Capacidade funcional em pacientes com doença coronariana multiarterial: foco na cinetica do VO2, segurança e aplicabilidade intrahospitalar.
Data
2024-10-16
Autores
Rocco, Isadora Salvador 
Orientadores
Guizilini, Solange
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A tese consistiu de três estudos descritos a seguir. O ESTUDO I intitulado: “Carga aterosclerótica coronariana e estado inflamatório: influência sobre a cinética do consumo de oxigênio durante o teste de caminhada de seis minutos”, objetivou investigar as associações entre fatores de estado inflamatório e carga aterosclerótica com a cinética do consumo de oxigênio (VO2) no TC6’ em pacientes com DAC. Concluiu-se que em contraste com a carga aterosclerótica coronariana, os marcadores inflamatórios foram associados tanto a intensidade da caminhada quanto a velocidade da cinética do VO2. Assim, este estudo contribui para uma mudança de paradigma na influência das lesões obstrutivas na DAC, evidenciando o papel crucial da inflamação nos mecanismos de resposta ao exercício. Já o ESTUDO II, intitulado: “Segurança do teste de caminhada de seis minutos no pré- operatório de cirurgia de revascularização do miocárdio em pacientes com doença coronariana multiarterial avançada”. O objetivo desse estudo foi avaliar a segurança do teste de caminhada de seis minutos (TC6’) no pré-operatório de cirurgia de revascularização do miocárdio (CRM) pela análise de variáveis metabólicas e cardiopulmonares e determinar se a topografia da lesão coronariana poderia contribuir para o aumento na ocorrência de eventos adversos durante o teste. Foi observado que o TC6’ é seguro para pacientes com doença arterial coronariana (DAC) obstrutiva à espera de CRM. A topografia da lesão não impactou na ocorrência de eventos adversos, apesar da menor capacidade funcional observada em pacientes com alta carga aterosclerótica. Finalmente, o ESTUDO III foi intitulado: “Limitação ventilatória e cinética do consumo de oxigênio lentificada no pós-operatório de cirurgia de revascularização do miocárdio”. Este estudo objetivou comparar a cinética do VO2 e respostas ventilatórias no T6CM entre o pré- e pós-operatório de CRM; determinar as principais causes de limitação ao esforço e explorar as correlações entre os parâmetros de cinética do VO2, respostas cardiopulmonares, força muscular e citocinas inflamatórias. O estudo concluiu que pacientes evoluem com prejuízo importante na capacidade funcional e na cinética do VO2. Tendo a limitação ventilatória como a principal causa de limitação ao esforço, com a força muscular ventilatória e o estado inflamatórios como elementos chaves na recuperação pós-operatória.
The post-doctoral degree thesis consisted of three studies described below. STUDY I entitled “Coronary Atherosclerotic Burden and Inflammatory Status: Influences on Oxygen Uptake On-Kinetics during the 6-Minute Walk Test”. This study aims to investigate how these factors correlate with oxygen uptake (VO2) on-kinetics in the Six-minute Walk Test (6MWT) in patients with CAD. The current study concluded that in contrast to anatomic burden, inflammatory markers were associated with both walking intensity and VO2 kinetics. Therefore, inflammation may be more crucial to exercise response mechanisms than coronary stenosis, suggesting a paradigm shift in our understanding of clinical repercussions of obstructive CAD. Actions able to attenuate the inflammatory profile may improve exercise capacity and prognosis. Secondly, the STUDY II entitled " Safety of Six-Minute Walk Test in the Preoperative of Coronary Bypass Grafting: A Focus on Multivessel Advanced Coronary Artery Disease”. The aim of the present study was to evaluate the safety of using the 6MWT in the preoperative assessment for coronary artery bypass grafting (CABG) by analyzing metabolic and cardiorespiratory responses and to determine if coronary lesion topography increases the risk of adverse events during the test. The study concluded that the use of the 6MWT in the preoperative assessment for CABG is safe in patients with multivessel CAD. Cardiopulmonary and metabolic measures confirmed the submaximal feature of the test in this population. The topography of coronary artery lesions, including LMA lesion, showed no increase in adverse events, despite the higher atherosclerotic burden impairing functional capacity. Finally, the STUDY III was entitled as “Ventilatory Constraints and Delayed Oxygen Uptake Kinetics as Major Causes of Exercise Limitation in Patient Underwent Coronary Artery Bypass Surgery”. This purpose of this study was to 1) compared VO2 on-kinetics and ventilatory constraints during the 6MWT between pre- and postoperative periods of CABG patients; 2) determine the main causes of postoperative exercise limitation; 3) explore the correlation between kinetic parameters, cardiopulmonary responses, respiratory muscle strength and inflammatory cytokines. In conclusion, ventilatory limitation was the main cause of exercise restriction, affecting 40% patients. Respiratory muscle strength and inflammatory cytokines were associated with kinetics parameters (p<0.01). The postoperative 6MWT unveils delayed VO2 on-kinetics and pronounced ventilatory constraints following CABG. Ventilatory limitation emerged as the primary cause to exercise intolerance, with respiratory muscle strength and inflammatory status as key factors.
The post-doctoral degree thesis consisted of three studies described below. STUDY I entitled “Coronary Atherosclerotic Burden and Inflammatory Status: Influences on Oxygen Uptake On-Kinetics during the 6-Minute Walk Test”. This study aims to investigate how these factors correlate with oxygen uptake (VO2) on-kinetics in the Six-minute Walk Test (6MWT) in patients with CAD. The current study concluded that in contrast to anatomic burden, inflammatory markers were associated with both walking intensity and VO2 kinetics. Therefore, inflammation may be more crucial to exercise response mechanisms than coronary stenosis, suggesting a paradigm shift in our understanding of clinical repercussions of obstructive CAD. Actions able to attenuate the inflammatory profile may improve exercise capacity and prognosis. Secondly, the STUDY II entitled " Safety of Six-Minute Walk Test in the Preoperative of Coronary Bypass Grafting: A Focus on Multivessel Advanced Coronary Artery Disease”. The aim of the present study was to evaluate the safety of using the 6MWT in the preoperative assessment for coronary artery bypass grafting (CABG) by analyzing metabolic and cardiorespiratory responses and to determine if coronary lesion topography increases the risk of adverse events during the test. The study concluded that the use of the 6MWT in the preoperative assessment for CABG is safe in patients with multivessel CAD. Cardiopulmonary and metabolic measures confirmed the submaximal feature of the test in this population. The topography of coronary artery lesions, including LMA lesion, showed no increase in adverse events, despite the higher atherosclerotic burden impairing functional capacity. Finally, the STUDY III was entitled as “Ventilatory Constraints and Delayed Oxygen Uptake Kinetics as Major Causes of Exercise Limitation in Patient Underwent Coronary Artery Bypass Surgery”. This purpose of this study was to 1) compared VO2 on-kinetics and ventilatory constraints during the 6MWT between pre- and postoperative periods of CABG patients; 2) determine the main causes of postoperative exercise limitation; 3) explore the correlation between kinetic parameters, cardiopulmonary responses, respiratory muscle strength and inflammatory cytokines. In conclusion, ventilatory limitation was the main cause of exercise restriction, affecting 40% patients. Respiratory muscle strength and inflammatory cytokines were associated with kinetics parameters (p<0.01). The postoperative 6MWT unveils delayed VO2 on-kinetics and pronounced ventilatory constraints following CABG. Ventilatory limitation emerged as the primary cause to exercise intolerance, with respiratory muscle strength and inflammatory status as key factors.
Descrição
Citação
ROCCO, Isadora Salvador. Capacidade funcional em pacientes com doença coronariana multiarterial: foco na cinética do VO2, segurança e aplicabilidade intrahospitalar. 2024. 148 f. Tese (Doutorado em Cardiologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.