Priscila Sperandio - Academia.edu (original) (raw)
Papers by Priscila Sperandio
Jornal Brasileiro de Pneumologia
Many patients hospitalized with COVID-19 were unable to return to work or their return was delaye... more Many patients hospitalized with COVID-19 were unable to return to work or their return was delayed due to their health condition. The aim of this observational study was to evaluate the impact of moderate-to-severe and critical COVID-19 infection on persistence of symptoms and return to work after hospital discharge. In this study, two thirds of hospitalized patients with pulmonary involvement reported persistence of symptoms six months after COVID-19 infection, such as memory loss (45.5%), myalgia (43.9%), fatigue (39.4%), and dyspnea (25.8%), and 50% slowly returned to work, with repercussions due to fatigue and/or loss of energy.
ERJ Open Research
RationalePost-COVID19 survivors frequently have dyspnea that can lead to exercise intolerance and... more RationalePost-COVID19 survivors frequently have dyspnea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID19 patients remain incompletely characterized.ObjectivesTo clarify the mechanisms of exercise intolerance in post-COVID19 survivors after hospitalization.MethodsProspective study evaluated consecutive patients previously hospitalized due to moderate-to-severe/critical COVID19. Within 90±10 days (mean±sd) of COVID19 acute symptoms onset, patients underwent a comprehensive cardiopulmonary assessment, including a cardiopulmonary exercise testing with earlobe arterialized capillary blood gas analysis.Measurements and Main ResultsEighty-seven patients were evaluated, their mean±sdpeak oxygen consumption were 19.5±5.0 ml kg−1·min−1, and the tertiles were: ≤17.0, 17.1–22.2 and ≥22.3 ml kg−1·min−1. Hospitalization severity was similar among the three groups; however, at the...
The International Journal of Tuberculosis and Lung Disease
BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a ... more BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchy...
ERJ Open Research, Dec 22, 2022
Authors' contribution: JAN, AR, FFA, MCN, PS, DMH, and DCB have been involved in data collection.... more Authors' contribution: JAN, AR, FFA, MCN, PS, DMH, and DCB have been involved in data collection. JAN had the original idea of the study and wrote the first draft of the manuscript.
Brazilian Journal of Medical and Biological Research, 2020
The oxygen uptake (. VO 2) kinetics during onset of and recovery from exercise have been shown to... more The oxygen uptake (. VO 2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The. VO 2 , heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (Po0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (Po0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (Po0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (Po0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P40.05 in group vs load analysis). The ventilatory efficiency was related to MRT of. VO 2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.
por todo amor, carinho e dedicação para minha formação pessoal e profissional; pelo apoio incondi... more por todo amor, carinho e dedicação para minha formação pessoal e profissional; pelo apoio incondicional e incentivo, mesmo distantes; pelo exemplo de caráter, perseverança e amor ao próximo, o que me faz admirá-los e amá-los cada vez mais. Sou extremamente grata por terem me ensinado a ser honesta e persistente. Ao meu filho, GUILHERME, GUILHERME, GUILHERME, GUILHERME, pela minha ausência em momentos de dedicação à elaboração deste trabalho e pela paciência, mesmo sendo criança. Ao meu namorado, ANDRÉ, ANDRÉ, ANDRÉ, ANDRÉ, pelo companheirismo, incentivo, auxílio e compreensão nos momentos difíceis. Você foi essencial para o meu crescimento pessoal e profissional neste ano. À minha irmã, VANESSA, VANESSA, VANESSA, VANESSA, pela amizade, incentivo e palavras sábias, não somente durante a realização deste trabalho, mas em todos os momentos da minha vida. vi Agradecimentos Agradeço a DEUS que me permitiu tudo isso, ao longo de toda minha vida e, não somente nestes anos como acadêmica. Reconheço cada vez mais que Você é o maior mestre que uma pessoa pode conhecer e reconhecer. Ao Prof. Dr. Dirceu Rodrigues de Almeida pela confiança, apoio e disponibilidade; meu respeito e admiração pela sua serenidade, sabedoria e capacidade de análise do perfil de seus alunos, e pelo seu Dom no ensino da Ciência, inibindo sempre a vaidade em prol da simplicidade e eficiência. Ao Prof. Dr. José Alberto Neder pela dedicação a todo o momento, confiança, incentivo, disponibilidade e empenho não somente no sucesso deste estudo, mas também no objetivo de fornecer ensinamentos científicos extremamente diferenciados. O meu reconhecimento pela oportunidade de realizar este trabalho ao lado de alguém que transpira sabedoria e por permitir que eu participasse da sua equipe no SEFICE, local de estímulo, perseverança e dedicação na busca de um objetivo. Ao apoio e incentivo de toda família Abreu Albanez (Guido, Rozangela, Ana Carolina, Natália e Maria Clara), pelos dias e noites que estiveram com meu filho para que eu pudesse trabalhar e concluir este trabalho, e pelas palavras de incentivo. À Tata, Bruno e Maria Eduarda, toda a minha admiração pelo incentivo. Tata, você foi essencial na minha formação pessoal, meu reconhecimento pelo exemplo de caráter, fé e amor ao próximo. À Drª. Iracema Ioco Kikuchi Umeda pelo convívio, apoio, amizade, incentivo e aprendizado profissional e pessoal durante todos esses anos de "Dante Pazzanese". À amiga Pilar pelas palavras, ouvidos, apoio, incentivo, ligações e ensinamentos semanais. Obrigada por fazer parte da minha história. vii À amiga Gisele Monteiro Campos (in memoriam) pelo incentivo, amizade e por ter feito parte do início da minha carreira acadêmica de uma forma especial e inesquecível. À amigas do Instituto Dante Pazzanese de Cardiologia, Vanessa e Tatiana Kawauchi, pelo convívio ao longo desses anos e, Mayron, Maria Luiza e Mariana, pela colaboração para a realização deste trabalho. Ao amigo Adriano, por dividir as alegrias, angústias e entusiasmos ao longo destes anos de pós-graduação. Às amigas e professoras do UNIFIEO e aos Fisioterapeutas do Hospital Municipal Central de Osasco pelo excelente convívio diário. À UNIFESP e especialmente ao SEFICE, pela estrutura de pesquisa extremamente diferenciada com ampla liberdade de atuação. Estes ensinamentos adquiridos realmente são inestimáveis. Aos colegas do SEFICE que sempre contribuíram para a realização dos testes e análises. Aos meus alunos de graduação do UNIFIEO e da especialização do Dante Pazzanese, motivos de inspiração, vontade e dedicação para que esta garra científica cresça a cada dia. Aos pacientes deste estudo, figuras anônimas que deram sua contribuição, sem a qual nada seria possível e faria sentido, com entusiasmo e dedicação. viii "Bom mesmo é ir a luta com determinação, abraçar a vida com paixão, perder com classe e vencer com ousadia, pois o triunfo pertence a quem se atreve e a vida é muito para ser insignificante..."
Journal of Cardiopulmonary Rehabilitation and Prevention, 2020
Vo 2) recovery kinetics appears to have considerable value in the assessment of functional capaci... more Vo 2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V. o 2 , heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. Methods: Nineteen males (10 HF/9 age-and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (T lim), receiving either sham ventilation or NIPPV. Results: Despite greater. Vo 2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4
Brazilian Journal of Medical and Biological Research, 2017
Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (... more Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (O 2) delivery (i.e., muscle blood flow in non-hypoxemic patients) to meet O 2 demands. The resulting increase in fractional O 2 extraction can be non-invasively tracked by deoxygenated hemoglobin concentration (deoxi-Hb) as measured by near-infrared spectroscopy (NIRS). We aimed to establish a simplified approach to extract deoxi-Hb-based indices of impaired muscle O 2 delivery during rapidly-incrementing exercise in heart failure. We continuously probed the right vastus lateralis muscle with continuous-wave NIRS during a rampincremental cardiopulmonary exercise test in 10 patients (left ventricular ejection fraction o35%) and 10 age-matched healthy males. Deoxi-Hb is reported as % of total response (onset to peak exercise) in relation to work rate. Patients showed lower maximum exercise capacity and O 2 uptake-work rate than controls (Po0.05). The deoxi-Hb response profile as a function of work rate was S-shaped in all subjects, i.e., it presented three distinct phases. Increased muscle deoxygenation in patients compared to controls was demonstrated by: i) a steeper mid-exercise deoxi-Hb-work rate slope (2.2±1.3 vs 1.0±0.3% peak/W, respectively; Po0.05), and ii) late-exercise increase in deoxi-Hb, which contrasted with stable or decreasing deoxi-Hb in all controls. Steeper deoxi-Hb-work rate slope was associated with lower peak work rate in patients (r=-0.73; P=0.01). This simplified approach to deoxi-Hb interpretation might prove useful in clinical settings to quantify impairments in O 2 delivery by NIRS during ramp-incremental exercise in individual heart failure patients.
European Respiratory Journal, 2016
Background: Heart failure with reduced left ventricular ejection fraction (HF) is a prevalent and... more Background: Heart failure with reduced left ventricular ejection fraction (HF) is a prevalent and disabling co-morbidiy of chronic obstructive pulmonary disease (COPD). Little is known about the influence of HF on key determinants of dyspnea in patients with COPD, i.e., inspiratory fraction and relative inspiratory reserve. Methods: After careful stabilization of both diseases, 56 patients with COPD (24 with COPD+HF, 23 men) prospectively underwent spirometry and body plethysmography. Results: COPD+HF had greater forced expiratory volume in one second (FEV 1 ) and FEV 1 /vital capacity; on the other hand, all key “static” lung volumes (residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC)) were lower in this group (p vs. 0.36 ± 0.10, respectively; p vs . 0.35 ± 0.10, p Conclusion: Despite the restrictive effects of HF, patients with COPD+HF had relatively greater volumes available for inspiration (i.e., larger inspiratory fraction). Those volumes are only partially used at rest probably in order to avoid critical reductions in inspiratory reserve volume and further increases in the elastic work of breathing.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2016
Excessive ventilation (V • E) to metabolic demand (carbon dioxide production [ V • CO 2 ]) during... more Excessive ventilation (V • E) to metabolic demand (carbon dioxide production [ V • CO 2 ]) during a rapidly incremental cardiopulmonary exercise test (CPET) is a key negative prognostic marker in heart failure (HF) 1 even in those with preserved exercise capacity. 2 Although varying among individuals, the underlying mechanisms
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2016
Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary di... more Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary disease (COPD) which may increase exercise ventilation due to heightened neural drive and/or impaired pulmonary gas exchange efficiency. The influence of heart failure on exercise ventilation, however, remains poorly characterized in COPD. In a prospective study, 98 patients with moderate to very severe COPD [41 with coexisting heart failure; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;overlap&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50%)] underwent an incremental cardiopulmonary exercise test (CPET). Compared to COPD, overlap had lower peak exercise capacity despite higher FEV1. Overlap showed lower operating lung volumes, greater ventilatory inefficiency and larger decrements in end-tidal CO2 (PETCO2) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). These results were consistent with those found in FEV1-matched patients. Larger areas under receiver operating characteristic curves to discriminate overlap from COPD were found for ventilation ([Formula: see text]E)-CO2 output [Formula: see text]CO2) intercept, [Formula: see text]E-[Formula: see text]CO2 slope, peak [Formula: see text]E/[Formula: see text]CO2 ratio and peak PETCO2. Multiple logistic regression analysis revealed that [Formula: see text]CO2 intercept ≤ 3.5 L/minute [odds ratios (95% CI) = 7.69 (2.61-22.65), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001] plus [Formula: see text]E-[Formula: see text]CO2 slope ≥ 34 [2.18 (0.73-6.50), P = 0.14] or peak [Formula: see text]E/[Formula: see text]CO2 ratio ≥ 37 [5.35 (1.96-14.59), P = 0.001] plus peak PETCO2 ≤ 31 mmHg [5.73 (1.42-23.15), P = 0.01] were indicative of overlapping. Heart failure increases the ventilatory response to metabolic demand in COPD. Variables reflecting excessive ventilation might prove useful to assist clinical interpretation of CPET responses in COPD patients presenting heart failure as co-morbidity.
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2016
Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and musc... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). ΔBlood flow was closely proportional to Δcardiac output in all groups (r = 0.89-0.98; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Overlap showed the largest impairments in Δcardiac output/ΔO2 uptake and Δblood flow/ΔO2 uptake (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). ΔBlood flow/ΔO2 uptake was related to time to exercise intolerance only in overlap and heart failure (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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.
Jornal Brasileiro de Pneumologia, 2016
Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in pa... more Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in...
Circulation
Background: Exercise training (ET) is well established to improve functional capacity and quality... more Background: Exercise training (ET) is well established to improve functional capacity and quality of life in patients (pts) with chronic heart failure. However, the ET benefits in acute heart failure (AHF) are unknown. Purpose: We aimed to study the safety and efficacy of ET alone or combined with non-invasive ventilation (NIV) compared to standard medical treatment in hospitalized pts with AHF. Methods: Twenty-nine pts with AHF (68% ischemic), 56±7 years, left ventricle ejection fraction of 25±5%, NTproBNP of 2456±730, 6-minute walk test distance (6MWD = 225±39meters) were randomized into 3 groups: ET + NIV with sub therapeutic positive airway pressure (PAP) (ET,n=9), ET + NIV set to 14 of inspiratory and 8 cmH2O of expiratory PAP, respectively (EV,n=11) and standard treatment (CO,n=9). The ET and EV groups performed a daily session of unloaded exercise on cycle ergometer for 20 min or tolerance limit, for 8 consecutives days. In EV and ET, oxygen pulse saturation (SpO2), heart rat...
Maintenance of blood oxygenation is paramount to preserve cerebral O 2 delivery during exercise. ... more Maintenance of blood oxygenation is paramount to preserve cerebral O 2 delivery during exercise. In fact, we previously found substantial impairments in cerebral oxygenation and exercise tolerance in COPD patients showing oxy-hemoglobin desaturation (Oliveira MF et al. Clin Physiol Funct Imaging 2012; 32:52).It remains unclear, however, whether this would also be the case when O 2 delivery is likely to be impaired by convective mechanisms (cerebral blood flow), e.g., in COPD plus heart failure with reduced left ventricular ejection fraction (HFrEF). Sixteen patients with COPD+HFrEF, 16 with COPD and 15 with HFrEF underwent a progressive cardiopulmonary exercise test on a cycle ergometer. Changes (Δ) in cardiac output (Q T ) by trans-thoracic cardioimpedance and mean arterial pressure (MAP) were measured. Pre-frontal oxygenation (HbO 2 ) and a blood flow index (BFI) were obtained by near infrared spectroscopy. COPD+HFrEF patients had blunted Δ Q T and Δ MAP responses compared to thei...
Jornal Brasileiro de Pneumologia
Many patients hospitalized with COVID-19 were unable to return to work or their return was delaye... more Many patients hospitalized with COVID-19 were unable to return to work or their return was delayed due to their health condition. The aim of this observational study was to evaluate the impact of moderate-to-severe and critical COVID-19 infection on persistence of symptoms and return to work after hospital discharge. In this study, two thirds of hospitalized patients with pulmonary involvement reported persistence of symptoms six months after COVID-19 infection, such as memory loss (45.5%), myalgia (43.9%), fatigue (39.4%), and dyspnea (25.8%), and 50% slowly returned to work, with repercussions due to fatigue and/or loss of energy.
ERJ Open Research
RationalePost-COVID19 survivors frequently have dyspnea that can lead to exercise intolerance and... more RationalePost-COVID19 survivors frequently have dyspnea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID19 patients remain incompletely characterized.ObjectivesTo clarify the mechanisms of exercise intolerance in post-COVID19 survivors after hospitalization.MethodsProspective study evaluated consecutive patients previously hospitalized due to moderate-to-severe/critical COVID19. Within 90±10 days (mean±sd) of COVID19 acute symptoms onset, patients underwent a comprehensive cardiopulmonary assessment, including a cardiopulmonary exercise testing with earlobe arterialized capillary blood gas analysis.Measurements and Main ResultsEighty-seven patients were evaluated, their mean±sdpeak oxygen consumption were 19.5±5.0 ml kg−1·min−1, and the tertiles were: ≤17.0, 17.1–22.2 and ≥22.3 ml kg−1·min−1. Hospitalization severity was similar among the three groups; however, at the...
The International Journal of Tuberculosis and Lung Disease
BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a ... more BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchy...
ERJ Open Research, Dec 22, 2022
Authors' contribution: JAN, AR, FFA, MCN, PS, DMH, and DCB have been involved in data collection.... more Authors' contribution: JAN, AR, FFA, MCN, PS, DMH, and DCB have been involved in data collection. JAN had the original idea of the study and wrote the first draft of the manuscript.
Brazilian Journal of Medical and Biological Research, 2020
The oxygen uptake (. VO 2) kinetics during onset of and recovery from exercise have been shown to... more The oxygen uptake (. VO 2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The. VO 2 , heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (Po0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (Po0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (Po0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (Po0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P40.05 in group vs load analysis). The ventilatory efficiency was related to MRT of. VO 2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.
por todo amor, carinho e dedicação para minha formação pessoal e profissional; pelo apoio incondi... more por todo amor, carinho e dedicação para minha formação pessoal e profissional; pelo apoio incondicional e incentivo, mesmo distantes; pelo exemplo de caráter, perseverança e amor ao próximo, o que me faz admirá-los e amá-los cada vez mais. Sou extremamente grata por terem me ensinado a ser honesta e persistente. Ao meu filho, GUILHERME, GUILHERME, GUILHERME, GUILHERME, pela minha ausência em momentos de dedicação à elaboração deste trabalho e pela paciência, mesmo sendo criança. Ao meu namorado, ANDRÉ, ANDRÉ, ANDRÉ, ANDRÉ, pelo companheirismo, incentivo, auxílio e compreensão nos momentos difíceis. Você foi essencial para o meu crescimento pessoal e profissional neste ano. À minha irmã, VANESSA, VANESSA, VANESSA, VANESSA, pela amizade, incentivo e palavras sábias, não somente durante a realização deste trabalho, mas em todos os momentos da minha vida. vi Agradecimentos Agradeço a DEUS que me permitiu tudo isso, ao longo de toda minha vida e, não somente nestes anos como acadêmica. Reconheço cada vez mais que Você é o maior mestre que uma pessoa pode conhecer e reconhecer. Ao Prof. Dr. Dirceu Rodrigues de Almeida pela confiança, apoio e disponibilidade; meu respeito e admiração pela sua serenidade, sabedoria e capacidade de análise do perfil de seus alunos, e pelo seu Dom no ensino da Ciência, inibindo sempre a vaidade em prol da simplicidade e eficiência. Ao Prof. Dr. José Alberto Neder pela dedicação a todo o momento, confiança, incentivo, disponibilidade e empenho não somente no sucesso deste estudo, mas também no objetivo de fornecer ensinamentos científicos extremamente diferenciados. O meu reconhecimento pela oportunidade de realizar este trabalho ao lado de alguém que transpira sabedoria e por permitir que eu participasse da sua equipe no SEFICE, local de estímulo, perseverança e dedicação na busca de um objetivo. Ao apoio e incentivo de toda família Abreu Albanez (Guido, Rozangela, Ana Carolina, Natália e Maria Clara), pelos dias e noites que estiveram com meu filho para que eu pudesse trabalhar e concluir este trabalho, e pelas palavras de incentivo. À Tata, Bruno e Maria Eduarda, toda a minha admiração pelo incentivo. Tata, você foi essencial na minha formação pessoal, meu reconhecimento pelo exemplo de caráter, fé e amor ao próximo. À Drª. Iracema Ioco Kikuchi Umeda pelo convívio, apoio, amizade, incentivo e aprendizado profissional e pessoal durante todos esses anos de "Dante Pazzanese". À amiga Pilar pelas palavras, ouvidos, apoio, incentivo, ligações e ensinamentos semanais. Obrigada por fazer parte da minha história. vii À amiga Gisele Monteiro Campos (in memoriam) pelo incentivo, amizade e por ter feito parte do início da minha carreira acadêmica de uma forma especial e inesquecível. À amigas do Instituto Dante Pazzanese de Cardiologia, Vanessa e Tatiana Kawauchi, pelo convívio ao longo desses anos e, Mayron, Maria Luiza e Mariana, pela colaboração para a realização deste trabalho. Ao amigo Adriano, por dividir as alegrias, angústias e entusiasmos ao longo destes anos de pós-graduação. Às amigas e professoras do UNIFIEO e aos Fisioterapeutas do Hospital Municipal Central de Osasco pelo excelente convívio diário. À UNIFESP e especialmente ao SEFICE, pela estrutura de pesquisa extremamente diferenciada com ampla liberdade de atuação. Estes ensinamentos adquiridos realmente são inestimáveis. Aos colegas do SEFICE que sempre contribuíram para a realização dos testes e análises. Aos meus alunos de graduação do UNIFIEO e da especialização do Dante Pazzanese, motivos de inspiração, vontade e dedicação para que esta garra científica cresça a cada dia. Aos pacientes deste estudo, figuras anônimas que deram sua contribuição, sem a qual nada seria possível e faria sentido, com entusiasmo e dedicação. viii "Bom mesmo é ir a luta com determinação, abraçar a vida com paixão, perder com classe e vencer com ousadia, pois o triunfo pertence a quem se atreve e a vida é muito para ser insignificante..."
Journal of Cardiopulmonary Rehabilitation and Prevention, 2020
Vo 2) recovery kinetics appears to have considerable value in the assessment of functional capaci... more Vo 2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V. o 2 , heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. Methods: Nineteen males (10 HF/9 age-and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (T lim), receiving either sham ventilation or NIPPV. Results: Despite greater. Vo 2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4
Brazilian Journal of Medical and Biological Research, 2017
Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (... more Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (O 2) delivery (i.e., muscle blood flow in non-hypoxemic patients) to meet O 2 demands. The resulting increase in fractional O 2 extraction can be non-invasively tracked by deoxygenated hemoglobin concentration (deoxi-Hb) as measured by near-infrared spectroscopy (NIRS). We aimed to establish a simplified approach to extract deoxi-Hb-based indices of impaired muscle O 2 delivery during rapidly-incrementing exercise in heart failure. We continuously probed the right vastus lateralis muscle with continuous-wave NIRS during a rampincremental cardiopulmonary exercise test in 10 patients (left ventricular ejection fraction o35%) and 10 age-matched healthy males. Deoxi-Hb is reported as % of total response (onset to peak exercise) in relation to work rate. Patients showed lower maximum exercise capacity and O 2 uptake-work rate than controls (Po0.05). The deoxi-Hb response profile as a function of work rate was S-shaped in all subjects, i.e., it presented three distinct phases. Increased muscle deoxygenation in patients compared to controls was demonstrated by: i) a steeper mid-exercise deoxi-Hb-work rate slope (2.2±1.3 vs 1.0±0.3% peak/W, respectively; Po0.05), and ii) late-exercise increase in deoxi-Hb, which contrasted with stable or decreasing deoxi-Hb in all controls. Steeper deoxi-Hb-work rate slope was associated with lower peak work rate in patients (r=-0.73; P=0.01). This simplified approach to deoxi-Hb interpretation might prove useful in clinical settings to quantify impairments in O 2 delivery by NIRS during ramp-incremental exercise in individual heart failure patients.
European Respiratory Journal, 2016
Background: Heart failure with reduced left ventricular ejection fraction (HF) is a prevalent and... more Background: Heart failure with reduced left ventricular ejection fraction (HF) is a prevalent and disabling co-morbidiy of chronic obstructive pulmonary disease (COPD). Little is known about the influence of HF on key determinants of dyspnea in patients with COPD, i.e., inspiratory fraction and relative inspiratory reserve. Methods: After careful stabilization of both diseases, 56 patients with COPD (24 with COPD+HF, 23 men) prospectively underwent spirometry and body plethysmography. Results: COPD+HF had greater forced expiratory volume in one second (FEV 1 ) and FEV 1 /vital capacity; on the other hand, all key “static” lung volumes (residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC)) were lower in this group (p vs. 0.36 ± 0.10, respectively; p vs . 0.35 ± 0.10, p Conclusion: Despite the restrictive effects of HF, patients with COPD+HF had relatively greater volumes available for inspiration (i.e., larger inspiratory fraction). Those volumes are only partially used at rest probably in order to avoid critical reductions in inspiratory reserve volume and further increases in the elastic work of breathing.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2016
Excessive ventilation (V • E) to metabolic demand (carbon dioxide production [ V • CO 2 ]) during... more Excessive ventilation (V • E) to metabolic demand (carbon dioxide production [ V • CO 2 ]) during a rapidly incremental cardiopulmonary exercise test (CPET) is a key negative prognostic marker in heart failure (HF) 1 even in those with preserved exercise capacity. 2 Although varying among individuals, the underlying mechanisms
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2016
Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary di... more Systolic heart failure is a common and disabling co-morbidity of chronic obstructive pulmonary disease (COPD) which may increase exercise ventilation due to heightened neural drive and/or impaired pulmonary gas exchange efficiency. The influence of heart failure on exercise ventilation, however, remains poorly characterized in COPD. In a prospective study, 98 patients with moderate to very severe COPD [41 with coexisting heart failure; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;overlap&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (left ventricular ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50%)] underwent an incremental cardiopulmonary exercise test (CPET). Compared to COPD, overlap had lower peak exercise capacity despite higher FEV1. Overlap showed lower operating lung volumes, greater ventilatory inefficiency and larger decrements in end-tidal CO2 (PETCO2) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). These results were consistent with those found in FEV1-matched patients. Larger areas under receiver operating characteristic curves to discriminate overlap from COPD were found for ventilation ([Formula: see text]E)-CO2 output [Formula: see text]CO2) intercept, [Formula: see text]E-[Formula: see text]CO2 slope, peak [Formula: see text]E/[Formula: see text]CO2 ratio and peak PETCO2. Multiple logistic regression analysis revealed that [Formula: see text]CO2 intercept ≤ 3.5 L/minute [odds ratios (95% CI) = 7.69 (2.61-22.65), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001] plus [Formula: see text]E-[Formula: see text]CO2 slope ≥ 34 [2.18 (0.73-6.50), P = 0.14] or peak [Formula: see text]E/[Formula: see text]CO2 ratio ≥ 37 [5.35 (1.96-14.59), P = 0.001] plus peak PETCO2 ≤ 31 mmHg [5.73 (1.42-23.15), P = 0.01] were indicative of overlapping. Heart failure increases the ventilatory response to metabolic demand in COPD. Variables reflecting excessive ventilation might prove useful to assist clinical interpretation of CPET responses in COPD patients presenting heart failure as co-morbidity.
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2016
Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and musc... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). ΔBlood flow was closely proportional to Δcardiac output in all groups (r = 0.89-0.98; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Overlap showed the largest impairments in Δcardiac output/ΔO2 uptake and Δblood flow/ΔO2 uptake (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). ΔBlood flow/ΔO2 uptake was related to time to exercise intolerance only in overlap and heart failure (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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.
Jornal Brasileiro de Pneumologia, 2016
Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in pa... more Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in...
Circulation
Background: Exercise training (ET) is well established to improve functional capacity and quality... more Background: Exercise training (ET) is well established to improve functional capacity and quality of life in patients (pts) with chronic heart failure. However, the ET benefits in acute heart failure (AHF) are unknown. Purpose: We aimed to study the safety and efficacy of ET alone or combined with non-invasive ventilation (NIV) compared to standard medical treatment in hospitalized pts with AHF. Methods: Twenty-nine pts with AHF (68% ischemic), 56±7 years, left ventricle ejection fraction of 25±5%, NTproBNP of 2456±730, 6-minute walk test distance (6MWD = 225±39meters) were randomized into 3 groups: ET + NIV with sub therapeutic positive airway pressure (PAP) (ET,n=9), ET + NIV set to 14 of inspiratory and 8 cmH2O of expiratory PAP, respectively (EV,n=11) and standard treatment (CO,n=9). The ET and EV groups performed a daily session of unloaded exercise on cycle ergometer for 20 min or tolerance limit, for 8 consecutives days. In EV and ET, oxygen pulse saturation (SpO2), heart rat...
Maintenance of blood oxygenation is paramount to preserve cerebral O 2 delivery during exercise. ... more Maintenance of blood oxygenation is paramount to preserve cerebral O 2 delivery during exercise. In fact, we previously found substantial impairments in cerebral oxygenation and exercise tolerance in COPD patients showing oxy-hemoglobin desaturation (Oliveira MF et al. Clin Physiol Funct Imaging 2012; 32:52).It remains unclear, however, whether this would also be the case when O 2 delivery is likely to be impaired by convective mechanisms (cerebral blood flow), e.g., in COPD plus heart failure with reduced left ventricular ejection fraction (HFrEF). Sixteen patients with COPD+HFrEF, 16 with COPD and 15 with HFrEF underwent a progressive cardiopulmonary exercise test on a cycle ergometer. Changes (Δ) in cardiac output (Q T ) by trans-thoracic cardioimpedance and mean arterial pressure (MAP) were measured. Pre-frontal oxygenation (HbO 2 ) and a blood flow index (BFI) were obtained by near infrared spectroscopy. COPD+HFrEF patients had blunted Δ Q T and Δ MAP responses compared to thei...