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
5 resultados
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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.
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.