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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- Analysis of the Correlation Between Central Obesity and Abdominal Aortic Diseases(2019) APOLONI, Rafael Correa; ZERATI, Antonio Eduardo; WOLOSKER, Nelson; SAES, Glauco Fernandes; WOLOSKER, Marina; CURADO, Taina; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. Methods: Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. Results: VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P < 0.01 in general and P < 0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P = 0.02). Conclusions: There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.
- Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men(2019) SOUSA, Adilson Santos Andrade de; CORREIA, Marilia A.; FARAH, Breno Quintella; SAES, Glauco; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; WOLOSKER, Nelson; CUCATO, Gabriel G.; RITTI-DIAS, Raphael M.This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity (p <.001) and lower moderate-vigorous physical activity (p < .001) than men. Women more often reported barriers such as ""not having anyone to accompany"" (p = .006), ""lack of money"" (p = .018), ""fear of falling or worsening the disease"" (p = .010), ""lack of security"" (p = .015), ""not having places to sit when feeling leg pain"" (p = .021), and ""difficulty in getting to a place to practice physical activity"" (p = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate-vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery 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.
- 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.
bookPart Isquemia de membros inferiores e membros superiores(2019) SAES, Glauco Fernandes; ZERATI, Antonio Eduardo- The Need for a Vena Cava Filter in Oncological Patients with Acute Venous Thrombosis: A Marker of a Worse Prognosis(2019) LEIDERMAN, Dafne Braga Diamante; ZERATI, Antonio Eduardo; MARIZ, Maria Paula Vieira; WOLOSKER, Nelson; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: Active cancer is found in approximately 20% of patients diagnosed with venous thromboembolism. This condition is more prevalent in patients with advanced and metastatic cancer and is the second largest cause of death among patients with active neoplasm. Many of them have contraindication for anticoagulation and needs an inferior vena cava filter to be implanted, but a large proportion of these patients have very low survival after filter implantation. Our aim was to verify whether the need for filter implantation represents an independent indicator of poor prognosis in oncological patients and to identify subgroups with a greater survival. Methods: This study included a retrospective analysis of 247 oncologic patients with acute proximal venous thrombosis. We compared survival between 100 consecutive patients who needed vena cava filter (FILTER group) versus a control group of 147 patients in whom anticoagulation was possible (ANTICOAGULATION group). We verified survival, cause of death, filter's indications (clinical and surgical), and factors that might lead to worse prognosis. Results: Risk of death was 8.83-fold higher in the FILTER group than that in the ANTICOAGULATION group, a greater risk than the presence of metastasis (OR: 2.47). Death was significantly more frequent in patients subjected to filter implantation because of clinical indications (93.2%) such as high risk of or recent bleeding and an adjusted risk of death of 2.24-fold higher in a multivariate analysis. Conclusions: The need to implant a vena cava filter in a patient with cancer is a marker that indicates patient's disease severity and worse prognosis. Survival was longer in the subgroup of patients who underwent filter implantation before oncologic surgery, probably because of a better status performance and less clinical complications.