LUIZ APARECIDO BORTOLOTTO

(Fonte: Lattes)
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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Impaired Baroreflex Sensitivity in Anabolic Steroid Users
    (2012) SANTOS, Marcelo Rodrigues dos; PORELLO, Rafael Armani; SAYEGH, Ana L. C.; HONG, Valeria; TOSCHI-DIAS, Edgar; BORTOLOTTO, Luiz A.; YONAMINE, Mauricio; NEGRAO, Carlos E.; ALVES, Maria-Janieire N. N.
    Purpose: Exacerbated sympathetic nerve activity and increased blood pressure have been documented in anabolic androgenic steroid users (AASU). We tested the hypothesis that arterial baroreflex sensitivity (BRS) and carotid distensibility would be reduced in AASU. Methods: Ten AASU and 10 age-paired anabolic androgenic steroid nonusers (AASNU) were studied. Both groups were involved in strength training (90% 1MR) and AASU were self-administered anabolic steroids for at least 2 years. The use of AAS was proved by urine. Heart rate (HR) was evaluated by EKG and blood pressure non-invasively on a beat to beat. BRS was analyzed by time domain through spontaneous fluctuations between systolic blood pressure (SBP) and HR. Carotid artery distensibility was measured by doppler (M-mode). Results: HR was higher in AASU compared to AASNU (69±3 vs. 59±3 bpm, P≤0.05). Systolic (123±4 vs. 118±2 mmHg, P=0.29), diastolic (72±2 vs. 67±2 mmHg, P=0.12) and mean blood pressure (90±3 vs. 85±2 mmHg, P=0.15) were not different between groups. BRS for increases (14.2±2 vs. 22.8±3 msec/mmHg, P=0.05) and decreases (13.3±1 vs. 19.2±2 msec/mmHg, P=0.04) were lower in AASU. Carotid distensibility was reduced in AASU (7±1 vs. 9±1 %, P≤0.05). Conclusion: Impaired BRS and reduced carotid distensibility may prematurely lead to increased cardiovascular risk in AASU.
  • article 23 Citação(ões) na Scopus
    The role of myocardial scintigraphy in the assessment of cardiovascular risk in patients with end-stage chronic kidney disease on the waiting list for renal transplantation
    (2012) LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; RAMIRES, Jose Antonio Franchini; BORTOLOTTO, Luiz A.
    The usefulness of stress myocardial perfusion scintigraphy for cardiovascular (CV) risk stratification in chronic kidney disease remains controversial. We tested the hypothesis that different clinical risk profiles influence the test. We assessed the prognostic value of myocardial scintigraphy in 892 consecutive renal transplant candidates classified into four risk groups: very high (aged epsilon 50 years, diabetes and CV disease), high (two factors), intermediate (one factor) and low (no factor). The incidence of CV events and death was 20 and 18, respectively (median follow-up 22 months). Altered stress testing was associated with an increased probability of cardiovascular events only in intermediate-risk (one risk factor) patients [30.3 versus 10, hazard ratio (HR) 2.37, confidence interval (CI) 1.693.33, P 0.0001]. Low-risk patients did well regardless of scan results. In patients with two or three risk factors, an altered stress test did not add to the already increased CV risk. Myocardial scintigraphy was related to overall mortality only in intermediate-risk patients (HR 2.8, CI 1.55.1, P 0.007). CV risk stratification based on myocardial stress testing is useful only in patients with just one risk factor. Screening may avoid unnecessary testing in 60 of patients, help stratifying for risk of events and provide an explanation for the inconsistent performance of myocardial scintigraphy.
  • article 6 Citação(ões) na Scopus
    Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion
    (2012) SILVA, Rita de Cassia Gengo e; BRUNORIO, Ludimila; GIRIBELA, Cassiana Rosa Galvao; BORTOLOTTO, Luiz Aparecido; WOLOSKER, Nelson; CONSOLIM-COLOMBO, Fernanda Marciano
    Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.
  • article 3 Citação(ões) na Scopus
    Which patients are more likely to benefit from renal transplantation?
    (2012) LIMA, Jose Jayme Galvao De; GOWDAK, Luis Henrique Wolff; PAULA, Flavio Jota de; CESAR, Luiz Antonio Machado; RAMIRES, Jose Antonio Franchini; BORTOLOTTO, Luiz A.
    Background: We evaluated whether the advantages conferred by renal transplantation encompass all individuals or whether they favor more specific groups of patients. Methods: One thousand and fifty-eight patients on the transplant waiting list and 270 receiving renal transplant were studied. End points were the composite incidence of CV events and death. Patients were followed up from date of placement on the list until transplantation, CV event, or death (dialysis patients), or from the date of transplantation, CV event, return to dialysis, or death (transplant patients). Results: Younger patients with no comorbidities had a lower incidence of CV events and death independently of the treatment modality (log-rank = 0.0001). Renal transplantation was associated with better prognosis only in high-risk patients (p = 0.003). Conclusions: Age and comorbidities influenced the prevalence of CV complications and death independently of the treatment modality. A positive effect of renal transplantation was documented only in high-risk patients. These findings suggest that age and comorbidities should be considered indication for early transplantation even considering that, as a group, such patients have a shorter survival compared with low-risk individuals.
  • conferenceObject
    Cardioprotective Drugs and Acute Coronary Syndrome in Patients on the Waiting List for Renal Transplantation
    (2012) LIMA, J. J. G. De; GOWDAK, L. H. W.; PAULA, F. J. de; CESAR, L. A. M.; BORTOLOTTO, L. A.
    Background: The incidence of Acute Coronary Syndrome (ACS) in patients (pts) with advanced CKD is close to 30/1000 pts-year (Kidney Int 2002; 62: 1799). The effect of cardioprotective medications on the incidence of ACS on the waiting-list pts is poorly understood. Objective : to assess the incidence and risk factors for ACS in a cohort of 1522 hemodialysis pts on the waiting list for renal transplantation prospectively treated with aspirin, b-blockers, statins and renin-angiotensin inhibitors irrespectively of risk strati fi cation starting on inception and maintained before and after transplantation. Results: 83 pts (57±8 yo, 65% males, 65% Caucasians, 53% diabetics and 49% with associated CV disease) developed ACS (5.4/1000 pts-year): myocardial infarction (MI) = 53 (66%) and unstable angina (UA) = 28 (34%). The median time for the occurrence of ACS was 52 months. Compared to pts who did not develop CV events, ACS pts were older and had more angina, diabetes, associated CV disease, higher serum total-cholesterol, LV mass index and abnormal myocardial scan. The sole independent predictor of ACS was an altered myocardial scan (p=0.0009, 95% CI 0.21-0.80, HR 0.50). 35 out of 53 pts with MI (66%) died during hospitalization; UA was not associated with in-hospital deaths. Mortality was higher in pts with ACS compared to controls (55% versus 20%, p=0.0001, HR 0.28, 95% CI 0.20- 0.39). 8 pts with ACS underwent renal transplantation. There were 2 deaths caused by MI 1.6 and 12 months after operation. In the control group (n= 360) there were 4 MI-related deaths. Overall post-transplant mortality was comparable in ACS and in controls (p=0.29). Conclusions: the incidence of ACS appears to be reduced in this cohort prospectively treated with cardioprotective medications. Risk factors do not differ from those in the general population. Myocardial scan is useful to detect pts at higher risk of ACS. The incidence of ACS was not increased by renal transplantation in pts with previous ACS. The in-hospital mortality by MI is very high.