THIAGO ANDRADE DE MACEDO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
9 resultados
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- INTERMITTENT CLAUDICATION IS COMMON AND INDEPENDENTLY ASSOCIATED WITH RENAL ARTERY STENOSIS IN HYPERTENSIVE PATIENTS REFERRED FOR RENAL ARTERIOGRAPHY(2015) BORTOLOTTO, L.; MACEDO, T. A.; PEDROSA, R.; GIORGI, D. M. A.; BRITO, T. M.; DRAGER, L. F.
- Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography(2017) MACEDO, Thiago Andrade; DRAGER, Luciano Ferreira; PEDROSA, Rodrigo Pinto; MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria; KAJITA, Luiz Junia; BORTOLOTTO, Luiz AparecidoOBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63 +/- 12 vs 56 +/- 12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis >= 70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (>= 70%) in patients clinically suspected of having renovascular hypertension.
- Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension(2018) COSTA-HONG, Valeria Aparecida; MUELA, Henrique Cotchi Simbo; MACEDO, Thiago Andrade; SALES, Allan Robson Kluser; BORTOLOTTO, Luiz AparecidoBackground: Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods: In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels >= 140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results: Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 +/- 9.8% vs. 20.1 +/- 11.7%, p < 0.01), AIx75 (29.6 +/- 6.7% vs. 18.3 +/- 9.4%, p < 0.01) and central systolic blood pressure (136 +/- 30 vs. 125 +/- 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women. Conclusion: Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status.
- Hypertension Severity Is Associated With Impaired Cognitive Performance(2017) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; MACEDO, Thiago A.; SHU, Edson B. S.; MASSARO, Ayrton R.; NITRINI, Ricardo; MANSUR, Alfredo J.; BORTOLOTTO, Luiz A.Background-Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results-In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, >= 160/100 or use of >= 3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on MiniMental State Examination (26.8 +/- 2.1 vs 27.4 +/- 2.1 vs 28.0 +/- 2.0; P= 0.004) or Montreal Cognitive Assessment (23.4 +/- 3.7 vs 24.9 +/- 2.8 vs 25.5 +/- 3.2; P< 0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions-Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.
- Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension(2018) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo C.; MANSUR, Alfredo J.; MASSARO, Ayrton R.; NITRINI, Ricardo; MACEDO, Thiago A.; BORTOLOTTO, Luiz A.Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8 +/- 2.1 vs 27.3 +/- 2.1 vs 28.0 +/- 2.0, P=.003) or the Montreal Cognitive Assessment test (23.4 +/- 3.5 vs 24.9 +/- 2.9 vs 25.6 +/- 3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.
- Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance(2017) MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria A.; YASSUDA, Monica Sanches; MACHADO, Michel Ferreira; NOGUEIRA, Ricardo de Carvalho; MORAES, Natalia C.; MEMÓRIA, Claudia Maia; MACEDO, Thiago A.; BOR-SENG-SHU, Edson; MASSARO, Ayrton Roberto; NITRINI, Ricardo; BORTOLOTTO, Luiz A.ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.
- High Dialysate Calcium Concentration is Associated with Worsening Left Ventricular Function(2019) SILVA, V. B.; MACEDO, T. A.; BRAGA, T. M. S.; SILVA, B. C.; GRACIOLLI, F. G.; V, W. Dominguez; DRAGER, L. F.; MOYSES, R. M.; ELIAS, R. M.Dialysate calcium concentration (d[Ca]) might have a cardiovascular impact in patients on haemodialysis (HD) since a higher d[Ca] determines better hemodynamic tolerability. We have assessed the influence of d[Ca] on global longitudinal strain (GLS) by two-dimensional echocardiography using speckle-tracking imaging before and in the last hour of HD. This is an observational crossover study using d[Ca] 1.75 mmol/L and 1.25 mmol/L. Ultrafiltration was the same between interventions; patients aged 44 +/- 13 years (N = 19). The 1.75 mmol/L d[Ca] was associated with lighter drop of blood pressure. Post HD serum total calcium was higher with d[Ca] 1.75 than with 1.25 mmol/L (11.5 +/- 0.8 vs. 9.1 +/- 0.5 mg/dL, respectively, p < 0.01). In almost all segments strain values were significantly worse in the peak HD with 1.75 mmol/L d[Ca] than with 1.25 mmol/L d[Ca]. GLS decreased from -19.8 +/- 3.7% at baseline to -17.3 +/- 2.9% and -16.1 +/- 2.6% with 1.25 d[Ca] and 1.75 d[Ca] mmol/L, respectively (p < 0.05 for both d[Ca] vs. baseline and 1.25 d[Ca] vs. 1.75 d[Ca] mmol/L). Factors associated with a worse GLS included transferrin, C-reactive protein, weight lost, and post dialysis serum total calcium. We concluded that d[Ca] of 1.75 mmol/L was associated with higher post dialysis serum calcium, which contributed to a worse ventricular performance. Whether this finding would lead to myocardial stunning needs further investigation.
- Renal Artery Stenosis Predicts Coronary Artery Disease in Patients with Hypertension(2013) MACEDO, Thiago A.; PEDROSA, Rodrigo P.; COSTA-HONG, Valeria; KAJITA, Luiz J.; MORAIS, Gustavo R.; LIMA, Jose J. G. De; DRAGER, Luciano F.; BORTOLOTTO, Luiz A.In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction >= 70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63 +/- 12 vs. 56 +/- 13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS >= 70% was independently associated with CAD >= 70% (OR: 11.48; 95% CI 3.2-40.2; p<0.001), even in patients without angina (OR: 13.48; 95% CI 2.6-12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS >= 70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.
- Dressler Syndrome: A Case Report(2016) MACEDO, Thiago Andrade; DANTAS JUNIOR, Roberto Nery; SILVA, Pedro Gabriel Melo de Barros e; SAMPAIO, Marcio CamposIntroduction: Dressler Syndrome should be considered in the differential diagnosis of chest pain, especially in patients who are in a late stage of the evolution of the ischemic process. Case Presentation: A 46-year-old male was admitted to the emergency department due to pleuritic chest pain. Two weeks before this admission, he presented with a typical angina episode, likely an ST segment elevation myocardial infarction (STEMI), and did not receive reperfusion therapy or any medical care. The patient's electrocardiogram showed diffuse ST segment elevation and PR segment depression, and his blood tests showed positive myocardial necrosis markers. A coronary angiography showed a proximal occlusion (not recanalized) of the circumflex artery. There was a late gadolinium enhancement area seen through cardiac magnetic resonance imaging (CMR), suggestive of recent transmural infarction, pericardial injury, and pleural effusion (inflammatory). Conclusions: These findings strongly suggest the diagnosis of delayed post-infarction pericarditis, or Dressler Syndrome, a rare disease in the age of reperfusion therapy. Although rare, it is a syndrome that must be considered in the differential diagnosis of chest pain.