Browsing by Subject "Pathophysiology"

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    Cardiopulmonary Exercise test in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis
    (MDPI, 2021-05-25) Bayonas Ruiz, Adrián; Muñoz Franco, Francisca M.; Ferrer Pérez, Vicente; Pérez Caballero, Carlos; Sabater Molina, María; Tomé Esteban, María Teresa; Bonacasa Fernández, Bárbara; Fisiología
    Background: Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. Methods: A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. Results: Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg−1·min−1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg−1·min−1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (−6.20 mL·kg−1·min−1; CI 95%: −7.95, −4.46; p < 0.01). Conclusions: CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.
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    Experiencias de Docencia Virtual en Facultades de Medicina Españolas durante la pandemia COVID-19 (I): Anatomía, Fisiología, Fisiopatología, Oncología
    (Centro de Estudios en Educación Médica de la Universidad de Murcia (CeuEM) y Editum (Servicio de Publicaciones de la Universidad de Murcia), 2020) Pericacho, M.; Rosado, JA.; Pons de Villanueva, J.; Arbea, L.
    Presentamos un resumen de las actividades que algunos profesores deFacultades de Medicina españolas han llevado a cabo durante las 3 semanas previasa las vacaciones de primavera. Durante este tiempo, debido a la pandemia provocadapor la COVID-19, la docencia presencial tuvo que ser sustituída por actividades enlínea o virtuales, a causa de la implantación del estado de alarma en España quemotivó el cierre completo de las Universidades desde el 13 de marzo de 2020. Lasexperiencias son de Anatomía, Fisiología, Fisiopatología y Oncología.
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    New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: an ultrasound study
    (Elsevier, 2018) Vázquez Costa, J. F.; Campins Romeu, M.; Martínez Payá, Jacinto Javier; Tembl, J. I.; Baño Aledo, María Elena del; Ríos Díaz, J.; Fornés Ferrer, V.; Chumillas, M. J.; Sevilla, T.; Fisioterapia
    Objective: To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. Methods: Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The numberof fasciculationswas recorded in each muscle and the muscle thickness and strengthwere additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. Results: US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations’ number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increasewith the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy.