Introdução: Durante a radioterapia torácica (RT) para o câncer de mama, parte do parênquima pulmonar adjacente a caixa torácica acaba secundariamente sendo incluída no campo de tratamento, podendo cursar com lesões pulmonares e perdas na capacidade funcional. Essas seqüelas necessitam ser mais bem compreendidas, considerando o bom prognóstico da doença. Objetivos: Avaliar o impacto da RT na capacidade funcional em pacientes com neoplasia de mama. Métodos: Estudo prospectivo que incluiu 41 pacientes consecutivas entre Janeiro de 2008 a Julho de 2009. As pacientes foram submetidas a uma avaliação da capacidade respiratória, da capacidade de exercício e tomografia de tórax de alta resolução antes do início e após 3 meses do término do tratamento. Para a avaliação respiratória foram mensurados a força de músculos respiratórios, mobilidade de caixa torácica e prova de função pulmonar completa. A capacidade de exercício foi avaliada através de teste cardiopulmonar de esforço (ergoespirometria). Foram calculados a dose pulmonar média e o volume pulmonar que recebeu uma dose de 25Gy em valor absoluto (V25cm3) e em porcentagem do volume pulmonar total (V25%). Os sintomas respiratórios (pneumonite) e dermatológicos (dermatite) foram classificados de acordo com escalas previamente descritos na literatura na avaliação final. Resultados: Após 3 meses da RT foram encontrados presença de sintomas de pneumonite actínica e dermatite actínica, com piora na performace status e diminuição da tolerância aos esforços para as atividades cotidianas. Na avaliação respiratória foram encontradas significativas perdas na força de músculos respiratórios (p<0,0001), mobilidade de caixa torácica (p<0,0001) e nos volumes e capacidades pulmonares. Não foram observados alterações na difusão (p=0,56). Os resultados obtidos na ergoespirometria foram significativamente piores após a RT e 87% das CT se mostraram alteradas. Conclusões: A RT agudamente cursa com perdas na capacidade funcional, caracterizando um quadro de descondicionamento físico. A inclusão da fossa supraclavicular no campo de tratamento aparentemente representa um fator de risco no surgimento dos sintomas de pneumonite e dermatite actínica / Introduction: Postoperative radiotherapy (RT) in breast cancer involves part of the pulmonary parenchyma with potential losses in functional capacity. Those effects deserve to be more depth understands, considering the good prognosis of the disease. The purpose of this study was to analyze the impact of radiotherapy in functional capacity after 3 months in patients treated with breast cancer. Methods: 41 consecutive women were performed lung high resolution computed tomography, respiratory and exercise capacity evaluation before and after 3 months of the completion of RT. The respiratory evaluation included complete pulmonary function test, respiratory muscle strength and chest wall measurement. Cardiopulmonary exercise test was used to evaluate the exercise capacity. The mean lung dose of RT and the lung volume receiving 25Gy in absolute value (V25cm3) and in percentage of total pulmonary volume (V25%) were calculated. Results: After 3 months significant decreases in respiratory muscle strength, chest wall mobility, exercise capacity and PFT were observed, except the diffusion capacity. HRCT showed changes related to RT in 87%, and that change was more important in patients with supraclavicular fossa included in RT treatment. Conclusions: Local RT for breast cancer led to a significant loss in functional capacity and physical deconditioning. The HRCT changes correlated with the inclusion of SCF in the treatment field and potentially represent a risk factor to development of radiation pneumonitis

A insuficiência aórtica (IAo) crônica é uma lesão regurgitante, caracterizada pelo fluxo retrógrado de sangue durante a diástole. A utilização do exercício físico como forma de exploração das repercussões funcionais, caracterização da gravidade da IAo e determinação da classe funcional objetivamente, além da identificação de parâmetros funcionais capazes de identificar o estágio clínicofuncional na IAo é bastante atraente. Objetivos: avaliar a capacidade funcional dos portadores de IAo através do teste de esforço cardiopulmonar (TCP) e do teste de caminhada de seis minutos (TC6\'), subdivididos de acordo com a gravidade da regurgitação da válvula; comparar o desempenho desses portadores de IAo no TCP a um grupo de voluntários saudáveis; testar a reprodutibilidade do TC6\' nessa amostra de portadores de IAo. Casuística e métodos: os pacientes foram submetidos à ressonância magnética cardíaca e distribuídos em grupos IAo leve (n=6), IAo moderada (n=9) e IAo grave (n=10). Doze voluntários saudáveis foram incluídos (grupo controle - GC). Os voluntários estudados foram submetidos a um TCP máximo em cicloergômetro, com protocolo incremental do tipo rampa e a dois testes de caminhada de seis minutos (TC6\'-1 e TC6\'-2), com intervalo de 30 minutos entre eles. Resultados: no repouso, não encontramos diferença estatisticamente significante dos valores de VO2, frequência cardíaca e pressão arterial diastólica; a pressão arterial sistólica foi menor no GC, comparada ao grupo IAo grave. No esforço submáximo não identificamos diferença estatisticamente significante nos parâmetros, exceto pela potência que foi menor no grupo IAo grave quando comparada ao GC. A FC pico foi maior no GC, comparado ao grupo IAo leve e IAo moderada; a potência no pico do esforço foi maior no GC comparado aos grupos IAo leve, IAo moderada e IAo grave; a Ve no pico do esforço foi menor no grupo IAo grave quando comparado ao GC. No 9 grupo IAo grave, a medida de VO2 pico real foi menor que o VO2 pico predito, representando 77% do predito. Ve/VCO2 slope, OUES e pulso de O2 não foram diferentes entre os grupos. As medidas obtidas no TC6\', no repouso, no pico ou na recuperação, não demonstraram diferença estatisticamente significante entre os grupos; os TC6\'-1 e TC6\'-2 se mostraram reprodutíveis e houve fraca correlação entre VO2 pico obtido no TCP e distância percorrida do TC6\'-2 nos portadores de IAo, independente da gravidade da regurgitação da válvula. Conclusão: em portadores de IAo crônica pura assintomáticos, as medidas de trocas gasosas e as respostas hemodinâmicas e metabólicas frente ao exercício físico podem não caracterizar a gravidade da regurgitação da válvula. Apesar de assintomáticos ou minimamente sintomáticos, e de apresentarem modestos sinais de remodelamento ventricular esquerdo, os portadores de IAo grave apresentavam-se com capacidade funcional reduzida, podendo ser resultado do processo evolutivo da doença. O TC6\' não foi capaz de diferenciar os portadores de IAo crônica pura assintomáticos, porém mostrou ser reprodutível nessa amostra de pacientes com IAo, o que sugere ser essa ferramenta útil no seguimento desses pacientes e possível identificação de limitações funcionais que possam vir a surgir com a evolução da doença. / Aortic regurgitation (AR) is a chronic regurgitant lesion, characterized by the backflow of blood during diastole. The use of physical exercise as a form of exploration of functional repercussions, characterizing the severity of AR and objectively determining the functional class, and identification of functional parameters able to identify the clinical and functional stage in AR is quite attractive. Objectives: To evaluate the functional capacity of patients with AR through cardiopulmonary exercise testing (CPET) and the six-minute walk test (6MWT), subdivided according to the severity of valve regurgitation; compare the performance of these carriers in the CPET with group of healthy volunteers; test the reproducibility of the 6MWT in this sample of patients with AR. Methods: Patients underwent cardiac resonance magnetic and distributed in mild AR groups (n = 6), moderate AR (n = 9) and severe AR (n = 10). Twelve healthy volunteers were included (control group - CG). Volunteers studied were submitted to a maximum CPET ergometer with incremental protocol ramp type and two sixminute walk test (6MWT-1 and 6MWT-2) with an interval of 30 minutes between them. Results: at rest, no statistically significant difference in VO2 values, heart rate (HR) and diastolic blood pressure; systolic blood pressure was lower in the CG compared to the severe AR group. In submaximal effort, we did not identify statistically significant differences in the parameters, except for the load that was less severe AR group compared to the CG. HR peak was higher in the CG compared to the mild group and moderate AR; load at peak exercise was greater in the CG compared with the mild AR groups, moderate and severe AR; the Ve at peak exercise was lower in severe AR group when compared to the CG. In severe AR group, the measure VO2 real peak was lower than the predicted peak VO2, representing 77% of predicted. Ve / VCO2 slope, OUES and O2 pulse were not different between groups. The measurements obtained in the 6MWT, at rest, at 11 the peak or recovery, showed no statistically significant difference between the groups; the 6MWT-1 and 6MWT-2 proved to be reproducible and there was a weak correlation between peak VO2 obtained in TCP and the distance traveled 6MWT-2 in patients with AR, independent of valve regurgitation severity. Conclusion: in patients with pure chronic asymptomatic AR, measures gas exchange and hemodynamic and metabolic responses during physical exercise can not characterize the valve regurgitation severity. Although asymptomatic or minimally symptomatic, and present modest signs of left ventricular remodeling, the severe AR carriers presented with reduced functional capacity, may be the result of the evolutionary process of the disease. The 6MWT was not able to differentiate patients with pure chronic AR asymptomatic, but proved to be reproducible in this sample of patients with AR, which suggests that this useful tool in monitoring these patients and possible identification of functional limitations that may arise with the evolution of the disease.

Introdução: Durante a radioterapia torácica (RT) para o câncer de mama, parte do parênquima pulmonar adjacente a caixa torácica acaba secundariamente sendo incluída no campo de tratamento, podendo cursar com lesões pulmonares e perdas na capacidade funcional. Essas seqüelas necessitam ser mais bem compreendidas, considerando o bom prognóstico da doença. Objetivos: Avaliar o impacto da RT na capacidade funcional em pacientes com neoplasia de mama. Métodos: Estudo prospectivo que incluiu 41 pacientes consecutivas entre Janeiro de 2008 a Julho de 2009. As pacientes foram submetidas a uma avaliação da capacidade respiratória, da capacidade de exercício e tomografia de tórax de alta resolução antes do início e após 3 meses do término do tratamento. Para a avaliação respiratória foram mensurados a força de músculos respiratórios, mobilidade de caixa torácica e prova de função pulmonar completa. A capacidade de exercício foi avaliada através de teste cardiopulmonar de esforço (ergoespirometria). Foram calculados a dose pulmonar média e o volume pulmonar que recebeu uma dose de 25Gy em valor absoluto (V25cm3) e em porcentagem do volume pulmonar total (V25%). Os sintomas respiratórios (pneumonite) e dermatológicos (dermatite) foram classificados de acordo com escalas previamente descritos na literatura na avaliação final. Resultados: Após 3 meses da RT foram encontrados presença de sintomas de pneumonite actínica e dermatite actínica, com piora na performace status e diminuição da tolerância aos esforços para as atividades cotidianas. Na avaliação respiratória foram encontradas significativas perdas na força de músculos respiratórios (p<0,0001), mobilidade de caixa torácica (p<0,0001) e nos volumes e capacidades pulmonares. Não foram observados alterações na difusão (p=0,56). Os resultados obtidos na ergoespirometria foram significativamente piores após a RT e 87% das CT se mostraram alteradas. Conclusões: A RT agudamente cursa com perdas na capacidade funcional, caracterizando um quadro de descondicionamento físico. A inclusão da fossa supraclavicular no campo de tratamento aparentemente representa um fator de risco no surgimento dos sintomas de pneumonite e dermatite actínica / Introduction: Postoperative radiotherapy (RT) in breast cancer involves part of the pulmonary parenchyma with potential losses in functional capacity. Those effects deserve to be more depth understands, considering the good prognosis of the disease. The purpose of this study was to analyze the impact of radiotherapy in functional capacity after 3 months in patients treated with breast cancer. Methods: 41 consecutive women were performed lung high resolution computed tomography, respiratory and exercise capacity evaluation before and after 3 months of the completion of RT. The respiratory evaluation included complete pulmonary function test, respiratory muscle strength and chest wall measurement. Cardiopulmonary exercise test was used to evaluate the exercise capacity. The mean lung dose of RT and the lung volume receiving 25Gy in absolute value (V25cm3) and in percentage of total pulmonary volume (V25%) were calculated. Results: After 3 months significant decreases in respiratory muscle strength, chest wall mobility, exercise capacity and PFT were observed, except the diffusion capacity. HRCT showed changes related to RT in 87%, and that change was more important in patients with supraclavicular fossa included in RT treatment. Conclusions: Local RT for breast cancer led to a significant loss in functional capacity and physical deconditioning. The HRCT changes correlated with the inclusion of SCF in the treatment field and potentially represent a risk factor to development of radiation pneumonitis

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by cardiac ventricular myocytes upon pressure and volume overload and is a prognostic marker to monitor the severity of precapillary pulmonary hypertension and the extent of right heart failure. Objectives: The impact of physical exercise on NT-proBNP levels in patients with left heart disease was demonstrated previously. No data regarding patients with isolated right heart failure and the influence of acute exercise on NT-proBNP serum levels exist. Methods: Twenty patients with precapillary pulmonary hypertension were examined. Hemodynamic parameters were measured during right heart catheterization. Serum NT-proBNP of patients was measured at rest, after a 6-min walking test, during ergospirometry and during recovery, all within 7 h. Significant differences in sequential NT-proBNP values, relative changes compared to values at rest and the correlation between NT-proBNP and obtained parameters were assessed. Results: At rest, the mean serum level of NT-proBNP was 1,278 ± 998 pg/ml. The mean level of NT-proBNP at maximal exercise was increased (1,592 ± 1,219 pg/ml), whereas serum levels decreased slightly during recovery (1,518 ± 1,170 pg/ml). The relative increase of serum NT-proBNP during exercise correlated with pulmonary vascular resistance (r = 0.45; p = 0.026) and cardiac output (r = –0.5; p = 0.015). Conclusions: In this study, we demonstrated acute changes in NT-proBNP levels due to physical exercise in a small group of patients with precapillary pulmonary hypertension. Our results also confirm the predominant usefulness of NT-proBNP as an intraindividual parameter of right heart load. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Made available in DSpace on 2016-06-02T20:19:18Z (GMT). No. of bitstreams: 1 4378.pdf: 3130081 bytes, checksum: fdc5d927859ef950b1a967b46b1a0e4c (MD5) Previous issue date: 2012-04-25 / Universidade Federal de Minas Gerais / Diabetes Mellitus (DM) is associated with many complications, including impairment of cardiorespiratory fitness and pulmonary function. Increasing evidences has suggested that comorbidities and systemic inflammation may be involved. The objective of this study was to evaluate cardiorespiratory function in rest and exercise in adults with DM and to verify the relationship between inflammation. Nineteen men with diabetes (51,16 years ± 5,92) and nineteen control subjects (48,79 years ± 7,47) were studied. All individuals were subjected to incremental cardiopulmonary exercise test in cycle ergometer, spirometry, intracellular cytokine lymphocyte profile, lipid and c-reactive protein (CRP) plasma concentration. In the exercise test, maximal overload (W), peak heart rate (HRpeak), oxygen consumption at peak (VO2peak) and at anaerobic threshold (VO2AT), respiratory exchange ratio (RER) were significantly lower in patients with DM than in control subjects. Control subjects and individuals with DM were not different in age, blood pressure, lipid and CRP plasma concentration and intracellular cytokine lymphocites production of TNF-&#945;, IFN-&#947;, IL-4, IL-10 e IL-17. No significant differences were noted in pulmonary function variables, but abnormalities in these data were predictors to DM. In conclusion, the results confirm impairment of the cardiopulmonary fitness in subjects with DM. The inflammation associated with DM might be influenced by other factors absent in our sample. In addition, the data suggest spirometric abnormalities as predictive to diabetes mellitus. / O Diabetes Mellitus (DM) está associada a diversas complicações, incluindo redução do condicionamento físico e alteração da função pulmonar. O número de evidências sugerindo o envolvimento da inflamação sistêmica na fisiopatologia do DM e suas complicações é crescente. O objetivo do presente estudo foi avaliar o função cardiorespiratória em repouso e durante o exercício físico em indivíduos portadores de DM e verificar a sua relação com mediadores inflamatórios. Participaram do estudo 19 homens portadores de DM (51,16 anos ± 5,92) e 19 controles saudáveis (48,79 anos ± 7,47). As avaliações incluiam: teste de função pulmonar, teste de exercício cardiopulmonar com protocolo incremental em cicloergômetro, concentrações plasmáticas de lipídios e de HbA1c e o perfil de produção intracelular de citocinas linfocitárias em sangue periférico. No teste de exercício verificamos que a potência máxima, frequência cardíaca pico (FCpico), consumo de oxigênio no pico do exercício (VO2pico) e no limiar de anaerobiose (VO2LA) e a taxa de troca gasosa (RER) foram significativamente menores em indivíduos do grupo diabético. Não houve diferença entre os grupos em relação a idade, concentração plasmática de lipídios, proteína C-reativa (PCR), perfil de produção linfocitária das citocinas TNF-&#945;, IFN-&#947;, IL-4, IL-10 e IL-17. Também não foram observadas diferenças entre os grupos no teste de função pulmonar, porém alterações nessas variáveis foram preditivas para DM. Concluindo, nossos resultados confirmam a redução da capacidade cardiopulmonar em indivíduos com DM. A inflamação sistêmica associada ao DM pode ser influenciada por outros fatores ausentes na amostra estudada. Adicionalmente, os dados sugerem anormalidades espirométricas como fatores preditivos para o diabetes mellitus.

Made available in DSpace on 2014-12-17T15:16:20Z (GMT). No. of bitstreams: 1 NicoleSOC_DISSERT.pdf: 1342792 bytes, checksum: c040154e5911aeafa634f51d3ef0bb57 (MD5) Previous issue date: 2013-11-29 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / obesity affects rightly functional capacity diminishing the cardiovascular system efficiency and oxygen uptake (VO2). Field tests, such as, Incremental Shuttle Walking Test (ISWT) and Six Minute Walk Test (6MWT) has been employed as alternative of Cardiopulmonary Exercise Test (CPX), to functional assessing for conditions which transport of oxygen to peripheral is diminished. Nevertheless, the knowing about metabolic variables response in real time and it comparing among different maximal and submaximal tests in obese is absent. Aim: to compare cardiopulmonary, metabolic response during CPX, ISWT and 6MWT and to analyse it influence of adiposity markers in obese. Material e Method: crosssectional, prospective study. Obese included if: (BMI>30Kg/m2; FVC>80%), were assessed as clinical, anthropometric (BMI, body adiposity index-BAI, waist-WC, hip- HC and neck-NC circumferences) and spirometry (forced vital capacity-FVC, Forced expiratory volume-1?second-FEV1, maximal voluntary ventilation-MVV) variables. Obese performed the sequence of tests: CPX, ISWT and 6MWT. Throughout tests was assessed breath-by-breath by telemetry system (Cortex-Biophysik-Metamax3B) variables; oxygen uptake on peak of activity (VO2peak); carbon dioxide production (VCO2); Volume Expiratory (VE); ventilatory equivalents for VO2 (VE/VO2) and CO2 (VE/VCO2); respiratory exchange rate (RER) and perceived effort-Borg6-20). Results: 15 obese (10women) 39.4+10.1years, normal spirometry (%CVF=93.7+9.7) finished all test. They have BMI (43.5+6.6kg/m2) and different as %adiposity (BAI=50.0+10.5% and 48.8+16.9% respectively women and men). Difference of VO2ml/kg/min and %VO2 were finding between CPX (18.6+4.0) and 6MWT (13.2+2.5) but not between ISWT (15.4+2.9). Agreement was found for ISWT and CPX on VO2Peak (3.2ml/kg/min; 95%; IC-3.0 9.4) and %VO2 (16.4%). VCO2(l/min) confirms similarity in production for CPX (2.3+1.0) and ISWT (1.7+0.7) and difference for 6MWT (1.4+0.6). WC explains more the response of CPX and ISWT than other adiposity markers. Adiposity diminishes 3.2% duration of CPX. Conclusion: ISWT promotes similar metabolic and cardiovascular response than CPX in obese. It suggesting that ISWT could be useful and reliable to assess oxygen uptake and functional capacity in obese / a obesidade afeta diretamente a capacidade funcional diminuindo a efici?ncia do sistema cardiovascular e o consumo de oxig?nio (VO2). Testes de campo, tais como, Incremental Shuttle Walking Test (ISWT) e Teste de Caminhada de 6 minutos (TC6M) tem sido empregados como alternativa ao Teste de Esfor?o Cardiopulmonar (TECP), para avalia??o funcional de patologias que levam a diminui??o da transfer?ncia de oxig?nio ? periferia, entretanto, pouco ? conhecido da respostas fisiol?gicas de vari?veis metab?licas e ventilat?rias em obesos durante teste incremental de exerc?cio. Objetivo: analisar e comparar as respostas cardiopulmonares, metab?licas (VO2pico-consumo de oxig?nio-pico e VCO2-produ??o de di?xido de carbono) e de esfor?o percebido nos testes subm?ximos de esfor?o (ISWT e TC6M) com o TECP. Materiais e M?todo: estudo transversal, prospectivo, onde foi avaliada a concord?ncia de dois diferentes testes de campo (TC6M e ISWT) com o TECP. Crit?rios de Inclus?o (IMC > 30Kg/m2; CVF > 80%). Os participantes realizaram avalia??o cl?nica, antropom?trica (IMC, IAC-?ndice de adiposidade corporal, RCQ-rela??o cintura-quadril, CQ-circunfer?ncia quadril, CC-circunfer?ncia cintura, CP-circunfer?ncia pesco?o) e espirom?trica (CVF-capacidade vital for?ada, VEF1-volume expirat?rio for?ado no 1? segundo, VVM-ventila??o volunt?ria m?xima). Obesos realizaram em momentos distintos a sequ?ncia de testes (TECP, TC6M e ISWT). Medidas ventilat?rias (VE-ventila??o por minuto, VE/VO2-equivalente ventilat?rio de oxig?nio, VE/VCO2-equivalente ventilat?rio de di?xido de carbono, RER-raz?o de troca gasosa) e metab?licas (VO2 e VCO2) dos gases expirados (breath-by-breath) com sistema de telemetria (Cortex-Biophysik-Metamax3B), al?m das vari?veis de percep??o de esfor?o (fadiga e dispneia-Borg6-20) foram tomadas. Resultados: os participantes eram adultos jovens (39.4+10.1 anos), com altos percentuais de adiposidade corporal (IAC=50.0+10.5%-mulheres; IAC=48.8+16.9%- homens) e IMC=43.5+6.6. Observou-se que IMC e CC justificaram isoladamente 56% e 48% da vari?ncia da dura??o do TECP. Diferen?as de VO2ml/kg/min e %VO2 nos obesos foram encontradas apenas entre TECP e TC6M (%VO2 p=0.008 em mulheres e p=0.01 nos homens), sendo os valores de VO2PICO de 18.6+4.0ml/kg/min no TECP; 15.4+2.9 no ISWT e 13.2+2.5 no TC6M. O Bland-Altman evidenciou concord?ncia entre TECP e o ISWT no VO2PICO (3.2ml/kg/min; 95%; IC -3.0 9.4) e no %VO2 (16.4%; 95%; -23.6 56.4). A an?lise da produ??o de CO2(l/min) xiv confirmou uma maior produ??o ao final do TECP (2.3+1.0), seguido do ISWT (1.7+0.7) e TC6M (1.4+0.6), por?m com diferen?as apenas entre o TECP e TC6M (p<0.01). Conclus?o: apesar de considerado um teste de esfor?o subm?ximo, o ISWT promove respostas metab?licas e cardiovasculares semelhantes ao TECP na popula??o obesa, sugerindo que o ISWT pode ser uma boa op??o para avaliar a capacidade funcional de obesos

A insuficiência aórtica (IAo) crônica é uma lesão regurgitante, caracterizada pelo fluxo retrógrado de sangue durante a diástole. A utilização do exercício físico como forma de exploração das repercussões funcionais, caracterização da gravidade da IAo e determinação da classe funcional objetivamente, além da identificação de parâmetros funcionais capazes de identificar o estágio clínicofuncional na IAo é bastante atraente. Objetivos: avaliar a capacidade funcional dos portadores de IAo através do teste de esforço cardiopulmonar (TCP) e do teste de caminhada de seis minutos (TC6\'), subdivididos de acordo com a gravidade da regurgitação da válvula; comparar o desempenho desses portadores de IAo no TCP a um grupo de voluntários saudáveis; testar a reprodutibilidade do TC6\' nessa amostra de portadores de IAo. Casuística e métodos: os pacientes foram submetidos à ressonância magnética cardíaca e distribuídos em grupos IAo leve (n=6), IAo moderada (n=9) e IAo grave (n=10). Doze voluntários saudáveis foram incluídos (grupo controle - GC). Os voluntários estudados foram submetidos a um TCP máximo em cicloergômetro, com protocolo incremental do tipo rampa e a dois testes de caminhada de seis minutos (TC6\'-1 e TC6\'-2), com intervalo de 30 minutos entre eles. Resultados: no repouso, não encontramos diferença estatisticamente significante dos valores de VO2, frequência cardíaca e pressão arterial diastólica; a pressão arterial sistólica foi menor no GC, comparada ao grupo IAo grave. No esforço submáximo não identificamos diferença estatisticamente significante nos parâmetros, exceto pela potência que foi menor no grupo IAo grave quando comparada ao GC. A FC pico foi maior no GC, comparado ao grupo IAo leve e IAo moderada; a potência no pico do esforço foi maior no GC comparado aos grupos IAo leve, IAo moderada e IAo grave; a Ve no pico do esforço foi menor no grupo IAo grave quando comparado ao GC. No 9 grupo IAo grave, a medida de VO2 pico real foi menor que o VO2 pico predito, representando 77% do predito. Ve/VCO2 slope, OUES e pulso de O2 não foram diferentes entre os grupos. As medidas obtidas no TC6\', no repouso, no pico ou na recuperação, não demonstraram diferença estatisticamente significante entre os grupos; os TC6\'-1 e TC6\'-2 se mostraram reprodutíveis e houve fraca correlação entre VO2 pico obtido no TCP e distância percorrida do TC6\'-2 nos portadores de IAo, independente da gravidade da regurgitação da válvula. Conclusão: em portadores de IAo crônica pura assintomáticos, as medidas de trocas gasosas e as respostas hemodinâmicas e metabólicas frente ao exercício físico podem não caracterizar a gravidade da regurgitação da válvula. Apesar de assintomáticos ou minimamente sintomáticos, e de apresentarem modestos sinais de remodelamento ventricular esquerdo, os portadores de IAo grave apresentavam-se com capacidade funcional reduzida, podendo ser resultado do processo evolutivo da doença. O TC6\' não foi capaz de diferenciar os portadores de IAo crônica pura assintomáticos, porém mostrou ser reprodutível nessa amostra de pacientes com IAo, o que sugere ser essa ferramenta útil no seguimento desses pacientes e possível identificação de limitações funcionais que possam vir a surgir com a evolução da doença. / Aortic regurgitation (AR) is a chronic regurgitant lesion, characterized by the backflow of blood during diastole. The use of physical exercise as a form of exploration of functional repercussions, characterizing the severity of AR and objectively determining the functional class, and identification of functional parameters able to identify the clinical and functional stage in AR is quite attractive. Objectives: To evaluate the functional capacity of patients with AR through cardiopulmonary exercise testing (CPET) and the six-minute walk test (6MWT), subdivided according to the severity of valve regurgitation; compare the performance of these carriers in the CPET with group of healthy volunteers; test the reproducibility of the 6MWT in this sample of patients with AR. Methods: Patients underwent cardiac resonance magnetic and distributed in mild AR groups (n = 6), moderate AR (n = 9) and severe AR (n = 10). Twelve healthy volunteers were included (control group - CG). Volunteers studied were submitted to a maximum CPET ergometer with incremental protocol ramp type and two sixminute walk test (6MWT-1 and 6MWT-2) with an interval of 30 minutes between them. Results: at rest, no statistically significant difference in VO2 values, heart rate (HR) and diastolic blood pressure; systolic blood pressure was lower in the CG compared to the severe AR group. In submaximal effort, we did not identify statistically significant differences in the parameters, except for the load that was less severe AR group compared to the CG. HR peak was higher in the CG compared to the mild group and moderate AR; load at peak exercise was greater in the CG compared with the mild AR groups, moderate and severe AR; the Ve at peak exercise was lower in severe AR group when compared to the CG. In severe AR group, the measure VO2 real peak was lower than the predicted peak VO2, representing 77% of predicted. Ve / VCO2 slope, OUES and O2 pulse were not different between groups. The measurements obtained in the 6MWT, at rest, at 11 the peak or recovery, showed no statistically significant difference between the groups; the 6MWT-1 and 6MWT-2 proved to be reproducible and there was a weak correlation between peak VO2 obtained in TCP and the distance traveled 6MWT-2 in patients with AR, independent of valve regurgitation severity. Conclusion: in patients with pure chronic asymptomatic AR, measures gas exchange and hemodynamic and metabolic responses during physical exercise can not characterize the valve regurgitation severity. Although asymptomatic or minimally symptomatic, and present modest signs of left ventricular remodeling, the severe AR carriers presented with reduced functional capacity, may be the result of the evolutionary process of the disease. The 6MWT was not able to differentiate patients with pure chronic AR asymptomatic, but proved to be reproducible in this sample of patients with AR, which suggests that this useful tool in monitoring these patients and possible identification of functional limitations that may arise with the evolution of the disease.

Kardiovaskuläre Erkrankungen spielen eine immer dominanter werdende Rolle als Ursachen von Morbidität und Mortalität. Endotheliale Dysfunktion, Arteriosklerose und ischämische Herzerkrankungen sind unangefochten die häufigsten Todesursachen in hochentwickelten Ländern. Die Krankheitslast kardiovaskulärer Erkrankungen wird durch die globale Zunahme von Risikofaktoren wie Übergewicht, metabolischem Syndrom und Diabetes mellitus Typ 2 in Zukunft wohl weiter steigen. Keines der in der heutigen Form existierenden Gesundheitssysteme ist den gesundheitlichen Folgen dieser bedenklichen epidemiologischen Entwicklung gewachsen, ohne dafür beträchtliche Einschnitte in Qualität oder Quantität hinnehmen zu müssen. Präventivmedizinische Strategien haben im Vergleich zur Akutmedizin bisher eine wesentlich geringere Aufmerksamkeit erfahren. Aufgrund der weiterhin steigenden Krankheitslast werden gerade präventivmedizinische Strategien immer wichtiger. Die Ermittlung der individuellen kardiovaskulären Gesundheit beinhalten neben einer Untersuchung wichtiger physiologsicher Kernsysteme, einen besonderen Fokus auf die Stärkung der gesundheitlichen Eigenverantwortung durch Vermittlung entsprechender medizinischer Zusammenhänge. Dies kann durch geeignete und prognostisch wertvolle Untersuchungsmethoden und laienverständliche Interpretationen der komplexen kardiovaskulären Zusammenhänge realisiert werden. Mithilfe eines besseren Verständnisses für die eigene kardiovaskuläre Gesundheit und gezielter konkreter Hilfestellungen von ärztlicher Seite, können grundlegende Strukturen für einen achtsameren Umgang mit der eigenen Gesundheit geschaffen werden. Alltägliche körperliche Aktivität, Körperzusammensetzung, Gefäßsteifigkeit und die maximale Leistungsfähigkeit bilden aktuellen Studien zufolge vier relativ einfach zu erhebend Hauptdeterminanten kardiovaskulärer Gesundheit mit großer prädiktiver Vorhersagekraft für kardiovaskulärer Ereignisse. Die Einordnung der Untersuchungsbefunde unter Berücksichtigung altersentsprechender Referenzdaten bietet zusätzlich die Möglichkeit, chronologisches und biologisches Alter zu differenzieren. Darüber hinaus könnte das hier vorgestellte Untersuchungskonzept ebenso dafür eingesetzt werden, die Effektivität von zuvor eingeleiteten therapeutischen Strategien zu überprüfen und eine Übermedikation zu vermeiden. Ein stärkerer Fokus auf nachhaltige kardiovaskuläre präventivmedizinische Strategien birgt das Potential Morbidität und Mortalität zu Reduzieren und die Lebensqualität und Selbstbestimmung der Klienten zu steigern. / Nowadays endothelial dysfunction, arteriosclerosis and ischaemic heart disease depict major issues in most developed countries. Chronic diseases cause an increasing number of deaths worldwide. Responsible for approximately 30% of all deaths, this number is shocking despite the knowledge that these lives could be saved in a realistic point of view. However, disturbing global tendencies and the increase in epidemic overweight, obesity, glucose intolerance and diabetes mellitus type 2 seem to amplify cardiovascular diseases and deaths. No existing medical care system could ever sufficiently match these emergent burdens of global chronic diseases if these tendencies will continue to grow. Due to fatal epidemiological changes general practitioners will not only have to treat more diseases of elderly people, but also be the first contact person for enquiries about their health concerning the cardiovascular systems of younger and older generations. Strengthening prevention concerning cardiovascular diseases is probably the most efficient and only way to escape the vicious circle of pathophysiological processes. To implement cardiovascular prevention it is essential to focus on cardiovascular health rather than on cardiovascular disease. In order to master this challenge sufficiently a deliberate concept of preventive examinations for cardiovascular health is required to quantify cardiovascular wellness and sharpen the awareness of one’s health. Therefore, it is to establish precise, predictive and cost-efficient examination methods to quantify cardiovascular health and subclinical changes at early stages of a disease. Broader acceptance of the preventive potential and the use of modern technological advances could therefore be a powerful instrument to solve the growing global problem of chronic diseases. In this context the routine evaluation of daily physical activity, body composition, arterial stiffness and the maximum physical performance could be a starting point for a preventive diagnostic approach. They can serve as future parameters reflecting health, detecting subclinical diseases and encouraging people’s responsibility for their own health. Detailed information about the major cardiovascular parameters opens specific and efficient course of action to create multiple strategies for gaining or rehabilitating cardiovascular wellbeing

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by cardiac ventricular myocytes upon pressure and volume overload and is a prognostic marker to monitor the severity of precapillary pulmonary hypertension and the extent of right heart failure. Objectives: The impact of physical exercise on NT-proBNP levels in patients with left heart disease was demonstrated previously. No data regarding patients with isolated right heart failure and the influence of acute exercise on NT-proBNP serum levels exist. Methods: Twenty patients with precapillary pulmonary hypertension were examined. Hemodynamic parameters were measured during right heart catheterization. Serum NT-proBNP of patients was measured at rest, after a 6-min walking test, during ergospirometry and during recovery, all within 7 h. Significant differences in sequential NT-proBNP values, relative changes compared to values at rest and the correlation between NT-proBNP and obtained parameters were assessed. Results: At rest, the mean serum level of NT-proBNP was 1,278 ± 998 pg/ml. The mean level of NT-proBNP at maximal exercise was increased (1,592 ± 1,219 pg/ml), whereas serum levels decreased slightly during recovery (1,518 ± 1,170 pg/ml). The relative increase of serum NT-proBNP during exercise correlated with pulmonary vascular resistance (r = 0.45; p = 0.026) and cardiac output (r = –0.5; p = 0.015). Conclusions: In this study, we demonstrated acute changes in NT-proBNP levels due to physical exercise in a small group of patients with precapillary pulmonary hypertension. Our results also confirm the predominant usefulness of NT-proBNP as an intraindividual parameter of right heart load. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Kardiovaskuläre Erkrankungen spielen eine immer dominanter werdende Rolle als Ursachen von Morbidität und Mortalität. Endotheliale Dysfunktion, Arteriosklerose und ischämische Herzerkrankungen sind unangefochten die häufigsten Todesursachen in hochentwickelten Ländern. Die Krankheitslast kardiovaskulärer Erkrankungen wird durch die globale Zunahme von Risikofaktoren wie Übergewicht, metabolischem Syndrom und Diabetes mellitus Typ 2 in Zukunft wohl weiter steigen. Keines der in der heutigen Form existierenden Gesundheitssysteme ist den gesundheitlichen Folgen dieser bedenklichen epidemiologischen Entwicklung gewachsen, ohne dafür beträchtliche Einschnitte in Qualität oder Quantität hinnehmen zu müssen. Präventivmedizinische Strategien haben im Vergleich zur Akutmedizin bisher eine wesentlich geringere Aufmerksamkeit erfahren. Aufgrund der weiterhin steigenden Krankheitslast werden gerade präventivmedizinische Strategien immer wichtiger. Die Ermittlung der individuellen kardiovaskulären Gesundheit beinhalten neben einer Untersuchung wichtiger physiologsicher Kernsysteme, einen besonderen Fokus auf die Stärkung der gesundheitlichen Eigenverantwortung durch Vermittlung entsprechender medizinischer Zusammenhänge. Dies kann durch geeignete und prognostisch wertvolle Untersuchungsmethoden und laienverständliche Interpretationen der komplexen kardiovaskulären Zusammenhänge realisiert werden. Mithilfe eines besseren Verständnisses für die eigene kardiovaskuläre Gesundheit und gezielter konkreter Hilfestellungen von ärztlicher Seite, können grundlegende Strukturen für einen achtsameren Umgang mit der eigenen Gesundheit geschaffen werden. Alltägliche körperliche Aktivität, Körperzusammensetzung, Gefäßsteifigkeit und die maximale Leistungsfähigkeit bilden aktuellen Studien zufolge vier relativ einfach zu erhebend Hauptdeterminanten kardiovaskulärer Gesundheit mit großer prädiktiver Vorhersagekraft für kardiovaskulärer Ereignisse. Die Einordnung der Untersuchungsbefunde unter Berücksichtigung altersentsprechender Referenzdaten bietet zusätzlich die Möglichkeit, chronologisches und biologisches Alter zu differenzieren. Darüber hinaus könnte das hier vorgestellte Untersuchungskonzept ebenso dafür eingesetzt werden, die Effektivität von zuvor eingeleiteten therapeutischen Strategien zu überprüfen und eine Übermedikation zu vermeiden. Ein stärkerer Fokus auf nachhaltige kardiovaskuläre präventivmedizinische Strategien birgt das Potential Morbidität und Mortalität zu Reduzieren und die Lebensqualität und Selbstbestimmung der Klienten zu steigern. / Nowadays endothelial dysfunction, arteriosclerosis and ischaemic heart disease depict major issues in most developed countries. Chronic diseases cause an increasing number of deaths worldwide. Responsible for approximately 30% of all deaths, this number is shocking despite the knowledge that these lives could be saved in a realistic point of view. However, disturbing global tendencies and the increase in epidemic overweight, obesity, glucose intolerance and diabetes mellitus type 2 seem to amplify cardiovascular diseases and deaths. No existing medical care system could ever sufficiently match these emergent burdens of global chronic diseases if these tendencies will continue to grow. Due to fatal epidemiological changes general practitioners will not only have to treat more diseases of elderly people, but also be the first contact person for enquiries about their health concerning the cardiovascular systems of younger and older generations. Strengthening prevention concerning cardiovascular diseases is probably the most efficient and only way to escape the vicious circle of pathophysiological processes. To implement cardiovascular prevention it is essential to focus on cardiovascular health rather than on cardiovascular disease. In order to master this challenge sufficiently a deliberate concept of preventive examinations for cardiovascular health is required to quantify cardiovascular wellness and sharpen the awareness of one’s health. Therefore, it is to establish precise, predictive and cost-efficient examination methods to quantify cardiovascular health and subclinical changes at early stages of a disease. Broader acceptance of the preventive potential and the use of modern technological advances could therefore be a powerful instrument to solve the growing global problem of chronic diseases. In this context the routine evaluation of daily physical activity, body composition, arterial stiffness and the maximum physical performance could be a starting point for a preventive diagnostic approach. They can serve as future parameters reflecting health, detecting subclinical diseases and encouraging people’s responsibility for their own health. Detailed information about the major cardiovascular parameters opens specific and efficient course of action to create multiple strategies for gaining or rehabilitating cardiovascular wellbeing