GABRIELA LIBERATO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor e Coautores FMUSP-HC Normalizados: AIDA LUIZA RIBEIRO TURQUETTO ×

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  • article 16 Citação(ões) na Scopus
    Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity
    (2018) TURQUETTO, Aida Luiza Ribeiro; SANTOS, Marcelo Rodrigues dos; SAYEGH, Ana Luiza Carrari; SOUZA, Francis Ribeiro de; AGOSTINHO, Daniela Regina; OLIVEIRA, Patricia Alves de; SANTOS, Yarla Alves dos; LIBERATO, Gabriela; BINOTTO, Maria Angelica; OTADUY, Maria Concepcion Garcia; NEGRAO, Carlos Eduardo; CANEO, Luiz Fernando; JATENE, Fabio Biscegli; JATENE, Marcelo Biscegli
    Background: Changes in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. Methods: Thirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. Results: Fontan patients have blunted FBF (1.59 +/- 0.33 vs 2.17 +/- 0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 +/- 0.04 vs 2.34 +/- 0.62 units p < 0.001), reduced CSA of the thigh (81.2 +/- 18.6 vs 116.3 +/- 26.4 cm(2) p < 0.001), lower peak VO2 (29.3 +/- 6 vs 41.5 +/- 9mL/kg/min p < 0.001), walked distance (607 +/- 60 vs 701 +/- 58m p < 0.001) and handgrip strength (21 +/- 9 vs 30 +/- 8 kgf p < 0.001). The MSNA (30 +/- 4 vs 22 +/- 3 bursts/min p < 0.001) and norepinephrine concentration [265 (236-344) vs 222 (147-262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (beta = 0.653; CI = 0.102-1.205; p = 0.022) and stroke volume (beta = 0.018; CI = 0.007-0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (beta = 5.283; CI = 2.254-8.312; p = 0.001) was independently associated with reduced peak VO2. Conclusion: Patients with Fontan operation have underdeveloped skeletal muscle with reduced strengh that is associated with suboptimal peripheral blood supply and diminished exercise capacity.
  • article 31 Citação(ões) na Scopus
    Impaired Pulmonary Function is an Additional Potential Mechanism for the Reduction of Functional Capacity in Clinically Stable Fontan Patients
    (2017) TURQUETTO, Aida L. R.; CANEO, Luiz F.; AGOSTINHO, Daniela R.; OLIVEIRA, Patricia A.; LOPES, Maria Isabel C. S.; TREVIZAN, Patricia F.; FERNANDES, Frederico L. A.; BINOTTO, Maria A.; LIBERATO, Gabriela; TAVARES, Glaucia M. P.; NEIROTTI, Rodolfo A.; JATENE, Marcelo B.
    Central factors negatively affect the functional capacity of Fontan patients (FP), but ""non-cardiac"" factors, such as pulmonary function, may contribute to their exercise intolerance. We studied the pulmonary function in asymptomatic FP and its correlations with their functional capacity. Pulmonary function and cardiopulmonary exercise tests were performed in a prospective study of 27 FP and 27 healthy controls (HC). Cardiovascular magnetic resonance was used to evaluate the Fontan circulation. The mean age at tests, the mean age at surgery, and the median follow-up time of FP were 20(+/- 6), 8(+/- 3), and 11(8-17) years, respectively. Dominant ventricle ejection fraction was within normal range. The mean of peak VO2 expressed in absolute values (L/min), the relative values to body weight (mL/kg/min), and their predicted values were lower in FP compared with HC: 1.69 (+/- 0.56) vs 2.81 (+/- 0.77) L/min; 29.9 (+/- 6.1) vs 41.5 (+/- 9.3) mL/kg/min p < 0.001 and predicted VO2 Peak [71% (+/- 14) vs 100% (+/- 20) p < 0.001]. The absolute and predicted values of the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), inspiratory capacity (IC), total lung capacity (TLC), diffusion capacity of carbon monoxide of the lung (DLCO), maximum inspiratory pressure (MIP), and sniff nasal inspiratory pressure (SNIP) were also significantly lower in the Fontan population compared to HC. An increased risk of restrictive ventilatory pattern was found in patients with postural deviations (OD:10.0, IC:1.02-97.5, p = 0.042). There was a strong correlation between pulmonary function and absolute peak VO2 [FVC (r = 0.86, p < 0.001); FEV1 (r = 0.83, p < 0.001); IC (r = 0.84, p < 0.001); TLC (r = 0.79, p < 0.001); and DLCO (r = 0.72, p < 0.001). The strength of the inspiratory muscles in absolute and predicted values was also reduced in FP [-79(+/- 28) vs -109(+/- 44) cmH(2)O (p = 0.004) and 67(+/- 26) vs 89(+/- 36) % (p = 0.016)]. Thus, we concluded that the pulmonary function was impaired in clinically stable Fontan patients and the static and dynamic lung volumes were significantly reduced compared with HC. We also demonstrated a strong correlation between absolute Peak VO2 with the FVC, FEV1, TLC, and DLCO measured by complete pulmonary test.
  • article 15 Citação(ões) na Scopus
    Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial
    (2021) TURQUETTO, Aida Luiza Ribeiro; SANTOS, Marcelo Rodrigues dos; AGOSTINHO, Daniela Regina; SAYEGH, Ana Luiza Carrari; SOUZA, Francis Ribeiro de; AMATO, Luciana Patrick; BARNABE, Milena Schiezari Ru; OLIVEIRA, Patricia Alves de; LIBERATO, Gabriela; BINOTTO, Maria Angelica; NEGRAO, Carlos Eduardo; CANEO, Luiz Fernando; TRINDADE, Evelinda; JATENE, Fabio Biscegli; JATENE, Marcelo Biscegli
    Background: The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. Methods: A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. Results: The AET decreased MSNA (p = 0.042), increased FBF (p 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. Conclusions: Both aerobic exercise and inspiratory musde training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry.