Changes of serum cardiac troponin i in exercise stress test and after exercise / Mudanças no soro cardíaco troponina i em testes de exercícios de estresse e após o exercício / Cambios en la troponina cardíaca i en pruebas de ejercicios de estrés y tras el ejercicio

ABSTRACT Introduction: Cardiac Troponin (CTN) has a strong organ specificity, which indicates that myocardial injury is present. However, it is worth noting that the increase does not suggest that the myocardium necessarily presents ischemic necrosis. Objective: To observe the changes in serum kerocalin I (CTNI) content after exercise, explore the effects of exercise training on hematocytes and that cause damage to myocardial cell stimulation. Methods: 18 rats were divided into three groups in this study, and three exercises were conducted separately. Results: After 6 weeks of exercise training, the number of red blood cells increased and the content of troponin I (CTNI) in the serum also significantly increased. The serum CTNI of the disposable large strength group was significantly higher than that of the quiet group (P <0.001). The serum CTNI in the 6-week exercise group was significantly higher than that of the quiet group (P <0.001), but the serum CTNI level between the two sports groups was not different. Conclusions: The motion training model used in this study can improve the number of red blood cells in the blood, improve synchronous blood capacity, and help the body's aerobic capacity increase. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A troponina cardíaca (CTN) tem uma alta especificidade orgânica, o que indica que lesões do miocárdio estão presentes. No entanto, vale observar que seu aumento não sugere que o miocárdio, necessariamente, apresenta necrose isquêmica. Objetivo: Observar as mudanças no conteúdo do soro kerocalino I (CTNI) após o exercício, explorar os efeitos do treino de exercícios nos hematócitos e que causam danos ao estimulo celular do miocárdio. Métodos: 18 ratos foram divididos em três grupos neste estudo, e três exercícios foram conduzidos separadamente. Resultados: Após seis semanas de treino com exercícios, o número de células vermelhas no sangue aumentou, e o conteúdo de troponina I (CTNI) no soro também aumentou consideravelmente. O soro CTNI do grupo descartável de alta força foi consideravelmente mais alto do que o do grupo imóvel (P <0,001). O nível CTNI de soro no grupo de exercícios de seis semanas foi significativamente mais alto do que aquele do grupo imóvel (P <0,001), mas o nível CTNI do soro entre os dois grupos de exercício não diferiu. Conclusões: O modelo de treino móvel usado neste estudo pode recuperar o número de células vermelhas no sangue, melhorar a capacidade sincrônica do sangue e auxiliar no aumento da capacidade aeróbica do corpo. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Introducción: La troponina cardíaca (CTN) tiene una alta especificidad orgánica, que indica que lesiones del miocardio están presentes. Sin embargo, vale observar que su aumento no sugiere que el miocardio necesariamente presente necrosis isquémica Objetivo: Observar los cambios en el contenido del suero cardíaco troponina I (CTNI) tras el ejercicio, explorar los efectos del entrenamiento de ejercicios en los hematocitos y que causan daños al estímulo celular del miocardio. Métodos: Se dividió 18 ratones en tres grupos en este estudio, y se condujo tres ejercicios separadamente. Resultados: Tras seis semanas de entrenamiento con ejercicios, el número de células rojas en la sangre aumentó, y el contenido de troponina I (CTNI) en el suero también aumentó considerablemente. El suero CTNI del grupo desechable de alta fuerza fue considerablemente más alto que del grupo inmueble (P<0,001). El nivel CTNI de suero en el grupo de ejercicios de seis semanas fue significativamente más alto que en el grupo inmueble (P<0,001), pero el nivel CTNI de suero entre los dos grupos de ejercicio no difirió. Conclusión: El modelo de entrenamiento mueble usado en este estudio puede recuperar el número de células rojas en la sangre, mejorar la capacidad sincrónica de la sangre y auxiliar en el aumento de la capacidad aeróbica del cuerpo. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Evaluation of blood oxygen saturation of high jumpers based on isokinetic test / Avaliação da saturação de oxigênio no sangue de saltadores de altura com base no teste isocinético / Evaluación de la saturación de oxígeno en la sangre de saltadores de altura con base en el test isocinético

ABSTRACT Introduction: An isokinetic test refers to the test of the force of a muscle or muscle group during centripetal and centrifugal movements at a constant speed in the whole range of joint motion by means of a isokinetic force tester. Objective: To explore the application of the knee centripetal flexor and extensor muscle groups in the blood oxygen saturation of high jumpers. Methods: Eighteen teenage female high jumper athletes above level 2 in a city sports school were selected. Their ages was 16.89±1.02 years old; height, 168.31±6.32cm; weight, 55.36±6.75kg. Results: At 60° S and 120° S test speed, the peak moment of the extensor muscle group on the same side of the knee was significantly greater than that of the flexor muscle group (P<0.05), while at 240° S test speed, it was the opposite. There was a significant difference in the peak moment of the flexor muscle group on the left and right side of the knee (P<0.01). Conclusions: The function of the dynamic muscle strength test system is one of the methods of studying the human muscle function. and can be used to test and evaluate the general strength of athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Um teste isocinético se refere ao teste de força de um músculo ou grupo de músculos durante movimentos centrípetas e centrífugas a uma velocidade constante em toda a amplitude de movimento articular por meio de um verificador de força isocinética. Objetivo: Explorar a aplicação dos grupos musculares flexor e extensor centrípetos do joelho na saturação de oxigênio do sangue de saltadores de altura. Métodos: Dezoito saltadoras de altura adolescentes acima do nível 2 em uma escola esportiva urbana foram selecionadas. Suas idades em anos eram 16.89±1.02; altura, 168.31±6.32cm; peso, 55.36±6.75kg. Resultados: A 60° S e 120° S a velocidade de teste, o momento de pico do grupo muscular de extensão do mesmo lado do joelho era consideravelmente maior do que aquele do grupo muscular de flexão (P<0.05), enquanto a 240° S a velocidade de teste foi o contrário. Houve uma diferença importante no momento de pico do grupo muscular flexor nos lados esquerdo e direito do joelho (P<0.01). Conclusões: A função do sistema de testes de forca muscular dinâmico é um dos métodos para o estudo da função muscular humana e pode ser usado para testar e avaliar a força geral de atletas. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: Un test isocinético se refiere al test de fuerza de un músculo o grupo de músculos durante movimientos centrípetos y centrífugos a una velocidad constante en toda la amplitud de movimiento articular por medio de un verificador de fuerza isocinética. Objetivo: Explorar la aplicación de los grupos musculares flexor y extensores centrípetos de la rodilla en la saturación de oxígeno de sangre de saltadores de altura. Métodos: Se seleccionó dieciocho saltadoras de altura adolescentes arriba del nivel 2 en una escuela deportiva. Sus edades eran 16.89±1.02; altura, 168.31±6.32cm; peso, 55.36±6.75kg. Resultados: A 60° S e 120° S la velocidad del test, el momento de pico del grupo muscular de extensión del mismo lado de la rodilla era considerablemente mayor que aquel del grupo muscular de flexión (P<0.05), mientras a 240° S la velocidad del test fue el contrario. Hubo una diferencia importante en el momento de pico del grupo muscular flexor en los lados izquierdo y derecho de la rodilla (P<0.01). Conclusiones: La función del sistema de test de fuerza muscular dinámico es uno de los métodos para el estudio de la función muscular humana y puede usarse para testar y evaluar la fuerza general de atletas. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Cardiac magnetic resonance imaging myocardial perfusion reserve index in heart transplant patients. / Valoración del índice de reserva de perfusión miocárdica por resonancia magnética en pacientes con trasplante cardíaco.

OBJECTIVE: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. MATERIAL AND METHODS: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac allograft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. RESULTS: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3±15.2 ml/m2 vs. 71.4±15.9 ml/m2 in those without transplants, p=0.03), lower MPRI (1.35±0.19 vs. 1.6±0.28 in those without transplants, p=0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1±5.4 bpm vs. 28.5±8.9 bpm in those without transplants, p <0.001). CONCLUSION: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants.

[Variables that influence the indication of a second myocardial perfusion gated-SPECT after a normal stress-rest gated SPECT]. / Variables que influyen en la indicación de una segunda gated-SPECT de perfusión miocárdica después una gated-SPECTde estrés-reposo normal.

OBJECTIVE: The objective of this study was to investigate predictor variables at the moment of normal stress-rest myocardial perfusion gated SPECT for indication of a second gated SPECT. MATERIAL AND METHODS: A prospective, single center cohort study was conducted. We evaluated 2326 consecutive patients (age 63.6 ± 13 years, 57.3% females) without perfusion defects and with normal left ventricular ejection fraction on a myocardial perfusion gated SPECT. Clinical and stress test variables were studied to predict indication of a second gated SPECT and presence of reversible perfusion defects in the second gated SPECT. RESULTS: During a mean follow-up of 3.6 ± 2 years a second gated SPECT was performed in 286 patients (12.3%). Independent predictor variables of a second gated SPECT were presence of three or more cardiovascular risk factors (χ(2): 5.510; HR: 1.4; p=0.019), previous acute myocardial infarction (χ(2): 3.867; HR: 1.4; p=0.049), previous coronary revascularization (χ(2): 41.081; HR: 2.5; p<0.001), and a positive stress test (χ(2): 8.713; HR: 1.5; p=0.003). Observation of perfusion defects in the 280 patients in whom a second stress-rest gated SPECT was performed was more likely in male patients (χ(2): 4.322; HR: 1.9; p=0.038) who had a first pure pharmacological gated-SPECT (χ(2): 7.182; HR: 2.6; p=0.007). CONCLUSIONS: In patients with a first normal myocardial perfusion gated SPECT, various clinical factors and variables derived from the stress test affect the indication of a second gated SPECT and the presence of ischemia in the latter.

Ecocardiograma de estrés / Stress echocardiogram

Objetivo. El objetivo del presente trabajo se dirige a revisar las indicaciones, protocolos y aplicaciones del ecocardiograma de estrés. materiales y métodos. Con las palabras clave "ecocardiograma de estrés", "ecocardiograma de esfuerzo" y "prueba de estres farmacológico" se hizo una búsqueda de información en la bases de datos de Pubmed/ Medline, Cochrane, SciELO, y en referencias de artículos de revistas y textos, principalmente de los últimos cinco años en inglés y en español. El resultado de esta búsqueda arrojó 203 referencias, de las cuales se tomaron las 46 más relevantes, teniendo en cuentra principalmente metanálisis, artículos de revision, actualizaciones, estudios aleatorios doble ciego y guías clínicas. Resultados. Los datos obtenidos de la función ventricular regional o global en el pico máximo de ejercicio son factores predictores importantes de eventos cardíacos, además de las variables clínicas, en el seguimiento de los pacientes. Un puntaje de motilidad parietal de esfuerzo mayor de 1,4 o una fracción de eyección de esfuerzo menor de 50%, implican un pronóstico significativamente adverso. Por otra parte, los indicadores de viabilidad miocárdica, mediante el estímulo farmacológico del miocardio, predicen la recuperación de la función cardiaca luego de los procedimientos de revascularización. Conclusión. El ecocardiograma de estrés es una técnica complementaria, útil para el diagnóstico y pronóstico del paciente con enfermedad coronaria. El fundamento de su uso consiste en que, al desencadenar isquemia, se produce una alteración de la motilidad parietal distal a la lesión coronaria obstructiva. Además, puede emplearse para evaluar la gravedad de una valvulopatía y para establecer el diagnóstico de la hipertensión pulmonar oculta.

Objective: the objective of this Project is to review the indications, protocols and applications of the stress echocardiogram. methods and materials: research on the following words was done in the PUBMED/Medline, Cochrane, SciELO databases, as well as in references in journal articles and texts mainly from texts from the last five years in English and in Spanish: stress echocardiogram, effort echocardiogram and phar-macological stress test. The result of this search returned 203 references, 46 of which were taken as the most relevant, taking into consideration mainly, meth analysis, revision articles, state of the art, random studies, DOBLE CIEGO, and clinical guides. Results: The data obtained from the regional ventricular function in the maximum peak of exercise, are important predictors of cardiac events; this, in addition to all of the clinical variables during patient follow up. A score of parietal motility, higher than 1.4, or a ejection fraction lower than 50%, imply a significant adverse forecast. On the other hand, the myocardiál an viábility indicators, through the pharmacologic stimulus of the myocardium, predict the recovery of the cardiac function after revascularization procedures. Conclusion: The stress echocardiogram (ECO) is a complementary technique, useful for the diagnose and forecast fo patients with coronary disease. The principles of its use consist on the basics that upon the creation of ischemia, an alteration in the distal parietal motility will be produced to the obstructive coronary injury. Furthermore, it can be used to evaluate the severity of a vulvopathy and to establish the diagnose of the hidden pulmonary hypertension.

Perfusión miocárdica SPECT con prueba de frío como predictor de desarrollo de isquemia de esfuerzo en el seguimiento de pacientes asintomáticos con riesgo cardiovascular moderado / Cold Pressor Test Myocardial Perfusion SPECT as a Predictor of the Development of Ischemia at Exercise in the Follow up of Asymptomatic Patients with Moderate Cardiovascular Risk

Introducción Estudios previos han publicado la correlación entre defectos de perfusión miocárdica (PM) SPECT durante la prueba de frío (PF) y la acetilcolina intracoronaria y su utilidad como marcador independiente de disfunción endotelial (DE). Objetivo Analizar la incidencia de positivización de los estudios de PM de esfuerzo en el seguimiento de pacientes asintomáticos con riesgo cardiovascular (CV) moderado y DE detectada con la PF. Material y métodos De 301 pacientes del Registro PARADIGMA (PM SPECT esfuerzo normal y probabilidad clínica < 20% de eventos a 10 años [riesgo moderado por índice de Framingham]), 55 tuvieron PF positiva (+) (18,3%). Se analizaron en forma prospectiva y consecutiva 15 pacientes asintomáticos con PF (+) y un grupo control (GC) de 15 pacientes con PF negativa (-), con apareamiento de sexo, edad y factores de riesgo coronario (FRC), que cumplieron un seguimiento de 12 ± 2 meses, en quienes se realizó una nueva PM SPECT de reposo y esfuerzo. Se utilizó un score de extensión de PM en un modelo de 17 segmentos. Se analizaron los FRC y la incidencia de isquemia en la PM de esfuerzo de seguimiento en cada grupo. Resultado Edad: PF (-) 57,3 ± 8,9 versus TF (+) 52,5 ± 7,5 (p = 0,09). Positivizaron la PM de esfuerzo: grupo PF (+) 5/15: 33,3% y 0 del GC (p = 0,04). Sin diferencias estadísticamente significativas en los FRC entre ambos grupos. Conclusiones Una PM SPECT anormal durante la PF en pacientes asintomáticos con riesgo CV moderado diferenció a aquellos pacientes que positivizaron los estudios de PM de esfuerzo a un año de seguimiento y no hubo estudios anormales en el grupo control.

Introduction Previous studies have published the correlation between myocardial perfusion SPECT (MP) during cold pressor test (CPT) and intracoronary acetylcholine and its usefulness as independent marker of endothelial dysfunction (ED). Objective To analyze the incidence of positivization of MP exercise studies in the follow up of asymptomatic patients with moderate cardiovascular risk (CV) and ED detected by PF. Material and Methods Of 301 patients of the PARADIGMA Registry (normal exercise MP SPECT and clinical probability < 20% of events at 10 years [moderate risk by Framingham index] 55 had positive PF (+) (18.3%). Prospectively and consecutively, 15 asymptomatic patients with PF (+), and a control group (CG) of 15 patients with negative PF, with paired sex, age and coronary risk factors (CRF), that accomplished a 12 ± 2 months follow up, and that underwent a new exercise and resting MP SPECT were analyzed. An MP extension score was used in a model of 17 segments. The CRF and the incidence of ischemia during follow up exercise MP of each group were assessed. Results Age: PF (-) 57.3 ± 8.9 versus TF (+) 52.5 ± 7.5 (p = 0,09). Positivized the exercise MP: PF group (+) 5/15: 33.3% and 0 in the CG (p=0.04). No statistically significant differences between CRF in both groups. Conclusions An abnormal MP SPECT during PF in asymptomatic patients with moderate CV risk differentiated those patients who positivized exercise MP studies at one year follow up and there were no abnormal studies in the control group.