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1.
BMC Pulm Med ; 24(1): 550, 2024 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-39482616

RESUMO

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), the clinical use of the minute ventilation-carbon dioxide production ([Formula: see text]E-[Formula: see text]CO2) slope has been reported as a measure of exercise efficiency, but the oxygen uptake efficiency slope (OUES), i.e., the slope of oxygen uptake ([Formula: see text]O2) versus the logarithmically transformed [Formula: see text]E, has rarely been reported. METHODS: We hypothesized that the [Formula: see text]E-[Formula: see text]CO2 slope is more useful than OUES in clinical use for the pathophysiological evaluation of COPD. Then, we investigated the cardiopulmonary exercise testing parameters affecting each of these slopes in 122 patients with all Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD grades selected from our database. RESULTS: Compared with the GOLD I-II group (n = 51), peak [Formula: see text]O2 (p < 0.0001), OUES (p = 0.0161), [Formula: see text]E at peak exercise (p < 0.0001), and percutaneous oxygen saturation (SpO2) at peak exercise (p = 0.0004) were significantly lower in the GOLD III-IV group (n = 71). The GOLD III-IV group was divided into two groups by the exertional decrease in SpO2 from rest to peak exercise: 3% or less (the non-desaturation group: n = 23), or greater than 3% (the desaturation group: n = 48). OUES correlated only weakly with peak [Formula: see text]O2, [Formula: see text]E at peak exercise, and the difference between inspired and expired mean O2 concentrations (ΔFO2) at peak exercise, i.e., an indicator of oxygen consumption ability throughout the body, in the GOLD III-IV group with exertional hypoxemia. In contrast, the [Formula: see text]E-[Formula: see text]CO2 slope was significantly correlated with ΔFO2 at peak exercise, regardless of the COPD grade and exertional desaturation. Across all COPD stages, there was no correlation between the [Formula: see text]E-[Formula: see text]CO2 slope and [Formula: see text]E at peak exercise, and stepwise analysis identified peak [Formula: see text]O2 (p = 0.0345) and ΔFO2 (p < 0.0001) as variables with a greater effect on the [Formula: see text]E-[Formula: see text]CO2 slope. CONCLUSIONS: The OUES may be less useful in advanced COPD with exertional hypoxemia. The [Formula: see text]E-[Formula: see text]CO2 slope, which is independent of [Formula: see text]E, focuses on oxygen consumption ability and exercise tolerance in COPD, regardless of the exertional hypoxemia level and COPD grade. Therefore, the [Formula: see text]E-[Formula: see text]CO2 slope might be useful in establishing or evaluating tailor-made therapies for individual patient's pathologies in COPD as an indicator focusing on oxygen consumption ability.


Assuntos
Teste de Esforço , Tolerância ao Exercício , Consumo de Oxigênio , Doença Pulmonar Obstrutiva Crônica , Troca Gasosa Pulmonar , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Tolerância ao Exercício/fisiologia , Masculino , Idoso , Feminino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Dióxido de Carbono/metabolismo , Oxigênio/metabolismo , Estudos Retrospectivos
2.
Circ Rep ; 6(10): 430-440, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39391548

RESUMO

Background: Inspiratory muscle training (IMT) is supported for outpatients with stable chronic heart failure, but its efficacy in hospitalized patients with acute decompensated heart failure (ADHF) remains unclear. The aim of the present study was to clarify IMT efficacy and safety in hospitalized ADHF patients. Methods and Results: Patients with inspiratory muscle weakness who underwent cardiac rehabilitation (CR) were analyzed. The control group was historical control data of patients admitted to the same facility. IMT was performed at 30% maximal inspiratory mouth pressure (15 reps/set, 2 sets/day, 5 times/week) with usual CR. Associations between IMT and changes in the 2-min walking distance (2MWD) were assessed using a linear mixed model. In total, 31 and 29 patients in the IMT and control groups (median age 83 [71-88] vs. 86 [77-88] years), respectively, were analyzed. After adjustment for covariates and propensity scores, calculated on the basis of heart-failure severity, frailty, physical function, nutritional status, and inspiratory muscle strength, the 2MWD was significantly higher in the IMT group than in the control group (F=4.697; P=0.035; ∆2MWD; +31.9 vs. +16.3 m). Among 348 IMT sessions, no adverse cardiovascular events or absolute termination criteria were identified. Eleven (3.2%) IMT sessions met relative termination criteria. Conclusions: Adding IMT to usual CR improves the 2MWD, can be safely performed in hospitalized patients with ADHF, and may represent a novel CR approach in patients with ADHF.

3.
Cureus ; 16(9): e69224, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39398827

RESUMO

Cardiac rehabilitation (CR) is a structured intervention aimed at improving the clinical outcomes for patients with coronary artery disease (CAD). This systematic review assesses how well different types of CR, such as high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), Nordic walking (NW), and home-based cardiac rehabilitation (HBCR), improve exercise capacity, quality of life, and lower death and illness rates. The objective is to assess the effectiveness of cardiovascular rehabilitation programs in enhancing clinical outcomes for patients diagnosed with CAD. A comprehensive literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model across Google Scholar, EMBASE, PubMed, Medline, and web browsers. Keywords such as "cardiac rehabilitation," "coronary artery disease," "exercise testing," "VO2 peak," and "physical activity" were used in different combinations. Studies were included if they were randomized controlled trials, observational studies, or longitudinal studies published after 2013 in English, with a focus on the impact of CR on CAD. Articles were excluded if they were reviews, meta-analyses, or did not meet the keyword requirements. A total of 375 articles were initially identified with relevant citations. After further screening, 10 studies met the inclusion criteria for analysis. The studies reviewed demonstrated that all forms of CR, including HIIT, MICT, NW, and HBCR, significantly improved exercise capacity and quality of life, and reduced depression severity among CAD patients. Nordic walking showed marked improvements in functional capacity, while HIIT resulted in higher VO2 peak levels compared to moderate-intensity exercise. Home-based CR showed greater adherence rates, especially among older patients and those with strong family support. The results also highlighted the importance of individualized exercise programs to enhance adherence and outcomes. Cardiac rehabilitation is a vital component of secondary prevention in CAD patients, significantly improving clinical outcomes, including exercise capacity, quality of life, and mortality rates. The findings underscore the importance of maintaining and expanding access to CR programs and tailoring interventions to patient needs to optimize long-term health outcomes. Future research should explore the comparative effectiveness of different CR modalities and strategies to increase patient adherence.

4.
Chest ; 2024 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-39427705

RESUMO

BACKGROUND: Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD). STUDY QUESTION: What is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting? STUDY DESIGN AND METHODS: Medical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR). RESULTS: A total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (ß=0.154; P=0.004). INTERPRETATION: STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.

5.
Int J Cardiol ; : 132668, 2024 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-39442760

RESUMO

BACKGROUND: We studied the prognostic value of exercise tolerance and exercise-associated diastolic dysfunction (Ex-DD) in elderly patients referred for exercise stress echocardiography (ExE). METHODS: A total of 674 patients ≥60 years who underwent ExE using the Bruce protocol between January 2017 and December 2020 were included in this study. The prognostic factors examined were exercise tolerance, quantified in metabolic equivalents of tasks (METs), and Ex-DD. Patients were followed for a composite endpoint of all-cause death and cardiovascular hospitalization. RESULTS: 122 (18 %) patients had Ex-DD and had a higher incidence of the combined outcome (23 [19 %] vs. 47 [9 %], p = 0.001) compared to patients without Ex-DD. Patients were classified into the following groups: group A (no Ex-DD and METs≥8.5), group B (either Ex-DD or METs<8.5), and group C (both Ex-DD and METs<8.5). Group B did not show higher mortality (HR: 1.6, p = 0.475) or cardiovascular hospitalization (HR: 1.8, p = 0.08) compared to group A, but showed an increased risk for the combined outcome (HR: 1.9, p = 0.038). Group C was associated with higher mortality (HR: 4.8, p = 0.032), cardiovascular hospitalization (HR: 3.9, p < 0.001), and the combined outcome (HR: 4.0, p < 0.001) compared to group A. CONCLUSIONS: Decreased exercise capacity and Ex-DD were associated with poor outcomes, especially when both findings were present.

6.
Biosensors (Basel) ; 14(10)2024 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-39451691

RESUMO

Introduction: Due to the possible impact of the thermoregulatory process on sports performance, it is necessary to explore the existing relationships between kinetic, mechanical, and physiological variables. The objective of this study was to evaluate metabolic stress using thermography in the lower limb after the Spanish Championship 2023 walk. Method: A descriptive study was carried out on national and international race walkers before and after the 2023 Spanish Championships. The participants performed different tests within the same circuit. Five walkers completed the long-distance race of 35 km, four walkers completed the middle-distance race of 20 km and finally, two walkers completed the short-distance race of 10 km. Result: Statistically significant changes were observed in the lower limbs of the walkers after completing the test. We observed a decrease in skin temperature in all the anatomical regions analyzed, except for the back of the leg. More specifically, the decrease was in the hip (-1.92 °C: p = 0.004), quadriceps, hamstrings (-1.23 °C: p = 0.002), and tibia (-1.23 °C: p = 0.030). However, in the posterior region of the leg, a significant increase in temperature was observed (+0.50 °C: p = 0.011) following the competition. Discussion and Conclusions: The findings in this descriptive investigation support the notion that thermography may serve as a useful tool in the acute analysis of muscle functional activation and metabolic response in professional marching athletes. Moreover, the results confirmed that the change in skin temperature is the result of a variation in acute metabolic and functional activation in the lower extremities of race walkers during competition, with infrared thermography representing an instrument capable of detecting such a change in a rapid and non-invasive manner.


Assuntos
Estresse Fisiológico , Termografia , Caminhada , Humanos , Caminhada/fisiologia , Masculino , Adulto , Temperatura Cutânea/fisiologia , Extremidade Inferior
8.
Antioxidants (Basel) ; 13(9)2024 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-39334806

RESUMO

Black ginger (Kaempferia parviflora) extract (KPE) is extracted from a ginger family plant grown in Thailand. The polyphenolic components have potential antioxidant effects and have been reported to enhance exercise performance. However, the impact of long-term KPE administration combined with long-term training on the endurance exercise performance of healthy individuals has not been fully studied. In this study, a healthy mouse model was used to investigate the effects of 8 weeks KPE administration and voluntary wheel running on the submaximal endurance exercise capacity and its mechanism. The results showed that 8 weeks of KPE administration significantly enhanced the submaximal endurance exercise capacity of mice and extended the daily voluntary wheel running distance. By measuring oxidative stress markers in plasma and the mRNA expression of antioxidant genes in skeletal muscle, we found that KPE significantly increased plasma antioxidant levels and activated the Nrf2 (Nuclear factor erythroid 2-related factor 2)/ARE (Antioxidant Response Element) pathway and its downstream antioxidant genes expression in skeletal muscle. These results suggest that KPE may enhance the antioxidant capacity of plasma and skeletal muscle by activating the Nrf2-ARE-centered antioxidant pathway, thereby increasing the daily running distance and improving the submaximal endurance exercise capacity of mice.

9.
Respir Med ; 234: 107816, 2024 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-39321999

RESUMO

BACKGROUND: Pulmonary rehabilitation (PR) guidelines support the efficacy and safety of supervised exercise training in mild-moderate pulmonary arterial hypertension (PAH). However, the exercise training response and safety of PR in PAH lung transplant (LTx) candidates has not been described. OBJECTIVES: (1) characterize the clinical characteristics and illness trajectory of adult patients with severe PAH listed for LTx and participating in PR; (2) evaluate the change in exercise capacity, aerobic and resistance training volumes; (3) assess PR safety. METHODS: Single-centre retrospective cohort study of PAH LTx candidates listed January 2014-December 2018 attending a supervised, facility-based outpatient program three times per week. Functional capacity was evaluated using 6-min walk distance (6MWD). Aerobic and muscle training volumes were evaluated with paired comparisons. RESULTS: 40 PAH LTx candidates (age 50 ± 12 years, 73% females, mean pulmonary artery pressure 53 ± 16 mmHg) were included. The median listing duration was 91 [IQR 43-232] days. Sixteen patients (40%) had ≥1 admission pre-transplant. Nine patients (56%) were discharged home and resumed outpatient PR. Baseline 6MWD was 330 ± 119 metres (n = 40) with the final 6MWD pre-LTx increasing by 18 metres 95% CI (-18 to 56), p-value = 0.31, n = 25) over a median duration of 225 [IQR 70-311] days. Modest gains were observed in aerobic and resistance training volumes in PR with no adverse safety events. CONCLUSION: Despite progressive and severe disease in PAH LTx candidates, patients safely participated in PR and maintained exercise capacity. Given frequent admissions, physiotherapy during hospitalization should focus on preserving functional capacity and facilitating re-integration into outpatient PR post-discharge.

10.
Sci Rep ; 14(1): 22505, 2024 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-39341902

RESUMO

This study aims to (1) compare the kinetics of pulmonary oxygen uptake (VO2p), skeletal muscle deoxygenation ([HHb]), and microvascular O2 delivery (QO2mv) between heart failure (HF) patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF), and (2) explore the correlation between body composition, kinetic parameters, and exercise performance. Twenty-one patients (10 HFpEF and 11 HFrEF) underwent cardiopulmonary exercise testing to assess VO2 kinetics, with near-infrared spectroscopy (NIRS) employed to measure [HHb]. Microvascular O2 delivery (QO2mv) was calculated using the Fick principle. Dual-energy X-ray absorptiometry (DEXA) was performed to evaluate body composition. HFrEF patients exhibited significantly slower VO2 kinetics (time constant [t]: 63 ± 10.8 s vs. 45.4 ± 7.9 s; P < 0.05) and quicker [HHb] response (t: 12.4 ± 9.9 s vs. 25 ± 11.6 s; P < 0.05). Microvascular O2 delivery (QO2mv) was higher in HFrEF patients (3.6 ± 1.2 vs. 1.7 ± 0.8; P < 0.05), who also experienced shorter time to exercise intolerance (281.6 ± 84 s vs. 405.3 ± 96 s; P < 0.05). Correlation analyses revealed a significant negative relationship between time to exercise and both QO2mv (ρ= -0.51; P < 0.05) and VO2 kinetics (ρ= -0.63). Body adiposity was negatively correlated with [HHb] amplitude (ρ= -0.78) and peak VO2 (ρ= -0.54), while a positive correlation was observed between lean muscle percentage, [HHb] amplitude, and tau (ρ= 0.74 and 0.57; P < 0.05), respectively. HFrEF patients demonstrate more severely impaired VO2p kinetics, skeletal muscle deoxygenation, and microvascular O2 delivery compared to HFpEF patients, indicating compromised peripheral function. Additionally, increased adiposity and reduced lean mass are linked to decreased oxygen diffusion capacity and impaired oxygen uptake kinetics in HFrEF patients.


Assuntos
Composição Corporal , Tolerância ao Exercício , Insuficiência Cardíaca , Consumo de Oxigênio , Oxigênio , Volume Sistólico , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/metabolismo , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Oxigênio/metabolismo , Cinética , Teste de Esforço , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatologia
12.
Int J Cardiol Heart Vasc ; 53: 101442, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39228972

RESUMO

Background: In Japan, the number of very elderly individuals with heart failure (HF) is on the rise. One indicator of HF stage progression is a decrease in exercise tolerance (ET). While peak oxygen uptake (peak VO2) determined by cardiopulmonary exercise testing (CPX) is the gold standard for ET assessment, the wide-scale applicability of CPX is constrained owing to expensive equipment and challenges in this population. The 30-second chair stand test (CS30), a simple and quick alternative, is widely used among community-dwelling elderly individuals. The objective of this study was to investigate whether CS30 is a predictor of ET in elderly individuals with stage A/B HF. Methods: Of 748 outpatients aged 75 years and over who visited our center between March 2021 and December 2022, 493 patients (296 males and 197 females) were included in this study. CS30 was measured using a seat height of 40 cm, and peak VO2 was assessed using CPX. Results: The findings showed a statistically significant positive association between CS30 and peak VO2 for both males and females (males: ß = 0.255, 95 % CI = 0.102-0.407; females: ß = 0.282, 95 % CI = 0.043-0.521). Receiver operating characteristic (ROC) analyses showed moderate accuracy of CS30 in predicting low ET in both sexes (males AUC = 0.740, 95 % CI = 0.640-0.841, p < 0.001; females AUC = 0.725, 95 % CI = 0.644-0.807, p < 0.001). The cut-off values of CS30 were established as 18 times for males and 16 times for females. Conclusions: CS30 is a potentially convenient method for estimating current ET in older adults, providing a feasible alternative to CPX.

13.
J Extra Corpor Technol ; 56(3): 128-135, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39303136

RESUMO

INTRODUCTION: Ventricular assist devices represent a treatment option for patients with advanced heart failure, offering control over various haemodynamic variables. Similarly, the prescription of exercise within a cardiac rehabilitation programme for heart failure patients is recommended to reduce symptoms, and hospitalisations, improve cardiorespiratory fitness, and increase exercise tolerance. Therefore, exercise prescription can impact those with ventricular assist devices. Given the limited evidence on exercise-based cardiac rehabilitation programmes for this population, this review aims to describe the most commonly used strategies and their health benefits when physical exercise is included in a cardiac rehabilitation programme for patients with ventricular assist devices. MATERIALS AND METHODS: An exploratory review was conducted through searches in the databases: PubMed, SCOPUS, PeDro, and ScienceDirect. The search was limited to studies published between 2013 and 2023. Filters were applied independently by title, abstract, and full text. The included articles were analysed based on the description of the types of cardiac rehabilitation strategies used in patients with ventricular assist devices. RESULTS: Seven articles were included. Each programme employed a cardiopulmonary exercise test before prescribing physical exercise. The most commonly used strategy was aerobic exercise, predominantly high-intensity interval training (HIIT) with intensities close to 90% of peak VO2, followed by continuous moderate-intensity exercise. Limb strength exercises were included in three programmes. CONCLUSIONS: The analysed literature suggests that cardiac rehabilitation in patients with ventricular assist devices is safe and can provide benefits in cardiorespiratory fitness and exercise tolerance. High-intensity interval training is identified as an appropriate strategy for achieving results, offering short-term improvements.


Assuntos
Reabilitação Cardíaca , Terapia por Exercício , Insuficiência Cardíaca , Coração Auxiliar , Humanos , Reabilitação Cardíaca/métodos , Terapia por Exercício/métodos , Terapia por Exercício/instrumentação , Insuficiência Cardíaca/reabilitação , Tolerância ao Exercício
14.
World J Transplant ; 14(3): 91637, 2024 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-39295971

RESUMO

Heart transplantation (HT), the treatment choice of advanced heart failure patients, is proven effective in increasing the survival and functional status of the recipients. However, compared to normal controls, functional status is lower in HT recipients. Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake (VO2 peak) and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits. Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular, pulmonary, exercise capacity, psychological, and quality of life (QoL) problems. High-intensity interval training (HIIT) is the most common type of exercise used in HT recipients and given as a hospital-based program. Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations. In general, exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups. Improvement of QoL was ascribed to improvement of exercise capacity, symptoms, pulmonary function, physical capacity improvement, anxiety, and depression.

16.
Rev Cardiovasc Med ; 25(7): 247, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39139420

RESUMO

Background: Cardiopulmonary exercise testing (CPET) assesses exercise capacity and causes of exercise limitation in patients with pulmonary hypertension (PH). At altitude, changes occur in the ventilatory pattern and a decrease in arterial oxygen pressure in healthy; these changes are increased in patients with cardiopulmonary disease. Our objective was to compare the response to exercise and gas exchange between patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) residing at the altitude of Bogotá (2640 m). Methods: All patients performed an incremental CPET with measurement of oxygen consumption ( VO 2 ), dead space (VD/VT), ventilatory equivalents (VE/ VCO 2 ), and alveolar-arterial oxygen gradient ( PA-aO 2 ). X 2 test and one-way analysis of variance were used for comparisons between PAH and CTEPH. Results: We included 53 patients, 29 with PAH, 24 with CTEPH, and 102 controls as a reference of the normal response to exercise at altitude. CTEPH patients had a higher New York Health Association (NYHA) functional class than PAH (p = 0.037). There were no differences between patients with PAH and CTEPH in hemodynamics and VO 2 % of predicted (67.8 ± 18.7 vs. 66.0 ± 19.8, p < 0.05), but those with CTEPH had higher dyspnea, VD/VT (0.36 ± 0.09 vs. 0.23 ± 0.9, p < 0.001), VE/ VCO 2 (45.8 ± 7.1 vs. 39.3 ± 5.6, p < 0.001), and PA-aO 2 (19.9 ± 7.6 vs. 13.5 ± 7.6, p < 0.001) than PAH patients. Conclusions: At altitude, patients with PH present severe alterations in gas exchange during exercise. There were no differences in exercise capacity between PAH and CTEPH, but patients with CTEPH had more dyspnea and greater alterations in gas exchange during exercise. CPET made it possible to identify alterations related to the pathophysiology of CTEPH that could explain the functional class and dyspnea in these patients.

17.
Circ Cardiovasc Imaging ; 17(8): e016549, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39163369

RESUMO

BACKGROUND: Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes. METHODS: Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography. RESULTS: Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, P=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; P=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (P<0.001 and P=0.022) and booster pump strain (P=0.011 and 0.028) at rest and during exercise, respectively. CONCLUSIONS: Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.


Assuntos
Função do Átrio Esquerdo , Ecocardiografia sob Estresse , Tolerância ao Exercício , Átrios do Coração , Insuficiência Cardíaca , Volume Sistólico , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Masculino , Feminino , Volume Sistólico/fisiologia , Pessoa de Meia-Idade , Idoso , Ecocardiografia sob Estresse/métodos , Átrios do Coração/fisiopatologia , Átrios do Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Teste de Esforço
18.
Bioorg Med Chem ; 111: 117845, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39059249

RESUMO

SR9009 is an activator of REV-ERBs with diverse biological activities, including improving exercise tolerance and controlling skeletal muscle mass. To optimise the carbamate motif of SR9009, analogues of SR9009 were synthesised and evaluated. All of them showed REV-ERB-α agonist activities. Among them, 5a, 5f, 5 g, 5m, and 5p showed potencies equivalent to or slightly higher than the potency of SR9009 in vitro. These data indicate that the halogenated benzyl group is an indispensable active group in these compounds. 5m, 5p and SR9009 improved exercise tolerance in normal mice in vivo. Additionally, in hyperlipidemic mice, 5m and 5p not only improved exercise tolerance but also lowered blood lipid levels. 5m and 5p displayed stronger hypoglycaemic activity than SR9009.


Assuntos
Glicolipídeos , Membro 1 do Grupo D da Subfamília 1 de Receptores Nucleares , Tiofenos , Animais , Camundongos , Tiofenos/farmacologia , Tiofenos/química , Tiofenos/síntese química , Membro 1 do Grupo D da Subfamília 1 de Receptores Nucleares/agonistas , Membro 1 do Grupo D da Subfamília 1 de Receptores Nucleares/metabolismo , Glicolipídeos/farmacologia , Glicolipídeos/química , Glicolipídeos/síntese química , Relação Estrutura-Atividade , Masculino , Humanos , Estrutura Molecular , Camundongos Endogâmicos C57BL , Pirrolidinas/farmacologia , Pirrolidinas/química , Pirrolidinas/síntese química , Hipoglicemiantes/farmacologia , Hipoglicemiantes/síntese química , Hipoglicemiantes/química , Relação Dose-Resposta a Droga , Tolerância ao Exercício/efeitos dos fármacos
19.
World J Clin Cases ; 12(20): 4137-4145, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39015888

RESUMO

BACKGROUND: Coronary stent implantation is usually used to treat unstable angina to alleviate stenosis or occlusion, promoting blood flow restoration and alleviating symptoms such as myocardial ischemia. And postoperative cardiac rehabilitation is essential for enhancing recovery and prognosis. Nevertheless, conventional rehabilitation lacks specificity, particularly for elderly patients with multiple comorbidities and poor compliance, rendering it less effective. AIM: To investigate the effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following coronary stenting intervention. METHODS: A retrospective enrollment was conducted comprising fifty-four elderly patients with unstable angina pectoris who underwent systematic cardiac rehabilitation training after receiving coronary intervention as the rehabilitation group, while fifty-three elderly patients who received basic nursing and rehabilitation guidance measures after coronary intervention were assigned to the control group. Differences in Seattle Angina Questionnaire scores, survival quality (SF-36) scores, cardiopulmonary exercise function assessment index, echocardiographic cardiac function index, and adverse cardiovascular events were compared between the two groups. RESULTS: After intervention, the rehabilitation group observed greater VO2 Max, maximum metabolic equivalent, eft ventricular ejection fraction, left ventricular end-diastolic diameter and smaller left ventricular end-systolic diameter. And the rehabilitation group observed greater scores of physical activity limitation, stable angina pectoris, treatment satisfaction, and SF-36 score. The incidence of adverse cardiovascular events in the two groups, showed no significant difference. CONCLUSION: Systematic cardiac rehabilitation following coronary stenting in elderly patients with unstable angina pectoris can enhance cardiac function recovery, consequently enhancing both quality of life and cardiopulmonary exercise tolerance.

20.
World J Clin Cases ; 12(20): 4289-4300, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39015926

RESUMO

BACKGROUND: Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients. AIM: To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population. METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using Review Manager software. RESULTS: A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected. CONCLUSION: RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

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