AMANDA GONZALES RODRIGUES
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- Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae(2023) FARIA, Diego; MOLL-BERNARDES, Renata J.; TESTA, Laura; MONIZ, Camila M. V.; RODRIGUES, Erika C.; RODRIGUES, Amanda G.; ARAUJO, Amanda; ALVES, Maria J. N. N.; ONO, Bruna E.; IZAIAS, Joao E.; SALEMI, Vera M. C.; JORDAO, Camila P.; AMARO-VICENTE, Graziela; RONDON, Maria U. P. B.; LUDWIG, Katelyn R.; CRAIGHEAD, Daniel H.; ROSSMAN, Matthew J.; CONSOLIM-COLOMBO, Fernanda M.; ANGELIS, Katia De; IRIGOYEN, Maria C. C.; SEALS, Douglas R.; NEGRAO, Carlos E.; SALES, Allan R. K.Background:COVID-19 has become a dramatic health problem during this century. In addition to high mortality rate, COVID-19 survivors are at increased risk for cardiovascular diseases 1-year after infection. Explanations for these manifestations are still unclear but can involve a constellation of biological alterations. We hypothesized that COVID-19 survivors compared with controls exhibit sympathetic overdrive, vascular dysfunction, cardiac morpho-functional changes, impaired exercise capacity, and increased oxidative stress. Methods:Nineteen severe COVID-19 survivors and 19 well-matched controls completed the study. Muscle sympathetic nerve activity (microneurography), brachial artery flow-mediated dilation and blood flow (Doppler-Ultrasound), carotid-femoral pulse wave velocity (Complior), cardiac morpho-functional parameters (echocardiography), peak oxygen uptake (cardiopulmonary exercise testing), and oxidative stress were measured similar to 3 months after hospital discharge. Complementary experiments were conducted on human umbilical vein endothelial cells cultured with plasma samples from subjects. Results:Muscle sympathetic nerve activity and carotid-femoral pulse wave velocity were greater and brachial artery flow-mediated dilation, brachial artery blood flow, E/e ' ratio, and peak oxygen uptake were lower in COVID-19 survivors than in controls. COVID-19 survivors had lower circulating antioxidant markers compared with controls, but there were no differences in plasma-treated human umbilical vein endothelial cells nitric oxide production and reactive oxygen species bioactivity. Diminished peak oxygen uptake was associated with sympathetic overdrive, vascular dysfunction, and reduced diastolic function in COVID-19 survivors. Conclusions:Our study revealed that COVID-19 survivors have sympathetic overactivation, vascular dysfunction, cardiac morpho-functional changes, and reduced exercise capacity. These findings indicate the need for further investigation to determine whether these manifestations are persistent longer-term and their impact on the cardiovascular health of COVID-19 survivors.
- High-intensity interval training decreases muscle sympathetic nerve activity and improves peripheral vascular function in patients with heart failure with reduced ejection fraction(2020) SALES, Allan; AZEVEDO, Luciene; OLIVEIRA, Thiago; ALVES, Maria Nunes; RODRIGUES, Amanda; OLIVEIRA, Patricia; JORDAO, Camila; ANDRADE, Ana; URIAS, Ursula; GUIMARAES, Guilherme; BOCCHI, Edimar; GRUNEWALD, Zachary; MARTINEZ-LEMUS, Luis; PADILLA, Jaume; NEGRAO, Carlos
- High-Intensity Interval Training Decreases Muscle Sympathetic Nerve Activity and Improves Peripheral Vascular Function in Patients With Heart Failure With Reduced Ejection Fraction(2020) SALES, Allan R. K.; AZEVEDO, Luciene F.; SILVA, Thiago O. C.; RODRIGUES, Amanda G.; OLIVEIRA, Patricia A.; JORDAO, Camila P.; ANDRADE, Ana C. M.; URIAS, Ursula; GUIMARAES, Guilherme V.; BOCCHI, Edimar A.; ALVES, Maria Janieire N. N.; HAJJAR, Ludhmila A.; FILHO, Roberto K.; GRUNEWALD, Zachary I.; MARTINEZ-LEMUS, Luis A.; PADILLA, Jaume; NEGRAO, Carlos E.
- Sympathetic neural overdrive and diminished exercise capacity in reduced ejection fraction heart failure related to anthracycline-based chemotherapy(2023) RODRIGUES, Amanda G.; SALES, Allan R. K.; FARIA, Diego; FONSECA, Silvia M. R.; BOND, Marina M. K.; JORDAO, Camila P.; SOUZA, Francis R. de; BITTAR, Cristina S.; SANTOS, Marilia H. H. Dos; SARMENTO, Adriana O.; NEGRAO, Marcelo V.; HAJJAR, Ludhmila A.; NEGRAO, Carlos E.; KALIL FILHO, RobertoCardiotoxicity is the most worrying cardiovascular alteration in patients treated with chemotherapy. To improve the understanding regarding the cardiotoxicity, we studied whether 1) patients with cardiac dysfunction related to anthracycline-based chemotherapy have augmented sympathetic nerve activity and decreased exercise capacity and 2) these responses are similar to those observed in patients with heart failure caused by other etiologies. Sixteen patients with heart failure with reduced ejection fraction related to anthracycline-based chemotherapy with or without chest radiation (HFrEFCA), 10 patients with heart failure with reduced ejection not related to cancer therapy (HFrEF), and 16 age- and body mass index (BMI)-matched healthy control subjects were studied. Left ventricular ejection fraction (LVEF, echocardiography), peak oxygen consumption (peak (V)over dot(O2), cardiopulmonary exercise test), muscle sympathetic nerve activity (MSNA, microneurography), and forearm blood flow (FBF, venous occlusion plethysmography) were measured. We found that peak oxygen consumption peak (V)over dot(O2) and LVEF were significantly reduced in patients with HFrEFCA compared with that of control subjects (P < 0.0001) but similar to those found in patients with HFrEFCA. The sympathetic nerve activity burst frequency and incidence were significantly higher in patients with HFrEFCA than that in control subjects (P < 0.0001). No differences were found between patients with HFrEF and HFrEFCA. Peak (V)over dot(O2) was inversely associated with MSNA burst frequency (r = -0.53, P = 0.002) and burst incidence (r = -0.38, P = 0.01) and directly associated with LVEF (r = 0.71, P < 0.0001). Taken together, we conclude that patients who develop heart failure due to anthracycline-based chemotherapy have sympathetic neural overdrive and reduced exercise capacity. In addition, these physiological changes are similar to those observed in patients with HFrEF.
- Effects of exercise training on brain metabolism and cognitive functioning in sleep apnea(2022) UENO-PARDI, Linda M.; SOUZA-DURAN, Fabio L.; MATHEUS, Larissa; RODRIGUES, Amanda G.; BARBOSA, Eline R. F.; CUNHA, Paulo J.; CARNEIRO, Camila G.; COSTA, Naomi A.; ONO, Carla R.; BUCHPIGUEL, Carlos A.; NEGRAO, Carlos E.; LORENZI-FILHO, Geraldo; BUSATTO-FILHO, GeraldoImpaired glucose metabolism reflects neuronal/synaptic dysfunction and cognitive function decline in patients with obstructive sleep apnea (OSA). The study investigated the extent to which exercise training (ET) improves cerebral metabolic glucose rate (CMRgl) and cognitive function in patients with OSA. Patients with moderate to severe OSA were randomly assigned to ET (3 times/week, n = 23) or no intervention (control, n = 24). Echocardiography and apolipoprotein epsilon 4 (APOE epsilon 4) genotyping were obtained at baseline. Both groups underwent cardiopulmonary exercise testing, polysomnography, cognitive tests, brain magnetic resonance imaging, and F-18-fluoro-2-deoxy-d-Glucose positron emission tomography ((18)FDG-PET) at baseline and study end. Compared with control, exercise-trained group had improved exercise capacity, decreased apnea-hypopnea index (AHI), oxygen desaturation and arousal index; increased attention/executive functioning, increased CMRgl in the right frontal lobe (P < 0.05). After ET an inverse relationships occurred between CMRgl and obstructive AHI (r = - 0.43, P < 0.05) and apnea arousal index (r = - 0.53, P < 0.05), and between the changes in CMRgl and changes in mean O-2 saturation during sleep and non-rapid eye movement sleep (r = - 0.43, P < 0.05), desaturation during arousal (r = - 0.44, P < 0.05), and time to attention function testing (r = - 0.46, P < 0.05). ET improves OSA severity and CMRg in the frontal lobe, which helps explain the improvement in attention/executive functioning. Our study provides promising data that reinforce the growing idea that ET may be a valuable tool to prevent hypoxia associated with decreased brain metabolism and cognitive functioning in patients with moderate to severe OSA.
conferenceObject Sympathetic Neural Overdrive, Endothelial Dysfunction and Aortic Stiffness in Coronavirus Disease 2019 Survivors: A Short-Term Study of Cardiovascular Sequelae(2021) FARIA, Diego; TESTA, Laura; MOLL-BERNARDES, Renata; MONIZ, Camila; RODRIGUES, Erika; COSTA-NETO, Abel; SOUSA, Andrea; RODRIGUES, Amanda; OLIVEIRA, Patricia; ALVES, Maria Janieire; SANTOS, Gabriel; SALEMI, Vera; PIMENTA, Ruan; PAIXAO, Camila; SANTOS, Beatriz; RONDON, Maria U.; CRAIGHEAD, Daniel; ROSSMAN, Matthew; CONSOLIM-COLOMBO, Fernanda M.; IRIGOYEN, Maria C.; MARTINEZ-LEMUS, Luis A.- Effects of exercise training on autonomic modulation and mood symptoms in patients with obstructive sleep apnea(2021) ARAUJO, C. E. L.; FERREIRA-SILVA, R.; GARA, E. M.; GOYA, T. T.; GUERRA, R. S.; MATHEUS, L.; TOSCHI-DIAS, E.; RODRIGUES, A. G.; BARBOSA, E. R. F.; FAZAN JR., R.; LORENZI-FILHO, G.; NEGRAO, C. E.; UENO-PARDI, L. M.We evaluated the effects of exercise training (ET) on the profile of mood states (POMS), heart rate variability, spontaneous baroreflex sensitivity (BRS), and sleep disturbance severity in patients with obstructive sleep apnea (OSA). Forty-four patients were randomized into 2 groups, 18 patients completed the untrained period and 16 patients completed the exercise training (ET). Beat-to-beat heart rate and blood pressure were simultaneously collected for 5 min at rest. Heart rate variability (RR interval) was assessed in time domain and frequency domain (FFT spectral analysis). BRS was analyzed with the sequence method, and POMS was analyzed across the 6 categories (tension, depression, hostility, vigor, fatigue, and confusion). ET consisted of 3 weekly sessions of aerobic exercise, local strengthening, and stretching exercises (72 sessions, achieved in 40 +/- 3.9 weeks). Baseline parameters were similar between groups. The comparisons between groups showed that the changes in apnea-hypopnea index, arousal index, and O-2 desaturation in the exercise group were significantly greater than in the untrained group (P < 0.05). The heart rate variability and BRS were significantly higher in the exercise group compared with the untrained group (P < 0.05). ET increased peak oxygen uptake (P < 0.05) and reduced POMS fatigue (P < 0.05). A positive correlation (r=0.60, P < 0.02) occurred between changes in the fatigue item and OSA severity. ET improved heart rate variability, BRS, fatigue, and sleep parameters in patients with OSA. These effects were associated with improved sleep parameters, fatigue, and cardiac autonomic modulation, with ET being a possible protective factor against the deleterious effects of hypoxia on these components in patients with OSA.
- Exercise Training Increases Metaboreflex Control in Patients with Obstructive Sleep Apnea(2019) GUERRA, Renan S.; GOYA, Thiago T.; SILVA, Rosyvaldo F.; LIMA, Marta F.; BARBOSA, Eline R. F.; ALVES, Maria Janieire De N. N.; RODRIGUES, Amanda G.; LORENZI-FILHO, Geraldo; NEGRAO, Carlos Eduardo; UENO-PARDI, Linda M.Introduction/Purpose We demonstrated that patients with obstructive sleep apnea (OSA) have reduced muscle metaboreflex control of muscle sympathetic nerve activity (MSNA). In addition, exercise training increased muscle metaboreflex control in heart failure patients. Objective We tested the hypothesis that exercise training would increase muscle metaboreflex control of MSNA in patients with OSA. Methods Forty-one patients with OSA were randomized into the following two groups: 1) nontrained (OSANT, n = 21) and 2) trained (OSAT, n = 20). Muscle sympathetic nerve activity was assessed by microneurography technique, muscle blood flow (FBF) by venous occlusion plethysmography, heart rate by electrocardiography, and blood pressure with an automated oscillometric device. All physiological variables were simultaneously assessed at rest, during isometric handgrip exercise at 30% of the maximal voluntary contraction, and during posthandgrip muscle ischemia (PHMI). Muscle metaboreflex sensitivity was calculated as the difference in MSNA between PHMI and the rest period. Patients in the OSAT group underwent 72 sessions of moderate exercise training, whereas patients in the OSANT group were clinical follow-up for 6 months. Results The OSANT and OSAT groups were similar in anthropometric, neurovascular, hemodynamic and sleep parameters. Exercise training reduced the baseline MSNA (34 2 bursts per minute vs 25 +/- 2 bursts per minute; P < 0.05) and increased the baseline FBF (2.1 +/- 0.2 mLmin(-1) per 100 g vs 2.4 +/- 0.2 mLmin(-1) per 100 g; P < 0.05). Exercise training significantly reduced MSNA levels and increased FBF responses during isometric exercise. Exercise training significantly increased MSNA responses during PHMI (6.5 +/- 1 vs -1.7 +/- 1 bursts per minute, P < 0.01). No significant changes in FBF or hemodynamic parameters in OSANT patients were found. Conclusions Exercise training increases muscle metaboreflex sensitivity in patients with OSA. This autonomic change associated with increased muscle blood flow may contribute to the increase in exercise performance in this set of patients.
- Abnormal neurovascular control during central and peripheral chemoreceptors stimulation in heart failure patients with preserved ejection fraction(2024) KATAOKA, Yufuko; SALES, Allan R. K.; RODRIGUES, Amanda G.; GOES-SANTOS, Beatriz R.; AZEVEDO, Luciene F.; GROEHS, Raphaela V.; SILVA, Edna O.; SANTOS, Luciana S.; OLIVEIRA, Patricia A.; JORDAO, Camila P.; ANDRADE, Ana C. M.; LOBO, Denise M. L.; RONDON, Eduardo; TOSCHI-DIAS, Edgar; ALVES, Maria Janieire N. N.; ALMEIDA, Dirceu R.; NEGRAO, Carlos E.Purpose Central and peripheral chemoreceptors are hypersensitized in patients with heart failure with reduced ejection fraction. Whether this autonomic alteration occurs in patients with heart failure with preserved ejection fraction (HFpEF) remains little known. We test the hypothesis that the central and peripheral chemoreflex control of muscle sympathetic nerve activity (MSNA) is altered in HFpEF. Methods Patients aged 55-80 years with symptoms of heart failure, body mass index <= 35 kg/m(2), left ventricular ejection fraction > 50%, left atrial volume index > 34 mL/m(2), left ventricular early diastolic filling velocity and early diastolic tissue velocity of mitral annulus ratio (E/e ' index) >= 13, and BNP levels > 35 pg/mL were included in the study (HFpEF, n = 9). Patients without heart failure with preserved ejection fraction (non-HFpEF, n = 9), aged-paired, were also included in the study. Peripheral chemoreceptors stimulation (10% O-2 and 90% N-2, with CO2 titrated) and central chemoreceptors stimulation (7% CO2 and 93% O-2) were conducted for 3 min. MSNA was evaluated by microneurography technique, and forearm blood flow (FBF) by venous occlusion plethysmography. Results During hypoxia, MSNA responses were greater (p < 0.001) and FBF responses were lower in patients with HFpEF (p = 0.006). Likewise, MSNA responses during hypercapnia were higher (p < 0.001) and forearm vascular conductance (FVC) levels were lower (p = 0.030) in patients with HFpEF. Conclusions Peripheral and central chemoreflex controls of MSNA are hypersensitized in patients with HFpEF, which seems to contribute to the increase in MSNA in these patients. In addition, peripheral and central chemoreceptors stimulation in patients with HFpEF causes muscle vasoconstriction.