Maria Otto | Universidade de Brasília - UnB (original) (raw)

Papers by Maria Otto

Information about reprints can be found online at: Reprints: document. Permissions and Rights Que... more Information about reprints can be found online at: Reprints: document. Permissions and Rights Question and Answer this process is available in the click Request Permissions in the middle column of the Web page under Services. Further information about Office. Once the online version of the published article for which permission is being requested is located, can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialHypertensionin Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions: by guest on February 26,

Brazilian Journal of Cardiovascular Surgery, 2021

Introduction Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon... more Introduction Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction. Methods From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis. Results The end point occurred in 18 patients (16.8%). We te...

Background Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective Determi... more Background Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. Methods A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05. Results iEOA was obtained in 176 patient...

American Journal of Hypertension

Rev Bras Ecocardiogr Imagem Cardiovasc, Sep 1, 2013

Arquivos brasileiros de cardiologia

International Medical Case Reports Journal, 2015

A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to... more A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography.

American Journal of Hypertension, 2004

BackgroundObstructive sleep apnea (OSA) is associated with hypertension. The vasorelaxing peptide... more BackgroundObstructive sleep apnea (OSA) is associated with hypertension. The vasorelaxing peptide adrenomedullin (ADM) may counteract effects of OSA-induced release of vasopressor substances.

Arquivos brasileiros de cardiologia, 2011

A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergo... more A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Journal of the American College of Cardiology, 2012

Journal of the American College of Cardiology, 2004

Background: We have shown that caffeine increases acutely arterial stiffness. Tea is a widely con... more Background: We have shown that caffeine increases acutely arterial stiffness. Tea is a widely consumed beverage, however, its effect on arterial stiffness has not been defined. Aortic stiffness is an important prognosticator of cardiovascular risk. Methods: We studied 12 healthy volunteers (33±5 years) in a randomized, single-blind, crossover fashion. The subjects were studied on 3 separate occasions: a) 6 gr of black tea, b) 175 mg of caffeine alone (the amount contained in 6 gr of tea) and c) placebo. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness using a validated automated, non-invasive device (Complior®). Results: Tea had a biphasic effect on aortic stiffness. Initially it led to a marginal (P=0.07) increase in PWV, which, however, rapidly disappeared. In contrast, caffeine alone led to a sustained increase in PWV (P<0.05, figure). The reversal of aortic stiffness increase with tea after the initial 30 minutes can be attributed to a beneficial effect of tea flavonoids that peak later than caffeine. Pressures were increased in a similar manner both with tea and caffeine (systolic: by 8.8 and 7.8 mmHg respectively, P<0.001 for both). Conclusions: Tea shows a tendency to increase initially aortic stiffness due to the caffeine that it contains. However, this effect is promptly counterbalanced by a beneficial effect of tea flavonoids. This finding provides valuable insights for the effects of tea consumption on the cardiovascular system.

Journal of the American College of Cardiology, 2004

Hypertension, 2000

No study has been performed on reflexes originating from receptors in the heart that might be inv... more No study has been performed on reflexes originating from receptors in the heart that might be involved in the pathological lesions of Chagas' heart disease. Our study was undertaken to analyze the role of cardiopulmonary reflex on cardiovascular control in Chagas' disease. We studied 14 patients with Chagas' disease without heart failure and 12 healthy matched volunteers. Central venous pressure, arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were recorded during deactivation of cardiopulmonary receptors. By reducing central venous pressure by applying Ϫ10 and Ϫ15 mm Hg of negative pressure to the lower body, we observed (a) a similar decrease of central venous pressure in both groups; (b) a marked increase in forearm vascular resistance in the control group but a blunted increase in the Chagas' group; and (c) no significant changes in blood pressure and heart rate. To analyze cardiopulmonary and arterial receptors, we applied Ϫ40 mm Hg of lower-body negative pressure. As a consequence, (a) central venous pressure decreased similarly in both groups; (b) blood pressure was maintained in the control group, whereas in patients with Chagas' disease, a decrease in systolic and mean arterial pressure occurred; (c) heart rate increased in both groups; and (d) forearm vascular resistance increased significantly and similarly in both groups. Unloading of receptors with low levels of lower-body negative pressure did not increase forearm vascular resistance in patients with Chagas' disease, which suggests that the reflex mediated by cardiopulmonary receptors is impaired in patients with Chagas' disease without heart failure. Overall control of circulation appears to be compromised because patients did not maintain blood pressure under high levels of lower-body negative pressure.

Rev. bras. ecocardiogr …, 2010

Resumo: A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma no... more Resumo: A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma nova estratégia de tratamento de pacientes com insuficiência cardíaca refratária ao tratamento clínico. Entretanto, cerca de 20 a 30% dos pacientes não são responsivos à ...

Brazilian Journal of Medical and Biological Research, 2004

The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negat... more The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negative pressure (LBNP) in patients with hypertensive cardiomyopathy have not been investigated in detail. We studied 15 hypertensive patients with left ventricular dysfunction (LVD) and 15 matched normal controls to observe the time course response of the forearm vascular resistance (FVR) during 3 min of LBNP at-10,-15, and-40 mmHg in unloading the cardiopulmonary receptors. Analysis of the average of 3-min intervals of FVR showed a blunted response of the LVD patients at-10 mmHg (P = 0.03), but a similar response in both groups at-15 and-40 mmHg. However, using a minute-to-minute analysis of the FVR at-15 and-40 mmHg, we observed a similar response in both groups at the 1st min, but a marked decrease of FVR in the LVD group at the 3rd min of LBNP at-15 mmHg (P = 0.017), and-40 mmHg (P = 0.004). Plasma norepinephrine levels were analyzed as another neurohumoral measurement of cardiopulmonary receptor response to LBNP, and showed a blunted response in the LVD group at-10 (P = 0.013),-15 (P = 0.032) and-40 mmHg (P = 0.004). We concluded that the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy is blunted at lower levels of LBNP. However, at higher levels, the cardiopulmonary reflex has a normal initial response that decreases progressively with time. As a consequence of the time-dependent response, the cardiopulmonary reflex response should be measured over small intervals of time in clinical studies.

Atherosclerosis, 2012

Objective: Diastolic dysfunction (DD) is a frequent condition in hypertensive patients whose pres... more Objective: Diastolic dysfunction (DD) is a frequent condition in hypertensive patients whose presence increases mortality and whose treatment remains unclear. The aim of this study was to investigate in a prospective, double-blinded, placebo-controlled randomized design the additive effect of simvastatin on DD in enalapril-treated hypertensive patients with average cholesterol levels. Methods: Hypertensive patients with DD and LDL-cholesterol <160 mg/dL underwent a run-in phase to achieve a systolic blood pressure (SBP) <135 mmHg and diastolic blood pressure (DBP) <85 mmHg with enalapril. Hydrochlorothiazide was added when need to achieve blood pressure control. Four weeks after reaching the optimum anti-hypertensive regimen patients were randomized to receive 80 mg simvastatin (n = 27) or placebo (n = 28) for a period of 20 weeks. Echocardiograms were performed before and after treatment with measurement of maximum left atrial volume (LAV), conventional and tissue Doppler velocities in early diastole (E, e) and late diastole (A, a). Results: After 20 weeks, the simvastatin group presented reduction in SBP (−4 ± 2 mmHg, p = 0.02), increase in E/A ratio (1.0 ± 0.05 to 1.2 ± 0.06, p = 0.03) and decrease of LAV indexed to body surface area (24.5 ± 0.9 to 21.1 ± 0.8 ml/m 2 , p = 0.048), as compared with placebo arm. No change in systolic function and no correlation between the E/A ratio, LAV and changes in blood pressure or lipid profile were observed. Conclusions: The addition of simvastatin to enalapril in hypertensive patients with average cholesterol levels improves parameters of diastolic function independently of changes in blood pressure or cholesterol.

Arquivos Brasileiros de Cardiologia, 2011

Fundamento: O aumento da pressão de capilar pulmonar (PCP) é um dos mecanismos de intolerância ao... more Fundamento: O aumento da pressão de capilar pulmonar (PCP) é um dos mecanismos de intolerância ao exercício. A avaliação da função diastólica pelo ecocardiograma (ECO) é capaz de estimar a PCP. Objetivo: Identificar variáveis determinantes da capacidade de exercício em paciente submetidos a teste ergométrico (TE) de rotina, ECO convencional e Doppler tecidual (DT). Métodos: Foram estudados, retrospectivamente, 640 pacientes submetidos a TE e ao ECO e DT. Pacientes com fração de ejeção < 55% foram excluídos. As velocidades de Doppler mitral convencional foram obtidas em diástole precoce (E) e diástole tardia (A), e o DT do anel mitral mediu as velocidades de diástole precoce (e') e diástole tardia (a'). E/e' > 10 foi considerada uma estimativa de aumento da PCP. A capacidade máxima de esforço foi avaliada pelo número de equivalentes metabólicos (MET). Para análise, os pacientes foram divididos em dois grupos: MET < 7 (n = 48) e MET > 7 (n = 572). O escore de Morise demonstrou uma população de baixo risco (60%) para doença coronariana (DAC). Resultados: O número de pacientes com E/e' > 10 foi significativamente maior no grupo MET < 7 em relação a MET > 7 (41,7% vs 9,4%, p = 0,001), bem como a presença de algum grau de disfunção diastólica (76,6% vs 34,1% p = 0,001). Pela análise de regressão logística, as variáveis independentes de baixa capacidade de exercício (MET < 7) foram a idade, o sexo feminino e a velocidade de A (diástole tardia). Conclusão: A disfunção diastólica determinada pelo ECO, sexo feminino e idade estão associados com a menor capacidade de exercício em uma população de baixo risco de DAC. (Arq Bras Cardiol 2011; 96(2): 107-113) Palavras-chave: Disfunção ventricular, teste de esforço, exercício, diástole; ecocardiograma, Doppler tecidual.

Hypertension, 2000

No study has been performed on reflexes originating from receptors in the heart that might be inv... more No study has been performed on reflexes originating from receptors in the heart that might be involved in the pathological lesions of Chagas' heart disease. Our study was undertaken to analyze the role of cardiopulmonary reflex on cardiovascular control in Chagas' disease. We studied 14 patients with Chagas' disease without heart failure and 12 healthy matched volunteers. Central venous pressure, arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were recorded during deactivation of cardiopulmonary receptors. By reducing central venous pressure by applying Ϫ10 and Ϫ15 mm Hg of negative pressure to the lower body, we observed (a) a similar decrease of central venous pressure in both groups; (b) a marked increase in forearm vascular resistance in the control group but a blunted increase in the Chagas' group; and (c) no significant changes in blood pressure and heart rate. To analyze cardiopulmonary and arterial receptors, we applied Ϫ40 mm Hg of lower-body negative pressure. As a consequence, (a) central venous pressure decreased similarly in both groups; (b) blood pressure was maintained in the control group, whereas in patients with Chagas' disease, a decrease in systolic and mean arterial pressure occurred; (c) heart rate increased in both groups; and (d) forearm vascular resistance increased significantly and similarly in both groups. Unloading of receptors with low levels of lower-body negative pressure did not increase forearm vascular resistance in patients with Chagas' disease, which suggests that the reflex mediated by cardiopulmonary receptors is impaired in patients with Chagas' disease without heart failure. Overall control of circulation appears to be compromised because patients did not maintain blood pressure under high levels of lower-body negative pressure.

AJP: Regulatory, Integrative and Comparative Physiology, 2004

Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular disease, endothelial... more Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular disease, endothelial dysfunction, and oxidative stress, generated by repetitive nocturnal hypoxemia and reperfusion. Circulating free nitrotyrosine has been reported as a novel biomarker of nitric oxide (NO)-induced oxidative/nitrosative stress. Nitrosative stress has been implicated as a possible mechanism for development of cardiovascular diseases. We tested the hypothesis that repetitive severe hypoxemia resulting from OSA would increase NO-mediated oxidative stress. We studied 10 men with newly diagnosed moderate to severe OSA who were free of other diseases, had never been treated for OSA, and were taking no medications. Nitrotyrosine measurements, performed by liquid chromatography-tandem mass spectrometry, were made before and after untreated apneic sleep. We compared free nitrotyrosine levels in these patients with those obtained at similar times in 10 healthy male control subjects without OSA, with...

The American Journal of Cardiology, 2007

Information about reprints can be found online at: Reprints: document. Permissions and Rights Que... more Information about reprints can be found online at: Reprints: document. Permissions and Rights Question and Answer this process is available in the click Request Permissions in the middle column of the Web page under Services. Further information about Office. Once the online version of the published article for which permission is being requested is located, can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialHypertensionin Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions: by guest on February 26,

Brazilian Journal of Cardiovascular Surgery, 2021

Introduction Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon... more Introduction Left ventricular dysfunction after surgical treatment of mitral stenosis is uncommon. We intend to determine the pattern of left ventricular remodeling, shortly after open mitral valve replacement for rheumatic mitral stenosis, with in-hospital postoperative outcomes and the determinants of postoperative worsening of left ventricular ejection fraction. Methods From January 2008 to January 2015, 107 adult patients with rheumatic mitral stenosis were submitted to open mitral valve replacement. Their mean age was 45±11 years and 93 (86.9%) were women. Left ventricular morphology and function were studied longitudinally with echocardiography. The end point was postoperative worsening of left ventricular ejection fraction, defined by a decrease of 10% compared to preoperative basal assessment. Determinants of worsening left ventricular ejection fraction were determined by multivariable logistic regression analysis. Results The end point occurred in 18 patients (16.8%). We te...

Background Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective Determi... more Background Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. Methods A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05. Results iEOA was obtained in 176 patient...

American Journal of Hypertension

Rev Bras Ecocardiogr Imagem Cardiovasc, Sep 1, 2013

Arquivos brasileiros de cardiologia

International Medical Case Reports Journal, 2015

A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to... more A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography.

American Journal of Hypertension, 2004

BackgroundObstructive sleep apnea (OSA) is associated with hypertension. The vasorelaxing peptide... more BackgroundObstructive sleep apnea (OSA) is associated with hypertension. The vasorelaxing peptide adrenomedullin (ADM) may counteract effects of OSA-induced release of vasopressor substances.

Arquivos brasileiros de cardiologia, 2011

A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergo... more A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Journal of the American College of Cardiology, 2012

Journal of the American College of Cardiology, 2004

Background: We have shown that caffeine increases acutely arterial stiffness. Tea is a widely con... more Background: We have shown that caffeine increases acutely arterial stiffness. Tea is a widely consumed beverage, however, its effect on arterial stiffness has not been defined. Aortic stiffness is an important prognosticator of cardiovascular risk. Methods: We studied 12 healthy volunteers (33±5 years) in a randomized, single-blind, crossover fashion. The subjects were studied on 3 separate occasions: a) 6 gr of black tea, b) 175 mg of caffeine alone (the amount contained in 6 gr of tea) and c) placebo. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness using a validated automated, non-invasive device (Complior®). Results: Tea had a biphasic effect on aortic stiffness. Initially it led to a marginal (P=0.07) increase in PWV, which, however, rapidly disappeared. In contrast, caffeine alone led to a sustained increase in PWV (P<0.05, figure). The reversal of aortic stiffness increase with tea after the initial 30 minutes can be attributed to a beneficial effect of tea flavonoids that peak later than caffeine. Pressures were increased in a similar manner both with tea and caffeine (systolic: by 8.8 and 7.8 mmHg respectively, P<0.001 for both). Conclusions: Tea shows a tendency to increase initially aortic stiffness due to the caffeine that it contains. However, this effect is promptly counterbalanced by a beneficial effect of tea flavonoids. This finding provides valuable insights for the effects of tea consumption on the cardiovascular system.

Journal of the American College of Cardiology, 2004

Hypertension, 2000

No study has been performed on reflexes originating from receptors in the heart that might be inv... more No study has been performed on reflexes originating from receptors in the heart that might be involved in the pathological lesions of Chagas' heart disease. Our study was undertaken to analyze the role of cardiopulmonary reflex on cardiovascular control in Chagas' disease. We studied 14 patients with Chagas' disease without heart failure and 12 healthy matched volunteers. Central venous pressure, arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were recorded during deactivation of cardiopulmonary receptors. By reducing central venous pressure by applying Ϫ10 and Ϫ15 mm Hg of negative pressure to the lower body, we observed (a) a similar decrease of central venous pressure in both groups; (b) a marked increase in forearm vascular resistance in the control group but a blunted increase in the Chagas' group; and (c) no significant changes in blood pressure and heart rate. To analyze cardiopulmonary and arterial receptors, we applied Ϫ40 mm Hg of lower-body negative pressure. As a consequence, (a) central venous pressure decreased similarly in both groups; (b) blood pressure was maintained in the control group, whereas in patients with Chagas' disease, a decrease in systolic and mean arterial pressure occurred; (c) heart rate increased in both groups; and (d) forearm vascular resistance increased significantly and similarly in both groups. Unloading of receptors with low levels of lower-body negative pressure did not increase forearm vascular resistance in patients with Chagas' disease, which suggests that the reflex mediated by cardiopulmonary receptors is impaired in patients with Chagas' disease without heart failure. Overall control of circulation appears to be compromised because patients did not maintain blood pressure under high levels of lower-body negative pressure.

Rev. bras. ecocardiogr …, 2010

Resumo: A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma no... more Resumo: A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma nova estratégia de tratamento de pacientes com insuficiência cardíaca refratária ao tratamento clínico. Entretanto, cerca de 20 a 30% dos pacientes não são responsivos à ...

Brazilian Journal of Medical and Biological Research, 2004

The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negat... more The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negative pressure (LBNP) in patients with hypertensive cardiomyopathy have not been investigated in detail. We studied 15 hypertensive patients with left ventricular dysfunction (LVD) and 15 matched normal controls to observe the time course response of the forearm vascular resistance (FVR) during 3 min of LBNP at-10,-15, and-40 mmHg in unloading the cardiopulmonary receptors. Analysis of the average of 3-min intervals of FVR showed a blunted response of the LVD patients at-10 mmHg (P = 0.03), but a similar response in both groups at-15 and-40 mmHg. However, using a minute-to-minute analysis of the FVR at-15 and-40 mmHg, we observed a similar response in both groups at the 1st min, but a marked decrease of FVR in the LVD group at the 3rd min of LBNP at-15 mmHg (P = 0.017), and-40 mmHg (P = 0.004). Plasma norepinephrine levels were analyzed as another neurohumoral measurement of cardiopulmonary receptor response to LBNP, and showed a blunted response in the LVD group at-10 (P = 0.013),-15 (P = 0.032) and-40 mmHg (P = 0.004). We concluded that the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy is blunted at lower levels of LBNP. However, at higher levels, the cardiopulmonary reflex has a normal initial response that decreases progressively with time. As a consequence of the time-dependent response, the cardiopulmonary reflex response should be measured over small intervals of time in clinical studies.

Atherosclerosis, 2012

Objective: Diastolic dysfunction (DD) is a frequent condition in hypertensive patients whose pres... more Objective: Diastolic dysfunction (DD) is a frequent condition in hypertensive patients whose presence increases mortality and whose treatment remains unclear. The aim of this study was to investigate in a prospective, double-blinded, placebo-controlled randomized design the additive effect of simvastatin on DD in enalapril-treated hypertensive patients with average cholesterol levels. Methods: Hypertensive patients with DD and LDL-cholesterol <160 mg/dL underwent a run-in phase to achieve a systolic blood pressure (SBP) <135 mmHg and diastolic blood pressure (DBP) <85 mmHg with enalapril. Hydrochlorothiazide was added when need to achieve blood pressure control. Four weeks after reaching the optimum anti-hypertensive regimen patients were randomized to receive 80 mg simvastatin (n = 27) or placebo (n = 28) for a period of 20 weeks. Echocardiograms were performed before and after treatment with measurement of maximum left atrial volume (LAV), conventional and tissue Doppler velocities in early diastole (E, e) and late diastole (A, a). Results: After 20 weeks, the simvastatin group presented reduction in SBP (−4 ± 2 mmHg, p = 0.02), increase in E/A ratio (1.0 ± 0.05 to 1.2 ± 0.06, p = 0.03) and decrease of LAV indexed to body surface area (24.5 ± 0.9 to 21.1 ± 0.8 ml/m 2 , p = 0.048), as compared with placebo arm. No change in systolic function and no correlation between the E/A ratio, LAV and changes in blood pressure or lipid profile were observed. Conclusions: The addition of simvastatin to enalapril in hypertensive patients with average cholesterol levels improves parameters of diastolic function independently of changes in blood pressure or cholesterol.

Arquivos Brasileiros de Cardiologia, 2011

Fundamento: O aumento da pressão de capilar pulmonar (PCP) é um dos mecanismos de intolerância ao... more Fundamento: O aumento da pressão de capilar pulmonar (PCP) é um dos mecanismos de intolerância ao exercício. A avaliação da função diastólica pelo ecocardiograma (ECO) é capaz de estimar a PCP. Objetivo: Identificar variáveis determinantes da capacidade de exercício em paciente submetidos a teste ergométrico (TE) de rotina, ECO convencional e Doppler tecidual (DT). Métodos: Foram estudados, retrospectivamente, 640 pacientes submetidos a TE e ao ECO e DT. Pacientes com fração de ejeção < 55% foram excluídos. As velocidades de Doppler mitral convencional foram obtidas em diástole precoce (E) e diástole tardia (A), e o DT do anel mitral mediu as velocidades de diástole precoce (e') e diástole tardia (a'). E/e' > 10 foi considerada uma estimativa de aumento da PCP. A capacidade máxima de esforço foi avaliada pelo número de equivalentes metabólicos (MET). Para análise, os pacientes foram divididos em dois grupos: MET < 7 (n = 48) e MET > 7 (n = 572). O escore de Morise demonstrou uma população de baixo risco (60%) para doença coronariana (DAC). Resultados: O número de pacientes com E/e' > 10 foi significativamente maior no grupo MET < 7 em relação a MET > 7 (41,7% vs 9,4%, p = 0,001), bem como a presença de algum grau de disfunção diastólica (76,6% vs 34,1% p = 0,001). Pela análise de regressão logística, as variáveis independentes de baixa capacidade de exercício (MET < 7) foram a idade, o sexo feminino e a velocidade de A (diástole tardia). Conclusão: A disfunção diastólica determinada pelo ECO, sexo feminino e idade estão associados com a menor capacidade de exercício em uma população de baixo risco de DAC. (Arq Bras Cardiol 2011; 96(2): 107-113) Palavras-chave: Disfunção ventricular, teste de esforço, exercício, diástole; ecocardiograma, Doppler tecidual.

Hypertension, 2000

No study has been performed on reflexes originating from receptors in the heart that might be inv... more No study has been performed on reflexes originating from receptors in the heart that might be involved in the pathological lesions of Chagas' heart disease. Our study was undertaken to analyze the role of cardiopulmonary reflex on cardiovascular control in Chagas' disease. We studied 14 patients with Chagas' disease without heart failure and 12 healthy matched volunteers. Central venous pressure, arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were recorded during deactivation of cardiopulmonary receptors. By reducing central venous pressure by applying Ϫ10 and Ϫ15 mm Hg of negative pressure to the lower body, we observed (a) a similar decrease of central venous pressure in both groups; (b) a marked increase in forearm vascular resistance in the control group but a blunted increase in the Chagas' group; and (c) no significant changes in blood pressure and heart rate. To analyze cardiopulmonary and arterial receptors, we applied Ϫ40 mm Hg of lower-body negative pressure. As a consequence, (a) central venous pressure decreased similarly in both groups; (b) blood pressure was maintained in the control group, whereas in patients with Chagas' disease, a decrease in systolic and mean arterial pressure occurred; (c) heart rate increased in both groups; and (d) forearm vascular resistance increased significantly and similarly in both groups. Unloading of receptors with low levels of lower-body negative pressure did not increase forearm vascular resistance in patients with Chagas' disease, which suggests that the reflex mediated by cardiopulmonary receptors is impaired in patients with Chagas' disease without heart failure. Overall control of circulation appears to be compromised because patients did not maintain blood pressure under high levels of lower-body negative pressure.

AJP: Regulatory, Integrative and Comparative Physiology, 2004

Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular disease, endothelial... more Obstructive sleep apnea (OSA) has been increasingly linked to cardiovascular disease, endothelial dysfunction, and oxidative stress, generated by repetitive nocturnal hypoxemia and reperfusion. Circulating free nitrotyrosine has been reported as a novel biomarker of nitric oxide (NO)-induced oxidative/nitrosative stress. Nitrosative stress has been implicated as a possible mechanism for development of cardiovascular diseases. We tested the hypothesis that repetitive severe hypoxemia resulting from OSA would increase NO-mediated oxidative stress. We studied 10 men with newly diagnosed moderate to severe OSA who were free of other diseases, had never been treated for OSA, and were taking no medications. Nitrotyrosine measurements, performed by liquid chromatography-tandem mass spectrometry, were made before and after untreated apneic sleep. We compared free nitrotyrosine levels in these patients with those obtained at similar times in 10 healthy male control subjects without OSA, with...

The American Journal of Cardiology, 2007