Banca de DEFESA: ANDERSON SANTANA DE MORAIS

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : ANDERSON SANTANA DE MORAIS
DATE: 05/09/2022
TIME: 19:30
LOCAL: VIDEOCONFERÊNCIA
TITLE:

Ventilatory oscillation assessed through cardiopulmonary stress test in heart failure.

KEY WORDS:

AVentilatory dispersion, heart failure, ventilatory oscilation.

PAGES: 43
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

BACKGROUND: Heart failure (HF) is a complex clinical syndrome defined by the inability of the heart to generate cardiac output. In addition to cardiac alterations, patients with HF have alterations in ventilatory control, such as hyperventilation at rest, during exercise, or during sleep. Ventilatory oscillation (VO) is described as periodic breathing during exercise characterized by periods of hypopnea and hyperpnea, with no intervening apnea. It is a variable that can be found during cardiopulmonary exercise test (CPET), where it can appear as a clinical oscillation of the minute volume (VE), with typical duration and amplitudes, and may have different forms of presentation, such as subjective visual analysis through the evaluation of two or more examiners. Recently, an objective and quantifiable measure of OV was created, the “ventilatory dispersion index” (VDI), based on a mathematical calculation taking into account the dispersion of ventilation over the test time. OBJECTIVE: To evaluate ventilatory oscillation through the ventilatory dispersion index in heart failure during CPET. MATERIAL AND METHOD: This is a retrospective study that analyzed the medical records of patients with HF referred to the Cardiac Rehabilitation Service of the Hospital Universitário Onofre Lopes (CORE/HUOL/UFRN) submitted to CPET, from October 2014 to June 2019. The medical records were included for analysis of patients with HF diagnosed by the cardiologist, with functional class I, II and III according to the New York Heart Association (NYHA) and with reduced and preserved ejection fraction. The data extracted from the medical records were spreadsheetd in an Excel table, with information regarding: anthropometry, disease burden, drug load, functional load, spirometry, echocardiogram and CPET data. The identification of VO was carried out by two independent researchers and there was agreement between them, through graphic analysis of the VExTime with a 30-second filter, being positive when the LV amplitude during exercise is greater than 15% of the LV amplitude at rest and present at least 60% of the total test time. The IDV calculation was done through a mathematical calculation proposed by latelly. Statistical Package for Social Science Software (SPSS – version 20.0) was used statistical analysis, data normality (used Kolmogorov-Smirnov (K-S) or Shapiro-Wilk (S-W) tests; descriptive to parametric and non with mean and standard deviation and frequency and quartis.  significance level of 5%. The ROC curve was used to analyze the ability of the VDI to predict OV, through the area under the curve (AUC). Pearson's correlation test was used to analyze the relationship between VDI and lung function/CPET/risk stratification variables. Significance level of 5% was proposed to all hypotesis. RESULTS: Were anaysed data of 93 patients with HF eligible to study. The majority patients was male, without significant difference between men (n=65) and women (n=28) for the variables of ventilatory function, EFLV and ventilatory dispersion. Mean age in the group was 50.8±14.2 years, normoweight (mean BMI 26.1±4.6), all with heart failure and systolic dysfunction with EFLV of 42.4±0.16%). I and II were the most prevalent NYHA functional classes. In the burden of disease, SAH dominated in 66.3%, followed by diabetes (32.5%) and 12 patients had previous acute MI. As a drug load, patients used mainly antihypertensive drugs (85.7%) and beta-blockers (80.5%). As for the functional load, most patients were sedentary (54.1%), and were classified as having moderate risk (88.5%) after stratification. The mean perception of fatigue and dyspnea reported at the end of the test was 14.2±3.4 and 14.8±3.3. The analyzed VDI mean was 0.551±0.306. The VDI was moderately and positively associated with volumes and capacities measured in spirometry positively and moderately associated with the CPET variables (rest and peak of exercise) showing that the higher these values, the higher the VDI. The association of visually measured OV with the VDI showed a cut-off point of 0.601 by the Younden index in the VDI, showing good discriminatory power (p<0.001) to define the ventilatory dispersion, with an AUC of 0.84 (IC 0 .75-0.93), a specificity of 63% and a sensitivity of 81%. CONCLUSION: The IDV is a quantifiable method that shows strong predictive validity with the OV.

COMMITTEE MEMBERS:
Externa ao Programa - 2646588 - JOCELINE CASSIA FEREZINI DE SA - nullExterna à Instituição - NICOLE SOARES OLIVER CRUZ - UNIESP
Presidente - 1149619 - SELMA SOUSA BRUNO