Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida
Las enfermedades cardiovasculares representan el grupo de enfermedades crónicas no transmisibles con mayor prevalencia a nivel mundial. Dentro de este grupo de patologías, la insuficiencia cardíaca (IC) destaca debido a su alta carga de morbilidad y mortalidad. Los programas de rehabilitación cardio...
- Autores:
-
Serna González, Diego Fernando
- Tipo de recurso:
- https://purl.org/coar/resource_type/c_7a1f
- Fecha de publicación:
- 2023
- Institución:
- Universidad El Bosque
- Repositorio:
- Repositorio U. El Bosque
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unbosque.edu.co:20.500.12495/12756
- Acceso en línea:
- https://hdl.handle.net/20.500.12495/12756
- Palabra clave:
- Insuficiencia cardiaca
Rehabilitación cardiovascular
Prueba de ejercicio cardipulmonar
Variables pronosticas
Heart failure
Cardiovascular rehabilitation
Cardiopulmonary exercise test
Prognostic variables
QT 261
- Rights
- openAccess
- License
- Atribución-NoComercial-CompartirIgual 4.0 Internacional
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|
dc.title.none.fl_str_mv |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
dc.title.translated.none.fl_str_mv |
Impact of a phase II cardiovascular rehabilitation program on prognostic variables of the cardiopulmonary exercise test in patients with heart failure with reduced left ventricular ejection fraction |
title |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
spellingShingle |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida Insuficiencia cardiaca Rehabilitación cardiovascular Prueba de ejercicio cardipulmonar Variables pronosticas Heart failure Cardiovascular rehabilitation Cardiopulmonary exercise test Prognostic variables QT 261 |
title_short |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
title_full |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
title_fullStr |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
title_full_unstemmed |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
title_sort |
Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducida |
dc.creator.fl_str_mv |
Serna González, Diego Fernando |
dc.contributor.advisor.none.fl_str_mv |
Sarmiento Castañeda, Juan Manuel Lineros, Alberto Ortiz, Oscar Medina Espitia, Oscar Leonardo Mendoza Beltran, Fernan Del Cristo |
dc.contributor.author.none.fl_str_mv |
Serna González, Diego Fernando |
dc.subject.none.fl_str_mv |
Insuficiencia cardiaca Rehabilitación cardiovascular Prueba de ejercicio cardipulmonar Variables pronosticas |
topic |
Insuficiencia cardiaca Rehabilitación cardiovascular Prueba de ejercicio cardipulmonar Variables pronosticas Heart failure Cardiovascular rehabilitation Cardiopulmonary exercise test Prognostic variables QT 261 |
dc.subject.keywords.none.fl_str_mv |
Heart failure Cardiovascular rehabilitation Cardiopulmonary exercise test Prognostic variables |
dc.subject.nlm.none.fl_str_mv |
QT 261 |
description |
Las enfermedades cardiovasculares representan el grupo de enfermedades crónicas no transmisibles con mayor prevalencia a nivel mundial. Dentro de este grupo de patologías, la insuficiencia cardíaca (IC) destaca debido a su alta carga de morbilidad y mortalidad. Los programas de rehabilitación cardiovascular y la prueba de ejercicio cardiopulmonar se consideran actualmente dos pilares complementarios para el manejo pronóstico y terapéutico de esta población. |
publishDate |
2023 |
dc.date.issued.none.fl_str_mv |
2023-11 |
dc.date.accessioned.none.fl_str_mv |
2024-07-29T20:22:30Z |
dc.date.available.none.fl_str_mv |
2024-07-29T20:22:30Z |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_7a1f |
dc.type.local.spa.fl_str_mv |
Tesis/Trabajo de grado - Monografía - Especialización |
dc.type.coar.none.fl_str_mv |
https://purl.org/coar/resource_type/c_7a1f |
dc.type.driver.none.fl_str_mv |
info:eu-repo/semantics/bachelorThesis |
dc.type.coarversion.none.fl_str_mv |
https://purl.org/coar/version/c_ab4af688f83e57aa |
format |
https://purl.org/coar/resource_type/c_7a1f |
dc.identifier.uri.none.fl_str_mv |
https://hdl.handle.net/20.500.12495/12756 |
dc.identifier.instname.spa.fl_str_mv |
instname:Universidad El Bosque |
dc.identifier.reponame.spa.fl_str_mv |
reponame:Repositorio Institucional Universidad El Bosque |
dc.identifier.repourl.none.fl_str_mv |
repourl:https://repositorio.unbosque.edu.co |
url |
https://hdl.handle.net/20.500.12495/12756 |
identifier_str_mv |
instname:Universidad El Bosque reponame:Repositorio Institucional Universidad El Bosque repourl:https://repositorio.unbosque.edu.co |
dc.language.iso.fl_str_mv |
spa |
language |
spa |
dc.relation.references.none.fl_str_mv |
1. Organización Mundial de la Salud, nota descriptiva Enfermedades no transmisibles, 13 de septiembre del 2022. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/noncommunicable-diseases. 2. Organización Mundial de la Salud, nota descriptiva Enfermedades cardiovasculares, 17 de mayo del 2017. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). 3. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MS. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022 Feb 22;145(8):e153-639. 4. Gómez E. Capítulo 2. Introducción, epidemiología de la falla cardiaca e historia de las clínicas de falla cardiaca en Colombia. Revista Colombiana de Cardiología. 2016 Mar 1;23:6-12. 5. Van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, Maggioni AP, Voors AA. Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. European journal of heart failure. 2014 Jan;16(1):103-11 6. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022 May 3;79(17):e263-421. 7. Ross RM. ATS/ACCP statement on cardiopulmonary exercise testing. American journal of respiratory and critical care medicine. 2003 May 1;167(10):1451-author. 8. Sietsema KE, Stringer WW, Sue DY, Ward S. Wasserman & Whipp's: principles of exercise testing and interpretation: including pathophysiology and clinical applications. Lippincott Williams & Wilkins; 2020 Jul 2. 9. Malhotra R, Bakken K, D’Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC: Heart Failure. 2016 Aug;4(8):607-16. 10. Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European journal of preventive cardiology. 2021 May;28(5):460-95. 11. López-Jiménez F, Pérez-Terzic C, Zeballos PC, Anchique CV, Burdiat G, González K, González G, Fernández R, Santibáñez C, Herdy A, Rodríguez Escudero JP. Consenso de rehabilitación cardiovascular y prevención secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Revista Uruguaya de Cardiología. 2013 Aug;28(2):189-224. 12. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. Jama. 2009 Apr 8;301(14):1439-50. 13. Corrà, U., Mezzani, A., Bosimini, E., & Giannuzzi, P. (2006). Prognostic value of time-related changes of cardiopulmonary exercise testing indices in stable chronic heart failure: a pragmatic and operative scheme. European Journal of Preventive Cardiology, 13(2), 186-192. 14. Wang Y, Wang L, Qu W. New national data show alarming increase in obesity and noncommunicable chronic diseases in China. European journal of clinical nutrition. 2017 Jan;71(1):149-50. 15. Dunlay SM, Roger VL. Understanding the epidemic of heart failure: past, present, and future. Current heart failure reports. 2014 Dec;11(4):404-15. 16. Cipriano G, Cipriano VT, da Silva VZ, Cipriano GF, Chiappa GR, de Lima AC, Cahalin LP, Arena R. Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis. Heart failure reviews. 2014 Sep;19:655-67. 17. Castro RR, Antunes-Correa LM, Ueno LM, Rondon MU, Negrao CE, Nóbrega AC. Reversal of periodic breathing after aerobic training in heart failure. European Respiratory Journal. 2010 Jun 1;35(6):1409-11. 18. Van Laethem C, Van De Veire N, De Backer G, Bihija S, Seghers T, Cambier D, Vanderheyden M, De Sutter J. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure. European journal of heart failure. 2007 Jun 7;9(6-7):625-9. 19. Gong JB, Yu XW, Yi XR, Wang CH, Tuo XP. Epidemiology of chronic noncommunicable diseases and evaluation of life quality in elderly. Aging Medicine. 2018 Jun;1(1):64-6. 20. Haykowsky MJ, Tomczak CR, Scott JM, Paterson DI, Kitzman DW. Determinants of exercise intolerance in patients with heart failure and reduced or preserved ejection fraction. Journal of applied physiology. 2015 Sep 15;119(6):739-44. 21. Bassett DR, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Medicine and science in sports and exercise. 2000 Jan 1;32(1):70-84. 22. Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, Garten R, Rodriguez-Miguelez P, Guazzi M, Lavie CJ, Abbate A. Exercise intolerance in patients with heart failure: JACC state-of-the-art review. Journal of the American College of Cardiology. 2019 May 7;73(17):2209-25. 23. Corrà U, Piepoli MF, Adamopoulos S, Agostoni P, Coats AJ, Conraads V, Lambrinou E, Pieske B, Piotrowicz E, Schmid JP, Seferović PM. Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role: a position paper from the committee on exercise physiology and training of the heart failure association of the ESC. European journal of heart failure. 2014 Sep;16(9):929-41. 24. Casaburi R. The Value of Cardiopulmonary Exercise Testing as a Predictor of Mortality in Heart Failure. Chest. 2022 Nov 1;162(5):957-8. 25. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds Jr LH, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991 Mar;83(3):778-86. 26. Ritt LE, Myers J, Stein R, Arena R, Guazzi M, Chase P, Bensimhon D, Ashley E, Cahalin LP, Forman DE. Additive prognostic value of a cardiopulmonary exercise test score in patients with heart failure and intermediate risk. International journal of cardiology. 2015 Jan 15;178:262-4. 27. Osada N, Chaitman BR, Miller LW, Yip D, Cishek MB, Wolford TL, Donohue TJ. Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. Journal of the American College of Cardiology. 1998 Mar;31(3):577-82. 28. Arena, R., Peberdy, M. A., Myers, J., Guazzi, M., & Tevald, M. (2006). Prognostic value of resting end-tidal carbon dioxide in patients with heart failure. International journal of cardiology, 109(3), 351-358. 29. Sun XG, Hansen JE, Beshai JF, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. Journal of the American College of Cardiology. 2010 Apr 27;55(17):1814-23. 30. Buber J, Robertson HT. Cardiopulmonary exercise testing for heart failure: pathophysiology and predictive markers. Heart. 2023 Feb 1;109(4):256-63. 31. Cohen-Solal A, Tabet JY, Logeart D, Bourgoin P, Tokmakova M, Dahan M. A non-invasively determined surrogate of cardiac power (‘circulatory power’) at peak exercise is a powerful prognostic factor in chronic heart failure. European heart journal. 2002 May 1;23(10):806-14. 32. Collaborative E, Piepoli MF, Davos C, Francis DP. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). Bmj. 2004 Jan 16;328(7433):189. 33. Taylor RS, Walker S, Ciani O, Warren F, Smart NA, Piepoli M, Davos CH. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technology Assessment (Winchester, England). 2019 May;23(25):1. 34. Swank AM, Horton J, Fleg JL, Fonarow GC, Keteyian S, Goldberg L, Wolfel G, Handberg EM, Bensimhon D, Illiou MC, Vest M. Modest increase in peak V̇O2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circulation: Heart Failure. 2012 Sep;5(5):579-85. 35. Zurek M, Corrà U, Piepoli MF, Binder RK, Saner H, Schmid JP. Exercise training reverses exertional oscillatory ventilation in heart failure patients. European respiratory journal. 2012 Nov 1;40(5):1238-44. 36. Gademan MG, Swenne CA, Verwey HF, Van de Vooren H, Haest JC, van Exel HJ, Lucas CM, Cleuren GV, Schalij MJ, Van der Wall EE. Exercise training increases oxygen uptake efficiency slope in chronic heart failure. European Journal of Preventive Cardiology. 2008 Apr 1;15(2):140-4. 37. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation. 1989 Feb;79(2):324-9. 38. Binder, R. K., Wonisch, M., Corra, U., Cohen-Solal, A., Vanhees, L., Saner, H., & Schmid, J. P. (2008). Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. European Journal of Preventive Cardiology, 15(6), 726-734. 39. Ukkonen, H., Burwash, I. G., Dafoe, W., de Kemp, R. A., Haddad, H., Yoshinaga, K., ... & Beanlands, R. S. (2008). Is ventilatory efficiency (V̇E/V̇CO2 slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure?. European journal of heart failure, 10(11), 1117-1122. 40. Baba, R., Nagashima, M., Goto, M., Nagano, Y., Yokota, M., Tauchi, N., & Nishibata, K. (1996). Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. Journal of the American College of Cardiology, 28(6), 1567-1572. 41. Mancini, D. M., Eisen, H., Kussmaul, W., Mull, R., Edmunds Jr, L. H., & Wilson, J. R. (1991). Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation, 83(3), 778-786. 42. Keteyian, S. J., Patel, M., Kraus, W. E., Brawner, C. A., McConnell, T. R., Piña, I. L., ... & HF-ACTION Investigators. (2016). Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure. Journal of the American College of Cardiology, 67(7), 780-789. 43. Baccanelli, G., Tomaselli, M., Ferri, U., Giglio, A., Munforti, C., Parati, G., ... & Malfatto, G. (2023). Effects of cardiac rehabilitation on cardiopulmonary test parameters in heart failure: A real world experience. International Journal of Cardiology Cardiovascular Risk and Prevention, 17, 200178. 44. Gitt, A. K., Wasserman, K., Kilkowski, C., Kleemann, T., Kilkowski, A., Bangert, M., ... & Senges, J. (2002). Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation, 106(24), 3079-3084. 45. Sun, X. G., Hansen, J. E., Beshai, J. F., & Wasserman, K. (2010). Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. Journal of the American College of Cardiology, 55(17), 1814-1823. 46. Wang, Y., Cao, J., Kong, X., Wang, S., Meng, L., & Wang, Y. (2021). The effects of CPET-guided cardiac rehabilitation on the cardiopulmonary function, the exercise endurance, and the NT-proBNP and hscTnT levels in CHF patients. American Journal of Translational Research, 13(6), 7104. 47. Jaussaud, J., Aimable, L., & Douard, H. (2011). The time for a new strong functional parameter in heart failure: the V̇E/V̇CO2 slope. International journal of cardiology, 147(2), 189-190. 48. Lewis, G. D., Shah, R. V., Pappagianopolas, P. P., Systrom, D. M., & Semigran, M. J. (2008). Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone. Circulation: Heart Failure, 1(4), 227-233. 49. Corrà, U., Mezzani, A., Bosimini, E., Scapellato, F., Imparato, A., & Giannuzzi, P. (2002). Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. American heart journal, 143(3), 418-426. 50. Arena, R., Myers, J., Abella, J., Peberdy, M. A., Bensimhon, D., Chase, P., & Guazzi, M. (2007). Development of a ventilatory classification system in patients with heart failure. Circulation, 115(18), 2410-2417. 51. Faoro, V., Deboeck, G., Vicenzi, M., Gaston, A. F., Simaga, B., Doucende, G., ... & Naeije, R. (2017). Pulmonary Vascular Function and Aerobic Exercise Capacity at Moderate Altitude. Medicine and science in sports and exercise, 49(10), 2131-2138. 52. Agostoni, P., Valentini, M., Magrí, D., Revera, M., Caldara, G., Gregorini, F., ... & Parati, G. (2008). Disappearance of isocapnic buffering period during increasing work rate exercise at high altitude. European Journal of Preventive Cardiology, 15(3), 354-358. 53. Davies, L. C., Wensel, R., Georgiadou, P., Cicoira, M., Coats, A. J., Piepoli, M. F., & Francis, D. P. (2006). Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis: oxygen uptake efficiency slope. European heart journal, 27(6), 684-690. 54. Myers, J., Gademan, M., Brunner, K., Kottman, W., Boesch, C., & Dubach, P. (2012). Effects of high-intensity training on indices of ventilatory efficiency in chronic heart failure. Journal of cardiopulmonary rehabilitation and prevention, 32(1), 9-16. 55. Arellano Quiñonez, N. (2019). Cambios en la pendiente de eficiencia de captación de oxígeno en pacientes con falla cardíaca después de un programa de rehabilitación cardiovascular. 56. Corrà, U., Giordano, A., Bosimini, E., Mezzani, A., Piepoli, M., Coats, A. J., & Giannuzzi, P. (2002). Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest, 121(5), 1572-1580. 57. Arena, R., Guazzi, M., & Myers, J. (2007). Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. International journal of cardiology, 117(1), 103-108. 58. Gonzalez-Garcia, M., Maldonado, D., Barrero, M., Casas, A., Perez-Padilla, R., & Torres-Duque, C. A. (2020). Arterial blood gases and ventilation at rest by age and sex in an adult Andean population resident at high altitude. European Journal of Applied Physiology, 120, 2729-2736. |
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Sarmiento Castañeda, Juan ManuelLineros, AlbertoOrtiz, OscarMedina Espitia, Oscar LeonardoMendoza Beltran, Fernan Del CristoSerna González, Diego Fernando2024-07-29T20:22:30Z2024-07-29T20:22:30Z2023-11https://hdl.handle.net/20.500.12495/12756instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coLas enfermedades cardiovasculares representan el grupo de enfermedades crónicas no transmisibles con mayor prevalencia a nivel mundial. Dentro de este grupo de patologías, la insuficiencia cardíaca (IC) destaca debido a su alta carga de morbilidad y mortalidad. Los programas de rehabilitación cardiovascular y la prueba de ejercicio cardiopulmonar se consideran actualmente dos pilares complementarios para el manejo pronóstico y terapéutico de esta población.Fundación Clinica ShaioEspecialista en Medicina del DeporteEspecializaciónCardiovascular diseases represent the group of chronic non-communicable diseases with the highest prevalence worldwide. Within this group of pathologies, heart failure (HF) stands out due to its high burden of morbidity and mortality. Cardiovascular rehabilitation programs and cardiopulmonary exercise testing are currently considered two complementary pillars for the prognostic and therapeutic management of this population.application/pdfAtribución-NoComercial-CompartirIgual 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertoinfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Insuficiencia cardiacaRehabilitación cardiovascularPrueba de ejercicio cardipulmonarVariables pronosticasHeart failureCardiovascular rehabilitationCardiopulmonary exercise testPrognostic variablesQT 261Impacto de un programa de rehabilitación cardiovascular fase II sobre variables pronósticas de la prueba de ejercicio cardiopulmonar en pacientes con insuficiencia cardíaca con fracción de eyección del ventrículo izquierdo reducidaImpact of a phase II cardiovascular rehabilitation program on prognostic variables of the cardiopulmonary exercise test in patients with heart failure with reduced left ventricular ejection fractionEspecialización en Medicina del DeporteUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. Organización Mundial de la Salud, nota descriptiva Enfermedades no transmisibles, 13 de septiembre del 2022. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/noncommunicable-diseases.2. Organización Mundial de la Salud, nota descriptiva Enfermedades cardiovasculares, 17 de mayo del 2017. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).3. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MS. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022 Feb 22;145(8):e153-639.4. Gómez E. Capítulo 2. Introducción, epidemiología de la falla cardiaca e historia de las clínicas de falla cardiaca en Colombia. Revista Colombiana de Cardiología. 2016 Mar 1;23:6-12.5. Van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, Maggioni AP, Voors AA. Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. European journal of heart failure. 2014 Jan;16(1):103-116. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022 May 3;79(17):e263-421.7. Ross RM. ATS/ACCP statement on cardiopulmonary exercise testing. American journal of respiratory and critical care medicine. 2003 May 1;167(10):1451-author.8. Sietsema KE, Stringer WW, Sue DY, Ward S. Wasserman & Whipp's: principles of exercise testing and interpretation: including pathophysiology and clinical applications. Lippincott Williams & Wilkins; 2020 Jul 2.9. Malhotra R, Bakken K, D’Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC: Heart Failure. 2016 Aug;4(8):607-16.10. Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European journal of preventive cardiology. 2021 May;28(5):460-95.11. López-Jiménez F, Pérez-Terzic C, Zeballos PC, Anchique CV, Burdiat G, González K, González G, Fernández R, Santibáñez C, Herdy A, Rodríguez Escudero JP. Consenso de rehabilitación cardiovascular y prevención secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Revista Uruguaya de Cardiología. 2013 Aug;28(2):189-224.12. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. Jama. 2009 Apr 8;301(14):1439-50.13. Corrà, U., Mezzani, A., Bosimini, E., & Giannuzzi, P. (2006). Prognostic value of time-related changes of cardiopulmonary exercise testing indices in stable chronic heart failure: a pragmatic and operative scheme. European Journal of Preventive Cardiology, 13(2), 186-192.14. Wang Y, Wang L, Qu W. New national data show alarming increase in obesity and noncommunicable chronic diseases in China. European journal of clinical nutrition. 2017 Jan;71(1):149-50.15. Dunlay SM, Roger VL. Understanding the epidemic of heart failure: past, present, and future. Current heart failure reports. 2014 Dec;11(4):404-15.16. Cipriano G, Cipriano VT, da Silva VZ, Cipriano GF, Chiappa GR, de Lima AC, Cahalin LP, Arena R. Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis. Heart failure reviews. 2014 Sep;19:655-67.17. Castro RR, Antunes-Correa LM, Ueno LM, Rondon MU, Negrao CE, Nóbrega AC. Reversal of periodic breathing after aerobic training in heart failure. European Respiratory Journal. 2010 Jun 1;35(6):1409-11.18. Van Laethem C, Van De Veire N, De Backer G, Bihija S, Seghers T, Cambier D, Vanderheyden M, De Sutter J. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure. European journal of heart failure. 2007 Jun 7;9(6-7):625-9.19. Gong JB, Yu XW, Yi XR, Wang CH, Tuo XP. Epidemiology of chronic noncommunicable diseases and evaluation of life quality in elderly. Aging Medicine. 2018 Jun;1(1):64-6.20. Haykowsky MJ, Tomczak CR, Scott JM, Paterson DI, Kitzman DW. Determinants of exercise intolerance in patients with heart failure and reduced or preserved ejection fraction. Journal of applied physiology. 2015 Sep 15;119(6):739-44.21. Bassett DR, Howley ET. Limiting factors for maximum oxygen uptake and determinants of endurance performance. Medicine and science in sports and exercise. 2000 Jan 1;32(1):70-84.22. Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, Garten R, Rodriguez-Miguelez P, Guazzi M, Lavie CJ, Abbate A. Exercise intolerance in patients with heart failure: JACC state-of-the-art review. Journal of the American College of Cardiology. 2019 May 7;73(17):2209-25.23. Corrà U, Piepoli MF, Adamopoulos S, Agostoni P, Coats AJ, Conraads V, Lambrinou E, Pieske B, Piotrowicz E, Schmid JP, Seferović PM. Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role: a position paper from the committee on exercise physiology and training of the heart failure association of the ESC. European journal of heart failure. 2014 Sep;16(9):929-41.24. Casaburi R. The Value of Cardiopulmonary Exercise Testing as a Predictor of Mortality in Heart Failure. Chest. 2022 Nov 1;162(5):957-8.25. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds Jr LH, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991 Mar;83(3):778-86.26. Ritt LE, Myers J, Stein R, Arena R, Guazzi M, Chase P, Bensimhon D, Ashley E, Cahalin LP, Forman DE. Additive prognostic value of a cardiopulmonary exercise test score in patients with heart failure and intermediate risk. International journal of cardiology. 2015 Jan 15;178:262-4.27. Osada N, Chaitman BR, Miller LW, Yip D, Cishek MB, Wolford TL, Donohue TJ. Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. Journal of the American College of Cardiology. 1998 Mar;31(3):577-82.28. Arena, R., Peberdy, M. A., Myers, J., Guazzi, M., & Tevald, M. (2006). Prognostic value of resting end-tidal carbon dioxide in patients with heart failure. International journal of cardiology, 109(3), 351-358.29. Sun XG, Hansen JE, Beshai JF, Wasserman K. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. Journal of the American College of Cardiology. 2010 Apr 27;55(17):1814-23.30. Buber J, Robertson HT. Cardiopulmonary exercise testing for heart failure: pathophysiology and predictive markers. Heart. 2023 Feb 1;109(4):256-63.31. Cohen-Solal A, Tabet JY, Logeart D, Bourgoin P, Tokmakova M, Dahan M. A non-invasively determined surrogate of cardiac power (‘circulatory power’) at peak exercise is a powerful prognostic factor in chronic heart failure. European heart journal. 2002 May 1;23(10):806-14.32. Collaborative E, Piepoli MF, Davos C, Francis DP. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). Bmj. 2004 Jan 16;328(7433):189.33. Taylor RS, Walker S, Ciani O, Warren F, Smart NA, Piepoli M, Davos CH. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technology Assessment (Winchester, England). 2019 May;23(25):1.34. Swank AM, Horton J, Fleg JL, Fonarow GC, Keteyian S, Goldberg L, Wolfel G, Handberg EM, Bensimhon D, Illiou MC, Vest M. Modest increase in peak V̇O2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circulation: Heart Failure. 2012 Sep;5(5):579-85.35. Zurek M, Corrà U, Piepoli MF, Binder RK, Saner H, Schmid JP. Exercise training reverses exertional oscillatory ventilation in heart failure patients. European respiratory journal. 2012 Nov 1;40(5):1238-44.36. Gademan MG, Swenne CA, Verwey HF, Van de Vooren H, Haest JC, van Exel HJ, Lucas CM, Cleuren GV, Schalij MJ, Van der Wall EE. Exercise training increases oxygen uptake efficiency slope in chronic heart failure. European Journal of Preventive Cardiology. 2008 Apr 1;15(2):140-4.37. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation. 1989 Feb;79(2):324-9.38. Binder, R. K., Wonisch, M., Corra, U., Cohen-Solal, A., Vanhees, L., Saner, H., & Schmid, J. P. (2008). Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. European Journal of Preventive Cardiology, 15(6), 726-734.39. Ukkonen, H., Burwash, I. G., Dafoe, W., de Kemp, R. A., Haddad, H., Yoshinaga, K., ... & Beanlands, R. S. (2008). Is ventilatory efficiency (V̇E/V̇CO2 slope) associated with right ventricular oxidative metabolism in patients with congestive heart failure?. European journal of heart failure, 10(11), 1117-1122.40. Baba, R., Nagashima, M., Goto, M., Nagano, Y., Yokota, M., Tauchi, N., & Nishibata, K. (1996). Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. Journal of the American College of Cardiology, 28(6), 1567-1572.41. Mancini, D. M., Eisen, H., Kussmaul, W., Mull, R., Edmunds Jr, L. H., & Wilson, J. R. (1991). Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation, 83(3), 778-786.42. Keteyian, S. J., Patel, M., Kraus, W. E., Brawner, C. A., McConnell, T. R., Piña, I. L., ... & HF-ACTION Investigators. (2016). Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure. Journal of the American College of Cardiology, 67(7), 780-789.43. Baccanelli, G., Tomaselli, M., Ferri, U., Giglio, A., Munforti, C., Parati, G., ... & Malfatto, G. (2023). Effects of cardiac rehabilitation on cardiopulmonary test parameters in heart failure: A real world experience. International Journal of Cardiology Cardiovascular Risk and Prevention, 17, 200178.44. Gitt, A. K., Wasserman, K., Kilkowski, C., Kleemann, T., Kilkowski, A., Bangert, M., ... & Senges, J. (2002). Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation, 106(24), 3079-3084.45. Sun, X. G., Hansen, J. E., Beshai, J. F., & Wasserman, K. (2010). Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure. Journal of the American College of Cardiology, 55(17), 1814-1823.46. Wang, Y., Cao, J., Kong, X., Wang, S., Meng, L., & Wang, Y. (2021). The effects of CPET-guided cardiac rehabilitation on the cardiopulmonary function, the exercise endurance, and the NT-proBNP and hscTnT levels in CHF patients. American Journal of Translational Research, 13(6), 7104.47. Jaussaud, J., Aimable, L., & Douard, H. (2011). The time for a new strong functional parameter in heart failure: the V̇E/V̇CO2 slope. International journal of cardiology, 147(2), 189-190.48. Lewis, G. D., Shah, R. V., Pappagianopolas, P. P., Systrom, D. M., & Semigran, M. J. (2008). Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone. Circulation: Heart Failure, 1(4), 227-233.49. Corrà, U., Mezzani, A., Bosimini, E., Scapellato, F., Imparato, A., & Giannuzzi, P. (2002). Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. American heart journal, 143(3), 418-426.50. Arena, R., Myers, J., Abella, J., Peberdy, M. A., Bensimhon, D., Chase, P., & Guazzi, M. (2007). Development of a ventilatory classification system in patients with heart failure. Circulation, 115(18), 2410-2417.51. Faoro, V., Deboeck, G., Vicenzi, M., Gaston, A. F., Simaga, B., Doucende, G., ... & Naeije, R. (2017). Pulmonary Vascular Function and Aerobic Exercise Capacity at Moderate Altitude. Medicine and science in sports and exercise, 49(10), 2131-2138.52. Agostoni, P., Valentini, M., Magrí, D., Revera, M., Caldara, G., Gregorini, F., ... & Parati, G. (2008). Disappearance of isocapnic buffering period during increasing work rate exercise at high altitude. European Journal of Preventive Cardiology, 15(3), 354-358.53. Davies, L. C., Wensel, R., Georgiadou, P., Cicoira, M., Coats, A. J., Piepoli, M. F., & Francis, D. P. (2006). Enhanced prognostic value from cardiopulmonary exercise testing in chronic heart failure by non-linear analysis: oxygen uptake efficiency slope. European heart journal, 27(6), 684-690.54. Myers, J., Gademan, M., Brunner, K., Kottman, W., Boesch, C., & Dubach, P. (2012). Effects of high-intensity training on indices of ventilatory efficiency in chronic heart failure. Journal of cardiopulmonary rehabilitation and prevention, 32(1), 9-16.55. Arellano Quiñonez, N. (2019). Cambios en la pendiente de eficiencia de captación de oxígeno en pacientes con falla cardíaca después de un programa de rehabilitación cardiovascular.56. Corrà, U., Giordano, A., Bosimini, E., Mezzani, A., Piepoli, M., Coats, A. J., & Giannuzzi, P. (2002). Oscillatory ventilation during exercise in patients with chronic heart failure: clinical correlates and prognostic implications. Chest, 121(5), 1572-1580.57. Arena, R., Guazzi, M., & Myers, J. (2007). Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. International journal of cardiology, 117(1), 103-108.58. Gonzalez-Garcia, M., Maldonado, D., Barrero, M., Casas, A., Perez-Padilla, R., & Torres-Duque, C. A. (2020). Arterial blood gases and ventilation at rest by age and sex in an adult Andean population resident at high altitude. European Journal of Applied Physiology, 120, 2729-2736.spaORIGINALTrabajo de grado.pdfTrabajo de grado.pdfapplication/pdf608118https://repositorio.unbosque.edu.co/bitstreams/0febc20a-5086-421b-b549-2b79ea0ae209/download22dc0b276d40b820c6f35035ee531eb7MD52CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8899https://repositorio.unbosque.edu.co/bitstreams/f8d05727-cc0f-41ad-95ed-0f0d89d8a753/download3b6ce8e9e36c89875e8cf39962fe8920MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://repositorio.unbosque.edu.co/bitstreams/b6fd807d-644c-4a4d-8226-d36da4edcf7b/download17cc15b951e7cc6b3728a574117320f9MD55Carta de autorización.pdfapplication/pdf167891https://repositorio.unbosque.edu.co/bitstreams/bb87467d-96b5-41f7-ad76-d7eadb6fefcf/download3bf0b385f86a57a585ffdd3ce6f4b1a1MD56Acta de grado.pdf.pdfapplication/pdf165249https://repositorio.unbosque.edu.co/bitstreams/fe2cb876-b33e-464e-86f9-8b2c0a168c80/download40bcbd3fd6ebb5cd346fec798d46910bMD57TEXTTrabajo de grado.pdf.txtTrabajo de grado.pdf.txtExtracted texttext/plain101768https://repositorio.unbosque.edu.co/bitstreams/e85d45cd-bfda-44f0-ae76-8699bf84cceb/downloadd52180251aaa8e4076d107bf4c8f8ad6MD58THUMBNAILTrabajo de grado.pdf.jpgTrabajo de grado.pdf.jpgGenerated Thumbnailimage/jpeg3137https://repositorio.unbosque.edu.co/bitstreams/e845f509-0ee0-44e7-ab9c-329f1ae7863f/download4ab2b11b53c0e30155d32358b2571972MD5920.500.12495/12756oai:repositorio.unbosque.edu.co:20.500.12495/127562024-08-01 03:00:32.142http://creativecommons.org/licenses/by-nc-sa/4.0/Atribución-NoComercial-CompartirIgual 4.0 Internacionalopen.accesshttps://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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 |