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Effects of Renal Medullary and Intravenous Norepinephrine on Renal Antihypertensive Function
- Anabela G. Correia,
- Anna C. Madden,
- Göran Bergström and
- Roger G. Evans
Hypertension Volume 35, Issue 41 April 2000

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Abstract—Increasing renal arterial pressure activates at least 3 antihypertensive mechanisms: reduced renin release, pressure natriuresis, and release of a putative renal medullary depressor hormone. To examine the role of renal medullary perfusion in these mechanisms, we tested the effects of the infusion of norepinephrine, either infusion into the renal medullary interstitium or intravenous infusion, on responses to increased renal arterial pressure in pentobarbital-anesthetized rabbits. We used an extracorporeal circuit, which allows renal arterial pressure to be set to any level above or below systemic arterial pressure. With renal arterial pressure initially set at 65 mm Hg, intravenous and medullary interstitial norepinephrine (300 ng · kg⁻¹ · min⁻¹) similarly increased mean arterial pressure (by 12% to 17% of baseline) and reduced total renal blood flow (by 16% to 17%) and cortical perfusion (by 13% to 19%), but only medullary norepinephrine reduced medullary perfusion (by 28%). When renal arterial pressure was increased to ≈160 mm Hg, in steps of ≈65 mm Hg, urine output and sodium excretion increased exponentially, and plasma renin activity and mean arterial pressure fell. Medullary interstitial but not intravenous norepinephrine attenuated the increased diuresis and natriuresis and the depressor response to increased renal arterial pressure. This suggests that norepinephrine can act within the renal medulla to inhibit these renal antihypertensive mechanisms, perhaps by reducing medullary perfusion. These observations support the concept that medullary perfusion plays a critical role in the long-term control of arterial pressure by its influence on pressure diuresis/natriuresis mechanisms and also by affecting the release of the putative renal medullary depressor hormone.
Abstract P228: Relationships of Dietary and Supplement Magnesium Intake and Its Urinary Metabolomic Biomarkers With Blood Pressure: The INTERMAP Study
- Queenie Chan,
- Chung-Ho E Lau,
- Rachel Gibson,
- Elena Chekmeneva,
- Goncalo Dos Santos Correia,
- Rueyleng Loo,
- Timothy M Ebbels,
- Joram M Posma,
- Alan R Dyer,
- Katsuyuki Miura,
- Hirotsugu Ueshima,
- Liancheng Zhao,
- Martha L Daviglus,
- Paul Elliott,
- Jeremiah Stamler,
- Elaine Holmes and
- Linda Van Horn
Circulation Volume 139, Issue Suppl_15 March 2019

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Background: Magnesium (Mg) and other mineral intakes are vital contributors to a healthy diet and appear to have a modest effect on the risk of hypertension. Studies suggest that supplemental Mg can significantly lower blood pressure (BP). Here, we investigate associations of total Mg consumption with the level of its urinary metabolomic biomarkers, and BP.Method: We used cross-sectional data from the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP) on 4269 men and women aged 40-59 years from Japan, China, United Kingdom, and United States (US). Regression coefficients with BP per 2 standard deviation (SD) higher dietary Mg from food plus supplement (obtained from 24-hr dietary recalls), urinary Mg (measured by atomic absorption flame photometry) and small molecules (analysed by direct injection mass spectrometry) were estimated using multivariable models, adjusted for age, gender, population sample, intake of total energy and other confounders (see Table). To estimate overall association, country-specific regression coefficients were pooled, weighted by inverse of their variance.Results: Average Mg intakes were 454 (SD=207) mg/day for 770 persons who reported Mg supplementation (89% from US), and 300 (SD=101) mg/day for those who did not. High correlation was found between Mg intake from food plus supplements with urinary Mg (r=0.38, P<0.0001). Partial correlations of small molecules with total Mg intake ranged from -0.007 to 0.19 for ascorbic acid (P<0.0001). Total Mg intake higher by 261.87 mg/day (2SD) was associated with a systolic BP difference of -2.65 mm Hg (P=6x10^-5). Urinary Mg excretion higher by 2.66 mmol/day was associated with a diastolic BP difference of -1.02 mm Hg (P=0.02). There was a non-significant inversed association between ascorbic acid and BP in some multivariable regression models.Conclusion: Higher intake of Mg, including supplements, was associated with lower BP levels.
Early Recanalization in Patients With Cerebral Venous Thrombosis Treated With Anticoagulation
- Diana Aguiar de Sousa,
- Lia Lucas Neto,
- Antonio Arauz,
- Ana Luísa Sousa,
- Denis Gabriel,
- Manuel Correia,
- Raquel Gil-Gouveia,
- Sara Penas,
- Mariana Carvalho Dias,
- Manuel A. Correia,
- Marta Carvalho,
- Patrícia Canhão and
- José M. Ferro
Stroke Volume 51, Issue 41 April 2020

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Background and Purpose—The hypothesis that venous recanalization prevents progression of venous infarction is not established in patients with cerebral venous thrombosis (CVT). Evidence is also scarce on the association between residual symptoms, particularly headache, and the recanalization grade. We aimed to assess, in patients with CVT treated with standard anticoagulation, (1) the rate of early venous recanalization, (2) whether lack of early recanalization was predictor of parenchymal brain lesion progression, and (3) the prevalence and features of persistent headache according to the recanalization grade achieved.Methods—PRIORITy-CVT (Pathophysiology of Venous Infarction – Prediction of Infarction and Recanalization in CVT) was a multicenter, prospective, cohort study including patients with newly diagnosed CVT. Standardized magnetic resonance imaging was performed at inclusion (≤24 hours of therapeutic anticoagulation), days 8 and 90. Potential imaging predictors of recanalization were predefined and analyzed at each anatomical segment. Primary outcomes were rate of early recanalization and brain lesion progression at day 8. Secondary outcomes were headache (days 8 and 90) and functional outcome (modified Rankin Scale at days 8 and 90).Results—Sixty eight patients with CVT were included, of whom 30 (44%) had parenchymal lesions. At the early follow-up (n=63; 8±2 days), 68% (n=43) of patients had partial recanalization and 6% (n=4) full recanalization. Early recanalization was associated both with early regression (P=0.03) and lower risk of enlargement of nonhemorrhagic lesions (P=0.02). Lesions showing diffusion restriction (n=12) were fully reversible in 66% of cases, particularly in patients showing early venous recanalization. Evidence of new or enlarged hemorrhagic lesions, headache at days 8 and 90, and unfavorable functional outcome at days 8 and 90 were not significantly different in patients achieving recanalization.Conclusions—Venous recanalization started within the first 8 days of therapeutic anticoagulation in most patients with CVT and was associated with early regression of nonhemorrhagic lesions, including venous infarction. There was an association between persistent venous occlusion at day 8 and enlargement of nonhemorrhagic lesions.
A Role for Plasminogen Activator Inhibitor-1 in Obesity: From Pie to PAI?
- Marcelo L.G. Correia and
- William G. Haynes
Arteriosclerosis, Thrombosis, and Vascular Biology Volume 26, Issue 101 October 2006

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Preconditioning by Preceding Ischemic Cerebrovascular Events
- Pamela N. Correia,
- Ivo A. Meyer,
- Ashraf Eskandari,
- Michael Amiguet,
- Lorenz Hirt and
- Patrik Michel
Journal of the American Heart Association Volume 10, Issue 1617 August 2021

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BackgroundEmerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long‐term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome.Methods and ResultsData for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3‐month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24‐hour improvement was not significant and 3‐month outcome was unfavorable.ConclusionsPreceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long‐term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.
The effect of captopril on renal blood flow in renal artery stenosis assessed by positron tomography with rubidium-82.
- N Tamaki,
- N M Alpert,
- C A Rabito,
- M Barlai-Kovach,
- J A Correia and
- H W Strauss
Hypertension Volume 11, Issue 31 March 1988

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The sequence and magnitude of acute changes in renal blood flow following administration of captopril were determined in a canine model of acute unilateral renal artery stenosis using rubidium-82 and positron emission tomography. Data were recorded in each of nine dogs under three conditions: 1) during a baseline control interval, 2) during renal artery stenosis, and 3) during stenosis with intravenous injection of captopril (1.2 mg/kg). Mean arterial blood pressure was 108 +/- 12 mm Hg at control, increased significantly to 125 +/- 13 mm Hg (p less than 0.01) during stenosis, and decreased to 98 +/- 13 mm/Hg (p less than 0.01) after captopril infusion. Mean renal blood flow was calculated using a steady state single compartment model from the images produced by positron emission tomography. The estimated flow to the affected kidney was 3.37 +/- 1.48 ml/min/g at control, 0.86 +/- 0.62 ml/min/g during stenosis (p less than 0.01), and 0.64 +/- 0.57 ml/min/g after captopril administration (p = NS compared with precaptopril value). The estimated flow to the contralateral kidney was minimally reduced from a baseline of 3.84 +/- 0.95 to 3.24 +/- 1.13 ml/min/g (p = NS) during stenosis and increased after captopril infusion (4.08 +/- 0.94 ml/min/g; p = 0.01). These data suggest that repetitive imaging with positron emission tomography can be used to delineate acute changes in renal perfusion following captopril administration.
Abstract 17397: Cardiac Dysfunction Resulting From Therapeutic Inhibition of the Vascular Endothelial Growth Factor Signaling Pathway in Cancer Patients
- John D Groarke,
- Matthew McGuiness,
- Andrew Correia,
- Dan Tong,
- Jay Khambhati,
- Pranoti Hiremath,
- Anju Nohria,
- Toni K Choueiri,
- Scott Solomon,
- Javid Moslehi and
- Susan Cheng
Circulation Volume 128, Issue suppl_2226 November 2013

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Background: Inhibitors of the vascular endothelial growth factor signaling pathway (VSP) are increasingly used in cancer treatments. VSP inhibitor therapy is frequently associated with blood pressure (BP) elevation and, rarely, with new-onset cardiomyopathy and heart failure. The extent to which VSP inhibitor therapy may lead to asymptomatic changes in cardiac structure and function is unknown.Methods: 37 patients (aged 58.3±9.8 years, 76% men) with solid tumors (73% renal cell carcinoma) underwent ≥2 (2.6±0.8) serial echocardiograms before and after initiation of VSP inhibitor therapy. Multivariable longitudinal regression was used to determine change in LV measures during therapy.Results: At baseline, before starting VSP inhibitor therapy, all patients had normal measures of cardiac structure and function: LV mass (204±62 g), EF (64±8%), and average E’ (0.11±0.03 m/s). During the follow up period (52±35 weeks), BP increased from 131±14/79±11 mmHg to 142±16/89±13 mmHg (P<0.001). There were no significant changes in LV mass, wall thickness, EF, or conventional measures of diastolic function (Table ). However, changes in LV systolic function were detected based on measures of myocardial deformation, including worse global longitudinal and transverse strain, and paradoxically ‘better’ circumferential and radial strain rate (Table ).Conclusions: Patients started on VSP inhibitor therapy experience a decline in global longitudinal strain and a paradoxical improvement in circumferential strain. This pattern of altered LV function is similar to that described in hypertensive heart disease, despite the lack of concurrent change in LV mass or wall thickness. Further research is needed to investigate the mechanisms underlying these findings. These results also reinforce the need for close monitoring of cardiac function during VSP inhibitor therapy.
Leptin Acts in the Central Nervous System to Produce Dose-Dependent Changes in Arterial Pressure
- Marcelo L. G. Correia,
- Donald A. Morgan,
- William I. Sivitz,
- Allyn L. Mark and
- William G. Haynes
Hypertension Volume 37, Issue 31 March 2001

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Systemic leptin increases energy expenditure through sympathetic mechanisms, decreases appetite, and increases arterial pressure. We tested the hypothesis that the pressor action of leptin is mediated by the central nervous system. The interaction of dietary salt with leptin was also studied. Leptin was infused for 2 to 4 weeks into the third cerebral ventricle of Sprague-Dawley rats. Arterial pressure was measured by radiotelemetry. To control for the effects of leptin on body weight, vehicle-treated rats were pair-fed to the leptin group. Intracerebroventricular infusion of leptin at 200 ng/h in salt-depleted rats caused a reduction in food intake, weight loss, tachycardia, and decreased arterial pressure. Leptin at 1000 ng/h caused further reduction in food intake, weight loss, and tachycardia and prevented the hypotensive effect of weight loss observed in pair-fed, vehicle-treated animals. Intracerebroventricular leptin at 1000 ng/h in high-salt–fed rats also caused a sustained pressor response (+3±1 mm Hg), but high-salt intake did not potentiate the pressor effect of leptin. Intracerebroventricular leptin potentiated the pressor effect of air-jet stress. Intravenous administration of the same dose of leptin (1000 ng/h) did not change weight or arterial pressure, suggesting a direct central nervous system action. In contrast, a high dose of intravenous leptin (18 000 ng/h) caused weight loss and prevented the depressor effect of weight loss. In conclusion, this study demonstrates that high-dose leptin increases arterial pressure and heart rate through central neural mechanisms but leptin does not enhance salt sensitivity of arterial pressure. Leptin appears to oppose the depressor effect of weight loss.
Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke
- Ana Inês Martins,
- João Sargento-Freitas,
- Fernando Silva,
- Joana Jesus-Ribeiro,
- Inês Correia,
- João Pedro Gomes,
- Mariana Aguiar-Gonçalves,
- Leila Cardoso,
- Cristina Machado,
- Bruno Rodrigues,
- Gustavo C. Santo and
- Luís Cunha
Stroke Volume 47, Issue 61 June 2016

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Background and Purpose—Historical stroke cohorts reported a U- or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments.Methods—Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated. Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio–computed tomography. Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients.Results—We included 674 patients; mean age was 73.28 (SD, 11.50) years. Arterial recanalization was documented in 355 (52.70%) patients. In multivariate analyses, systolic BP and diastolic BP in the first 24 hours post stroke show a J-shaped relationship with functional outcome in the total population and in the nonrecanalyzed patients. Recanalyzed patients show a linear association with functional outcome (systolic BP: odds ratio, 1.015; 95% confidence interval, 1.007–1.024; P=0.001; R² change=0.001; P=0.412 and diastolic BP: odds ratio, 1.019; 95% confidence interval, 1.004–1.033; P=0.012; R² change<0.001; P=0.635).Conclusions—Systemic BP in the first 24 hours after ischemic stroke influences 3-month clinical outcome. This association is dependent on the revascularization status.
Role of Corticotrophin-Releasing Factor in Effects of Leptin on Sympathetic Nerve Activity and Arterial Pressure
Hypertension Volume 38, Issue 31 September 2001

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Leptin and corticotrophin-releasing factor increase sympathetic nervous activity to interscapular brown adipose tissue, kidneys, and adrenal glands. Leptin is known to increase hypothalamic corticotrophin-releasing factor. In this study, we tested the hypothesis that leptin-dependent increases in sympathetic nervous activity are mediated through increases in central nervous system corticotrophin-releasing factor activity. We examined the effects of intracerebroventricular administration of corticotrophin-releasing factor and intravenous leptin on sympathetic nervous activity to interscapular brown adipose tissue through multifiber neurography in anesthetized Sprague-Dawley rats pretreated with intracerebroventricular α-helical corticotrophin-releasing factor_9–41 (corticotrophin-releasing factor receptor antagonist) or vehicle. Centrally administered corticotrophin-releasing factor substantially increased interscapular brown adipose tissue sympathetic nervous activity. The responses to corticotrophin-releasing factor were substantially attenuated in animals pretreated with α-helical corticotrophin-releasing factor_9–41. Leptin-dependent increases in interscapular brown adipose tissue sympathetic nervous activity were significantly inhibited by pretreatment with α-helical corticotrophin-releasing factor_9–41. Interestingly, leptin also significantly increased arterial pressure over 6 hours, but this pressor action was not attenuated by the corticotrophin-releasing factor receptor antagonist. These results suggest that corticotrophin-releasing factor may mediate the sympathoexcitatory effect of leptin on thermogenic tissue without altering its cardiovascular actions.
Whole blood viscosity parameters and cerebral blood flow.
- J Grotta,
- R Ackerman,
- J Correia,
- G Fallick and
- J Chang
Stroke Volume 13, Issue 31 May 1982

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This report describes the statistical relationship of several whole blood viscosity parameters and cerebral blood flow (CBF) in 53 consecutive patients and normal controls. Significant correlations were present between CBF and serum fibrinogen (P = .05), hematocrit (P less than .05), and a relationship involving both fibrinogen and hematocrit (P less than .01). We conclude that heightened whole blood viscosity does correlate with decreased cerebral blood flow in the ranges measured in our patients, that both fibrinogen and hematocrit must be taken into consideration in viscosity determinations, and that changes in viscosity may have an important effect on CBF in regions of low flow.
Reversion of the Inflammatory Markers in Patients With Chronic Limb‐Threatening Ischemia
- Joana Ferreira,
- Susana Roque,
- Alexandre Lima Carneiro,
- Adhemar Longatto‐Filho,
- Isabel Vila,
- Cristina Cunha,
- Cristina Silva,
- Amílcar Mesquita,
- Jorge Cotter,
- Margarida Correia‐Neves,
- Armando Mansilha and
- Pedro Guimarães Cunha
Journal of the American Heart Association Volume 13, Issue 816 April 2024

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BackgroundPeripheral artery disease is characterized by an intense inflammatory process that can be associated with a higher mortality rate, particularly in chronic limb‐threatening ischemia (CLTI). This study aims to compare the evolution of inflammatory markers between patients with claudication with those with CLTI at 3, 6, and 12 months.Methods and ResultsAn observational, single‐center, and prospective study was conducted. A total of 119 patients with peripheral artery disease (65 with claudication and 54 with CLTI) were observed and inflammatory markers collected at admission and 3, 6, and 12 months. At admission, patients with CLTI, when compared with patients with claudication, had significantly higher serum levels of C‐reactive protein and fibrinogen (positive acute‐phase proteins) and lower serum level of albumin, total cholesterol, and high‐density lipoprotein (negative acute‐phase proteins): C‐reactive protein (g/dL), 2.90 (25th–75th percentile, 2.90–4.90) versus 6.80 (25th–75th percentile, 2.90–53.26) (P=0.000); fibrinogen (mg/dL), 293.00 (25th–75th percentile, 269.25–349.00) versus 415.50 (25th–75th percentile, 312.00–615.75) (P=0.000); total cholesterol (mg/dL), 161.79±95% [152.74–170.85] versus 146.42%±95% [135.30–157.53] (P=0.034); high‐density lipoprotein (mg/dL), 50.00 (25th–75th percentile, 41.00–60.00) versus 37.00 (25th–75th percentile, 30.00–45.50) (P=0.000); albumin (g/dL): 4.00 (25th–75th percentile, 3.70–4.20) versus 3.60 (25th–75th percentile, 3.10–4.00) (P=0.003). The association between CLTI and total cholesterol was lost after adjusting for confounders. Three months after the resolution of the CLTI, there was an increase in the levels of negative acute‐phase proteins and a decrease in positive acute‐phase proteins. These inflammatory proteins did not register an evolution in patients with claudication. The differences in the inflammatory proteins between groups disappeared at 6 months.ConclusionsCLTI has an inflammatory environment that can be partially reverted after resolution of the ischemic process, emphasizing the importance of timely intervention.
Obesity-Induced Hypertension : New Concepts From the Emerging Biology of Obesity
- Allyn L. Mark,
- Marcelo Correia,
- Donald A. Morgan,
- Richard A. Shaffer and
- William G. Haynes
Hypertension Volume 33, Issue 11 January 1999

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Abstract—Obesity is associated with an increased risk of hypertension. In the past 5 years there have been dramatic advances into the genetic and neurobiological mechanisms of obesity with the discovery of leptin and novel neuropeptide pathways regulating appetite and metabolism. In this brief review, we argue that these mounting advances into the neurobiology of obesity have and will continue to provide new insights into the regulation of arterial pressure in obesity. We focus our comments on the sympathetic, vascular, and renal mechanisms of leptin and melanocortin receptor agonists and on the regulation of arterial pressure in rodent models of genetic obesity. We suggest 3 concepts. First, the effect of obesity on blood pressure may depend critically on the genetic-neurobiological mechanisms underlying the obesity. Second, obesity is not consistently associated with increased blood pressure, at least in rodent models. Third, the blood pressure response to obesity may be critically influenced by modifying alleles in the genetic background.
Abstract 19678: Anderson-Fabry Disease in Patients With Hypertrophic Cardiomiopathy: Differential Diagnosis
Circulation Volume 134, Issue suppl_111 November 2016

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Introduction: Anderson-Fabry disease (AFD) is a rare pathology which is inherited by the X chromosome. It is caused by mutations of the gene that encodes the α-galactosidase A lysosomal enzyme. It is associated with multisystemic disorders, including renal, cutaneous, neurological and cardiac manifestations. The isolated cardiac form is even rarer, with few reports in the literature. The differential diagnosis with Hypertrophic Cardiomyopathy (HC) is hard, although it is essential because AFD has a specific treatment.Hypothesis: We assessed the prevalence of AFD and the factors related to its diagnosis in patients initially diagnosed with HC.Methods: We randomly selected a cohort of 106 patients with an initial diagnosis of HC, and applied genetic and/or enzymatic testing for AFD, during the period of January 2013 to January 2016. All patients had only cardiac manifestations. We assigned patients into 2 groups (positive Vs. negative test for AFD) and evaluated them clinically, demographically, echocardiographically and electrocardiographically. Univariate analyzes were performed using the chi-square and Fisher tests.Results: Three patients presented positive genetic and/or enzymatic testing for AFD (2.8%). The presence of three or more risk factors for sudden death (SD) was a significant factor for the diagnosis of AFD (p = 0.001) as well as the indication of Implantable Cardioverter Defibrillator (ICD) (p = 0.017), right anterior fascicular block (RAFB) in the electrocardiogram (p = 0.047), septal thickness > 25mm (p=0.04) and left ventricular mass (LVM) > 400g (p =0.022). The diagnosis of AFD was not correlated statistically to gender, race, thickness of the LV posterior wall, but there was a trend for association with left atrial enlargement (p = 0.055) and SD in relatives under 40 years old (p = 0.074).Conclusions: The differential diagnosis of HC and AFD can be done by considering factors such as: septal thickness > 25 mm, the presence of three or more risk factors for SD, LVM > 400 g, indication of ICD and RAFB in the electrocardiogram, which in this study were statistically associated with the diagnosis of AFD. The prevalence of AFD in a random cohort of patients initially diagnosed with MH was similar to that found in other studies in the literature (2.8%).
A new ECG classification system for myocardial infarction based on receiver operating characteristic curve analysis and information theory.
- C Abreu-Lima,
- D M Correia,
- J Almeida,
- M Antunes-Lopes and
- M Cerqueira-Gomes
Circulation Volume 67, Issue 61 June 1983

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An optimized three-lead ECG hierarchial decision-tree type of classification system for myocardial infarction is presented. For selection of the best threshold values for each criterion and the best association of features, we developed a procedure based on "receiver operating characteristic" (ROC) curve data analysis and information theory. Optimization was obtained through maximization of information content of the criteria. The classifier is based on nine measurements that can be easily obtained by hand (QX duration, Q/R Y amplitude, R Y amplitude, Q/R Y duration, Q Z amplitude, QRS and T axes in the horizontal plane, Q Z duration and R Z amplitude) and achieved a satisfactory performance in an independent group of patients (true-positive ratio 0.853, false-positive ratio 0.105, average information content 0.308 bits).
Abstract 18744: Time Trends in the Population Attributable Risk for Cardiovascular Disease: Atherosclerosis Risk in Communities Study
- Susan Cheng,
- Brian Claggett,
- Andrew Correia,
- Amil Shah,
- Deepak Gupta,
- Hicham Skali,
- Hanyu Ni,
- Josef Coresh and
- Scott Solomon
Circulation Volume 128, Issue suppl_2226 November 2013

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BACKGROUND: Traditional cardiovascular disease (CVD) risk factors remain widely prevalent in the community. Whether relative contributions of risk factors to incident CVD may have changed over time, in the population at large or in important subgroups, is unclear.METHODS: We studied 13,541 participants (56% women, 26% black) in the Atherosclerosis Risk in Communities Study who were aged 52-66 years and free of CVD at visits 1 (1987-1989), 2 (1990-1992), 3 (1993-1995), or 4 (1996-1998). In this middle-aged sample at each visit, and in sex- and race-stratified analyses, we estimated multivariable-adjusted population attributable risks (PAR) for the 10-year incidence of new-onset CVD.RESULTS: Overall, the contributions of smoking (PAR 0.15 [95% CI 0.12-0.17] to 0.12 [0.10-0.14], P=0.05) and dyslipidemia (0.18 [0.10-0.24] to 0.09 [0.03-0.16], P=0.085) to CVD risk appeared to decrease from visit 1 to visit 4; the contributions of obesity (P=0.79), hypertension (P=0.70), and diabetes (P=0.28) were unchanged. The contribution of all risk factors combined was higher in women than men at visit 1 (P<0.001) but not by visit 4 (P=0.11) (Figure). The contribution of all risk factors combined appeared higher in blacks than whites at visit 1 (P=0.06) and this difference was more pronounced by visit 4 (P=0.02). Differences by sex (P=0.051) and race (P=0.089) in the contribution of hypertension to CVD risk had decreased and were borderline significant by visit 4. However, the contribution of diabetes remained substantially higher in women than men (P<0.001) and in blacks than whites (P<0.001) by visit 4.CONCLUSION: The contribution to incident CVD of all traditional risk factors combined is greater in blacks than whites, and this difference may be increasing. The CVD risks attributable to hypertension and diabetes have remained especially high, in women as well as blacks, highlighting the need for continued targeted risk factor modification particularly in these subgroups.
Transient Ischemic Attacks in Rural and Urban Northern Portugal: Incidence and Short-Term Prognosis
- Manuel Correia,
- Mário R. Silva,
- Rui Magalhães,
- Laura Guimarães and
- M. Carolina Silva
Stroke Volume 37, Issue 11 January 2006

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Background and Purpose— There are no community-based studies on the incidence of transient ischemic attacks (TIAs) in Portugal. This study was designed to determine TIA incidence and the risk of stroke occurrence in rural and urban populations in northern Portugal.Methods— All suspected first-ever TIAs occurring between October 1998 and September 2000 in 18 677 residents in a rural municipality and 86 023 living in the city of Porto were entered into a population-based registry. Standard definitions and comprehensive sources of information were used for identification of patients who were followed up at 3 and 12 months after the TIA.Results— During a 24-month period, 141 patients with a first-ever TIA were registered, 36 in rural and 104 in urban areas. The vascular territory was carotid in 66.7% of the patients, vertebrobasilar in 29.1%, and undetermined in 4.3%. The overall crude annual incidence rate per 1000 was 0.67 (95% CI, 0.45 to 1.04), 0.61 (95% CI, 0.38 to 1.01) for rural, and 0.96 (95% CI, 0.43 to 2.33) for urban populations. The risk of stroke within the first 7 days of the index event was 12.8% (95% CI, 7.3 to 18.3), reaching 21.4% (95% CI, 14.6 to 28.1) at 1 year. Three factors were associated with stroke occurrence within 120 days after TIA: patients’ age ≥65 years and an episode in the carotid distribution lasting ≥3 hours.Conclusions— The incidence of TIA in northern Portugal, particularly in rural populations, ranks among the highest reported in community-based studies, following closely the stroke incidence trend (ACINrpc). Early recognition of TIA by patients and physicians is crucial for effective stroke prevention.
Positron imaging of cerebral blood flow during continuous inhalation of C15O2.
- R H Ackerman,
- R Subramanyam,
- J A Correia,
- N M Alpert and
- J M Taveras
Stroke Volume 11, Issue 11 January 1980

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This investigation tests the hypothesis that the normal cerebral image obtained non-invasively during continuous inhalation of C15O2 is related to cerebral blood flow. Trace amounts of CO2 labeled with the positron-emitting radionuclide 15O were administered to 4 normal subjects at normo- and hypocapnia and to 2 of these subjects at hypercapnia. Hypocapnia typically caused a marked decrease in cerebral 15O activity, and hypercapnia a small increase in activity. The relative difference in the change in count rate in response to hypo- and hypercapnia is what one would expect if the activity represented bloow flow, according to a mathematical model which assumes the 15O label enters the brain as water of perfusion. The findings in this study suggest that the normal cerebral image obtained during continuous inhalation of C15O2 is related to cerebral blood flow, but in a non-linear fashion, and that the technique would be more sensitive to ischemic events than to hyperemic phenomena.
Abstract 19648: Post-exercise Blood Pressure Following Different Resistance Training Methods in Treated Older Hypertensive Women
- Ana Luiza M Correia,
- Rafael Gauche,
- André B Gadelha,
- Flávio M Paiva,
- Sílvia G Neri and
- Ricardo M Lima
Circulation Volume 132, Issue suppl_310 November 2015

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Introduction: The purpose of this study was to examine post-exercise blood pressure following different resistance training methods in treated older hypertensive women.Methods: The sample consisted of 14 female volunteers with controlled hypertension (age 69.86 ± 5.67 years, weight 59.31 ± 9.77 kg, height 1.52 ± 0.06 m, BMI 25.76 ± 4.44 kg/m2) who attended six Laboratory visits. The first four visits aimed at collecting anthropometric data, familiarization and determining the training load. In the fifth and sixth visits, volunteers performed a traditional resistance exercise method (TRE) and a circuit resistance exercise method (CRE), in a randomized order. The sessions were separated by at least 48 hours, involved the following exercises: leg press, seated row, knee extension, bench press, knee flexion, lateral raise with dumbbells and seated calf raises. In TRE, the exercises were performed in three sets of 12 repetitions with an interval of 60 seconds between sets and exercises. In the CRE, the exercises were performed in circuit, with 3 rounds of 12 repetitions with 30 seconds rest between exercises and 60 seconds between rounds. The intensity was adjusted corresponding to the level 4 of the scale of perceived exertion to resistance exercise. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at rest, 15, 30, 45 and 60 minutes after the exercise sessions. Mean blood pressure (MBP) was calculated. Data normality was verified with the Shapiro-Wilk test. ANOVA for repeated measures (time X method) was used for data analysis. Significance was set at p <0.05.Results: Although mean SBP values were reduced following exercise, no significant effects of time, methods or time X method interaction were noted in SBP, DBP and MBP.Conclusions: Both resistance training methods, on intensity corresponding to the level 4 of perceived exertion scale, were not able to significantly alter the blood pressure of treated older hypertensive women
Abstract P362: Left Atrial Dimension and Global Cardiovascular Framingham 10 Year Risk Score Predicting 20-year Clinical Cardiovascular Events in Young Healthy Adults: The CARDIA Study
- Anderson C Armstrong,
- Kiang Liu,
- Cora E Lewis,
- Stephen Sidney,
- Laura Colangelo,
- Satoru Kishi,
- Bharath Ambale,
- David Jacobs,
- Luis C Correia,
- Samuel S Gidding and
- Joao A Lima
Circulation Volume 127, Issue suppl_1226 March 2013

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OBJECTIVE An enlarged left atrial dimension (LAD) is associated with incident cardiovascular (CV) outcomes. However, the incremental value of LAD over Framingham risk score (FRS) in young adults is unclear. We investigate whether adding information about LAD would improve CV risk prediction in young adults beyond the FRS.METHODS The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled 5115 African-American and White adults from 4 US centers in 1985-1986. CARDIA year-5 exam was defined as baseline, when the cohort underwent first echocardiography assessment. Participants were divided in low, intermediate, and high risk groups for FRS <2.5%, 2.5-15%, and >15%, respectively. LAD was assessed by M-mode echocardiography and indexed by height (LADi). The combined endpoint of the first CV outcome included: cardiovascular death, or nonfatal heart failure, myocardial infarction, or stroke. We assessed calibration and discrimination, as well as global and stratified net reclassification improvement (NRI) for adding LADi to FRS.RESULTS A total of 4082 participants were included; aged 30±4 years, 46% males, and 52% White. The mean±SD value of LADi was 2.07±0.27 mm/m. 123 participants (3%) had outcomes over the following 20 years. Event incidence across FRS low, intermediate, and high risk groups was 1.3%, 5.3%, and 22.4%; changing to 1.08%, 5.56%, and 22.67% with the addition of LADi to FRS categories. Adjusted for FRS, the hazard ratio for each 1 SD increase in LADi predicting outcomes was 1.27 (95% confidence interval: 1.07, 1.51). Adding LADi modestly increased the area under the ROC curve compared to FRS alone (0.759 to 0.772, p = 0.04). NRI showed improvement by adding LADi to the FRS, particularly in the low and intermediate risk groups (Table).CONCLUSION In young adults, the FRS is a robust CV risk marker based on clinical parameters. LAD, as an early marker of increased ventricular filling pressures, may add relevant information to FRS predicting CV outcomes.

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