GERALDO LORENZI FILHO

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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 16 Citação(ões) na Scopus
    Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation
    (2017) GENTA, Pedro R.; DRAGER, Luciano F.; LORENZI FILHO, Geraldo
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    Accuracy Of Non-Dipping Blood Pressure In Predicting Obstructive Sleep Apnea In Patients SuBMItted To Ambulatory Blood Pressure Monitoring
    (2017) FURLAN, S. F.; GENTA-PEREIRA, D. C.; OMOTE, D. D. Q.; GIORGI, D.; BORTOLOTTO, L. A.; LORENZI-FILHO, G.; DRAGER, L. F.
  • article 27 Citação(ões) na Scopus
    Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure
    (2017) PERGER, Elisa; INAMI, Toru; LYONS, Owen D.; ALSHAER, Hisham; SMITH, Stephanie; FLORAS, John S.; LOGAN, Alexander G.; ARZT, Michael; CANTOLLA, Joaquin Duran; DELGADO, Diego; FITZPATRICK, Michael; FLEETHAM, John; KASAI, Takatoshi; KIMOFF, R. John; LEUNG, Richard S. T.; LORENZI FILHO, Geraldo; MAYER, Pierre; MIELNICZUK, Lisa; MORRISON, Debra L.; PARATI, Gianfranco; PARTHASARATHY, Sairam; REDOLFI, Stefania; RYAN, Clodagh M.; SERIES, Frederic; TOMLINSON, George A.; WOO, Anna; BRADLEY, T. Douglas
    Study Objectives: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. Methods: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. Results: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 +/- 6.4 versus 25.8 +/- 5.9 seconds, P <.01), longer cycle time (67.8 +/- 15.9 versus 51.7 +/- 9.9 seconds, P <.01), higher NT-proBNP concentrations (2740 [6769] versus 570 [864] pg/ml, P =.01), and worse New York Heart Association class (P =.02) than those with a positive pattern. LFCT and LVEF did not differ between groups. Conclusions: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. Commentary: A commentary on this article appears in this issue on page 1227.
  • article 19 Citação(ões) na Scopus
    Muscle Metaboreflex Control of Sympathetic Activity in Obstructive Sleep Apnea
    (2017) UENO-PARDI, Linda M.; GUERRA, Renan S.; GOYA, Thiago T.; SILVA, Rosyvaldo F.; GARA, Elisangela M.; LIMA, Marta F.; NOBRE, Thais S.; ALVES, Maria J. N. N.; TROMBETTA, Ivani C.; LORENZI-FILHO, Geraldo
    Purpose: Previous studies report abnormal muscle metaboreflex control of muscle sympathetic nerve activity (MSNA) in obesity, hypertension, and heart failure. We hypothesized that obstructive sleep apnea (OSA) is associated with augmented metaboreflex control of MSNA. Methods: Thirty-one sedentary individuals with no comorbidities (age = 52 +/- 1 yr, body mass index = 28 +/- 1 kg.m(-2)) without (control, n = 14) and with OSA(n = 17) defined by polysomnography, underwent echocardiography. HR, blood pressure (BP), MSNA (microneurography), and forearm blood flow measured by venous occlusion plethysmography were continuously measured 4 min at baseline, during 3 min of 30% handgrip static exercise, and during 2 min of post-handgrip muscle ischemia (PHMI). Results: Control and OSA groups were similar in age, body mass index, and ejection fraction. Baseline HR, BP, and forearm blood flow increased similarly during handgrip exercise. Blood pressure remained significantly elevated in relation to baseline during PHMI, but HR and forearm blood flow returned toward baseline during PHMI in both groups. Baseline MSNA was significantly higher in the OSA group than in controls (P < 0.05). During peak 30% static handgrip exercise, MSNA increased significantly in both control and OSA groups, but MSNA responses were higher in patients with OSA. During PHMI, MSNA in control subjects remained significantly elevated compared with that at baseline. In contrast, in patients with OSA, MSNA decreased to baseline values. A significant correlation was found between changes in MSNA due to PHMI and apnea-hypopnea index (r = -0.61, P < 0.001), and with minimum O-2 saturation (r = 0.70, P G 0.001). Conclusions: These findings suggest an association between OSA and decreased metaboreflex control of MSNA. Muscle vasodilation during handgrip static exercise is preserved in patients with OSA.
  • article 17 Citação(ões) na Scopus
    Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women
    (2017) MEDEIROS, Ana Kelley L.; COUTINHO, Ricardo Q.; BARROS, Isly M. L.; COSTA, Laura O. B. F.; LEITE, Ana Paula D. L.; BITTENCOURT, Marcio S.; LUSTOSA, Thais C.; CARVALHO, Martinha M. B.; LIRA, Maria Priscila Figueiredo; FERREIRA, Moacir N. L.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.; PEDROSA, Rodrigo P.
    Obstructive sleep apnea (OSA) is associated with coronary disease among men. However, this association is not clear for women. In this study, we evaluate the association between OSA and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in middle-aged women. We evaluated consecutive women aged between 45 and 65 years in perimenopause or postmenopause period (with menstrual irregularity-amenorrhea > 60 days), without manifest cardiovascular disease (heart failure, coronary disease, and stroke), from two gynecologic clinics. All patients underwent clinical evaluation, computed tomographic examination for coronary artery calcium (CAC > 100 Agatston units), and portable sleep study. Multiple logistic regression models were used to evaluate the association between OSA and CAC, controlling for traditional risk factors including Framingham Risk Score (FRS), body mass index (BMI), and diabetes. We studied 214 women (age 56 years (52-61); BMI 28 kg/m(2) (25-31), 25 % diabetes, 62 % hypertension). OSA (apnea-hypopnea index (AHI) 5 events/h) was diagnosed in 82 women (38.3 %). CAC was more prevalent in patients with moderate/severe OSA (AHI 15 events/h) than in patients without or with mild OSA, 19 % vs 4.5 and 1.6 %, respectively (p < 0.01). Moderate to severe OSA was associated with CAC in unadjusted (odds ratio = 6.25, 95 % CI 1.66-23.52; p < 0.01) and adjusted (odds ratio = 8.19, 95 % CI 1.66-40.32; p = 0.01) logistic regression analysis. Moderate to severe OSA is independently associated with the presence of CAC in middle-aged women. These results reinforce the concept that women are also susceptible to the cardiovascular consequences of OSA.
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  • article 16 Citação(ões) na Scopus
    Restless legs syndrome in Wilson's disease: frequency, characteristics, and mimics
    (2017) TRINDADE, M. C.; BITTENCOURT, T.; LORENZI-FILHO, G.; ALVES, R. C.; ANDRADE, D. C. de; FONOFF, E. T.; BOR-SENG-SHU, E.; MACHADO, A. A.; TEIXEIRA, M. J.; BARBOSA, E. R.; TRIBL, G. G.
    ObjectiveTo determine characteristics, clinical significance, frequency, and mimics of restless legs syndrome (RLS) in a cohort of Wilson's disease (WD, n = 42/f = 18), compared to healthy, matched controls. Materials and methodsStructured clinical interviews (patients and caregiving family members), repeated neurological examinations (afternoon and presleep), comprehensive laboratory tests, WD-, RLS-, and sleep-specific rating scales, and video-polysomnography. ResultsThirteen patients with WD (13/42 = 31.0%) clearly fulfilled the five diagnostic criteria of RLS; in eight patients (19.1%), the burden of RLS was clinically significant. The RLS was of moderate severity, equally distributed among sexes, manifested mainly in the evening and before falling asleep, and had developed mostly after clinical manifestation of WD (time elapsed 10.2 14.5 years), still at a young mean age (27.5 +/- 11.5 years). The known RLS-associated features were absent (normal iron and kidney parameters) or rare (positive family history, polyneuropathy). Compared to WD patients without RLS, patients with RLS were significantly elder and had suffered longer from WD. WD-specific RLS mimics as well as RLS confounding motor comorbidities (dystonia, tremor, chorea) were frequent and a diagnostic challenge; in difficult cases, the differentiation was reached by clinical observation of the motor behavior in the evening or at nighttime. ConclusionRLS was frequent in this cohort of WD and might be causally related to WD. RLS should be included in the diagnostic work-up of WD. In complex motor disorders, differential diagnosis of RLS might require evening/nighttime examination and video-polysomnography. In WD patients with a clinically significant RLS, treatment with dopaminergic substances may be considered.
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    Comparison Of Site And Configuration Of Upper Airway Collapse Between Natural And Propofol-Induced Sleep Endoscopy - Preliminary Results
    (2017) ORDONES, A. B.; GRAD, G.; CAHALI, M.; SENNES, L. U.; LORENZI-FILHO, G.; GENTA, P.
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    Impact of Cpap on Arterial Stiffness in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
    (2017) BITTENCOURT, Marcio S.; CHALEGRE, Sintya; LUSTOSA, Thais C.; FRANCA, Marcus V.; COUTO, Tarcya L.; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; PEDROSA, Rodrigo P.
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    Diet and Exercise Training Improve Insulin-Glucose Metabolism and Sympathetic Hyperactivation in Obstructive Sleep Apnea and Metabolic Syndrome
    (2017) CEPEDA, Felipe X.; RODRIGUES, Sara; DUTRA-MARQUES, Akothirene C. B.; CARVALHO, Jefferson C.; TOSCHI-DIAS, Edgar; RONDON, Maria Urbana P. B.; ALVES, Maria Janieire N. N.; LORENZI-FILHO, Geraldo; TROMBETTA, Ivani C.