CARLOS ALEXANDRE WAINROBER SEGRE

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Influence of the concentration and molecular composition on the LDL and HDL functional characteristics in patients with the metabolic syndrome
    (2012) CASELLA-FILHO, Antonio; TROMBETTA, Ivani C.; CASELLA, Lia B.; DENARDI, Celise; DOURADO, Paulo; SEGRE, Alexandre; ROEVER-BORGES, Leonardo; NEGRAO, Carlos Eduardo; MARANHAO, Raul; CHAGAS, Antonio Carlos
    Introduction: Long-term exercise associated with diet changes lipoproteins plasma levels. Objectives: We sought to analize the effects of short-term exercise training without any specific diet (T) on the concentration,composition and functional characteristics of LDL and HDL in patients with metabolic syndrome (MS). Methods: Forty sedentary persons were studied,30 with MS and 10 controls.Twenty of those with MS were subjected to a 3 times/week controlled training load (45 min/day) for 3 months on a bicycle ergometer.LDL and HDL subfractions were obtained by plasma ultracentrifugation 1 and their compositions were analyzed. LDL from control subjects was incubated with HDL2a,HDL3b from the MS patients (before and after T) and the in vitro resistance to oxidation was verified. An artificial lipoprotein emulsion (LDE) labeled with 14C-phospholipid, 3 H-triglycerides, 14 C-cholesterol and 3 H-cholesteryl ester was incubated with plasma from the participants. After precipitation of VLDL, LDL and LDE the HDL-containing supernatant was counted for radioactivity to verify the HDL ability to accept lipids. 2 Results: T decreased triglycerides (TG) but did not change apoB,apoA-I,LDL-C and HDL-C plasma levels. LDL resistance to oxidation increased (+91%) after T,associated with a decrease in the LDL content of apoB (-16%) and TG (-14%) and in the concentration of the small and dense LDL particles. Oxidizability of control LDL decreased when mixed with HDL2a or 3b from patients with MS, before vs. after T (-23% for HDL2a and -18% for HDL3b),associated with an increase in PON1 activity in the MS group (58.3±36.2 before vs.70.7±38.4ng/ml/min after T, p<0.05) and with a significant decrease in the content of total cholesterol (TC) and TG in HDL3b and HDL3c but with an increase in cholesterol ester (CE) in HDL3b. T did not significantly modify concentrations of TC and TG in HDL2a, 2b and 3a. Phospholipids and total protein content did not change in all HDL subfractions.T significantly increased free cholesterol and CE transfer from LDE to HDL in MS group to levels similar to those observed in controls. Conclusion: In patients with the MS, T influences the LDL and HDL functionality by earlier changes in molecular composition rather than their concentration, emphasizing the early benefits of exercise and highlighting the importance of evaluating the functional aspects of the lipoproteins besides their plasma levels
  • conferenceObject
    LIPID TRANSFER TO HDL IN PATIENTS WITH CORONARY ARTERY DISEASE
    (2014) SPRANDEL, Mar lia O.; HUEB, Whady; CASELLA-FILHO, Antonio; SCUDELER, Thiago; REZENDE, Paulo; LIMA, Eduardo; SEGRE, Alexandre; CARVALHO, Ana; MARANHAO, Raul; KALIL-FILHO, Roberto
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    RELATIONSHIPS BETWEEN HDL FUNCTIONAL CHARACTERISTICS AND ENDOTHELIAL VASCULAR FUNCTION AFTER SHORT-TERM EXERCISE TRAINING IN PATIENTS WITH THE METABOLIC SYNDROME
    (2013) CASELLA-FILHO, Antonio; TROMBETTA, Ivani C.; DOURADO, Paulo; LEITE-JUNIOR, Antonio C.; JONKE, Vivian; SEGRE, Alexandre; SANTOS, Raul; NEGRAO, Carlos E.; MARANHAO, Raul C.; CHAGAS, Antonio
    Introduction: Endothelial dysfunction, leading to vasodilation impairment and atherosclerosis, frequently affects patients with metabolic syndrome (MS). A recent study showed that HDL estimulates endothelial nitric oxide synthase (eNOS: a key regulator of vascular nitric oxide production) by activation of Akt and MAP kinases in cultured endothelial cells. Objectives: To investigate the relationships between HDL characteristics (concentration, composition, functionality) on the eNOS availability and endothelial vascular function in patients with MS after a short-term exercise training (T). Methods: Forty sedentary persons (30 MS and 10 controls) were studied. Twenty with MS were subjected to a 3 times/week of a training load (45min/d) for 3 months on a bicycle. Cyclic guanosine monophosphate (cGMP), blood nitrite concentrations (biomarkers of eNOS availability) and HDL subfractions obtained by plasma ultracentrifugation were analyzed. A control LDL was incubated with HDL subfractions from the patients with MS (before-after T) and the in vitro resistance to oxidation was verified. An artificial radio-labeled lipoprotein emulsion was incubated with plasma from the participants. After precipitation of VLDL and LDL, the HDL containing supernatant was counted for radioactivity, to verify the HDL ability to accept lipids. Endothelial vascular function was assessed from forearm blood flow-mediated responses to vasodilation tests (FMD). Results: T did not change HDL-C concentration but changed the molecular composition and improved the functional characteristics of the HDL-particles subfractions: protecting LDL against oxidation (+21%) and increasing the HDL-particles ability to accept lipids (+23%). T increased cGMP and blood nitrite concentrations. The best HDL functional results were associated with the highest cGMP and blood nitrite concentrations and with the best FMD improvement results in the MS group. Conclusions: T early changes functional characteristics of HDL-particles, rather than HDL-C concentration, associated with eNOS biomarkers and with endothelial vascular function improvement in patients with MS, highlighting the early vascular benefits of exercising
  • conferenceObject
    IN BOTH GENDERS, HIGH RATE UNESTERIFIED CHOLESTEROL TRANSFER TO HDL IN THE PLASMA CAN BE PROTECTIVE AGAINST CORONARY ARTERY DISEASE
    (2014) SPRANDEL, M. C. O.; HUEB, W. A.; SEGRE, A. C.; LAVERDY, O. G.; LEITE-JUNIOR, A. C.; FREITAS, F. R.; KALIL-FILHO, R.; MARANHAO, R. C.
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    Cardiovascular secondary prevention setting and lipid controlu, update data from PINNACLE BRAZIL REGISTRY
    (2019) SARAIVA, J. F. K.; MATTOS, A. Cordeiro; SARAIVA, G. B. F.; PINTO, I. M.; ROMBALDI, A. R.; KATO, N. H.; SILVA, L. F. Gomes Da; MINELLI, C.; CARVALHO, I. T. N.; DANTAS, J. M. M.; SOUZA FILHO, J. M. De; FIGUINHA, F. C. R.; SEGRE, C. A. W.; FONSECA, H. A. R.; AVEZUM, A.
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    Expression of Ischemic Preconditioning in Patients With Stable Multivessel Coronary Artery Disease With and Without Diabetes Mellitus
    (2013) REZENDE, Paulo C.; GARCIA, Rosa M.; UCHIDA, Augusto H.; LIMA, Eduardo G.; GARZILLO, Cibele L.; SEGRE, Carlos A.; CESAR, Luiz A.; HUEB, Whady; RAMIRES, Jose A.; KALIL FILHO, Roberto
  • conferenceObject
    Prognosis in 10 years of follow-up of three therapeutic strategies for chronic multivessel coronary artery disease in women (study MASS)
    (2013) MANSUR, A. P.; HUEB, W. A.; TAKADA, J. Y.; AVAKIAN, S. D.; REZENDE, P. C.; SEGRE, A.; SOARES, P. R.; GARZILLO, C.; RAMIRES, J. A. F.; KALIL FILHO, R.
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    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.
  • conferenceObject
    SHORT-TERM EXERCISE TRAINING CHANGES TRIGLYCERIDES MOLECULAR CONTENT OF THE LDL AND HDL PARTICLES AFFECTING THEIR FUNCTIONAL CHARACTERISTICS IN METABOLIC SYNDROME
    (2013) CASELLA-FILHO, Antonio; TROMBETTA, Ivani; DOURADO, Paulo Magno; LEITE-JUNIOR, Antonio Carlos; SPRANDEL, Marilia C. O.; SEGRE, Alexandre; SANTOS, Raul; NEGRAO, Carlos Eduardo; MARANHAO, Raul C.; CHAGAS, Antonio
    Background: Long–term exercise training associated with diet changes lipoproteins plasma levels. Objectives: We sought to investigate the effects of short–term exercise training without any specific diet (T) on the concentration, composition and functional characteristics of LDL and HDL particles in patients with metabolic syndrome (MS). Methods: Forty sedentary persons (30 MS and 10 controls) were studied. Twenty of those with MS were subjected to a 3 times/week controlled training load (45 min/day) for 3 months on a bicycle ergometer. LDL and HDL subfractions were obtained by plasma ultracentrifugation and their compositions were analyzed. The in vitro resistance to oxidation of the LDL from the patients with MS (before and after T) was verified. A control LDL was incubated with HDL2a and HDL3b from the patients with MS (before – after T) and the in vitro resistance to oxidation was verified. An artificial lipoprotein emulsion (LDE) labeled with 14C–phospholipid, 3H–triglycerides, 14C–cholesterol and 3H–cholesteryl ester was incubated with plasma from the participants. After precipitation of VLDL, LDL and LDE, the HDL–containing supernatant was counted for radioactivity, to verify the HDL ability to accept lipids. Results: T decreased triglycerides (TG) but did not change LDL–C and HDL–C plasma levels. The LDL resistance to oxidation of the MS group increased (+91%) after T, associated with a significant decrease in the LDL–particles content of TG (−14%) and apoB (−16%), and with a 27% reduction of the small and dense LDL–particles plasma levels. The oxidizability of the control LDL decreased when mixed with HDL2a or HDL3b from patients with MS, before vs. after T (−23% for HDL2a and −18% for HDL3b) associated with a significant decrease in the content of TG in HDL3b (−12%) and HDL3c (−15%). The transference of TG to HDL normalized after T in the MS group. Conclusions: In patients with MS, T early reduces TG concentration influencing the LDL and HDL functionality by changing their molecular composition rather than their concentration, emphasizing the early benefits of exercise and highlighting the importance of evaluating lipoproteins composition and functional aspects besides their plasma levels.
  • conferenceObject
    Five year follow-up of on-pump versus off pump coronary artery bypass surgery in elderly patients - the MASS III trial
    (2012) MELO, R. M. Vieira De; REZENDE, P. C.; GARZILLO, C. L.; LIMA, E. G.; SEGRE, C. A. W.; COSTA, L. M. A.; OIKAWA, F. T.; HUEB, W.; RAMIRES, J. A. F.; KALIL FILHO, R.
    Purpose: Advanced age is associated with increased mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG), which may be a consequence of cardiopulmonary bypass. Thus, off-pump surgery may have an increased benefit in elderly patients. We aim to evaluate cardiac events and long-term clinical outcomes in elderly patients with stable coronary artery disease and preserved left ventricular ejection fraction undergoing off-pump and on-pump CABG. Methods: The MASS III was a single-center randomized trial that evaluate 308 patients with stable coronary artery disease and preserved ventricular function assigned for off-pump (n=155) or on-pump (n=153) CABG. Of this, 176 (58,3%) patients had 60 years or older at the time of randomization (of-pump=90 and on-pump=86). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), or stroke. Results: The two randomized groups were well-matched for baseline demographic, clinical, and angiographic characteristics. The mean age was 67,2 ( ± 5,0) years. After 5-year follow-up, there were no significant differences between on- pump and off-pump groups in the composite end points: 27,9% vs 21,1% (hazard ratio 1.17, 95% CI 0.87 to 1.59; P=0.29) Figure 1. Six patients (7.0%) died in the on-pump group compared with 10 (11.1%) in the of-pump group (hazard ratio 0.78, 95% CI 0.47 to 1.29; p=0.33). On-pump patients had a higher incidence of postoperative stroke or myocardial infarction: 13 (15.1%) vs 5 (5,6%); p=0,036. Conclusions: Patients undergoing off-pump surgery had a lower incidence of in hospital stroke or myocardial infarction. This finding did not add benefit in clinical outcomes at 5-years follow-up.