ABSTRACT
OBJECTIVE: We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION: Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS: Twenty heart transplantation (18 men, 49±11 years and 8.5±3.3 years after transplantation), 11 heart failure (8 men, 43±10 years), and 7 healthy subjects (5 men 39±8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS: During rest, patients' norepinephrine plasma level (659±225 pg/mL) was higher in heart transplant recipients (463±167 pg/mL) and heathy subjects (512±132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248±692 pg/mL) was not different from that of heart failure patients (1174±653 pg/mL). Both these groups had a higher level than healthy subjects had (545±95 pg/mL), p<0.05. CONCLUSION: Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Exercise Test , Heart Failure/blood , Heart Transplantation/physiology , Norepinephrine/blood , Walking/physiology , Case-Control Studies , Heart Failure/surgeryABSTRACT
FUNDAMENTO: Estudos têm demonstrado que o consumo de oxigênio de pico (VO2 pico) e a inclinação VE/VCO2 são preditores de sobrevida em pacientes com insuficiência cardíaca (IC). Entretanto, com a adição do betabloqueador no tratamento da IC, os valores de prognóstico do VO2 pico e da Inclinação VE/VCO2 não estão totalmente estabelecidos. OBJETIVO: Avaliar o efeito dos betabloqueadores no valor de prognóstico do VO2 pico e da inclinação VE/VCO2 em pacientes com IC. MÉTODOS: Estudamos 391 pacientes com insuficiência cardíaca, com idade de 49 ± 14 anos e fração de ejeção do ventrículo esquerdo de 38 ± 10 por cento. Total de pacientes que usavam (grupo I - GI) e não usavam (grupo II - GII) betabloqueadores: 229 e 162, respectivamente. Todos os pacientes foram submetidos a teste de esforço cardiopulmonar, em esteira, usando o protocolo de Naughton. RESULTADOS: O VO2 pico < 10 ml.kg-1.min-1 identificou pacientes de alto risco, enquanto valores > 16 ml.kg-1.min-1 categorizaram pacientes com melhor prognóstico em médio prazo. A faixa do VO2 pico entre > 10 e < 16 ml.kg-1.min-1 indicou risco moderado para evento cardíaco em quatro anos de seguimento. O betabloqueador reduziu significativamente a inclinação VE/VCO2 em pacientes com IC. O valor prognóstico da inclinação VE/VCO2 < 34 no grupo betabloqueado pode refletir o impacto desse fármaco nessa variável cardiorrespiratória. CONCLUSÃO: O VO2 pico baixo e a inclinação VE/VCO2 elevado são fortes e independentes preditores de eventos cardíacos na insuficiência cardíaca. Assim, ambas as variáveis continuam a ser preditores importantes de sobrevida em pacientes com insuficiência cardíaca, principalmente na era do betabloqueador.
BACKGROUND: Studies have demonstrated that peak oxygen consumption (peak VO2) and the VE/VCO2 slope are predictors of survival in patients with heart failure (HF). However, with the advent of betablockers in the treatment of HF, the prognostic values of peak VO2 and VE/VCO2 slope have not been fully established. OBJECTIVE: To evaluate the effect of betablocker use on the prognostic value of peak VO2 and VE/VCO2 slope in patients with HF. METHODS: We studied 391 patients with heart failure, aged 49 ± 14 years and presenting a left ventricular ejection fraction of 38 ± 10 percent. The total number of patients that used (Group I - GI) or did not use (Group II - GII) betablockers was 229 and 162, respectively. All patients were submitted to a cardiopulmonary stress test on a treadmill, using the Naughton protocol. RESULTS: A peak VO2 < 10 ml.kg-1.min-1 identified high-risk patients, whereas values > 16 ml.kg-1.min-1 categorizes patients with a better mid-term prognosis. Peak VO2 values between > 10 and < 16 ml.kg-1.min-1 indicated moderate risk for cardiac event in four years of follow up. The betablocker use significantly reduced the VE/VCO2 slope in patients with HF. The prognostic value of the VE/VCO2 slope < 34 in the group using betablocker can reflect the impact of the drug on this cardiorespiratory variable. CONCLUSION: A low peak VO2 and an elevated VE/VCO2 slope are strong and independent predictors of cardiac events in HF. Thus, both variables remain important survival predictors in patients with HF, especially at the age of betablockers.
Subject(s)
Female , Humans , Male , Middle Aged , Adrenergic beta-Antagonists/therapeutic use , Carbon Dioxide/metabolism , Exercise Test , Heart Failure/drug therapy , Oxygen Consumption/physiology , Brazil , Epidemiologic Methods , Heart Failure/etiology , Heart Failure/mortality , Heart Rate/physiology , PrognosisABSTRACT
BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5±8.2 years; Body mass index: 27.8±4.7 kg/m²) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60 percent of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126±8.6 vs. 123.1±8.7 mmHg, p=0.004) and diastolic blood pressure (81.9±8 vs. 79.8±8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5±8.5 vs. 83.9±8.8 mmHg, p=0.04), and nighttime S (116.8±9.9 vs. 112.5±9.2 mmHg, p<0.001) and diastolic blood pressure (73.5±8.8 vs. 70.1±8.4 mmHg, p<0.001). Post-exercise daytime systolic blood pressure also tended to be reduced (129.8±9.3 vs. 127.8±9.4 mmHg, p=0.06). These post-exercise decreases in ambulatory blood pressure increased the percentage of patients displaying normal 24h systolic blood pressure (58 percent vs. 76 percent, p=0.007), daytime systolic blood pressure (68 percent vs. 82 percent, p=0.02), and nighttime diastolic blood pressure (56 percent vs. 72 percent, p=0.02). Nighttime systolic blood pressure also tended to increase (58 percent vs. 80 percent, p=0.058). CONCLUSION: A single bout of aerobic exercise reduced 24h ambulatory blood pressure levels in long-term-treated hypertensive patients and increased the percentage of patients reaching normal...
Subject(s)
Female , Humans , Male , Middle Aged , Exercise/physiology , Hypertension/rehabilitation , Blood Pressure Monitoring, Ambulatory , Time FactorsABSTRACT
Após o transplante cardíaco os pacientes melhoram a qualidade de vida. Porém, freqüentemente apresentam problemas clínicos pós-operatórios, como descondicionamento físico, atrofia e fraqueza muscular e menor capacidade aeróbia máxima, decorrentes em parte da inatividade pré-operatória e de fatores como diferenca de superfície corpórea doador/receptor, denervacão do coracão, entre outros. A atividade física regular tem papel importante na terapêutica dos transplantados, devendo ser iniciada precocemente, se possível ainda na fase hospitalar, dando prosseguimento pós-alta hospitalar, para que possam retornar a um estilo de vida normal, próximo do que tinham antes da doenca, permitindo um convívio social satisfatório, com retorno a uma vida ativa e produtiva.