Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 116
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Physiol ; 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32472698

RESUMO

KEY POINTS: Exercise intolerance is common in chronic obstructive pulmonary disease (COPD) patients. In patients with COPD, we compared an interval exercise (IE) protocol (alternating 30 s at 100% peak work rate (WRpeak ) with 30 s at 50% WRpeak ) with moderate-intensity constant-load exercise (CLE) at 75% WRpeak , which yielded the same work rate. Exercise endurance time and total work output were almost twice as high for IE than CLE. At exercise isotime (when work completed was the same between IE and CLE), IE was associated with less dynamic hyperinflation, lower blood lactate concentration, and greater respiratory and locomotor muscle oxygenation, but there were no differences in ventilation or cardiac output. However, at the limit of tolerance for each modality, dynamic hyperinflation was not different between IE and CLE, while blood lactate remained lower and muscle oxygenation higher with IE. Taken together, these findings suggest that dynamic hyperinflation and not muscle-based factors dictate the limits of tolerance in these COPD patients. ABSTRACT: The relative importance of ventilatory, circulatory and peripheral muscle factors in determining tolerance to exercise in patients with chronic obstructive pulmonary disease (COPD) is not known. In 12 COPD patients (forced expiratory volume in one second: 58 ± 17%pred.) we measured ventilation, cardiac output, dynamic hyperinflation, local muscle oxygenation, blood lactate and time to exhaustion during (a) interval exercise (IE) consisting of 30 s at 100% peak work rate alternating with 30 s at 50%, and (b) constant-load exercise (CLE) at 75% peak work rate, designed to produce the same average work rate. Exercise time was substantially longer during IE than CLE (19.5 ± 4.8 versus 11.4 ± 2.1 min, p = 0.0001). Total work output was therefore greater during IE than CLE (81.3 ± 27.7 versus 48.9 ± 23.8 kJ, p = 0.0001). Dynamic hyperinflation (assessed by changes from baseline in inspiratory capacity, ΔIC) was less during IE than CLE at CLE exhaustion time (isotime, p = 0.009), but was similar at exhaustion (ΔICCLE : -0.38 ± 0.10 versus ΔICIE : -0.33 ± 0.12 l, p = 0.102). In contrast, at isotime, minute ventilation, cardiac output and systemic oxygen delivery did not differ between protocols (P > 0.05). At exhaustion in both protocols, the vastus lateralis and intercostal muscle oxygen saturation were higher in IE than CLE (p = 0.014 and p = 0.0002, respectively) and blood lactate concentrations were lower (4.9 ± 2.4 mmol l-1 versus 6.4 ± 2.2 mmol l-1 , p = 0.039). These results suggest that (1) exercise tolerance with COPD is limited by dynamic hyperinflation; and (2) cyclically lower (50%) effort intervals in IE help to preserve muscle oxygenation and reduce metabolic acidosis compared with CLE at the same average work rate; but these factors do not appear to determine time to exhaustion.

2.
Respir Physiol Neurobiol ; 277: 103436, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32259687

RESUMO

In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB. At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043). Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.

3.
Exp Physiol ; 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103536

RESUMO

NEW FINDINGS: What is the topic of this review? The work presented here focuses mostly on testing the theory of blood flow redistribution from the locomotor to the respiratory muscles during heavy exercise in healthy participants and in patients with COPD. What advances does it highlight? Studies presented and the direct experimental approach to measure muscle blood flow by indocyanine green dye detected by near infrared spectroscopy, show that exercise interferes with respiratory muscle blood flow especially in COPD, but even in healthy. ABSTRACT: We have developed an indicator-dilution method to measure muscle blood flow at rest and during exercise using the light absorbing tracer indocyanine green dye (ICG) injected as an intravenous bolus, with surface optodes placed over muscles of interest to record the ICG signal by near-infrared spectroscopy. Here we review findings for both quadriceps and intercostal muscle blood flow (measured simultaneously) in trained cyclists and in patients with chronic obstructive pulmonary disease (COPD). During resting hyperpnoea in both athletes and patients, intercostal muscle blood flow increased with ventilation, correlating closely and linearly with the work of breathing, with no change in quadriceps flow. During graded exercise in athletes, intercostal flow at first increased, but then began to fall approaching peak effort. Unexpectedly, in COPD, intercostal muscle blood flow during exercise fell progressively from resting values, contrasting sharply with the response to resting hyperpnoea. During exercise at peak intensity, we found no quadriceps blood flow reduction in favour of the respiratory muscles in either athletes or patients. In COPD at peak exercise, when patients breathed 21% oxygen in helium or 100% oxygen, there was no redistribution of blood flow observed between legs and respiratory muscles in either direction. Evidence of decrease in leg blood flow and increase in respiratory muscle flow was found only when imposing expiratory flow limitation (EFL) during exercise in healthy individuals. However, because EFL caused substantial physiological derangement, lowering arterial oxygen saturation and raising end-tidal P C O 2 and heart rate, these results cannot be projected onto normal exercise.

4.
Med Sci Sports Exerc ; 52(5): 1126-1134, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31876666

RESUMO

INTRODUCTION: We aimed to compare acute mechanical and metabolic responses of the diaphragm and rib cage inspiratory muscles during two different types of respiratory loading in patients with chronic obstructive pulmonary disease. METHODS: In 16 patients (age, 65 ± 13 yr; 56% male; forced expiratory volume in the first second, 60 ± 6%pred; maximum inspiratory pressure, 82 ± 5%pred), assessments of respiratory muscle EMG, esophageal pressure (Pes) and gastric pressures, breathing pattern, and noninvasive assessments of systemic (V˙O2, cardiac output, oxygen delivery and extraction) and respiratory muscle hemodynamic and oxygenation responses (blood flow index, oxygen delivery index, deoxyhemoglobin concentration, and tissues oxygen saturation [StiO2]), were performed during hyperpnea and loaded breathing. RESULTS: During hyperpnea, breathing frequency, minute ventilation, esophageal and diaphragm pressure-time product per minute, cardiac output, and V˙O2 were higher than during loaded breathing (P < 0.05). Average inspiratory Pes and transdiaphragmatic pressure per breath, scalene (SCA), sternocleidomastoid, and intercostal muscle activation were higher during loading breathing compared with hyperpnea (P < 0.05). Higher transdiaphragmatic pressure during loaded breathing compared with hyperpnea was mostly due to higher inspiratory Pes (P < 0.05). Diaphragm activation, inspiratory and expiratory gastric pressures, and rectus abdominis muscle activation did not differ between the two conditions (P > 0.05). SCA-blood flow index and oxygen delivery index were lower, and SCA-deoxyhemoglobin concentration was higher during loaded breathing compared with hyperpnea. Furthermore, SCA and intercostal muscle StiO2 were lower during loaded breathing compared with hyperpnea (P < 0.05). CONCLUSION: Greater inspiratory muscle effort during loaded breathing evoked larger rib cage and neck muscle activation compared with hyperpnea. In addition, lower SCA and intercostal muscle StiO2 during loaded breathing compared with hyperpnea indicates a mismatch between inspiratory muscle oxygen delivery and utilization induced by the former condition.

6.
Eur Respir Rev ; 28(154)2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31852745

RESUMO

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2-3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.


Assuntos
Teste de Esforço , Pneumopatias/diagnóstico , Doença Crônica , Protocolos Clínicos , Europa (Continente) , Humanos
7.
Mater Sociomed ; 31(3): 177-180, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31762698

RESUMO

Introduction: Spontaneous dissection of the coronary arteries is relatively rare and usually does not affect life expectancy. However specific types have been implicated to episodes of sudden cardiac death and myocardial ischemia. The recognition of both clinical and imaging characteristics contributes to appropriate decision and patient management. Aim: The aim of the study is the epidemiological and Coronary Angiographic (CA) estimation of patients with spontaneous dissection of the coronary arteries, who were hospitalized in the cardiology department with Acute Coronary Syndrome or were submitted to coronary angiographic examination in the laboratory. Material and Methods: The epidemiological, clinical and angiographic data of 31 patients who were hospitalized in our department and suffered from spontaneous dissection of the coronary vessels were studied retrospectively. Results: In 31 patients (11 men and 20 women, mean age 52.8+18.6 years) who were hospitalized for acute coronary syndrome (ACS), spontaneous dissection of coronary arteries was detected. Precipitating factors were hypertension in 12 patients (38.71%), dyslipidemia in 13 patients (42%) and smoking in 17 patients (54.84%). Among the women, 13 (65%) had a history of hypertension in pregnancy, preeclampsia or/and gestational diabetes. In 8 patients, the coronary angiography showed multivessel disease, while in 12 patients there were no significant lesions in the coronary vessels. Fourteen women (70%) reported a history of depression compared to none in men. Conclusion: The incidence of spontaneous dissection of the coronary vessels in this sample of patients from northern Greece is similar to that of the other centers. The incidence is greater in females with hormonal changes and depression. In a large number there were no significant atherosclerotic lesions.

8.
Eur Respir Rev ; 28(154)2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31722891

RESUMO

The aim of this study was to examine the use of pedometers as a tool to promote daily physical activity levels in patients with COPD.A systematic review meta-analysis of pedometer physical activity promotion in patients with COPD was conducted. Medline/PubMed, Cochrane Library, Web of Science and CINAHL were searched from inception to January 2019. The search strategy included the following keywords: physical activity promotion, pulmonary rehabilitation and daily physical activity. The eligibility criteria for selecting studies were randomised controlled trials reporting pedometer physical activity promotion in patients with COPD.Improvements in steps per day were found with pedometer physical activity promotion either standalone (n=12, mean 0.53 (95% CI 0.29-0.77); p=0.00001) or alongside pulmonary rehabilitation (n=7, 0.51 (0.13-0.88); p=0.006). A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity.Future trials should consider the way in which pedometers are used to promote physical activity to inform clinical practice in the setting of pulmonary rehabilitation.

9.
Int J Chron Obstruct Pulmon Dis ; 14: 1979-1992, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564846

RESUMO

Purpose: Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients. Patients and methods: This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months). Results: At 12 months (n=157; FEV1% predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs 3533±293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV1% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters. Conclusion: COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.


Assuntos
Clima , Tolerância ao Exercício/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Comportamento Sedentário , Caminhada/fisiologia , Idoso , Progressão da Doença , Feminino , Monitores de Aptidão Física , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória , Fatores de Tempo
10.
Breathe (Sheff) ; 15(3): 250-257, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31508165

RESUMO

In COPD patients the ergogenic effect of heliox or oxygen breathing might be related both to improvements in ventilatory parameters (that lessen dyspnoea) and to enhanced oxygen delivery to respiratory and locomotor muscles http://bit.ly/2JlJBTc.

11.
Med Arch ; 73(2): 76-80, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391691

RESUMO

Introduction: Platelets play a crucial role in thrombotic episodes. Mean Platelet Volume (MPV) is the primary indicator of platelet's activation; its measurement is easy and time-effective. Aim: We tested the hypothesis that MPV is correlated with SYNTAX score in patients that suffered from an Acute Coronary Syndrome (ACS). Material and Methods: One hundred and four (104) patients (79 male-25 female, mean age 64.2±11.1 years), who were hospitalized for an ACS and underwent coronary angiography, were included in the study. Syntax score, as an indicator of the severity of coronary artery disease (CAD), was calculated. We tried to investigate the correlation between the first measured MPV, CRP, Creatinine and high sensitivity Troponin with the Syntax score of the patient and the association of MPV and a possible Major Advanced Cardiac Event (MACE) during hospitalization. Results: The patients were divided into four groups according to the SYNTAX score: Group A (SYNTAX score: 0, n=12), group B: Mild CAD (SYNTAX score: 1-22, n=68), group C: Moderate CAD (SYNTAX score: 23-32, n=12), and group D: Severe CAD (SYNTAX score: ≥ 33, n=12). Four patients (3.8%) developed a MACE during their hospitalization. MPV was significantly correlated to Syntax score (r=0.658, p<0.001) and was found to be an independent predictor factor of MACE with HR=6.8 (95% Confidence Interval 1.46-33.36). The cut-off value of MPV was 7.5 with a sensitivity of 98% and a specificity of 30.8%. Conclusion: We determined a positive correlation between MPV and Syntax score, transforming this simple test in a possible factor of risk stratification in ACS.


Assuntos
Síndrome Coronariana Aguda/sangue , Doença da Artéria Coronariana/sangue , Infarto do Miocárdio/sangue , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Creatinina/sangue , Feminino , Cardiopatias/mortalidade , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prognóstico , Recidiva , Índice de Gravidade de Doença , Troponina T/sangue
12.
Respirology ; 24(9): 854-862, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31270909

RESUMO

Chronic respiratory diseases (CRD) are characterized by exertional dyspnoea, exercise limitation and reduced health-related quality of life (QoL). Exercise training is essential for improving symptoms, physical function and QoL. Current research available supports the effectiveness of exercise training in patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis and interstitial lung disease (ILD). However, recent studies have also shown safety and effectiveness of exercise training in patients with pulmonary arterial hypertension (PAH) and asthma. Despite the lack of clinical guidelines for exercise training in PAH, a recent Cochrane review has reported improvements in functional capacity and effective reductions in mean pulmonary arterial pressure. In the other CRD, a number of Cochrane reviews, supported by numerous randomized controlled trials, have been published outlining the benefits of different types of exercise training. The aim of this review is to establish the principles and modalities of personalized exercise training and the effects of exercise training across a number of CRD. In addition, this review provides information on personalized exercise prescription for CRD patients with co-morbidities.

13.
Respir Physiol Neurobiol ; 268: 103248, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31271841

RESUMO

VitaBreath is a portable, non-invasive ventilation device (pNIV) that relieves shortness of breath in COPD by delivering fixed inspiratory and expiratory positive airway pressures (IPAP/EPAP: 18/8 cmH2O). Fixed pressures may cause circulatory compromise. We investigated the circulatory effects of pNIV during normal breathing (NB) and after Eucapnic Voluntary Hyperpnoea trials (EVH) sustained at 80% MVV. In a balanced order sequence, 10 healthy men performed four trials on one visit: 1-min of pNIV (intervention) or 1-min quiet breathing (QB) during NB; and 1-min pNIV (intervention) or 1-min QB during recovery from 3-min EVH. Compared to QB, pNIV application was associated with greater cardiac output (CO: 1.6 ± 1.9 L.min-1; P = 0.03). One minute into recovery from EVH, pNIV caused greater CO (2.2 ± 1.6 L.min-1; P = 0.01) compared to QB. Mean blood pressure was not different with pNIV compared to control. pNIV increased thoracoabdominal volumes and breathing frequency during NB and recovery from EVH. pNIV application does not induce adverse hemodynamic effects in healthy men.


Assuntos
Hemodinâmica/fisiologia , Ventilação não Invasiva , Músculos Respiratórios/fisiologia , Fenômenos Fisiológicos Respiratórios , Adolescente , Adulto , Pressão Sanguínea/fisiologia , Humanos , Masculino , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/instrumentação , Adulto Jovem
14.
J Clin Med ; 8(7)2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31323895

RESUMO

Patients with severe chronic obstructive pulmonary disease (COPD) are unable to exercise at high intensities for sufficiently long periods of time to obtain true physiological training effects. It therefore appears sensible to increase training duration at sub-maximal exercise intensities to optimize the benefit of exercise training. We compared the effects on exercise tolerance of two endurance cycloergometer submaximal exercise protocols with different cumulative training loads (one (G1) versus two (G2) daily 40 min training sessions) both implemented over 20 consecutive days in 149 patients with COPD (forced expiratory volume at first second (FEV1): 39% predicted) admitted to an inpatient pulmonary rehabilitation program. Patients in G2 exhibited greater improvement (p = 0.011) in submaximal endurance time (from 258 (197) to 741 (662) sec) compared to G1 (from 303 (237) to 530 (555) sec). Clinically meaningful improvements in health-related quality of life, 6MWT, and chronic dyspnea were not different between groups. Doubling the volume of endurance training is feasible and can lead to an additional benefit on exercise tolerance. Future studies may investigate the applicability and benefits of this training strategy in the outpatient or community-based pulmonary rehabilitation settings to amplify the benefits of exercise interventions.

15.
Acta Inform Med ; 27(1): 35-39, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31213741

RESUMO

Introduction: The 12-lead ECG at admission of patients suffering from acute myocardial infarction (AMI) is mandatory for accurate diagnosis and prompt therapeutic measures, mainly reperfusion. It has been shown that recording additional ECG leads may improve the diagnostic accuracy and therefore, the prognosis of selected cases. Aim: The aim of the study was to assess the usefulness of the 15-lead ECG (12 classic plus 3 posterior leads) in the management of chest pain patients, especially when 12-lead ECG is not diagnostic of AMI. Methods: Total amount of 186 consecutive patients (127 men, 59 women, mean age 69.7±13.8 years) were admitted with an acute coronary syndrome. The initial ECG recorded the 12 classic leads, and subsequently, the 3 additional posterior leads. Demographic and clinical data, including ECG alterations and selected treatment strategy, were also studied. The cumulative impact of the 15-lead ECG on the diagnosis and management of AMI were, overall, evaluated. Results: The 12-lead ECG was diagnostic of ST-elevation AMI (STEMI) in 158 patients (Group A-84.5%) who were promptly reperfused. On the other hand, the interpretation of the posterior leads was required in 28 patients (Group B-15.1%) to establish the STEMI diagnosis warranting reperfusion therapy. Multivariate analysis illustrated that the 15-lead ECG was the only factor associated with achieving the STEMI diagnosis in non-conclusive 12-lead ECG cases (OR=2.43-p=0.04). Conclusion: The use of the 15-lead ECG contributes to a faster and more accurate diagnosis of STEMI, particularly in the Emergency Department, facilitating the prompt reperfusion therapy.

16.
Breathe (Sheff) ; 15(2): 147-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31191730

RESUMO

Meet @ERSTalk Assembly 1: general pneumology http://ow.ly/EbtX30oaYuK.

18.
J Sex Med ; 16(8): 1199-1211, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31133422

RESUMO

INTRODUCTION: Sexual health plays an important role in heart failure (HF) patients, and the relationship between HF and sexual dysfunction is well established; however, the role of right ventricular function in sexual dysfunction has not been investigated sufficiently. AIM: To investigate the potential association between right ventricular dysfunction and sexual dysfunction in both male and female patients with HF. METHODS: Patients with a clinical diagnosis of HF were evaluated in a cross-sectional study. Patients from the whole spectrum of HF were included in the study, regardless of cause, duration, and classification of HF. Sexual function in men was evaluated with the International Index of Erectile Function and in women with the Female Sexual Functioning Index. MAIN OUTCOME MEASURES: We demonstrate that right ventricular dysfunction is associated with worse sexual function in both men and women. RESULTS: 306 consecutive patients with HF participated in the study. Right ventricular systolic dysfunction ranged from 24.2-39.1% and right ventricular diastolic dysfunction from 16.1-83.1%, depending on the echocardiographic parameter that was assessed. Right ventricular systolic dysfunction assessed by tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary artery systolic pressure ratio, and right ventricular basal diameter was associated with a lower International Index of Erectile Function score (P = .031, P = .009, and P < .001, respectively). Multiple linear regression analysis revealed that erectile function was independently associated only with TAPSE/pulmonary artery systolic pressure ratio and tricuspid late tricuspid diastolic flow velocity wave (ß = 32.84, P = .006; and ß = -0.47, P = .026, respectively), whereas female sexual function was independently associated only with the early tricuspid diastolic flow velocity/late tricuspid diastolic flow velocity ratio (ß= -0.47, P = .026). CLINICAL IMPLICATIONS: Our study demonstrates that right ventricular dysfunction in patients with HF reflects an impaired sexual function status. Physicians should be aware of this association and closely evaluate those patients for sexual dysfunction. STRENGTHS & LIMITATIONS: We innovatively assessed the correlation between right ventricular dysfunction and sexual function using validated questionnaires. The main limitation is the relatively small sample size. CONCLUSIONS: Our study provides some new insights into the relationship between sexual dysfunction and right ventricular systolic and diastolic dysfunction in HF patients, also suggesting potential interventions to improve sexual and right ventricular function and prognosis in this population. Koutsampasopoulos K, Vogiatzis I, Ziakas A, et al. Right Ventricular Function and Sexual Function: Exploring Shadows in Male and Female Patients With Heart Failure. J Sex Med 2019;16:1199-1211.

19.
Eur Respir J ; 53(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30956204

RESUMO

Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.

20.
Clin Respir J ; 13(4): 222-231, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30724023

RESUMO

INTRODUCTION: Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question. OBJECTIVES: We therefore compared concurrent CO measurements captured by IC (PhysioFlow: COIC ) and by the indocyanine green dye dilution method (CODD ) in patients with COPD. METHODS: Fifty paired CO measurements were concurrently obtained using the two methods from 10 patients (FEV1 : 50.5 ± 17.5% predicted) at rest and during cycling at 25%, 50%, 75% and 100% peak work rate. RESULTS: From rest to peak exercise COIC and CODD were strongly correlated (r = 0.986, P < 0.001). The mean absolute and percentage differences between COIC and CODD were 1.08 L/min (limits of agreement (LoA): 0.05-2.11 L/min) and 18 ± 2%, respectively, with IC yielding systematically higher values. Bland-Altman analysis indicated that during exercise only 7 of the 50 paired measurements differed by more than 20%. When data were expressed as changes from rest, correlations and agreement between the two methods remained strong over the entire exercise range (r = 0.974, P < 0.001, with no significant difference: 0.19 L/min; LoA: -0.76 to 1.15 L/min). Oxygen uptake (VO2 ) and CODD were linearly related: r = 0.893 (P < 0.001), CODD = 5.94 × VO2 + 2.27 L/min. Similar results were obtained for VO2 and COIC (r = 0.885, P < 0.001, COIC = 6.00 × VO2 + 3.30 L/min). CONCLUSIONS: These findings suggest that IC provides an acceptable CO measurement from rest to peak cycling exercise in patients with COPD.


Assuntos
Débito Cardíaco/fisiologia , Cardiografia de Impedância/métodos , Teste de Esforço/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Técnica de Diluição de Corante/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA