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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2011.tde-07122011-132655
Document
Author
Full name
Bruno Arantes Dias
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Souza, Rogério de (President)
Deheinzelin, Daniel
Fernandes, Caio Julio Cesar dos Santos
Jardim, Carlos Viana Poyares
Teixeira, Ricardo Henrique de Oliveira Braga
Title in Portuguese
Resposta cardiovascular ao exercício em pacientes portadores de hipertensão arterial pulmonar
Keywords in Portuguese
Esforço físico
Exercício
Fenômenos fisiológicos cardiovasculares
Hemodinâmica
Hipertensão pulmonar
Peptídeos natriuréticos
Abstract in Portuguese
O entendimento adequado da resposta cardiovascular ao exercício é fundamental para o manejo e tratamento dos pacientes com hipertensão arterial pulmonar (HAP). Entretanto, dados a respeito da adaptação da mecânica vascular pulmonar e da adaptação do ventrículo direito ao esforço são escassos na literatura. O objetivo desse estudo é caracterizar a resposta cardiovascular ao exercício nos pacientes nesse grupo de pacientes. Foram selecionados 30 pacientes com HAP (Grupo 1 de Dana Point) e 7 controles com hemodinâmica invasiva normal, entre dezembro de 2009 e novembro de 2010, que realizaram protocolo incremental de esforço em cicloergômetro limitado por sintomas. Foram avaliados o comportamento das variáveis hemodinâmicas, da mecânica vascular pulmonar e o comportamento do peptídeo natriurético tipo B durante o esforço nos pacientes e comparado sua resposta com os controles. O grupo HAP apresentou elevação da PAPm superior ao grupo controle, com elevação da Poap e FC semelhantes. A elevação do débito cardíaco no pico do esforço foi inferior nesse grupo, sem variação do volume sistólico. A complacência e resistência vascular pulmonar apresentam queda no grupo HAP, permanecendo com complacência inferior e resistência superior no pico do esforço em relação aos controles. Estas variáveis permanecem inversamente acopladas sob a função C = t / R em repouso e durante todos os passos do esforço, reforçando o poder desse acoplamento e o papel na CVP na avaliação desses pacientes. No entanto, o comportamento da resistência não é uniforme em todos os pacientes com HAP, podendo ser separada em 3 grupos distintos: elevação, manutenção e queda durante o esforço. O BNP apresenta elevação durante o esforço no grupo HAP, mas os valores de BNP basal apresentam correlação inversa superior com o DC de pico do que os valores de BNP no pico do esforço. Na avaliação por curva ROC, o BNP de pico e a variação de BNP pico basal não se mostraram superiores ao BNP basal na discriminação da resposta do DC no esforço, reforçando o papel do BNP basal na avaliação dos pacientes com HAP
Title in English
Cardiovascular response to exercise in patients with pulmonary arterial hypertension
Keywords in English
Cardiovascular physiological phenomena
Exercise
Hemodynamics
Natriuretic peptides
Physical exertion
Pulmonary hypertension
Abstract in English
The proper understanding of the cardiovascular response to exercise has a central role in the management and treatment of patients with pulmonary arterial hypertension (PAH). However, data concerning the evolution of pulmonary vascular mechanics and right ventricular adaptation to effort are scarce. The aim of this study is characterize the cardiovascular response to exercise in these patients. We selected 30 patients with PAH (Group 1 Dana Point) and 7 controls with normal invasive hemodynamics between December 2009 and November 2010 who underwent a symptom-limited exercise protocol on cycle ergometer. Were evaluated the behavior of hemodynamic parameters, pulmonary vascular mechanics and B-type natriuretic peptide during stress in patients and compared their response with controls. The PAH group showed elevation of mPAP greater than the controls, with the same elevated PCWP and HR response between the groups. Cardiac output at peak exercise was lower in the PAH patients with no change of stroke volume during effort. Compliance and pulmonary vascular resistance have decrease in PAH group, remaining with lower compliance and higher resistance at peak exercise compared to controls. These variables are inversely related at rest and during every step of the effort, strengthening the power of this relation and the role of CVP in evaluation of these patients. However, the behavior of resistance is not uniform in all PAH patients and may be separated into three distinct groups: rise, fall and maintenance during exercise. The BNP raises during exercise in PAH group, but the values of baseline BNP already has an stronger inverse correlation with peak CO, better than the correlation of peak exercise BNP with the same variable. BNP at peak exercise and the variation of BNP peak - baseline were not superior to baseline BNP in discriminating the response of the CO during exercise, when evaluated by ROC curves. These findings reinforce the role of baseline BNP in evaluating patients with PAH
 
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Publishing Date
2011-12-07
 
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