Made available in DSpace on 2014-06-11T19:22:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-15Bitstream added on 2014-06-13T19:48:21Z : No. of bitstreams: 1 ambrozin_arp_dr_botfm.pdf: 169682 bytes, checksum: e35521aad39da34ec6c55a5da6cd12ad (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de... / Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)

Cancer (CA) is the second leading cause of death in the United States preceded only by cardiovascular disease (CVD). Over the past 30 years, the 5-year survival rate for all cancers combined has increased by more than 20%. This improved survival rate is due to early diagnosis and advances in treatment involving a multimodality treatment approach that includes radiotherapy [RT] with about half of all CA patients receiving some type of RT sometime during the course of their treatment. Cardiotoxicity is one of the most important adverse reactions of RT and leads to a meaningful risk of CVD-related morbidity and mortality. Radiotherapy-related cardiotoxicity is a heterogeneous clinical syndrome characterized by symptoms related to impaired cardiac function due to radiation-injury to one or more cardiac structures. Furthermore, the relative risk of CVD increases with increasing incidental radiation dose to the heart. There is not a unified consensus on the definition of CA-related cardiotoxicity although most trials have focused on changes in resting systolic function, and/or development of cardiac symptoms.Commonly used tools to assess cardiac function are insensitive to minor injury hence subtle changes may go unnoticed for many years. Cardiotoxicity definitions should include a dynamic functional assessment of the CV system. This may allow detection of latent CV abnormalities before the precipitous decline of resting myocardial function or the development of CV symptomology that may impact quality of life. Cardiopulmonary exercise testing (CPET) including measurement of peak oxygen consumption (VO2) is the gold standard for the assessment of cardiorespiratory fitness (CRF). Cardiorespiratory fitness is a strong, independent predictor of mortality, CVD-related mortality, HF-related morbidity and mortality, CA-related mortality and may be involved in the pathophysiologic link between anti-CA related treatments and the increased risk of late CVD events. Emerging evidence indicates CRF may be reduced in CA survivors and have utility to detect subclinical cardiotoxicity, but this has not been evaluated in CA survivors treated with RT with significant heart involvement. This dissertation consists of one literature review and one comprehensive paper that will examine the ability of CPET to detect subclinical cardiotoxicity.

Objetivo: Avaliar o condicionamento cardiorrespiratório de crianças e adolescentes com BOPI através do teste cardiopulmonar de exercício (TCPE). Métodos: Foram estudadas 20 crianças com BOPI, com idade de 8 a 16 anos, que estavam em acompanhamento ambulatorial. Os pacientes realizaram TCPE máximo em esteira, teste de caminhada de seis minutos (TC6), espirometria e pletismografia, seguindo as diretrizes ATS/ACCP, ATS e ATS/ERS, respectivamente. Para o cálculo dos percentuais esperados, foram utilizados: Armstrong (TCPE); Geiger (TC6); Kundson (espirometria), Zapletal (pletismografia). Resultados: A idade média foi de 11,4 ± 2,2 anos; 70 % meninos; peso: 36,8 ± 12,3 Kg; altura: 143,8 ± 15,2 cm; IMC: 17,6 ± 3,0. Na espirometria, os pacientes apresentavam os fluxos forçados diminuídos e, na pletismografia, os volumes estavam aumentados, quando comparados com a população de referência. No TCPE, 11 pacientes apresentaram valores do VO2 de pico inferiores (77,5 ± 37,5%) a 80% do percentual do predito e o VO 2LV foi considerado normal (40%VO2). A relação VE/VVM aumentada foi observada em 68% pacientes. A média da distância total percorrida foi de 512 ± 102 m (77,0 ± 15,7%). O VO2 de pico não se correlacionou com distância (TC6); no entanto, correlacionou-se com a CVF (L) (r=0,90/p=0,00), o VEF1 (L) (r=0,86/ p=0,00) e a VR/CPT (r=-0,71/ p=0,02) e, em percentual do predito, com a VR/CPT (-0,63/ p=0,00). Conclusões: O presente estudo demonstra que os pacientes com BOPI apresentam valores do consumo de oxigênio inferiores ao da população hígida e a reserva ventilatória diminuída, sugerindo que o comprometimento pulmonar pode ser um dos fatores limitantes para o exercício. / Objective: To assess the physical conditioning of children and adolescents with Post Infectious Bronchiolitis Obliterans (PIBO) through cardiopulmonary exercise testing (CPET). Methods: 20 children with PIBO, in follow-up at an outpatient clinic carried out CPET, six minute walking test (6MWT) and pulmonary function tests (PFT), following ATS/ACCP e ATS guidelines, respectively. Results were expressed as percentage of predicted reference values: Armstrong’s for CPET, Geiger’s for 6MWT, Knudson’s for spirometry, and Zapletal’s for plethysmography.Results: Means ± SD were: for age, 11,4 ± 2,2 years; weight: 36,8 ± 12,3 kg; height: 143,8 ± 15,2 cm; BMI: 17,6 ± 3,0. Gender: 70% boys. When compared to reference values, PFT had lower forced flows (spirometry) and increased volumes (plethysmography). CPET had 11 patients with reduced VO2peak values (< 80% predicted) and had normal VO2LV (VO2peak40%). An increased VE/MVV ratio was observed in 68% of patients. The mean distance (6MWT) was 77,0 ± 15,7% of predicted (512 ± 102 m). VO2peak did not correlate with 6MWT; however, it did correlate with FVC(L) (r=0,90/p=0,00), with FEV1(L) (r=0,86/p=0,00) and with RV/TLC (r=-0,71/p=0,02). When in percentage of predicted, with RV/TLC (r=-0,63/ p=0,00). Conclusions: This study shows that PIOB patients have lower oxygen consumption values when compared to the reference population. They also showed a diminished pulmonary reserve which might have contributed to that exercise limitation.

Objetivo: Avaliar o condicionamento cardiorrespiratório de crianças e adolescentes com BOPI através do teste cardiopulmonar de exercício (TCPE). Métodos: Foram estudadas 20 crianças com BOPI, com idade de 8 a 16 anos, que estavam em acompanhamento ambulatorial. Os pacientes realizaram TCPE máximo em esteira, teste de caminhada de seis minutos (TC6), espirometria e pletismografia, seguindo as diretrizes ATS/ACCP, ATS e ATS/ERS, respectivamente. Para o cálculo dos percentuais esperados, foram utilizados: Armstrong (TCPE); Geiger (TC6); Kundson (espirometria), Zapletal (pletismografia). Resultados: A idade média foi de 11,4 ± 2,2 anos; 70 % meninos; peso: 36,8 ± 12,3 Kg; altura: 143,8 ± 15,2 cm; IMC: 17,6 ± 3,0. Na espirometria, os pacientes apresentavam os fluxos forçados diminuídos e, na pletismografia, os volumes estavam aumentados, quando comparados com a população de referência. No TCPE, 11 pacientes apresentaram valores do VO2 de pico inferiores (77,5 ± 37,5%) a 80% do percentual do predito e o VO 2LV foi considerado normal (40%VO2). A relação VE/VVM aumentada foi observada em 68% pacientes. A média da distância total percorrida foi de 512 ± 102 m (77,0 ± 15,7%). O VO2 de pico não se correlacionou com distância (TC6); no entanto, correlacionou-se com a CVF (L) (r=0,90/p=0,00), o VEF1 (L) (r=0,86/ p=0,00) e a VR/CPT (r=-0,71/ p=0,02) e, em percentual do predito, com a VR/CPT (-0,63/ p=0,00). Conclusões: O presente estudo demonstra que os pacientes com BOPI apresentam valores do consumo de oxigênio inferiores ao da população hígida e a reserva ventilatória diminuída, sugerindo que o comprometimento pulmonar pode ser um dos fatores limitantes para o exercício. / Objective: To assess the physical conditioning of children and adolescents with Post Infectious Bronchiolitis Obliterans (PIBO) through cardiopulmonary exercise testing (CPET). Methods: 20 children with PIBO, in follow-up at an outpatient clinic carried out CPET, six minute walking test (6MWT) and pulmonary function tests (PFT), following ATS/ACCP e ATS guidelines, respectively. Results were expressed as percentage of predicted reference values: Armstrong’s for CPET, Geiger’s for 6MWT, Knudson’s for spirometry, and Zapletal’s for plethysmography.Results: Means ± SD were: for age, 11,4 ± 2,2 years; weight: 36,8 ± 12,3 kg; height: 143,8 ± 15,2 cm; BMI: 17,6 ± 3,0. Gender: 70% boys. When compared to reference values, PFT had lower forced flows (spirometry) and increased volumes (plethysmography). CPET had 11 patients with reduced VO2peak values (< 80% predicted) and had normal VO2LV (VO2peak40%). An increased VE/MVV ratio was observed in 68% of patients. The mean distance (6MWT) was 77,0 ± 15,7% of predicted (512 ± 102 m). VO2peak did not correlate with 6MWT; however, it did correlate with FVC(L) (r=0,90/p=0,00), with FEV1(L) (r=0,86/p=0,00) and with RV/TLC (r=-0,71/p=0,02). When in percentage of predicted, with RV/TLC (r=-0,63/ p=0,00). Conclusions: This study shows that PIOB patients have lower oxygen consumption values when compared to the reference population. They also showed a diminished pulmonary reserve which might have contributed to that exercise limitation.

Objetivo: Avaliar o condicionamento cardiorrespiratório de crianças e adolescentes com BOPI através do teste cardiopulmonar de exercício (TCPE). Métodos: Foram estudadas 20 crianças com BOPI, com idade de 8 a 16 anos, que estavam em acompanhamento ambulatorial. Os pacientes realizaram TCPE máximo em esteira, teste de caminhada de seis minutos (TC6), espirometria e pletismografia, seguindo as diretrizes ATS/ACCP, ATS e ATS/ERS, respectivamente. Para o cálculo dos percentuais esperados, foram utilizados: Armstrong (TCPE); Geiger (TC6); Kundson (espirometria), Zapletal (pletismografia). Resultados: A idade média foi de 11,4 ± 2,2 anos; 70 % meninos; peso: 36,8 ± 12,3 Kg; altura: 143,8 ± 15,2 cm; IMC: 17,6 ± 3,0. Na espirometria, os pacientes apresentavam os fluxos forçados diminuídos e, na pletismografia, os volumes estavam aumentados, quando comparados com a população de referência. No TCPE, 11 pacientes apresentaram valores do VO2 de pico inferiores (77,5 ± 37,5%) a 80% do percentual do predito e o VO 2LV foi considerado normal (40%VO2). A relação VE/VVM aumentada foi observada em 68% pacientes. A média da distância total percorrida foi de 512 ± 102 m (77,0 ± 15,7%). O VO2 de pico não se correlacionou com distância (TC6); no entanto, correlacionou-se com a CVF (L) (r=0,90/p=0,00), o VEF1 (L) (r=0,86/ p=0,00) e a VR/CPT (r=-0,71/ p=0,02) e, em percentual do predito, com a VR/CPT (-0,63/ p=0,00). Conclusões: O presente estudo demonstra que os pacientes com BOPI apresentam valores do consumo de oxigênio inferiores ao da população hígida e a reserva ventilatória diminuída, sugerindo que o comprometimento pulmonar pode ser um dos fatores limitantes para o exercício. / Objective: To assess the physical conditioning of children and adolescents with Post Infectious Bronchiolitis Obliterans (PIBO) through cardiopulmonary exercise testing (CPET). Methods: 20 children with PIBO, in follow-up at an outpatient clinic carried out CPET, six minute walking test (6MWT) and pulmonary function tests (PFT), following ATS/ACCP e ATS guidelines, respectively. Results were expressed as percentage of predicted reference values: Armstrong’s for CPET, Geiger’s for 6MWT, Knudson’s for spirometry, and Zapletal’s for plethysmography.Results: Means ± SD were: for age, 11,4 ± 2,2 years; weight: 36,8 ± 12,3 kg; height: 143,8 ± 15,2 cm; BMI: 17,6 ± 3,0. Gender: 70% boys. When compared to reference values, PFT had lower forced flows (spirometry) and increased volumes (plethysmography). CPET had 11 patients with reduced VO2peak values (< 80% predicted) and had normal VO2LV (VO2peak40%). An increased VE/MVV ratio was observed in 68% of patients. The mean distance (6MWT) was 77,0 ± 15,7% of predicted (512 ± 102 m). VO2peak did not correlate with 6MWT; however, it did correlate with FVC(L) (r=0,90/p=0,00), with FEV1(L) (r=0,86/p=0,00) and with RV/TLC (r=-0,71/p=0,02). When in percentage of predicted, with RV/TLC (r=-0,63/ p=0,00). Conclusions: This study shows that PIOB patients have lower oxygen consumption values when compared to the reference population. They also showed a diminished pulmonary reserve which might have contributed to that exercise limitation.

No description available.

Resumo: Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below) / Orientador: Daniele Cristina Cataneo / Coorientador: Antônio José Maria Cataneo / Banca: Roberto Saab Junior / Banca: Paulo Monoel Pego Fernandes / Banca: Irma de Godoy / Banca: Lidia Raquel de Carvalho / Doutor

Title: Power output and selected cardiorespiratory parameters in elite athletes during the third to fourth week after COVID-19 infection Objectives: The aim of this thesis is to compare power output and selected cardiorespiratory parameters in elite athletes before and three to four weeks after COVID- 19 infection. Since the elite athletes undergo these health checks on a yearly basis, it is possible to compare the data before and immediately after the infection without difficulty. Methods: This thesis has a character of a quantitative research based on testing the outcomes with confirming or denying hypotheses. Out of the total of 64 elite athletes with the CPET data after the infection 17 athletes, fulfilling other criteria, were selected. I was provided with the data by Centrum sportovní medicíny z. s.. These values became the foundation for statistical hypotheses testing. Analysis of the data was done by means of a pair t-test in R software. Results: There were no significant differences in the majority of the spirometry parameters. Only the inspiration vital capacity was significantly higher (p = 0,004) after the COVID-19 infection in 14 athletes with 0,21±0,18 l improvement. There were significant differences in five of CPET parameters. Load in RCP was significantly lower (p = 0,011) in 13...

La décompensation cardiaque se manifeste par une symptomatologie de dyspnée et de fatigue, et par une diminution de l’aptitude aérobie. La décompensation cardiaque peut être globale ou gauche (DCG), ou droite comme dans le cas de l’hypertension artérielle pulmonaire (HTAP). Les mesures fonctionnelles de repos (fonction ventriculaire gauche ou pression artérielle pulmonaire moyenne) sont peu corrélées à l’aptitude aérobie, qui est cependant un élément important de la mise au point et du suivi clinique des patients atteints de DCG ou d’HTAP. L’aptitude aérobie est évaluée par une ergospirométrie. Réalisée sur cycloergomètre ou sur tapis roulant elle mesure l’évolution des variables ventilatoires (ventilation, consommation en oxygène et production de CO2), la fréquence cardiaque et la tension artérielle lors d’un effort à intensité croissante jusqu’à l’effort maximal. Elle apporte une analyse fine du comportement à l’exercice des patients, de la cause de la limitation à l’effort et permet la détermination précise de la consommation d’oxygène maximale (VO2max). Plus simple que l’ergospirométrie, le test de marche de 6 minutes (TDM6) mesure la distance maximale parcourue en marchant 6 minutes. Il évalue la réponse intégrée des systèmes cardiovasculaire, respiratoire et musculaire à l’effort, mais, contrairement à l’ergospirométrie, il ne permet pas d’identifier les facteurs déterminants l’aptitude aérobie. Le TDM6 est corrélé de façon significative, mais non étroite, à la VO2 max et à la classe fonctionnelle telle qu’évaluée par l’échelle à 4 points de la New York Heart Association. Les travaux réunis dans le présent travail ont eu pour but de contribuer à l’étude de la pathophysiologie de l’aptitude aérobie et à la compréhension des tests utilisés pour l’évaluer dans l’HTAP et de la DCG. Dans une première étude, nous avons comparé le profil ergospirométrique et le périmètre de marche de 6 minutes chez les patients DCG ou HTAP. Les résultats montrent que la VO2 max et le TDM sont diminués dans les mêmes proportions chez des patients à handicap fonctionnel (NYHA) comparable, avec toutefois une propension plus marquée à l’hyperventilation dans l’HTAP. Dans une seconde étude, nous avons mesuré la réponse métabolique au TDM6 au moyen d’un ergospiromètre portable chez des patients HTAP. Les résultats montrent que le TDM6 est réalisé à une VO2 correspondant à la VO2max mesurée à l’ergospirométrie sur cycloergomètre, avec cependant une ventilation, un quotient respiratoire et une fréquence cardiaque inférieures. Durant le TDM6, les patients stabilisent leur effort à un quotient respiratoire légèrement inférieur à 1. Ces résultats s’expliquent soit par la cinétique de la VO2 durant l’ergospirométrie à protocole standardisé comportant un incrément de charge trop rapide par minute, soit par une différence des masses musculaires mises en œuvre durant la marche ou l’effort sur bicyclette. Ces résultats suggèrent que le TDM6 pourrait être un test plus adéquat que l’ergospirométrie pour évaluer l’aptitude aérobie dans l’HTAP. Dans un troisième travail, plus modeste, nous avons réalisé la réplique du précédent, dans la DCG. Nous y avons observé les mêmes résultats. Dans un dernier travail nous avons évalué la valeur pronostique de l’ergospirométrie et du TDM6 dans l’HTAP. Nous avons analysé les ergospirométries et TDM6 de 65 patients atteints d’HTAP et discerné un sous groupe de patients atteints d’HTAP idiopathique ou associée à la prise d’anorexigène. Le TDM6 et le produit « distance x poids » étaient pronostiques de mortalité dans le groupe entier de patients et dans le sous groupe de patients atteints d’HTAP idiopathique ou associée à la prise d’anorexigène. La pente VE/VCO2 n’était facteur pronostique de mortalité que dans le groupe de patients atteints d’HTAP idiopathique ou associée à la prise d’anorexigène. La VO2pic n’était prédictive de mortalité dans aucun des groupes de patients. En conclusion, nos travaux ont montré que la DCG et l’HTAP menaient à une diminution similaire de la capacité à l’exercice. Ils ont également contribué à montrer l’intérêt du TDM6 (avec mesures ergospirométriques) dans l’évaluation de cette amputation de l’aptitude à l’effort. Le TDM6 paraît plus adéquat pour la mesure de l’aptitude purement aérobie (quotient respiratoire < 1). Ceci permet probablement de comprendre la supériorité du TDM6 par rapport à l’ergospirométrie en tant que facteur pronostique et en sensibilité aux effets d’interventions thérapeutiques.

Made available in DSpace on 2016-06-02T20:18:24Z (GMT). No. of bitstreams: 1 6556.pdf: 2232464 bytes, checksum: d84f3d538456b42ad0ec52f81c1f7771 (MD5) Previous issue date: 2015-02-11 / Financiadora de Estudos e Projetos / This thesis consisted of two studies described below. The Study 1 aimed to investigate if expiratory flow limitation (EFL) present at moderate intensity exercise in subjects following myocardial infarction (MI) (as shown in a previous study conducted in our laboratory) already manifests in those with stable coronary artery disease (CAD). Forty-one men aged 40-65 years were allocated into four different groups: 1) stable coronary artery disease (SCADG) (n=9), 2) recent myocardial infarction (RMIG) (n=8), 3) late myocardial infarction group (LMIG) (n=12), and 4) health control group (CG) (n=12). Two cardiopulmonary exercise testing (CPX) at constant workload (moderate and high intensity) were applied and EFL was evaluated by exercise flow-volume loops. We observed that during moderate intensity exercise the RMIG and LMIG presented with a significantly higher number of subjects with EFL compared to the CG, while no significant difference was observed among groups at high intensity exercise. Regarding the degree of expiratory flow limitation, the RMIG and LMIG showed significantly higher values at moderate intensity exercise when compared to the CG. At high intensity exercise, significantly higher values for the degree of expiratory flow limitation were observed only in the LMIG compared to the CG. We concluded that an EFL was only present in MI groups (recent and late) during moderate intensity exercise; whereas at high intensity exercise all groups presented EFL. Thus, EFL observed at moderate intensity exercise in both MI groups may be linked to the consequences of event and not to CAD. Following, the Study II aimed to investigate the indexes of circulatory (CP) and ventilatory power (VP) in CAD patients. Eighty-seven men were studied aged 40-65 years, being 42 subjects in the CAD group and 45 in the CG. CPX was performed on a treadmill and the following measures were obtained: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic BP x peak HR), 5) peak oxygen pulse = (peak VO2/peak HR), 6) the oxygen uptake efficiency (OUES), 7) the carbon dioxide production efficiency (VE/VCO2 slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/VE/VCO2 slope). The CAD group had significantly lower values for peak VO2, peak HR, peak systolic BP, peak rate-pressure product, peak oxygen pulse, the OUES, CP and VP and significantly higher values for peak diastolic BP and the VE/VCO2 slope compared to the CG. Furthermore, a stepwise regression analysis showed that CP was influenced by the group and VP was influenced both by group and by number of vessels with stenosis after treatment. Given the findings, we concluded that the indices of CP and VP were lower in men with CAD compared to CG. Thus, both studies brought important findings related to the responses of the cardiovascular, pulmonary and musculoskeletal systems of patients with CAD during physical exercise, bringing many contributions to clinical practice and assisting in the prescription of exercise training. / Esta tese constou de 2 estudos descritos a seguir. O Estudo I teve como objetivo verificar se a limitação ao fluxo expiratório (LFE) presente na moderada intensidade do exercício em sujeitos com infarto do miocárdio (IM) (conforme mostrado em estudo prévio realizado em nosso laboratório) já está presente naqueles com doença arterial coronariana (DAC) estável. Quarenta e um homens com idade entre 40 e 65 anos foram alocados em quatro diferentes grupos: 1) DAC estável (GDAC) (n=9), 2) IM recente (GIMR) (n=8), 3) IM tardio (GIMT) (n=12) e, 4) grupo controle saudável (GC) (n=12). Dois testes de exercício cardiopulmonar (TECP) em carga constante (moderada e alta intensidade) foram aplicados e a LFE foi avaliada por meio da alça fluxo-volume corrente durante o exercício. Nós observamos que durante a moderada intensidade do exercício somente os GIMR e GIMT apresentaram número significativamente maior de sujeitos com LFE comparados ao GC, enquanto nenhuma diferença significativa foi observada entre os grupos na alta intensidade do exercício. Em relação ao grau de LFE, tanto o GIMR como o GIMT apresentaram significativamente maiores valores de LFE na moderada intensidade do exercício comparado ao GC, e na alta intensidade do exercício foi observado maior grau de LFE somente para o GIMT em relação ao GC. Concluímos que a LFE esteve presente somente nos grupos com IM (recente e tardio) durante a moderada intensidade do exercício; já na alta intensidade do exercício todos os grupos apresentaram LFE. Diante do exposto, a LFE observada na moderada intensidade do exercício em ambos os grupos com IM pode estar relacionada às consequências do evento e não à DAC. Na sequência, o Estudo II objetivou investigar os índices da potência circulatória (PC) e ventilatória (PV) em pacientes com DAC comparados a indivíduos saudáveis. Para isso foram estudados oitenta e sete homens com idade entre 45 a 65 anos, sendo 42 sujeitos no grupo DAC e 45 no GC. Um TECP foi realizado em esteira e as seguintes variáveis foram obtidas: 1) consumo de oxigênio (VO2) pico, 2) frequência cardíaca (FC) pico, pressão arterial (PA) pico, duplo produto pico (PA sistólica pico x FC pico), 5) pulso de oxigênio pico (VO2 pico dividido pela FC pico), 6) eficiência ventilatória para o consumo de oxigênio (OUES), 7) eficiência ventilatória para a produção de dióxido de carbono (VE/VCO2 slope), 8) PC (VO2 pico x PA sistólica pico) e 9) PV (PA sistólica pico dividido pelo VE/VCO2 slope). O grupo DAC apresentou significativamente menores valores no pico do exercício de VO2, FC, PA sistólica, duplo produto, pulso de oxigênio, OUES, PC e PV e, significativamente maiores valores de PA diastólica e VE/VCO2 slope em relação ao GC. Além disso, uma análise de regressão pelo método stepwise mostrou que a PC foi influenciada pelo grupo e a PV tanto pelo grupo quanto pelo número de vasos com estenose pós tratamento. Diante dos achados, nós concluímos que os índices da PC e PV foram menores em homens com DAC comparados ao GC. Desta forma, ambos os estudos trouxeram importantes achados relacionados às respostas dos sistemas cardiovascular, pulmonar e musculoesquelético de pacientes com DAC durante o exercício físico, trazendo contribuições para a prática clínica e auxiliando na prescrição do treinamento físico.