Lack of association of estrogen receptor alpha gene polymorphisms with cardiorespiratory and metabolic variables in young women.

This study examined the association of estrogen receptor alpha gene (ESR1) polymorphisms with cardiorespiratory and metabolic parameters in young women. In total, 354 healthy women were selected for cardiopulmonary exercise testing and short-term heart rate (HR) variability (HRV) evaluation. The HRV analysis was determined by the temporal indices rMSSD (square root of the mean squared differences of successive R-R intervals (RRi) divided by the number of RRi minus one), SDNN (root mean square of differences from mean RRi, divided by the number of RRi) and power spectrum components by low frequency (LF), high frequency (HF) and LF/HF ratio. Blood samples were obtained for serum lipids, estradiol and DNA extraction. ESR1 rs2234693 and rs9340799 polymorphisms were analyzed by PCR and fragment restriction analysis. HR and oxygen uptake (VO(2)) values did not differ between the ESR1 polymorphisms with respect to autonomic modulation. We not find a relationship between ESR1 T-A, T-G, C-A and C-G haplotypes and cardiorespiratory and metabolic variables. Multiple linear regression analysis demonstrated that VO(2), total cholesterol and triglycerides influence HRV (p < 0.05). The results suggest that ESR1 variants have no effect on cardiorespiratory and metabolic variables, while HRV indices are influenced by aerobic capacity and lipids in healthy women.

Cardiovascular responses to low-intensity isometric handgrip exercise in coronary artery disease: effects of posture.

BACKGROUND: Coronary artery disease (CAD) lead to cardiovascular autonomic control disfunctions that can worsen exercise and/or posture adjustments. OBJECTIVES: To verify the cardiovascular responses to low-intensity isometric handgrip exercise performed in different postures in CAD patients. This study tested the hypothesis that the posture influences the cardiovascular responses during isometric handgrip exercise and that the presence of CAD leads to greater cardiovascular stress during this type of exercise. METHODS: We investigated cardiovascular responses to isometric handgrip exercise in 15 CAD patients (CADG) and 15 health matched-control (CG). The subjects performed isometric handgrip exercise at 30% of maximum voluntary contraction until exhaustion in SUPINE, SITTING and STANDING positions. Systolic arterial pressure, diastolic arterial pressure, mean blood pressure, heart rate, peripheral vascular resistance, cardiac output, stroke volume and double product were measured during rest (baseline), exercise (peak value) and recovery in the 1st minute (REC1). Delta PB (ΔPB, peak minus baseline) and PR1 (ΔPR1, peak minus REC1) were calculated. RESULTS: Higher ΔPB and ΔPR1 of systolic and mean arterial pressure and double product were observed in STANDING when compared to SITTING and/or SUPINE. CADG showed higher ΔPB of systolic and mean arterial pressure in all postures and higher ΔPR1 of strove volume in the SITTING. CONCLUSION: We concluded that the posture during isometric handgrip exercise influences the cardiovascular responses with STANDING leading to higher cardiovascular stress. CAD promoted higher arterial pressure responses however these responses were physiological and expected due to the presence of disease and type of exercise.

The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties.

Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals. Graphical abstract Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol "*" indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol "§" indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.

Interval training based on ventilatory anaerobic threshold improves aerobic functional capacity and metabolic profile: a randomized controlled trial in coronary artery disease patients.

BACKGROUND: Exercise training has been an essential component of cardiac rehabilitation. However, it is not known if interval training (IT) based on the ventilatory anaerobic threshold (VAT) could be effective in improving aerobic functional capacity and metabolic profile in patients without or with coronary artery disease (CAD). AIM: To investigate the effects of an IT program, based-intensity between 70-110% of workload reached at the VAT, on the aerobic functional capacity and metabolic profile of patients with and without CAD. DESIGN: Randomized controlled trial. SETTING: Outpatients from a cardiac rehabilitation. POPULATION: A sample was composed of 32 patients with CAD (CAD group) and 32 patients without CAD (noCAD group) that were randomized into a trained or control groups. METHODS: Submaximal cardiopulmonary exercise test on the cycle ergometer and blood samples were realized at baseline and post 16 weeks of IT program. The cardiorespiratory variables were obtained at the VAT level. Trained groups (CAD-T, N.=15; noCAD-T, N.=15) underwent a supervised three-week session IT program (30-40 minutes each exercise session, at the intensity workloads equivalent to %VAT [70-110%]) for 16 weeks. RESULTS: After 16 weeks of IT program, there were a significant increase of VO(2VAT) and workload in the trained groups (P<0.05), while in the control groups VO(2VAT) and heart rate decreased (P<0.05). Body mass and body index mass decreased in trained groups (P<0.05), and low-density lipoprotein increased only in noCAD group after 16 weeks (P<0.05). The magnitude of the improvement in VO(2VAT) was related to VO(2VAT) (r=-0.57, P<0.05) and workload (r=-0.52, P<0.05) at baseline. CONCLUSION: The IT program prescribed with intensities based on VAT improved the aerobic functional capacity and decreased body mass and body index mass loss in patients with and without CAD. CLINICAL REHABILITATION IMPACT: IT program based on VAT provides new possibilities for cardiac rehabilitation in relation to individualized exercise prescription of the interval training.

Interval training based on ventilatory anaerobic threshold increases cardiac vagal modulation and decreases high-sensitivity c-reative protein: randomized clinical trial in coronary artery disease.

BACKGROUND: Autonomic dysfunction and inflammatory activity are involved in the development and progression of coronary artery disease (CAD), and exercise training has been shown to confer a cardiovascular benefit. OBJECTIVE: To evaluate the effects that interval training (IT) based on ventilatory anaerobic threshold (VAT) has on heart rate variability (HRV) and high-sensitivity C-reactive protein (hs-CRP) levels, as well as the relationship between both levels, in patients with CAD and/or cardiovascular risk factors (RF). METHOD: Forty-two men (aged 57.88±6.20 years) were divided into two training groups, CAD-T (n= 12) and RF-T (n= 10), and two control groups, CAD-C (n= 10) and RF-C (n=10). Heart rate and RR intervals in the supine position, cardiopulmonary exercise tests, and hs-CRP levels were measured before and after IT. HRV was analyzed by spectral and symbolic analysis. The CAD-T and RF-T underwent a 16-week IT program of three weekly sessions at training intensities based on the VAT. RESULTS: In the RF-T, cardiac sympathetic modulation index and hs-CRP decreased (p<0.02), while cardiac parasympathetic modulation index increased (p<0.02). In the CAD-T, cardiac parasympathetic modulation index increased, while hs-CRP, systolic, and diastolic blood pressures decreased (p<0.02). Both control groups showed increase in hs-CRP parameters (p<0.02). There was a strong and significant association between parasympathetic and sympathetic modulations with hs-CRP. CONCLUSION: The IT program based on the VAT promoted a decrease in hs-CRP associated with improvement in cardiac autonomic modulation.

Lack of Association Between ACE Indel Polymorphism and Cardiorespiratory Fitness in Physically Active and Sedentary Young Women.

BACKGROUND: Polymorphisms at the angiotensin-converting enzyme gene (ACE), such as the indel [rs1799752] variant in intron 16, have been shown to be associated with aerobic performance of athletes and non-athletes. However, the relationship between ACE indel polymorphism and cardiorespiratory fitness has not been always demonstrated. OBJECTIVES: The relationship between ACE indel polymorphism and cardiorespiratory fitness was investigated in a sample of young Caucasian Brazilian women. PATIENTS AND METHODS: This study investigated 117 healthy women (aged 18 to 30 years) who were grouped as physically active (n = 59) or sedentary (n = 58). All subjects performed an incremental exercise test (ramp protocol) on a cycle-ergometer with 20-25 W/min increments. Blood samples were obtained for DNA extraction and to analyze metabolic and hormonal profiles. ACE indel polymorphism was determined by polymerase chain reaction (PCR) and fragment size analysis. RESULTS: The physically active group had higher values of peak oxygen uptake (VO2 peak), carbon dioxide output (VCO2), ventilation (VE) and power output than the sedentary group (P < 0.05) at the peak of the exercise test. However, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) did not differ between groups. There was no relationship between ACE indel polymorphism and cardiorespiratory variables during the test in both the physically active and sedentary groups, even when the dominant (DD vs. D1 + 2) and recessive (2 vs. DI + DD) models of inheritance were tested. CONCLUSIONS: These results do not support the concept that the genetic variation at the ACE locus contributes to the cardiorespiratory responses at the peak of exercise test in physically active or sedentary healthy women. This indicates that other factors might mediate these responses, including the physical training level of the women.

Association of estrogen receptor alpha gene polymorphisms with autonomic modulation of heart rate in users and nonusers of oral contraceptives.

BACKGROUND: This study examined the association between estrogen receptor α gene (ESR1) polymorphisms and blood pressure (BP), heart rate (HR) and autonomic modulation of HR in a sample population. STUDY DESIGN: Two hundred thirty-two young healthy women were selected, and those using oral contraceptives (OC) were compared with nonusers (control group). Short-term HR variability (HRV) was evaluated in both the supine and sitting positions using temporal indices rMSSD [square root of the mean squared differences of successive R-R intervals (RRi) divided by the number of RRi minus one], SDNN (root mean square of differences from mean RRi, divided by the number of RRi) and frequency domain methods. Power spectral components were reported at low frequency (LF) and high frequency (HF) and as LF/HF ratio. ESR1 c.454-397T>C (rs2234693) and c.454-351A>G (rs9340799) polymorphisms were determined by polymerase chain reaction and fragment restriction analysis. RESULTS: The ESR1 T>C and A>G polymorphisms had no effect on HR, rMSSD, SDNN, LF, HF or LF/HF ratio (supine or sitting), independently of OC use. The ESR1 T-A, T-G, C-A and C-G haplotypes were not associated with HR, BP or HRV. CONCLUSIONS: ESR1 variants had no effect on the autonomic modulation of HR in young women users and nonusers of OC and may not be implicated in cardiovascular risk in young women.

Cardiopulmonary exercise testing in the early-phase of myocardial infarction.

OBJECTIVE: To evaluate and to compare the cardiorespiratory and metabolic variables at the ventilatory anaerobic threshold level (AT) and at submaximal cardiopulmonary exercise testing (CPET) in both, healthy volunteers and in patients in the early phase after acute myocardial infarction (AMI). METHOD: Twenty-six volunteers underwent a submaximal or symptom-limited cardiopulmonary exercise testing (CPET) on a cycle ergometer and were divided into AMI group (AMIG=12, 56.33±8.65 years) and healthy group (CG=14, 53.33±3.28 years). The primary outcome measures were the cardiorespiratory and metabolic variables obtained at the peak workload and at the AT of the CPET. Statistical test: independent Student's t-test, α=5%. RESULTS: The AMIG presented lower values at the AT and the peak workload of the CPET compered to the CG: power in watts (91.06±30.10 and 64.88±19.92; 154.93±34.65 and 120.40±29.60); VO2 mL.kg-1.min-1 (17.26±2.71 and 12.19±2.51; 25.39±5.73 and 19.41±5.63); VCO2 L/min-1 (1.43±0.31 and 0.93±0.23; 2.07±0.43 and 1.42±0.36), VO2 L/min-1 (1.33±0.32 and 1.00±0.23; 1.97±0.39 and 1.49±0.36); VE L/min-1 (42.13±8.32 and 27.51±5.86; 63.07±20.83 and 40.82±11.96); HR (bpm) (122.96±14.02 and 103.46±13.38; 149.67±13.77 and 127.60±10.04), double product (DP) (bpm.mmHg.min-1) (21835.86±3245.93 and 17333.25±2716.51; 27302.33±3053.08 and 21864.00±2051.48), respectively. The variable oxygen uptake efficiency slope (OUES L/min) was lower in the AMIG (1.79±0.51) than the CG (2.26±0.37). The AMIG presented neither ECG alterations nor symptoms that limited the CPET. CONCLUSION: The results suggest that patients with AMI Killip class I presented lower functional capacity and DP compared to the CG without presenting ischemic alterations. Thus, the study suggests that submaximal CPET can be applied at an early stage to evaluate cardiorespiratory status since it is both safe and highly sensitive to detect changes.

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease.

BACKGROUND: A reduction in heart rate variability (HRV) is considered an important indicator of autonomic dysfunction. OBJECTIVES: The aims of this study were to evaluate the presence of autonomic dysfunction measured by HRV in patients with coronary artery disease (CAD) and to compare them with normal subjects. METHODS: A sample of 52 men (mean age 54±5.39 years) was allocated into three groups: obstructive CAD ≥50% (CAD+ n=18), obstructive CAD <50%, (CAD- n=17) and apparently healthy controls (CG n=17). Heart rate (HR) was measured at rest using a Polar®S810i for 15 min. HRV was analyzed via Shannon entropy (SE) and symbolic analysis (0V and 2ULV), which relate to sympathetic and vagal predominance, respectively. Statistical analysis included the Kruskal-Wallis test and multivariate analysis (p<0.05). RESULTS: The CAD+ group presented lower SE and 2ULV% values and higher 0V% compared to CAD- and control groups (p<0.05). In the multivariate analysis, the presence of the clinical characteristics such as myocardial infarction and revascularization in the CAD+ group lead to a lower SE and higher 0V compared to the CAD- group. The use of angiotensin converting enzymes led to a higher SE in the CAD- group compared to the CAD+ (p<0.05). CONCLUSION: In uncomplicated CAD+ patients the patterns of HRV have a lower complexity, a greater sympathetic modulation and a lower parasympathetic modulation compared to CAD- and control groups in supine resting conditions. These results indicate that autonomic heart dysfunction is related to the degree of coronary occlusion and cardiac compromise.

Interval training based on ventilatory anaerobic threshold increases cardiac vagal modulation and decreases high-sensitivity c-reative protein: randomized clinical trial in coronary artery disease

Background: Autonomic dysfunction and inflammatory activity are involved in the development and progression of coronary artery disease (CAD), and exercise training has been shown to confer a cardiovascular benefit. Objective: To evaluate the effects that interval training (IT) based on ventilatory anaerobic threshold (VAT) has on heart rate variability (HRV) and high-sensitivity C-reactive protein (hs-CRP) levels, as well as the relationship between both levels, in patients with CAD and/or cardiovascular risk factors (RF). Method: Forty-two men (aged 57.88±6.20 years) were divided into two training groups, CAD-T (n= 12) and RF-T (n= 10), and two control groups, CAD-C (n= 10) and RF-C (n=10). Heart rate and RR intervals in the supine position, cardiopulmonary exercise tests, and hs-CRP levels were measured before and after IT. HRV was analyzed by spectral and symbolic analysis. The CAD-T and RF-T underwent a 16-week IT program of three weekly sessions at training intensities based on the VAT. Results: In the RF-T, cardiac sympathetic modulation index and hs-CRP decreased (p<0.02), while cardiac parasympathetic modulation index increased (p<0.02). In the CAD-T, cardiac parasympathetic modulation index increased, while hs-CRP, systolic, and diastolic blood pressures decreased (p<0.02). Both control groups showed increase in hs-CRP parameters (p<0.02). There was a strong and significant association between parasympathetic and sympathetic modulations with hs-CRP. Conclusion: The IT program based on the VAT promoted a decrease in hs-CRP associated with improvement in cardiac autonomic modulation.

Ratings of perceived exertion at anaerobic threshold in patients with coronary artery disease / Percepción subjetiva del esfuerzo en el liminar anaeróbico en pacientes con enfermedad arterial coronaria / Percepção subjetiva do esforço no limiar anaeróbio em pacientes com doença arterial coronariana

The study aimed to identify and compare the ratings of perceived exertion (RPE) at the ventilatory anaerobic threshold (VAT) in healthy subjects and patients with coronary artery disease (CAD). A total of 30 male subjects took part in the study and were divided into three groups: a control group (CG) composed of 10 healthy participants; a group composed of 10 participants diagnosed with CAD beta-blocker user (G-DACb); and a group composed of 10 participants with CAD non-beta-blocker user (G-DAC). The participants performed a cardiopulmonary exercise test (CPET) with continuous type ramp protocol to determine the VAT, through the visual graphical analysis (loss of parallelism between the oxygen uptake and the carbon dioxide output). During CPET, before the end of each one-minute period, the subjects were asked to rate dyspnea (RPE-D) and leg fatigue (RPE-L) on the Borg CR-10 scale. After the VAT was determined, the score that the participants gave on the Borg CR10 scale was verified. CG participants showed higher workload, oxygen uptake, carbon dioxide output, ventilation and heart rate at the VAT compared to the G-DAC and G-DACb (p<0.05). However, regarding the RPE-L and the RPE-D, no significant difference between the groups were observed (p<0.05). Values between five and six on Borg CR-10 scale matched the VAT in the subjects studied. However, other parameters must be concomitantly used for prescribing exercise intensity in physical training protocols, at levels close to the VAT for patients with CAD.

El objetivo del estudio fue identificar y comparar la percepción subjetiva del esfuerzo (PSE) en el liminar anaeróbico ventilatorio (LAV) en sujetos sanos y con enfermedad arterial coronaria (EAC). Fueron estudiados 30 hombres siendo10 sanos que constituyeron el grupo control (GC) y 20 diagnosticados con EAC, de los cuales 10 utilizaban medicamento betabloqueante (G-DACb) y 10 no utilizaban (G-DAC). Los voluntarios fueron sometidos a una prueba de ejercicio cardiopulmonar (TECP) con protocolo continuo tipo rampa para la determinación del LAV, a través del análisis gráfico visual (pérdida del paralelismo entre el consumo de oxígeno y producción de dióxido de carbono). Durante la realización del TECP, se pidió a los voluntarios que informaran al final de cada minuto la percepción subjetiva del esfuerzo de los miembros inferiores (PSE-M) y la percepción subjetiva del esfuerzo respiratorio (PSE-R) a través de la escala de Borg CR-10. El GC presentó mayores valores de potencia, consumo de oxígeno, producción de dióxido de carbono, ventilación y frecuencia cardiaca en el LAV comparado con los grupos G-DAC y G-DACb (p<0,05). La PSE-M fue menor en el G-DACb comparado con el GC (p<0,05). Después del ajuste por la covariable potencia, no hubo diferencia significativa entre los grupos para PSE-M y PSE-R (p>0,05). Los valores entre cinco y seis en la escala CR-10 de Borg correspondieron al LAV en la muestra estudiada. Sin embargo, otros parámetros deben ser utilizados simultáneamente para la prescripción de la intensidad del ejercicio en los protocolos de entrenamiento físico, en niveles cercanos al LAV para pacientes con EAC.

O objetivo do estudo foi identificar e comparar a percepção subjetiva do esforço (PSE) no limiar anaeróbio ventilatório (LAV) em indivíduos saudáveis e com doença arterial coronariana (DAC). Foram estudados 30 homens, sendo 10 saudáveis que constituíram o grupo controle (GC) e 20 diagnosticados com DAC, dos quais 10 faziam uso de medicamento betabloqueador (G-DACb) e 10 não faziam uso (G-DAC). Os voluntários foram submetidos a um teste de exercício cardiopulmonar (TECP) com protocolo contínuo tipo rampa para determinação do LAV, através da análise visual gráfica (perda do paralelismo entre o consumo de oxigênio e a produção de dióxido de carbono). Durante a realização do TECP, foi solicitado aos voluntários que relatassem ao final de cada minuto a percepção subjetiva do esforço de membros inferiores (PSE-M) e a percepção subjetiva do esforço respiratório (PSE-R), através da escala CR-10 de Borg. O GC apresentou maiores valores de potência, consumo de oxigênio, produção de dióxido de carbono, ventilação e frequência cardíaca no LAV comparado aos grupos G-DAC e G-DACb (p<0,05). A PSE-M foi menor no G-DACb comparado ao GC (p<0,05). Após ajuste pela covariável potência, não houve diferença significativa entre os grupos para PSE-M e PSE-R (p>0,05). Valores entre cinco e seis na escala CR-10 de Borg correspondeu ao LAV na amostra estudada. Entretanto, outros parâmetros devem ser utilizados concomitantemente para a prescrição da intensidade de exercício nos protocolos de treinamento físico, em níveis próximos ao LAV para pacientes com DAC.

Cardiopulmonary exercise testing in the early-phase of myocardial infarction / Teste de exercício cardiopulmonar na fase precoce do infarto do miocárdio

OBJECTIVE: To evaluate and to compare the cardiorespiratory and metabolic variables at the ventilatory anaerobic threshold level (AT) and at submaximal cardiopulmonary exercise testing (CPET) in both, healthy volunteers and in patients in the early phase after acute myocardial infarction (AMI). METHOD: Twenty-six volunteers underwent a submaximal or symptom-limited cardiopulmonary exercise testing (CPET) on a cycle ergometer and were divided into AMI group (AMIG=12, 56.33±8.65 years) and healthy group (CG=14, 53.33±3.28 years). The primary outcome measures were the cardiorespiratory and metabolic variables obtained at the peak workload and at the AT of the CPET. Statistical test: independent Student's t-test, α=5%. RESULTS: The AMIG presented lower values at the AT and the peak workload of the CPET compered to the CG: power in watts (91.06±30.10 and 64.88±19.92; 154.93±34.65 and 120.40±29.60); VO2 mL.kg-1.min-1 (17.26±2.71 and 12.19±2.51; 25.39±5.73 and 19.41±5.63); VCO2 L/min-1 (1.43±0.31 and 0.93±0.23; 2.07±0.43 and 1.42±0.36), VO2 L/min-1 (1.33±0.32 and 1.00±0.23; 1.97±0.39 and 1.49±0.36); VE L/min-1 (42.13±8.32 and 27.51±5.86; 63.07±20.83 and 40.82±11.96); HR (bpm) (122.96±14.02 and 103.46±13.38; 149.67±13.77 and 127.60±10.04), double product (DP) (bpm.mmHg.min-1) (21835.86±3245.93 and 17333.25±2716.51; 27302.33±3053.08 and 21864.00±2051.48), respectively. The variable oxygen uptake efficiency slope (OUES L/min) was lower in the AMIG (1.79±0.51) than the CG (2.26±0.37). The AMIG presented neither ECG alterations nor symptoms that limited the CPET. CONCLUSION: The results suggest that patients with AMI Killip class I presented lower functional capacity and DP compared to the CG without presenting ischemic alterations. Thus, the study suggests that submaximal CPET can be applied at an early stage to evaluate cardiorespiratory status since it is both safe and highly sensitive to detect changes.

OBJETIVO: Avaliar e comparar as variáveis cardiorrespiratórias e metabólicas no nível do limiar de anaerobiose ventilatório (LAV) e no pico do teste de exercício cardiopulmonar (TECP) submáximo em voluntários saudáveis e em pacientes na fase precoce após o infarto agudo do miocárdio (IAM). MÉTODO: Vinte e seis voluntários realizaram TECP submáximo ou sintoma limitante em cicloergômetro e foram divididos em grupo IAM (G-IAM=12, 56,33±8,65 anos) e grupo saudável (GC=14, 53,33±3,28 anos). As medidas dos desfechos principais foram as variáveis cardiorrespiratórias e metabólicas obtidas no pico e no LAV do TECP. Teste estatístico: t-Student não pareado, α=5%. RESULTADOS: O G-IAM apresentou menores valores no LAV e no pico do TECP que o GC (p<0,05): potência em Watts (91,06±30,10 e 64,88±19,92; 154,93±34,65 e 120,40±29,60); VO2mL.kg-1.min-1 (17,26±2,71 e 12,19±2,51; 25,39±5,73 e 19,41±5,63); VCO2L/min-1 (1,43±0,31 e 0,93±0,23; 2,07±0,43 e 1,42±0,36), VO2L/min-1 (1,33±0,32 e 1,00±0,23; 1,97±0,39 e 1,49±0,36); VEL/min-1 (42,13±8,32 e 27,51±5,86; 63,07±20,83 e 40,82±11,96); FC (bpm) (122,96±14,02 e 103,46±13,38; 149,67±13,77 e 127,60±10,04); duplo produto (DP) (bpm.mmHg.min-1) (21835,86±3245,93 e 17333,25±2716,51; 27302,33±3053,08 e 21864,00±2051,48), respectivamente. A variável Oxygen Uptake Efficiency Slope (OUES L/min) do G-IAM foi 1,79±0,51 e do GC 2,26±0,37, p<0.05. O G-IAM não apresentou alterações eletrocardiográficas ou sintomas que limitassem o TECP. CONCLUSÃO: Os resultados mostram que os pacientes com IAM Killip I apresentaram menor capacidade funcional e DP em relação ao GC, sem apresentar alterações isquêmicas. Assim, o estudo sugere que o TECP submáximo pode ser aplicado precocemente para a avaliação cardiorrespiratória por apresentar alta sensibilidade para detectar alterações de forma segura.

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease / Relação entre a modulação autonômica cardíaca e as características clínicas e angiográficas de pacientes com doença arterial coronariana

BACKGROUND: A reduction in heart rate variability (HRV) is considered an important indicator of autonomic dysfunction. OBJECTIVES: The aims of this study were to evaluate the presence of autonomic dysfunction measured by HRV in patients with coronary artery disease (CAD) and to compare them with normal subjects. METHODS: A sample of 52 men (mean age 54±5.39 years) was allocated into three groups: obstructive CAD ≥50 percent (CAD+ n=18), obstructive CAD <50 percent, (CAD- n=17) and apparently healthy controls (CG n=17). Heart rate (HR) was measured at rest using a Polar®S810i for 15 min. HRV was analyzed via Shannon entropy (SE) and symbolic analysis (0V and 2ULV), which relate to sympathetic and vagal predominance, respectively. Statistical analysis included the Kruskal-Wallis test and multivariate analysis (p<0.05). RESULTS: The CAD+ group presented lower SE and 2ULV percent values and higher 0V percent compared to CAD- and control groups (p<0.05). In the multivariate analysis, the presence of the clinical characteristics such as myocardial infarction and revascularization in the CAD+ group lead to a lower SE and higher 0V compared to the CAD- group. The use of angiotensin converting enzymes led to a higher SE in the CAD- group compared to the CAD+ (p<0.05). CONCLUSION: In uncomplicated CAD+ patients the patterns of HRV have a lower complexity, a greater sympathetic modulation and a lower parasympathetic modulation compared to CAD- and control groups in supine resting conditions. These results indicate that autonomic heart dysfunction is related to the degree of coronary occlusion and cardiac compromise.

CONTEXTUALIZAÇÃO: A redução da variabilidade da frequência cardíaca (VFC) é considerada como um importante marcador de disfunção autonômica. OBJETIVOS: Avaliar a VFC em pacientes com doença arterial coronariana (DAC) e compará-los com sujeitos saudáveis. MÉTODOS: Cinquenta e dois homens (53±7,2 anos), divididos em três grupos, sendo dois grupos com obstrução coronariana (DAC+ com obstrução ≥50 por cento, n=17 e DAC+ com obstrução ≥50 por cento, n=18) e um grupo controle (GC, n=17). A frequência cardíaca (FC) foi captada batimento a batimento, a partir do Polar®S810i, em repouso supino, durante 15 minutos. A análise da VFC foi feita pelos cálculos da entropia de Shannon (ES) e pelos padrões da análise simbólica (0V e 2ULV por cento), relacionados à predominância simpática e vagal, respectivamente. A análise estatística incluiu o teste de Kruskal-Wallis e a análise multivariada (p<0,05) RESULTADOS:O grupo DAC+ apresentou menores valores de ES e 2ULV por cento e maior 0V quando comparado aos grupos DAC- e CG. Na análise multivariada, observou-se menor ES e maior 0V na presença das características clínicas prévias, como infarto e revascularização do miocárdio no grupo DAC+ comparado ao grupo DAC-. O uso de inibidores da enzima conversora de angiotensina contribuiu para maior ES do grupo DAC- comparado ao DAC+. CONCLUSÃO: Na DAC+ não complicada, os padrões da VFC apresentam menor complexidade, maior modulação autonômica simpática e menor modulação parassimpática comparativamente ao DAC- e ao GC em repouso supino. Esses resultados indicam que a disfunção autonômica cardíaca está relacionada ao grau de oclusão coronariana e ao comprometimento cardíaco.

Comprometimento arterial coronariano e função pulmonar em homens de meia idade / The involvement of the coronary arteries and pulmonary function in middle-aged men

Introdução: Redução da função pulmonar tem sido associada a eventos coronarianos, contribuindo para o aumento da incidência de morte por doença cardiovascular. Objetivo: Comparar a função pulmonar entre sujeitos aparetemente saudáveis e com comprometimento arterial coronariano. Materiais e Métodos: Participaram de estudo 46 homens de meia idade, com baixo nível de atividade física, os quais foram divididos em quatro grupos: aparetemente saudáveis (GS,n=10); com obstrução do diâmetro luminal coronariano menor que 50% nas artérias comprometidas (GDAC-,n=12); e com infarto agudo do miocárdio (IAM), classificação clínica KIllip 1 (GIAM n=12). Todos foram submetidos à avaliação da função pulmonar por meio da espirometria. Resultados: Tanto para a capacidade vital forçada (CVF) como para o volume expiratório forçado no primeiro segundo (VEF1), o GS apresentou maiores valores quando comparado aos grupos Dac+ e IAM (p<0,05). Na comparação dos resultados entre os grupos com comprometimento arterial coronariano, tanto a CVF com VEF, o GDAC- e o GDAC+ apresentaram maiores valores quando comparados ao GIAM (p<0,05). A análise de regressão linear múltipla mostrou que a variável de maior associação com o VEF, foi o comprometimento arterial coronariano (r2=0,50, p<0,0001), não tendo o tabagismo apresentado significância (p>0,67). Conclusão: redução nos valores de CVF e VEF1 está relacionada ao grau de compropmetimento coronariano neste grupo de pacientes, independentemente do tabagismo, sugerindo que o processo aterogênico pode ter impacto negativo sobre a função pulmonar de pacientes com DAC.

Introduction: Reduction of pulmonary function has been associated with coronary events, contributing to the increased incidence of death by cardiovascular disease. Objective: To compare the pulmonary function among apparently healthy subjects with arterial coronary obstruction. Materials and Methods: A group of 46 middle-aged men with low levels of weekly physical activity, which were divided into: apparently healthy (AH,n=10); with obstruction of coronary luminal diameter less than 50% obstruction arteries (GCAD-,n=10); with coronary obstruction greater than or equal to 50% in at least one artery (DCAD+,n=12); and with acute myocardial infarction (AMI) clinical classification KILLIP I (GAIM,n=12). All were submited for the evaluation of pulmonary function by spirometry. Results: Both for the forced vital capacity (FVC) and forced experiratory volume in one second (FEV1), The AH presented greater values when compared to CAD+ and AMI group (p<0.005). Comparison of results between the groups with arterial coronary obstruction, both for the CVF as to the VEF1, the GCAD- and the larger values when GCAD+ feature compared to the GAIM (p<0.05). Multiple linear regression analysis showed that the largest association with FEV1 was the coronary obstruction (r2=0.50p<0.0001), not having smoking presented significance (p>0.67). Conclusion: The reduction in values of FVC and FEV1 is related to the degree of coronary obstruction in this group of patients, independent of smoking, suggesting that the atherogenic process can have a negative impact on pulmonary function of patients with CAD.

Prevalência de amputação em membros inferiores de causa vascular: análise de prontuários / Prevalence amputation on inferior members from vascular cause: analyses of promptuary

A amputação é o procedimento cirúrgico mais antigo e significa retirada, geralmente, cirúrgica, total ou parcial de um membro. A amputação não deve ser considerada como fim, e sim como o início de uma nova fase, que tem como principal objetivo manter e/ou devolver a dignidade e funcionalidade do paciente. Acredita-se em que, dentre todas as amputações, as de membros inferiores ocorrem em 85 por cento dos casos, sendo suas causas mais comuns: insuficiência vascular periférica como conseqüência de diabetes, aterosclerose, embolias, tromboses arteriais, traumatismos e tumores malignos. Das causas vasculares que levam a amputação, o diabetes corresponde a 80 por cento, e as taxas de mortalidade associada à amputação variam de 6 a 17 por cento. Acredita-se em que o prognóstico é pios em pacientes idosos, pois está associado a uma habilidade física desfavorável e uma maior dependência social. As amputações podem levar a complicações como: hematoma, infecções, necrose, contraturas, neuromas, sensação fantasma e dor fantasma, além das complicações psicológicas. Foi realizado um levantamento de dados dos prontuários dos anos de 2002 e 2003 do Hospital Regional da cidade de Cascavel-PR, e coletados dados referentes à idade do paciente, sexo, motivo vascular da amputação, nível glicêmico e número de amputações sofridas pelo mesmo paciente