ABSTRACT
Fundamentos: Estudos observacionais sugerem que exercício físico possui efeito anti-inflamatório, no entanto essa hipótese não está definitivamente confirmada por ensaios clínicos randomizados.Objetivo: Verificar o efeito da atividade física aeróbica sobre o processo inflamatório sistêmico em indivíduos com risco cardiovascular. Métodos: Ensaio clínico randomizado, em que foram incluídos indivíduos sedentários, com pelo menos dois fatores de risco para doença coronariana ou doença cardiovascular estabelecida. Os voluntários foram randomizados para três meses de treinamento aeróbico supervisionado (grupo-treino) ou apenas aconselhamento quando a hábitos de vida saudáveis (grupo-controle). Proteína C-reativa (PCR) foi mensurada por método de alta sensibilidade antes e após a intervenção. Resultados: Avaliados 68 indivíduos. Os grupos treino e controle apresentaram características basais semelhantes. Houve melhora da capacidade funcional apenas nos pacientes do grupo-treino. Observou-se aumento de PCR após três meses no grupo-controle, cuja mediana evoluiu de 2,2 mg/L (IIQ =1,0 mg/L - 4,3 mg/L)para 3,2 mg/L (IIQ =2,4 mg/L - 5,5 mg/L), p=0,006.Esse fenômeno não foi observado no grupo-treino,que apresentou mediana basal de 1,7 mg/L(IIQ =0,97 mg/ L - 4,8 mg/L), estatisticamente semelhante ao valor final de 2,5 mg/L (1,0 mg/L - 4,7 mg/L), p=0,46.Quando a variação percentual da PCR foi comparada entre os grupos, houve maior incremento no grupo controle(+58,0 %; IIQ =11,0 % - 151,0 %), comparado ao grupo-treino (+17,0 %; IIQ =-36,0 % - 79,0 %),p intergrupo=0,046.
Background: Although observational studies suggest that exercise has anti-inflammatory effects, this possibility has not been confirmed definitively through randomized clinical trials. Objective: To assess the effects of aerobic activities on systemic inflammatory processes among people at cardiovascular risk. Methods: A randomized clinical trial encompassing sedentary subjects with at least two risk factors for heart disease or established cardiovascular disease. These volunteers were assigned randomly to three months of supervised aerobic training (training group) or just counseling on healthy lifestyle habits (control group). C-reactive protein (CRP) was measured by a highly sensitive method before and after these interventions. Results: Assessing 68 subjects. The training and control groups had similar baseline characteristics. There was improvement in functional capacity among only the training group patients. After three months, an increase in the CRP was noted in the control group, whose median rose from 2.2mg/L(IQR=1.0 to 4.3mg/L) to 3.2mg/L (IQR=2.4 to5.5mg/L) - p=0.006. This phenomenon was not found in the training group, which presented a baseline median of 1.7mg/L (IQR =0.97 to 4.8mg/L),statistically similar to the final value of 2.5mg/L(1.0 to 4.7mg/L) - p=0.46. When the percentage variation in the CRP was compared for these groups, there was a greater increase in the control group (+58%, IQR=11% to 151%), compared to the training group (+17%, IQR= -36% to 79%) - intergroupp=0.046.
Subject(s)
Humans , Female , Middle Aged , Cardiovascular Diseases/epidemiology , Exercise/physiology , Physical and Rehabilitation Medicine/education , C-Reactive Protein/chemistry , Randomized Controlled Trials as Topic/methods , Prevalence , Exercise TestABSTRACT
Introducción y objetivos. La enfermedad de Chagas es una causa frecuente de insuficiencia cardiaca en Latinoamérica, y su pronóstico es peor que el de otras etiologías. La puntuación de supervivencia en la insuficiencia cardiaca (Heart Failure Survival Score) se ha utilizado para evaluar el pronóstico de los pacientes con insuficiencia cardiaca; sin embargo, dicha puntuación no se ha evaluado todavía en pacientes con cardiopatía chagásica. Métodos. Se calculó la puntuación Heart Failure Survival Score en 55 pacientes con disfunción sistólica ventricular izquierda grave debida a enfermedad de Chagas. Se evaluaron las correlaciones entre la Heart Failure Survival Score y las variables derivadas de las ecocardiografías, las pruebas de esfuerzo cardiorrespiratorias, las medidas de la calidad de vida y las pruebas de distancia recorrida en 6 min. Resultados. Se distribuyó a los pacientes según las clases II-IV de la New York Heart Association; un 89% recibía tratamiento con inhibidores de la enzima de conversión de la angiotensina o antagonistas de los receptores de la angiotensina II; un 62%, con bloqueadores beta; un 86%, con diuréticos y un 74%, con antagonistas de los receptores de aldosterona. La media de la puntuación Heart Failure Survival Score fue de 8,75±0,80. La puntuación mostró buena correlación con las variables derivadas de la prueba cardiorrespiratoria, como la captación de oxígeno máxima (0,662; p<0,01), la captación de oxígeno en el umbral anaeróbico (0,644; p<0,01), la pendiente de eficiencia ventilatoria de dióxido de carbono (-0,417; p<0,01), el pulso de oxígeno (0,375; p<0,01), la pendiente de eficiencia de captación de oxígeno (0,626; p<0,01), la prueba de distancia recorrida en 6 min (0,370; p<0,01), la fracción de eyección ventricular izquierda (0,650; p=0,01) y el diámetro de la aurícula izquierda (-0,377; p<0,01). Se observó también una correlación en el límite de la significación estadística entre la puntuación Heart Failure Survival Score y la calidad de vida (-0,283; p<0,05). Conclusiones. En pacientes con enfermedad de Chagas que presentaban insuficiencia cardiaca, la puntuación Heart Failure Survival Score mostró buena correlación con las principales variables de las pruebas funcionales pronósticas (AU)
Introduction and objectives. Chagas disease is a prevalent cause of heart failure in Latin America, and its prognosis is worse than other etiologies. The Heart Failure Survival Score has been used to assess prognosis in patients with heart failure; however, this score has not yet been studied in patients with Chagas cardiopathy. Methods. The Heart Failure Survival Score was calculated in 55 patients with severe left ventricular systolic dysfunction due to Chagas disease. Correlations were assessed between the Heart Failure Survival Score and variables obtained from echocardiograms, cardiopulmonary exercise tests, quality-of-life measures, and 6-minute walking tests. Results. Patients were distributed among New York Heart Association classes II-IV; 89% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 62% were taking beta-blockers, 86% were taking diuretics, and 74% were taking aldosterone receptor blockers. The mean Heart Failure Survival Score was 8.75 (0.80). The score correlated well with cardiopulmonary test variables such as peak oxygen uptake (0.662; P<.01), oxygen uptake at the anaerobic threshold (0.644; P<.01), ventilation carbon dioxide efficiency slope (−0.417; P<.01), oxygen pulse (0.375; P<.01), oxygen uptake efficiency slope (0.626; P<.01), 6-minute walking test (0.370; P<.01), left ventricle ejection fraction (0.650; P=.01), and left atrium diameter (−0.377; P<.01). There was also a borderline significant correlation between the Heart Failure Survival Score and quality of life (−0.283; P<.05). Conclusions. In heart failure patients with Chagas disease, the Heart Failure Survival Score correlated well with the main prognostic functional test variables (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , /complications , /diagnosis , Chagas Disease/complications , Heart Failure/complications , Heart Failure/diagnosis , Prognosis , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Quality of LifeABSTRACT
INTRODUCTION AND OBJECTIVES: Chagas disease is a prevalent cause of heart failure in Latin America, and its prognosis is worse than other etiologies. The Heart Failure Survival Score has been used to assess prognosis in patients with heart failure; however, this score has not yet been studied in patients with Chagas cardiopathy. METHODS: The Heart Failure Survival Score was calculated in 55 patients with severe left ventricular systolic dysfunction due to Chagas disease. Correlations were assessed between the Heart Failure Survival Score and variables obtained from, cardiopulmonary exercise tests, quality-of-life measures, and 6-minute walking tests. RESULTS: Patients were distributed among New York Heart Association classes II-IV; 89% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 62% were taking beta-blockers, 86% were taking diuretics, and 74% were taking aldosterone receptor blockers. The mean Heart Failure Survival Score was 8.75 (0.80). The score correlated well with cardiopulmonary test variables such as peak oxygen uptake (0.662; P<.01), oxygen uptake at the anaerobic threshold (0.644; P<.01), ventilation carbon dioxide efficiency slope (-0.417; P<.01), oxygen pulse (0.375; P<.01), oxygen uptake efficiency slope (0.626; P<.01), 6-minute walking test (0.370; P<.01), left ventricle ejection fraction (0.650; P=.01), and left atrium diameter (-0.377; P<.01). There was also a borderline significant correlation between the Heart Failure Survival Score and quality of life (-0.283; P<.05). CONCLUSIONS: In heart failure patients with Chagas disease, the Heart Failure Survival Score correlated well with the main prognostic functional test variables.
Subject(s)
Chagas Cardiomyopathy/mortality , Heart Failure/mortality , Ventricular Dysfunction, Left/mortality , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Chagas Cardiomyopathy/complications , Chagas Cardiomyopathy/physiopathology , Echocardiography , Exercise Test/methods , Female , Heart Failure/drug therapy , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Male , Middle Aged , Quality of Life , Survival Analysis , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Young AdultABSTRACT
Heart failure due to Chagas cardiomyopathy (HFCC) differs from failure with other etiologies because of the occurrence of intense inflammatory infiltrate and right ventricle compromise. This article investigates correlations of B-type natriuretic peptide (BNP) levels with parameters of severity in HFCC. Twenty-eight patients and 8 normal controls underwent heart catheterization and clinical and laboratory analyses. BNP levels were higher in patients with HFCC (P<.0001) and correlated with New York Heart Association (NYHA) class; right atrial pressure; wedge pressure; cardiac output; levels of serum sodium, hemoglobin, urea, and tumor necrosis factor-alpha; and ejection fraction. Interferon-gamma and transforming growth factor-beta did not correlate with BNP level. The authors conclude that BNP levels are elevated in patients experiencing HFCC, irrespective of NYHA class, and that the occurrence of HFCC correlates with severity of disease.
