 +/- 99 meters vs. placebo: 150 +/- 126 meters; P= 0.798) and total walking distance (GCS: 330 +/- 108 meters vs. placebo: 324 +/- 60 meters; P= 0.130) were similar between conditions. There were no differences in StO(2) parameters between conditions (P > 0.05). Conclusions: GCS does not decrease walking performance and calf muscle oxygenation saturation during 6-minute walk test in patients with IC.
- Physical Activity Levels in Peripheral Artery Disease Patients(2019) GERAGE, Aline Mendes; CORREIA, Marilia de Almeida; OLIVEIRA, Paulo Mesquita Longano de; PALMEIRA, Aline Cabral; DOMINGUES, Wagner Jorge Ribeiro; ZERATTI, Antonio Eduardo; PUECH-LEAO, Pedro; WOLOSKER, Nelson; RITTI-DIAS, Raphael Mendes; CUCATO, Gabriel GrizzoBackground. Increases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients. Objective: To describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease. Methods; This cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05. Results: Patients spent in average of 640 +/- 121 min/day, 269 +/- 94 min/day, 36 +/- 27 min/day and 15 +/- 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05). Conclusion: The patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations.
- Cardiac Autonomic Modulation Is Associated with Arterial Stiffness in Patients with Symptomatic Peripheral Artery Disease(2019) GERMANO-SOARES, Antonio Henrique; CUCATO, Gabriel Grizzo; LEICHT, Anthony Scott; ANDRADE-LIMA, Aluisio; PECANHA, Tiago; CORREIA, Marilia de Almeida; ZERATI, Antonio Eduardo; WOLOSKER, Nelson; RITTI-DIAS, Raphael MendesBackground: The objective of this study was to analyze the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral artery disease (PAD). Methods: This cross-sectional study included one hundred fourteen patients with symptomatic PAD (67.5% men; 65 +/- 7 years; body mass index: 26.8 +/- 4.5 kg/m(2)). Heart rate variability (HRV) was measured within time (standard deviation of all RR intervals [beat to beat heart interval] [SDNN], root mean square of the successive differences between adjacent normal RR intervals [RMSSD], and the proportion of successive RR intervals that differed by more than 50 msec [pNN50]) and frequency (low frequency [LF] and high frequency [HF]) domains. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Crude and adjusted linear regression analyses examined the relationship between HRV and cfPWV. Results: Nonsignificant crude associations were identified among cfPWV and RMSSD (P = 0.181), SDNN (P = 0.105), pNN50 (P = 0.087), LF (P = 0.376), HF (P = 0.175), and LF/HF ratio (P = 0.426). After adjustments for age, sex, smoking, body mass index, ankle-brachial index, and use of beta-blockers, significant associations were identified among cfPWV and RMSSD (P = 0.037), SDNN (P = 0.049), and pNN50 (P = 0.049). Conclusions: Cardiac autonomic modulation was significantly associated with arterial stiffness in patients with PAD after adjustment for confounding factors. This relationship may contribute to the enhanced cardiovascular disease risk for PAD patients and provides a target for strategies to improve patient clinical outcomes.
- Comparação entre os métodos subjetivo e objetivo para avaliação da capacidade funcional durante tratamento clínico em pacientes com claudicação intermitente(2013) CUCATO, Gabriel Grizzo; ZERATI, Antônio Eduardo; CHEHUEN, Marcel da Rocha; RITTI-DIAS, Raphael Mendes; SAEZ, Glauco; RAGAZZO, Luciana; PUECH-LEÃO, Pedro; WOLOSKER, NelsonOBJECTIVE: To analyze if there is any relation between functional capacity assessed by subjective and objective methods regarding the current state and after clinical treatment in patients with intermittent claudication. METHODS: A total of 500 patients with intermittent claudication were enrolled. All patients underwent clinical examination and a functional evaluation by subjective (clinical visit) and objective method (treadmill test). Additionally, 50 patients were selected to evaluate the effect of clinical treatment by subjective and objective methods in relation to functional capacity. RESULTS: Out of 500 patients, only 60 (12.0%) had similar results in both methods. The remaining, that is 440 patients (88.0%) had subject values in disagreement with stress test findings. Regarding the clinical effect of the treatment on the functional outcomes, results were similar in both methods (χ²=1.7; p=0.427). CONCLUSION: Although the subjective method overestimates the functional capacity when compared to the objective method, no significant differences were observed between both methods when analyzing the effect of clinical treatment. Thus, the subjective method provides similar information as compared with objective method, in monitoring the clinical treatment of patients with intermittent claudication.
- Remote ischemic preconditioning in patients with intermittent claudication(2013) SAES, Glauco Fernandes; ZERATI, Antonio Eduardo; WOLOSKER, Nelson; RAGAZZO, Luciana; ROSOKY, Ruben Miguel Ayzin; RITTI-DIAS, Raphael Mendes; CUCATO, Gabriel Grizzo; CHEHUEN, Marcelo; FARAH, Breno Quintella; PUECH-LEAO, PedroOBJECTIVE: Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. We hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. METHODS: In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index <0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS: Group A showed a significant increase in the initial claudication distance in the second test compared to the first test. CONCLUSION: RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients.
- Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication(2021) RAGAZZO, Luciana; PUECH-LEAO, Pedro; WOLOSKER, Nelson; LUCCIA, Nelson de; SAES, Glauco; RITTI-DIAS, Raphael M.; CUCATO, Gabriel Grizzo; KAMIKAVA, Debora Yumi Ferreira; ZERATI, Antonio EduardoOBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.
- Walking Training Improves Ambulatory Blood Pressure Variability in Claudication(2021) CHEHUEN, Marcel da Rocha; CUCATO, Gabriel Grizzo; CARVALHO, Celso Ricardo Fernandes de; ZERATI, Antonio Eduardo; LEICHT, Anthony; WOLOSKER, Nelson; RITTI-DIAS, Raphael Mendes; FORJAZ, Claudia Lucia de MoraesBackground: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown. Objectives: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD. Methods: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD 24), the awake and asleep weighted standard deviation (SD dn), and the 24-hour average real variability (ARV 24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant. Results: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP - 13.3 +/- 2.8 vs 11.8 +/- 2.3, 12.1 +/- 2.84 vs 10.7 +/- 2.5 and 9.4 +/- 2.3 vs 8.8 +/- 2.2 mmHg); Mean BP - 11.0 +/- 1.7 vs 10.4 +/- 1.9, 10.1 +/- 1.6 vs 9.1 +/- 1.7 and 8.0.+/- 1.7 vs 7.2 +/- 1.5 mmHg) for SD 24, SD dn and ARV 24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks. Conclusion: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD.