GUILHERME VEIGA GUIMARAES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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- Physical Exercise and MicroRNAs: New Frontiers in Heart Failure(2012) FERNANDES-SILVA, Miguel Morita; CARVALHO, Vagner Oliveira; GUIMARAES, Guilherme Veiga; BACAL, Fernando; BOCCHI, Edimar AlcidesAlthough 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.
conferenceObject 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, EdimarBackground 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- 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 AlcidesMicroRNAs (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.
- Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study(2012) CONCEICAO-SOUZA, Germano Emilio; PEGO-FERNANDES, Paulo Manuel; CRUZ, Fatima das Dores; GUIMARAES, Guilherme Veiga; BACAL, Fernando; VIEIRA, Marcelo Luiz Campos; GRUPI, Cesar Jose; GIORGI, Maria Clementina Pinto; CONSOLIM-COLOMBO, Fernanda Marciano; NEGRAO, Carlos Eduardo; RONDON, Maria Urbana P.; MOREIRA, Luiz Felipe Pinho; BOCCHI, Edimar AlcidesTo evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) 40, sinus rhythm, and resting heart rate 65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 6.6 to 33 5.2 (P 0.03); 6 min walking distance improved from 167 35 to 198 47 m (P 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 5 to 15 7 (P 0.06). The remaining analysed variables were unchanged. During 848 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
- Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial(2012) GUIMARAES, Guilherme Veiga; CARVALHO, Vitor Oliveira; BOCCHI, Edimar Alcides; D'AVILA, Veridiana MoraesBackground: Conventional cardiac rehabilitation program consist of 15 min of warm-up, 30 min of aerobic exercise and followed by 15 min calisthenics exercise. The Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure (HF). Purpose: Investigate the effects of Pilates on exercise capacity variables in HF. Methods: Sixteen pts with HF, left ventricular ejection fraction 27 +/- 14%, NYHA class III were randomly assigned to conventional cardiac rehabilitation program (n = 8) or mat Pilates training (n = 8) for 16 weeks of 30 min of aerobic exercise followed by 20 min of the specific program. Results: At 16 weeks, pts in the mat Pilates group and conventional group showed significantly increase on exercise time 11.9 +/- 2.5 to 17.8 +/- 4 and 11.7 +/- 3.9 to 14.2 +/- 4 min, respectively. However, only the Pilates group increased significantly the ventilation (from 56 +/- 20 to 69 +/- 17 L/min, P= 0.02), peak VO2 (from 20.9 +/- 6 to 24.8 +/- 6 mL/kg/min, P= 0.01), and O-2 pulse (from 11.9 +/- 2 to 13.8 +/- 3 mL/bpm, P= 0.003). The Pilates group showed significantly increase in peak VO2 when compared with conventional group (24.8 +/- 6 vs. 18.3 +/- 4, P= 0.02). Conclusions: The result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with HF who are already receiving standard medical therapy.
- Endothelial function in pre-pubertal children at risk of developing cardiomyopathy: a new frontier(2012) TAVARES, Aline Cristina; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme VeigaAlthough it is known that obesity, diabetes, and Kawasaki's disease play important roles in systemic inflammation and in the development of both endothelial dysfunction and cardiomyopathy, there is a lack of data regarding the endothelial function of pre-pubertal children suffering from cardiomyopathy. In this study, we performed a systematic review of the literature on pre-pubertal children at risk of developing cardiomyopathy to assess the endothelial function of pre-pubertal children at risk of developing cardiomyopathy. We searched the published literature indexed in PubMed, Bireme and SciELO using the keywords 'endothelial', 'children', 'pediatric' and 'infant' and then compiled a systematic review. The end points were age, the pubertal stage, sex differences, the method used for the endothelial evaluation and the endothelial values themselves. No studies on children with cardiomyopathy were found. Only 11 papers were selected for our complete analysis, where these included reports on the flow-mediated percentage dilatation, the values of which were 9.80 +/- 1.80, 5.90 +/- 1.29, 4.50 +/- 0.70, and 7.10 +/- 1.27 for healthy, obese, diabetic and pre-pubertal children with Kawasaki's disease, respectively. There was no significant difference in the dilatation, independent of the endothelium, either among the groups or between the genders for both of the measurements in children; similar results have been found in adolescents and adults. The endothelial function in cardiomyopathic children remains unclear because of the lack of data; nevertheless, the known dysfunctions in children with obesity, type 1 diabetes and Kawasaki's disease may influence the severity of the cardiovascular symptoms, the prognosis, and the mortality rate. The results of this study encourage future research into the consequences of endothelial dysfunction in pre-pubertal children.
- Age-Related Maximum Heart Rate Among Ischemic and Nonischemic Heart Failure Patients Receiving beta-Blockade Therapy(2012) SILVA, Miguel Morita Fernandes; BACAL, Fernando; ROQUE, Jean Marcelo; TEIXEIRA-NETO, Iram Soares; CARVAS JUNIOR, Nelson; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme VeigaBackground: Equations to predict maximum heart rate (HRmax) in heart failure (HF) patients receiving beta-adrenergic blocking (BB) agents do not consider the cause of HF. We determined equations to predict HRmax in patients with ischemic and nonischemic HF receiving BB therapy. Methods and Results: Using treadmill cardiopulmonary exercise testing, we studied HF patients receiving BB therapy being considered for transplantation from 1999 to 2010. Exclusions were pacemaker and/or implantable defibrillator, left ventricle ejection fraction (LVEF) >50%, peak respiratory exchange ratio (RER) <1.00, and Chagas disease. We used linear regression equations to predict HRmax based on age in ischemic and nonischemic patients. We analyzed 278 patients, aged 47 +/- 10 years, with ischemic (n = 75) and nonischemic (n = 203) HF. LVEF was 30.8 +/- 9.4% and 28.6 +/- 8.2% (P = .04), peak VO2 16.9 +/- 4.7 and 16.9 +/- 5.2 mL kg(-1) min(-1) (P = NS), and the HRmax 130.8 +/- 23.3 and 125.3 +/- 25.3 beats/min (P = .051) in ischemic and nonischemic patients, respectively. We devised the equation HRmax = 168 - 0.76 x age (R-2 = 0.095; P = .007) for ischemic HF patients, but there was no significant relationship between age and HRmax in nonischemic HF patients (R-2 = 0.006; P = NS). Conclusions: Our study suggests that equations to estimate HRmax should consider the cause of HF. (J Cardiac Fail 2012;18:831-836)
conferenceObject Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients-3 years follow-up(2012) CONCEICAO-SOUZA, G. E.; PEGO-FERNANDES, P. M.; MOREIRA, L. F. P.; CRUZ, F. D.; GUIMARAES, G. V.; BACAL, F.; VIEIRA, M. L. C.; CONSOLIM-COLOMBO, F. M.; NEGRAO, C. E.; BOCCHI, E. A.