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    Avaliação Da Força E Fatigabilidade Muscular Periférica Por Dinamometria Isocinética Em Pacientes Com Doença Pulmonar Obstrutiva Crônica Associada À Insuficiência Cardíaca
    (Universidade Federal de São Paulo (UNIFESP), 2017-07-31) Medina, Luiz Antonio Rodrigues [UNIFESP]; Medeiros, Wladimir Musetti [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure with ejection fraction reduced left ventricular (IC) is underdiagnosed and is associated with poor prognosis. Cardiocirculatory and pulmonary changes found in both diseases can impair the supply of oxygen (O2) to the peripheral muscles resulting in decreased muscle strength and endurance, resulting in the exercise intolerance and the decline in functional capacity. Fifty male patients, with twentyfive COPD + IC (age 67.8 ± 6.9; FEV1 62.5 ± 17.4% predicted; EF = 36.1 ± 10.7) and twenty-five COPD (age 66.1 ± 9.1; FEV1 51.3 ± 17.0% predicted; EF = 67.6 ± 4.7) underwent clinical evaluation, resting echocardiography, pulmonary function, cardiopulmonary test incremental exercise (CPET), step test 4 minutes, 6 minute walk test and peripheral muscle isokinetic evaluation. The groups did not differ in demographic and anthropometric characteristics (p> 0.05). The functional capacity measured in 6-minute walk test showed a trend of smaller distance in COPD + IC group (401.4 ± 92.7) compared to COPD (451.5 ± 99.4) maximum effort COPD + IC group had significantly lower values load achieved when compared with the COPD group (57.6 ± 24.3 vs. 73.5 ± 22.7; P <0.05). The muscle performance is compromised in both COPD and in COPD + IC group. The lower torque, power and work, it is most evident in COPD + IC group. The most significant findings were in the flexor muscles of the knee, the isokinetic evaluation at 60°/s and 300 °/s respectively. The 60 °/s work and the torque peak as a percentage of predicted in COPD + IC group was lower than the COPD group (54.7 ± 13.3 vs. 65.8 ± 13.1; P < 0.05), (87.0 ± 24.0 vs. 94.8 ± 22.8; P < 0.05). The COPD + HF group showed significantly lower values in the fatigue index in percentage corrected by muscle mass in the torque variables (1.5 ± 0.4 vs. 1.2 ± 0.3; P < 0.05), work (1.4 ± 0.4 vs. 1.1 ± 0.3; P < 0.05), and power (1.8 ± 0.4 vs. 1.4 ± 0.4; P < 0.05). The overlap of HF in patients with COPD worsens muscle dysfunction observed in patients with isolated COPD. However, this increase is not uniform over the entire lower limb muscles, specifically affecting the knee flexors.