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While the majority of individuals with coronavirus disease 2019 (COVID-19) recover completely, a significant percentage experience persistent symptom, which has been characterized as Long COVID and may be associated with cardiac and autonomic dysfunction. We evaluated heart rate variability (HRV) at rest and during deep-breathing (M-RSA) in patients with Long COVID. Case-control design involved 21 patients with Long COVID and 20 controls; the HRV was evaluated (POLAR system) at rest in the supine position and during M-RSA and expressed in time domain and non-linear analysis. In the supine position we found a reduction HRV measures in Long COVID' patients compared to controls for: Mean_iRR (p < 0.001), STD_iRR (p < 0.001); STD_HR (p < 0.001); SD1 (p < 0.001); SD2 (p < 0.001); alpha2 (p < 0.001). In the M-RSA we found reduction Mean_iRR (p < 0.001), STD_iRR (p < 0.001), STD_HR (p < 0.001), rMSSD (p < 0.001), RR_tri-index (p < 0.001) in Long COVID' patients except for highest Mean_HR p < 0.001. In conclusion, Long COVID reduced HRV at rest and during deep breathing. These findings may imply impairment of cardiac autonomic control when symptoms of COVID-19 persist following initial recovery.
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COVID-19 , Síndrome de COVID-19 Pós-Aguda , Humanos , Frequência Cardíaca/fisiologia , Sistema Nervoso Autônomo , CoraçãoRESUMO
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Our aim was to identify optimal cardiopulmonary exercise testing (CPET) threshold values that distinguish disease severity progression in patients with co-existing systolic heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to evaluate the impact of the cut-off determined on the prognosis of hospitalizations. We evaluated 40 patients (30 men and 10 woman) with HF and COPD through pulmonary function testing, doppler echocardiography and maximal incremental CPET on a cycle ergometer. Several significant CPET threshold values were identified in detecting a forced expiratory volume in 1 second (FEV1) < 1.6 L: 1) oxygen uptake efficiency slope (OUES) < 1.3; and 2) circulatory power (CP) < 2383 mmHg.mlO2.kg-1. CPET significant threshold values in identifying a left ventricular ejection fraction (LVEF) < 39% were: 1) OUES: < 1.3; 2) CP < 2116 mmHg.mlO2.kg-1.min-1 and minute ventilation/carbon dioxide production (VÌE/VÌCO2) slope>38. The 15 (38%) patients hospitalized during follow-up (8 ± 2 months). In the hospitalizations analysis, LVEF < 39% and FEV1 < 1.6, OUES < 1.3, CP < 2116 mmHg.mlO2.kg-1.min-1 and VÌE/VÌCO2 > 38 were a strong risk predictor for hospitalization (P ≤ 0.050). The CPET response effectively identified worsening disease severity in patients with a HF-COPD phenotype. LVEF, FEV1, CP, OUES, and the VÌE/VÌCO2 slope may be particularly useful in the clinical assessment and strong risk predictor for hospitalization.
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Teste de Esforço/métodos , Tolerância ao Exercício , Insuficiência Cardíaca Sistólica/diagnóstico , Consumo de Oxigênio , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Volume Sistólico , Idoso , Estudos Transversais , Feminino , Volume Expiratório Forçado , Insuficiência Cardíaca Sistólica/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Curva ROC , Testes de Função RespiratóriaRESUMO
Introdução: Pelo fato do período pós Acidente Vascular Cerebral requerer de uma série de cuidados especiais, os profissionais da saúde atuantes em sua reabilitação devem apresentar adequado tratamento ao paciente e para isto deve atualizar-se dos métodos existentes. Por apresentar maior número de sequelas sensório motoras, o fisioterapeuta é um dos profissionais indispensáveis para o devido tratamento. Objetivo: Apresentar uma revisão sistemática de literatura sobre os métodos fisioterapêuticos e a sua efetividade na reabilitação de sequelas após AVC. Métodos: Revisão sistemática de literatura na qual se utilizou para busca, as bases de dados Pubmed, Bireme, Scielo, Lilacs e Medline, no período de janeiro de 2008 a janeiro de 2018. Resultados: Foram encontrados 1.913 estudos com as palavras-chave selecionadas, e destes foram mantidos 15 estudos relevantes para o tratamento fisioterapêutico na reabilitação de sequelas após AVC. Conclusão: Evidenciou-se vasto campo de métodos fisioterapêuticos eficazes para a reabilitação após AVC, que irão auxiliar de forma objetiva e construtiva na abordagem do fisioterapeuta. (AU)
Introduction: Patient post-stroke period requires special care, health professionals working in their rehabilitation should provide appropriate and updated therapies. As it presents a greater number of sensorimotor sequences, the physiotherapist is one of the indispensable professionals for the due treatment. Objective: To present a systematic review of the literature on physiotherapeutic methods and their effectiveness in the rehabilitation of sequels after stroke. Methods: A systematic review of the literature in the databases Pubmed, Bireme, Scielo, Lilacs and Medline databases from January 2008 to January 2018. Results: We selected 1,913 studies and 15 of these studies were relevant for the physical therapy of stroke sequel and rehabilitation. Conclusion: A large and effective physiotherapeutic methods are efficient for stroke rehabilitation, which will help in the objective and constructive approach of the physiotherapist. (AU)
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Humanos , Reabilitação , Modalidades de Fisioterapia , Acidente Vascular Cerebral , Pacientes , Efetividade , Atenção à SaúdeRESUMO
PURPOSE: To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients. METHODS: Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated. RESULTS: During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005 and P=0.005, respectively]); frequency domain indices (LF increased [P=0.033] and HF decreased [P=0.002]); associations were found between forced expiratory volume in 1 second (FEV1) vs RMSSD (P=0.04; r=-0.55), FEV1 vs HR (P=0.04; r=-0.48), forced vital capacity (FVC) vs RMSSD (P=0.05; r=-0.62), maximum inspiratory pressure (MIP) vs HF (P=0.02; r=0.68). FEV1 and FVC justified 30% of mean HR. During VM: HR increased (P=0.01); the nadir showed normal bradycardic response; the Valsalva index was =0.7. CONCLUSION: COPD patients responded properly to the upper limb IC and to the VM; however, HR recovery during VM was impaired in these patients. The severity of the disease and MIP were associated with increased parasympathetic modulation and higher chronotropic response.
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Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Coração/inervação , Contração Isométrica , Pulmão/fisiopatologia , Músculo Esquelético/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Manobra de Valsalva , Adaptação Fisiológica , Idoso , Brasil , Estudos Cross-Over , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Recuperação de Função Fisiológica , Fatores de Tempo , Extremidade Superior , Capacidade VitalRESUMO
BACKGROUND: The pathophysiology of chronic obstructive pulmonary disease (COPD) is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise. OBJECTIVES: To evaluate the relationship between peripheral arterial occlusive disease (PAOD) and peripheral muscle strength and exercise capacity in COPD patients. METHODS: We conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM) of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT). RESULTS: COPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02) and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02) when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001) and the 1RM/knee extension (r = 0.71; p = 0.03); and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02) and the 1RM/knee flexion (r = 0.92; p < 0.001). The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01). CONCLUSION: COPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.
CONTEXTO: A doença pulmonar obstrutiva crônica (DPOC) apresenta uma complexa fisiopatologia e sua compreensão vem se modificando nos últimos anos, com atenção para as manifestações multissistêmicas, em especial a disfunção periférica e sua influência na intolerância ao exercício físico. OBJETIVO: Avaliar o impacto da doença arterial periférica obstrutiva (DAOP) na força muscular periférica e na capacidade de exercício dos portadores de DPOC. MÉTODOS: Estudo transversal realizado com 35 portadores de DPOC, que foram avaliados pelo índice tornozelo-braquial, teste de força de preensão palmar (FPP), uma repetição máxima (1RM) de extensores e flexores de joelho, e a distância no incremental shuttle walking test (dISWT). RESULTADOS: Portadores de DPOC com DAP coexistente apresentaram menor FPP da mão dominante (33,00 versus 26,66 kgf, p = 0,02) e pior desempenho no dISWT (297,32 versus 219,41 m, p = 0,02) quando comparados aos portadores de DPOC sem DAP. Fortes correlações foram encontradas entre a medida da FPP e a dISWT (r = 0,78; p < 0,001) e a 1RM/extensão de joelho (r = 0,71; p = 0,03); entre a dISWT e a 1RM/extensão de joelho (r = 0,72; p = 0,02) e a 1RM/flexão de joelho (r = 0,92; p < 0,001). O modelo de regressão linear identificou que a variável dISWT explica isoladamente 15,3% do resultado do índice tornozelo braquial (p = 0,01). CONCLUSÃO: Portadores de DPOC com DAOP coexistente apresentam maior perda da força muscular periférica e pior desempenho da capacidade de exercício quando comparados aos portadores de DPOC sem DAOP.
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INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is recognized as a multisystemic inflammatory disease associated with extrapulmonary comorbidities, including respiratory muscle weakness and cardiovascular and cardiac autonomic regulation disorders. We investigated whether alterations in respiratory muscle strength (RMS) would affect cardiac autonomic modulation in COPD patients. METHODS: This study was a cross-sectional study done in ten COPD patients affected by moderate to very severe disease. The heart rate variability (HRV) signal was recorded using a Polar cardiofrequencimeter at rest in the sitting position (10 minutes) and during a respiratory sinus arrhythmia maneuver (RSA-M; 4 minutes). Linear analysis in the time and frequency domains and nonlinear analysis were performed on the recorded signals. RMS was assessed using a digital manometer, which provided the maximum inspiratory pressure (PImax) and the maximum expiratory pressure (PEmax). RESULTS: During the RSA-M, patients presented an HRV power increase in the low-frequency band (LFnu) (46.9±23.7 vs 75.8±27.2; P=0.01) and a decrease in the high-frequency band (HFnu) (52.8±23.5 vs 24.0±27.0; P=0.01) when compared to the resting condition. Significant associations were found between RMS and HRV spectral indices: PImax and LFnu (r=-0.74; P=0.01); PImax and HFnu (r=0.74; P=0.01); PEmax and LFnu (r=-0.66; P=0.01); PEmax and HFnu (r=0.66; P=0.03); between PEmax and sample entropy (r=0.83; P<0.01) and between PEmax and approximate entropy (r=0.74; P=0.01). Using a linear regression model, we found that PImax explained 44% of LFnu behavior during the RSA-M. CONCLUSION: COPD patients with impaired RMS presented altered cardiac autonomic control, characterized by marked sympathetic modulation and a reduced parasympathetic response; reduced HRV complexity was observed during the RSA-M.
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Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Coração/inervação , Pulmão/fisiopatologia , Força Muscular , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Idoso , Expiração , Feminino , Humanos , Inalação , Modelos Lineares , Masculino , Manometria , Pessoa de Meia-Idade , Dinâmica não Linear , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de Doença , Processamento de Sinais Assistido por Computador , Espirometria , Telemetria , Fatores de TempoRESUMO
BACKGROUND: We investigated a potential link between genetic polymorphisms in genes XRCC1 (Arg399Gln), OGG1 (Ser326Cys), XRCC3 (Thr241Met), and XRCC4 (Ile401Thr) with the level of DNA damage and repair, accessed by comet and micronucleus test, in 51 COPD patients and 51 controls. METHODS: Peripheral blood was used to perform the alkaline and neutral comet assay; and genetic polymorphisms by PCR/RFLP. To assess the susceptibility to exogenous DNA damage, the cells were treated with methyl methanesulphonate for 1-h or 3-h. After 3-h treatment the % residual damage was calculated assuming the value of 1-h treatment as 100%. The cytogenetic damage was evaluated by buccal micronucleus cytome assay (BMCyt). RESULTS: COPD patients with the risk allele XRCC1 (Arg399Gln) and XRCC3 (Thr241Met) showed higher DNA damage by comet assay. The residual damage was higher for COPD with risk allele in the four genes. In COPD patients was showed negative correlation between BMCyt (binucleated, nuclear bud, condensed chromatin and karyorrhexic cells) with pulmonary function and some variant genotypes. CONCLUSION: Our results suggest a possible association between variant genotypes in XRCC1 (Arg399Gln), OGG1 (Ser326Cys), XRCC3 (Thr241Met), and XRCC4 (Ile401Thr), DNA damage and progression of COPD.