Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preserved in COPD. It is unknown whether prevalent cardiovascular co-morbidities, such as heart failure, may impair CBF and COx responses to exertion. Eighteen males with moderate-to-severe COPD (8 with and 10 without overlapping heart failure) underwent a progressive exercise test with pre-frontal CBF and COx measurements (indocyanine green and near-infrared spectroscopy). Mean arterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards the end of progressive exercise. CBF index was consistently higher and increased further by ∼40% during exercise in COPD whereas a ∼10% reduction was observed in overlap. COx was lower in overlap despite preserved arterial oxygenation. In conclusion, heart failure introduces pronounced negative effects on CBF and COx in COPD which may be associated with clinically relevant outcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognitive impairment.
Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and muscle blood flow thereby contributing to exercise intolerance. To investigate the role of impaired central and peripheral hemodynamics in limiting exercise tolerance in COPD-heart failure overlap, cycle ergometer exercise tests at 20% and 80% peak work rate were performed by overlap (FEV1 = 56.9 ± 15.9% predicted, ejection fraction = 32.5 ± 6.9%; N = 16), FEV1-matched COPD (N = 16), ejection fraction-matched heart failure patients (N = 15) and controls (N = 12). Differences (Δ) in cardiac output (impedance cardiography) and vastus lateralis blood flow (indocyanine green) and deoxygenation (near-infrared spectroscopy) between work rates were expressed relative to concurrent changes in muscle metabolic demands (ΔO2 uptake). Overlap patients had approximately 30% lower endurance exercise tolerance than COPD and heart failure (p < 0.05). ΔBlood flow was closely proportional to Δcardiac output in all groups (r = 0.89-0.98; p < 0.01). Overlap showed the largest impairments in Δcardiac output/ΔO2 uptake and Δblood flow/ΔO2 uptake (p < 0.05). Systemic arterial oxygenation, however, was preserved in overlap compared to COPD. Blunted limb perfusion was related to greater muscle deoxygenation and lactate concentration in overlap (r = 0.78 and r = 0.73, respectively; p < 0.05). ΔBlood flow/ΔO2 uptake was related to time to exercise intolerance only in overlap and heart failure (p < 0.01). In conclusion, COPD and heart failure add to decrease exercising cardiac output and skeletal muscle perfusion to a greater extent than that expected by heart failure alone. Treatment strategies that increase muscle O2 delivery and/or decrease O2 demand may be particularly helpful to improve exercise tolerance in COPD patients presenting heart failure as co-morbidity.
Introdução: Programas de reabilitação cardiovascular são fundamentais para garantir uma melhor qualidade de vida (QV) em pacientes cardiopatas. Objetivos: Avaliar a QV de pacientes submetidos à reabilitação cardíaca (RC) e investigar se aspectos sociodemográficos, tipo de diagnóstico e tempo de tratamento são variáveis que influenciam a QV desses pacientes. Métodos: Realizou-se um estudo transversal com 82 pacientes, 64,52 ± 9,04 anos, que responderam dois questionários para avaliação da QV (questionário SF-36). Foram feitas a classificação do nível socioeconômico e a determinação do perfil sociodemográfico dos participantes. Resultados: Maiores valores dos escores do questionário SF-36 que avaliam aspectos emocionais foram observados em todas as associações realizadas. Os aspectos do perfil da amostra abordados neste estudo não repercutiram de forma representativa na QV. Conclusão: Pacientes cardiopatas submetidos à RC apresentaram maiores valores em escores de qualidade de vida que avaliam aspectos emocionais. Os fatores estudados não influenciaram a QV desses participantes.
Objetivos: Analisar e correlacionar o nível de atividade física (NAF) e a qualidade de vida (QV) de pacientes com doença renal crônica (DRC) submetidos à hemodiálise, e verificar, nos praticantes de atividades físicas (AF), se eles seguem normas e recomendações adequadas para sua prática. Método: A QV (questionário KDQOL-SFTM), o NAF (questionário IPAQ) e avaliação de normas e recomendações para prática de AF foram analisados em 101 pacientes. Resultados: Foi observado comprometimento nas diferentes dimensões da QV, com os maiores valores para função sexual e suporte social (88,6), e os menores, para papel profissional (25,2) e função física (47,7). A maioria dos pacientes apresentou baixos NAF, e a maior parte dos praticantes de AF executa exercícios incorretamente. Diferenças entre NAF e alguns domínios da QV foram observadas. Conclusões: Os pacientes com DRC submetidos à hemodiálise apresentaram baixos NAFs e comprometimento na QV, e a maioria dos que realizavam AF não seguiam normas e recomendações adequadas para sua prática.
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