Examinando por Autor "Mazzucco, Guillermo"

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    Agreement and reliability between tele-assessment and in-person assessment of the one-minute sit-to-stand test in patients with chronic respiratory diseases
    (Multidisciplinary Digital Publishing Institute (MDPI), 2025-07-16) Larrateguy, Santiago; Otto-Yáñez, Matías; Bogado, Juan; Larrateguy, Luis; Barros Poblete, Marisol; Mazzucco, Guillermo; Blanco Vich, Isabel; Gimeno Santos, Elena; Torres Castro, Rodrigo
    Background/Objectives: Telemedicine has emerged as a valuable tool for overcoming access barriers in healthcare, particularly in rehabilitation. However, the validity and reliability of remotely conducted physical capacity assessments remain unclear. This study evaluated the agreement and intra-rater reliability between in-person and tele-assessment administration of the one-minute sit-to-stand test (1 min-STST) in individuals with chronic respiratory diseases (CRDs). Methods: In this cross-sectional study, forty adults (55% female; mean age 59.8 ± 15.9 years) diagnosed with CRDs—including chronic obstructive pulmonary disease (52.5%), asthma (20%), and pulmonary fibrosis (20%)—completed the 1 min-STST in two conditions: in person and via tele-assessment. The primary outcome was the number of repetitions completed in each condition. Intra-rater reliability was analyzed using the intraclass correlation coefficient (ICC), and agreement between methods was evaluated with Bland–Altman analysis. Results: The mean number of repetitions was 24.4 ± 8.0 in person and 24.3 ± 8.1 via tele-assessment, with no significant difference (p = 0.78). Excellent reliability was observed (ICC = 0.978, p < 0.001), and Bland–Altman analysis showed good agreement with a mean difference of 0.08 ± 1.7 repetitions and limits of agreement from −3.26 to 3.41. No adverse events were reported. Conclusions: Tele-assessment of the 1 min-STST shows excellent agreement and reliability compared to in-person assessment in individuals with CRDs. These findings support tele-assessment as a valid and practical alternative for evaluating functional capacity remotely. Further research is needed to confirm its implementation in home-based or less-controlled settings.
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    Effects of cardiovascular rehabilitation on myocardial perfusion and functional exercise capacity in patients with stable coronary artery disease and myocardial ischemia
    (Wolters Kluwer Health, 2025-03) Mazzucco, Guillermo; Pilón, Leonardo; Torres Castro, Rodrigo; Lista Paz, Ana; López, Silvana; Chichizola, Nicolás; Zapata, Gerardo; López, Jorge; Berenguel Senén, Alejandro; Arbillaga Etxarri, Ane
    PURPOSE: Myocardial ischemia is prevalent in chronic heart diseases. Cardiac rehabilitation (CR) offers non-pharmacological benefits to reduce hospitalization and mortality, yet its impact on coronary vascular changes remains unclear. We assessed the effects of CR on myocardial perfusion and exercise capacity in patients with stable coronary artery disease and exercise-induced ischemia. METHODS: We conducted a retrospective observational study in individuals with stable coronary artery disease and myocardial ischemia enrolled in a CR program. Inclusion criteria required a minimum of 3 months of supervised CR and cardiac single-photon emission computed tomography (SPECT) imaging before and after the program. Blinded analysis and interpretation of the SPECT studies was carried out by nuclear cardiologists. The primary outcome was a change in myocardial perfusion via SPECT analysis. Secondary outcomes included changes in exercise capacity, electrocardiographic changes during treadmill stress tests, and evaluation of adverse effects during training. Cinecoronariographies reports were collected for further cardiac status assessment. RESULTS: Of 394 patients, 22 with myocardial ischemia were analyzed (96% males, 61.5 ± 9.5 yr). Number of CR sessions ranged from 42 to 73. Stress-induced ischemia significantly decreased (P = .019), with improvements in exercise capacity, including absolute peak oxygen uptake (mL/min, P = .027), relative oxygen uptake (mL/kg/min, P = .044), maximum metabolic equivalent of task (P = .019), and exercise duration (P < .001). No adverse events occurred. CONCLUSION: After a structured CR program of at least 3 months in patients with stable coronary artery disease and exercise-induced ischemia, there was a notable reduction in stress-induced ischemia and enhancements in exercise capacity, highlighting the safety and efficacy of CR in improving myocardial perfusion and exercise tolerance.
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    Evidence-based practice in respiratory healthcare professionals in Latin America: a survey of the Latin American Thoracic Association (ALAT)
    (Facultad de Salud de la Universidad del Valle, 2024) Benavides, Vicente; Torres Castro, Rodrigo; Fregonezi, Guilherme A.F.; Resqueti, Vanessa; Pérez Nieto, Orlando; Cañas, Alejandra; Larrateguy, Santiago; Mazzucco, Guillermo; Betancourt Peña, Jhonatan
    Background: Evidence-based practice (EBP) is a systematic approach to professional practice using the best available evidence to make informed clinical decisions in healthcare. It is necessary to measure and identify strengths and opportunities for improvement. Objective: To assess the knowledge and application of EBP in respiratory health professionals in Latin America. Methods: A cross-sectional study was conducted. The questionnaire was distributed online to health professionals in Latin American countries. Demographic data, professional characteristics, EBP training, and questionnaire responses were collected. Descriptive and inferential statistical analyses were performed. Results: A total of 448 respiratory health professionals participated in the study. Responses were obtained from 17 countries where the majority were female, with an average age of 42. Participants included physicians, physiotherapists, nurses, respiratory therapists, speech therapists, and occupational therapists. Overall scores indicated moderate to high levels of EBP knowledge and application. However, variations were observed in different dimensions. Factors such as EBP training, reading scientific articles, and professional characteristics were associated with higher scores. Barriers to implementing EBP were identified mostly related to institutional support. Conclusions: This study provides information on the knowledge and implementation of EBP in respiratory health professionals in Latin America. Although the overall levels of knowledge and application of EBP were moderate to high, there are options for improvement, especially in addressing barriers to implementation.
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    Is non-invasive ventilation effective in improving the exercise capacity in patients with cardiac heart failure?: a randomised crossover trial
    (Public Library of Science, 2025-07-01) Mazzucco, Guillermo; Torres Castro, Rodrigo; Intelangelo, Leonardo; Lista Paz, Ana; Escalante, Juan Pablo; Zumeta Olaskoaga, Lore; Veiga, Gonzalo; Arbillaga Etxarri, Ane
    Introduction Heart failure (HF) is a prevalent global health issue, characterized by the heart’s inability to effectively pump or fill with blood, leading to inadequate cardiac output. Despite advances in medical treatments, exercise intolerance remains a significant challenge, impacting their quality of life and contributing to frequent hospitalizations. Recent studies suggest that non-invasive ventilation (NIV) may further enhance exercise performance by reducing ventilatory workload and fatigue. However, limited research has directly compared different ventilatory modes during exercise in patients with heart failure. This study aims to evaluate the effects of two NIV devices on exercise capacity. Methods A randomised crossover trial was conducted in patients with HF, reduced ejection fraction (≤ 40%), New York Heart Association functional class I-III and clinically stable. All participants underwent an initial assessment followed by an incremental exercise test to determine maximum aerobic velocity. They were then randomized to perform three constant work rate tests on separate days under three conditions: (1) with Continuous Positive Airway Pressure (CPAP), (2) with pressure support (PS) and (3) without NIV. The primary outcome was time to exhaustion. Key physiological variables were recorded during each test. Participants were recruited and completed all testing between April 29 and July 18, 2022. ClinicalTrials.gov registration number: NCT05433610. Results A total of 11 patients (mean age: 67±9.6 years) completed the study. Exercise duration was significantly longer in the pressure support group (9.8±6.2 minutes) compared to the CPAP group (8.9±6.0 minutes) and the control group (7.3±6.2 minutes) (p=0.043). No significant differences were found in average heart rate (HR), final HR, or oxygen saturation (SpO2) between the groups (p>0.05). Similarly, dyspnea and leg fatigue (modified Borg scale) showed no statistically significant differences between conditions (p>0.05). Conclusion The use of NIV, particularly the PS mode, during exercise significantly improved exercise duration in patients with HF compared to CPAP or no ventilatory support.
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    Optimización de la rehabilitación cardiovascular en pacientes con enfermedades cardiovasculares: enfoque en intervenciones de rehabilitación personalizadas y basadas en la evidencia
    (Universidad de Deusto, 2025-12-22) Mazzucco, Guillermo; Arbillaga Etxarri, Ane
    Las enfermedades cardiovasculares continúan siendo la principal causa de morbimortalidad a nivel mundial, con un impacto considerable en términos clínicos, sociales y económicos. Dentro del abordaje integral de estas patologías, además del tratamiento farmacológico y las intervenciones invasivas, cobran especial importancia las estrategias no farmacológicas que contribuyen a mejorar la capacidad funcional, la perfusión miocárdica y la calidad de vida. En este contexto, la rehabilitación cardíaca (RC) y la ventilación no invasiva (VNI) han surgido como herramientas de gran interés. Sin embargo, los beneficios específicos de cada una y su aplicación diferenciada según el tipo de patología cardiovascular aún requieren mayor caracterización. La presente tesis tiene como objetivo analizar el impacto de la RC y de la VNI sobre parámetros de capacidad funcional de ejercicio y variables cardiovasculares en dos poblaciones de especial interés: pacientes con enfermedad arterial coronaria (EAC) y pacientes con insuficiencia cardíaca (IC). Para ello, se desarrollaron tres abordajes metodológicos complementarios: un estudio observacional, una revisión sistemática con metaanálisis y un ensayo clínico cruzado. En primer lugar, mediante el estudio observacional se evaluó la influencia de la RC sobre la perfusión miocárdica y la tolerancia al ejercicio en pacientes con EAC. Los resultados demostraron que los programas estructurados de RC, basados en ejercicio físico supervisado y estrategias de optimización cardiovascular, generan mejoras significativas tanto en la perfusión miocárdica como en la capacidad aeróbica. Estos hallazgos refuerzan la evidencia de que la RC no solo tiene un efecto sintomático, sino que puede modular favorablemente la fisiopatología subyacente, contribuyendo a una mejor reserva coronaria y a la prevención de nuevos eventos cardiovasculares. En segundo lugar, se llevó a cabo una revisión sistemática con metaanálisis sobre el uso de VNI en el contexto del entrenamiento físico en pacientes con IC. El análisis integró la evidencia disponible hasta la fecha y permitió concluir que la aplicación de VNI, particularmente en su modalidad de presión soporte, potencia la tolerancia al esfuerzo, facilita una mayor duración del ejercicio y reduce la disnea percibida. Estos efectos parecen estar mediados por una disminución de la carga respiratoria, una optimización del intercambio gaseoso y una reducción de la presión transmural cardíaca, lo que en conjunto mejora el rendimiento funcional. Finalmente, mediante un ensayo clínico cruzado se exploró la eficacia del uso combinado de VNI durante el entrenamiento físico dentro de programas de RC. Los resultados evidenciaron que la incorporación de VNI potencia los beneficios del ejercicio aeróbico, incrementando la tolerancia funcional y favoreciendo la adaptación cardiovascular en comparación con el ejercicio convencional. Se evidenció, además, que esta estrategia resulta segura, bien tolerada y aplicable en el entorno clínico habitual. En conjunto, los hallazgos de esta tesis respaldan la utilidad de integrar la RC y la VNI como herramientas complementarias dentro del abordaje integral de la enfermedad cardiovascular. La RC demuestra un efecto positivo en la perfusión miocárdica y en la capacidad de ejercicio en pacientes con EAC, mientras que la VNI, especialmente bajo presión soporte, emerge como un recurso capaz de optimizar la respuesta al entrenamiento físico en pacientes con IC. En conclusión, esta tesis contribuye a ampliar la comprensión sobre las intervenciones no invasivas en cardiología y abre nuevas perspectivas para el diseño de programas de RC más personalizados y efectivos.
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    Reference equations for maximal respiratory pressures in healthy children and adolescents
    (Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), 2025-09-22) Barral Fernández, Margarita; Jácome Pumar, María Amalia; Souto-Camba, Sonia; González Doniz, Luz; Ramón Belmonte, María Antonia; Amor Barbosa, Marta; Arbillaga Etxarri, Ane; Mazzucco, Guillermo; Bravo Cortés, Pilar; Corral Núñez-Flores, Tamara del; Martín Valero, Rocío; Llorca Cerdà, Carlos; Murcia Lillo, Fabiola; Sanchez Santos, José Antonio; Francín Gallego, Marina; Martín Cortijo, Concepción; García Delgado, Esther; Serrano Veguillas, Cristina; Varas de la Fuente, Ana B.; San José Herranz, Paula; González Montañez, Carolina; Gimeno Santos, Elena; Torres Castro, Rodrigo; Fregonezi, Guilherme A.F.; Pardàs Peraferrer, Mireia; Vilaró, Jordi; Fernández Cadenas, Ángeles; Ríos Cortés, Antonio Tomás; Moreno Valera, María José; Langer, Daniel; Lista Paz, Ana
    Objectives: Maximal respiratory pressures are key indicators of respiratory muscle strength; however, reference equations and cut-offs to define respiratory muscle weakness are scarce in the European paediatric population. The aim was to create sex-specific reference equations for maximal inspiratory and expiratory pressures (PImax/PEmax) in a large sample of healthy children and to objectively establish cut-offs to define respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy children aged 6–18 years, stratified by sex and age, were recruited. Maximal respiratory pressures were measured following standardized methodology in accordance with international guidelines. Reference equations were developed through multiple linear regression analyses. Age- and sex specific cut-offs for respiratory muscle weakness were determined using Z-scores ≥ 1.645 standard deviation (SD) below group means. Results: The final sample included 513 subjects (257 boys; 11.5 [SD3.5] years). Reference equations are: (1) PImax: boys = −41.41 + 10.21 * age + 6.26 * body mass index (BMI) − 0.37 * age * BMI; girls = 125.96–0.34 * age − 0.41 * age2 − 5.75 * BMI + 0.63 * age * BMI; (2) PEmax: boys = 20.93 + 5.23 * age + 2.93 * BMI; girls = −12.67 + 11.98 * age − 0.39 * age2 + 2.57 * BMI. Cut-offs for respiratory muscle weakness are higher in boys and increase with age (p < .001). Depending on age, PImax cut-offs range from 46 to 85 cmH2O in boys and from 45 to 68 cmH2O in girls, while PEmax cut-offs span 54–98 cmH2O in boys and 57–85 cmH2O in girls. Conclusions: This study provides new reference equations for PImax and PEmax derived from the largest dataset of normative values in European children and adolescents. It also establishes age-specific cut-offs to define respiratory muscle weakness. These findings will facilitate the identification of respiratory muscle weakness and the selection of candidates for targeted training programmes.