LUCIANA OLIVEIRA CASCAES DOURADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
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- Obstructive sleep apnoea is associated with myocardial injury in patients with refractory angina(2016) GEOVANINI, Glaucylara R.; PEREIRA, Alexandre C.; GOWDAK, Luis H. W.; DOURADO, Luciana Oliveira Cascaes; POPPI, Nilson T.; VENTURINI, Gabriela; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoObjective To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. Methods Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00. Results We studied 80 consecutive patients (age: 62 +/- 10 years; male: 66%; body mass index (BMI): 29.5 +/- 4 kg/m(2)) with well-established diagnosis of refractory angina. The mean apnoea-hypopnoea index (AHI) was 37 +/- 29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI >= 51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p = 0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p = 0.028) in multivariate analysis. Conclusion Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.
- Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results(2018) DOURADO, Luciana Oliveira Cascaes; BITTENCOURT, Marcio Sommer; PEREIRA, Alexandre Costa; POPPI, Nilson Tavares; DALLAN, Luis Alberto Oliveira; KRIEGER, Jose Eduardo; CESAR, Luiz Antonio Machado; GOWDAK, Luis Henrique WolffBackground Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals. Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory. Results A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.
- Brazilian Cardiovascular Rehabilitation Guideline-2020(2020) CARVALHO, Tales de; MILANI, Mauricio; FERRAZ, Almir Sergio; SILVEIRA, Anderson Donelli da; HERDY, Artur Haddad; HOSSRI, Carlos Alberto Cordeiro; SILVA, Christina Grune Souza e; ARAUJO, Claudio Gil Soares de; ROCCO, Eneas Antonio; TEIXEIRA, Jose Antonio Caldas; DOURADO, Luciana Oliveira Cascaes; MATOS, Luciana Diniz Nagem Janot de; EMED, Luiz Gustavo Marin; RITT, Luiz Eduardo Fonteles; SILVA, Marconi Gomes da; SANTOS, Mauro Augusto dos; SILVA, Miguel Morita Fernandes da; FREITAS, Odilon Gariglio Alvarenga de; NASCIMENTO, Pablo Marino Correa; STEIN, Ricardo; MENEGHELO, Romeu Sergio; SERRA, Salvador Manoel
bookPart Angina refratária(2022) DOURADO, Luciana Oliveira Cascaes- The effectiveness of intensive medical treatment in patients initially diagnosed with refractory angina(2015) DOURADO, Luciana Oliveira Cascaes; POPPI, Nilson Tavares; ADAM, Eduardo Leal; LEITE, Thiago Nunes Pereira; PEREIRA, Alexandre da Costa; KRIEGER, Jose Eduardo; CESAR, Luiz Antonio Machado; GOWDAK, Luis Henrique Wolff
- Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina?(2022) MONTENEGRO, Carla Giuliano de Sa Pinto; DOURADO, Luciana Oliveira Cascaes; JORDAO, Camila Paixao; VIEIRA, Marcelo Luiz Campos; ASSUMPCAO, Camila Regina Alves; GOWDAK, Luis Henrique Wolff; PEREIRA, Alexandre da Costa; NEGRAO, Carlos Eduardo; MATOS, Luciana Diniz Nagem Janot deBackground: It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA). Objective: We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA. Methods: This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant. Results: Thirty-two patients with RA were included (61 +/- 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L).The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657). Conclusions: A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.
- The Role of the Heart Team in Patients with Diffuse Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting(2021) DOURADO, Luciana Oliveira Cascaes; PEREIRA, Alexandre C.; POPPI, Nilson Tavares; CAVALCANTE, Rafael; GAIOTTO, Fabio; DALLAN, Luis Alberto Oliveira; BITTENCOURT, Marcio Sommer; CESAR, Luiz Antonio M.; GOWDAK, Luis Henrique W.Background In patients eligible for coronary artery bypass grafting, no data assess the importance of the Heart Team in programming the best surgical strategy for patients with diffuse coronary artery disease (CAD). This study aims to determine the contribution of the Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic surgical success in these patients based on visual angiographic analysis. Methods Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass graft surgery were prospectively included. One-year postoperative coronary angiograms were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular surgeons, and one interventional cardiologist retrospectively analyzed preoperative angiograms. A subjective scale was applied at a single moment to quantify the chance of successful coronary artery bypass grafting for each coronary territory with anatomical indication for revascularization. Based on individual scores, the Heart Team's and the specialists' scores were calculated and compared. Results The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected. The Heart Team's accuracy for predicting the angiographic success of the surgery was 74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional cardiologist predicted left anterior descending territory grafting success. The Heart Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity and low specificity in predicting angiographic success. Conclusion The multispecialty Heart Team achieved good accuracy in predicting the angiographic coronary artery bypass graft success in patients with diffuse CAD, with a high specificity and reasonable sensitivity.
- In the Cardiac Rehabilitation Era, is There a ""No-Option"" Refractory Angina Patient?: A Case Report(2023) DOURADO, Luciana Oliveira Cascaes; JORDAO, Camila Paixao; ASSUMPCAO, Camila Regina Alves; MATOS, Luciana Diniz Nagem Janot deExercise-based cardiac rehabilitation, an effective and safe adjuvant treatment recommended to patients with coronary artery disease, is scarcely applied to patients with refractory angina (RA) due to difficulties related to safety, trainning prescription and their clinical management. This case report presents an instance of a ""no-option"" patient with RA, who was included in a 12-week exercise program, in sessions consisted of 40 minutes of treadmill aerobic exercise, three times a week, and intensity prescribed between ischemic/ angina threshold and ventilatory threshold 1, obtained in the cardiopulmonary exercise test; mild to moderate angina was allowed during training. Furthermore, 15 minutes of moderate-intensity resistance training (large group muscle exercises, two sets of 8 to 12 repetitions) was performed. At the end of the protocol, the patient presented an important improvement in functional performance (VO2 peak 17.0 ml/ kg/min to 27.3 ml/kg/min), angina threshold (HR 68 bpm to 95 bpm), and intensity chest pain (levels 7 to 5) with no clinical adverse events during the period. Exercise-based cardiac rehabilitation was safe, even in the occurrence of angina/ ischemia during training, according to tolerability to symptoms and other warning clinical signs.
- Concomitant Use of Ranolazine and Trimetazidine in Patients with Refractory Angina: An Initial Experience(2022) DOURADO, Luciana Oliveira Cascaes; MORENO, Cristian Paul Delgado; GROBE, Sarah Fagundes; GOWDAK, Luis Henrique Wolff; CESAR, Luiz Antonio Machado
- Large Bilateral Coronary Artery Fistula: 10-year Follow-up in Clinical Treatment(2019) KULCHETSCKI, Rodrigo Melo; LECHINEWSKI, Luka David; DOURADO, Luciana Oliveira Cascaes; HUEB, Whady Armindo; CESAR, Luiz Antonio Machado