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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.