Navegando por Palavras-chave "Lung disease"

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    Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?
    (Lippincott Williams & Wilkins, 2016) Alencar, Maria Clara Noman de [UNIFESP]; Arbex, Flavio Ferlin [UNIFESP]; Souza, Aline [UNIFESP]; Mazzuco, Adriana; Sperandio, Priscila Abreu [UNIFESP]; Rocha, Alcides [UNIFESP]; Hirai, Daniel Müller [UNIFESP]; Mancuso, Frederico José Neves [UNIFESP]; Berton, Danilo Cortozi [UNIFESP]; Borghi-Silva, Audrey; Almeida, Dirceu Rodrigues de [UNIFESP]; O'Donnell, Denis Eunan; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(V) over dot(E)]-carbon dioxide output [(V) over dotCO(2)] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% +/- 17% predicted, ejection fraction = 35% +/- 6%) were prospectively followed up during 412 +/- 261 days for major cardiac events. RESULTS: Fourteen patients (46%) had a negative outcome. Patients who had an event had lower echocardiographically determined right ventricular fractional area change (RVFAC), greater ventilatory inefficiency (higher (V) over dot(E)/(V) over dotCO(2) nadir), and lower end-tidal CO2 (PETCO2) (all P < .05). Multivariate Cox models revealed that (V) over dot(E)/(V) over dotCO(2) nadir > 36, Delta P-ET CO2(PEAK-REST)>= 2 mm Hg, and PETCO2PEAK <= 33 mm Hg added prognostic value to RVFAC <45%. Kaplan-Meyer analyses showed that although 18% of patients with RVFAC > 45% had a major cardiac event after 1 year, no patient with RVFAC > 45% and (V) over dot(E)/ (V) over dotCO(2) nadir = 36 (or PETCO2PEAK>33 mm Hg) had a negative event. Conversely, although 69% of patients with RVFAC <= 45% had a major cardiac event after 1 year, all patients with RVFAC <= 45% and. PETCO2(PEAK-REST)>= 2 mm Hg had a negative event. CONCLUSION: Ventilatory inefficiency remains a powerful prognostic marker in HF despite the presence of mechanical ventilatory constraints induced by COPD. If these preliminary findings are confirmed in larger studies, optimal thresholds for outcome prediction are likely greater than those traditionally recommended for HF patients without COPD.
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    High oxygen extraction and slow recovery of muscle deoxygenation kinetics after neuromuscular electrical stimulation in COPD patients
    (Springer, 2016) Azevedo, Diego de Paiva; Medeiros, Wladimir Musetti [UNIFESP]; Manfredi de Freitas, Flavia Fernandes; Amorim, Cesar Ferreira; Gimenes, Ana Cristina Oliveira [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Chiavegato, Luciana Dias [UNIFESP]
    It was hypothesized that patients with chronic obstructive pulmonary disease (COPD) would exhibit a slow muscle deoxygenation (HHb) recovery time when compared with sedentary controls. Neuromuscular electrical stimulation (NMES 40 and 50 mA, 50 Hz, 400 A mu s) was employed to induce isometric contraction of the quadriceps. Microvascular oxygen extraction (A mu O2EF) and HHb were estimated by near-infrared spectroscopy (NIRS). Recovery kinetic was characterized by measuring the time constant Tau (HHb-tau). Torque and work were measured by isokinetic dynamometry in 13 non-hypoxaemic patients with moderate-to-severe COPD [SpO(2) = 94.1 +/- 1.6 %
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    Inhaled Treprostinil in Pulmonary Hypertension Associated with Lung Disease
    (Springer, 2018) Faria-Urbina, Mariana; Oliveira, Rudolf Krawczenko Feitoza de [UNIFESP]; Agarwal, Manyoo; Waxman, Aaron B.
    Pulmonary hypertension (PH) in the setting of parenchymal lung disease adversely affects quality of life and survival. However, PH-specific drugs may result in ventilation/perfusion imbalance and currently, there are no approved PH treatments for this patient population. In the present retrospective study, data from 22 patients with PH associated with lung disease treated with inhaled treprostinil (iTre) and followed up clinically for at least 3 months are presented. PH was defined by resting right heart catheterization as a mean pulmonary artery pressure (mPAP) >= 35 mmHg, or mPAP >= 25 mmHg associated with pulmonary vascular resistance >= 4 Woods Units. Follow-up evaluation was performed at the discretion of the attending physician. From baseline to follow-up, we observed significant improvement in functional class (n = 22, functional class III-IV 82 vs. 59%, p = 0.041) and 6-min walk distance (n = 11, 243 +/- 106 vs. 308 +/- 109