Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification ≥II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF<0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF.

Efeito do ultra-som e do d-pantenol na regeneracao tegumentar / Effect of ultrasound and dexpanthenol on wound healing

Estudar os efeitos dos tratamentos com ultra-som (US) e d-pantenol (d-p) na reparacao tegumentar em ratos por meio de analise histoetrica e histopatologica. Metodo: foram utilizados 50 ratos wistar, anestesiados por Thionembutal sodico (50 mg/kg), dos quais foi retirado 1cm2 de pele na rehiao dorsal, sendo que 25 foram submetidos a tratamento diario por 7 dias e 25 por 14 dias. Os grupos experimentais (n=5) foram: controle (C), gel (G), US (3MHz, 0,1 W/cm2, 1 minuto, modo continuo), d-p na concentracao de (10 por cento) e US+d-p. seccoes de 6 um de espessura da lesao foram procesados para coloracao em Hematoxilina-Eosina. A re-epitelizacao e o numero de fibroblastos e leucocitos foram obtidos num processador de imagens (Software Imagem Pro-Plus) e analisados pelo teste ANOVA, seguido de Tukey para comparacao da medias. Resultados: a re-epitelizacao dos grupos US(1869,6+-238,4 um) e US+d-p(2167,7+-232 um) foi maior (p<-0,05) em relacao ao C(987,7+-146,8 um), mas nao diferiram entre si. O numero de fibroblastos no grupo US (419+-37) com sete dias de tratamento foi significativamente maior em relacao aos demais grupos: (C:250+-17), (d-p:296+-49) e (US+d-p:274+-18). No grupo US, tratado por sete dias, a media de leucocitos (134+-15) foi menor (p<-0,05) em relacao ao C (253+-37), d-p (222+-29) e US+d-p (153+-14), evidenciando seu efeito na fase inicial do processo inflamatorio. Conclusoes: o US acelera o processo de reparo, bem como associado ao d-p. Porem, essa associacao dos tratamentos, US+d-p, n'ao mostrou resultados significativos em relacao ao tratamento com US isolado