EDMUNDO ARTEAGA FERNANDEZ
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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- Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy(2013) NERBASS, Flavia B.; PEDROSA, Rodrigo P.; GENTA, Pedro R.; ANTUNES, Murillo O.; ARTEAGA-FERNANDEZ, Edmundo; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoOBJECTIVE: Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy. METHODS: Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46 +/- 15 years; body mass index, 26.6 +/- 4.9 kg/m(2)) were included, and obstructive sleep apnea (respiratory disturbance index >= 15 events/h) was present in 37 patients (41%). RESULTS: Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age >= 45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47-13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43-20.12; p = 0.013]. CONCLUSION: Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.
- Acute Effects of Nasal CPAP in Patients With Hypertrophic Cardiomyopathy(2016) NERBASS, Flavia B.; SALEMI, Vera M. C.; PEDROSA, Rodrigo P.; PORTILHO, Natanael de P.; FERREIRA-FILHO, Julio C. A.; MORIYA, Henrique T.; ANTUNES, Murillo O.; ARTEAGA-FERNANDEZ, Edmundo; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoBACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common genetic disease that may cause left ventricular outflow tract (LVOT) obstruction, heart failure, and sudden death. Recent studies have shown a high prevalence of OSA among patients with HCM. Because the hemodynamics in patients with LVOT obstruction are unstable and depend on the loading conditions of the heart, we evaluated the acute effects of CPAP on hemodynamics and cardiac performance in patients with HCM. METHODS: We studied 26 stable patients with HCM divided into nonobstructive HCM (n = 12) and obstructive HCM (n = 14) groups (LVOT gradient pressure lower or higher than 30 mm Hg, respectively). Patients in the supine position while awake were continuously monitored with beat-to-beat BP measurements and electrocardiography. Two-dimensional echocardiography was performed at rest (baseline) and after 20 min of nasal CPAP at 1.5 cm H2O and 10 cm H2O, which was applied in a random order interposed by 10 min without CPAP. RESULTS: BP, cardiac output, stroke volume, heart rate, left ventricular ejection fraction, and LVOT gradient did not change during the study period in either group. CPAP at 10 cm H2O decreased right atrial size and right ventricular relaxation in all patients. It also decreased left atrial volume significantly and decreased right ventricular outflow acceleration time, suggesting an increase in pulmonary artery pressure in patients with obstructive HCM. CONCLUSIONS: The acute application of CPAP is apparently safe in patients with HCM, because CPAP does not lead to hemodynamic compromise. Long-term studies in patients with HCM and sleep apnea and nocturnal CPAP are warranted.
- Obstructive sleep apnea and hypertrophic cardiomyopathy: A common and potential harmful combination(2013) NERBASS, Flavia B.; PEDROSA, Rodrigo P.; DANZI-SOARES, Naury J.; DRAGER, Luciano F.; ARTEAGA-FERNANDEZ, Edmund; LORENZI-FILHO, GeraldoHypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease and is characterized by large and asymmetric septal and left ventricle hypertrophy. HCM is a cause of disability, including heart failure, atrial fibrillation, and sudden death, with an annual mortality varying from 1% to 6%. Obstructive sleep apnea (USA) is extremely common among patients with established cardiovascular disease, including hypertension and atrial fibrillation and when present may contribute to worse cardiovascular outcome. Although patients with HCM do not necessarily have typical characteristics of patients with USA, such as obesity and increasing age, there is recent evidence that USA is extremely common among patients with HCM, with a prevalence ranging from 32% to 71%. The presence of USA among patients with HCM is independently associated with worse structural and functional impairment of the heart, including atrial and aorta enlargement, worse New York Heart Association functional class, and worse quality of life. The prevalence of atria fibrillation, an independent marker of mortality among patients with HCM, is significantly higher (similar to four times) in the presence of USA. Therefore, the recognition of USA is a new area of research that may impact the management of patients with HCM.