Long-Term Impact of Left Bundle Branch Block on Cardiopulmonary Exercise Test Variables and Left Ventricular Systolic Function: A Two-Stage Observational Study.

INTRODUCTION: Left bundle branch block (LBBB) disrupts the electrical activation of the left ventricle (LV), potentially impairing its systolic function, leading to LBBB-induced cardiomyopathy. This study examined cardiopulmonary exercise test (CPET) variables in patients with and without LBBB and assessed the longitudinal development of left ventricular ejection fraction (LVEF). METHOD: An observational, comparative clinical study was executed in two stages at a private hospital in Brazil. The sample consisted of 27 individuals: 11 with LBBB and 16 without LBBB, all with preserved LVEF (>50%) and without confirmed ischemia. CPET variables were assessed, and after four years, participants had a transthoracic echocardiogram (TTE) for LVEF re-evaluation. Groups were compared using the t-test or the Chi-square (X²) test. Multivariate analysis of covariance (MANCOVA) determined effect magnitude. RESULTS: Patients with LBBB demonstrated significant differences in CPET variables, particularly in predicted peak V̇O2, predicted peak PO2, V̇E/V̇CO2 slope, and T½V̇O2. They also exhibited a more significant decline in LVEF over a four-year span compared to the patients without LBBB. Although initial preservation of LVEF, changes in contractile patterns due to LBBB interfered with its systolic function, suggesting early ventricular dysfunction indicated by a reduction in LVEF and an increase in the V̇E/V̇CO2 slope. Despite differences in cardiopulmonary function and changes in LVEF over time between patients with and without LBBB, the effect size was considered mild to moderate. CONCLUSIONS: LBBB patients with initially preserved LVEF displayed reduced exercise tolerance and a decrease in LVEF over time, emphasizing the need for vigilant monitoring and early intervention in these patients.

Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study.

The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

The Benefits of Exercise in Breast Cancer. / Os Benefícios dos Exercícios Físicos no Câncer de Mama.

Breast cancer is the most prevalent cancer among women, accounting for nearly 30% of all cancers, while in men, it represents only 1% of cases. Breast cancer is the main cause of death for cancer, and its incidence and mortality vary according to patients' ethnicity, geographic region, and socioeconomic status. Due to the low prevalence of breast cancer among men and the scarcity of studies in the literature, exercises have been prescribed based on extrapolations from studies on female patients. Scientific evidence has suggested beneficial effects of physical exercises on breast cancer prevention, treatment, and post-treatment. In addition to combatting sedentary behavior, it is essential to maintain a healthy body weight, limit alcohol consumption, and follow a balanced diet, rich in fruit, vegetables, grains and fibers, and limited in red meat. The effects of exercises are not restricted to breast cancer, but extend to controlling modifiable risk factors, and reducing the incidence of cardiovascular diseases, and all-cause and cardiovascular mortality.

O câncer de mama é a neoplasia mais prevalente nas mulheres, em torno de 30% de todos os tipos de câncer, enquanto no sexo masculino é responsável por apenas 1% dos casos. No mundo, é a primeira causa de morte por câncer em mulheres. A incidência e a mortalidade variam de acordo com a etnia, região territorial e nível socioeconômico. Em virtude da baixa prevalência do câncer de mama em homens e a escassez de literatura, as condutas são baseadas em extrapolações dos estudos no sexo feminino. As evidências científicas sugerem efeitos benéficos dos exercícios físicos na prevenção, durante o tratamento e no pós-tratamento do câncer de mama. Além do combate ao sedentarismo, é importante manter um peso saudável, limitar o consumo de álcool, e seguir dieta balanceada, rica em frutas, vegetais, grãos e fibras e reduzida em carnes vermelhas. As ações dos exercícios não se restringem ao câncer de mama, mas têm impacto importante no controle dos fatores de risco modificáveis, diminuindo a incidência das doenças cardiovasculares e a mortalidade por causas globais e cardíaca.

Os Benefícios dos Exercícios Físicos no Câncer de Mama / The Benefits of Exercise in Breast Cancer

Resumo O câncer de mama é a neoplasia mais prevalente nas mulheres, em torno de 30% de todos os tipos de câncer, enquanto no sexo masculino é responsável por apenas 1% dos casos. No mundo, é a primeira causa de morte por câncer em mulheres. A incidência e a mortalidade variam de acordo com a etnia, região territorial e nível socioeconômico. Em virtude da baixa prevalência do câncer de mama em homens e a escassez de literatura, as condutas são baseadas em extrapolações dos estudos no sexo feminino. As evidências científicas sugerem efeitos benéficos dos exercícios físicos na prevenção, durante o tratamento e no pós-tratamento do câncer de mama. Além do combate ao sedentarismo, é importante manter um peso saudável, limitar o consumo de álcool, e seguir dieta balanceada, rica em frutas, vegetais, grãos e fibras e reduzida em carnes vermelhas. As ações dos exercícios não se restringem ao câncer de mama, mas têm impacto importante no controle dos fatores de risco modificáveis, diminuindo a incidência das doenças cardiovasculares e a mortalidade por causas globais e cardíaca.

Abstract Breast cancer is the most prevalent cancer among women, accounting for nearly 30% of all cancers, while in men, it represents only 1% of cases. Breast cancer is the main cause of death for cancer, and its incidence and mortality vary according to patients' ethnicity, geographic region, and socioeconomic status. Due to the low prevalence of breast cancer among men and the scarcity of studies in the literature, exercises have been prescribed based on extrapolations from studies on female patients. Scientific evidence has suggested beneficial effects of physical exercises on breast cancer prevention, treatment, and post-treatment. In addition to combatting sedentary behavior, it is essential to maintain a healthy body weight, limit alcohol consumption, and follow a balanced diet, rich in fruit, vegetables, grains and fibers, and limited in red meat. The effects of exercises are not restricted to breast cancer, but extend to controlling modifiable risk factors, and reducing the incidence of cardiovascular diseases, and all-cause and cardiovascular mortality.

As particularidades da investigação da doença arterial coronariana pelo teste de exercício na mulher / The particularities of the investigation of coronary artery disease by the exercise testing in women

A doença arterial coronariana (DAC) é a principal causa de morbidade e mortalidade nas mulheres. Um dos fatores que dificulta o reconhecimento precoce da DAC é a manifestação clínica, uma vez que os sintomas no gênero feminino são mais atípicos, podendo aparecer como náusea, dispneia, fadiga, desconforto epigástrico, dor na região dorsal, cervical ou mandibular. As mulheres apresentam frequentemente DAC não obstrutiva associada à disfunção microvascular ou endotelial ou outras alterações cardiovasculares, que reduzem a acurácia dos exames não invasivos. O teste de exercício (TE), um dos mais utilizados no diagnóstico da isquemia miocárdica, apresenta baixo valor preditivo positivo no diagnóstico de DAC nas mulheres. Algumas explicações para a menor acurácia do TE são: baixa amplitude eletrocardiográfica pela presença de mamas volumosas, influência autonômica e hormonal, níveis menores de hemoglobina, tamanho menor das artérias coronárias, maior prevalência de doença coronariana uniarterial, aumento inapropriado de catecolaminas ao esforço e o estrogênio. As diretrizes recomendam indicar o TE nas mulheres com risco intermediário, eletrocardiograma de base normal e condição aeróbica superior a 5 MET, para melhorar acurácia do método. Algumas variáveis podem também contribuir no valor prognóstico do exame, como: o escore de Duke (adaptado para mulher) a capacidade de exercício, o índice cronotrópico e a recuperação da frequência cardíaca. Entender as diferenças específicas do comportamento da DAC na mulher, desde a fisiopatologia, apresentação clínica e procedimentos diagnósticos, é fundamental para a detecção precoce da doença, instituição do tratamento adequado e consequentemente, redução da mortalidade. (AU)