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O entendimento adequado da resposta cardiovascular ao exercicio e fundamental para o manejo e tratamento dos pacientes com hipertensao arterial pulmonar (HAP). Entretanto, dados a respeito da adaptacao da mecânica vascular pulmonar e da adaptacao do ventriculo direito ao esforco sao escassos na literatura. O objetivo desse estudo e caracterizar a resposta cardiovascular ao exercicio nos pacientes nesse grupo de pacientes. Foram selecionados 30 pacientes com HAP (Grupo 1 de Dana Point) e 7 controles com hemodinâmica invasiva normal, entre dezembro de 2009 e novembro de 2010, que realizaram protocolo incremental de esforco em cicloergometro limitado por sintomas. Foram avaliados o comportamento das variaveis hemodinâmicas, da mecânica vascular pulmonar e o comportamento do peptideo natriuretico tipo B durante o esforco nos pacientes e comparado sua resposta com os controles. O grupo HAP apresentou elevacao da PAPm superior ao grupo controle, com elevacao da Poap e FC semelhantes. A elevacao do debito cardiaco no pico do esforco foi inferior nesse grupo, sem variacao do volume sistolico. A complacencia e resistencia vascular pulmonar apresentam queda no grupo HAP, permanecendo com complacencia inferior e resistencia superior no pico do esforco em relacao aos controles. Estas variaveis permanecem inversamente acopladas sob a funcao C = t / R em repouso e durante todos os passos do esforco, reforcando o poder desse acoplamento e o papel na CVP na avaliacao desses pacientes. No entanto, o comportamento da resistencia nao e uniforme em todos os pacientes com HAP, podendo ser separada em 3 grupos distintos: elevacao, manutencao e queda durante o esforco. O BNP apresenta elevacao durante o esforco no grupo HAP, mas os valores de BNP basal apresentam correlacao inversa superior com o DC de pico do que os valores de BNP no pico do esforco. Na avaliacao por curva ROC, o BNP de pico e a variacao de BNP pico basal nao se mostraram superiores ao BNP basal na... The proper understanding of the cardiovascular response to exercise has a central role in the management and treatment of patients with pulmonary arterial hypertension (PAH). However, data concerning the evolution of pulmonary vascular mechanics and right ventricular adaptation to effort are scarce. The aim of this study is characterize the cardiovascular response to exercise in these patients. We selected 30 patients with PAH (Group 1 Dana Point) and 7 controls with normal invasive hemodynamics between December 2009 and November 2010 who underwent a symptom-limited exercise protocol on cycle ergometer. Were evaluated the behavior of hemodynamic parameters, pulmonary vascular mechanics and B-type natriuretic peptide during stress in patients and compared their response with controls. The PAH group showed elevation of mPAP greater than the controls, with the same elevated PCWP and HR response between the groups. Cardiac output at peak exercise was lower in the PAH patients with no change of stroke volume during effort. Compliance and pulmonary vascular resistance have decrease in PAH group, remaining with lower compliance and higher resistance at peak exercise compared to controls. These variables are inversely related at rest and during every step of the effort, strengthening the power of this relation and the role of CVP in evaluation of these patients. However, the behavior of resistance is not uniform in all PAH patients and may be separated into three distinct groups: rise, fall and maintenance during exercise. The BNP raises during exercise in PAH group, but the values of baseline BNP already has an stronger inverse correlation with peak CO, better than the correlation of peak exercise BNP with the same variable. BNP at peak exercise and the variation of BNP peak - baseline were not superior to baseline BNP in discriminating the response of the CO during exercise, when evaluated by ROC curves. These findings reinforce the role of baseline BNP in...

Resposta cardiovascular ao exercício em pacientes portadores de hipertensão arterial pulmonar