LUIS HENRIQUE WOLFF GOWDAK
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/13 - Laboratório de Genética e Cardiologia Molecular, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
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- Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results(2018) DOURADO, Luciana Oliveira Cascaes; BITTENCOURT, Marcio Sommer; PEREIRA, Alexandre Costa; POPPI, Nilson Tavares; DALLAN, Luis Alberto Oliveira; KRIEGER, Jose Eduardo; CESAR, Luiz Antonio Machado; GOWDAK, Luis Henrique WolffBackground Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals. Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory. Results A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016). Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.
- Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with refractory angina: A study with speckle tracking echocardiography(2018) DUQUE, Anderson S.; CECCON, Conrado L.; JR, Wilson Mathias; MAJESKY, Joana Diniz; GOWDAK, Luis H.; SBANO, Joao C. N.; CESAR, Luis Antonio Machado; ABDUCH, Maria Cristina; LIMA, Marcio S. M.; DOURADO, Paulo M. M.; V, Cecilia B. B. Cruz; TSUTSUI, Jeane M.BackgroundCardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA. MethodWe prospectively studied 19 patients who underwent CSWT. Left ventricular mechanics were evaluated by speckle tracking echocardiography (STE), and myocardial perfusion by single-photon emission computed tomography, using stress/rest-Technetium-99m Sestamibi, for determination of summed stress score (SSS). Canadian Cardiac Society (CCS), New York Heart Association (NYHA), and quality of life by Seattle Angina Questionnaire (SAQ) were assessed at baseline and 6months after therapy. ResultsCSWT therapy was applied without major side effects. At baseline, 18 patients (94.7%) had CCS class III or IV, and after CSWT there was reduction to 3 (15.8%), P=.0001, associated with improvement in SAQ (38.5%; P<.001). Thirteen (68.4%) had class NYHA III or IV before treatment, with significant reduction to 7 (36.8%); P=.014. No change was observed in the global SSS from baseline to 6-month follow-up (15.338.60 vs 16.60 +/- 8.06; P=.157). However, there was a significant reduction in the average SSS of the treated ischemic segments (2.1 +/- 0.87 pre vs 1.6 +/- 1.19 post CSWT; P=.024). Global longitudinal strain by STE remained unaltered (-13.03 +/- 8.96 pre vs -15.88 +/- 3.43 6-month post CSWT; P=.256). ConclusionCSWT is a safe procedure for the treatment of patients with RA that results in better quality of life, improvement in myocardial perfusion of the treated segments with preservation of left ventricular mechanics.
conferenceObject Double-Blind, Placebo-Controlled, Randomized Trial of Stem Cell Therapy Combined With Bypass Surgery - The MiHeart Trial(2018) GOWDAK, Luis Henrique W.; SCHETTERT, Isolmar T.; MENEGHETTI, Jose Claudio; ROCHITTE, Carlos Eduardo; DALLAN, Luis Alberto O.; GUARITA-SOUZA, Luiz Cesar; BRITO, Jose Oscar R.; CESAR, Luiz Antonio M.; OLIVEIRA, Sergio A. de; CARVALHO, Antonio Carlos C. de; KRIEGER, Jose Eduardoarticle 0 Citação(ões) na Scopus Focus on trimetazidine in acute coronary syndrome(2018) GOWDAK, L. H. W.>Trimetazidine is an anti-ischemic agent that acts at the cellular level by shifting the cardiac energy metabolism from ß-oxidation of free fatty acids to the more efficient glucose oxidation. In patients with an acute myocardial infarction (AMI) who are treated with thrombolysis and/or a percutaneous coronary intervention (PCI), ischemia-reperfusion injury may occur after reestablishing myocardial blood supply to an ischemic region. In animal models of ischemia-reperfusion injury, trimetazidine markedly reduced casein kinase and lactate dehydrogenase activities and decreased the infarct size. In patients with an AMI, trimetazidine reduced the rate of any form of reperfusion arrhythmias, more so with potentially life-threatening arrhythmias. In the EMPI-FR study (European Myocardial Infarction Project-Free Radicals), in the subset of patients not receiving thrombolysis assessed as per-protocol analysis, there was an 11.9% and 13.8% risk reduction in 35-day mortality and in-hospital mortality, respectively, in patients receiving trimetazidine. More recently, it was shown that trimetazidine, as an adjunctive therapy to PCI, reduced myocardial damage and preserved left ventricular function more than PCI alone. In a large registry of patients with AMI, the use of trimetazidine was associated with significant reductions in all-cause mortality and combined major adverse cardiac events (MACE), a finding that was confirmed in the first meta-analysis to report these benefits in patients with AMI treated with trimetazidine, showing a 67% risk reduction for MACE, which was defined as the composite of death, recurrent nonfatal MI, target vessel revascularization, coronary artery bypass graft, recurrence of angina, and/or hospitalization for heart failure. © 2018 Les Laboratoires Seriver. All rights reserved.- COMPUTED TOMOGRAPHY MYOCARDIAL PERFUSION ADDS DIAGNOSTIC POWER TO CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN RENAL TRANSPLANT CANDIDATES: PRELIMINARY RESULTS(2018) ADAM, Eduardo Leal; ROCHITTE, Carlos; LEMOS, Pedro; CESAR, Luiz Machado; LIMA, Jose Jayme de; GOWDAK, Luis Henrique
- Evaluation of a protocol for coronary artery disease investigation in asymptomatic elderly hemodialysis patients(2018) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.Background: Coronary artery disease (CAD) is prevalent in older patients on dialysis, but the prognostic relevance of coronary assessment in asymptomatic subjects remains undefined. We tested the usefulness of a protocol, based on clinical, invasive, and noninvasive coronary assessment, by answering these questions: Could selecting asymptomatic patients for coronary invasive assessment identify those at higher risk of events? Is CAD associated with a worse prognosis? Methods: A retrospective study including 276 asymptomatic patients at least 65 years old on the waiting list, prospectively evaluated for CAD and followed up until death or renal transplantation, were classified into two groups: 1) low-risk patients who did not undergo coronary angiography (n=63) and 2) patients who did undergo angiography (n=213). The latter group was reclassified into patients with significant CAD or normal angiograms/nonsignificant CAD. Results: CAD (>= 70% stenosis) occurred in 124 subjects (58%). The incidence of death by any cause, coronary death, and major cardiovascular (CV) events were similar in patients selected or not for angiography and in those with or without significant CAD. Myocardial revascularization (surgical/percutaneous) was performed in only 21/276 patients (7.6%) and did not result in a reduction in mortality. Conclusion: In older patients on renal replacement therapy, the prevalence of CAD was high, but coronary investigation was not useful as a risk stratification tool and also resulted in a rather small proportion of patients eligible for intervention. Therefore, in the elderly, coronary investigation should not be considered routine in asymptomatic patients.