Guilherme Wesley Peixoto da Fonseca

Background: Indoor climbing can be associated with improvements in muscle strength and cardiorespiratory capacity. However, acute climbing sessions have shown to elicit an excessive hemodynamic response, and chronic vascular adaptations are still unknown. The aim of this study was to evaluate vascular adaptations and their association with grip strength and hangboard performance after an 18-week bouldering program in participants without prior climbing experience. Methods: Forearm blood flow (FBF) was measured with venous occlusion plethysmography. Muscle strength was assessed by handgrip dynamometry, muscle endurance by the dead-hang test, and body composition by air displacement plethysmography. Results: We enrolled 26 controls and 27 novice climbers. At baseline, there was no difference between controls and novice climbers regarding age, sex, body composition, FBF, muscle strength and endurance. Novice climbers showed greater delta improvement in left-hand [5.7 (IQR: −1.6–17.2) vs. −4.1 (IQR: −8.0–1.9) %; p = 0.001], right-hand grip strength [3.8 (IQR: −1.3–13.6) vs. −0.9 (IQR: −6.4–4.5) %; p = 0.011], and hangboard time [23.8 (IQR: 5.1–68.7) vs. 1.8 (IQR: −21.7–13.9) %; p = 0.005]. Novice climbers had better delta changes in FBF [34.0 (IQR: 2.8–54.5) vs. 0.1 (IQR: −23.1–23.6) %; p = 0.010] and forearm vascular conductance [26.5 (IQR: 6.7–66.7) vs. 0.3 (IQR: −23.1–20.2) %; p = 0.011]. A positive correlation was found between delta changes in hangboard time and forearm vascular conductance ( r = 0.29; p = 0.041), along with left-hand grip strength ( r = 0.28; p = 0.038). Conclusion: In conclusion, an 18-week bouldering program improved handgrip strength, hangboard time and vascular function in participants without prior climbing experience, while gains in hangboard performance were associated with improvements in vascular function.

Obesity is recognized as a systemic disease characterized by chronic, low-grade inflammation. The persistent inflammatory state can be driven by secretion of cytokines from adipose tissue, also known as adipokines. In patients with obesity, adipose tissue releases elevated levels of pro-inflammatory cytokines that can have an autocrine and paracrine function. The main cytokines involved in this process include tumor necrosis factor alpha (TNF-α), interleukin-6, and interleukin-1 beta (IL-1β). These molecules actively contribute to metabolic dysregulation by interfering with insulin signaling pathways and facilitating the infiltration of immune cells into adipose tissue. Thus, a vicious cycle can be established in which inflammation perpetuates metabolic disturbances, increasing the risk of developing cardiovascular disease, type II diabetes mellitus, and other chronic conditions. On the other hand, physical exercise can release myokines with anti-inflammatory properties, such as interleukin-6 and irisin, which can positively modulate immune response. Regular physical activity and healthy eating patterns emerge as essential tools to counteract low-grade inflammation. A diet rich in bioactive compounds, such as antioxidants and polyunsaturated fatty acids, may also regulate cytokine expression, reinforcing the role of nutrition as a therapeutic strategy for obesity management. In conclusion, the role of inflammatory cytokines in obesity is central and managing their activity through non-pharmacological interventions, combining exercise and nutrition, represents a powerful tool to prevent long-term complications. However, more studies are needed to elucidate the exact molecular mechanisms by which nutrition and exercise modulate inflammation in obesity, in order to develop more effective interventions.

Background A Brazilian athlete has proposed setting a new world record for consecutive marathons by running 366 marathons in 366 consecutive days. The impact of such a feat on the cardiovascular system is unknown. Objective To monitor the cardiovascular system to assess the athlete’s cardiovascular adaptations or maladaptations over the period. Methods During the pre-study evaluation, we conducted the pre-participation clinical evaluation (PPE) composed of anamnesis, electrocardiogram, blood test, and functional capacity by maximum cardiopulmonary exercise test (CPET). At follow-up, serial CPET, body composition assessment, blood sample, and echocardiogram were periodically performed for 12 months. Results At PPE, male, 43-year-old, height: 1.83 m, weight: 76.9 kg, maximum oxygen consumption (VO2max): 52 ml/kg/min, body fat: 12.6%, systolic and diastolic blood pressure: 120/80 mmHg, blood glucose: 92 mg/dL, total cholesterol (TC): 185 mg/dL, high-sensitivity C-reactive protein (hs-CRP): 0.08 mg/dL, creatine phosphokinase (CPK): 183 U/L, and high-sensitivity troponin T (hs-TnT): 7.1 ng/L. At follow-up, the average of VO2max remained at 48.7 ± 1.2 ml/kg/min, left ventricular ejection fraction (LVEF) at 62 ± 2%, LV strain global longitudinal at 19 ± 1%, LV mass index at 83 ± 7 g/m2, hs-CRP at 0.07 ± 0.01 mg/L, CPK at 169 ± 36 U/L, hs-TnT at 8.2 ± 1.4 ng/L, and no malignant arrhythmias were observed. Conclusion The athlete’s cardiovascular system had adapted to an extremely high volume of consecutive marathons at moderate intensity for one year and remained functioning at normal range. In addition, the athlete set a new world record for most consecutive days to run a marathon, recognized by Guinness World Records.

Resumo Fundamento Um atleta brasileiro propôs estabelecer um novo recorde mundial de maratonas consecutivas, competindo em 366 maratonas durante 366 dias consecutivos. O impacto dessas maratonas consecutivas sobre o sistema cardiovascular permanece desconhecido. Objetivo Monitorar o sistema cardiovascular para avaliar quaisquer adaptações cardiovasculares do atleta ao longo do período. Métodos Durante a avaliação pré-estudo, conduzimos uma avaliação clínica pré-participação (APP) composta por anamnese, eletrocardiograma, exame de sangue e capacidade funcional por meio do teste cardiopulmonar no exercício (TCPE). Durante o acompanhamento, o TCPE seriado, a avaliação da composição corporal, a análise de amostra de sangue e o ecocardiograma foram realizados periodicamente, por 12 meses. Resultados Na APP, indivíduo do sexo masculino, 43 anos, altura: 1,83 m, peso: 76,9 kg, consumo máximo de oxigênio (VO2máx): 52 ml/kg/min, gordura corporal: 12,6%, pressão arterial sistólica e diastólica: 120/80 mmHg, glicemia: 92 mg/dL, colesterol total: 185 mg/dL, proteína C reativa de alta sensibilidade (hs-CRP): 0,08 mg/dL, creatina fosfoquinase (CPK): 183 U/L e troponina T de alta sensibilidade (hs-TnT): 7,1 ng/L. Durante o acompanhamento, a média de VO2máx permaneceu em 48,7 ± 1,2 ml/kg/min, a Fração de Ejeção do Ventrículo Esquerdo (FEVE) em 62 ± 2%, o strain longitudinal global do VE em 19 ± 1%, o índice de massa do VE em 83 ± 7 g/m2, o hs-CRP em 0,07 ± 0,01 mg/L, a CPK em 169 ± 36 U/L, a hs-TnT em 8,2 ± 1,4 ng/L e nenhuma arritmia maligna foi observada. Conclusão O sistema cardiovascular do atleta se adaptou a um volume extremamente alto de maratonas consecutivas em intensidade moderada por 1 ano e permaneceu funcional na faixa de normalidade. Além disso, o atleta estabeleceu um novo recorde mundial de maratonas consecutivas, reconhecido pelo Guinness World Records.

Background Hypertrophic cardiomyopathy (HCM) presents echocardiographic abnormalities that are important for diagnosis and prognosis. Data are scarce in the Brazilian literature. Objective To assess clinical and echocardiographic characteristics and disease progression in a Brazilian cohort of patients with HCM. Methods This retrospective cohort included patients with HCM aged ≥ 18 years. Patients with moderate or severe aortic stenosis and those undergoing septal reduction were excluded. The significance level adopted in the statistical analysis was 5%. Results The study included 1244 patients, between 2010 and 2022, with a mean follow-up time of 7.7 ± 4.5 years; 53.6% of patients were men. Mean age was 54.6 ± 16.5 years, and mean left ventricular ejection fraction (LVEF) was 65.8% ± 7.6. We observed LVEF ≤ 50% in 5.8% of patients, asymmetric form in 88.7%, and septal hypertrophy in 85.4%. We found systolic anterior motion of the mitral valve in 30.1% of patients, left ventricular outflow tract obstruction in 30.7%, and septum ≥ 28 mm in 7.2%. Only 1 patient had ventricular aneurysm. Atrial fibrillation/flutter occurred in 9.6% of patients. Overall mortality occurred in 232 patients (1.3%/year). Patients with B-type natriuretic peptide (BNP) > 200 pg/ml, left atrium ≥ 45 mm, and LVEF ≤ 50% had higher mortality (p < 0.001). Age and atrial fibrillation/flutter were also associated with mortality. Conclusions The majority of patients had LVEF > 50%, asymmetric hypertrophy, and septal predominance. BNP, LA diameter, LVEF ≤ 50%, age, and atrial fibrillation/flutter were associated with worse prognosis.

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) apresenta alterações ecocardiográficas importantes para diagnóstico e prognóstico. Os dados da literatura nacional são escassos. Objetivo Avaliar, em uma coorte brasileira de pacientes com CMH, as características clínicas, ecocardiográficas e a evolução da doença. Métodos Coorte retrospectiva de pacientes com CMH e idade ≥ 18 anos. Foram excluídos pacientes com estenose aórtica moderada ou importante e aqueles submetidos à redução septal. O nível de significância adotado na análise estatística foi de 5%. Resultados Foram incluídos 1244 pacientes, entre os anos de 2010 e 2022, com tempo médio de seguimento de 7,7 anos ± 4,5, sendo 53,6% homens. A idade média foi de 54,6 anos ± 16,5, e a fração de ejeção do ventrículo esquerdo (FEVE) média foi de 65,8% ± 7,6. A FEVE ≤ 50% foi observada em 5,8% dos pacientes, a forma assimétrica em 88,7% e a hipertrofia septal em 85,4%. Movimento sistólico anterior da valva mitral foi encontrado em 30,1% dos pacientes, obstrução da via de saída do ventrículo esquerdo em 30,7% e septo ≥ 28 mm em 7,2%. Apenas 1 paciente apresentou aneurisma ventricular. Fibrilação/flutter atrial ocorreu em 9,6% dos pacientes. A mortalidade geral ocorreu em 232 pacientes (1,3%/ano). Pacientes com peptídeo natriurético tipo B (BNP) > 200 pg/ml, átrio esquerdo ≥ 45 mm e FEVE ≤ 50% apresentaram maior mortalidade (p < 0,001). Além disso, idade e fibrilação/flutter atrial também foram relacionadas com mortalidade. Conclusões A maioria dos pacientes apresentava FEVE > 50%, hipertrofia assimétrica e predomínio septal. BNP, diâmetro do AE, FEVE ≤ 50%, idade e fibrilação/flutter atrial foram associados com pior prognóstico.

Sarcopenia is characterized by a decline in muscle strength, generalized loss of skeletal muscle mass, and impaired physical performance, which are common outcomes used to screen, diagnose, and determine severity of sarcopenia in older adults. These outcomes are associated with poor quality of life, increased risk of falls, hospitalization, and mortality in this population. The development of sarcopenia is underpinned by aging, but other factors can lead to sarcopenia, such as chronic diseases, physical inactivity, inadequate dietary energy intake, and reduced protein intake (nutrition‐related sarcopenia), leading to an imbalance between muscle protein synthesis and muscle protein breakdown. Protein digestion and absorption are also modified with age, as well as the reduced capacity of metabolizing protein, hindering older adults from achieving ideal protein consumption (i.e., 1–1.5 g/kg/day). Nutritional supplement strategies, like animal (i.e., whey protein) and plant‐based protein, leucine, and creatine have been shown to play a significant role in improving outcomes related to sarcopenia. However, the impact of other supplements (e.g., branched‐chain amino acids, isolated amino acids, and omega‐3) on sarcopenia and related outcomes remain unclear. This narrative review will discuss the evidence of the impact of these nutritional strategies on sarcopenia outcomes in older adults.

Background: Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous. We present data on physical signs and symptoms, cardiac and neurological assessments and genetic profile of patients enrolled in the Transthyretin Cardiac Amyloidosis Registry of the State of São Paulo, Brazil. Results: Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Eleven different mutations were detected, the most common being Val50Met (47.5%) and V142Ile (39.2%). Overall, more than half of the patients presented cardiac involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p < 0.001). The prevalence of the neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p < 0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between ATTRv and ATTRwt groups. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients. Conclusions: This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.

Purpose: Sarcopenia, the loss of muscle mass and function, is a common comorbidity in patients with heart failure (HF). The skeletal muscle modulates the respiratory response during exercise. However, whether ventilatory behavior is affected by sarcopenia is still unknown. Methods: We enrolled 169 male patients with HF. Muscle strength was measured by a handgrip dynamometer. Body composition was measured with dual-energy X-ray absorptiometry. Sarcopenia was defined by handgrip strength 2) 2. Oxygen uptake efficiency slope (OUES), ventilation (VE), oxygen uptake (VO₂), and carbon dioxide output (VCO₂) were measured by a cardiopulmonary exercise test. Results: Sarcopenia was identified in 29 patients (17%). At the first ventilatory threshold, VE/VO₂ (36.9 ± 5.9 vs 32.7 ± 6.5; P = .003) and VE/VCO₂ (39.8 ± 7.2 vs 35.3 ± 6.9; P = .004) were higher in patients with sarcopenia compared to those without sarcopenia. At the exercise peak, compared to patients without sarcopenia, patients with sarcopenia had lower OUES (1186 ± 295 vs 1634 ± 564; P < .001), relative VO₂ (16.2 ± 5.0 vs 19.5 ± 6.5 mL/kg/min; P = .01), and VE (47.3 ± 10.1 vs 63.0 ± 18.2 L/min; P < .0001), while VE/VCO₂ (42.9 ± 8.9 vs 38.7 ± 8.4; P = .025) was increased. OUES was positively correlated with ALM/height² (r = 0.36; P < .0001) and handgrip strength (r = 0.31; P < .001). Hemoglobin (OR = 1.149; 95% CI, 0.842-1.570; P = .038), ALM/height² (OR = 2.166; 95% CI, 1.338-3.504; P = .002), and VO_2peak (OR = 1.377; 95% CI, 1.218-1.557; P < .001) were independently associated with OUES adjusted by cofounders. Conclusions: Our results suggest that sarcopenia is related to impaired ventilatory response during exercise in patients with HF.