MARIA JANIEIRE DE NAZARE NUNES ALVES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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- Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure(2020) SANTOS, Marcelo Rodrigues Dos; FONSECA, Guilherme Wesley Peixoto da; SHERVENINAS, Leticia Pironato; SOUZA, Francis Ribeiro de; BATTAGLIA FILHO, Antonio Carlos; NOVAES, Caio Eduardo; PEREIRA, Rosa Maria Rodrigues; NEGRAO, Carlos Eduardo; BARRETTO, Antonio Carlos Pereira; ALVES, Maria-Janieire de Nazare NunesAims We studied the association between android (A) to gynoid (G) fat ratio and functional capacity (peak VO2) in male patients with heart failure with reduced ejection fraction (HFrEF). Methods and results We enrolled 118 male patients with HFrEF with left ventricular ejection fraction (LVEF) <40%. Body composition (by using dual x-ray absorptiometry) and peak VO2 (by cardiopulmonary exercise testing) were measured. Sarcopenic obesity was defined according to the Foundation for the National Institutes of Health criteria (FNIH). Blood sample for metabolic and hormonal parameters were measured. Fifteen patients (12.7%) showed sarcopenic obesity (body mass index > 25 kg/m(2) with FNIH index < 0.789). The median A/G ratio was 0.55. A/G ratio > 0.55 was detected in 60 patients. Relative peak VO2 was lower in patients with A/G ratio > 0.55 than in patients with A/G ratio <0.55 (18.7 +/- 5.3 vs. 22.5 +/- 6.1 mL/kg/min, P < 0.001). Logistic regression analysis showed A/G ratio >0.55 to be independently associated with reduced peak VO2 adjusted for age, body mass index, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% confidence interval 1.030-14.730, P = 0.045). Conclusions Body fat distribution, particularly android and gynoid fat composition, together with other cofactors, might have an important adverse role on functional capacity in male patients with HFrEF. Future studies are needed to address possible mechanisms involved in this relationship.
conferenceObject EFFECT OF EXERCISE TRAINING ON PLATELET AGGREGATION AND ON P2Y12 INHIBITOR RESISTANCE AFTER MYOCARDIAL INFARCTION: A RANDOMIZED CLINICAL TRIAL(2020) DALCOQUIO, Talia; FURTADO, Remo Holanda de Mendonca; ARANTES, Flavia Bittar Britto Britto; SANTOS, Mayara Alves dos; ALVES, Leandro Silva; RONDON, Maria Urbana Pinto Brandao; FERREIRA-SANTOS, Larissa; ALVES, Maria Janieire de Nazare Nunes; FERRARI, Aline Gehlen; GENESTRETI, Paulo Rizzo; BARACIOLI, Luciano Moreira; FRANCI, Andre; SALSOSO, Rocio; NEGRAO, Carlos Eduardo; NICOLAU, Jose Carlos- Discriminating sarcopenia in overweight/obese male patients with heart failure: the influence of body mass index(2020) FONSECA, G. W. P. D.; SANTOS, Marcelo Rodrigues dos; SOUZA, Francis Ribeiro de; TAKAYAMA, Liliam; PEREIRA, Rosa Maria Rodrigues; NEGRAO, Carlos Eduardo; ALVES, Maria-Janieire de Nazare NunesAims The definition of sarcopenia based on appendicular lean mass/height ((2)) (ALM/height ((2))) is often used, although it can underestimate the prevalence of sarcopenia in overweight/obese patients with heart failure. Therefore, new methods have been proposed to overcome this limitation. We aimed to evaluate the prevalence of sarcopenia by three methods and compare body composition in this population. Methods and results We enrolled 168 male patients with heart failure (left ventricular ejection fraction <40%). Sixty-six patients (39.3%) were identified with sarcopenia by at least one method. The lower 20th percentile defined as the cut-off point for sarcopenia was 7.03 kg/m(2), -2.32 and 0.76 for Baumgartner's (20.8%), Newman's (21.4%), and Studenski's methods (21.4%), respectively. Patients with body mass index (BMI) <25 kg/m(2) were more likely to be identified by Baumgartner's than Studenski's method (P < 0.001). However, in patients with BMI >= 25 kg/m(2), Studenski's and Newman's methods were more likely to detect sarcopenia than Baumgartner's method (both P < 0.005). Patients were further divided into three subgroups: (i) patients classified in all indexes (n = 8), (ii) patients classified in Baumgartner's (sarcopenic; n = 27), and (iii) patients classified in both Newman's and Studenski's methods (sarcopenic obesity; n = 31). Comparing body composition among groups, all sarcopenic groups presented lower total lean mass compared with non-sarcopenic patients, whereas sarcopenic obese patients had higher total lean mass than lean sarcopenic patients. Conclusions Our results demonstrate that the prevalence of sarcopenia in overweight/obese patients is similar to lean sarcopenic patients when other methods are considered. In patients with higher BMI, Studenski's method seems to be more feasible to detect sarcopenia.
- Exercise training reverses cancer-induced oxidative stress and decrease in muscle COPS2/ TRIP15/ALIEN(2020) ALVES, Christiano R. R.; NEVES, Willian das; ALMEIDA, Ney R. de; EICHELBERGER, Eric J.; JANNIG, Paulo R.; VOLTARELLI, Vanessa A.; TOBIAS, Gabriel C.; BECHARA, Luiz R. G.; FARIA, Daniele de Paula; ALVES, Maria J. N.; HAGEN, Lars; SHARMA, Animesh; SLUPPHAUG, Geir; MOREIRA, Jose B. N.; WISLOFF, Ulrik; HIRSHMAN, Michael F.; NEGRAO, Carlos E.; CASTRO JR., Gilberto de; CHAMMAS, Roger; SWOBODA, Kathryn J.; RUAS, Jorge L.; GOODYEAR, Laurie J.; BRUM, Patricia C.Objective: We tested the hypothesis that exercise training would attenuate metabolic impairment in a model of severe cancer cachexia. Methods: We used multiple in vivo and in vitro methods to explore the mechanisms underlying the beneficial effects induced by exercise training in tumor-bearing rats. Results: Exercise training improved running capacity, prolonged lifespan, reduced oxidative stress, and normalized muscle mass and contractile function in tumor-bearing rats. An unbiased proteomic screening revealed COP9 signalosome complex subunit 2 (COPS2) as one of the most downregulated proteins in skeletal muscle at the early stage of cancer cachexia. Exercise training normalized muscle COPS2 protein expression in tumor-bearing rats and mice. Lung cancer patients with low endurance capacity had low muscle COPS2 protein expression as compared to agematched control subjects. To test whether decrease in COPS2 protein levels could aggravate or be an intrinsic compensatory mechanism to protect myotubes from cancer effects, we performed experiments in vitro using primary myotubes. COPS2 knockdown in human myotubes affected multiple cellular pathways, including regulation of actin cytoskeleton. Incubation of cancer-conditioned media in mouse myotubes decreased F-actin expression, which was partially restored by COPS2 knockdown. Direct repeat 4 (DR4) response elements have been shown to positively regulate gene expression. COPS2 overexpression decreased the DR4 activity in mouse myoblasts, and COPS2 knockdown inhibited the effects of cancer-conditioned media on DR4 activity. Conclusions: These studies demonstrated that exercise training may be an important adjuvant therapy to counteract cancer cachexia and uncovered novel mechanisms involving COPS2 to regulate myotube homeostasis in cancer cachexia. (C) 2020 The Author(s).
- Effects of aerobic and inspiratory training on skeletal muscle microRNA-1 and downstream-associated pathways in patients with heart failure(2020) ANTUNES-CORREA, Ligia M.; TREVIZAN, Patricia F.; BACURAU, Aline V. N.; FERREIRA-SANTOS, Larissa; GOMES, Joao L. P.; URIAS, Ursula; OLIVEIRA, Patricia A.; ALVES, Maria Janieire N. N.; ALMEIDA, Dirceu R. de; BRUM, Patricia C.; OLIVEIRA, Edilamar M.; HAJJAR, Ludhmila; KALIL FILHO, Roberto; NEGRAO, Carlos EduardoBackground The exercise intolerance in chronic heart failure with reduced ejection fraction (HFrEF) is mostly attributed to alterations in skeletal muscle. However, the mechanisms underlying the skeletal myopathy in patients with HFrEF are not completely understood. We hypothesized that (i) aerobic exercise training (AET) and inspiratory muscle training (IMT) would change skeletal muscle microRNA-1 expression and downstream-associated pathways in patients with HFrEF and (ii) AET and IMT would increase leg blood flow (LBF), functional capacity, and quality of life in these patients. Methods Patients age 35 to 70 years, left ventricular ejection fraction (LVEF) <= 40%, New York Heart Association functional classes II-III, were randomized into control, IMT, and AET groups. Skeletal muscle changes were examined by vastus lateralis biopsy. LBF was measured by venous occlusion plethysmography, functional capacity by cardiopulmonary exercise test, and quality of life by Minnesota Living with Heart Failure Questionnaire. All patients were evaluated at baseline and after 4 months. Results Thirty-three patients finished the study protocol: control (n = 10; LVEF = 25 +/- 1%; six males), IMT (n = 11; LVEF = 31 +/- 2%; three males), and AET (n = 12; LVEF = 26 +/- 2%; seven males). AET, but not IMT, increased the expression of microRNA-1 (P = 0.02; percent changes = 53 +/- 17%), decreased the expression of PTEN (P = 0.003; percent changes = -15 +/- 0.03%), and tended to increase the p-AKT(ser473)/AKT ratio (P = 0.06). In addition, AET decreased HDAC4 expression (P = 0.03; percent changes = -40 +/- 19%) and upregulated follistatin (P = 0.01; percent changes = 174 +/- 58%), MEF2C (P = 0.05; percent changes = 34 +/- 15%), and MyoD expression (P = 0.05; percent changes = 47 +/- 18%). AET also increased muscle cross-sectional area (P = 0.01). AET and IMT increased LBF, functional capacity, and quality of life. Further analyses showed a significant correlation between percent changes in microRNA-1 and percent changes in follistatin mRNA (P = 0.001, rho = 0.58) and between percent changes in follistatin mRNA and percent changes in peak VO2 (P = 0.004, rho = 0.51). Conclusions AET upregulates microRNA-1 levels and decreases the protein expression of PTEN, which reduces the inhibitory action on the PI3K-AKT pathway that regulates the skeletal muscle tropism. The increased levels of microRNA-1 also decreased HDAC4 and increased MEF2c, MyoD, and follistatin expression, improving skeletal muscle regeneration. These changes associated with the increase in muscle cross-sectional area and LBF contribute to the attenuation in skeletal myopathy, and the improvement in functional capacity and quality of life in patients with HFrEF. IMT caused no changes in microRNA-1 and in the downstream-associated pathway. The increased functional capacity provoked by IMT seems to be associated with amelioration in the respiratory function instead of changes in skeletal muscle. (Identifier: NCT01747395)
- 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
- Disturbed blood flow acutely increases endothelial microparticles and decreases flow mediated dilation in patients with heart failure with reduced ejection fraction(2020) SALES, Allan; OLIVEIRA, Thiago; MENDONCA, Gustavo; FONSECA, Guilherme; BRAGA, Pedro; ROCHA, Helena; ROCHA, Natalia; LIMA, Marta; NEGRAO, Carlos; ALVES, Maria
- Adjuvant Treatment with5-Fluorouraciland Oxaliplatin Does Not Influence Cardiac Function, Neurovascular Control, and Physical Capacity in Patients with Colon Cancer(2020) GROEHS, Raphaela V.; NEGRAO, Marcelo V.; HAJJAR, Ludhmila A.; JORDAO, Camila P.; CARVALHO, Bruna P.; TOSCHI-DIAS, Edgar; ANDRADE, Ana C.; HODAS, Fabiana P.; ALVES, Maria J. N. N.; SARMENTO, Adriana O.; TESTA, Laura; HOFF, Paulo M. G.; NEGRAO, Carlos E.; KALIL FILHO, RobertoBackground Adjuvant chemotherapy with 5-fluorouracil (5-FU) and oxaliplatin increases recurrence-free and overall survival in patients with colon adenocarcinoma. It is known that these drugs have been associated with cardio- and neurotoxicity. We investigated the effects of 5-FU +/- oxaliplatin on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer. Methods Twenty-nine patients with prior colectomy for stage II-III adenocarcinoma and clinical indication for adjuvant chemotherapy were allocated to receive 5-FU (n= 12) or 5-FU + oxaliplatin (n= 17), according to the oncologist's decision. All the analyses were performed just before and after the end of chemotherapy. Cardiac function was assessed by echocardiography and speckle tracking, and cardiac autonomic control was assessed by heart rate variability (HRV). Vascular endothelial function was assessed by flow-mediated dilation (FMD). Muscle sympathetic nerve activity (MSNA) was directly recorded by microneurography technique, and muscle blood flow by venous occlusion plethysmography. Physical capacity was evaluated by cardiopulmonary exercise test. Results Chemotherapy (pooled data) did not significantly change left ventricular ejection fraction (58 +/- 1 vs. 55 +/- 2%,p= .14), longitudinal strain (-18 +/- 1 vs. -18 +/- 1%,p= .66), and HRV. Likewise, chemotherapy did not significantly change FMD, muscle blood flow, and MSNA (33 +/- 2 vs. 32 +/- 1 bursts/min,p= .31). Physical capacity was not significantly changed in both groups. Similar findings were observed when the patients were subdivided in 5-FU and 5-FU + oxaliplatin treatment groups. 5-FU and 5-FU + oxaliplatin did not significantly change cardiac function, HRV, vascular responses, MSNA, and physical capacity. Conclusion This study provides evidence that adjuvant treatment with 5-FU +/- oxaliplatin is well tolerated and does not promote changes compatible with long-term cardiotoxicity. Implications for Practice Adjuvant chemotherapy with 5-fluorouracil (5-FU) and oxaliplatin increases recurrence-free and overall survival in patients with colon adenocarcinoma; however, these drugs have been associated with cardio- and neurotoxicity. This study investigated the effects of these drugs on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer. It was found that 5-FU and oxaliplatin did not significantly change cardiac function, cardiac autonomic control, vascular endothelial function, muscle sympathetic nerve activity, and physical capacity. This study provides evidence that adjuvant treatment with 5-FU +/- oxaliplatin is well tolerated and does not promote changes compatible with long-term cardiotoxicity.
- Ms, muscle strength, and functional capacity in patients with heart failure of Chagas disease and other aetiologies(2020) FONSECA, Guilherme Wesley Peixoto da; MACEDO, Tania Garfias; EBNER, Nicole; SANTOS, Marcelo Rodrigues dos; SOUZA, Francis Ribeiro de; MADY, Charles; TAKAYAMA, Liliam; PEREIRA, Rosa Maria Rodrigues; DOEHNER, Wolfram; ANKER, Stefan D.; NEGRAO, Carlos Eduardo; ALVES, Maria Janieire de Nazare Nunes; HAEHLING, Stephan vonAims Patients with Chagas disease and heart failure (HF) have a poor prognosis similar to that of patients with ischaemic or dilated cardiomyopathy. However, the impact of body composition and muscle strength changes in these aetiologies is still unknown. We aimed to evaluate these parameters across aetiologies in two distinct cohort studies [TESTOsterone-Heart Failure trial (TESTO-HF; Brazil) and Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF; Germany)]. Methods and results A total of 64 male patients with left ventricular ejection fraction <= 40% were matched for body mass index and New York Heart Association class, including 22 patients with Chagas disease (TESTO-HF; Brazil), and 20 patients with dilated cardiomyopathy and 22 patients with ischaemic heart disease (SICA-HF; Germany). Lean body mass (LBM), appendicular lean mass (ALM), and fat mass were assessed by dual energy X-ray absorptiometry. Sarcopenia was defined as ALM divided by height in metres squared <7.0 kg/m(2)(ALM/height(2)) and handgrip strength cut-off for men according to the European Working Group on Sarcopenia in Older People. All patients performed maximal cardiopulmonary exercise testing. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Chagasic and ischaemic patients had lower total fat mass (16.3 +/- 8.1 vs. 19.3 +/- 8.0 vs. 27.6 +/- 9.4 kg;P < 0.05) and reduced peak oxygen consumption (VO2) (1.17 +/- 0.36 vs. 1.15 +/- 0.36 vs. 1.50 +/- 0.45 L/min;P < 0.05) than patients with dilated cardiomyopathy, respectively. Chagasic patients showed a trend towards decreased LBM when compared with ischaemic patients (48.3 +/- 7.6 vs. 54.2 +/- 6.3 kg;P = 0.09). Chagasic patients showed lower handgrip strength (27 +/- 8 vs. 37 +/- 11 vs. 36 +/- 14 kg;P < 0.05) and FBF (1.84 +/- 0.54 vs. 2.75 +/- 0.76 vs. 3.42 +/- 1.21 mL/min/100 mL;P < 0.01) than ischaemic and dilated cardiomyopathy patients, respectively. There was no statistical difference in the distribution of sarcopenia between groups (P = 0.87). In addition, FBF correlated positively with LBM (r = 0.31;P = 0.012), ALM (r = 0.25;P = 0.046), and handgrip strength (r = 0.36;P = 0.004). In a logistic regression model using peak VO(2)as the dependent variable, haemoglobin (odds ratio, 1.506; 95% confidence interval, 1.043-2.177;P = 0.029) and ALM (odds ratio, 1.179; 95% confidence interval, 1.011-1.374;P = 0.035) were independent predictors for peak VO(2)adjusted by age, left ventricular ejection fraction, New York Heart Association, creatinine, and FBF. Conclusions Patients with Chagas disease and HF have decreased fat mass and exhibit reduced peripheral blood flow and impaired muscle strength compared with ischaemic HF patients. In addition, patients with Chagas disease and HF show a tendency to have greater reduction in total LBM, with ALM remaining an independent predictor of reduced functional capacity in these patients. The percentage of patients affected by sarcopenia was equal between groups.
- 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.