ABSTRACT
Rheumatic mitral stenosis (RMS) is still a significant public health problem in low- and middle-income countries. Pulmonary hypertension (PH) is a common consequence of RMS and may be used as a surrogate of disease severity. Cardiopulmonary exercise testing (CPET) provides a comprehensive assessment of the cardiorespiratory systems and can identify indirect signs of PH. To evaluate the relationship between CPET parameters and PH quantified by echocardiography in patients with RMS. This cross-sectional study retrospectively included thirty patients with RMS referred for CPET from 2012 to 2020. Two groups of patients were defined according to echocardiographic-derived pulmonary systolic arterial pressure (PASP): significant PH group (PSAP ≥ 50 mmHg); and non-significant PH group (PSAP < 50 mmHg). A decrease in peak oxygen consumption (VO2) and oxygen pulse predicted (O2PP) was observed in the PH group compared to the non-significant PH group (11.1±2.8 mL/kg/min vs 14.1±2.9 mL/kg/min; Pâ¯=â¯0.02; 54±9% vs 67.8±15%; Pâ¯=â¯0.02). The PH group exhibited a greater VE/VCO2 nadir rather than non-significant PH group (38±5 vs 32±3; P < 0.001). Receiver operating characteristic (ROC) analysis with O2PP <54% showed sensitivity and specificity of 67% and 90%, respectively. VE/VCO2 nadir ≥ 40 and VO2 peak < 10.8 mL/kg/min showed 44% and 56% of sensitivity and 100% and 90% of specificity respectively. CPET can improve the assessment of disease severity in patients with RMS with high specificity. The presence of higher O2PP, higher VO2 peak, and lower VE/VCO2 nadir highly suggests the absence of significant PH.
Subject(s)
Hypertension, Pulmonary , Mitral Valve Stenosis , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Exercise Test , Mitral Valve/diagnostic imaging , Retrospective Studies , Cross-Sectional Studies , Echocardiography , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/diagnosisABSTRACT
We aimed to analyse cardiac autonomic control by assessing the post-exercise heart rate recovery (HRR) and physical fitness in children and adolescents with spina bifida (SB), compared to participants with typical development. A total of 124 participants, 42 with spina bifida (SB group) and 82 typical developmental controls (CO group) performed the arm cranking exercise test with a gas analysis system. HRR was determined at the first (HRR_1) and second (HRR_2) minute at recovery phase. Data are shown as [mean difference (95% CI)]. The SB group showed reduced HR reserve [14.5 (7.1-22.0) bmp, P<0.01], slower HRR_1 [12.4 (7.4-17.5) bpm, P<0.01] and HRR_2 [16.3 (10.6-21.9) bpm; P<0.01], lower VO2peak [VO2peak relative: 7.3 (4.2-10.3) mL·min-1·kg-1, P<0.01; VO2peak absolute: 0.42 (0.30-0.54) L·min-1, P<0.01], and lower O2 pulse [2.5 (1.8-3.2) mL·bpm, P<0.01] and ventilatory responses [13.5 (8.8-18.1) L·min-1, P<0.01] than the CO group. VE/VO2 was not different between groups [-2.82 (-5.77- -0.12); P=0.06], but the VE/VCO2 [-2.59 (-4.40-0.78); P<0.01] and the values of the anaerobic threshold corrected by body mass [-3.2 (-5.8- -0.6) mL·min-1·kg-1, P=0.01] were higher in the SB group than in the CO group. We concluded that children and adolescents with SB have reduced physical fitness and a slower HRR response after maximal effort.
Subject(s)
Heart Rate/physiology , Oxygen Consumption/physiology , Physical Fitness/physiology , Spinal Dysraphism/physiopathology , Adolescent , Child , Exercise Test , Female , Humans , MaleABSTRACT
Modelo do estudo: Retrospectivo. Objetivos do estudo: Avaliar o efeito do treinamento físico aeróbico nas variáveis cardiovasculares em pacientes coronariopatas participantes do Programa de Reabilitação Cardiovascular. Metodologia: Foram incluídos pacientes portadores de coronariopatia estável e foram avaliadas as variáveis cardiovasculares de testes ergométricos seriados, realizados antes e após um período mínimo de 12 semanas de treinamento físico aeróbico em um Programa de Reabilitação Cardiovascular, de fevereiro de 2002 a julho de 2005. Resultados: Documentou-se incremento significativo (p < 0,0001) do consumo de oxigênio pico(VO2 pico) após a reabilitação cardiovascular (30,1 ± 9,5 versus 35,5 ± 8,8 ml/kg/min). Este delta do VO2 pico apresentou correlação negativa com a capacidade física inicial, com maiores ganhos nos pacientes com menores valores iniciais de VO2 pico. Não foram observadas diferenças significativas na pressão arterial sistólica e no duplo produto pico, e uma diferença de pequena magnitude foi observada na freqüência cardíaca pico. A melhora no limiar isquêmico do miocárdio, avaliada pelo consumo de oxigênio na positivação, foi ainda mais expressiva, com incremento de 7,4 ml/kg/min (p < 0,0001) (21,0 ± 6,9 versus 28,4 ± 8,2 ml/kg/min). Conclusões: A reabilitação cardiovascular melhorou a capacidade física e o limiar isquêmico de pacientes participantes do Programa de Reabilitação Cardiovascular. O benefício na capacidade física foi maior nos pacientes com menores valores iniciais de consumo de oxigênio pico.
Study model: Retrospective. Study objectives: Evaluate the effect of aerobic physical training in cardiovascular variables in patients with coronary artery disease participants of a Cardiovascular Rehabilitation Program. Methods: Patients with stable coronary artery disease were included and were analyzed the cardiovascular variables of exercise testing, carried out before and after a minimum period of 12 weeks of aerobic physical training in a Cardiovascular Rehabilitation Program, from February 2002 to July 2005. Results: A significant increment (p <0.0001) of maximal oxygen consumption (VO2 max) was observed after the cardiovascular rehabilitation (30.1 ± 9.5 versus 35.5 ± 8.8 ml/kg/min). The difference of the VO2 max had negative correlation with the initial physical capacity, with greater benefits in patients with smaller initial values of VO2 max. Significant differences were not observed in maximal systolic blood pressure and double product, and a small difference was observed in maximal heart rate. The improvement in ischemic threshold was more pronounced, with an increment of 7.4 ml/kg/min in oxygen consumption, with statistical significance (p < 0.0001) (21.0 ± 6.9 versus 28.4 ± 8.2 ml/kg/min). Conclusions: The cardiovascular rehabilitation improved physical capacity and ischemic thresholdin patients participants of a Cardiovascular Rehabilitation Program. The benefit in physical capacity was greater in patients with smaller initial values of maximal oxygen consumption.
Subject(s)
Humans , Male , Female , Middle Aged , Coronary Disease , Vascular Diseases , Exercise , RehabilitationABSTRACT
Sabe-se que muitos pacientes diabeticos apresentam comprometimento do sistema nervoso autonomo. A maior parte do nosso conhecimento acerca do controle autonomico cardiovascular em pacientes diabeticos resulta de investigacoes sobre os reflexos cardiovasculares e cardiorrespiratorios. Neste estudo, nos comparamos as respostas cardiovasculares a tres testes da funcao autonomica em pacientes diabeticos e em individuos normais: 1) respostas da frequencia cardiaca e da pressao arterial ao teste postural passivo com inclinacao de 70 graus. 2) respostas da frequencia cardiaca e da pressao arterial a manobra de Valsalva. 3) variacao da frequencia cardiaca durante respiracao em seis ciclos/minuto (arritmia sinusal respiratoria). Alem disso, nos medimos a resistencia das vias aereas antes e apos a inalacao de sulfato de atropina nos pacientes diabeticos e nos individuos do grupo controle. Comparados aos normais, nos pacientes diabeticos nos observamos respostas cardiovasculares alteradas sugerindo comprometimento da atividade parassimpatica e simpatica. Varios pacientes com neuropatia autonomica tiveram resposta broncodilatadora diminuida a atropina, sugerindo que a inervacao vagal das vias aereas pode estar lesada no diabetes mellitus.
