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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- A prospective study of patients with refractory angina: outcomes and the role of high-sensitivity troponin T(2017) POPPI, Nilson T.; GOWDAK, Luis H. W.; DOURADO, Luciana O. C.; ADAM, Eduardo L.; LEITE, Thiago N. P.; MIOTO, Bruno M.; KRIEGER, Jose E.; CESAR, Luiz A. M.; PEREIRA, Alexandre C.BackgroundThe predictors of cardiovascular events in patients with chronic refractory angina are limited. High-sensitivity cardiac troponin T (hs-cTnT) assays are biomarkers that may be used to determine the prognosis of patients with stable coronary artery disease. HypothesisHs-cTnT is a predictor of death and nonfatal myocardial infarction (MI) in patients with refractory angina. MethodsWe prospectively enrolled 117 consecutive patients in this study. A heart team ruled out myocardial revascularization feasibility after assessing recent coronary angiograms; evidence of myocardial ischemia served as an inclusion criterion. Optimal medical therapy was encouraged via outpatient visits every 6 months; plasma hs-cTnT levels were determined at baseline. The primary endpoint was the composite incidence of death and nonfatal MI. ResultsDuring a median follow-up period of 28.0 months (interquartile range, 18.0-47.5 months), an estimated 28.0-month cumulative event rate of 13.4% was determined via the Kaplan-Meier method. Univariate predictors of the composite endpoint were hs-cTnT levels and LV dysfunction. Following a multivariate analysis, only hs-cTnT was independently associated with the events in question, either as a continuous variable (hazard ratio per unit increase in the natural logarithm: 2.83, 95% confidence interval: 1.62-4.92, P < 0.001) or as a categorical variable (hazard ratio for concentrations above the 99th percentile: 5.14, 95% confidence interval: 2.05-12.91, P < 0.001). ConclusionsIn patients with chronic refractory angina, plasma concentration of hs-cTnT is the strongest predictor of death and nonfatal MI. Notably, none of the outcomes in question occurred in patients with baseline plasma levels <5.0 ng/L.
- 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.
conferenceObject Obstructive Sleep Apnea Is Extremely Common And Associated With Myocardial Ischemia In Patients With Refractory Angina(2014) GEOVANINI, G. R.; PEREIRA, A. C.; GOWDAK, L. H. W.; DOURADO, L. O.; POPPI, N.; CESAR, L. M.; DRAGER, L. F.; LORENZI-FILHO, G.conferenceObject Cardiac rehabilitation in patients with refractory angina: preliminary results(2019) DOURADO, L.; ASSUMPCAO, C. R. A. A.; JORDAO, C. P.; VIEIRA, M. L. C.; GOWDAK, L. H. W.; CESAR, L. A. M.; MATOS, L. D. N. J.conferenceObject Obstructive Sleep Apnea In The Spectrum Of Coronary Artery Disease: Stable Versus Refractory Angina Patients(2013) GEOVANINI, G. R.; DANZI-SOARES, N.; DOURADO, L. O. C.; POPPI, N. T.; PEREIRA, A. C.; GOWDAK, L. W.; DRAGER, L. F.; LORENZI-FILHO, G.- Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation(2022) ASSUMPCAO, Camila R. A. de; PRADO, Danilo M. L. do; JORDAO, Camila P.; DOURADO, Luciana O. C.; VIEIRA, Marcelo L. C.; MONTENEGRO, Carla G. de S. P.; NEGRAO, Carlos E.; GOWDAK, Luis H. W.; MATOS, Luciana D. N. J. DeObjectives: Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is con-sidered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also stud-ied the O-2 pulse response by CPET and the association of ischemic changes with contractile modifications by exer-cise stress echocardiography (ESE). Methods: Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Soci-ety class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. Results: The patients had low cardiorespiratory capacity (OUES of 1.74 +/- 0.4 L/min; 63.9 +/- 14.7% of predicted), and 77% of patients had a flattening or drop in O-2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). Conclusion: Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensi-tivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O-2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.
- 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
conferenceObject Clinical impact of medical intensive treatment on functional class in patients initially diagnosed as refractory angina(2012) DOURADO, Luciana O. C.; POPPI, Nilson T.; PEREIRA, Alexandre C.; CESAR, Luiz Antonio M.; GOWDAK, Luis Henrique W.Introduction: Refractory angina is a major clinical challenge. Patients (pt) usually have significant functional impairment due to disabling symptoms, which greatly adversely impact their quality of life. Many pt may be erroneously diagnosed as refractory angina, if not on intensive medical therapy. Objectives: To evaluate the impact of intensive medical treatment on angina functional class in pt initially diagnosed as refractory angina. Methods: 45 pt (31 men, 59±13 years) were included based on the following criteria: 1) disabling symptoms; 2) objectively documented myocardial ischemia; 3) coronary anatomy unsuitable for myocardial revascularization procedures. Medical visits were scheduled every 4 weeks during a 3-month period (Vo to V3). Angina functional class was recorded in each visit as proposed by the Canadian Cardiovascular Society (CCS). Medical therapy was strongly encouraged to be optimized based on patient’s tolerance. Statistical analysis included the Student s t-test (continuous variables), the chi-square test (categorical variables), and the Wilcoxon test (changes in functional class). Results: There was an overall improvement in CCS class between V0 to V3 (p,<0,001), with 30 pt (66.7%) improving at least 1 class. In 14 pt (31.1%) there was no difference and in only 1 pt (2.2%) there was worsening of CCS class. In V0 and V3, anti-ischemic drugs were used as follows (%), respectively: beta-blockers (96 vs. 96), calcium channel blockers (78 vs. 84), long-acting nitrates (96 vs. 100), and trimetazidine (38 vs. 93). Mean daily dosages (mg)of selected drugs were: atenolol 105±49 to 113±59 (P=0.16); carvedilol 44±16 to 55±20 (P=0.06); amlodipine 7±3 to 8±3(P=0.12); isossorbide 95±28 to 106±24(P=0.09). There was a non-significant 4.4% decrease in the mean heart rate (bpm) from 66±11 to 63±9(P=0.10), and a non-significant 4% reduction in mean systolic (SBP) and diastolic (DBP) blood pressure: SBP - 128±23 to 123±23mmHg (P=0.10), and DBP -75±11 to 72±14mmHg (P=0.11). Conclusion: Pt enrolled in this clinical program, although initially diagnosed as refractory angina, experienced a significant improvement in their functional class. This could not be attributed to an increase in anti-ischemic drugs or to an hemodynamic effect. We believe that the regular visits at shorter intervals may have led to a better treatment adherence, emotional easiness and self-confidence. This study exemplifies how complex is the relationship between extensiveness of the disease and functional impairment.- OSA and Depression Are Common and Independently Associated With Refractory Angina in Patients With Coronary Artery Disease(2014) GEOVANINI, Glaucylara R.; GOWDAK, Luis H. W.; PEREIRA, Alexandre C.; DANZI-SOARES, Naury de Jesus; DOURADO, Luciana O. C.; POPPI, Nilson T.; CESAR, Luiz Antonio Machado; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoOBJECTIVE: Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS: We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS: Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 +/- 4 kg/m(2) vs 28.5 +/- 4 kg/ m(2), P = .06), and were older (61 +/- 10 y vs 57 +/- 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 +/- 6 vs 8 +/- 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 +/- 8 vs 10 +/- 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 +/- 30 events/h vs 23 +/- 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% + 13 vs 4% + 9, P = .04), and a higher proportion of severe OSA (AHI >= 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS: OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.