Navegando por Palavras-chave "pulmonary hypertension"
Agora exibindo 1 - 8 de 8
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosAnálise do gasto energético nas atividades da vida diária (avd) em pacientes com hipertensão arterial pulmonar idiopática (hapi)(Universidade Federal de São Paulo (UNIFESP), 2015-07-31) Almeida, Melline Della Torre de [UNIFESP]; Arakaki, Jaquelina Sonoe Ota Arakaki [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Patients with idiopathic pulmonary arterial hypertension (IPAH) have significant functional limitation caused by progressive exercise tolerance. These patients show symptoms such as dyspnoea and fatigue, which can lead to decrease functional capacity and difficulty performing activities of daily living (ADL). Considering that the main symptoms are raised by effort, practical tests to evaluate the tolerance to exercise are fundamental. Believed that those tools widely used in clinical practice may be used to assess indirectly the limitation presented on ADLs by the patients with IPAH. The evaluation of energy spent in ADLs will lead to a better understanding of disabilities caused by the disease allowing guidelines, including labour and rehabilitation, of these patients more appropriately. Objective: Evaluate metabolic, cardiovascular, respiratory and symptoms responses during the simulation of ADLs in individuals of IPAH and control groups; associate the energy spent of ADLs with metabolic, cardiovascular and respiratory variables at incremental cardiopulmonary exercises test (CPETinc) with upper limb and legs and associate the energy spent of ADLs with the distance in six-minute walk test (D6MWT), quality of life (QL) and functional class according to the New York Heart Association (CF-NYHA). Materials and Methods: A prospective study of 15 patients with IPAH and 9 healthy subjects in the control group. Participants performed incremental cycle ergometer test of upper limbs and legs, six-minute walk test (6MWT), simulations of 11 activities of daily living and answered the quality of life questionnaire SF-36. Through a portable metabolic system metabolic, respiratory, cardiovascular and dyspnoea (BORG scale) responses were evaluated during practical tests and simulations of ADLs. Results: Oxygen consumption in ADLs (absolute V?O2) was similar, not shown significant difference between both groups (control e IPAH). However individuals with IPAH had a higher consumption in ADLs compared with the peak in CPETinc of upper limbs and legs, as well as several ADLs were performed above the anaerobic threshold (AT) obtained in incremental tests. There was cardiovascular limitation in ADLs related to legs, excepted for activity up and down ramp. In addition, IPAH group presented greater dyspnoea, largest reduction in pulse oxygen saturation (SpO2) and increased ventilation in relation to carbon dioxide production (V?E/V?CO2). There was an association between distance walked in the 6MWT and energy spent in all ADLs. In CPETinc the variable that showed a better association with V?O2 in ADLs was ?V?E/?V?CO2 to the respiratory compensation point (RCP). Conclusion: Individuals with IPAH, despite of presented similar V?O2 values to perform ADLs, have bigger energy spent in relation to V?O2 max obtained in CPETinc and with respect to AT. They also have greater dyspnoea, higher reduction in saturation and bigger ratio ?V?E/?V?CO2.
- ItemSomente MetadadadosExercise-Induced Abnormal Increase of Systolic Pulmonary Artery Pressure in Adult Patients With Sickle Cell Anemia: An Exercise Stress Echocardiography Study(Wiley, 2016) Lima-Filho, Newton Nunes de [UNIFESP]; Figueiredo, Maria Stella [UNIFESP]; Vicari, Perla [UNIFESP]; Cancado, Rodolfo; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Bordin, Jose Orlando; Campos, Orlando [UNIFESP]Background: Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced abnormal response of systolic pulmonary artery pressure (SPAP) in adult patients with SCA and normal SPAP at rest, and to identify the independent predictors of this abnormal response. Methods and Results: Forty-four adult patients with SCA and normal SPAP at rest (tricuspid regurgitant jet flow velocity [TRV] < 2.5 m/sec) were studied and divided into 2 groups: exhibiting normal SPAP after treadmill EE (TRV <= 2.7 m/sec) (G1), and exhibiting abnormal exercise-induced increase of SPAP (TRV > 2.7 m/sec) (G2). TRV cutoff points at rest and during EE were based on data from healthy-matched control subjects. Abnormal response of SPAP with exercise occurred in 57% of the sample (G2), with mean TRV level of 3.39 +/- 0.41 m/sec (range 2.8-4.5 m/sec), significantly higher than those of G1 (2.29 +/- 0.25 m/sec, range 2.0-2.7 m/sec
- ItemAcesso aberto (Open Access)Functional impact of exercise pulmonary hypertension in patients with borderline resting pulmonary arterial pressure(Sage Publications Inc, 2017) Oliveira, Rudolf K. F. [UNIFESP]; Faria-Urbina, Mariana; Maron, Bradley A.; Santos, Mario; Waxman, Aaron B.; Systrom, David M.Borderline resting mean pulmonary arterial pressure (mPAP) is associated with adverse outcomes and affects the exercise pulmonary vascular response. However, the pathophysiological mechanisms underlying exertional intolerance in borderline mPAP remain incompletely characterized. In the current study, we sought to evaluate the prevalence and functional impact of exercise pulmonary hypertension (ePH) across a spectrum of resting mPAP's in consecutive patients with contemporary resting right heart catheterization (RHC) and invasive cardiopulmonary exercise testing. Patients with resting mPAP < 25mmHg and pulmonary arterial wedge pressure <= 15mmHg (n=312) were stratified by mPAP < 13, 13-16, 17-20, and 21-24mmHg. Those with ePH (n=35) were compared with resting precapillary pulmonary hypertension (rPH
- ItemAcesso aberto (Open Access)The Impact of Heterozygous KCNK3 Mutations Associated With Pulmonary Arterial Hypertension on Channel Function and Pharmacological Recovery(Wiley, 2017) Bohnen, Michael S.; Roman-Campos, Danilo; Terrenoire, Cecile [UNIFESP]; Jnani, Jack; Sampson, Kevin J.; Chung, Wendy K.; Kass, Robert S.Background-Heterozygous loss of function mutations in the KCNK3 gene cause hereditary pulmonary arterial hypertension (PAH). KCNK3 encodes an acid-sensitive potassium channel, which contributes to the resting potential of human pulmonary artery smooth muscle cells. KCNK3 is widely expressed in the body, and dimerizes with other KCNK3 subunits, or the closely related, acid-sensitive KCNK9 channel. Methods and Results-We engineered homomeric and heterodimeric mutant and nonmutant KCNK3 channels associated with PAH. Using whole-cell patch-clamp electrophysiology in human pulmonary artery smooth muscle and COS7 cell lines, we determined that homomeric and heterodimeric mutant channels in heterozygous KCNK3 conditions lead to mutation-specific severity of channel dysfunction. Both wildtype and mutant KCNK3 channels were activated by ONO-RS-082 (10 mu mol/L), causing cell hyperpolarization. We observed robust gene expression of KCNK3 in healthy and familial PAH patient lungs, but no quantifiable expression of KCNK9, and demonstrated in functional studies that KCNK9 minimizes the impact of select KCNK3 mutations when the 2 channel subunits co-assemble. Conclusions-Heterozygous KCNK3 mutations in PAH lead to variable loss of channel function via distinct mechanisms. Homomeric and heterodimeric mutant KCNK3 channels represent novel therapeutic substrates in PAH. Pharmacological and pH-dependent activation of wildtype and mutant KCNK3 channels in pulmonary artery smooth muscle cells leads to membrane hyperpolarization. Co-assembly of KCNK3 with KCNK9 subunits may provide protection against KCNK3 loss of function in tissues where both KCNK9 and KCNK3 are expressed, contributing to the lung-specific phenotype observed clinically in patients with PAH because of KCNK3 mutations.
- ItemAcesso aberto (Open Access)Impaired systemic oxygen extraction in treated exercise pulmonary hypertension: a new engine in an old car?(Sage Publications Inc, 2018) Faria-Urbina, Mariana; Oliveira, Rudolf K. F. [UNIFESP]; Segrera, Sergio A.; Lawler, Laurie; Waxman, Aaron B.; Systrom, David M.Ambrisentan in 22 patients with pulmonary hypertension diagnosed during exercise (ePH) improved pulmonary hemodynamics; however, there was only a trend toward increased maximum oxygen uptake (VO(2)max) secondary to decreased maximum exercise systemic oxygen extraction (Ca-vO(2)). We speculate that improved pulmonary hemodynamics at maximum exercise "unmasked" a pre-existing skeletal muscle abnormality.
- ItemSomente MetadadadosOptimizing the evaluation of excess exercise ventilation for prognosis assessment in pulmonary arterial hypertension(Sage Publications Ltd, 2014-11-01) Ferreira, Eloara V. M. [UNIFESP]; Ota-Arakaki, Jaquelina S. [UNIFESP]; Ramos, Roberta P. [UNIFESP]; Barbosa, Priscila B. [UNIFESP]; Almeida, Melline [UNIFESP]; Treptow, Erika C. [UNIFESP]; Valois, Fabricio M. [UNIFESP]; Nery, Luiz E. [UNIFESP]; Neder, J. Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Queens UnivBackground Increased ventilatory ((V) over dotE) response to carbon dioxide output ((V) over dotCO(2)) is a key finding of incremental cardiopulmonary exercise testing in both heart failure and pulmonary arterial hypertension (PAH). As with heart failure, measures of excessive exercise ventilation considering high-to-peak exercise (V) over dotE-(V) over dotCO(2) might have higher prognostic relevance than those restrained to sub-maximal exercise in PAH.Design Cross-sectional and observational study on a tertiary center.Methods Eighty-four patients (36 idiopathic and 48 with associated conditions) were followed up for up to five years. Excessive exercise ventilation was calculated as a slope (Delta (V) over dotE/Delta (V) over dotCO(2) to the respiratory compensation point ((RCP)) and to exercise cessation ((PEAK))) and as a ratio ((V) over dotE/(V) over dotCO(2) at the anaerobic threshold ((AT)) and at (PEAK)).Results Thirteen patients died and three had atrial septostomy. Multivariable regression analyses revealed that Delta (V) over dotE/Delta(V) over dotCO(2(PEAK)) <55 and (V) over dotE/(V) over dotCO(2(PEAK)) <57 were better related to prognosis than Delta (V) over dotE/Delta (V) over dotCO(2(RCP)) and (V) over dotE/(V) over dotCO(2(AT)) (p<0.01). Delta oxygen uptake ((V) over dotO(2))/ work rate >5.5ml/min per W was the only other independent prognostic index. According to a Kaplan-Meier survival analysis, 96.9% (90.8% to 100%) of patients showing (V) over dotE/ (V) over dotCO(2(PEAK)) <55 and (V) over dotO(2/) work rate >5.5ml/min per W were free from a PAH-related event. in contrast, 74.7% (70.1% to 78.2%) with both parameters outside these ranges had a negative outcome.Conclusion Measurements of excessive exercise ventilation which consider all data points maximize the usefulness of incremental cardiopulmonary exercise testing in the prognosis evaluation of PAH.
- ItemSomente MetadadadosPulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation(Wiley-Blackwell, 2013-09-01) Rivera, Ivan Romero [UNIFESP]; Mendonca, Maria Alayde [UNIFESP]; Andrade, Jose Lazaro [UNIFESP]; Moises, Valdir [UNIFESP]; Campos, Orlando [UNIFESP]; Silva, Celia Camelo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Aims: There is no definitive and reliable echocardiographic method for estimating the pulmonary vascular resistance (PVR) to differentiate persistent vascular disease from dynamic pulmonary hypertension. the aim of this study was to analyze the relationship between the pulmonary venous blood flow velocity- time integral (VTIpv) and PVR. Methods and Results: Eighteen patients (10 females; 4 months to 22 years of age) with congenital heart disease and left to right shunt were studied. They underwent complete cardiac catheterization, including measurements of the PVR and Qp: Qs ratio, before and after 100% oxygen inhalation. Simultaneous left inferior pulmonary venous flow VTIpv was obtained by Doppler echocardiography. the PVR decreased significantly from 5.0 +/- 2.6 W to 2.8 +/- 2.2 W (P = 0.0001) with a significant increase in the Qp: Qs ratio, from 3.2 +/- 1.4 to 4.9 +/- 2.4 (P = 0.0008), and the VTIpv increased significantly from 22.6 +/- 4.7 cm to 28.1 +/- 6.2 cm (P = 0.0002) after 100% oxygen inhalation. VTIpv correlated well with the PVR and Qp: Qs ratio (r = -0.74 and 0.72, respectively). Diagnostic indexes indicated a sensitivity of 86%, specificity of 75%, accuracy of 83%, a positive predictive value of 92% and a negative predictive value of 60%. Conclusion : the VTIpv correlated well with the PVR. the measurement of this index before and after oxygen inhalation may become a useful noninvasive test for differentiating persistent vascular disease from dynamic and flow-related pulmonary hypertension.
- ItemSomente MetadadadosSignal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension(Wiley-Blackwell, 2012-09-01) Ferreira, Eloara M. [UNIFESP]; Ota-Arakaki, Jaquelina S. [UNIFESP]; Barbosa, Priscila B. [UNIFESP]; Siqueira, Ana Cristina B. [UNIFESP]; Bravo, Daniela M. [UNIFESP]; Kapins, Carlos Eduardo B. [UNIFESP]; Silva, Celia Maria C. [UNIFESP]; Nery, Luiz Eduardo [UNIFESP]; Alberto Neder, J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background Haemodynamic responses to exercise are related to physical impairment and worse prognosis in patients with pulmonary arterial hypertension (PAH). It is clinically relevant, therefore, to investigate the practical usefulness of non-invasive methods of monitoring exercise haemodynamics in this patient population. Methods Using a novel impedance cardiography (ICG) approach that does not require basal impedance estimations and relies on a morphological analysis of the impedance signal (Signal-Morphology-ICG (TM)), stroke volume (SV) and cardiac index (CI) were evaluated in 50 patients and 21 age-matched controls during a ramp-incremental cardiopulmonary exercise testing. Results Technically unacceptable readings were found in 12 of 50 (24%) patients. in the remaining subjects, early decrease (N = 9) or a plateau in SV (N = 8) and Delta (peak-unloaded exercise) SV <10 ml were markers of more advanced PAH (P<0.05). Delta CI = 1.5-fold and early estimated lactate threshold were the only independent predictors of a severely reduced peak oxygen uptake ((V) over dotO(2)) in patients (R-2 = 0.71, P<0.001). the finding of Delta CI = 1.5-fold plus peak (V) over dot O-2 < 50% predicted was associated with a number of clinical and functional markers of disease severity (P<0.001). in addition, abnormal SV responses and Delta CI = 1.5-fold were significantly related to 1-year frequency of PAH-related adverse events (death and balloon atrial septostomy, N = 8; P<0.05). Conclusions Qualitative and semi-quantitative signal-morphology impedance cardiography (TM) (PhysioFlow (TM)) during incremental exercise provided clinically useful information to estimate disease severity and short-term prognosis in patients with PAH in whom acceptable impedance signals could be obtained.