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Ramos RS, Rocco IS, Viceconte M, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, Jatene FB, Cavalcanti AB, Zilli AC, Pimentel WDS, Hossne Junior NA, Branco JNR, Trimer R, Evora PRB, Gomes WJ, Guizilin S. Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients. Braz J Cardiovasc Surg 2024; 39:e20230133. [PMID: 38569010 PMCID: PMC10987126 DOI: 10.21470/1678-9741-2023-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. METHODS A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. RESULTS Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. CONCLUSION Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.
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Affiliation(s)
- Rodrigo Santin Ramos
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isadora Salvador Rocco
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcela Viceconte
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Otavio Berwanger
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
| | | | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul,
Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Fabio B. Jatene
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Division, Instituto do Coração
- InCor, Hospital das Clínicas da Faculdade de Medicina da Universidade de
São Paulo - HCFMUSP, São Paulo, São Paulo, Brazil
| | | | - Alexandre Cabral Zilli
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Walace de Souza Pimentel
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Nelson Américo Hossne Junior
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - João Nelson Rodrigues Branco
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Renata Trimer
- Department of Physical Therapy, Universidade Federal de São
Carlos, São Carlos, São Paulo, Brazil
| | - Paulo Roberto Barbora Evora
- Department of Surgery and Anatomy, Escola de Medicina de
Riberão Preto, Universidade de São Paulo, Ribeirão Preto,
São Paulo, Brazil
| | - Walter J. Gomes
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Solange Guizilin
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Pechstein AE, Gollie JM, Keyser RE, Guccione AA. Walking Endurance and Oxygen Uptake On-Kinetics in Individuals With Parkinson Disease Following Overground Locomotor Training. J Neurol Phys Ther 2023; 47:99-111. [PMID: 36538418 DOI: 10.1097/npt.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Poor walking endurance in Parkinson disease (PD) may be attributable to both bioenergetic and biomechanical factors, but locomotor training methods addressing both these factors simultaneously are understudied. Our objective was to examine the effects of overground locomotor training (OLT) on walking endurance in individuals with mild-to-moderate PD, and to further explore potential cardiorespiratory contributions. METHODS A single-arm, longitudinal design was used to examine the effects of 24 biweekly sessions of OLT in people with mild-to-moderate PD (n = 12). Walking endurance was measured as total distance walked during a 10-minute walk test (10minWT). Oxygen uptake (V˙ o2 ) on-kinetic profiles were determined using a monoexponential function. Perceived fatigability was assessed following the 10minWT using a self-report scale. Magnitude of change in primary outcomes was assessed using Cohen's d and adjusted for sample size (Cohen's d(unbiased) ). RESULTS Participants executed 3036 (297) steps and maintained 65.5% (8%) age-predicted heart rate maximum in a typical session lasting 56.9 (2.5) minutes. Medium effects in total distance walked-885.9 (157.2) versus 969.5 (140.9); Cohen's d(unbiased) = 0.54-and phase II time constant of the V˙ o2 on-kinetic profile-33.7 (12.3) versus 25.9 (15.3); Cohen's d(unbiased) = 0.54-were observed alongside trivial effects for perceived fatigability-4.7 (1.4) versus 4.8 (1.5); Cohen's d(unbiased) = 0.11-following OLT. DISCUSSION AND CONCLUSIONS These preliminary findings may demonstrate the potential for moderate-intensity OLT to improve walking endurance and enhance cardiorespiratory adjustments to walking activity in adults with mild-to-moderate PD.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A407 ).
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Affiliation(s)
- Andrew E Pechstein
- Department of Rehabilitation Science, George Mason University, Fairfax, Virginia (A.E.P., J.M.G., R.E.K., A.A.G.); Department of Physical Therapy, University of Delaware, Newark (A.E.P.); and Research Service, Veterans Affairs Medical Center, Washington, District of Columbia (J.M.G.)
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Lenasi H, Novak A, Jug B, Dervišević E, Karpljuk D, Videmšek M, Sorić M, Hadžić V. An Alternative Prediction Equation for Evaluation of Six-Minute Walk Distance in Stable Coronary Artery Disease Patients. Front Physiol 2022; 13:844847. [PMID: 35432004 PMCID: PMC9008480 DOI: 10.3389/fphys.2022.844847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: As cardio-vascular diseases are the leading cause of death worldwide, establishing measures to improve cardiovascular health is of crucial importance. Exercise plays an essential role in cardiac rehabilitation of patients with coronary artery disease (CAD), in whom an evaluation of the cardiorespiratory fitness (CRF) is necessary. CRF of CAD patients could be assessed using 6-min walk test (6MWT), and the results interpreted by using Enright-Sherill prediction equation which has mainly been designed and evaluated for a healthy population. Hypothesizing that the Enright-Sherill prediction equation might not be best suited for CAD patients, our aim was to reevaluate this equation in CAD patients, and potentially establish a more accurate 6MWD prediction equation to be applied in these patients.Methods: 6MWD was measured in a cross-sectional study in 67 CAD patients (44 women) who were members of the Coronary club Ljubljana, Slovenia. In addition, the predicted 6MWD was calculated for men and women using Enright-Sherill gender specific regression equation. Multivariate regression analysis was used to obtain a new prediction equation, and the agreement between the measured and the predicted 6MWD analyzed using the repeated measures ANOVA.Results: Men achieved 451 ± 122 m and women 485 ± 69 m without significant differences between sexes (F = 0.022, p = 0.882) when adjusted for age, height, body mass, and waist circumference. When comparing the measured (473 ± 91 m) and the predicted (422 ± 57 m) values of 6MWD in CAD patients we found that the Enright-Sherill prediction equation significantly (F = 27.734, p < 0.001) underestimated the 6MWD by 52 ± 81 m. A significant regression equation was established [F (3,63) = 44.663, p < 0.001], with a R2 of 0.680 where 6MWD equals 1,057 m—4.966 x age (years)—0.614 x WC (cm)–68.629 x NYHA class.Conclusion: The results of this study stress the importance of regular and actual walking ability testing in patients with stable CAD to obtain their CRF, rather than simply predicting it from regression equations obtained from non-representative or non-comparable samples. Our developed prediction equation warrants additional validation and may represent a good substitute for currently used predictions obtained from a healthy population.
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Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Novak
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Edvin Dervišević
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Damir Karpljuk
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Videmšek
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Maroje Sorić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Vedran Hadžić
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Vedran Hadžić,
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Begot I, Gomes WJ, Rocco IS, Bublitz C, Gonzaga LRA, Bolzan DW, Santos VB, Moreira RSL, Breda JR, Almeida DRD, Arena R, Guizilini S. Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation. Braz J Cardiovasc Surg 2021; 36:308-317. [PMID: 33438847 PMCID: PMC8357387 DOI: 10.21470/1678-9741-2020-0344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. METHODS Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. RESULTS Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. CONCLUSION An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.
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Affiliation(s)
- Isis Begot
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Walter J Gomes
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Caroline Bublitz
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laion R A Gonzaga
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Douglas W Bolzan
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | - João R Breda
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Solange Guizilini
- Department of Human Motion Sciences, Federal University of Sao Paulo, São Paulo, Brazil
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Soares SMDTP, Nucci LB. Association between early pulmonary complications after abdominal surgery and preoperative physical capacity. Physiother Theory Pract 2019; 37:835-843. [PMID: 31402737 DOI: 10.1080/09593985.2019.1650404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To investigate whether early postoperative pulmonary complications after abdominal surgery are associated with a lower performance in preoperative six-minute walk test.Methods: A cross-sectional cohort study of 50 participants who underwent elective abdominal surgery and performed the six-minute walk test within 48 hours prior to surgery were conducted. Postoperative pulmonary complications up to the seventh postoperative day were obtained from medical records.Results: Overall, 25 participants developed postoperative pulmonary complications. The mean (standard deviation) preoperative walked distances of the participants with and without postoperative pulmonary complications were, respectively, 444.8 (81.3) meters and 498.3 (63.7) meters (p = .013). The incidence of postoperative pulmonary complications was greater in the participants with walked distance < 400 meters. The multivariable logistic regression model revealed a significant association between postoperative pulmonary complications and preoperative walked distance (Odds ratio = 0.978, p = .010) in participants who underwent intestinal, stomach, or bile tract resection. Conclusions: This study found a high incidence of postoperative pulmonary complications in abdominal surgery participants and an association between lower preoperative physical capacity and the risk of postoperative pulmonary complications in participants who underwent intestinal, stomach, and biliary tract resection.
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Affiliation(s)
| | - Luciana Bertoldi Nucci
- Health Science Postgraduate Program, Life Sciences Centre, Pontifical Catholic University of Campinas, Campinas-São Paulo, Brazil
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