MIGUEL MORITA FERNANDES DA SILVA

(Fonte: Lattes)
Índice h a partir de 2011
8
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina

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  • article 28 Citação(ões) na Scopus
    Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study
    (2013) GUIMARAES, Guilherme V.; CRUZ, Lais G. B.; TAVARES, Aline C.; DOREA, Egidio L.; FERNANDES-SILVA, Miguel M.; BOCCHI, Edimar A.
    High blood pressure (BP) increases the risk of cardiovascular diseases, and its control is a clinical challenge. Regular exercise lowers BP in patients with mild-to-moderate hypertension. No data are available on the effects of heated water-based exercise in hypertensive patients. Our objective was to evaluate the effects of heated water-based exercise on BP in patients with resistant hypertension. We tested the effects of 60-min heated water-based exercise training three times per week in 16 patients with resistant hypertension (age 55 +/- 6 years). The protocol included walking and callisthenic exercises. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM) before and after a 2-week exercise program in a heated pool. Systolic office BP was reduced from 162 to 144 mmHg (P<0.004) after heated-water training. After the heated-water exercise training during 24-h ABPM, systolic BP decreased from 135 to 123 mmHg (P=0.02), diastolic BP decreased from 83 to 74 mmHg (P=0.001), daytime systolic BP decreased from 141 to 125 mmHg (P=0.02), diastolic BP decreased from 87 to 77 mmHg (P=0.009), night-time systolic BP decreased from 128 to 118 mmHg (P=0.06), and diastolic BP decreased from 77 to 69 mmHg (P=0.01). In addition, BP cardiovascular load was reduced significantly during the 24-h daytime and night-time period after the heated water-based exercise. Heated water-based exercise reduced office BP and 24-h daytime and night-time ABPM levels. These effects suggest that heated water-based exercise may have a potential as a new therapeutic approach to resistant hypertensive patients.
  • article 16 Citação(ões) na Scopus
    Physical Exercise and MicroRNAs: New Frontiers in Heart Failure
    (2012) FERNANDES-SILVA, Miguel Morita; CARVALHO, Vagner Oliveira; GUIMARAES, Guilherme Veiga; BACAL, Fernando; BOCCHI, Edimar Alcides
    Although the impact of exercise on survival of patients with heart failure has been recently questioned, exercise training improves quality of life, functional capacity, inflammation, endothelial and autonomic function. In recent years, interest has increased regarding a group of small non-protein coding RNAs called microRNAs. Studies have shown that the expression of these molecules changes in several pathological conditions, such as myocardial infarction, myocardial ischemia and heart failure, and when clinical improvement occurs, they seem to normalize. With the potential for practical applicability, markers that may be useful in diagnostic and prognostic assessment of heart failure have been identified, such as miR-423-5p. In addition, results of experimental studies have indicated that there are potential therapeutic effects of microRNAs. MicroRNAs are involved in the regulation of gene expression during fetal development and in adult individuals, increasing or decreasing in the heart in response to physiological stress, injury or hemodynamic overload. Thus, the study of the behavior of these molecules in physical exercise has brought important information about the effects of this therapeutic modality and represents a new era in the understanding of heart failure. This review aims to integrate the evidence on microRNAs in heart failure with greater relevance in the study of physical exercise.
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    AGE-RELATED MAXIMUM HEART RATE AMONG ISCHEMIC AND NON-ISCHEMIC HEART FAILURE PATIENTS RECEIVING BETA-BLOCKADE THERAPY
    (2012) SILVA, Miguel Morita; GUIMARAES, Guilherme; ROQUE, Jean M.; TEIXEIRA NETO, Iran S.; BACAL, Fernando; BOCCHI, Edimar
    Background At the setting of evaluation of functional capacity, heart failure (HF) patients must be evaluated under optimised clinical therapy, including beta-adrenergic blockade (BB). Predicted maximum heart rate (HRmax) based on 220 – age is widespread used, but it is not applicable to patients receiving BB therapy. Few studies suggest other equations which estimate HRmax in patients receiving BB therapy with and without heart failure. However, these studies do not consider the etiology in HF. The purpose of this study was to determine an equation to predict HRmax in patients with ischemic and non ischemic HF who are receiving BB therapy. Methods We included patients with heart failure who were being considered for heart transplantation and underwent treadmill cardiopulmonary exercise testing between 1999 and 2010, using Naughton protocol. All patients were taking BB at maximum tolerated dose at the discretion of the treating physician. We excluded patients with pacemaker and/or implantable defibrillator, ejection fraction greater than 0.50 or peak respiratory exchange ratio (RER) less than 1.00 and chagas disease. We used linear regression to develop the equation that predict HR max, based on age in ischemic and non-ischemic patients. Results We analysed 278 patients, age 47±10, ischemic (n=75) and non-ischemic (n=203). The left ventricle ejection fraction was 30.8±9.4 and 28.6±8.2% (p = 0.04), peak VO2 was 16.9±4.7 and 16.9±5.2 ml/kg/min (p = NS) and the HRmax was 130.8±23.3 and 125.3±25.3 bpm (p = 0.051) in ischemic and non-ischemic respectively. We have found the equation HRmax = 168 − 0.76 × age for ischemic and HRmax = 134 − 0.18 × age for non-ischemic HF patients. Conclusion Our results suggest that equations to estimate HR max should consider the etiology in heart failure patients. ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m. Session Title: Does the Exercise ECG Have a Role in 2012? Abstract Category: 25. Diagnostic Testing: ECG Exercise Presentation Number: 1155-455
  • article 29 Citação(ões) na Scopus
    MicroRNAs: A New Paradigm in the Treatment and Diagnosis of Heart Failure?
    (2012) OLIVEIRA-CARVALHO, Vagner; CARVALHO, Vitor Oliveira; SILVA, Miguel Morita; GUIMARAES, Guilherme Veiga; BOCCHI, Edimar Alcides
    MicroRNAs (miRNAs) are a group of newly discovered small RNAs, non-coding, which represent one of the most exciting areas of modern medical science as they modulate a huge and complex regulatory network of gene expression. Lines of evidence have recently suggested that miRNAs play a key role in the pathogenesis of heart failure. Some miRNAs highly expressed in the heart, such as miR-1, miR-133 and miR-208, are strongly associated with the development of cardiac hypertrophy, while the exact role of miR-21 in the cardiovascular system remains controversial. Serum levels of circulating miRNAs such as miR-423-5p are being evaluated as potential biomarkers in the diagnosis and prognosis of heart failure. On the other hand, the manipulation of levels of miRNAs using techniques such as mimicking the miRNAs (miRmimics) and antagonistic miRNAs (antagomiRs) is making increasingly evident the enormous potential of miRNAs as promising therapeutic strategies in heart failure.
  • article 67 Citação(ões) na Scopus
    Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial)
    (2014) GUIMARAES, Guilherme Veiga; CRUZ, Lais Galvani de Barros; FERNANDES-SILVA, Miguel Morita; DOREA, Egidio Lima; BOCCHI, Edimar Alcides
    Background: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heatedwater-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients. Methods: This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32 C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). Results: 32 patients (HEx n = 16; control n = 16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mm Hg). HEx decreased 24-hour systolic (from 137 +/- 23 to 120 +/- 12 mm Hg, p = 0.001) and diastolic BPs (from 81 +/- 13 to 72 +/- 10 mm Hg, p = 0.009); daytime systolic (from 141 +/- 24 to 120 +/- 13 mm Hg, p < 0.0001) and diastolic BPs (from 84 +/- 14 to 73 +/- 11 mm Hg, p = 0.003); and nighttime systolic (from 129 +/- 22 to 114 +/- 12 mm Hg, p = 0.006) and diastolic BPs (from 74 +/- 11 to 66 +/- 10 mm Hg, p < 0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs. Conclusion: HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
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    Heated Water-based Exercise Training Reduces 24-hour Ambulatory Blood Pressure Levels In Resistant Hypertensive Patients: A Randomized Controlled Trial (HEx Trial)
    (2014) CRUZ, Lais G.; BOCCHI, Edimar Alcides; FERNANDES-SILVA, Miguel Morita; DOREA, Egidio Lima; GUIMARAES, Guilherme Veiga
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    Neurohormonal response to Heated water-based Exercise training in treatment of resistant hypertension: results from the HEx Trial
    (2014) GUIMARAES, G. V.; CRUZ, L. G. B.; FERNANDES-SILVA, M. M.; DOREA, E. L.; BOCCHI, E. A.
  • article 29 Citação(ões) na Scopus
    Inflammatory biomarkers and effect of exercise on functional capacity in patients with heart failure: Insights from a randomized clinical trial
    (2017) FERNANDES-SILVA, Miguel M.; GUIMARAES, Guilherme V.; RIGAUD, Vagner O. C.; LOFRANO-ALVES, Marco S.; CASTRO, Rafael E.; CRUZ, Lais G. de Barros; BOCCHI, Edimar A.; BACAL, Fernando
    Background: In patients with heart failure, inflammation has been associated with worse functional capacity, but it is uncertain whether it could affect their response to exercise training. We evaluated whether inflammatory biomarkers are related to differential effect of exercise on the peak oxygen uptake (VO2) among patients with heart failure. Design: Open, parallel group, randomized controlled trial. Methods: Patients with heart failure and ejection fraction 0.4 were randomized into exercise training or control for 12 weeks. Patients were classified according to: 1) inflammatory biomarkers blood levels, defined as low' if both interleukin-6 and tumor necrosis factor-alpha blood levels were below median, and high' otherwise; and 2) galectin-3 blood levels, which also reflect pro-fibrotic processes. Results: Forty-four participants (507 years old, 55% men, 25% ischemic) were allocated to exercise training (n=28) or control (n=16). Exercise significantly improved peak VO2 among participants with low' inflammatory biomarkers (3.5 +/- 0.9 vs. -0.7 +/- 1.1ml/kg per min, p=0.006), as compared with control, but not among those with high' inflammatory biomarkers (0.4 +/- 0.6 vs. -0.2 +/- 0.7ml/kg per min, p=0.54, p for interaction=0.009). Similarly, exercise improved peak VO2 among participants with below median (2.4 +/- 0.8 vs. -0.3 +/- 0.9ml/kg per min, p=0.032), but not among those with above median galectin-3 blood levels (0.3 +/- 0.7 vs. -0.7 +/- 1.0ml/kg per min, p=0.41, p for interaction=0.053). Conclusion: In patients with heart failure, levels of biomarkers that reflect pro-inflammatory and pro-fibrotic processes were associated with differential effect of exercise on functional capacity. Further studies should evaluate whether exercise training can improve clinical outcomes in patients with heart failure and low levels of these biomarkers.
  • article 4 Citação(ões) na Scopus
    Effects of age on aerobic capacity in heart failure patients under beta-blocker therapy: Possible impact in clinical decision-making?
    (2013) CIOLAC, Emmanuel Gomes; BOCCHI, Edimar Alcides; SILVA, Miguel Morita Fernandes da; TAVARES, Aline Cristina; TEIXEIRA-NETO, Iram Soares; GUIMARAES, Guilherme Veiga
    Background: Heart failure (HF) is associated with impaired maximal aerobic capacity as indicated by decreases in peak oxygen uptake (peak VO2). Considering that aging by itself has a negative effect on this variable, the evaluation of maximum capacity is often questioned because current predicted peak VO2 is based on subjects without heart disease or beta-blocker therapy. In contrast, if decline in predicted and attained peak VO2 were age-related, proportionally, loss of aerobic function (predicted peak VO2, %) would remain stable over time in these patients. The purpose of this investigation is to assess the effects of age on peak VO2 in HF patients taking beta-blockers. Methods: We retrospectively evaluated 483 (132 female) patients (aged 20-88 years, LVEF 31 +/- 11%) with non-ischemic (n = 362), ischemic (n = 74) and Chagas-related HF (n = 47) who had been submitted to an incremental cardiopulmonary exercise testing on a motorized treadmill. Linear regression was used to develop the equation to predict peak VO2, based on age. Results: Peak VO2 decreased 0.9 mL/min/kg per age-decade, maximum HR also decreased with aging and VE/VCO2 slope was similar among all decades. The predicted new beta-blocker equation to peak VO2bb was 20.934 - 0.092 x age. Conclusions: Clinical interpretation of aerobic capacity impairment is influenced by aging in HF patients. This evidence must be considered when using peak VO2 for prognostic stratification and clinical decision-making in patients with HF under beta-blocker therapy.
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