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1.
An. sist. sanit. Navar ; 46(3)sept. - dic. 2023. tab, ilus
Article in Spanish | IBECS | ID: ibc-230026

ABSTRACT

Fundamento. El objetivo de este estudio es analizar los efectos de un programa de rehabilitación cardiaca (PRC) extrahospitalario en un centro municipal deportivo sobre la capacidad funcional y la adherencia al ejercicio físico, entre otras variables, en comparación con un modelo hospitalario. Métodos. Ensayo clínico aleatorizado con dos grupos paralelos de pacientes con síndrome coronario agudo que realizaron un PRC con ejercicio físico moderado interválico coordinado con educación en hábitos saludables en un centro deportivo municipal (GE) y en un hospital terciario (GC), entre septiembre de 2019 y junio de 2020. Se analizaron variables de adherencia, antropométricas, clínicas, psicológicas, de fuerza, de prevención secundaria (dieta, tabaco) y capacidad funcional en la prueba de ergoespirometría. Resultados. Veintidós pacientes completaron el PRC (GC=10, GE=12). Se observaron mejoras significativas pre-post en GC (colesterol, test de la silla, frecuencia cardiaca en VT1 y VT2, y vatios en VT1) y en GE (colesterol HDL, triglicéridos, test de la silla, y frecuencia cardiaca y vatios en VT1). Estas mejoras fueron mayores en el GC para la frecuencia cardiaca en VT2 (11,17 vs 2,88 lpm) y en el GE para el colesterol HDL (11,0 vs 0,63 mg/dL). Conclusiones. Este estudio no ha podido determinar la eficacia de los PRC extrahospitalarios por falta de potencia (abundantes abandonos debidos al confinamiento por COVID-19). A pesar de ello, en el GE se observó mayor aumento en colesterol HDL que en el GC, aunque la frecuencia cardiaca en VT2 fue mayor en el GC (AU)


Background. This study aimed to analyze the effects of an outpa-tient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical activity – among other variables – compared to an in-hospital program.Methods. Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a car-diac rehabilitation program that consisted of moderate physical ex-ercise intervals along with learning healthy habits in a municipal sports center (EG) and in a tertiary hospital (CG) between Septem-ber 2019 and June 2020. We collected the following data: compli-ance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirom-etry. Results. Twenty-two patients completed the cardiac rehabilitation program (EG=12, CG=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the CG, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the EG. Better achievement was found in the CG for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL).Conclusions. We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). How-ever, the EG achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the CG (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Exercise Therapy/methods , Cardiac Rehabilitation/methods , Acute Coronary Syndrome/rehabilitation , Health Education , Treatment Outcome
2.
An Sist Sanit Navar ; 46(3)2023 11 24.
Article in English | MEDLINE | ID: mdl-37997791

ABSTRACT

BACKGROUND: This study aimed to analyze the effects of an outpatient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical exercise - among other variables - compared to an in-hospital program. METHODS: Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a cardiac rehabilitation program that consisted of moderate physical exercise intervals along with learning healthy habits in a municipal sports center (experimental group) and in a tertiary hospital (control group) between September 2019 and June 2020. We collected the following data: compliance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirometry. RESULTS: Twenty-two patients completed the cardiac rehabilitation program (experimental group=12, control group=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the control group, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the experimental group. Better achievement was found in the control group for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL). CONCLUSIONS: We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). However, the experimented group achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the control group.


Subject(s)
Cardiac Rehabilitation , Sports , Humans , Exercise , Exercise Therapy , Cholesterol , Hospitals
3.
Rev Esp Cardiol ; 59(7): 737-9, 2006 Jul.
Article in Spanish | MEDLINE | ID: mdl-16938217

ABSTRACT

Prostacyclin improves symptoms, exercise tolerance, and survival in patients with pulmonary arterial hypertension. However, the difficulty of administration (whether intravenous, subcutaneous, or by inhalation) often causes side effects that can reduce the patient's quality of life and which may sometimes be serious. Bosentan, an orally active endothelin receptor antagonist, improves functional class and exercise tolerance in these patients. We describe the successful transition from prostacyclin to bosentan in five patients with severe pulmonary arterial hypertension who suffered serious side effects with prostacyclin treatment.


Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension, Pulmonary/drug therapy , Sulfonamides/therapeutic use , Adult , Bosentan , Epoprostenol/therapeutic use , Female , Humans , Male , Middle Aged , Severity of Illness Index
4.
Rev. esp. cardiol. (Ed. impr.) ; 59(7): 737-739, jul. 2006. tab
Article in Es | IBECS | ID: ibc-048575

ABSTRACT

La prostaciclina mejora los síntomas, la capacidad de ejercicio y la supervivencia en los pacientes con hipertensión arterial pulmonar. Sin embargo, sus complejas vías de administración (intravenosa, inhalada, subcutánea) ocasionan frecuentes efectos adversos que disminuyen la calidad de vida y pueden ser graves. Bosentán, un antagonista oral de los receptores de la endotelina, mejora la clase funcional y la capacidad de ejercicio en estos pacientes. Describimos la transición de prostaciclina a bosentán en 5 pacientes con hipertensión arterial pulmonar severa e importantes complicaciones secundarias al tratamiento con prostaciclina


Prostacyclin improves symptoms, exercise tolerance, and survival in patients with pulmonary arterial hypertension. However, the difficulty of administration (whether intravenous, subcutaneous, or by inhalation) often causes side effects that can reduce the patient's quality of life and which may sometimes be serious. Bosentan, an orally active endothelin receptor antagonist, improves functional class and exercise tolerance in these patients. We describe the successful transition from prostacyclin to bosentan in five patients with severe pulmonary arterial hypertension who suffered serious side effects with prostacyclin treatment


Subject(s)
Adult , Middle Aged , Humans , Antihypertensive Agents/therapeutic use , Receptors, Endothelin/therapeutic use , Hypertension, Pulmonary/drug therapy , Epoprostenol/therapeutic use , Treatment Outcome , Follow-Up Studies , Severity of Illness Index
5.
Med Clin (Barc) ; 125(18): 685-8, 2005 Nov 19.
Article in Spanish | MEDLINE | ID: mdl-16324479

ABSTRACT

BACKGROUND AND OBJECTIVE: Toxic oil syndrome is a risk factor for pulmonary arterial hypertension (PAH) and new cases of this entity are emerging after more than 20 years since the initial toxic oil epidemic. Abnormal elevation of pulmonary systolic pressure with exercise may be considered an early marker of PAH in populations at risk. We aimed to analyze the pulmonary systolic pressure with exercise echocardiography in toxic oil syndrome patients. PATIENTS AND METHOD: 50 toxic oil syndrome patients (cases), and 20 healthy control subjects were submitted to rest and peak exercise echocardiography (semi supine cycloergometer) measuring pulmonary systolic pressure. In toxic oil syndrome patients, pulmonary carbon monoxide diffusion capacity was also analyzed. RESULTS: Peak exercise pulmonary systolic pressure was statistically similar in cases and controls. Nevertheless, 8% of cases reached a pulmonary systolic pressure > or = 80 mmHg and this fact was associated with mild pulmonary arterial hypertension, reduced right ventricular function and abnormal pulmonary diffusion capacity in the rest study. A rest pulmonary systolic pressure cut-off value > or = 27 mmHg had a 100% sensitivity and 71% specificity to predict a peak exercise systolic pulmonary pressure > or = 80 mmHg. CONCLUSIONS: A minority of toxic oil syndrome patients develop severe pulmonary arterial hypertension during exercise. This abnormal response is associated with other markers of pulmonary vasculopathy. Further studies are needed to elucidate the relation between these findings and the likelihood to develop pulmonary arterial hypertension in the future.


Subject(s)
Brassica , Exercise/physiology , Foodborne Diseases/physiopathology , Hypertension, Pulmonary/etiology , Plant Oils/poisoning , Adult , Echocardiography, Stress , Fatty Acids, Monounsaturated , Female , Humans , Male , Middle Aged , Rapeseed Oil
6.
Med. clín (Ed. impr.) ; 125(18): 685-688, nov. 2005. tab, graf
Article in Es | IBECS | ID: ibc-041079

ABSTRACT

Fundamento y objetivo: Los pacientes con síndrome del aceite tóxico son una población de riesgo de padecer hipertensión arterial pulmonar. La elevación anómala de la presión sistólica pulmonar (PSP) durante el ejercicio podría considerarse un marcador temprano de hipertensión pulmonar en poblaciones de riesgo. El objetivo del presente estudio ha sido analizar mediante ecocardiografía la respuesta de la PSP al ejercicio en pacientes con síndrome del aceite tóxico. Pacientes y método: Se estudió a 50 pacientes con síndrome del aceite tóxico y a 20 voluntarios sanos con ecocardiograma en reposo y en el máximo ejercicio (cicloergómetro semisupino) y se midió la PSP. En los pacientes se determinó la capacidad de difusión de monóxido de carbono. Resultados: No se observaron diferencias en el valor medio de la PSP en el ejercicio entre los pacientes y los voluntarios sanos. En un 8% de los primeros se observó un valor igual o superior a 80 mmHg, lo que se asoció a hipertensión pulmonar leve en reposo, disminución de la función ventricular derecha y trastornos de la difusión pulmonar. Un valor de corte de la PSP en reposo igual o superior a 27 mmHg tuvo una sensibilidad del 100% y una especificidad del 71% para predecir una PSP pico de 80 mmHg o superior. Conclusiones: Una minoría de pacientes con síndrome del aceite tóxico muestra hipertensión pulmonar grave con el ejercicio. Este tipo de respuesta anormal se asocia a otros marcadores de vasculopatía pulmonar. Futuros estudios han de esclarecer la relación entre estas anomalías y el riesgo de desarrollar ulteriormente hipertensión arterial pulmonar


Background and objective: Toxic oil syndrome is a risk factor for pulmonary arterial hypertension (PAH) and new cases of this entity are emerging after more than 20 years since the initial toxic oil epidemic. Abnormal elevation of pulmonary systolic pressure with exercise may be considered an early marker of PAH in populations at risk. We aimed to analyze the pulmonary systolic pressure with exercise echocardiography in toxic oil syndrome patients. Patients and method: 50 toxic oil syndrome patients (cases), and 20 healthy control subjects were submitted to rest and peak exercise echocardiography (semi supine cicloergometer) measuring pulmonary systolic pressure. In toxic oil syndrome patients, pulmonary carbon monoxide diffusion capacity was also analyzed. Results: Peak exercise pulmonary systolic pressure was statistically similar in cases and controls. Nevertheless, 8% of cases reached a pulmonary systolic pressure >= 80 mmHg and this fact was associated with mild pulmonary arterial hypertension, reduced right ventricular function and abnormal pulmonary diffusion capacity in the rest study. A rest pulmonary systolic pressure cut-off value >= 27 mmHg had a 100% sensitivity and 71% specificity to predict a peak exercise systolic pulmonary pressure >= 80 mmHg. Conclusions: A minority of toxic oil syndrome patients develop severe pulmonary arterial hypertension during exercise. This abnormal response is associated with other markers of pulmonary vasculopathy. Further studies are needed to elucidate the relation between these findings and the likelihood to develop pulmonary arterial hypertension in the future


Subject(s)
Male , Female , Humans , Hypertension, Pulmonary/physiopathology , Physical Exertion , Foodborne Diseases/physiopathology , Case-Control Studies , Brassica rapa/toxicity , Foodborne Diseases/complications , Oils/toxicity , Echocardiography , Exercise Test
7.
Rev Esp Cardiol ; 57(10): 946-51, 2004 Oct.
Article in Spanish | MEDLINE | ID: mdl-15469792

ABSTRACT

INTRODUCTION AND OBJECTIVE: Prostacyclin therapy is an effective treatment for severe pulmonary hypertension. Sildenafil, a selective phosphodiesterase type 5 inhibitor, induces selective vasodilatation of the pulmonary vessels. A synergistic effect has been described for these two drugs. The aim of this study was to evaluate the efficacy and safety of sildenafil as rescue therapy in patients with severe pulmonary hypertension on chronic treatment with prostacyclin whose clinical or functional course was unsatisfactory. PATIENTS AND METHOD: Observational study of 11 patients (7 men, 4 women, mean age 42 [8] years) diagnosed as having severe idiopathic pulmonary hypertension, who were receiving chronic prostacyclin therapy. Sildenafil was started after a worsening of their clinical or functional status. Baseline, 3-month and 12-month follow-up evaluations were based on functional status (NYHA functional class and 6-minute walking test), the presence of decompensated right heart failure and echocardiogram. RESULTS: Seven of the 11 patients showed significant improvements in exercise capacity (distance walked in 6 minutes) at 3 (+25 m) and 12 months' follow-up (+36 m). Improvements in functional class were seen, and heart failure disappeared. No significant adverse effects of sildenafil were detected. The echocardiographic parameters showed a significant reduction in right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. One patient died after 4 months of follow-up from sudden cardiac death. CONCLUSIONS: The addition of oral sildenafil to chronic prostacyclin treatment in patients with severe pulmonary hypertension improved functional capacity and reduced episodes of decompensated right heart failure, with good tolerance and no significant adverse effects.


Subject(s)
Antihypertensive Agents/administration & dosage , Epoprostenol/administration & dosage , Hypertension, Pulmonary/drug therapy , Phosphodiesterase Inhibitors/administration & dosage , Piperazines/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Oral , Adult , Data Interpretation, Statistical , Drug Therapy, Combination , Echocardiography , Female , Follow-Up Studies , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/physiopathology , Male , Middle Aged , Piperazines/adverse effects , Purines , Safety , Sildenafil Citrate , Sulfones , Time Factors , Treatment Outcome , Vasodilator Agents/adverse effects
8.
Rev Esp Cardiol ; 56(3): 230-5, 2003 Mar.
Article in Spanish | MEDLINE | ID: mdl-12622952

ABSTRACT

INTRODUCTION: Primary pulmonary hypertension and its associated forms is a progressive and often fatal disease, the course of which has been favourably modified by prostacyclin therapy in the last decade. OBJECTIVE: The aim of this study is to analize retrospectively the efficacy of continuous intravenous epoprostenol (synthetic prostacyclin) therapy in pulmonary arterial hypertension, and to compare it with conventional therapy (anticoagulants, digoxin and diuretics). METHODS: Between 1990-2000, 31 patients with severe precapillary pulmonary hypertension in functional class III or IV went on continuous intravenous epoprostenol therapy, administered by a portable infusion pump through a Hickman catheter. We compared their survival with a group of 16 patients treated with conventional therapy alone. RESULTS: Time of follow-up was 33.25 months in the prostacyclin group and 20 months in the conventional group. The one- three- and five- year survival rates were 86%, 50% and 38% respectively for patients treated with epoprostenol compared with 40%, 40% and 8% survival rates at idetical periods for patients treated conventionally (p = 0,02). Functional class and the mean distance walked in the 6 minutes test were improved in patients treated with prostacyclin (p < 0,01). Serious complications attributable to the delivery system included 3 deaths, mainly due to infection. CONCLUSION: Continuous intravenous epoprostenol therapy improves survival and exercise capacity in patients with severe pulmonary arterial hypertension despite potentially serious complications attributable to the delivery system.


Subject(s)
Antihypertensive Agents/therapeutic use , Epoprostenol/therapeutic use , Hypertension, Pulmonary/drug therapy , Adult , Female , Humans , Hypertension, Pulmonary/mortality , Infusions, Intravenous , Male , Prostaglandins A/therapeutic use , Retrospective Studies
9.
Rev. esp. cardiol. (Ed. impr.) ; 56(3): 230-235, mar. 2003.
Article in Es | IBECS | ID: ibc-19632

ABSTRACT

Introducción. La hipertensión pulmonar (HTP) primaria y sus formas asociadas tienen un curso habitualmente progresivo y fatal, modificado en la última década por el tratamiento con prostaciclina. Objetivo. Analizar retrospectivamente la eficacia del tratamiento con epoprostenol (prostaciclina sintética) en perfusión intravenosa continua en HTP primaria y sus formas asociadas, comparándola con tratamiento convencional (anticoagulación, digoxina y diuréticos).Métodos. Entre 1990 y 2000, 31 pacientes con HTP arterial grave en clase funcional (CF) III/IV de la NYHA recibieron tratamiento con epoprostenol en perfusión intravenosa continua a través de catéter tipo Hickman y bomba de perfusión portátil. Se compara su supervivencia con un grupo de 16 pacientes tratados convencionalmente. Resultados. El tiempo de seguimiento en el grupo de prostaciclina fue de 33,25 meses y en el de tratamiento convencional 20 meses. La supervivencia a 1,3 y 5 años fue del 86, 50 y 38 por ciento, respectivamente, en los pacientes tratados con epoprostenol, del 40 por ciento al año y 3 años y del 8 por ciento a los 5 años en los pacientes tratados convencionalmente (p = 0,02). Se observó una mejora en la CF y en la distancia recorrida en el test de 6 min en los pacientes tratados con epoprostenol (p < 0,01). El sistema de infusión fue un problema grave y causó 3 muertes fundamentalmente por infección. Conclusión. El epoprostenol en perfusión intravenosa continua mejora la supervivencia y la capacidad funcional en los pacientes con HTP arterial, a pesar de las complicaciones graves relacionadas con el sistema de infusión (AU)


Subject(s)
Adult , Male , Female , Humans , Prostaglandins A , Epoprostenol , Retrospective Studies , Antihypertensive Agents , Hypertension, Pulmonary , Infusions, Intravenous
10.
Rev. esp. cardiol. (Ed. impr.) ; 54(2): 194-210, feb. 2001.
Article in Es | IBECS | ID: ibc-2044

ABSTRACT

La hipertensión pulmonar primaria es una enfermedad de carácter progresivo, más frecuente en mujeres jóvenes y de mediana edad. Su etiología se desconoce, aunque existe una predisposición familiar hasta en un 6 por ciento de los casos. Las teorías patogénicas actuales se centran en la existencia de disfunción endotelial y fallos en los canales iónicos de las fibras musculares lisas del vaso. Las pruebas diagnósticas se dirigen a descartar las causas secundarias y a evaluar la gravedad de la enfermedad. El test vasodilatador agudo es imprescindible para la elección del tratamiento más adecuado. La anticoagulación oral está indicada en todos los pacientes. El trasplante de pulmón queda reservado a aquellos casos en los que fracasa el tratamiento médico. La septostomía auricular es un procedimiento paliativo útil en casos seleccionados. La hipertensión pulmonar tromboembólica crónica es una forma especial de hipertensión pulmonar secundaria; aunque indistinguible clínicamente de la hipertensión pulmonar primaria, su diagnóstico resulta crucial, ya que es posible su curación mediante la realización de tromboendarterectomía pulmonar. El tromboembolismo pulmonar es frecuente en pacientes hospitalizados, presentando elevadas tasas de mortalidad (el 30 por ciento en pacientes no tratados). El diagnóstico es difícil, ya que puede acompañar o simular otras enfermedades cardiopulmonares. Las pruebas diagnósticas no invasivas tienen una baja sensibilidad y especificidad. Nuevas alternativas como la determinación de dímero D o la TAC helicoidal incrementan la precisión diagnóstica. El tratamiento estándar consiste en la administración de heparina durante 5-10 días y posteriormente anticoagulantes orales durante 3-6 meses. La prevención con heparinas o dextranos en los pacientes de alto riesgo ha demostrado claros beneficios (AU)


Subject(s)
Humans , Thromboembolism , Hypertension, Pulmonary , Prognosis , Algorithms
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