SILVANA ANGELINA D'ORIO NISHIOKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Role of cardiac arrhythmias in sudden cardiac death in renal transplant candidates(2014) MARTINELLI FILHO, M.; PEIXOTO, G. L.; SILVA, R. T.; SIQUEIRA, S. F.; LIMA, J. J. G.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.; NISHIOKA, S. A. D.- Effects of Cardiac Resynchronization Therapy on Muscle Sympathetic Nerve Activity(2014) KUNIYOSHI, Ricardo R.; MARTINELLI, Martino; NEGRAO, Carlos E.; SIQUEIRA, Sergio F.; RONDON, Maria U. P. B.; TROMBETTA, Ivani C.; KUNIYOSHI, Fatima H. S.; LATERZA, Mateus C.; NISHIOKA, Silvana A. D'Orio; COSTA, Roberto; TAMAKI, Wagner T.; CREVELARI, Elizabeth S.; PEIXOTO, Giselle De Lima; RAMIRES, Jose A. F.; KALIL, RobertoIntroductionMuscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable. ObjectivesIn this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF. MethodsWe assessed 11 HF patients (51 3.4 years; New York Heart Association class III-IV; left ventricular ejection fraction 27.8 2.2%; optimal medical therapy) submitted to CRT. Evaluations were made prior to and 3 months after CRT. MSNA was performed at rest and during moderate static exercise (handgrip). Peak oxygen consumption (VO2) was evaluated by means of cardiopulmonary exercise test. HF patients with advanced NYHA class without CRT and healthy individuals were also studied. ResultsCRT reduced MSNA at rest (48.9 +/- 11.1 bursts/min vs 33.7 +/- 15.3 bursts/min, P < 0.05) and during handgrip exercise (MSNA 62.3 +/- 13.1 bursts/min vs 46.9 +/- 14.3 bursts/min, P < 0.05). Among HF patients submitted to CRT, the peak VO2 increased (12.9 +/- 2.8 mL/kg/min vs 16.5 +/- 3.9 mL/kg/min, P < 0.05) and an inverse correlation between peak VO2 and resting MSNA (r = -0.74, P = 0.01) was observed. ConclusionsIn patients with advanced HF and severe systolic dysfunction: (1) a significant reduction of MSNA (at rest and during handgrip) occurred after CRT, and this behavior was significantly superior to HF patients receiving only medical therapy; (2) MSNA reduction after CRT had an inverse correlation with O-2 consumption outcomes.
conferenceObject Role of impedance cardiography in predicting clinical near-term outcomes of patients with cardiac resynchronization therapy(2014) MARTINELLI FILHO, MMartino; PEIXOTO, G. L.; SIQUEIRA, S. F.; LENSI, M. M.; TRINDADE, R. H. L.; NISHIOKA, S. A. D.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.conferenceObject Chagas cardiomyopathy patients with pacemaker: predictors of left ventricular remodeling(2014) PEIXOTO, G.; MADIA, R. O.; SIQUEIRA, S. F.; LENSI, M. M.; TEIXEIRA, R. A.; NISHIOKA, S. A. D.; PEDROSA, A. A. A.; SACCAB, M. G. M.; COSTA, R.; MARTINELLI, M.- Evidence for cardiac safety and antiarrhythmic potential of chloroquine in systemic lupus erythematosus(2014) TEIXEIRA, Ricardo Alkmim; BORBA, Eduardo F.; PEDROSA, Anisio; NISHIOKA, Silvana; VIANA, Vilma S. T.; RAMIRES, Jose A.; KALIL-FILHO, Roberto; BONFA, Eloisa; MARTINELLI FILHO, MartinoTo perform a comprehensive evaluation of heart rhythm disorders and the influence of disease/therapy factors in a large systemic lupus erythematosus (SLE) cohort. Three hundred and seventeen consecutive patients of an ongoing electronic database protocol were evaluated by resting electrocardiogram and 142 were randomly selected for 24 h Holter monitoring for arrhythmia and conduction disturbances. The mean age was 40.2 +/- 12.1 years and disease duration was11.4 +/- 8.1 years. Chloroquine (CQ) therapy was identified in 69.7% with a mean use of 8.5 +/- 6.7 years. Electrocardiogram abnormalities were detected in 66 patients (20.8%): prolonged QTc/QTd (14.2%); bundle-branch block (2.5%); and atrioventricular block (AVB) (1.6%). Age was associated with AVB (P = 0.029) and prolonged QTc/QTd (P = 0.039) whereas anti-Ro/SS-A and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were not (P > 0.05). Chloroquine was negatively associated with AVB (P = 0.01) as was its longer use (6.1 +/- 6.9 vs. 1.0 +/- 2.5 years, P = 0.018). Time of CQ use was related with the absence of AVB [odds ratio (OR) = 0.103; 95% confidence interval (CI) = 0.011-0.934, P = 0.043] in multiple logistic regression. Holter monitoring revealed abnormalities in 121 patients (85.2%): supraventricular ectopies (63.4%) and tachyarrhythmia (18.3%); ventricular ectopies (45.8%). Atrial tachycardia/fibrillation (AT/AF) were associated with shorter CQ duration (7.05 +/- 7.99 vs. 3.63 +/- 5.02 years, P = 0.043) with a trend to less CQ use (P = 0.054), and older age (P < 0.001). Predictors of AT/AF in multiple logistic regression were age (OR = 1.115; 95% CI = 1.059-1.174, P < 0.001) and anti-Ro/SS-A (OR = 0.172; 95% CI = 0.047-0.629, P = 0.008). Chloroquine seems to play a protective role in the unexpected high rate of cardiac arrhythmias and conduction disturbances observed in SLE. Further studies are necessary to determine if this antiarrhythmic effect is due to the disease control or a direct effect of the drug.
conferenceObject Left ventricular remodeling behavior of patients with Chagas cardiomyopathy and pacemaker in a long-term follow-up(2014) PEIXOTO, G.; MARTINELLI, M.; SIQUEIRA, S. F.; MADIA, R. O.; LENSI, M. M.; NISHIOKA, S. A. D.; TEIXEIRA, R. A.; PEDROSA, A. A. A.; COSTA, R.