Exequibilidade e segurança do teste cardiopulmonar de exercício na avaliação pré-operatória de cirurgia de revascularização miocárdica eletiva
Exequibilidade e segurança do teste cardiopulmonar de exercício na avaliação pré-operatória de cirurgia de revascularização miocárdica eletiva
Data
2019
Autores
Carazza, Mariana
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A avaliação do risco pré-operatório de cirurgias cardíacas baseia-se no uso de escores de risco, porém tais ferramentas apresentam inúmeras limitações. Em cirurgias não cardíacas observa-se o aumento progressivo do uso do teste cardiopulmonar de exercício (TCPE) na estratificação do risco pré-operatório. O objetivo deste estudo é avaliar a factibilidade da realização de um TCPE em pacientes com indicação de cirurgia de revascularização miocárdica (CRVM) eletiva e descrever os resultados e possíveis complicações deste exame nesta população.
Métodos: Pacientes internados em pré-operatório de CRVM eletiva e com doença coronariana estável foram submetidos a um TCPE. Foram registradas as ocorrências de morte, ventilação mecânica prolongada, novo acidente vascular cerebral, insuficiência renal aguda, infecção profunda de esterno e reoperação no pós-operatório no grupo de pacientes que realizou o TCPE e num grupo controle. Consumo de oxigênio no pico do exercício (VO2pico), pulso de oxigênio, consumo de oxigênio no limiar anaeróbico (VO2LA), inclinação do equivalente ventilatório de CO2 (Incl. VE/VO2), inclinação da eficiência do consumo de oxigênio (OUES) e queda da frequência cardíaca no primeiro minuto da recuperação (QFC1R) foram comparadas entre os pacientes que apresentaram ou não complicações no pós-operatório.
Resultados: Vinte e oito pacientes (75% homens) com idade 61 8 anos foram submetidos ao TCPE. Todos os exames transcorreram sem complicações embora 67.9% dos exames tenham sido interrompidos por sinais ou sintomas de isquemia. Não houve diferença entre as taxas de complicações dos pacientes submetidos ao TCPE e do grupo controle. VO2LA só pôde ser identificado em 57% dos casos. Devido ao grande número de testes submáximos, pressupõe-se que as variáveis submáximas como Incl. VE/VCO2, OUES e QFC sejam mais úteis nessa população.
Conclusão: A realização do TCPE no pré-operatório de CRVM eletiva foi um procedimento factível e seguro nesta amostra capaz de oferecer variáveis submáximas interpretáveis como OUES, Incl. VE/VO2 e QFC1R no primeiro minuto da recuperação.
Introduction: Preoperative risk assessment in cardiac surgeries is based on risk scores, however, these tools have several limitations. In non-cardiac surgeries, it has been observed an increase in the use of cardiopulmonary exercise test (CPET) in the assessment of preoperative risk. The objective of this study is to evaluate the feasibility of performing a CPET in patients with coronary artery disease and indication of elective coronary artery bypass grafting surgery (CABG) and describe the results and possible complications of this test on this population. Methods: Patients with stable coronary artery disease and hospitalized for elective CABG underwent a CPET. The occurrence of death, prolonged mechanical ventilation, stroke, acute renal failure, deep sternum infection and reoperation in the postoperative period were recorded in the group of patients who underwent CPET and in a control group. Oxygen consumption, oxygen pulse, oxygen consumption at the anaerobic threshold (ATVO2), minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), oxygen uptake efficiency slope (OUES) and heart rate recovery (HRR) were compared between the patients who suffered or not postoperative complications. Results: Twenty-eight patients (75% men) aged 61 ± 8 years underwent a CPET. All tests were uncomplicated, although 67.9% of the exams were interrupted by signs or symptoms of ischemia. There was no difference between complication rates of patients submitted to CPET and the control group. ATVO2 could only be identified in 57% of the tests. Due to the large number of submaximal tests, it is assumed that the submaximal variables such as VE/VCO2, OUES and HRR are more useful in this population. Conclusions: Preoperative CPET before elective CABG was a feasible and safe procedure capable to provide interpretable submaximal variables as VE/VCO2, OUES and HRR.
Introduction: Preoperative risk assessment in cardiac surgeries is based on risk scores, however, these tools have several limitations. In non-cardiac surgeries, it has been observed an increase in the use of cardiopulmonary exercise test (CPET) in the assessment of preoperative risk. The objective of this study is to evaluate the feasibility of performing a CPET in patients with coronary artery disease and indication of elective coronary artery bypass grafting surgery (CABG) and describe the results and possible complications of this test on this population. Methods: Patients with stable coronary artery disease and hospitalized for elective CABG underwent a CPET. The occurrence of death, prolonged mechanical ventilation, stroke, acute renal failure, deep sternum infection and reoperation in the postoperative period were recorded in the group of patients who underwent CPET and in a control group. Oxygen consumption, oxygen pulse, oxygen consumption at the anaerobic threshold (ATVO2), minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), oxygen uptake efficiency slope (OUES) and heart rate recovery (HRR) were compared between the patients who suffered or not postoperative complications. Results: Twenty-eight patients (75% men) aged 61 ± 8 years underwent a CPET. All tests were uncomplicated, although 67.9% of the exams were interrupted by signs or symptoms of ischemia. There was no difference between complication rates of patients submitted to CPET and the control group. ATVO2 could only be identified in 57% of the tests. Due to the large number of submaximal tests, it is assumed that the submaximal variables such as VE/VCO2, OUES and HRR are more useful in this population. Conclusions: Preoperative CPET before elective CABG was a feasible and safe procedure capable to provide interpretable submaximal variables as VE/VCO2, OUES and HRR.
Description
Palavras-chave
Cirurgia de revascularização miocárdica, Teste cardiopulmonar de exercício, Preoperative period, Exercise test, Pré-operatório, Myocardial revascularization
Citação
Carazza M. Exequibilidade e segurança do teste cardiopulmonar de exercício na avaliação pré-operatória de cirurgia de revascularização miocárdica eletiva. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]; 2019.