Letter to the Editor
Relationship between arterial stiffness parameters and cardiovascular responses to maximal exercise testing in Parkinson's disease patients
Relação entre parâmetros da rigidez arterial e resposta cardiovascular em prova de esforço máximo em pacientes com doença de Parkinson
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The repreented values are the area under the curve (AUC) of each test, a measure of the overall platelet aggregation. Reference values of AUC ADP-TEM for citrated samples are 56-139 Ω*min (the lower the value, the better the inhibition). AUC: area under the curve.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Inês Fialho, João B. Augusto, Susana Fevereiro, Miguel B. Santos, Sérgio Bravo Baptista, David Roque" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Inês" "apellidos" => "Fialho" ] 1 => array:2 [ "nombre" => "João B." "apellidos" => "Augusto" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "Fevereiro" ] 3 => array:2 [ "nombre" => "Miguel B." "apellidos" => "Santos" ] 4 => array:2 [ "nombre" => "Sérgio Bravo" "apellidos" => "Baptista" ] 5 => array:2 [ "nombre" => "David" "apellidos" => "Roque" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025512200035X?idApp=UINPBA00004E" "url" => "/08702551/0000004100000006/v3_202206160259/S087025512200035X/v3_202206160259/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Relationship between arterial stiffness parameters and cardiovascular responses to maximal exercise testing in Parkinson's disease patients" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "520" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hélcio Kanegusuku, Marilia Almeida Correia, Paulo Longano, Erika Okamoto, Maria Elisa Pimentel Piemonte, Gabriel Grizzo Cucato, Raphael Mendes Ritti-Dias" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Hélcio" "apellidos" => "Kanegusuku" "email" => array:1 [ 0 => "helciokng@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marilia Almeida" "apellidos" => "Correia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Paulo" "apellidos" => "Longano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Erika" "apellidos" => "Okamoto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Maria Elisa Pimentel" "apellidos" => "Piemonte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Gabriel Grizzo" "apellidos" => "Cucato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Raphael Mendes" "apellidos" => "Ritti-Dias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Hospital Israelita Albert Einstein, São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Nove de Julho, São Paulo, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Brazil Parkinson Association, São Paulo, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "University of São Paulo, São Paulo, SP, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Northumbria University, Newcastle Upon Tyne, United Kingdom" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Relação entre parâmetros da rigidez arterial e resposta cardiovascular em prova de esforço máximo em pacientes com doença de Parkinson" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Parkinson's disease (PD) patients frequently present cardiovascular autonomic regulation dysfunction, leading to blunted heart rate (HR) and systolic blood pressure (BP) response to exercise compared to healthy subjects.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Arterial stiffness may also be increased in some PD patients.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In these patients, higher arterial stiffness has been associated with several cardiovascular alterations, including orthostatic hypotension, supine hypertension and nocturnal hypertension.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Therefore, it is plausible that arterial stiffness in these patients is also associated with blunted cardiovascular responses to exercise. However, whether similar responses occur in PD patients is unknown. Thus, the aim of the study was to assess the relationship between arterial stiffness parameters and cardiovascular response to maximal exercise test in PD patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nineteen male PD patients (65±7 yr, 27.6±4.1 kg/m<span class="elsevierStyleSup">2</span>, 6.8±3.6 yr disease diagnosis, and 2.2±0.6 modified Hoehn & Yahr) and presenting no other neurological disorders, or any diagnosed cardiac disease, hypertension or diabetes completed the study. Patients were under PD medication treatment, such as levodopa (100%), dopamine agonist (42%), amantadine (32%) and selegiline (11%).</p><p id="par0015" class="elsevierStylePara elsevierViewall">All patients performed a maximal exercise test on a cycle ergometer, following the previously published protocol.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> HR and systolic BP response to maximal exercise testing was calculated based on the difference between peak exercise minus pre-exercise values. After an interval of at least five days, all the patients participated in an experimental session that assessed arterial stiffness parameters, such as carotid-femoral pulse wave velocity (PWV), pulse pressure and augmentation index (AIx), following the guidelines of the Clinical Application of Arterial Stiffness, Task Force III.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The study protocol complies with the principles of the Declaration of Helsinki. The study was approved by the local ethics committee of the Universidade Nove de Julho (Certificate of Submission for Ethical appraisal: 95350718.6.0000.5511), and written informed consent was obtained from all patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Correlation between arterial stiffness parameters and cardiovascular response to maximal exercise testing were analyzed by partial correlation and used the peak workload obtained during maximal exercise testing as covariate response (p≤0.05).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients presented mean values for pulse pressure of 32±9 mmHg, 22±10% for AIx and 6.8±2.1 m/s for PWV. In response to maximal exercise testing, patients presented an increase of 46±14 bpm and 51±23 mmHg for HR and systolic BP, respectively. They also presented mean values for peak workload of 91±22 watts.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Pulse pressure and AIx were negatively correlated with systolic BP response to maximal exercise test (r=-0.699, p≤0.01 and r=-0.468, p=0.05, respectively). However, PWV was not significantly correlated with systolic BP and HR response to maximal exercise testing (r=-0.003 and r=-0.307, p>0.05, respectively). Pulse pressure and AIx were also not significantly correlated with HR response to maximal exercise test (r=-0.076 and r=0.031, p>0.05, respectively).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The correlation between increased pulse wave reflection parameters assessed at rest and blunted systolic BP response to maximal exercise testing suggests that alterations in peripheral artery function, such as arterial endothelial dysfunction,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> among other alterations also impair the vascular response to exercise in these patients.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The results of the current study have some practical relevance, since a significant correlation was observed between increased wave reflection parameters with blunted systolic BP. In practical terms, the increased pulse pressure at rest may be potentially related to impaired cardiovascular responses during maximal exercise. Thus, the PD treatment should also include strategies that improve vascular functionality and structure in these patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, in PD patients, increased wave reflection parameters are related to blunted systolic BP response to exercise.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Sources of funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">RR received a research productivity fellowship granted by the <span class="elsevierStyleGrantSponsor" id="gs1">Brazilian National Council for Scientific and Technological Development</span> and HK received a fellowship granted by <span class="elsevierStyleGrantSponsor" id="gs2">Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP</span> (<span class="elsevierStyleGrantNumber" refid="gs2">2018/11564-6</span>).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Sources of funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack611781" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blunted maximal and submaximal responses to cardiopulmonary exercise tests in patients with Parkinson disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kanegusuku" 1 => "C. Silva-Batista" 2 => "T. Pecanha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apmr.2015.12.020" "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil" "fecha" => "2016" "volumen" => "97" "paginaInicial" => "720" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26780469" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular responses during resistance exercise in patients with Parkinson disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.S. Miyasato" 1 => "C. Silva-Batista" 2 => "T. Peçanha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pmrj.2018.04.009" "Revista" => array:6 [ "tituloSerie" => "PM R" "fecha" => "2018" "volumen" => "10" "paginaInicial" => "1145" "paginaFinal" => "1152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29753113" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arterial stiffness and cardiovascular autonomic dysfunction in patients with Parkinson's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Kim" 1 => "S.H. Lee" 2 => "Y.S. Oh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000450613" "Revista" => array:6 [ "tituloSerie" => "Neurodegener Dis" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "89" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27784025" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical applications of arterial stiffness. Task Force III: recommendations for user procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.M. Van Bortel" 1 => "D. Duprez" 2 => "M.J. Starmans-Kool" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0895-7061(01)02326-3" "Revista" => array:6 [ "tituloSerie" => "Am J Hypertens" "fecha" => "2002" "volumen" => "15" "paginaInicial" => "445" "paginaFinal" => "452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12022247" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral arterial endothelial dysfunction of neurodegenerative diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Fukui" 1 => "N. Hishikawa" 2 => "J. Shang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2016" "volumen" => "366" "paginaInicial" => "94" "paginaFinal" => "99" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack611781" "titulo" => "Acknowledgments" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">We express our thanks to the volunteers and the Brazilian Parkinson's Association.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004100000006/v3_202206160259/S0870255122000373/v3_202206160259/en/main.assets" "Apartado" => array:4 [ "identificador" => "93625" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004100000006/v3_202206160259/S0870255122000373/v3_202206160259/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122000373?idApp=UINPBA00004E" ]
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