Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients

Objective: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. Methods: Forty-six male patients (age: 53.1 +/- 13.6 years oldleft ventricular ejection fraction [LVEF]: 30 +/- 8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 34 and peak VO2 34 to patients who just had one of these responses either. Conclusion: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ)Univ Fed Rio de Janeiro, Fac Med, Res Grp Cardioresp Rehabil GECARE, Rio de Janeiro, RJ, BrazilUniv Fed Rio de Janeiro, Fac Med, Dept Phys Therapy, Rio de Janeiro, RJ, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Resp Div,Pulm Funct & Clin Exercise Physiol Unit, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Physiotherapy, Resp Div, Sao Paulo, BrazilUniv Fed Sao Carlos UFSCAR, Dept Phys Therapy, Lab Cardiopulm Phys Therapy LACAP, Sao Carlos, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Dept Med, Resp Div,Pulm Funct & Clin Exercise Physiol Unit, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Physiotherapy, Resp Div, Sao Paulo, BrazilWeb of Scienc

Comparative analysis of predictive formulas for the evaluation of functional capacity with cardiopulmonary test in professional female soccer players

Comparar a validade de duas fórmulas de predição do consumo de oxigênio (VO2 ) com os valores obtidos no teste cardiopulmonar (TCP) em esteira ergométrica de jogadoras de futebol profissional. Dezoito jogadoras de futebol profissional foram submetidas ao TCP em esteira em um protocolo de carga incremental. Na sequência, foi determinado o VO2 da potência do limiar anaeróbio ventilatório (LAV) e no pico do exercício físico. Posteriormente, as fórmulas de predição de VO2 – i) VO2 = (0,2 x velocidade) + (0,9 x velocidade x inclinação) + 3,5 – velocidade em mph e inclinação %); e ii) MET (equivalente metabólica) = 6xHRI-5, onde HRI = frequência cardíaca máxima/frequência cardíaca de repouso – foram aplicadas nas mesmas potências para comparação. Para a primeira fórmula foi observado que tanto no LAV como no pico do TCP, os dados obtidos ficaram abaixo do previsto, sugerindo que a fórmula superestima o VO2 e, consequentemente, a capacidade e a potência aeróbicas. Na segunda fórmula foi observado que os valores ficaram abaixo do obtido, sugerindo que a fórmula subestimou o VO2 e, consequentemente a potência aeróbica, e mais uma vez a capacidade funcional. Diante disso, as fórmulas de predição não mostraram similaridade na determinação da capacidade funcional (CF) de jogadoras de futebol profissional, sugerindo não serem recomendadas para essa populaçãoComparar la validez de dos fórmulas para predecir el consumo de oxígeno (VO2) con los valores obtenidos en la prueba cardiopulmonar (PCP) en una cinta de correr de jugadoras de fútbol profesionales. Dieciocho jugadoras de fútbol profesional se sometieron al PCP en cinta de correr en un protocolo de carga incremental. En la secuencia, se determinó el VO2 de la potencia del Umbral Anaeróbico Ventilatorio (UAV) y en el pico del ejercicio físico. Posteriormente, las fórmulas de predicción de VO2 –i) VO2 = (0,2 × velocidad) + (0,9 × velocidad × inclinación) + 3,5 − velocidad en mph e inclinación %); y ii) MET (equivalente metabólico) = 6xHRI−5, donde HRI = frecuencia cardiaca máxima/ frecuencia cardíaca de reposo– se aplicaron en las mismas potencias para comparación. Para la primera fórmula se observó que tanto en la UAV como en el pico del PCP, los datos obtenidos quedaron por debajo de lo previsto, sugiriendo que la fórmula sobrestima el VO2 y, consecuentemente, la capacidad y la potencia aeróbica. En la segunda fórmula se observó que los valores quedaron por debajo de lo obtenido, sugiriendo que la fórmula subestimó el VO2 y, consecuentemente, la potencia aeróbica, y una vez más la capacidad funcional. Por lo tanto, las fórmulas de predicción no mostraron semejanza en la determinación de la capacidad funcional (CF) de las jugadoras de fútbol profesional, sugiriendo que no son recomendadas para esa población.To compare the validity of two oxygen consumption (VO2 ) prediction formulas with the values obtained through cardiopulmonary exercise test (CPT) in a treadmill with professional female soccer players. Eighteen professional female soccer players performed CPT in a treadmill with an incremental protocol. The VO2 of the gas exchange threshold (GET) was determined, as well as at peak exercise. After that, the following formula of VO2 prediction i) VO2 = (0.2 x velocity) + (0.9 x velocity x incline) + 3.5 – velocity, in mph and %incline); and ii) MET (metabolic equivalent) = 6xHRI-5, where HRI = maximum heart rate/ resting heart rate, were applied in the same power for comparison. In the first formula, the values obtained in GET and at peak exercise were below the estimated, indicating that the formula overestimated VO2 and, consequently, aerobic capacity and power. In the second formula, the values were below the estimated, indicating that the formula also underestimated VO2 and, consequently, aerobic capacity and power. Given these results, the prediction formulas do not present similarity in determining the functional capacity (FC) of professional female soccer players, indicating they are not suitable for this population

Cardiorespiratory adjustments during the accentuation of respiratory sinus arrhythmia: influence from time of maneuver on minute volume, fraction of expired CO 2 , and heart rate variability

La frecuencia cardíaca sufre oscilaciones durante el ciclo respiratorio, fenómeno conocido como arritmia sinusal respiratoria. La maniobra para acentuación de la arritmia sinusal respiratoria (M-ASR) consiste en mantener ventilación educada con frecuencia respiratoria de seis ciclos por minuto con relación al tiempo inspiración/espiración (TI:TE) de 1:1. En este estudio se propone a evaluar la conducta del volumen minuto, de la fracción espirada de CO2 (FeCO2 infiere sobre el PaCO2) y el control autonómico de la frecuencia cardíaca durante la M-ASR con duración mayor de 90s. Se evaluaron 16 varones jóvenes sanos (de 18 a 25 años de edad). Se les orientaron para que realizasen inspiraciones y espiraciones pausadas de 10 segundos de duración por ciclo, TI:TE de 1:1, y consecuente frecuencia respiratoria de seis incursiones por minuto, durante cuatro minutos. Durante la evaluación se recolectaron la frecuencia cardíaca (FC), latido a latido a través de un monitor de frecuencia cardíaca, el volumen minuto (VM) y la FeCO2 mediante un ergoespirómetro. Para el análisis estadístico se empleó ANOVA one-way (con post-hoc de Tukey) o test de Kruskal-Wallis (con post-hoc de Dunn) cuando necesario (pHeart rate (HR) fluctuate during the respiratory cycle. This phenomenon is known as respiratory sinus arrhythmia. The deep breathing test is to keep a paced breathing in six breathing per minute and I:E relationship 1:1. The purpose of this study is to access minute volume, expired fraction of carbon dioxide (EFCO2) and autonomic control of heart rate during deep breathing test longer than 90 seconds. Sixteen young healthy male (18 - 25 years old) were assessed. The subjects were instructed to perform inspirations and expirations with duration of 10 seconds per cycle, I:E = 1:1, and consequently respiratory rate of 6 cycles per minute, for about four minutes with one minute after and before, totaling six minutes. HR was recorded beat-to-beat using a cardio frequencimeter; MV and EFCO2 was measured and recorded using a mobile ergoespirometer. To analyse statistics differences, ANOVA one way (Tuckey post-hoc) and Kruskall Wallis (Dunn post-hoc) were used (pA frequência cardíaca sofre variações durante o ciclo respiratório, fenômeno conhecido como arritmia sinusal respiratória. A manobra para acentuação da arritmia sinusal respiratória (M-ASR) consiste em manter ventilação educada com uma frequência respiratória de seis ciclos por minuto com relação tempo inspiração/expiração (TI:TE) de 1:1. Este estudo tem como objetivo avaliar o comportamento do volume minuto, da fração expirada de CO2 (FeCO2 infere sobre PaCO2) e do controle autonômico da frequência cardíaca durante a M-ASR com duração maior do que 90s. Foram avaliados 16 homens jovens saudáveis (de 18 a 25 anos). Todos foram orientados a realizar inspirações e expirações lentas com duração de 10 segundos por ciclo, TI:TE de 1:1 e consequente frequência respiratória de seis incursões por minuto, durante quatro minutos. Durante a avaliação foi coletada a frequência cardíaca (FC) batimento a batimento por meio de um cardiofrequencímetro, o volume minuto (VM) e a FeCO2 através de um ergoespirômetro. Para análise estatística empregou-se ANOVA one-way (com post-hoc de Tukey) ou teste de Kruskal-Wallis (com post-hoc de Dunn) quando conveniente (

Reproducibility of the lactate minimum test in wistar rats after training at the maximal lactate steady state intensity

The aim of this study was to verify the reproducibility of the lactate minim (LM) test after four weeks of aerobic training, as well as its validity with the maximal lactate steady state (MLSS) in Wistar rats submitted to swimming exercise. Ten rats with 90 days were used. The aerobic and anaerobic capacity was determined by the LM test before and after the training. The protocol of MLSS was also applied before and after the training. Training was accomplished for four weeks, being the first two weeks with a volume of 30 minutes and the other two weeks with a volume of 45 minutes, both in the intensity of MLSS. With the training, the intensity of LM and the concentration of LM [Lac] increased of 16.19±1.87 to 18.84 ± 0.96 g and of 3.58±1.78 to 5.42±1.13 mmol/L, respectively. The intensity of MLSS increased of 18.64±1.75 to 19.97±2.15 g. The intensity of LM and MLSS in the pre and post-training phase presented high correlations (r=0.92) and (r=0.87), respectively. It was concluded that the LM test presented sensibility to the effects of the training, as well as validity with gold standard test (MLSS) in rats submitted to swimming exercise

A practical approach to assess leg muscle oxygenation during ramp-incremental cycle ergometry in heart failure

Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (O2) delivery (i.e., muscle blood flow in non-hypoxemic patients) to meet O2 demands. The resulting increase in fractional O2 extraction can be non-invasively tracked by deoxygenated hemoglobin concentration (deoxi-Hb) as measured by near-infrared spectroscopy (NIRS). We aimed to establish a simplified approach to extract deoxi-Hb-based indices of impaired muscle O2 delivery during rapidly-incrementing exercise in heart failure. We continuously probed the right vastus lateralis muscle with continuous-wave NIRS during a rampincremental cardiopulmonary exercise test in 10 patients (left ventricular ejection fraction o35%) and 10 age-matched healthy males. Deoxi-Hb is reported as % of total response (onset to peak exercise) in relation to work rate. Patients showed lower maximum exercise capacity and O2 uptake-work rate than controls (Po0.05). The deoxi-Hb response profile as a function of work rate was S-shaped in all subjects, i.e., it presented three distinct phases. Increased muscle deoxygenation in patients compared to controls was demonstrated by: i) a steeper mid-exercise deoxi-Hb-work rate slope (2.2±1.3 vs 1.0±0.3% peak/W, respectively; Po0.05), and ii) late-exercise increase in deoxi-Hb, which contrasted with stable or decreasing deoxi-Hb in all controls. Steeper deoxi-Hb-work rate slope was associated with lower peak work rate in patients (r=–0.73; P=0.01). This simplified approach to deoxi-Hb interpretation might prove useful in clinical settings to quantify impairments in O2 delivery by NIRS during ramp-incremental exercise in individual heart failure patients.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Sao Paulo, Disciplina Cardiol, Sao Paulo, SP, BrazilInst Dante Pazzanese Cardiol, Dept Cardiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Setor Fisiol Clin Exercicio, Disciplina Pneumol, Sao Paulo, SP, BrazilUniv Fed Rio de Janeiro, Fac Med, Dept Fisioterapia, Rio De Janeiro, RJ, BrazilQueens Univ, Div Resp & Crit Care Med, Lab Clin Exercise Physiol, Kingston, ON, CanadaUniv Fed Sao Paulo, Disciplina Cardiol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Setor Fisiol Clin Exercicio, Disciplina Pneumol, Sao Paulo, SP, BrazilWeb of Scienc

Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

Background: It is currently unclear whether the additive effects of a long-acting beta(2)-agonist (LABA) and the antimuscarinic tiotropium bromide (TIO) on resting lung function are translated into lower operating lung volumes and improved exercise tolerance in patients with chronic obstructive pulmonary disease (COPD).Methods: On a double-blind and cross-over study, 33 patients (FEV(1) = 47.4 +/- 12.9% predicted) were randomly allocated to 2-wk formoterol fumarate 12 mu g twice-daily (FOR) plus TIO 18 mu g once-daily or for plus placebo (PLA). Inspiratory capacity (IC) was obtained on constant-speed treadmill tests to the limit of tolerance (Tlim).Results: FOR-TIO was superior to FOR-PLA in increasing post-treatment FEV(1) and Tlim (1.34 +/- 0.42 L vs. 1.25 +/- 0.39 L and 124 +/- 27% vs. 68 +/- 14%, respectively; p < 0.05). FOR-TIO slowed the rate of decrement in exercise IC compared to FOR-PLA (Delta isotime-rest = -0.27 +/- 0.40 L vs. -0.45 +/- 0.36 L, p < 0.05). in addition, end-expiratory lung volume (% total lung capacity) was further reduced with FOR-TIO (p < 0.05). of note, patients showing greater increases in Tlim with FOR-TIO (16/26, 61.6%) had more severe airways obstruction and lower exercise capacity at baseline. Improvement in Tlim with FOR-TIO was also related to larger increases in FEN(1) (p < 0.05).Conclusions: Compared to for monotherapy, FOR-TIO further improved effort-induced dynamic hyperinflation and exercise endurance in patients with moderate-to-severe COPD. These beneficial consequences were more likely to be found in severely-disabled patients with larger resting functional responses to the combination therapy.Trial registration: Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov]. (C) 2010 Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Paulista Sch Med UNIFESP EPM, Pulm Funct & Clin Exercise Physiol Unit SEFICE, Resp Div,Dept Med, BR-04020050 São Paulo, BrazilFeevale Univ, Hlth Sci Inst, Novo Hamburgo, BrazilUniversidade Federal de São Paulo, Dept Prevent & Social Med, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Sch Med UNIFESP EPM, Pulm Funct & Clin Exercise Physiol Unit SEFICE, Resp Div,Dept Med, BR-04020050 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Prevent & Social Med, BR-04020050 São Paulo, BrazilWeb of Scienc

Nasal tip reconstruction: case reports and historical review

Traumatic amputations of the nasal tip are disfiguring injuries, which determine important social rejection, imposing additional suffering on the patient and those already caused by the wound and its functional limitations resulting from the trauma. Such defects represent a challenge for plastic surgeons, and several techniques can be adopted to treat this type of defect. This work shows three cases of traumatic amputation exclusively of the nasal tip with their respective treatments. They present a historical review and discussion of the different techniques used for nasal tip reconstruction, comparatively evaluating and emphasizing the technical evolution in plastic surgery armament