LUCIANA OLIVEIRA CASCAES DOURADO

@incor.usp.br

Instituto do Coracao da Faculdade de Medicina da Universidade de Sao Paulo



           

https://researchid.co/lucianaocdourado

RESEARCH, TEACHING, or OTHER INTERESTS

Cardiology and Cardiovascular Medicine

15

Scopus Publications

Scopus Publications

  • Exercise Training on Anginal Threshold Does Not Improve Endothelial Function in Refractory Angina Patients
    Camila P. Jordão, Luciana O.C. Dourado, Camila R.A. de Assumpção, Marcelo L.C. Vieira, Carla G. De S.P. Montenegro, Carlos E. Negrão, Luís H.W. Gowdak, and Luciana D.N.J. De Matos
    Elsevier BV

  • In the Cardiac Rehabilitation Era, is There a “No-Option” Refractory Angina Patient?: A Case Report
    Luciana Oliveira Cascaes Dourado, Camila Paixão Jordão, Camila Regina Alves Assumpção, and Luciana Diniz Nagem Janot de Matos
    Sociedade Brasileira de Cardiologia
    Resumo A reabilitação cardíaca baseada em exercícios, um tratamento adjuvante eficaz e seguro recomendado para pacientes com doença arterial coronariana, é pouco aplicada em pacientes com angina refratária (AR) devido a dificuldades relacionadas à segurança, prescrição do treinamento e o seu manejo clínico. Este relato de caso apresenta um paciente “sem opção” com AR, incluído em um programa de exercícios de 12 semanas de duração, composto de 40 minutos de exercício aeróbico em esteira por sessão, três vezes por semana, e intensidade prescrita entre limiares isquêmicos/anginosos e limiar ventilatório 1, conforme obtidos no teste de exercício cardiopulmonar; angina leve a moderada foi permitida durante o treinamento. Além disso, foram realizados 15 minutos de treinamento de resistência de intensidade moderada (exercícios de grandes grupos musculares, duas séries de 8 a 12 repetições). Ao final do protocolo, o paciente apresentou melhora importante no desempenho funcional (VO 2 máximo de 17,0 ml/kg/min para 27,3 ml/kg/min), limiar anginoso (FC de 68 bpm para 95 bpm) e na intensidade da dor torácica (nível 7 para 5) sem eventos clínicos adversos durante o período. A reabilitação cardíaca baseada em exercícios se mostrou segura, mesmo na ocorrência de angina/isquemia durante o treinamento, de acordo com a tolerabilidade aos sintomas e outros sinais clínicos de alerta.

  • Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina?
    Carla Giuliano de Sá Pinto Montenegro, Luciana Oliveira Cascaes Dourado, Camila Paixão Jordão, Marcelo Luiz Campos Vieira, Camila Regina Alves Assumpção, Luis Henrique Wolff Gowdak, Alexandre da Costa Pereira, Carlos Eduardo Negrão, and Luciana Diniz Nagem Janot de Matos
    Sociedade Brasileira de Cardiologia
    Resumo Fundamento Não está claro se o exercício é seguro em pacientes com formas mais avançadas de doença arterial coronariana, como aqueles com angina refratária (AR). Objetivo Visamos determinar o efeito de uma sessão de exercício aeróbico agudo (SEAA) nos níveis de troponina T cardíaca de alta sensibilidade (TnT-as) em pacientes com AR. Métodos Trata-se de um estudo clínico longitudinal, não randomizado e não controlado. Os participantes foram recrutados de abril de 2015 a janeiro de 2019. Em uma escala visual de dor de 0 a 10, a dor classificada até 3 foi considerada como o nível máximo permitido para continuar o exercício. Avaliamos TnT-as na linha de base e 3 horas após a SEAA. O protocolo consistiu em 5 minutos de aquecimento, 30 minutos de exercício aeróbico contínuo na frequência cardíaca correspondente ao limiar anaeróbio ou limiar de angina obtido no teste de esforço cardiopulmonar e 5 minutos de resfriamento. Foram considerados estatisticamente significativos valores de p menores que 0,05. Resultados Foram incluídos 32 pacientes com AR (61 ± 9 anos, 59,4% do sexo masculino). A concentração basal de TnT-as foi de 10,9 ng/L (intervalo de confiança de 95%: 9,1 a 13,0 ng/L). A TnT-as coletada 3 horas após a SEAA foi de 11,1 ng/L (intervalo de confiança de 95%: 9,1 a 13,5 ng/L). Nenhuma diferença ocorreu na TnT-as antes e após a SEAA (p = 0,657). Conclusões Uma única SEAA realizada no limiar de angina com correspondente escala visual de dor não alterou a TnT-as em pacientes com AR, sugerindo que nenhuma lesão miocárdica significativa foi provocada pelo exercício e que este protocolo de exercício pode ser considerado seguro.

  • Concomitant Use of Ranolazine and Trimetazidine in Patients with Refractory Angina: An Initial Experience
    Luciana Oliveira Cascaes Dourado, Cristian Paul Delgado Moreno, Sarah Fagundes Grobe, Luis Henrique Wolff Gowdak, and Luiz Antonio Machado Cesar
    Sociedade Brasileira de Cardiologia
    Introdução A angina refratária (AR), uma condição extremamente debilitante, requer tratamento médico especializado com ajustes terapêuticos muitas vezes complexos na tentativa de melhorar ao máximo os sintomas e a qualidade de vida.1 O tratamento médico geralmente compreende uma combinação de medicamentos antianginosos. Dentre eles, a trimetazidina (T) e a ranolazina (R) são uma terapia complementar devido ao seu perfil de eficácia e segurança no tratamento de pacientes com AR.1-3 No entanto, na recente “abordagem diamante”,4 que descreve combinações preferenciais de diferentes classes de medicamentos antianginosos para o tratamento de pacientes com angina, o uso concomitante de T e R não é considerado uma estratégia útil devido ao seu mecanismo de ação relacionada.4 Embora nenhuma interação conhecida entre ambas as drogas tenha sido descrita,5 não há dados sobre a eficácia e segurança do uso de R em pacientes que já estão usando T. Portanto, objetivamos avaliar o efeito do uso concomitante de R e T em pacientes com AR.

  • Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation
    Camila R.A. de Assumpção, Danilo M.L. do Prado, Camila P. Jordão, Luciana O.C. Dourado, Marcelo L.C. Vieira, Carla G. de S.P. Montenegro, Carlos E. Negrão, Luís H.W. Gowdak, and Luciana D.N.J. De Matos
    Clinics Elsevier BV

  • The Role of the Heart Team in Patients with Diffuse Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting
    Luciana Oliveira Cascaes Dourado, Alexandre C. Pereira, Nilson Tavares Poppi, Rafael Cavalcante, Fabio Gaiotto, Luis Alberto Oliveira Dallan, Marcio Sommer Bittencourt, Luiz Antonio M. Cesar, and Luis Henrique W. Gowdak
    Thoracic and Cardiovascular Surgeon Georg Thieme Verlag KG
    Abstract Background In patients eligible for coronary artery bypass grafting, no data assess the importance of the Heart Team in programming the best surgical strategy for patients with diffuse coronary artery disease (CAD). This study aims to determine the contribution of the Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic surgical success in these patients based on visual angiographic analysis. Methods Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass graft surgery were prospectively included. One-year postoperative coronary angiograms were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular surgeons, and one interventional cardiologist retrospectively analyzed preoperative angiograms. A subjective scale was applied at a single moment to quantify the chance of successful coronary artery bypass grafting for each coronary territory with anatomical indication for revascularization. Based on individual scores, the Heart Team's and the specialists' scores were calculated and compared. Results The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected. The Heart Team's accuracy for predicting the angiographic success of the surgery was 74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional cardiologist predicted left anterior descending territory grafting success. The Heart Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity and low specificity in predicting angiographic success. Conclusion The multispecialty Heart Team achieved good accuracy in predicting the angiographic coronary artery bypass graft success in patients with diffuse CAD, with a high specificity and reasonable sensitivity.

  • Brazilian cardiovascular rehabilitation guideline – 2020
    Tales de Carvalho, Mauricio Milani, Almir Sergio Ferraz, Anderson Donelli da Silveira, Artur Haddad Herdy, Carlos Alberto Cordeiro Hossri, Christina Grüne Souza e Silva, Claudio Gil Soares de Araújo, Eneas Antonio Rocco, José Antonio Caldas Teixeira,et al.
    Sociedade Brasileira de Cardiologia
    Autores da Diretriz: Tales de Carvalho,1,2 Mauricio Milani,3 Almir Sergio Ferraz,4 Anderson Donelli da Silveira,5,6,7 Artur Haddad Herdy,1,8,9 Carlos Alberto Cordeiro Hossri,4,10 Christina Grüne Souza e Silva,11 Claudio Gil Soares de Araújo,11 Eneas Antonio Rocco,12 José Antonio Caldas Teixeira,13 Luciana Oliveira Cascaes Dourado,14 Luciana Diniz Nagem Janot de Matos,15 Luiz Gustavo Marin Emed,16 Luiz Eduardo Fonteles Ritt,17,18 Marconi Gomes da Silva,19 Mauro Augusto dos Santos,20,21 Miguel Morita Fernandes da Silva,22 Odilon Gariglio Alvarenga de Freitas,23 Pablo Marino Corrêa Nascimento,13,21 Ricardo Stein,5,6,7 Romeu Sergio Meneghelo,4,15 Salvador Manoel Serra24

  • Large bilateral coronary artery fistula: 10-year follow-up in clinical treatment
    Rodrigo Melo Kulchetscki, Luka David Lechinewski, Luciana Oliveira Cascaes Dourado, Whady Armindo Hueb, and Luiz Antonio Machado César
    Sociedade Brasileira de Cardiologia
    Large Bilateral Coronary Artery Fistula: 10-year Follow-up in Clinical Treatment Rodrigo Melo Kulchetscki,1 Luka David Lechinewski,2 Luciana Oliveira Cascaes Dourado,1 Whady Armindo Hueb,1 Luiz Antonio Machado César1 Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP),1 São Paulo, SP – Brazil Hospital da Irmandade da Santa Casa de Misericórdia de Curitiba,2 Curitiba, PR – Brazil

  • Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results
    Marcio Bittencourt, Alexandre Pereira, Nilson Poppi, Luis Dallan, José Krieger, Luiz Cesar, Luís Gowdak, and Luciana Dourado
    Georg Thieme Verlag KG
    Background 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 1 year 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.

  • A prospective study of patients with refractory angina: outcomes and the role of high-sensitivity troponin T
    Nilson T. Poppi, Luís H.W. Gowdak, Luciana O.C. Dourado, Eduardo L. Adam, Thiago N.P. Leite, Bruno M. Mioto, José E. Krieger, Luiz A.M. César, and Alexandre C. Pereira
    Wiley
    BackgroundThe predictors of cardiovascular events in patients with chronic refractory angina are limited. High‐sensitivity cardiac troponin T (hs‐cTnT) assays are biomarkers that may be used to determine the prognosis of patients with stable coronary artery disease.HypothesisHs‐cTnT is a predictor of death and nonfatal myocardial infarction (MI) in patients with refractory angina.MethodsWe prospectively enrolled 117 consecutive patients in this study. A heart team ruled out myocardial revascularization feasibility after assessing recent coronary angiograms; evidence of myocardial ischemia served as an inclusion criterion. Optimal medical therapy was encouraged via outpatient visits every 6 months; plasma hs‐cTnT levels were determined at baseline. The primary endpoint was the composite incidence of death and nonfatal MI.ResultsDuring a median follow‐up period of 28.0 months (interquartile range, 18.0–47.5 months), an estimated 28.0‐month cumulative event rate of 13.4% was determined via the Kaplan‐Meier method. Univariate predictors of the composite endpoint were hs‐cTnT levels and LV dysfunction. Following a multivariate analysis, only hs‐cTnT was independently associated with the events in question, either as a continuous variable (hazard ratio per unit increase in the natural logarithm: 2.83, 95% confidence interval: 1.62‐4.92, P < 0.001) or as a categorical variable (hazard ratio for concentrations above the 99th percentile: 5.14, 95% confidence interval: 2.05‐12.91, P < 0.001).ConclusionsIn patients with chronic refractory angina, plasma concentration of hs‐cTnT is the strongest predictor of death and nonfatal MI. Notably, none of the outcomes in question occurred in patients with baseline plasma levels <5.0 ng/L.

  • Obstructive sleep apnoea is associated with myocardial injury in patients with refractory angina
    Glaucylara R Geovanini, Alexandre C Pereira, Luis H W Gowdak, Luciana Oliveira Cascaes Dourado, Nilson T Poppi, Gabriela Venturini, Luciano F Drager, and Geraldo Lorenzi-Filho
    BMJ
    Objective To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. Methods Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00. Results We studied 80 consecutive patients (age: 62±10 years; male: 66%; body mass index (BMI): 29.5±4 kg/m2) with well-established diagnosis of refractory angina. The mean apnoea–hypopnoea index (AHI) was 37±29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI ≥51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p=0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p=0.028) in multivariate analysis. Conclusion Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.

  • The effectiveness of intensive medical treatment in patients initially diagnosed with refractory angina
    Luciana Oliveira Cascaes Dourado, Nilson Tavares Poppi, Eduardo Leal Adam, Thiago Nunes Pereira Leite, Alexandre da Costa Pereira, José Eduardo Krieger, Luiz Antonio Machado Cesar, and Luís Henrique Wolff Gowdak
    Elsevier BV

  • OSA and depression are common and independently associated with refractory angina in patients with coronary artery disease
    Glaucylara R. Geovanini, Luis H.W. Gowdak, Alexandre C. Pereira, Naury de Jesus Danzi-Soares, Luciana O.C. Dourado, Nilson T. Poppi, Luiz Antonio Machado Cesar, Luciano F. Drager, and Geraldo Lorenzi-Filho
    Elsevier BV
    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/m2 vs 28.5 ± 4 kg/m2, 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.

  • Large bilateral coronary artery fistula: The choice of clinical treatment
    Luciana Oliveira Cascaes Dourado, Aécio Flávio Teixeira de Góis, Whady Hueb, and Luiz Antônio Machado César
    FapUNIFESP (SciELO)
    : We report the case of an asymptomatic female patient, with a large non-complicated bilateral coronary-pulmonary artery fistula. Clinical monitoring was the choice of treatment. We discuss the therapeutic options in depth, emphasizing the excessive tendency of the surgical approach and the great scarcity of reports on long-term clinical follow-up in asymptomatic patients.

  • Venous aneurysm of the foot: Case reports and review of the literature
    Octavio Cascaes Dourado, Aristoteles Guilliod de Miranda, Antonio Pinheiro Filho, and Luciana Oliveira Dourado
    FapUNIFESP (SciELO)
    Este relato descreve dois casos de aneurisma venoso no pé, apresentados sob a forma de tumoração indolor e não-pulsátil no dorso do pé e sem história de trauma. O ultra-som Doppler evidenciou formação ovalada, anecóica, em comunicação com a veia e com sinal Doppler venoso, sugestiva de aneurisma venoso. O diagnóstico foi confirmado pelo exame histopatológico, com dilatação aneurismática constituída pelos três componentes da parede da veia. O tratamento consistiu na ligadura e ressecção cirúrgica. Os aneurismas venosos são relativamente raros, havendo relato de sua presença em várias localizações, principalmente nos membros inferiores. Na revisão da literatura, não foram encontrados relatos de aneurismas venosos no pé.