published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Medical Sciences

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[Truncated abstract] This thesis concerns itself primarily with the impact of exercise training on cardiac and vascular adaptations in humans. It contains longitudinal studies of individuals at either end of the physical activity spectrum; young elite athletes and obese children and adolescents. The study of these diverse groups was intentional, as a particular interest was to investigate the possible inter-relationships between morphological adaptations in the heart, evident in both obese and athletic populations, and the possible consequences of such adaptations for cardiac function. Whilst there exists a long tradition of echocardiographic assessment of cardiac dimensions and mass in both athletic and clinical populations, investigation of the impact of each of these “conditions” on cardiac diastolic function is novel, and has been facilitated by recent advances in the technical approach to diastolic function assessment in humans. Studies presented in the following chapters utilise advanced echocardiography imaging combined with pulse wave and tissue Doppler approaches to investigate the effects of exercise training regimen on wall thickness and ventricular mass, as well as diastolic function indices. State-of-the-art vascular imaging approaches have also been used in these populations to determine whether changes in vascular wall thickness, diameter or function occur with training in the elite athletes or obese youth.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (Ph.D.)--Biomedical Engineering, Georgia Institute of Technology, 2008. / Committee Chair: Oshinski, John N.; Committee Member: Fyfe, Derek A.; Committee Member: León, Angel R.; Committee Member: Skrinjar, Oskar; Committee Member: Taylor, W. Robert.

Orientador: José Irineu Gorla / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-24T18:25:00Z (GMT). No. of bitstreams: 1 CostaeSilva_AnselmodeAthayde_D.pdf: 1122497 bytes, checksum: 85ceca5e69e46e5e7bf7f22dd2199bbb (MD5) Previous issue date: 2014 / Resumo: O objetivo do presente estudo foi identificar as características clínicas, cardiológicas e de biomarcadores de remodelação cardiovascular em praticantes de esporte em cadeira de rodas para verificar se atletas com outros tipos de deficiência física (Outros: com amputados e com sequela de poliomielite principalmente) diferem do grupo com Lesão de Medula Espinhal (LME). Participaram do estudo 28 sujeitos, os quais foram divididos em dois grupos (LME, n=13, Outros, n=15) e como grupo controle tomaram parte do estudo 12 sujeitos não deficientes. Foram mensurados os aspectos clínicos e os parâmetros ecocardiográficos e de ultrassonografia de artérias carótidas. Como variáveis independentes foram mensurados os níveis de Matriz de Metaloproteinase - 2, 8 e 9 e LDL oxidado. Nosso estudo mostrou que, apesar da igualdade no perfil clínico, atletas com LME apresentam menor diâmetro atrial em comparação ao grupo Outros (LME 29,38 ±4,68mm, Outros 33,12 ±2,94 mm, p<0,05) e função diastólica (E/Em) diminuída em comparação ao grupo Outros e ao grupo controle (LME 6,55 ±1,51, Outros 5,12 ±1,06 e Controle 4,85 ±1,67, com p<0,05). Tais diferenças não foram associadas aos biomarcadores analisados, sendo possível atribuir às diferenças observadas à especificidade da LME / Abstract: This study aims to identify the clinical and cardiologic features in wheelchair athletes to know if athletes with other disabilities (Group others, mainly composed by individuals with Lower limb amputees and polio sequelae) are different of spinal cord injured athletes (SCI Group). 28 subjects were divided in two groups (SCI, n=13, others, n=15) and 12 male able-bodied subjects were allocated in control group. We measured clinical, echocardiography and carotid features. Also, Matrix of Metalloproteinase - 2, 8 and 9 and oxidized LDL. Our study have shown that athletes with SCI had lower left atrium diameter in comparing to Others Group (SCI 29.38 ±4.68mm, Others 33.12 ±2.94 mm, p<0.05) and worst diastolic function (E/Em) when compared to Others and Control group (SCI 6.55 ±1.51, Others 5.12 ±1.06 e Control 4.85 ±1.67, with p<0.05). This differences are not associated to biomarkers and we believe that is possible which the differences are due SCI specify / Doutorado / Atividade Fisica Adaptada / Doutor em Educação Física

Orientador: Heitor Moreno Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T22:07:27Z (GMT). No. of bitstreams: 1 Silva_ThiagoQuinagliaAraujoCosta_D.pdf: 1420649 bytes, checksum: e60823c9257fdc54d91d49f992550d11 (MD5) Previous issue date: 2013 / Resumo: Objetivo: A falha no controle da pressão arterial (PA), apesar do uso de três ou mais antihipertensivos caracteriza hipertensão arterial resistente (HAR). A disfunção endotelial está intrinsecamente associada a esta condição e inibidores da fosfodiesterase 5 (iPDE5)-inibindo a degradação de GMP cíclico (GMPc)-reduzem a PA em pacientes com HAR. A administração aguda de iPDE5 poderia melhorar parâmetros hemodinâmicos, endoteliais e de função diastólica do ventrículo esquerdo (FDVE) em pacientes com HAR e o polimorfismo T-786C da sintase de óxido nítrico (NO) endotelial (eNOS) modularia essas respostas. Métodos: Os pacientes (n = 26) foram dispostos em três grupos de acordo com o genótipo da eNOS T-786C: CC (n = 8), a CT (n = 9) e TT (n = 9). Doses crescentes de sildenafil oral (37,5, 50 e 100 mg) e placebo (em datas separadas por pelo menos 2 semanas) foram administradas a intervalos de 30 minutos, enquanto parâmetros hemodinâmicos (não invasivos e contínuos) foram obtidos. Também foram determinados: FDVE; vasodilatação mediada por fluxo (VMF); e nitrito e GMPc plasmáticos ao início e término do protocolo. Resultados: PA média (PAM) e resistência periférica total (RPT) diminuíram no grupo total (n=26) após o sildenafil (84,17 ± 21,04-75 ± 17,21 mmHg, 1149 ± 459,7-1,037 dyn.s/cm-5 ± 340, respectivamente; p<0,05). Similarmente, o sildenafil melhorou a FDVE (volume atrial esquerdo: 25 ± 5,8-20 ± 4,4; Tempo de relaxamento isovolumétrico: 104 ± 19,33-88 ± 15,22; E/e'septal: 9,7 ± 3,8-7,9 ± 2,9; E/e' lateral: 7,7 ± 3,4-6,4 ± 3,2; p<0,05). Os grupos TT e TC obtiveram redução sustentada da RPT ao longo do protocolo. No CC, os valores da RPT retornaram aos basais após as doses. Não houve alterações significativas da VMF, nitrito e GMPc após a administração do sildenafil. Conclusão: A administração aguda de iPDE5 melhora o perfil hemodinâmico e função diastólica em HAR e o polimorfismo T-786C da eNOS modula a resposta hemodinâmica, mas não a FDVE / Abstract: Purpose: Failure to control blood pressure (BP) despite the use of three or more drugs characterizes resistant hypertension (RHTN). Impaired endothelial function is associated to this condition and phosphodiesterase-5 inhibitors (PDE5i)-inhibiting cGMP breakdown-reduce BP in RHTN patients. We hypothesized that acute administration of PDE5i could ameliorate hemodynamic, endothelial parameters and left ventricular diastolic function (LVDF) in RHTN patients and that the T-786C nitric oxide (NO) endothelial synthase (eNOS) polymorphism could modulate these responses. Methods: Subjects (n= 26) were arranged into three groups: CC (n= 8), TC (n= 9) and TT (n= 9) according to T-786C eNOS genotype. Increasing doses of oral sildenafil (37.5, 50 and 100 mg) and placebo (in protocols at least 2 weeks apart) were given at 30 minute intervals while continuous non-invasive hemodynamic measures were assessed. LVDF, Flow Mediated Dilation (FMD), plasma nitrite and cGMP were also determined. Results: Mean arterial pressure (MAP) and total peripheral resistance (RPT) decreased in all patients (84.17 ± 21.04 to 75 ± 17.21 mmHg; 1149 ± 459.7 to 1037 ± 340 dyn.s/cm-5, respectively; p<0.05). Likewise, sildenafil improved LVDF parameters (Left atrial volume: 25 ± 5.8 to 20 ± 4.4; Isovolumetric relaxation time: 104 ± 19.33 to 88 ± 15.22; E/e' septal: 9.7 ± 3.8 to 7.9 ± 2.9; E/e' lateral: 7.7 ± 3.4 to 6.4 ± 3.2; p<0.05). While TT and TC genotype groups sustained RPT reduction during the increasing sildenafil doses, CC group failed to sustain the RPT drop, by the end of the protocol. No statistical changes were found in FMD, nitrite and cGMP after PDE5i administration. Conclusion: Our data suggest PDE5i acutely improves hemodynamic profile and diastolic function in RHTN, also T-786C eNOS polymorphism modulates the hemodynamic response, but not diastolic function / Doutorado / Farmacologia / Doutor em Farmacologia

Obesity is a multifactorial chronic disease, associated with increased cardiovascular risk, that produces hemodynamic changes, in cardiac structure and function, increasing the risk of heart failure, especially the diastolic; what is important to evaluate these patients more carefully. The aim of this study is to evaluate left ventricular diastolic function in severe obese in preoperative for bariatric surgery. This is an observational, prospective and analytical study. Were evaluated in 132 patients, severely obese, asymptomatic, with normal systolic function that were in the preoperative evaluation for bariatric surgery. Stratified into three groups, according to diastolic function, the group Nl comprised 61 patients with normal diastolic function, the group DD mild, consisted of 24 patients with mild diastolic dysfunction and the group DD M/S composed of 41 patients with moderate diastolic dysfunction (pseudonormal pattern) and 06 patients with severe diastolic dysfunction (restrictive pattern). After stratification, we compared the clinical and echocardiographic characteristics among groups. Of the 132 patients, 97 (73.5%) were women. The mean age was 38.5 ± 10.5 years and average BMI was 43.7 ± 7.2 kg/m². 48 patients had obesity class II and 84 grade III obesity. The cardiovascular risk factors that showed significant differences between groups Nl vs DD mild and Nl vs DD M/G were: metabolic syndrome with 67.5% (81 patients), hypertension with 59.8% (79 patients) and diabetes mellitus with 25.2% (32 patients). Regarding clinical values we found significant differences among groups in age, waist circumference and systolic blood pressure. Regarding echocardiographic variables, we found a larger left atrial diameter, left ventricular diastolic diameter, left atrial volume at 4 and 2 chambers, index of left atrial volume, index of left ventricular mass to body surface, and this index for height, in the groups with DD mild and DD M/S vs Nl. The higher prevalence of left ventricular diastolic dysfunction in pre-clinical phase in severe obese patients justifies the need for a careful echocardiographic assessment using joint analysis of all available echocardiographic techniques, in order to identify individuals at high risk for heart failure, so that early intervention measures are adopted. / Obesidade é uma doença crônica, multifatorial, associada a aumento do risco cardiovascular e de insuficiência cardíaca, principalmente a diastólica, o que torna importante a avaliação mais criteriosa dos pacientes obesos. O objetivo deste estudo é avaliar a função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica. Trata-se de um estudo observacional, transversal, prospectivo e analítico. Foram avaliados 132 pacientes obesos graves e assintomáticos, do ponto de vista cardiovascular, e que estavam em avaliação pré-operatória para cirurgia bariátrica. Estratificados em 3 grupos, de acordo com a função diastólica, sendo o grupo N1 constituído por 61 pacientes com função diastólica normal, o grupo DD leve constituído por 24 pacientes com disfunção diastólica leve e o grupo DD M/G constituído por 41 pacientes com disfunção diastólica moderada (padrão pseudonormal) e 06 pacientes com disfunção diastólica grave (padrão restritivo). Após estratificação, foram comparadas as características clínicas e ecocardiográficas entre os grupos. Dos 132 pacientes, 97 (73,5%) eram mulheres. A idade média foi de 38,5 ± 10,5 anos e o IMC médio foi de 43,7 ± 7,2 Kg/m², sendo 48 pacientes com obesidade grau II e 84 com obesidade grau III. Os fatores de risco cardiovascular que apresentaram diferença significativa entre os grupos Nl vs DD leve e Nl vs DD M/G foram: síndrome metabólica com 67,5% (81 pacientes), HAS com 59,8% (79 pacientes) e DM com 25,2% (32 pacientes). Quanto as variáveis clínicas, apresentaram diferença significativa entre os grupos foram a idade, a circunferência abdominal e a pressão arterial sistólica. Em relação às variáveis ecocardiográficas, encontrou-se um maior diâmetro do átrio esquerdo, diâmetro diastólico do ventrículo esquerdo, volume do átrio esquerdo em 4 e 2 câmaras, índice de volume atrial esquerdo, índice de massa do ventrículo esquerdo para superfície corpórea e esse índice para altura, nos grupos com DD leve e DD M/G vs o grupo Nl. A alta prevalência de disfunção diastólica do ventrículo esquerdo na fase pré-clínica em obesos graves justifica a necessidade de uma avaliação ecocardiográfica criteriosa, utilizando a análise conjunta de todas as técnicas ecocardiográficas disponíveis, com o objetivo de identificar indivíduos com maior risco de insuficiência cardíaca, para que medidas de intervenção precoce sejam adotadas.

Bakgrund: I hälso-och sjukvården är blodtrycksmätning en viktig och grundläggande metod vid korrekt diagnostik och hantering av högt blodtryck. Forskning har under flera år påvisat att olika komponenter påverkar noggrannheten av blodtrycksmätningen. Eftersom auskultatorisk och oscillometrisk blodtrycksmätning utförs på två olika sätt finns en risk att blodtrycksvärdet kan variera mellan metoderna. Syfte: Syftet med studien var att undersöka om det finns någon skillnad mellan auskultatorisk och oscillometrisk blodtrycksmätning utfört i både vila och efter ansträngning. Material och metod: Studien bestod av 20 slumpmässigt utvalda studenter från Hälsohögskolan i Jönköping. Blodtrycksmätning utfördes med hjälp av auskultatorisk blodtrycksmanschett med handmanometer och stetoskop samt oscillometrisk modalitet (OMRON M7). Resultat: Statistisk signifikant skillnad observerades mellan auskultatorisk och oscillometrisk modalitet, både i vila och efter ansträngning. Skillnaden är som störst efter ansträngning för auskultatorisk och oscillometrisk mätmetod, i både systoliskt och diastoliskt blodtrycksvärde. Diskussion: I vården har användning av oscillometrisk blodtrycksmodalitet ökat och därmed finns en risk för minskad reliabilitet och validitet av blodtrycksvärdet. Slutsatser: Statistisk signifikant skillnad föreligger mellan modaliteterna, både i vila och efter ansträngning. / Background: Blood pressure measurement is an important and fundamental method for correct diagnosis and management of high blood pressure, in healthcare. For several years, research has shown that different components affect the accuracy of blood pressure measurement. There is a risk that the blood pressure value may vary between auscultatory and oscillometric measurements because they are performed in two different ways. Purpose: The purpose was to investigate whether there is any difference between auscultatory and oscillometric blood pressure values performed in both rest and after stress. Material and method: The study consists of 20 randomly selected students from the School of Health and Welfare of Jönköping. The measurement was performed using auscultatory blood pressure cuff, sphygmomanometer with stethoscope and oscillometric modality (OMRON M7). Result: Statistically significant difference was observed between auscultatory and oscillometric values, both in rest and stress. The difference is greater after stress for both methods, in systolic and diastolic values. Discussion: In healthcare, use of oscillometric modality has increased thus there is a risk of reduced reliability and validity of the blood pressure value. Conclusion: Statistically significant difference was observed between auscultatory and oscillometric values, both in rest and after stress.