RESUMEN
INTRODUCTION: Muscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable. OBJECTIVES: In this study, we investigated the effects of cardiac resynchronization therapy (CRT) on MSNA response at rest and during exercise in patients with advanced HF. METHODS: We assessed 11 HF patients (51 ± 3.4 years; New York Heart Association class III-IV; left ventricular ejection fraction 27.8 ± 2.2%; optimal medical therapy) submitted to CRT. Evaluations were made prior to and 3 months after CRT. MSNA was performed at rest and during moderate static exercise (handgrip). Peak oxygen consumption (VO2 ) was evaluated by means of cardiopulmonary exercise test. HF patients with advanced NYHA class without CRT and healthy individuals were also studied. RESULTS: CRT reduced MSNA at rest (48.9 ± 11.1 bursts/min vs 33.7 ± 15.3 bursts/min, P < 0.05) and during handgrip exercise (MSNA 62.3 ± 13.1 bursts/min vs 46.9 ± 14.3 bursts/min, P < 0.05). Among HF patients submitted to CRT, the peak VO2 increased (12.9 ± 2.8 mL/kg/min vs 16.5 ± 3.9 mL/kg/min, P < 0.05) and an inverse correlation between peak VO2 and resting MSNA (r = -0.74, P = 0.01) was observed. CONCLUSIONS: In patients with advanced HF and severe systolic dysfunction: (1) a significant reduction of MSNA (at rest and during handgrip) occurred after CRT, and this behavior was significantly superior to HF patients receiving only medical therapy; (2) MSNA reduction after CRT had an inverse correlation with O2 consumption outcomes.
Asunto(s)
Terapia de Resincronización Cardíaca , Tolerancia al Ejercicio , Insuficiencia Cardíaca/prevención & control , Insuficiencia Cardíaca/fisiopatología , Contracción Isométrica , Músculo Esquelético/fisiopatología , Consumo de Oxígeno , Potenciales de Acción , Adulto , Presión Sanguínea , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Fuerza Muscular , Músculo Esquelético/inervaciónAsunto(s)
Endocarditis/etiología , Microsporidios/aislamiento & purificación , Microsporidiosis/diagnóstico , Marcapaso Artificial/efectos adversos , Antibacterianos/uso terapéutico , Ecocardiografía Transesofágica , Electrocardiografía , Endocarditis/diagnóstico , Endocarditis/diagnóstico por imagen , Endocarditis/patología , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Masculino , Microscopía Electrónica , Microsporidios/genética , Microsporidios/crecimiento & desarrollo , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Radiografía TorácicaRESUMEN
Objetivo: Avaliar a importância clínica da presença de marcapasso definitivo (MPD) previamente ao implante de CDI de nossa instituição, foram selecionados 275 submetidos a implante de CDI para prevenção secundária de morte súbita cardíaca (MSC), agrupados de acordo com a cardiomiopatia de base e a presença de MPD prévio ao implante de CDI. As variáveis analisadas foram: sexo, idade, CF-NYHAA, medicações, ritmo cardíaco, FEVE e TVNS. Para análise estatística, utilizou-se o método de Kaplan Meier e o teste de log-rank. Resultados: A amostra reduzida de pacientes com consistentes...
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Enfermedad de Chagas/complicaciones , Enfermedad de Chagas/diagnóstico , Muerte Súbita/prevención & control , Marcapaso Artificial/efectos adversos , Marcapaso ArtificialRESUMEN
PURPOSE: To analyze the influence of biventricular pacing (BP) on clinical behavior, ventricular arrhythmia (VA) prevalence, and left ventricular ejection fraction (LV EF) by gated ventriculography. METHODS: Twenty-four patients with left bundle branch block (LBBB) and NYHA class III and IV underwent pacemaker implantation and were randomized either to the conventional or BP group, all receiving BP after 6 months. RESULTS: Sixteen patients were in NYHA class IV (66.6%) and 8 were in class III (33.4%). After 1-year follow-up, 14 patients were in class II (70%) and 5 were in class III (25%). Two sudden cardiac deaths occurred. A significant reduction in QRS length was found with BP (p=0.006). A significant statistical increase, from a mean of 19.13 +/- 5.19% (at baseline) to 25.33 +/- 5.90% (with BP) was observed in LVEF Premature ventricular contraction prevalence decreased from a mean of 10,670.00 +/- 12,595.39 SD or to a mean of 3,007.00 +/- 3,216.63 SD PVC/24 h with BP (p<0.05). Regarding the hospital admission rate over 1 year, we observed a significant reduction from 60. To 16 admissions with BP (p<0.05). CONCLUSION: Patients with LBBB and severe heart failure experienced, with BP, a significant NYHA class and LVEF improvement. A reduction in the hospital admission rate and VA prevalence also occurred.
Asunto(s)
Bloqueo de Rama/epidemiología , Bloqueo de Rama/terapia , Gasto Cardíaco Bajo/fisiopatología , Gasto Cardíaco Bajo/terapia , Estimulación Cardíaca Artificial/métodos , Adulto , Anciano , Bloqueo de Rama/etiología , Gasto Cardíaco Bajo/complicaciones , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Volumen SistólicoRESUMEN
PURPOSE: To analyze the influence of biventricular pacing (BP) on clinical behavior, ventricular arrhythmia (VA) prevalence, and left ventricular ejection fraction (LV EF) by gated ventriculography. METHODS: Twenty-four patients with left bundle branch block (LBBB) and NYHA class III and IV underwent pacemaker implantation and were randomized either to the conventional or BP group, all receiving BP after 6 months. RESULTS: Sixteen patients were in NYHA class IV (66.6 per cent) and 8 were in class III (33.4 per cent). After 1-year follow-up, 14 patients were in class II (70 per cent) and 5 were in class III (25 per cent). Two sudden cardiac deaths occurred. A significant reduction in QRS length was found with BP (p=0.006). A significant statistical increase, from a mean of 19.13 ñ 5.19 per cent (at baseline) to 25.33 ñ 5.90 per cent (with BP) was observed in LVEF Premature ventricular contraction prevalence decreased from a mean of 10,670.00 ñ 12,595.39 SD or to a mean of 3,007.00 ñ 3,216.63 SD PVC/24 h with BP (p<0.05). Regarding the hospital admission rate over 1 year, we observed a significant reduction from 60. To 16 admissions with BP (p<0.05). CONCLUSION: Patients with LBBB and severe heart failure experienced, with BP, a significant NYHA class and LVEF improvement. A reduction in the hospital admission rate and VA prevalence also occurred.