ANA LUIZA CARRARI SAYEGH
Projetos de Pesquisa
Unidades Organizacionais
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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conferenceObject Impaired Baroreflex Sensitivity in Anabolic Steroid Users(2012) SANTOS, Marcelo Rodrigues dos; PORELLO, Rafael Armani; SAYEGH, Ana L. C.; HONG, Valeria; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.Purpose: Exacerbated sympathetic nerve activity and increased blood pressure have been documented in anabolic androgenic steroid users (AASU). We tested the hypothesis that arterial baroreflex sensitivity (BRS) and carotid distensibility would be reduced in AASU. Methods: Ten AASU and 10 age-paired anabolic androgenic steroid nonusers (AASNU) were studied. Both groups were involved in strength training (90% 1MR) and AASU were self-administered anabolic steroids for at least 2 years. The use of AAS was proved by urine. Heart rate (HR) was evaluated by EKG and blood pressure non-invasively on a beat to beat. BRS was analyzed by time domain through spontaneous fluctuations between systolic blood pressure (SBP) and HR. Carotid artery distensibility was measured by doppler (M-mode). Results: HR was higher in AASU compared to AASNU (69±3 vs. 59±3 bpm, P≤0.05). Systolic (123±4 vs. 118±2 mmHg, P=0.29), diastolic (72±2 vs. 67±2 mmHg, P=0.12) and mean blood pressure (90±3 vs. 85±2 mmHg, P=0.15) were not different between groups. BRS for increases (14.2±2 vs. 22.8±3 msec/mmHg, P=0.05) and decreases (13.3±1 vs. 19.2±2 msec/mmHg, P=0.04) were lower in AASU. Carotid distensibility was reduced in AASU (7±1 vs. 9±1 %, P≤0.05). Conclusion: Impaired BRS and reduced carotid distensibility may prematurely lead to increased cardiovascular risk in AASU.- Resting spontaneous baroreflex sensitivity and cardiac autonomic control in anabolic androgenic steroid users(2018) SANTOS, Marcelo R. dos; SAYEGH, Ana L. C.; ARMANI, Rafael; COSTA-HONG, Valeria; SOUZA, Francis R. de; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.OBJECTIVES: Misuse of anabolic androgenic steroids in athletes is a strategy used to enhance strength and skeletal muscle hypertrophy. However, its abuse leads to an imbalance in muscle sympathetic nerve activity, increased vascular resistance, and increased blood pressure. However, the mechanisms underlying these alterations are still unknown. Therefore, we tested whether anabolic androgenic steroids could impair resting baroreflex sensitivity and cardiac sympathovagal control. In addition, we evaluate pulse wave velocity to ascertain the arterial stiffness of large vessels. METHODS: Fourteen male anabolic androgenic steroid users and 12 nonusers were studied. Heart rate, blood pressure, and respiratory rate were recorded. Baroreflex sensitivity was estimated by the sequence method, and cardiac autonomic control by analysis of the R-R interval. Pulse wave velocity was measured using a noninvasive automatic device. RESULTS: Mean spontaneous baroreflex sensitivity, baroreflex sensitivity to activation of the baroreceptors, and baroreflex sensitivity to deactivation of the baroreceptors were significantly lower in users than in nonusers. In the spectral analysis of heart rate variability, high frequency activity was lower, while low frequency activity was higher in users than in nonusers. Moreover, the sympathovagal balance was higher in users. Users showed higher pulse wave velocity than nonusers showing arterial stiffness of large vessels. Single linear regression analysis showed significant correlations between mean blood pressure and baroreflex sensitivity and pulse wave velocity. CONCLUSIONS: Our results provide evidence for lower baroreflex sensitivity and sympathovagal imbalance in anabolic androgenic steroid users. Moreover, anabolic androgenic steroid users showed arterial stiffness. Together, these alterations might be the mechanisms triggering the increased blood pressure in this population.
- Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity(2018) TURQUETTO, Aida Luiza Ribeiro; SANTOS, Marcelo Rodrigues dos; SAYEGH, Ana Luiza Carrari; SOUZA, Francis Ribeiro de; AGOSTINHO, Daniela Regina; OLIVEIRA, Patricia Alves de; SANTOS, Yarla Alves dos; LIBERATO, Gabriela; BINOTTO, Maria Angelica; OTADUY, Maria Concepcion Garcia; NEGRAO, Carlos Eduardo; CANEO, Luiz Fernando; JATENE, Fabio Biscegli; JATENE, Marcelo BiscegliBackground: Changes in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. Methods: Thirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. Results: Fontan patients have blunted FBF (1.59 +/- 0.33 vs 2.17 +/- 0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 +/- 0.04 vs 2.34 +/- 0.62 units p < 0.001), reduced CSA of the thigh (81.2 +/- 18.6 vs 116.3 +/- 26.4 cm(2) p < 0.001), lower peak VO2 (29.3 +/- 6 vs 41.5 +/- 9mL/kg/min p < 0.001), walked distance (607 +/- 60 vs 701 +/- 58m p < 0.001) and handgrip strength (21 +/- 9 vs 30 +/- 8 kgf p < 0.001). The MSNA (30 +/- 4 vs 22 +/- 3 bursts/min p < 0.001) and norepinephrine concentration [265 (236-344) vs 222 (147-262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (beta = 0.653; CI = 0.102-1.205; p = 0.022) and stroke volume (beta = 0.018; CI = 0.007-0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (beta = 5.283; CI = 2.254-8.312; p = 0.001) was independently associated with reduced peak VO2. Conclusion: Patients with Fontan operation have underdeveloped skeletal muscle with reduced strengh that is associated with suboptimal peripheral blood supply and diminished exercise capacity.
- Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure(2015) SANTOS, Marcelo Rodrigues dos; SAYEGH, Ana Luiza Carrari; GROEHS, Raphaela Vilar Ramalho; FONSECA, Guilherme; TROMBETTA, Ivani Credidio; BARRETTO, Antonio Carlos Pereira; ARAP, Marco Antonio; NEGRAO, Carlos Eduardo; MIDDLEKAUFF, Holly R.; ALVES, Maria-Janieire de Nazare NunesBackground: Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. Objective: We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Methods: Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. Results: Length of hospital stay was longer in the LT group compared to in the NT group (37 +/- 4 vs. 25 +/- 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58-4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67-8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23-8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 +/- 3 vs. 51 +/- 4 bursts/100 heart beats; p < 0.001). Conclusion: These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.
conferenceObject Impact of exercise training and testosterone replacement on skeletal muscle atrophy and muscle sympathetic nerve activity in heart failure patients with hypogonadism(2014) SANTOS, M. R. Dos; SAYEGH, A. L.; BACURAU, A. V. N.; ARAP, M. A.; PEREIRA, R. M. R.; BRUM, P. C.; TAKAYAMA, L.; PEREIRA, A. C.; ALVES, M. J. N. N.conferenceObject Neurovascular Control and Spontaneous Baroreflex Sensitivity in Heart Failure Patients with Preserved Ejection Fraction(2014) SAYEGH, Ana Luiza C.; SANTOS, Marcelo R. dos; SOUZA, Francis R. de; SALEMI, Vera Maria C.; OLIVEIRA, Carlos Augusto P.; FONSECA, Felipe X.; RODRIGUES, Sara; TROMBETTA, Ivani C.; TOSCHI-DIAS, Edgar; NEGRAO, Carlos Eduardo; ALVES, Maria-Janieire N.; MADY, Charles- Caracterização das Variáveis do Teste de Esforço Cardiopulmonar em Pacientes com Endomiocardiofibrose após Cirurgia de Ressecção Endocárdica(2017) SAYEGH, Ana Luiza C.; SANTOS, Marcelo R. dos; OLIVEIRA, Patricia de; FERNANDES, Fabio; RONDON, Eduardo; SOUZA, Francis R. de; SALEMI, Vera M. C.; ALVES, Maria Janieire de N. N.; MADY, CharlesBackground: Endomyocardial fibrosis (EMF) is a rare disease, characterized by diastolic dysfunction which leads to reduced peak oxygen consumption (VO2). Cardiopulmonary exercise testing (CPET) has been proved to be a fundamental tool to identify central and peripheral alterations. However, most studies prioritize peak VO2 as the main variable, leaving aside other important CPET variables that can specify the severity of the disease and guide the clinical treatment. Objective: The aim of this study was to evaluate central and peripheral limitations in symptomatic patients with EMF by different CPET variables. Methods: Twenty-six EMF patients (functional class III, NYHA) were compared with 15 healthy subjects (HS). Functional capacity was evaluated using CPET and diastolic and systolic functions were evaluated by echocardiography. Results: Age and gender were similar between EMF patients and HS. Left ventricular ejection fraction was normal in EMF patients, but decreased compared to HS. Peak heart rate, peak workload, peak VO2, peak oxygen (O-2) pulse and peak pulmonary ventilation (V-E) were decreased in EMF compared to HS. Also, EMF patients showed increased Delta heart rate /Delta oxygen uptake and Delta oxygen uptake /Delta work rate compared to HS. Conclusion: Determination of the aerobic capacity by noninvasive respiratory gas exchange during incremental exercise provides additional information about the exercise tolerance in patients with EMF. The analysis of different CPET variables is necessary to help us understand more about the central and peripheral alterations cause by both diastolic dysfunction and restrictive pattern.
conferenceObject Galectin-3 levels are normal in patients with constrictive pericarditis and are associated with exercise intolerance after pericardiectomy(2018) FERNANDES, F.; MELLO, D. T. P.; RAMIRES, F. J. A.; SABINO, E. C.; MOREIRA, C. H. V.; BENVENUTTI, L.; HOTTA, V. T.; SAYEG, A.; DIAS, R. R.; MADY, C.conferenceObject Functional capacity in patients with restrictive syndromes: endomyocardial fibrosis versus constrictive pericarditis(2015) SAYEGH, A. L.; MELO, D. T. P.; SOUZA, F. R. De; SANTOS, M. R. Dos; DUTRA-MARQUES, A. C. B.; SALEMI, V. C.; NEGRAO, C. E.; MADY, C.; ALVES, M. J. N. N.; FERNANDES, F.- Neurovascular Response during Exercise and Mental Stress in Anabolic Steroid Users(2018) PORELLO, Rafael Armani; SANTOS, Marcelo Rodrigues Dos; SOUZA, Francis Ribeiro De; FONSECA, Guilherme Wesley Peixoto Da; SAYEGH, Ana Luiza Carrari; OLIVEIRA, Tiago Franco De; AKIHO, Cesar Abreu; YONAMINE, Mauricio; PEREIRA, Rosa Maria Rodrigues; NEGRAO, Carlos Eduardo; ALVES, Maria-Janieire De Nazare NunesPurpose Increased resting muscle sympathetic nerve activity (MSNA) and lower forearm blood flow (FBF) were observed in young men who use anabolic androgenic steroids (AAS). However, the response of MSNA and FBF in AAS users triggered by muscle mechanoreflex and central command has never been tested. In addition, we evaluated the blood pressure (BP) and heart rate (HR) responses during these maneuvers. Methods Nineteen AAS users (AASU) 31 6 yr of age and 18 AAS nonusers (AASNU) 29 4 yr of age were recruited. All participants were involved in strength training. AAS use was determined using a urine test (liquid chromatography with tandem mass spectrometry). MSNA was measured using the microneurography technique. FBF was measured by using venous occlusion plethysmography. BP was measured using an automatic oscillometric device. HR was recorded continuously through ECG. Isometric handgrip exercise was performed at 30% of the maximal voluntary contraction for 3 min, and mental stress was elicited by the Stroop color-word test for 4 min. Results The MSNA and FBF responses during exercise were similar between AASU and AASNU, with a trend toward higher MSNA (bursts per minute; P = 0.084) and lower forearm vascular conductance (FVC; units; P = 0.084) in AASU than in AASNU. During mental stress, AASU showed a significantly higher MSNA (P < 0.05) and lower FBF (P < 0.05) compared with AASNU. During both maneuvers, HR and BP increased linearly in both groups; however, AASU showed a significantly higher HR compared with AASNU. Conclusions During muscle mechanoreflex activation (isometric exercise), AASU have normal MSNA and FBF responses, whereas during central command (mental stress) stimulation, AASU have exacerbated MSNA and blunted vasodilation. Therefore, mental stress seems to exacerbate neurovascular control throughout stress reaction situations in AASU.