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Effects of exercise training on endothelial function and functional properties of large arteries in patients with systemic autoimmune myopathies

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Author(s):
Rafael Giovane Missé
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
Defense date:
Examining board members:
Samuel Katsuyuki Shinjo; Bruno Gualano; Edgard Torres dos Reis Neto; Fernando Henrique Carlos de Souza
Advisor: Samuel Katsuyuki Shinjo
Abstract

Background. Dermatomyositis (DM), polymyositis (PM) and antisynthetase syndrome (ASS) are a group of rare diseases defined as systemic autoimmune myopathies (SAMs). Recent data have shown the presence of endothelial dysfunction and increased arterial stiffness in several systemic autoimmune diseases. However, there is only one study that evaluated these parameters in patients with SAMs. In addition, there are no studies evaluating the behavior of these vascular parameters in these patients undergoing an exercise training program. Purpose. To evaluate the endothelial function and structural properties of large arteries of patients with SAMs. Secondarily, to evaluate the impact of combined physical training on these vascular parameters. Methods. The study consisted of two phases (transversal and longitudinal), in which 23 consecutive female patients with SAMs were included (14 patients with DM, 7 patients with ASS and 2 patients with PM), from 2017 to 2018. In the transversal analysis, the patients were matched by age and ethnicity with 12 healthy female individuals (control group). In the longitudinal study, patients underwent a combined physical and aerobic training program (twice a week for a period of 12-weeks). The disease status parameters were based on the International Myositis Assessment & Clinical Studies Group (IMACS) scores. Endothelial function assessment was performed through vascular endotheliumdependent flow-mediated vasodilation (FMD), while structural properties were measured by pulse wave velocity (PWV) and by mechano-transducers in the carotid-femoral pathway. Results. In the transversal analysis, 21 out of 23 patients (14 patients with DM and 7 patients with ASS) were evaluated and compared with the control group. The mean age of patients with DM and ASS and the control group were, respectively, 45.4±8.6, 44.0±6.1 and 43.9±7.2 years (P > 0.999), with predominance of the white ethnicity. FMD (P=0.372) and PWV (P=0.253) values were comparable among all patients and the control group. In an additional analysis, similar FMD values were observed between patients\' group with DM vs. ASS [8.3% (4.5%-10.9%) vs. 6.0% (-1.8%-8.2%); P=0.585]. Likewise, the mean PWV values were similar between groups with DM vs. ASS (7.4±0.8 m/s vs. 7.4±0.9 m/s, P=1,000). Five patients (three patients with DM and two patients with PM) were evaluated in the longitudinal analysis. After the intervention, FMD percentage reduction was observed (- 44.0%, -50.4%, -80.0%, -44.4%), and increasing of the PWV (+15.0%, +3.3%, +1.1%, +15.4%) in four patients. Conclusions. Patients with SAMs presented endothelial function and vascular functional properties similar to healthy individuals. With a combined physical training program, the percentage of the FMD reduced, whereas the percentage of the PWV increased. Additional studies are needed to corroborate the data from the present study (AU)

FAPESP's process: 16/23574-0 - Effects of physical training in endothelial function and functional properties of large arteries in patients with idiopathic inflammatory myopathies: A randomized controlled trial
Grantee:Rafael Giovani Misse
Support Opportunities: Scholarships in Brazil - Master