CARLOS ALEXANDRE WAINROBER SEGRE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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conferenceObject Gender-related Differences in the Management of Chronic Coronary Syndrome: Registry Data of a Tertiary Center in Brazil(2020) SERRANO, Carlos V.; MOREIRA, Eduardo M.; GARZILLO, Cibele L.; MONTENEGRO, Luiz M.; TABUSE, Cindy L.; KORMANN-MOREIRA, Mylena C.; SEGRE, Alexandre W.; BOLTA, Paula M.; FAVARATO, Desiderio; PITTA, Fabio G.; LIMA, Eduardo G.; REZENDE, Paulo H.; HUEB, Whady A.- Hypotheses, rationale, design, and methods for evaluation of ischemic preconditioning assessed by sequential exercise tests in diabetic and non-diabetic patients with stable coronary artery disease - a prospective study(2013) REZENDE, Paulo Cury; GARCIA, Rosa Maria Rahmi; UCHIDA, Augusto Hiroshi; COSTA, Leandro Menezes Alves; SCUDELER, Thiago Luis; MELO, Rodrigo Morel Vieira; OIKAWA, Fernando Teiichi Costa; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; SEGRE, Carlos Alexandre Wainrober; FAVARATO, Desiderio; GIRARDI, Priscyla; TAKIUTI, Myrthes; STRUNZ, Celia Cassaro; HUEB, Whady; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: Ischemic preconditioning is a powerful mechanism of myocardial protection and in humans it can be evaluated by sequential exercise tests. Coronary Artery Disease in the presence of diabetes mellitus may be associated with worse outcomes. In addition, some studies have shown that diabetes interferes negatively with the development of ischemic preconditioning. However, it is still unknown whether diabetes may influence the expression of ischemic preconditioning in patients with stable multivessel coronary artery disease. Methods/Design: This study will include 140 diabetic and non-diabetic patients with chronic, stable coronary artery disease and preserved left ventricular systolic function. The patients will be submitted to two sequential exercise tests with 30-minutes interval between them. Ischemic parameters will be compared between diabetic and non-diabetic patients. Ischemic preconditioning will be considered present when time to 1.0 mm ST-segment deviation is greater in the second of two sequential exercise tests. Exercise tests will be analyzed by two independent cardiologists. Discussion: Ischemic preconditioning was first demonstrated by Murry et al. in dog's hearts. Its work was reproduced by other authors, clearly demonstrating that brief periods of myocardial ischemia followed by reperfusion triggers cardioprotective mechanisms against subsequent and severe ischemia. On the other hand, the demonstration of ischemic preconditioning in humans requires the presence of clinical symptoms or physiological changes difficult to be measured. One methodology largely accepted are the sequential exercise tests, in which, the improvement in the time to 1.0 mm ST depression in the second of two sequential tests is considered manifestation of ischemic preconditioning. Diabetes is an important and independent determinant of clinical prognosis. It's a major risk factor for coronary artery disease. Furthermore, the association of diabetes with stable coronary artery disease imposes worse prognosis, irrespective of treatment strategy. It's still not clearly known the mechanisms responsible by these worse outcomes. Impairment in the mechanisms of ischemic preconditioning may be one major cause of this worse prognosis, but, in the clinical setting, this is not known. The present study aims to evaluate how diabetes mellitus interferes with ischemic preconditioning in patients with stable, multivessel coronary artery disease and preserved systolic ventricular function.
- Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease(2023) SEGRE, Carlos Alexandre W.; LEMOS, James A. de; ASSUNCAO, Antonildes Nascimento; NOMURA, Cesar Higa; FAVARATO, Desiderio; STRUNZ, Celia Maria Cassaro; VILLA, Alexandre Volney; PARGA FILHO, Jose Rodrigues; REZENDE, Paulo Cury; HUEB, Whady; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; SERRANO, Carlos VicenteBackground:Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. Methods:We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. Results:A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means +/- standard deviations) increased across tertiles: nativeT1 (1006 +/- 27 ms vs 1016 +/- 27 ms vs 1034 +/- 37 ms, ptrend = 0.006) and ECV (22 +/- 3% vs 23 +/- 1.9% vs 25 +/- 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. Conclusion:In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
conferenceObject Role of Hypoglycemic Agents on Ischemic Preconditioning in Diabetic Patients with Stable Multivessel Coronary Artery Disease(2012) GARCIA, Rosa M.; HUEB, Whady; UCHIDA, Augusto H.; REZENDE, Paulo C.; LIMA, Eduardo G.; GARZILLO, Cibele L.; SEGRE, Carlos A.; FAVARATO, Desiderio; RAMIRES, Jose A.; KALIL FILHO, RobertoconferenceObject LIPID TRANSFER TO HIGH DENSITY LIPOPROTEINS IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT CORONARY ARTERY DISEASE(2012) SPRANDEL, Marilia C. O.; HUEB, Whady; CASELLA-FILHO, Antonio; SEGRE, Alexandre; REZENDE, Paulo Cury; CARVALHO, Ana L. O.; FAVARATO, Desiderio; MARANHAO, Raul C.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground In type 2 diabetes mellitus (DM2), HDL-cholesterol is diminished and it is important to understand the functional and metabolic changes existing in HDL in DM2 patients that may predispose to coronary artery disease (CAD). Lipid transfers between HDL and the other lipoproteins, mediated by cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP), are crucial steps in HDL formation and role in reverse cholesterol transfer. Objective Investigate whether development of CAD in DM2 patients are associated with alterations in lipid transfers to HDL and in content of free cholesterol in the plasma. Methods 78 patients with DM2 and CAD (DM2-CAD) and 78 with DM2 without CAD, as diagnosed by cineangiography, were studied. They were of both genders, aged 40-80 yrs. Plasma was incubated for 1h at 37oC with a donor nanoemulsion labeled with 3H -cholesteryl-esters and14C -phospholipids or with 14C-free-cholesterol and 3H -triglycerides. Radioactive lipids transferred from the donor nanoemulsion to HDL were measured in the supernatant after chemical precipitation of non-HDL fractions and the nanoemulsion. Results are % of the total radioactivity of each lipid in HDL. Results In DM2-CAD, LDL-cholesterol and triglycerides were higher than in DM2; HDL-cholesterol was lower. Compared to DM2, DM2-CAD showed diminished transfer to HDL of free-cholesterol (DM2-CAD=4.23±0.24; DM2= 5.66±0.14, p<0.0001) and of triglycerides (1.65±0.13 vs 3.08±0.11, p<0.0001), whereas cholesteryl-ester transfer was increased (3.67±0.16 vs 2.25±0.13, p<0.0001); phospholipid transfer was equal (15.37±0.60 vs15.18±0.20, p=0.76). CETP concentration was equal, while plasma free-cholesterol was higher in DM2-CAD (DM2-CAD=36.9±0.9; DM2=33.1±0.7, p=0.003).HDL particle diameter was equal in both groups. Conclusion The reduction of free-cholesterol transfer to HDL may hinder cholesterol esterification and reverse cholesterol transport. Alterations in triglyceride and cholesteryl-ester transfer may affect lipoprotein stability. Those disturbances in HDL metabolism may facilitate CAD development in DM2. ACC Oral Contributions McCormick Place South, S100c Sunday, March 25, 2012, 9:04 a.m.-9:17 a.m. Session Title: Prevention: Focus on Lipids Abstract Category: 9. Prevention: Clinical Presentation Number: 911-8- Troponin in diabetic patients with and without chronic coronary artery disease(2015) SEGRE, Carlos Alexandre Wainrober; HUEB, Whady; GARCIA, Rosa Maria Rahmi; REZENDE, Paulo Cury; FAVARATO, Desiderio; STRUNZ, Celia Maria Cassaro; SPRANDEL, Marilia da Costa Oliveira; ROGGERIO, Alessandra; CARVALHO, Ana Luiza de Oliveira; MARANHAO, Raul Cavalcante; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: Cardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes. Both diabetes mellitus and coronary artery disease are known predictors of troponin elevation. It is not known whether diabetic patients with coronary artery disease have different levels of troponin compared with diabetic patients with normal coronary arteries. To investigate this question, we determined the concentrations of a level 1 troponin assay in two groups of diabetic patients: those with multivessel coronary artery disease and those with angiographically normal coronary arteries. Methods: We studied 95 diabetic patients and compared troponin in serum samples from 50 patients with coronary artery disease (mean age = 63.7, 58 % male) with 45 controls with angiographically normal coronary arteries. Brain natriuretic peptide and the oxidative stress biomarkers myeloperoxidase, nitrotyrosine and oxidized LDL were also determined. Results: Diabetic patients with coronary artery disease had higher levels of troponin than did controls (median values, 12.0 pg/mL (95 % CI:10-16) vs 7.0 pg/mL (95 % CI: 5.9-8.5), respectively; p = 0.0001). The area under the ROC curve for the diagnosis of CAD was 0.712 with a sensitivity of 70 % and a specificity of 66 %. Plasma BNP levels and oxidative stress variables (myeloperoxidase, nitrotyrosine, and oxidized LDL) were not different between the two groups. In a multivariate analysis, gender (p = 0.04), serum glucose (0.03) and Troponin I (p = 0.01) had independent statistical significance. Conclusion: Troponin elevation is related to the presence of chronic coronary artery disease in diabetic patients with multiple associated cardiovascular risk factors. Troponin may serve as a biomarker in this high-risk population.
conferenceObject CORONARY ARTERY BYPASS GRAFT SURGERY OUTCOMES IN PATIENTS WITH AND WITHOUTCOVID-19 DURING THE PANDEMIC FIRST WAVE(2023) MATUCK, Bruna Scarpa; PINESI, Henrique; MARTINS, Eduardo; GARZILLO, Cibele Larrosa; LOTTENBERG, Marcos Pita; LIMA, Joao A. C.; SEGRE, Alexandre; FAVARATO, Desiderio; LIMA, Eduardo Gomes; RACHED, Fabiana Hanna; PITTA, Fabio Grunspun; LISBOA, Luiz Augusto; JATENE, Fabio Biscegli; KALIL-FILHO, Roberto; SERRANO JR., Carlos V.conferenceObject THE TRIGLYCERIDE/HDL RATIO REMAINS AS AN INDEPENDENT PLASMA LIPID MARKER OF MAJOR CARDIOVASCULAR EVENTS IN DIABETIC PATIENTS 10-YEAR FOLLOW-UP FROM THE MEDICINE ANGIOPLASTY OR SURGERY STUDY II (MASS II) TRIAL(2012) CASELLA-FILHO, Antonio; HUEB, Whady; JONKE, Vivian; SANTOS, Raul; FAVARATO, Desiderio; LIMA, Eduardo; SEGRE, Alexandre; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; CHACRA, Ana P. M.; RAMIRES, Jose; KALIL-FILHO, RobertoBackground: The second Medical, Angioplasty, or Surgery Study (MASS II) compared the long-term effects of medical treatment (MT), angioplasty (PCI), or surgical strategies (CABG) among patients with stable angina symptoms of multivessel coronary artery disease (CAD) and preserved ventricular function who were appropriate candidates for all 3 therapies. Plasma lipids are important risk factors for cardiovascular events in CAD patients, especially in diabetics. We showed previously that the TG/HDL ratio was the only parameter independently associated with major cardiovascular events (MACE; overall death, myocardial infarction, and unstable angina that required myocardial revascularization) in patients after the 10-year follow up of stable CAD patients in the MASS II. In this analysis we evaluated the association of plasma lipids with MACE in diabetic patients after a 10-year follow-up of the MASS II. Methods: The data of 200 patients of the MASS II, 100 diabetics and 100 non diabetics, were analyzed for risk factors and plasma lipids levels. The levels of fasting plasma lipids were determined at baseline and 6 months after randomization. It was instituted in all study patient groups the same lipid therapy. Concentrations of total cholesterol, HDL, non-HDL and LDL-cholesterol as well as LDL/HDL, and TG/HDL ratios were divided according to distribution quartiles. The association of plasma lipids at baseline and at 6 months with MACE was determined by Cox regression models. Results: The patients were followed up for an average of 11.4 years. In the subgroup of diabetic patients, after adjustment for confounders, older age (> 65 years old), randomized treatment for CAD (CABG vs. MT) and the TG/HDL ratio determined at 6 months were independently associated with MACE. There was no association between MACE and other plasma lipids. Conclusions: The TG/HDL remains as a lipid parameter independently associated with MACE in diabetic patients after the 10-year follow up of stable CAD patients in the MASS II.- Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil(2023) MOREIRA, Eduardo Martelli; PINESI, Henrique Trombini; MARTINS, Eduardo Bello; PITTA, Fabio Grunspun; BOLTA, Paula Mathias Paulino; SEGRE, Carlos Alexandre Wainrober; FAVARATO, Desiderio; RACHED, Fabiana Hanna; HUEB, Whady Armindo; LIMA, Eduardo Gomes; FILHO, Roberto Kalil; GARZILLO, Cibele Larrosa; JR, Carlos Vicente SerranoBackground: The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records.Objectives: This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil.Methods: Patients with CIHD who reported for clinical evaluation at Instituto do Coracao (Sao Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted.Results: From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 - 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. Conclusion: This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.
conferenceObject Diabetes and Chronic Kidney Disease: Prevalence, Associated Factors and Influence on Optimal Medical Therapy in Patients with Coronary Artery Disease(2021) MOREIRA, Eduardo M.; PINESI, Henrique Trombini; BOLTA, Paula; MARTINS, Eduardo; RACHED, Fabiana H.; PITTA, Fabio G.; FAVARATO, Desiderio; LIMA, Eduardo G.; GARZILLO, Cibele L.; SEGRE, Carlos A.; SERRANO, Carlos V.