Strain Magnitude Assessed at Rest and During Stress Echocardiography in Patients with Normal Coronary Flow Reserve

Abstract Background Coronary flow and myocardial contractile performance assessed by strain magnitude increase during a dobutamine stress echocardiogram (DSE). Normal coronary flow reserve (CFR) can be attained upon completion of a DSE at age-predicted maximum heart rate (HR) (HRmax = 220 - age)] or submaximal HR [(0.85) HRmax] or before completion (early CFR). Objective To ascertain the association between delta strain and HR in patients with early normal CFR. Methods This prospective study included patients whose normal CFR was obtained before the DSE was completed. Percentage of resting HR (%HRrest) = [(HRrest ÷ HRmax) 100]% and %HR CFR = [(HR at the time of CFR attainment) ÷ (HRmax) 100]% were recorded. Strain was assessed in the left ventricular region of interest, and delta strain was calculated as the difference between the measures obtained at HRrest and after the DSE was completed. Strain agreement analysis for HRrest, %HRrest, and %HR CFR was performed using the kappa coefficient. The Shapiro-Wilk test was used to assess data normality, and the Mann-Whitney test was used to compare the groups. A p-value < 0.05 was considered statistically significant. Results Strain measured -23.3% ± 4.3% at baseline and -31.1% ± 4.9% during the DSE. In delta strain > 8 absolute points, the ROC curves showed an area under the curve of 0.874 ± 0.07 for %HRrest (p = 0.001) and an area under the curve of 0.862 ± 0.07 for %HR CFR (p = 0.001). In delta strain > 8 points, %HRrest ≤ 42.6% of HRmax and %HR CFR ≤ 62.5% of HRmax showed an accuracy of 82.9% and 79.8%, respectively. Conclusion In this study, lower HRrest and HR at the time of CFR attainment had a good association with better myocardial contractile performance, according to the change in strain magnitude.

Comparison of the apoptotic effects of topically applied papaverine, diltiazem, and nitroprusside to internal thoracic artery

Abstract Objective: To detect and to compare the apoptotic effects of intraoperatively topically applied diltiazem, papaverine, and nitroprusside. Methods: Internal thoracic artery segments of ten patients were obtained during coronary bypass grafting surgery. Each internal thoracic artery segment was divided into four pieces and immersed into four different solutions containing separately saline (Group S), diltiazem (Group D), papaverine (Group P), and nitroprusside (Group N). Each segment was examined with both hematoxylin-eosin and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method in order to determine and quantify apoptosis. Results: Apoptotic cells were counted in 50 microscopic areas of each segment. No significant difference was observed among the four groups according to hematoxylin-eosin staining. However, the TUNEL method revealed a significant increase in mean apoptotic cells in the diltiazem group when compared with the other three groups (Group S=4.25±1.4; Group D=13.31±2.8; Group N=9.48±2.09; Group P=10.75±2.37). The differences between groups were significant (P=0.0001). No difference was observed between the samples of the diabetic and non-diabetic patients in any of the study groups. Conclusion: The benefit of topically applied vasodilator drugs must outweigh the potential adverse effects. In terms of apoptosis, diltiazem was found to have the most deleterious effects on internal thoracic artery graft segments. Of the analyzed medical agents, nitroprusside was found to have the least apoptotic activity, followed by papaverine. Diabetes did not have significant effect on the occurrence of apoptosis in left internal thoracic artery grafts.

Antioxidant and Vasodilatory Action of Grape Juices Produced in Different Regions of Brazil

Grapes and its derivatives (wines and juices) are rich in polyphenols that have high antioxidant and vasodilator capacity. These biological activities may vary in the juices marketed and produced in different regions of Brazil. Objectives: To determine the antioxidant and vasorelaxant effects of grape juice samples produced in different regions of Brazil. Methods: The content of phenolic compounds and antioxidant capacity were evaluated by the methods of Folin-Ciocalteau, DPPH, ABTS and a new electroanalytical approach (differential pulse voltammetry - DPV). Vasodilator effects were analyzed in isolated aorta from rats in an organ bath. Results: The samples from RJ and SP presented respectively the higher and lower phenolic content and also antioxidant capacity by the methods used (ABTS and DPPH). The results of the electrochemical index corroborate to the other tests, with the best results to RJ (21.69 ± 3.15 µA/V) and worse to the SP sample (11.30 ± 0.52 µA/V). In the vascular reactivity studies, the relaxation induced by each sample presented more distinct differences, following the order: RJ (87.9 ± 4.8%) > RS1 (71.6 ± 8.6%) > GO (56.2 ± 7.2%) > SP (39.9 ± 7.8%) > PR (39.4 ± 9.5%) > RS2 (19.5 ± 6.2%). Inhibition of endothelial NO practically abolished (p < 0.001) the relaxation for all samples, except one. Conclusion: The phenolic content and antioxidant capacity vary greatly among samples. The results obtained for the order of antioxidant activity were: RJ > RS1 > GO > RS2 > PR > SP. The juices were able to induce vascular relaxation at quite varied levels, and the RJ sample the most effective. The L-NAME practically blocked all samples except one (RS2)

Vasodilatadores: re-visión de un viejo armamento / Vasodilator agents: re-viewing an old weapon

Resumen Los agentes con propiedades vasodilatadoras son un grupo heterogéneo de fármacos que conforman parte del arsenal del cardiólogo desde hace décadas y si bien su prescripción es amplia, no suele ser óptima. El término siempre ha sido ambiguo y propenso a confusión con respecto a los fármacos que deben ser incluidos. Este artículo revisa de manera concisa el estado actual de estos fármacos, incluidos los nuevos agentes desarrollados, con insistencia en sus indicaciones terapéuticas precisas demostradas por evidencia, sus limitaciones y contraindicaciones desde una perspectiva práctica para el cardiólogo clínico. Se realizó una revisión estructurada no sistemática de la bibliografía mediante búsqueda en la base de datos PubMed con el término MeSH: agente vasodilatador. Se incluyeron artículos en español e inglés. Se redactó una revisión narrativa, orientada a una perspectiva clínica, donde se describe el papel actual de los vasodilatadores en la medicina cardiovascular contemporánea. Los vasodilatadores tienen un papel activo y determinante en la cardiología moderna y son una herramienta esencial en diversos escenarios clínicos.

Abstract Agents with vasodilatory properties are a heterogeneous group of drugs that have been part of the arsenal of the cardiologist for decades, and although their use is broad, it is not optimal. The term has always been ambiguous and prone to confusion with respect to the drugs that should be included. This paper makes a concise review of the current state of these drugs including the new agents developed, emphasizing their precise therapeutic uses demonstrated by evidence, its limitations and contraindications from a practical perspective for the clinical cardiologist. A structured, non-systematic review of the literature was performed by searching the PubMed database with the MeSH term: vasodilator agent. Articles in Spanish and English were included. A narrative review was written, oriented to a clinical perspective, which describes the current role of vasodilators in contemporary cardiovascular medicine. Vasodilators have an active and determining role in modern cardiology and are an essential tool in various clinical scenarios.

Lesão renal aguda induzida pela sepse e potenciais terapias renoprotetoras / Acute kidney injury induced by sepsis and potential renoprotective therapies

A lesão renal aguda (LRA) é uma complicação comum no paciente grave e está associada à alta mortalidade, tendo a sepse como o mais prevalente fator de risco em pacientes críticos. A LRA na sepse está envolvida com estresse oxidativo e vasoconstrição. Diversas medidas terapêuticas para minimizar os danos renais na sepse já foram investigadas, com destaque para os fármacos antioxodantes, e não se confirmaram como intervenção a ser incorporada na clínica. O objetivo desse estudo foi avaliar a resposta inflamatória sistêmica na sepse, a função renal e os efeitos renoprotetores do vasodilatador cilostazol e dos antioxidantes n-acetilcisteína (NAC) e diosmina hesperidina no modelo de sepse experimental. Foram avaliados parâmetros sistêmicos, o perfil inflamatório renal, intestinal e pulmonar (TGF- e interleucina 6-IL-6), a função renal (FR-clearance de creatinina), a geração urinária de peróxidos (PU) e a análise histopatológica dos rins. Foram utilizados ratos Wistar, machos, divididos em 5 grupos: Sham (controle); Sepse: sepse induzida pela técnica de ligadura e punção do cecon (LPC); Sepse+Cilostazol; Sepse+N-acetilcisteína (NAC) e Sepse+Diosmina. Os resultados mostraram que o grupo Sepse apresentou elevação de TGF- e IL-6 e parâmetros globais como redução da temperatura e hipotensão que caracterizaram o padrão da sepse. Os grupos sepse, tratados ou não, mostraram redução da função renal, com diminuição do fluxo urinário e elevação do parâmetro oxidante analisado, os PUs. Apenas o grupo Sepse+Diosmina demonstrou atenuar a redução da FR desencadeada pela sepse e redução dos PUs na comparação ao grupo Sepse. Todos os grupos sepse apresentaram alterações histológicas renais. O estudo confirmou a LRA por sepse, sendo que apenas o fármaco diosmina hesperidina contribuiu para a melhora da função renal e redução do estresse oxidativo.

Acute renal injury (AKI) is a common complication in critically ill patient and it is associated with high mortality, with sepsis being the most prevalent risk factor for renal failure in critically ill patients. LRA in sepsis is involved with oxidative stress and vasoconstriction. Therapeutic initiatives aimed at minimizing renal damage in sepsis were not confirmed. This study evaluated the systemic inflammatory response in sepsis, renal function and renoprotective effects of the vasodilator cilostazol and the antioxidants n-acetylcysteine (NAC) and diospenes hesperidin. Systemic parameters, the inflammatory renal, in the intestine and in the lungs profile (TGF- and interleukin 6-IL-6), renal function (RF-creatinine clearance), urinary peroxides generation (PU) and histopathological analysis of the kidneys were performed. Male Wistar rats were divided into 5 groups: Sham (control); Sepsis: sepsis induced by the technique of ligation and puncture of the cecon (LPC); Sepsis+cilostazol; Sepsis+N-acetylcysteine (NAC) and Sepsis+diosmin. The results showed that the Sepsis group presented elevation of TGF- and IL-6 and global parameters such as temperature reduction and hypotension characterizing the sepsis pattern. Sepsis groups showed reduced renal function and urinary flow and elevation on UPs. The Sepsis+Diosmina group was the only one to attenuate RF reduction and PU reduction when compared to the Sepsis group. All sepsis groups had renal histological changes. The study confirmed that sepsis induces AKI, being diosmin hesperidin the only agent to contribute to the improvement of renal function and reduction of oxidative stress.

Distorsión morfológica isquémica de la onda T en la centellografía de perfusión miocárdica con estrés vasodilatador / Ischemic T wave distortion associated with vasodilator-stress myocardial perfusion imaging

Los protocolos que utilizan vasodilatadores para inducir isquemia en la centellografía de perfusión miocárdica han demostrado una exactitud diagnóstica elevada e incidencia muy baja de complicaciones graves. Sin embargo, el significado fisiológico y valor diagnóstico de diversas alteraciones electrocardiográficas asociadas al estrés vasodilatador ha sido escasamente evaluado más allá del segmento ST. Describimos cinco pacientes que presentan distorsión morfológica de la onda T en derivaciones electrocardiográficas torácicas asociada a diversos defectos de perfusión, discutiendo los potenciales aportes de estos cambios al diagnóstico y cuantificación de la isquemia miocárdica en los estudios de imagen que utilizan estrés con vasodilatadores.

The protocols using vasodilators to induce ischemia on myocardial perfusion scintigraphy have shown a high diagnostic accuracy and a very low incidence of serious complications. However, the physiological significance and diagnostic value of various electrocardiographic changes associated with vasodilator stress has not been deeply evaluated beyond the ST-segment. Five clinical cases presenting morphological distortion of the T-wave in electrocardiographic chest leads associated with varying degrees of perfusion defects are described, discussing potential contributions of these changes to the diagnosis and quantification of myocardial ischemia in imaging studies using vasodilator stress.

Hipertensión pulmonar asociada a cardiopatías congénitas y síndrome de Eisenmenger / Pulmonary hypertension associated with congenital heart disease and Eisenmenger syndrome

La hipertensión arterial pulmonar es una complicación frecuente de las cardiopatías congénitas (CC). Es reconocido que las CC son las malformaciones más frecuentes al nacimiento con una prevalencia que va de 6 a 8 por 1,000 recién nacidos vivos. En nuestro país se calcula que cada año nacen de 12,000 a 16,000 niños con algún tipo de malformación cardiaca. En los pacientes no corregidos con cortocircuitos de izquierda a derecha el aumento de la presión pulmonar provoca incremento en las resistencias pulmonares y desencadena una disfunción endotelial y remodelación vascular, consecuencia de alteraciones en los mediadores vasoactivos que provocan vasoconstricción, inflamación, trombosis, proliferación y apoptosis celular así como fibrosis. Como consecuencia hay un incremento progresivo de las resistencias pulmonares y de la presión del ventrículo derecho. Finalmente ocurre que el flujo sanguíneo se invierte y se desarrolla el síndrome de Eisenmenger, la forma más avanzada de hipertensión arterial pulmonar consecutiva a CC. La frecuencia de hipertensión arterial pulmonar secundaria a CC ha disminuido en países desarrollados no así en países en vías de desarrollo tanto por un diagnóstico tardío como por falta de infraestructura hospitalaria o de recursos humanos para la atención de los pacientes portadores de CC. Con el advenimiento del tratamiento farmacológico para la hipertensión arterial pulmonar, se han vislumbrado nuevas oportunidades terapéuticas, siendo cada vez más cotidiano que se sumen al tratamiento intervencionista o quirúrgico en pacientes con hipertensión arterial pulmonar secundaria a CC. Se requiere conocer los factores fisiopatológicos involucrados así como llevar a cabo una cuidadosa evaluación para definir la mejor estrategia terapéutica.

Pulmonary arterial hypertension is a common complication of congenital heart disease (CHD). Congenital cardiopathies are the most frequent congenital malformations. The prevalence in our country remains unknown, based on birthrate, it is calculated that 12,000 to 16,000 infants in our country have some cardiac malformation. In patients with an uncorrected left-to-right shunt, increased pulmonary pressure leads to vascular remodeling and endothelial dysfunction secondary to an imbalance in vasoactive mediators which promotes vasoconstriction, inflammation, thrombosis, cell proliferation, impaired apotosis and fibrosis. The progressive rise in pulmonary vascular resistance and increased pressures in the right heart provocated reversal of the shunt may arise with the development of Eisenmenger' syndrome the most advanced form de Pulmonary arterial hypertension associated with congenital heart disease. The prevalence of Pulmonary arterial hypertension associated with CHD has fallen in developed countries in recent years that is not yet achieved in developing countries therefore diagnosed late as lack of hospital infrastructure and human resources for the care of patients with CHD. With the development of targeted medical treatments for pulmonary arterial hypertension, the concept of a combined medical and interventional/surgical approach for patients with Pulmonary arterial hypertension associated with CHD is a reality. We need to know the pathophysiological factors involved as well as a careful evaluation to determine the best therapeutic strategy.

Estudio cualitativo del efecto del consumo de tintura madre de Allium sativum L. en la concentración de lisozima y proteínas totales en niños menores de 6 años con infecciones respiratorias agudas (I.R.A.) en el consultorio de Hualqui, VIII Región, Chile / Qualitative study of the effect on consumption of the mother tincture of Allium sativum (garlic) in the lysozyme concentration and total protein in children under 6 years old with acute respiratory infection in the Hualqui Medic´s office, VIII Region of Chile

Sampled population was children under 6 years with acute respiratory infection and the sample were obtained from sputum. The aim was to determine the changes in the concentrations ob both, lisozyme and total protein, before and after the intervention with the garlic mother tincture. It was a pilot study quantitative and through a system of nonrandomness simple of the probabilistic a sample of 25 individuals for determining if you belong to the treatment group (mother tincture) or control (placebo). The results indicate a decrease in the concentration of lysozyme and total proteins in the treatment group between 3 to 5 days after initiated treatment, on the other hand the control group showed an increase in the measurements. Only the treatment group showed positive changes in type symptomatical of the disease. Mother Tincture of garlic is a phytotherapeutic alternative excellent for effectively combat acute respiratory infections in children.

La población muestreada fueron niños menores de 6 años con I.R.A y la muestra fue obtenida de la expectoración. El objetivo fue determinar los cambios en la concentraciones de lisozima y proteínas totales, antes y después de la intervención con la tintura madre de ajo. Fue un estudio cuantitativo experimental y a través de un sistema de aleatoriedad simple del tipo probabilístico se toma una muestra de 25 individuos para determinar si pertenecerán al grupo tratamiento (tintura madre) o control (placebo). Los resultados obtenidos indican una disminución en la concentración de lisozima y proteínas totales del grupo tratamiento entre los 3 a 5 días después de iniciado el tratamiento, en cambio el grupo control reveló un aumento en las mediciones. Solamente el grupo tratamiento evidenció cambios positivos de tipo sintomatológico de la enfermedad. La tintura madre de ajo es una excelente alternativa fitoterapeútica para el combate eficaz contra las infecciones respiratorias agudas en niños.

Interpretación de la relación presión-flujo en la hipertensión arterial pulmonar idiopática / Pressure-flow relationships interpretation in idiopathic pulmonary arterial hypertension

Objetivo: Conocer más de la relación presión arterial pulmonar media/índice cardiaco y sus perfiles en enfermos con hipertensión arterial pulmonar idiopática. Métodos: La presión arterial pulmonar media/índice cardiaco y la presión extrapolada al eje de cero flujo se obtuvo en 40 enfermos respirando aire ambiente, oxígeno 99.5% e hidralazina. Se obtuvieron dos grupos de acuerdo a criterios de "respuesta vasodilatadora aguda", respondedores (n = 20) y no respondedores (n = 20). Se analizó este criterio versus el propuesto por la Task Force de la Sociedad Europea de Cardiología en la población respondedora. Resultados: La presión arterial pulmonar media/Índice cardiaco se ubicó de forma anormal en el diagrama de presión-flujo de la cohorte total, (p < 0.01). Sin alteraciones en el intercambio gaseoso o mecánica pulmonar. Para los enfermos respondedores versus no respondedores, la pendiente fue anormal 2.2 (95%IC:1.1-3.3) vs. 5.89 (95%IC:4.69-7.11) mm Hg/L min/m² e incremento de la presión extrapolada al eje de cero flujo (38.2 ± 7.5 a 66.3 ± 7.5 mm Hg, p < 0.01). Sin diferencias con oxígeno al 99.5%. Con vasodilatador, la presión arterial pulmonar media disminuyó (52.1 ± 9.5 a 40 ± 5.5 mm Hg, p < 0.01) vs. no se modificó (96.2 ± 8.5 vs. 90 ± 7.5 mmHg, p = 0.3), pendiente 1.15 (95%IC:0.68-1.62) vs. 1.28 (95%IC:0.78-1.78) mmHg/Lmin/m², la presión extrapolada al eje de cero flujo no cambió vs. incrementó (69.4 ± 7.8 a 85.1 ± 8.5 mm Hg, p < 0.01), en relación al control. En no respondedores con vasodilatador, la presión arterial pulmonar media/índice cardiaco (90 ± 7.5 mmHg, pendiente:1.28; 95%IC: 0.78 - 1.78 mm Hg/L min/m²) fue diferente al comparar respondedores con menor o mayor de 40 mm Hg de presión arterial pulmonar media. Presiones 34 ± 3 vs. 45 ± 4 mm Hg y pendientes 1.14 (95%IC: 0.67 -1.61 vs. 2.22 (95%IC: 1.35 - 3.09 mm Hg/L min/m²), respectivamente p < 0.01. Conclusiones: Las anormalidades de la relación presión arterial pulmonar media/Índice cardiaco reflejan el incremento de las resistencias vasculares pulmonares reales a nivel arteriolar pulmonar en enfermos con hipertensión arterial pulmonar idiopática. Ambos criterios de respuesta vasodilatadora aguda son de utilidad para identificar respondedores y no, en esta población de enfermos.

Objectives: We analyze exercise-derived mean pulmonary artery pressure/cardiac index relationship to expand the concepts regarding its nature and to better identify "responders" in idiopathic pulmonary arterial hypertension patients. Methods: Mean pulmonary artery pressure/cardiac index relationship and extrapolated pressure to zero flow were obtained in 40 patients' breathing room air, oxygen 99.5% and hydralazine. The hemodynamic characteristics were analyzed for the cohort and separate for responders (n = 20) and non responders (n = 20) according to the acute response to vasodilator. We tested this previous criteria versus the Task Force on diagnosis and treatment prescribed by the European Society of Cardiology. Results: The mean pulmonary arterial pressure/cardiac index was located abnormally in the pressure-flow diagram of the total cohort (p < 0.01). No alterations in gas exchange or lung mechanics. For patients responders versus non-responders, the slope was abnormal 2.2 (95% CI:1.1-3.3) vs. 5.89 (95% CI: 4.69 - 7.11), mm Hg/L min/m² and increased extrapolated pressure to zero flow (38.2 ± 7.5 to 66.3 ± 7.5 mm Hg, p <0.01). Without difference with oxygen 99.5%. With vasodilator effect, mean pulmonary arterial pressure decreased (52.1 ± 9.5 to 40 ± 5.5 mm Hg, p <0.01) versus it did not change (96.2 ± 8.5 versus 90 ± 7.5 mm Hg, p=0.3), slope 1.15 (95% CI: 0.68 - 1.62) vs. 1.28 (95% CI: 0.78-1.78) mmHg/L min/m², the extrapolated pressure to zero flow did not change (69.4 ± 7.8 to 85.1 ± 8.5 mm Hg), p <0.01, compared to control. In non-responders with vasodilator, mean pulmonary arterial pressure/cardiac index (90 ± 7.5 mmHg, slope: 1.28, 95% CI :0.78 - 1.78 mm Hg/L min/m²) was different between responders < or > 40 mmHg mean pulmonary arterial pressure. Pressures were 34 ± 3 vs. 45 ± 4 mm Hg and slopes 1.14 (95% CI: 0.67 - 1.61) vs. 2.22(95% CI: 1.35 - 3.09) mm Hg/L min/m², p <0.01, respectively.. Conclusions: Abnormalities of the mean pulmonary arterial pressure/cardiac index relationship exercise-derived seems to reflect "mainly arteriolar" increased lineal pulmonary vascular resistance in idiopathic pulmonary arterial hypertension patients. Both acute vasodilator response criteria are useful to identify responders and not responders in this patient population.

Efeito do tratamento com benazepril e carvedilol administrado de forma isolada e em associação com treinamento físico supervisionado sobre a evolução clínica de cães com insuficiência mitral crônica naturalmente adquirida / Effect of benazepril and carvedilol treatment alone and in association with a supervised physical training in the development of naturally acquired chronic mitral valve regurgitation in dogs

INTRODUÇÃO: Pacientes com insuficiência mitral crônica apresentam aumento da atividade simpática mesmo quando assintomáticos. Contudo, pouco se sabe sobre o efeito de drogas beta bloqueadoras ou de um programa de treinamento físico supervisionado como moduladores desta atividade simpática durante a evolução da doença. O objetivo deste estudo foi avaliar o efeito do carvedilol e de um programa de treinamento físico aeróbico regular sobre a evolução da insuficiência mitral crônica num modelo da doença em cães. Além disso, objetivou-se analisar as principais variáveis que atuam como preditoras de óbito. MÉTODOS: Foram selecionados 10 cães hígidos para padronização dos parâmetros normais. Outros 36 cães com diagnóstico de insuficiência mitral crônica foram divididos em 3 subgrupos (I, II e III). Do início do estudo (T0) até os 6 meses (T2), todos receberam tratamento clínico convencional (benazepril e digoxina, codeína, diurético quando necessário), sendo que no II (n=10) e III (n=13) associou-se o carvedilol durante todo o período, e no I (n=13) e II, após os 3 meses iniciais (T1), associou-se o treinamento físico supervisionado. As principais variáveis clínicas (número de intercorrências, peso, qualidade de vida avaliada pelo questionário FETCH, freqüência e ritmo cardíacos, classe funcional de insuficiência cardíaca e pressão arterial sistólica e diastólica); laboratoriais (norepinefrina, troponina I, sódio, uréia e creatinina) e ecodopplercardiográficas foram avaliadas. RESULTADOS: Não houve diferença de sobrevida entre os 3 subgrupos. Em relação às variáveis clínicas, observou-se melhora da qualidade de vida (FETCH) nos três subgrupos: I (T0= 5,56±4,67 vs T2=2,67±3,12; p<0,05), II (T0= 11,29±5,12 vs T2= 3± 3,32; p,0,05); III (T0= 15,50±9,94 vs T1=5 ±3,21 e T0 vs T2=4,25± 2,82; p<0,05)...

INTRODUCTION: Sympathetic activation is present in patients having chronic mitral valve regurgitation even in asymptomatic ones. However, the effect of beta- blockers and a physical training program to modulate this sympathetic activation during this valve disease is unknown. The objective of this study has been to evaluate the effect of carvedilol and a physical aerobic training in the development of chronic mitral valve regurgitation in an experimental model of the disease in dogs. Moreover, the objective sought for some death predict variables in these dogs. METHODS: 10 healthy dogs were selected to evaluate the normal parameters. The other 36 chronic valve mitral regurgitation dogs were divided into 3 sub-groups (I, II e III). From the beginning of the study (T0) to 6 months (T2) all of them received the conventional treatment (Benazepril and Digoxine, codeine, diuretic when necessary). In the sub-group II (n=10) and III (n=13) the carvedilol was added to the treatment during all the study. In the sub-group I (n=13) and II, after the first 3 months (T1) the physical supervised training was added. The main clinical variables (number of interoccurrences, body weight, quality of life estimated by FETCH questionnaire, heart rate, cardiac rhythm, functional classification of heart failure, systolic and diastolic blood pressure), laboratory variables (norepinephrine, troponin I, sodium, urea, creatinine) and echodopplercardiographic variables were evaluated. RESULTS: The analyzes of the clinic variables showed an improvement in the quality of life (FETCH) in all the sub-groups: (T0= 5,56±4,67 vs T2=2,67±3,12; p<0,05), II (T0= 11,29±5,12 vs T2= 3± 3,32; p,0,05); III (T0= 15,50±9,94 vs T1=5 ±3,21 e T0 vs T2=4,25± 2,82; p<0,05). The heart rate (beats/min) results showed differences (p=0,023) in the sub-groups I (T0=139,44±22,97 vs T2=126,67±12,25), II (T0=128,57±31,32 vs T2=117,14± 25,63) and III (T0=142,50±53,39 vs T2=117,75±28,92)...