Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFPB |
Texto Completo: | https://repositorio.ufpb.br/jspui/handle/123456789/21551 |
Resumo: | Introduction: systemic arterial hypertension has a high prevalence and low control rates, being responsible for functional and structural changes in several organs, including the heart. Speckle tracking echocardiography allows the analysis of the dynamics of ventricular contraction, enabling the early detection of myocardial dysfunction. Objectives: to evaluate the degree of myocardial deformation at rest and at peak aerobic exercise in hypertensive patients without left ventricular hypertrophy (LVH) and compare these parameters with healthy controls. Methods: this is an observational cross-sectional study, carried out from October 2020 to May 2021, in patients diagnosed with arterial hypertension, with preserved ejection fraction, without LVH and of both genders. Healthy individuals with characteristics similar to hypertensive individuals were included in the study. Volunteers underwent myocardial deformity assessment by measuring global longitudinal strain (GLS), at rest and at peak stress with speckle tracking during a maximum effort test. Normality and homoscedasticity were assessed using the Shapiro-Wilk and Levene tests, respectively. Mann Whitney t or U tests, one-way ANOVA and Spearman's correlation test were used and the accepted significance level was p < 0.05. Cohen's d was used to assess the size of the effect reported on the variation in myocardial strain between groups. Results: twenty volunteers were evaluated, matched for sex, age, body mass index and echocardiographic parameters. The hypertensive group had higher SBP (137.3 ± 10.5 mmHg vs 122.3 ± 9.3 mmHg, p = 0.01) and MAP (104.0 ± 9.2 mmHg vs 94.1 ± 5, 4 mmHg, p = 0.03) compared to the control group. The other characteristics and hemodynamic parameters at rest and at the exercise test were similar between groups (p>0.05 for all comparisons). In the analysis of the GLS, there were no significant differences in hypertensive individuals in relation to the control, either in the baseline GLS (18.5 ± 1.9 vs 18.0 ± 1.6%, respectively; p = 0.48) or during the Peak GLS (21.0 ± 1.4 vs 22.0 ± 2.8%, respectively; p = 0.39). In the intragroup analysis between baseline vs peak GLS, there is a statistical difference in the hypertensive group (18.5 ± 1.9 vs 21.0 ± 1.4%, p=0.003) and in the control group (18.0 ± 1.6 vs 22.0 ± 2.8%, p=0.001). Conclusion: hypertensive patients with controlled blood pressure, without cardiac remodeling and preserved ejection fraction present similar GLS compared to control volunteers. However, hypertensive individuals have less clinical variation from left ventricular systolic contractility to physical stress. |
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Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdoHipertensãoDeformação miocárdicaExercícioStrain miocárdicoHypertensionMyocardial deformationExerciseMyocardial strainCNPQ::CIENCIAS DA SAUDE::EDUCACAO FISICAIntroduction: systemic arterial hypertension has a high prevalence and low control rates, being responsible for functional and structural changes in several organs, including the heart. Speckle tracking echocardiography allows the analysis of the dynamics of ventricular contraction, enabling the early detection of myocardial dysfunction. Objectives: to evaluate the degree of myocardial deformation at rest and at peak aerobic exercise in hypertensive patients without left ventricular hypertrophy (LVH) and compare these parameters with healthy controls. Methods: this is an observational cross-sectional study, carried out from October 2020 to May 2021, in patients diagnosed with arterial hypertension, with preserved ejection fraction, without LVH and of both genders. Healthy individuals with characteristics similar to hypertensive individuals were included in the study. Volunteers underwent myocardial deformity assessment by measuring global longitudinal strain (GLS), at rest and at peak stress with speckle tracking during a maximum effort test. Normality and homoscedasticity were assessed using the Shapiro-Wilk and Levene tests, respectively. Mann Whitney t or U tests, one-way ANOVA and Spearman's correlation test were used and the accepted significance level was p < 0.05. Cohen's d was used to assess the size of the effect reported on the variation in myocardial strain between groups. Results: twenty volunteers were evaluated, matched for sex, age, body mass index and echocardiographic parameters. The hypertensive group had higher SBP (137.3 ± 10.5 mmHg vs 122.3 ± 9.3 mmHg, p = 0.01) and MAP (104.0 ± 9.2 mmHg vs 94.1 ± 5, 4 mmHg, p = 0.03) compared to the control group. The other characteristics and hemodynamic parameters at rest and at the exercise test were similar between groups (p>0.05 for all comparisons). In the analysis of the GLS, there were no significant differences in hypertensive individuals in relation to the control, either in the baseline GLS (18.5 ± 1.9 vs 18.0 ± 1.6%, respectively; p = 0.48) or during the Peak GLS (21.0 ± 1.4 vs 22.0 ± 2.8%, respectively; p = 0.39). In the intragroup analysis between baseline vs peak GLS, there is a statistical difference in the hypertensive group (18.5 ± 1.9 vs 21.0 ± 1.4%, p=0.003) and in the control group (18.0 ± 1.6 vs 22.0 ± 2.8%, p=0.001). Conclusion: hypertensive patients with controlled blood pressure, without cardiac remodeling and preserved ejection fraction present similar GLS compared to control volunteers. However, hypertensive individuals have less clinical variation from left ventricular systolic contractility to physical stress.NenhumaIntrodução: a hipertensão arterial sistêmica possui alta prevalência e baixas taxas de controle, sendo responsável por alterações funcionais e estruturais em diversos órgãos, entre eles o coração. A ecocardiografia com speckle tracking permite a análise da dinâmica de contração ventricular, possibilitando a detecção precoce da disfunção miocárdica. Objetivos: avaliar o grau de deformação miocárdica no repouso e no pico do exercício aeróbio em pacientes hipertensos sem hipertrofia ventricular esquerda e comparar estes parâmetros com controles saudáveis. Métodos: trata-se de um estudo observacional com corte transversal, que foi realizado no período de outubro de 2020 a maio de 2021, em pacientes com diagnóstico de hipertensão arterial, com fração de ejeção preservada, sem HVE e de ambos os sexos. Indivíduos saudáveis com características semelhantes aos hipertensos foram incluídos no estudo. Os voluntários foram submetidos a avaliação da deformidade miocárdica pela medida strain longitudinal global (GLS), no repouso e no pico do estresse com speckle tracking durante teste de esforço máximo. A normalidade e a homocedasticidade foram avaliadas pelos testes de Shapiro-Wilk e Levene, respectivamente. Os testes t ou U Mann Whitney, ANOVA de um fator e o teste de correlação de Spearman foram empregados e o nível de significância aceito foi de p < 0,05. O d de Cohen foi utilizado para avaliar o tamanho do efeito relatado a variação da deformação miocardica entre os grupos. Resultados: foram avaliados 20 voluntários, pareados por sexo, idade, índice de massa corporal e parâmetros ecocardiográficos. O grupo de hipertensos apresentou maior PAS (137,3 ± 10,5 mmHg vs 122,3 ± 9,3 mmHg, p = 0,01) e PAM (104,0 ± 9,2 mmHg vs 94,1 ± 5,4 mmHg, p = 0,03) em comparação com o grupo controle. As demais características e parâmetros hemodinâmicos de repouso e ao teste ergométrico foram similares entre os grupos (p>0,05 para todas as comparações). Na análise do GLS, não houveram diferenças significantes nos hipertensos em relação ao controle, quer seja no GLS basal (18,5 ± 1,9 vs 18,0 ± 1,6%, respectivamente; p = 0,48) ou durante o GLS pico (21,0 ± 1,4 vs 22,0 ± 2,8%, respectivamente; p = 0,39). Na análise intragrupo entre o GLS basal vs pico, verifica-se diferença estatística no grupo de hipertensos (18,5 ± 1,9 vs 21,0 ± 1,4%, p=0,003) e no grupo controle (18,0 ± 1,6 vs 22,0 ± 2,8%, p=0,001). Conclusão: hipertensos com pressão arterial controlada, sem remodelamento cardíaco e fração de ejeção preservada apresenta similar GLS em comparação aos voluntários controles. Contudo, os hipertensos tem menos variação clínica da contratilidade do ventrículo esquerdo ao estresse físico.Universidade Federal da ParaíbaBrasilMedicinaPrograma Associado de Pós Graduação em Educação Física (UPE/UFPB)UFPBSantos, Maria do Socorro Brasileirohttp://lattes.cnpq.br/6981801923251207Santos, Amilton da Cruzhttp://lattes.cnpq.br/8367611526515442Almeida, Rômulo Leal2021-12-09T19:31:09Z2021-08-252021-12-09T19:31:09Z2021-07-27info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesishttps://repositorio.ufpb.br/jspui/handle/123456789/21551porhttp://creativecommons.org/licenses/by-nd/3.0/br/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFPBinstname:Universidade Federal da Paraíba (UFPB)instacron:UFPB2022-08-09T16:37:23Zoai:repositorio.ufpb.br:123456789/21551Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufpb.br/PUBhttp://tede.biblioteca.ufpb.br:8080/oai/requestdiretoria@ufpb.br|| diretoria@ufpb.bropendoar:2022-08-09T16:37:23Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB)false |
dc.title.none.fl_str_mv |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
title |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
spellingShingle |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo Almeida, Rômulo Leal Hipertensão Deformação miocárdica Exercício Strain miocárdico Hypertension Myocardial deformation Exercise Myocardial strain CNPQ::CIENCIAS DA SAUDE::EDUCACAO FISICA |
title_short |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
title_full |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
title_fullStr |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
title_full_unstemmed |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
title_sort |
Avaliação da deformação miocárdica em repouso e durante o exercício em pacientes hipertensos sem hipertrofia do ventrículo esquerdo |
author |
Almeida, Rômulo Leal |
author_facet |
Almeida, Rômulo Leal |
author_role |
author |
dc.contributor.none.fl_str_mv |
Santos, Maria do Socorro Brasileiro http://lattes.cnpq.br/6981801923251207 Santos, Amilton da Cruz http://lattes.cnpq.br/8367611526515442 |
dc.contributor.author.fl_str_mv |
Almeida, Rômulo Leal |
dc.subject.por.fl_str_mv |
Hipertensão Deformação miocárdica Exercício Strain miocárdico Hypertension Myocardial deformation Exercise Myocardial strain CNPQ::CIENCIAS DA SAUDE::EDUCACAO FISICA |
topic |
Hipertensão Deformação miocárdica Exercício Strain miocárdico Hypertension Myocardial deformation Exercise Myocardial strain CNPQ::CIENCIAS DA SAUDE::EDUCACAO FISICA |
description |
Introduction: systemic arterial hypertension has a high prevalence and low control rates, being responsible for functional and structural changes in several organs, including the heart. Speckle tracking echocardiography allows the analysis of the dynamics of ventricular contraction, enabling the early detection of myocardial dysfunction. Objectives: to evaluate the degree of myocardial deformation at rest and at peak aerobic exercise in hypertensive patients without left ventricular hypertrophy (LVH) and compare these parameters with healthy controls. Methods: this is an observational cross-sectional study, carried out from October 2020 to May 2021, in patients diagnosed with arterial hypertension, with preserved ejection fraction, without LVH and of both genders. Healthy individuals with characteristics similar to hypertensive individuals were included in the study. Volunteers underwent myocardial deformity assessment by measuring global longitudinal strain (GLS), at rest and at peak stress with speckle tracking during a maximum effort test. Normality and homoscedasticity were assessed using the Shapiro-Wilk and Levene tests, respectively. Mann Whitney t or U tests, one-way ANOVA and Spearman's correlation test were used and the accepted significance level was p < 0.05. Cohen's d was used to assess the size of the effect reported on the variation in myocardial strain between groups. Results: twenty volunteers were evaluated, matched for sex, age, body mass index and echocardiographic parameters. The hypertensive group had higher SBP (137.3 ± 10.5 mmHg vs 122.3 ± 9.3 mmHg, p = 0.01) and MAP (104.0 ± 9.2 mmHg vs 94.1 ± 5, 4 mmHg, p = 0.03) compared to the control group. The other characteristics and hemodynamic parameters at rest and at the exercise test were similar between groups (p>0.05 for all comparisons). In the analysis of the GLS, there were no significant differences in hypertensive individuals in relation to the control, either in the baseline GLS (18.5 ± 1.9 vs 18.0 ± 1.6%, respectively; p = 0.48) or during the Peak GLS (21.0 ± 1.4 vs 22.0 ± 2.8%, respectively; p = 0.39). In the intragroup analysis between baseline vs peak GLS, there is a statistical difference in the hypertensive group (18.5 ± 1.9 vs 21.0 ± 1.4%, p=0.003) and in the control group (18.0 ± 1.6 vs 22.0 ± 2.8%, p=0.001). Conclusion: hypertensive patients with controlled blood pressure, without cardiac remodeling and preserved ejection fraction present similar GLS compared to control volunteers. However, hypertensive individuals have less clinical variation from left ventricular systolic contractility to physical stress. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-12-09T19:31:09Z 2021-08-25 2021-12-09T19:31:09Z 2021-07-27 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufpb.br/jspui/handle/123456789/21551 |
url |
https://repositorio.ufpb.br/jspui/handle/123456789/21551 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nd/3.0/br/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nd/3.0/br/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Medicina Programa Associado de Pós Graduação em Educação Física (UPE/UFPB) UFPB |
publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Medicina Programa Associado de Pós Graduação em Educação Física (UPE/UFPB) UFPB |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações da UFPB instname:Universidade Federal da Paraíba (UFPB) instacron:UFPB |
instname_str |
Universidade Federal da Paraíba (UFPB) |
instacron_str |
UFPB |
institution |
UFPB |
reponame_str |
Biblioteca Digital de Teses e Dissertações da UFPB |
collection |
Biblioteca Digital de Teses e Dissertações da UFPB |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB) |
repository.mail.fl_str_mv |
diretoria@ufpb.br|| diretoria@ufpb.br |
_version_ |
1801842985866887168 |