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      Rehabilitación cardiorrespiratoria en hipertensión pulmonar: experiencia en un centro de referencia Translated title: Cardiorespiratory rehabilitation in pulmonary hypertension: experience in a reference center

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          Abstract

          RESUMEN Introducción: La hipertensión pulmonar (HP) abarca un grupo heterogéneo de enfermedades que genera discapacidad y aumento de la morbimortalidad. La rehabilitación cardiorrespiratoria (RC) es un recurso terapéutico subutilizado en esta condición. Objetivo: Estimar los efectos de un programa de RC en una prueba de caminata de campo y en la calidad de vida de pacientes con diagnóstico de HP de los grupos I y IV. Materiales y Métodos: Los pacientes fueron evaluados antes y después de la intervención mediante la prueba de caminata de 6 minutos (PC6M) y el Saint George’s Respiratory Questionnaire (SGRQ). El programa de RC consistió en 8 semanas de ejercicios supervisados con modalidad institucional. Resultados: Se incluyeron 19 pacientes con diagnóstico de HP precapilar por cateterismo cardíaco derecho, 18 mujeres (94,7%) con una media de edad de 45,5 ± 14,3 años. Trece (68,4%) presentaron HP del grupo I, y 6 (31,6%) HP del grupo IV. Se observaron cambios estadísticamente significativos en la PC6M (diferencia de medias -DM- 31 ± 27,3 metros; p <0,001), y en el SGRQ (DM 8,2 ± 10,2; p<0,01). No se reportaron eventos adversos graves durante el programa. Conclusiones: Nuestro estudio sugiere que un programa de RC supervisado en pacientes con HP podría mejorar la distancia caminada y la calidad de vida.

          Translated abstract

          ABSTRACT Background: Pulmonary hypertension (PH) comprises a heterogeneous group of diseases resulting in disability and increased morbidity and mortality. Cardiopulmonary rehabilitation (CR) is a therapeutic resource not widely used in this condition. Objective: The aim of this study was to evaluate the effects of a CR program on a walking test and on the quality of life in patients with group 1 and group 4 PH Methods: Patients were evaluated before and after the intervention with the six-minute walk test (6MWT) and Saint George’s Respiratory Questionnaire (SGRQ). The program consisted of 8 weeks of supervised exercises within the institution. Results: Nineteen patients with precapillary PH diagnosed by right heart catheterization were included; 18 were women (94.7%) with a mean age of 45.5±14.3 years. Thirteen (68.4%) patients had group 1 PH and 6 (31.6%) had group 4 PH. There were statistically significant changes in the 6MWT [mean difference (MD) 31±27.3 m; p<0.001], and in the SGRQ (MD 8.2±10.2; p<0.01). No adverse events were reported during the program. Conclusions: Our study suggests that a supervised CR program in patients with PH could improve the distance walked and the quality of life.

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          Most cited references40

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          ATS statement: guidelines for the six-minute walk test.

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            2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

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              Haemodynamic definitions and updated clinical classification of pulmonary hypertension

              Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this mean value would suggest mPAP >20 mmHg as above the upper limit of normal (above the 97.5th percentile). This definition is no longer arbitrary, but based on a scientific approach. However, this abnormal elevation of mPAP is not sufficient to define pulmonary vascular disease as it can be due to an increase in cardiac output or pulmonary arterial wedge pressure. Thus, this 6th WSPH Task Force proposes to include pulmonary vascular resistance ≥3 Wood Units in the definition of all forms of pre-capillary PH associated with mPAP >20 mmHg. Prospective trials are required to determine whether this PH population might benefit from specific management. Regarding clinical classification, the main Task Force changes were the inclusion in group 1 of a subgroup “pulmonary arterial hypertension (PAH) long-term responders to calcium channel blockers”, due to the specific prognostic and management of these patients, and a subgroup “PAH with overt features of venous/capillaries (pulmonary veno-occlusive disease/pulmonary capillary haemangiomatosis) involvement”, due to evidence suggesting a continuum between arterial, capillary and vein involvement in PAH.
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                Author and article information

                Journal
                rac
                Revista argentina de cardiología
                Rev. argent. cardiol.
                Sociedad Argentina de Cardiología (Ciudad Autónoma de Buenos Aires, , Argentina )
                1850-3748
                September 2022
                : 90
                : 4
                : 265-272
                Affiliations
                [2] orgnameHospital General de Agudos Juan A. Fernández orgdiv1Sección Neumonología Argentina
                [7] orgnameHospital General de Agudos Juan A. Fernández orgdiv1División Cardiología Argentina
                [4] orgnameHospital General de Agudos Juan A. Fernández orgdiv1División Clínica Médica Argentina
                [5] orgnameHospital General de Agudos Juan A. Fernández orgdiv1Sección Salud Mental Argentina
                [1] orgnameHospital General de Agudos Juan A. Fernández orgdiv1Unidad Kinesiología Argentina
                [6] orgnameHospital General de Agudos Juan A. Fernández orgdiv1División Enfermería Argentina
                [3] Buenos Aires orgnameUniversidad Nacional de La Matanza Argentina
                Article
                S1850-37482022000400265 S1850-3748(22)09000400265
                10.7775/rac.es.v90.i4.20537
                edfe1463-0170-46e4-b283-b4dd8146f04b

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 11 March 2022
                : 29 July 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 8
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                SciELO Argentina

                Categories
                Artículo original

                Pulmonary hypertension,Cardiac rehabilitation,Six-minute walk test,Quality of life,Hipertensión pulmonar,Rehabilitación cardíaca,Prueba de caminata de seis minutos,Calidad de vida

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