Navegando por Palavras-chave "Teste De Esforço"

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    Achatamento Precoce Do Pulso De Oxigênio Durante O Teste De Exercício Cardiopulmonar Em Adultos Assintomáticos E Sua Associação Com Fatores De Risco Cardiovascular
    (Universidade Federal de São Paulo (UNIFESP), 2018-05-21) Almeida, Vitor Rossi De [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Individuals With Ischemic Heart Disease Present O2 Pulse Morphology With Early Flattening (Plateau) During Cardiopulmonary Exercise Test. Despite This O2 Pulse Response Is Well Known In Patients With Heart Disease, The Clinical Relevance Of These Changes In Asymptomatic Patients Is Unknown. Objective: The Aim Of The Study Was To Quantify The Prevalence Of Flattening Of O2 Pulse In Asymptomatic Adults And Verify Its Association With Cardiovascular Risk Factors. Methods: A Cross-Sectional Study Was Conducted With 824 Adults Aged 18-80 Years Selected From Epidemiology And Human Movement Study (Epimov). We Evaluated Anthropometrics, Body Composition And Cardiovascular Risk. Cardiorespiratory And Metabolic Responses Was Obtained During Treadmill Cardiopulmonary Exercise Test. Results: The Prevalence Of Early Flattening Of The O2 Pulse Was 36.8%. These Participants Are Predominantly Female, Older, With Lower Schooling, Greater Mass And Percentage Of Body Fat And Lower Percentage Of Lean Body Mass. In
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    Perda funcional após ressecção de parênquima pulmonar por câncer de pulmão: análise comparativa entre pacientes com e sem DPOC
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Bedin, Danielle Cristine Campos [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Cardiopulmonary exercise test (CPET) is an important tool for preoperative risk assessment of lung resection for non-small cell lung cancer. However, there are still few studies that evaluated and compared the variables of this test after lung resection considering patients with and without COPD. Objectives: To evaluate respiratory function loss at rest and during exercise in patients with suspected or diagnosed lung cancer who underwent lung resection until lobectomy. We hypothesized that functional loss is lower in COPD patients according to spirometric criteria in relation to those who present normal spirometric values. Methods: Prospective cohort study. Patients were divided into COPD group and Control group according to spirometry. The study was divided in 4 phases: Preoperative - clinical and functional evaluation (spirometry, DLCO and CPET) in order to obtain surgical risk; Intraoperative - to register complications and ASA score; Early postoperative - to register complications, mortality, ICU time and length of hospital stay; Sixth month postoperative - to clinical and functional evaluation (spirometry,DLCO and CPET). The study was powered to detect a 20% difference in the V̇O2PEAK between the groups (β=0.2%; α=0.05). Student's t-test was used for comparison between two independent samples of normal distribution and Mann-Whitney test for comparison between two independent samples of non-normal distribution. For comparison between dependent samples, we used the t-test for normal distribution samples and Wilcoxon test for non-normal distribution samples. Results: Eighteen patients were selected after applying the exclusion criteria, ten to COPD group and eight to Control group. In both groups, the majority of the patients were male. In the COPD group, there were more current smokers and in the Control group more former smokers. Follow-up after six months showed no difference in FVC, FEV1 or DLCO values intra-group. Control group presented a decrease in V̇O2PEAK in the postoperative period (20.8 ± 7.1 mL/kg/min to 16.3 ± 5.3 mL/kg/min). This difference was not observed in the COPD group (15.6 ± 3.7 mL/kg/min to 14.5 ± 4.1 mL/kg/min). In both groups there were no difference in the ΔV̇E/ΔV̇CO2 values, but in COPD group an increase of the ΔV̇E/ΔV̇CO2RCP intercept was observed after surgery (2.9 ± 2.0 L/min to 4.4 ± 2.4 L/min). In the COPD group, post-operative predicted FEV1 and V̇O2PEAK were lower than observed in the postoperative period (54.9 ± 10.7% versus 62.1 ± 14.5%; 12.8 ± 3.6 mL/kg/ min versus 14.5 ± 4.1 mL/kg/ min). Conclusion: The COPD group presented a lower decrease of V̇O2PEAK after surgery, increase of the ΔV̇E/ΔV̇CO2 RCP intercept and overestimation of post-operative functional loss.
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    Valor prognóstico do achatamento precoce do platô do pulso de oxigênio no TECP, na ocorrência de doenças cardiovasculares
    (Universidade Federal de São Paulo (UNIFESP), 2019-03-21) Barbosa, Alan Carlos Brisola [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: cardiopulmonary exercise test (CPET) is considered the gold standard for the diagnosis of exercise intolerance and its causes. Cardiovascular exercise intolerance has some important characteristics, like absolute plateau of the oxygen pulse rise curve (PuO2 = VO2/HR). The CPET can be performed in laboratory using different types of ergometers. The treadmill and lower limb cycle ergometer are the most popular. The greatest advantage of the cycle ergometer lies in the precision and accuracy with which the applied workload can be measured, differently from the treadmill that presents limitations for this measure. Therefore, the cycloergometer is supposed to be the ergometer of choice for assessing cardiovascular limitation to exercise and early flattening of PuO2. Objectives: To evaluate the reliability of the evaluation of the abnormal kinetic behavior of PuO2 in adults submitted to CPET in treadmill in comparison with the lower limb cycle ergometer. Materials and methods: We evaluated 35 asymptomatic adults (21 women, 45 ± 14 years, 31.7 ± 24.6 kg/m2) randomly selected from a previous study with a sample of 841 individuals. Participants underwent CPET on treadmill and exercise bicycle on two different days with intervals between 48 hours and two weeks. The visual analysis of the kinetic behavior of PuO2 was carried out by four evaluators experienced in the application of the test, two for treadmill CPET and two for CPET on cycle ergometer. We determined the agreement of the kinetic behavior of PuO2 also by mathematical model. After the identification of the anaerobic threshold (AT), we adjusted a linear regression in the PuO2 curve starting from AT up to 2 minutes (slope 1 - S1) and starting from AT up to another 2 minutes (slope 2 - S2). For visual evaluation, we used the Kappa coefficient to assess the iteration observers reliability. For the reliability of the S2 - S1 difference between the ergometers, we used the paired t test, the intraclass correlation coefficient (ICC) and its 95% confidence interval (95% CI) and coefficient of variation. For agreement, we used the Bland and Altman graph with the mean of the difference and 95% CI Results: Of the 70 tests analyzed, five tests on the treadmill and seven tests on the cycle ergometer showed early flattening of the PuO2 according to the visual inspection of the evaluators. The agreement between the evaluators was generally good (Kappa = 0.65, p <0.001). The two positive tests only on the cycle ergometer were evaluated by two other evaluators, who, independently, agreed with the analysis. As for the tests considered without flattening PuO2, all were concordant among the evaluators. Therefore, we observed some discrepancy among the ergometers, however, there was 100% agrément among the evaluators. For the mathematical method, we observed acceptable agrément between treadmill and bicycle. The difference in the S2 - S1 index on the treadmill was not significantly different from the cycle ergometer (-0.0024 ± 0.080 vs. -0.0040 ± 0.0159 mL/min/bpm/s). The agreement was acceptable (mean, -0.001 mL/min/bpm/s: 95% CI, -0.017 - 0.020). However, the ICC presented values compatible with only moderate reliability (ICC, 0.642: 95% CI, 0.247-0.812) and coefficient of variation (12%). Conclusion: the treadmill is a reliable ergometer for visual evaluation of the abnormal kinetic behavior of PuO2 in asymptomatic adults. Our results suggest that mathematical models are useful as complementary methods to the visual inspection of this measurement.