LUIS HENRIQUE WOLFF GOWDAK

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina

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  • article 297 Citação(ões) na Scopus
    Prognostic Value of Nonobstructive and Obstructive Coronary Artery Disease Detected by Coronary Computed Tomography Angiography to Identify Cardiovascular Events
    (2014) BITTENCOURT, Marcio Sommer; HULTEN, Edward; GHOSHHAJRA, Brian; O'LEARY, Daniel; CHRISTMAN, Mitalee P.; MONTANA, Philip; TRUONG, Quynh A.; STEIGNER, Michael; MURTHY, Venkatesh L.; RYBICKI, Frank J.; NASIR, Khurram; GOWDAK, Luis Henrique W.; HAINER, Jon; BRADY, Thomas J.; CARLI, Marcelo F. Di; HOFFMANN, Udo; ABBARA, Suhny; BLANKSTEIN, Ron
    Background- The contribution of plaque extent to predict cardiovascular events among patients with nonobstructive and obstructive coronary artery disease (CAD) is not well defined. Our objective was to evaluate the prognostic value of plaque extent detected by coronary computed tomography angiography. Methods and Results- All consecutive patients without prior CAD referred for coronary computed tomography angiography to evaluate for CAD were included. Examination findings were classified as normal, nonobstructive (< 50% stenosis), or obstructive (>= 50%). Based on the number of segments with disease, extent of CAD was classified as nonextensive (<= 4 segments) or extensive (> 4 segments). The cohort included 3242 patients followed for the primary outcome of cardiovascular death or myocardial infarction for a median of 3.6 (2.1-5.0) years. In a multivariable analysis, the presence of extensive nonobstructive CAD (hazard ratio, 3.1; 95% confidence interval, 1.5-6.4), nonextensive obstructive (hazard ratio, 3.0; 95% confidence interval, 1.3-6.9), and extensive obstructive CAD (hazard ratio, 3.9; 95% confidence interval, 2.2-7.2) were associated with an increased rate of events, whereas nonextensive, nonobstructive CAD was not. The addition of plaque extent to a model that included clinical probability as well as the presence and severity of CAD improved risk prediction. Conclusions- Among patients with nonobstructive CAD, those with extensive plaque experienced a higher rate of cardiovascular death or myocardial infarction, comparable with those who have nonextensive disease. Even among patients with obstructive CAD, greater extent of nonobstructive plaque was associated with higher event rate. Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.
  • conferenceObject
    Obstructive Sleep Apnea Is Extremely Common And Associated With Myocardial Ischemia In Patients With Refractory Angina
    (2014) GEOVANINI, G. R.; PEREIRA, A. C.; GOWDAK, L. H. W.; DOURADO, L. O.; POPPI, N.; CESAR, L. M.; DRAGER, L. F.; LORENZI-FILHO, G.
  • article 30 Citação(ões) na Scopus
    High Dose of N-Acetylcystein Prevents Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Myocardial Revascularization
    (2014) SANTANA-SANTOS, Eduesley; GOWDAK, Luis Henrique W.; GAIOTTO, Fabio A.; PUIG, Luiz B.; HAJJAR, Ludhmila A.; ZEFERINO, Suely P.; DRAGER, Luciano F.; SHIMIZU, Maria Heloisa M.; BORTOLOTTO, Luiz A.; LIMA, Jose J. G. De
    Background. The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial. Methods. We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney disease patients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification. Results. The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p = 0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p = 0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p = 0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p = 0.01) and abolished in patients receiving N-acetylcystein. Conclusions. Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function. (C) 2014 by The Society of Thoracic Surgeons
  • conferenceObject
    DIABETES AND CARDIOVASCULAR DISEASE ARE EQUALLY STRONG PREDICTORS OF CARDIOVASCULAR EVENTS IN PATIENTS WITH END-STAGE RENAL DISEASE
    (2014) GOWDAK, Luis Henrique Wolff; PAULA, Flavio de; CESAR, Luiz Antonio Machado; LIMA, Jose Jayme G. De
  • article 25 Citação(ões) na Scopus
    OSA and Depression Are Common and Independently Associated With Refractory Angina in Patients With Coronary Artery Disease
    (2014) GEOVANINI, Glaucylara R.; GOWDAK, Luis H. W.; PEREIRA, Alexandre C.; DANZI-SOARES, Naury de Jesus; DOURADO, Luciana O. C.; POPPI, Nilson T.; CESAR, Luiz Antonio Machado; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo
    OBJECTIVE: Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS: We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS: Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 +/- 4 kg/m(2) vs 28.5 +/- 4 kg/ m(2), P = .06), and were older (61 +/- 10 y vs 57 +/- 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 +/- 6 vs 8 +/- 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 +/- 8 vs 10 +/- 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 +/- 30 events/h vs 23 +/- 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% + 13 vs 4% + 9, P = .04), and a higher proportion of severe OSA (AHI >= 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS: OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.
  • conferenceObject
    Predictors of death and myocardial infarction in patients with refractory angina
    (2014) POPPI, N. Tavares; DOURADO, L. O. C.; VENTURINI, G.; ADAM, E. L.; LEITE, T. N. P.; CESAR, L. A. Machado; PEREIRA, A. C.; GOWDAK, L. H. W.
  • article 49 Citação(ões) na Scopus
    Diretriz de Doença Coronária Estável
    (2014) CESAR, LA; FERREIRA, JF; ARMAGANIJAN, D; GOWDAK, LH; MANSUR, AP; BODANESE, LC; SPOSITO, A; SOUSA, AC; CHAVES, AJ; MARKMAN, B; CARAMELLI, B.; VIANNA, CB; OLIVEIRA, CC; MENEGHETTI, C; ALBUQUERQUE, DC; STEFANINI, E; NAGIB, E; PINTO, IMF; CASTRO, I; SAAD, JA; SCHNEIDER, JC; TSUTSUI, JM; CARNEIRO, JKR; TORRES, K; PIEGAS, LS; DALLAN, LA; LISBOA, LAF; SAMPAIO, MF; MORETTI, MA; LOPES, NH; COELHO, OR; LEMOS, P; SANTOS, RD; BOTELHO, R; STAICO, R; MENEGHELLO, R; MONTENEGRO, ST; VAZ, VD