Relationship between ventilation heterogeneity and exercise intolerance in adults with sickle cell anemia.

Sickle cell anemia (SCA) causes dysfunction of multiple organs, with pulmonary involvement as a major cause of mortality. Recently, there has been growing interest in the nitrogen single-breath washout (N2SBW) test, which is able to detect ventilation heterogeneity and small airway disease when the results of other pulmonary function tests (PFTs) are still normal. Thus, the objectives of the present study were to assess the heterogeneity in the ventilation distribution in adults with SCA and to determine the association between the ventilation distribution and the clinical, cardiovascular, and radiological findings. This cross-sectional study included 38 adults with SCA who underwent PFTs, echocardiography, computed tomography (CT), and 6-min walk test. To evaluate the ventilation heterogeneity, the patients were categorized according to the phase III slope of the N2SBW (SIIIN2). Compared with adults with lower SIIIN2 values, adults with higher SIIIN2 values showed lower hemoglobin levels (P=0.048), a history of acute chest syndrome (P=0.001), an elevated tricuspid regurgitation velocity (P=0.039), predominance of a reticular pattern in the CT (P=0.002), a shorter 6-min walking distance (6MWD) (P=0.002), and lower peripheral oxygen saturation (SpO2) after exercise (P=0.03). SIIIN2 values correlated significantly with hemoglobin (rs=-0.344; P=0.034), forced vital capacity (rs=-0.671; P<0.0001), diffusing capacity for carbon monoxide (rs=-0.376; P=0.019), 6MWD (rs=-0.554; P=0.0003), and SpO2 after exercise (P=0.040). Heterogeneity in the ventilation distribution is one of the most common pulmonary dysfunctions in adults with SCA. Moreover, relationships exist between ventilation heterogeneity, worsening of pulmonary structural damage, and reduced tolerance for exercise.

Efeito da suplementação com vitamina E sobre os metabolismos oxidativo e cardíaco em equinos submetidos a exercício de alta intensidade / Effect of vitamin E on oxidative and cardiac metabolism in horses submitted to high intensity exercise

A suplementação antioxidante visa prevenir os danos oxidativos induzidos pelo exercício físico em diversos tecidos, como o miocárdio. Nesse contexto, este estudo objetivou avaliar os marcadores cardíacos e a lipoperoxidação em equinos no teste de exercício de rápida aceleração e curta duração (TRA), em esteira de alta velocidade, antes e após a suplementação com vitamina E. Para tanto, foram utilizados 10 equinos sem treinamento, que realizaram o primeiro TRA (TRA1) com carga de trabalho fundamentada no consumo máximo de oxigênio individual (VO2max) e que induziu a concentração de lactato maior que 4mmol/L, sendo considerado predominantemente anaeróbico. Em seguida, os equinos receberam vitamina E (dl-alfa-tocoferol) na dose de 1.000UI/dia, por via oral, durante 52 dias, e, posteriormente, realizaram um segundo TRA (TRA2) com o mesmo protocolo de TRA1. As amostras de sangue foram colhidas nos momentos antes do exercício, imediatamente após o término do teste e em 1h, 3h, 6h, 12h e 24h subsequentes. Determinou-se o malondialdeído (MDA) plasmático como índice de lipoperoxidação, e as concentrações séricas de troponina I cardíaca (cTnI), isoenzima MB da creatinoquinase (CK-MB) e mioglobina, como marcadores cardíacos. Como efeito do exercício, observou-se aumento discreto de MDA, de cTnI e de CK-MB, sendo significativo apenas para CK-MB. A suplementação foi capaz de amenizar a produção das espécies reativas de oxigênio, evidenciada pela menor concentração de MDA em TRA2, em 24h, além de causar um efeito protetor no miocárdio, devido ao menor valor de cTnI em 6h no TRA2 em relação ao TRA1. Não houve grandes alterações na concentração de mioglobina. Concluiu-se que o exercício de alta intensidade promoveu estresse no miocárdio nos equinos avaliados, bem como houve efeito benéfico da vitamina E na proteção miocárdica e sobre a lipoperoxidação.

Antioxidant supplementation aims to prevent oxidative damage induced by physical exercise in several tissues, including myocardium. This study aimed to assess cardiac and lipid peroxidation markers of horses submitted to a high intensity and short duration exercise test (TRA) on a high speed treadmill, before and after vitamin E supplementation. Ten untrained horses performed the first TRA test (TRA1), with workload based on maximal oxygen uptake (VO2max), which induced a blood lactate higher than 4mmol/L, i.e. predominantly anaerobic exercise test. After TRA1, the horses were supplemented with oral vitamin E (dl-alpha-tocopherol) at a daily dose of 1,000IU for 52 days. Then they performed the second test (TRA2) with the same protocol of TRA1. Blood samples were collected before exercise, immediately after and at 1h, 3h, 6h, 12h and 24h after the end of test. Plasma malondialdehyde (MDA), as lipid peroxidation index, and serum cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB) and myoglobin, as cardiac markers, were determined. There was a slight increase in MDA, cTnI and CK-MB levels caused by the exercise, but statistically significant only for CK-MB levels. Vitamin E was effective on scavenging reactive oxygen species, as evidenced by lower MDA level after supplementation (TRA2) at 24h. Also, vitamin E caused myocardial protection showed by lower cTnI concentration at 6h in TRA2 when compared to TRA1. There were no changes on myoglobin levels. In conclusion, high intensity exercise induced myocardial stress in horses and we also verified the beneficial effect of vitamin E on myocardial protection and lipid peroxidation.