GLAUCYLARA REIS GEOVANINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
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- Obstructive sleep apnoea is associated with myocardial injury in patients with refractory angina(2016) GEOVANINI, Glaucylara R.; PEREIRA, Alexandre C.; GOWDAK, Luis H. W.; DOURADO, Luciana Oliveira Cascaes; POPPI, Nilson T.; VENTURINI, Gabriela; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoObjective To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. Methods Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00. Results We studied 80 consecutive patients (age: 62 +/- 10 years; male: 66%; body mass index (BMI): 29.5 +/- 4 kg/m(2)) with well-established diagnosis of refractory angina. The mean apnoea-hypopnoea index (AHI) was 37 +/- 29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI >= 51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p = 0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p = 0.028) in multivariate analysis. Conclusion Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.
conferenceObject Obstructive Sleep Apnea Is Extremely Common And Associated With Myocardial Ischemia In Patients With Refractory Angina(2014) GEOVANINI, G. R.; PEREIRA, A. C.; GOWDAK, L. H. W.; DOURADO, L. O.; POPPI, N.; CESAR, L. M.; DRAGER, L. F.; LORENZI-FILHO, G.conferenceObject Obstructive Sleep Apnea In The Spectrum Of Coronary Artery Disease: Stable Versus Refractory Angina Patients(2013) GEOVANINI, G. R.; DANZI-SOARES, N.; DOURADO, L. O. C.; POPPI, N. T.; PEREIRA, A. C.; GOWDAK, L. W.; DRAGER, L. F.; LORENZI-FILHO, G.- OSA and Depression Are Common and Independently Associated With Refractory Angina in Patients With Coronary Artery Disease(2014) GEOVANINI, Glaucylara R.; GOWDAK, Luis H. W.; PEREIRA, Alexandre C.; DANZI-SOARES, Naury de Jesus; DOURADO, Luciana O. C.; POPPI, Nilson T.; CESAR, Luiz Antonio Machado; DRAGER, Luciano F.; LORENZI-FILHO, GeraldoOBJECTIVE: Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS: We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS: Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 +/- 4 kg/m(2) vs 28.5 +/- 4 kg/ m(2), P = .06), and were older (61 +/- 10 y vs 57 +/- 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 +/- 6 vs 8 +/- 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 +/- 8 vs 10 +/- 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 +/- 30 events/h vs 23 +/- 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% + 13 vs 4% + 9, P = .04), and a higher proportion of severe OSA (AHI >= 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS: OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.
- Poor sleep quality and lipid profile in a rural cohort (The Baependi Heart Study)(2019) GEOVANINI, Glaucylara Reis; LORENZI-FILHO, Geraldo; PAULA, Lilian K. de; OLIVEIRA, Camila Maciel; ALVIM, Rafael de Oliveira; BEIJAMINI, Felipe; NEGRAO, Andre Brooking; SCHANTZ, Malcolm von; KNUTSON, Kristen L.; KRIEGER, Jose Eduardo; PEREIRA, Alexandre CostaAim: To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration. Methods: A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration). Results: The sample mean age was 43 +/- 16 years, 66% were female, and mean body mass index (BMI) was 26 +/- 5 kg/m(2). Only 20% were classified as obese (BMI >= 30). Overall, 50% of participants reported poor sleep quality as defined by a PSQI score >= 5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta = 0.392, p = 0.012) and higher triglyceride levels (beta = 0.017, p = 0.006), even after adjustments, including the apneaehypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta = 1.976, p = 0.027), sleep medication use (beta = 1.121, p = 0.019), and daytime dysfunction (beta = 1.290, p = 0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta = 0.066, p = 0.004). Conclusion: Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.
conferenceObject Obstructive sleep apnoea is highly frequent in consecutive patients with refractory angina(2012) GEOVANINI, G.; DRAGER, L.; DOURADO, L. O. C.; POPPI, N. T.; PEREIRA, A. C.; GOWDAK, L. H. W.; LORENZI-FILHO, G.Purpose: Obstructive sleep apnoea (OSA) is common among patients with stable coronary artery disease and may contribute to poor cardiovascular outcome. OSA has not been investigated in patients with refractory angina, a debilitating condition characterized by persistent symptoms despite optimized medical therapy. Methods: Consecutive patients with multi-vessel coronary disease by angiography and refractory angina (severe ischemic symptoms that persist despite optimal medical therapy and whom coronary revascularization procedures are no longer feasible or helpful) were recruited from a specialized out patient clinic. Regardless of sleep complaints, all patients were evaluated by standard overnight polysomnography, symptoms of excessive daytime sleepiness by Epworth Sleepiness Scale (ESS) and one week diary of angina. Results: We evaluated 31 patients (18 males, age: 62±10y, body mass index: 29.8±4.5kg/m2). Co-morbidities were common (dyslipidemia 100%, hypertension 93% and diabetes 61%) and all patients presented persistent angina despite optimal anti-ischemic medical therapy and preserved systolic function (ejection fraction on echocardiography: 53±11%). Patients presented poor sleep quality, poor sleep efficiency (60±16%) and the prevalence of OSA (AHI>15) and severe OSA (AHI>30) was 71 and 55%, respectively. As compared with patients without OSA patients with OSA presented similar age, gender, BMI (28.2±5 vs. 30.4±4.5kg/m2, p=0.26) similar ESS (10±6 vs. 11±6), non-significant trend to higher frequency of diurnal (66 vs. 91%, p=0.13) and nocturnal angina (45 vs. 77%, p=0.10). Conclusions: This preliminary study showed a high frequency of OSA in consecutive patients with refractory angina. Traditional risk factors for OSA, including age, male gender and BMI did not discriminate patients with OSA. Non-significant trends to higher frequency of diurnal and nocturnal angina suggest that OSA may contribute to trigger angina symptoms.- Carotid intima-media thickness and metabolic syndrome in a rural population: Results from the Baependi Heart Study(2020) GEOVANINI, G.R.; SOUSA, I. Pinheiro de; TEIXEIRA, S.K.; FRANCISCO NETO, M.J.; GóMEZ, L.M. Gómez; GUERRA, G.C. Del; PEREIRA, A.C.; KRIEGER, J.E.Background and aims: Carotid intima-media thickness (cIMT) is a strong predictor of cardiovascular events and associated with metabolic syndrome (MetS). MetS is a cluster of cardiovascular risk factors, but the association structure between specific factors and disease development is not well-established in rural populations. We described the association structure between MetS factors and cIMT in a sample from rural Brazil. Methods: We studied 1937 participants from the Baependi Heart Study who underwent carotid ultrasound exam. We used ATP–III–2001 for MetS definition and linear mixed-effects models, adjusting by the family structure, to assess independent associations between the cardiovascular risk factors which define MetS and cIMT. Results: The sample's mean age was 46 ± 16y, 61% female, 73% white, mean body-mass-index 26±5 kg/m2, mean cIMT 0.53 ± 0.16 mm, with 35% of the sample classified with MetS. As expected, cIMT demonstrated a linear relationship with increasing age, and cIMT higher values were observed for MetS (0.58 ± 0.16 mm) compared to non-MetS (0.49 ± 0.14 mm). Considering models for cIMT with MetS and all of its factors, we found that blood pressure, glucose and obesity were independently associated with cIMT, but not HDL or triglycerides. Conclusions: cIMT showed a linear relationship with increasing age. Blood pressure, obesity, and glucose were independently associated with cIMT, but not HDL-cholesterol or triglycerides. In a rural population, hypertension, diabetes and obesity play a more important role than lipids in determining cIMT interindividual variability. © 2020 The Authors
- Age and Sex Differences in Heart Rate Variability and Vagal Specific Patterns - Baependi Heart Study(2020) GEOVANINI, Glaucylara Reis; VASQUES, Enio Rodrigues; ALVIM, Rafael de Oliveira; MILL, Jose Geraldo; ANDREAO, Rodrigo Varejao; VASQUES, Bruna Kim; PEREIRA, Alexandre Costa; KRIEGER, Jose EduardoBackground: Heart rate variability (HRV) is a noninvasive method for assessing autonomic function. Age, sex, and chronic conditions influence HRV. Objectives: Our aim was to evaluate HRV measures exploring differences by age, sex, and race in a sample from a rural area. Methods: Analytical sample (n = 1,287) included participants from the 2010 to 2016 evaluation period of the Baependi Heart Study, a family-based cohort in Brazil. Participants underwent 24-hour Holter-ECG (Holter) monitoring. To derive population reference values, we restricted our analysis to a 'healthy' subset (i.e. absence of medical comorbidities). A confirmatory analysis was conducted with a subgroup sample that also had HRV derived from a resting ECG 10'-protocol obtained during the same time period. Results: The 'healthy' subset included 543 participants. Mean age was 40 +/- 14y, 41% were male, 74% self-referred as white and mean body-mass-index was 24 +/- 3kg/m(2). Time domain HRV measures showed significant differences by age-decade and by sex. Higher values were observed for males across almost all age-groups. Parasympathetic associated variables (rMSSD and pNN50) showed a U-shaped distribution and reversal increase above 60y. Sympathetic-parasympathetic balance variables (SDNN, SDANN) decreased linearly by age. Race differences were no significant. We compared time domain variables with complete data (Holter and resting ECG) between 'healthy' versus 'unhealthy' groups. Higher HRV values were shown for the 'healthy' subset compared with the 'unhealthy' group. Conclusion: HRV measures vary across age and sex. A U-shaped pattern and a reversal increase in parasympathetic variables may reflect an age-related autonomic dysfunction even in healthy individuals that could be used as a predictor of disease development.