ABSTRACT
To retrieve and assess the available data in the literature about the safety and efficacy of baroreflex activation therapy (BAT) in heart failure with reduced ejection fraction (HFrEF) patients, through a rapid systematic review of clinical studies. Rapid systematic review of literature. Searched electronic databases included PubMed, EMBASE, CENTRAL, Scopus, and Web of Science using Mesh and free terms for heart failure and BAT. No language restriction was used for the searches. We included full peer reviewed publications of clinical studies (randomized or not), including patients with HFrEF undergoing BAT, with or without control group, assessing safety and efficacy outcomes. One reviewer conducted the analysis of the selected abstracts and the full-text articles, performed data extraction, and evaluated the methodological quality of the selected articles. The methodological quality was assessed according to the Cochrane Collaboration instruments. A descriptive summary of the results is provided. Of the 441 citations screened, 10 publications were included (three were only conference abstracts), reporting data from three studies. Only one study was a randomized clinical trial. Two studies reported a 6 month following, and the other study analysed outcomes up to 41 months. The procedure seems to be safe when performed by a well-trained multi-professional team. An 86% rate of system and procedure-related complication-free was reported, with no cranial nerve injuries. Improvements in New York Heart Association class of heart failure, quality of life, 6 min walk test, and hospitalization rates, as well as in muscle sympathetic nerve activity. No meta-analysis was conducted because of the lack of homogeneity across studies; the results from each study are reported individually. BAT procedure seems to be safe if appropriate training is provided. Improvements in clinical outcomes were described in all included studies. However, several limitations do not allow us to make conclusive statements on the efficacy of BAT for HFrEF. New well-designed trials are still needed.
Subject(s)
Baroreflex , Electric Stimulation Therapy , Heart Failure , Heart Failure/therapy , Humans , Quality of Life , Randomized Controlled Trials as Topic , Stroke VolumeABSTRACT
The organophosphate, diisopropyl fluorophosphate (DFP), may impair cardiovascular, autonomic and immune function while exercise training is thougt to be restorative. Experiments determined effects of wheel exercise in C57B1 male mice, testing cardiovascular and autonomic function and characterization of the immunological profile. Sedentary (S) and exercise (ET) groups were treated with corticosterone (CORT) followed by injection of DFP. This model was associated with systolic and diastolic dysfunction in the S group, measured using echocardiography (ECHO). Chronic exercise ameliorated the cardiac deficit. Autonomic balance, accessed by heart rate variability (HRV), showed increased sympathetic and decreased parasympathetic modulation in S group. Autonomic balance in ET mice was not affected by DFP. Our DFP model resulted in mild neuroinflammation seen by increased IL5, IL12 and MIP2 in brain and plasma IL6 and IL1a. DFP had a negative impact on cardiac/autonomic function and inflammatory markers, effects reduced by exercise. Data suggest a beneficial effect of exercise training on the cardiovascular and autonomic responses to DFP/CORT.
ABSTRACT
Este estudo visou avaliar o efeito do repouso e do exercício, realizados no solo e na água, sobre a frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólica (PAD) e o volume de diurese em indivíduos hipertensos e normotensos. Foram analisados 20 indivíduos divididos em dois grupos, normotensos (GN, n=8) e hipertensos (GH, n=12). Em ambos foram realizados quatro protocolos distintos, dois de exercícios e dois de repouso, no solo e na água. A PAS, PAD e FC foram mensuradas durante repouso e aos 30, 60 e 90 minutos após cada protocolo. O volume de diurese foi corrigido pelo peso corporal e coletado 30 minutos após cada protocolo. No GH, o protocolo de exercício no solo promoveu redução média de 16,5±3,7 mmHg (p=0,01) da PAS aos 90 minutos pós-exercício. No GN, o protocolo de repouso na água promoveu redução média de 14 bpm (p<0,01) da FC e o volume de diurese foi maior quando comparado aos protocolos realizados no solo (p<0,01). Portanto, a imersão desencadeou bradicardia e aumento do volume de diurese no GN. Não houve efeito hipotensor significativo nos protocolos realizados na água em ambos os grupos. Os resultados sugerem que uma sessão de exercício físico no solo com duração de 45 minutos, em intensidade submáxima, provoca redução da PAS em indivíduos hipertensos.
The aim of this study was to assess the effect of rest and exercise, accomplished on the ground or in water on the heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the volume of diuresis in hypertensive and normotensive individuals. Twenty individuals were analyzed and divided into two groups, normotensive (GN, n=8) and hypertensive (GH, n=12). Both groups accomplished four distinct protocols, two protocols of exercise and two protocols of rest on the ground and in the water. The SBP, DBP and HR were measured at rest and at 30, 60 and 90 minutes after each protocol. The volume of diuresis was corrected for the body weight and collected 30 minutes after each protocol. In the GH, the exercise protocol on the ground caused an average reduction of 16.5±3.7 mmHg (p=0.01) in SBP at 90 minutes post-exercise. In the GN, the protocol of rest in the water caused an average reduction of 14 bpm (p<0.01) in HR and the volume of diuresis was increased when compared with the protocols accomplished on the ground (p<0.01). Therefore, the immersion triggered bradycardia and increase in volume of diuresis in the normotensive group. There was no significant hypotensive effect in the protocols performed in water in both groups. The results suggest that an exercise session on the ground during 45 minutes in submaximal intensity causes a reduction in SBP in hypertensive subjects.
Subject(s)
Humans , Male , Female , Aged , Bed Rest , Cardiovascular Diseases/rehabilitation , Exercise Therapy , Hydrotherapy , Hypertension , Prospective StudiesABSTRACT
Esta pesquisa teve como objeto de estudo os soldados recrutas que ingressaram no serviço militar em março de 1999, no 29§ Grupo de Artilharia de Campanha da cidade de Cruz Alta. A amostra foi de 20 soldados subdivididos em grupo experimental (G1) e controle (G2). Foram realizadas 3 avaliaçöes, das variáveis espirométricas e da força muscular respiratória. A 1ª no início das atividades do Treinamento Físico Militar (TFM); a 2ª passado 4 meses da avaliaçäo inicial, após o término do Treinamento Muscular Respiratório (TMR) do G1, e a 3ª após 4 meses desta última (período que ambos os grupos receberam somente TFM). O G2, em todas as fases, recebeu somente TFM. O TMR do G1 foi realizado por meio do manovacuômetro, num período de 2 meses com frequência de 3 vezes por semana, totalizando 24 sessöes, com um período de duraçäo de 40 minutos cada sessäo. O objetivo deste estudo foi verificar as alteraçöes ocorridas nas variáveis espirométricas e na força muscular respiratória em soldados submetidos ao treinamento e destreinamento da musculatura respiratória e/ou TFM. Por meio da análise de variância (ANOVA), observou-se que näo ocorreram alteraçöes estatísticas significativas nas variáveis espirométricas e, por meio do Teste t de Student, obteve-se alteraçöes da força muscular respiratória após o TMR e a força manteve-se após o período de destreinamento.
