Navegando por Palavras-chave "Pulmonary arterial hypertension"
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- ItemAcesso aberto (Open Access)Contribuição tônica do quimiorreflexo carotídeo para o controle vagal cardíaco no repouso, ortostatismo e durante a recuperação após o exercício em pacientes com hipertensão arterial pulmonar(Universidade Federal de São Paulo (UNIFESP), 2018-11-28) Ribeiro, Marcelle de Paula [UNIFESP]; Silva, Bruno Moreira [UNIFESP]; http://lattes.cnpq.br/6680100353729718; http://lattes.cnpq.br/7001582128466985; Universidade Federal de São Paulo (UNIFESP)Pulmonary Arterial Hypertension (PAH) is a rapidly progressive disease with multiple etiologies and an extremely poor prognosis. Patients with PAH present marked autonomic dysfunction, characterized by increase in sympathetic activity and reduction in vagal activity to cardiovascular system. The augmented peripheral chemoreflex responsiveness seems to play a role on autonomic dysfunction in PAH. However, remains unclear the tonic contribution of the peripheral chemoreflex to cardiac vagal control in PAH. We hypothesized that the carotid chemoreflex would impair the cardiac vagal control at rest and during orthostatic challenge in patients with PAH and this impairment would be increased during post-exercise recovery, since evidences have shown that the peripheral chemoreflex might be sensitized by different substances released during exercise. To test these hypothesis, 20 patients with established PAH and 13 age and sex matched healthy controls (CON) took part of the study. Both groups underwent to peripheral chemoreflex sensitivity evaluation through transient hypoxic inhalation. Afterwards, they were randomly exposed to 1) hyperoxia (carotid chemoreflex inhibition, 100% O2), or 2) normoxia (control session, 21% O2); during cardiac vagal modulation assessment (baroreflex sensitivity [BRS]; heart rate variability [HRV]; heart rate recovery [HRR]). Data are shown as mean ± SD and comparisons between gases and groups were acquired using the Mixed Linear Model (p ≤ 0.05). The PAH showed peripheral chemoreflex sensitivity to hypoxia compared to CON (P=0.01). During rest, hyperoxia increased vagal indexes of HRV and BRS in both PAH and CON groups, and this increase was similar among groups, indicating that the carotid chemoreflex tonically modulates the cardiac vagal control in healthy subjects and patients with PAH. During orthostatic challenge, hyperoxia increased BRS in both groups and this effect was greater in PAH, indicating that the carotid chemoreflex is sensitized in PAH and contributes to impaired BRS during orthostatic challenge in this group. During post-exercise recovery, hyperoxia increased HRR and HRV in both groups and this effect was greater in PAH, indicating that the carotid chemoreflex is sensitized in PAH and contributes to impaired post-exercise vagal reactivation in this group. Taking together, the results suggest that the carotid chemoreflex tonically modulate the cardiac vagal control in healthy humans and contributes to cardiac vagal dysfunction during orthostatism and during post-exercise recovery in patients with PAH.
- ItemSomente MetadadadosDiagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance(Springer, 2017) da Costa Junior, Augusto Alberto; Ota-Arakaki, Jaquelina Sonoe; Ramos, Roberta Pulcheri; Uellendahl, Marly; Neves Mancuso, Frederico Jose; Gil, Manuel Adan; Fischer, Claudio Henrique; Moises, Valdir Ambrosio; de Camargo Carvalho, Antonio Carlos; Campos, OrlandoRight ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83
- ItemAcesso aberto (Open Access)Quality of life as a prognostic marker in pulmonary arterial hypertension(Biomed Central Ltd, 2014-08-30) Fernandes, Caio J. C. S.; Martins, Barbara C. S.; Jardim, Carlos V. P.; Ciconelli, Rozana M. [UNIFESP]; Morinaga, Luciana K.; Breda, Ana Paula; Hoette, Susana; Souza, Rogerio; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Background: Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. the objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment.Methods: Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months.Results: After treatment, the patients demonstrated an improved 6MWT (414 +/- 124 m vs. 440 +/- 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores.Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58).Conclusions: Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving pre-determined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.
- ItemAcesso aberto (Open Access)Valor diagnóstico e impacto prognóstico da deformação miocárdica (strain) do ventrículo direito em pacientes com hipertensão arterial pulmonar e capacidade funcional relativamente preservada. Um estudo com ecocardiografia e ressonância magnética cardíaca(Universidade Federal de São Paulo (UNIFESP), 2018-11-09) Costa Junior, Augusto Alberto da [UNIFESP]; Campos Filho, Orlando [UNIFESP]; http://lattes.cnpq.br/9406673742771373; http://lattes.cnpq.br/0071408732189488; Universidade Federal de São Paulo (UNIFESP)Background: Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional twodimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. Objectives: The diagnostic and prognostic impact of 2DE speckletracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Patients and Methods: Sixtysix group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMRRVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Results and Conclusion: Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMRRVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤−14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25–17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable nongeometric 2DE surrogate of CMRRVEF in PAH patients, constituting a powerful independent predictor of longterm outcome in this cohort with relatively preserved functional capacity.