Galdino Gabriela Aguiar Mesquita, Rehder-Santos Patrícia, Linares Stephanie Nogueira, Beltrame Thomas, Catai Aparecida Maria
Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Samsung R&D Institute Brazil - SRBR, Campinas, SP, Brazil.
Heart Lung. 2023 May-Jun;59:23-32. doi: 10.1016/j.hrtlng.2023.01.004. Epub 2023 Jan 19.
Cardiopulmonary exercise testing (CPET) is the gold standard for analyzing cardiorespiratory fitness and integrating physiological responses. However, the presence of chronic diseases may compromise cerebral hemodynamic responses during CPET. In addition, the acute response of cerebral oxygenation during incremental CPET may identify abnormal behavior and ensure greater safety for patients with cardiovascular, respiratory, and metabolic diseases.
To summarize the cerebral oxygenation acute response during CPET of patients with cardiovascular, metabolic, or respiratory diseases.
From inception to 23rd September 2022, five databases (PubMed, SCOPUS, Web of Science, Embase and CINAHAL) were searched for cross-sectional studies performing incremental CPET and measuring the cerebral oxygenation acute response in cardiovascular, metabolic, or respiratory diseases compared with healthy individuals. The Downs and Black tool assessed the risk of bias of the studies.
We included seven studies with 428 participants (305 men and 123 women), aged 43 to 70 years. Of these, 101 had heart failure NYHA II and III; 77 idiopathic dilated cardiomyopathy; 33 valvular disease; 25 coronary heart disease; 22 pulmonary arterial hypertension; 15 had severe obstructive sleep apnea (OSA) and 166 were apparently healthy. There was no eligible article with metabolic disease. There was a lower magnitude increase in cerebral oxygenation of cardiovascular patients compared with the healthy individuals during the CPET. Furthermore, pulmonary arterial hypertension patients presented increased cerebral oxygen extraction, differently to those with severe OSA.
Considering the heterogeneity of the included studies, patients with cardiovascular disease may suffer from reduced cerebral oxygen supply, and individuals with OSA presented lower brain oxygen extraction during the CPET. Future studies should aim for strategies to improve cerebral oxygenation to ensure greater safety at CPET of cardiovascular and OSA patients. An acute response pattern for metabolic and other respiratory diseases was not established.
心肺运动试验（CPET）是分析心肺适能和整合生理反应的金标准。然而，慢性病的存在可能会在CPET期间损害脑血流动力学反应。此外，递增式CPET期间脑氧合的急性反应可能会识别异常行为，并确保心血管、呼吸和代谢疾病患者的更高安全性。
总结心血管、代谢或呼吸系统疾病患者在CPET期间的脑氧合急性反应。
从开始到2022年9月23日，检索了五个数据库（PubMed、SCOPUS、科学网、Embase和CINAHL），以查找进行递增式CPET并测量心血管、代谢或呼吸系统疾病患者与健康个体相比脑氧合急性反应的横断面研究。采用唐斯和布莱克工具评估研究的偏倚风险。
我们纳入了7项研究，共428名参与者（305名男性和123名女性），年龄在43至70岁之间。其中，101人患有纽约心脏病协会（NYHA）II级和III级心力衰竭；77人患有特发性扩张型心肌病；33人患有瓣膜病；25人患有冠心病；22人患有肺动脉高压；15人患有重度阻塞性睡眠呼吸暂停（OSA），166人明显健康。没有符合条件的关于代谢疾病的文章。与健康个体相比，心血管疾病患者在CPET期间脑氧合增加的幅度较小。此外，肺动脉高压患者脑氧摄取增加，这与重度OSA患者不同。
考虑到纳入研究的异质性，心血管疾病患者可能存在脑氧供应减少的情况，而OSA患者在CPET期间脑氧摄取较低。未来的研究应致力于改善脑氧合的策略，以确保心血管疾病和OSA患者在CPET时的更高安全性。尚未建立代谢疾病和其他呼吸系统疾病的急性反应模式。
