Effects of Cardiac Resynchronization Therapy on a Six-minute Walk Test, Maximal Inspiratory Pressure and Peak Expiratory Flow in Patients with Heart Failure: A Longitudinal Study

Abstract Background: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure. Objective: To evaluate the response of CRT in maximal inspiratory pressure (MIP), peak expiratory flow (PEF), and exercise tolerance as determined by the six-minute walk test (6MWT) in patients with HF. Methods: This study used the 6MWT and Manovacuometer to assess functional capacity in relation to activities of daily living, in which fatigue and dyspnea are common. Results: After six months of CRT, this study identified improvements in the 6MWT, p<0.05; MIP, p=0.01; and PEF, p=0.03. Conclusion: After CRT, this study showed a significant improvement in MIP, PEF, and exercise tolerance. However, further studies are warranted to demonstrate the relevance of these findings.

Fadiga: Um sintoma complexo e seu impacto no câncer e na Insuficiência cardíaca / Fatigue: a complex symptom and its impact on cancer heart failure

Nas doenças crônicas, como câncer e insuficiência cardíaca (IC), a fadiga é um sintoma comum e complexo do ponto de vista etiológico e fisiopatológico, portanto, um tema de relevância na recente área da cardio-oncologia. A fadiga é prevalente em 80-90% dos pacientes oncológicos tratados com quimioterapia e/ou radioterapia e acomete cerca de 50-96% dos indivíduos com IC. A toxicidade atribuída aos quimioterápicos pode determinar o grau de fadiga do paciente e até predizer sua sobrevida. Nas últimas décadas, o avanço das terapias antineoplásicas impactaram substancialmente a sobrevida dos pacientes com câncer, e os riscos dos efeitos lesivos destas terapias ao sistema cardiovascular têm sido cada vez mais descritos. Portanto, a cooperação entre oncologistas e cardiologistas levou ao surgimento da cardio-oncologia e do novo conceito de cardiovigilância. A cardiotoxicidade é uma das complicações clínicas no tratamento do câncer, apresentando como manifestação típica a disfunção sistólica ventricular esquerda. Novas estratégias diagnósticas e terapêuticas têm sido empregadas na cardiovigilância em pacientes com câncer. A fadiga nestes pacientes vem sendo estudada criteriosamente com um olhar multidisciplinar e com o desenvolvimento de escalas visuais para melhor quantificar e correlacionar o seu real impacto na qualidade de vida e sobrevida destes indivíduos. O Pictograma de Fadiga e Escala de Fadiga de Piper são ferramentas cada vez mais utilizadas na pesquisa e na prática clínica. Os mecanismos envolvidos na fadiga, do ponto de vista conceitual, podem ser de origem central (sistema nervoso central) ou periférica (musculoesquelética), ambos os quais podem estar presentes no paciente com câncer. A presente revisão objetiva discutir os novos conceitos na avaliação da fadiga em pacientes oncológicos. Esses conceitos são fundamentais aos profissionais que atuam na emergente área da cardio-oncologia

Controlled Study of Correlation of Biomechanical Profile of Hemiparetic Patients with Distance Travelled in Six Minutes.

The six-minute walking test (6MWT) is used to assess exercise tolerance that is associated with motor function of the lower limbs in hemiparetic patients. It is suggested that, for post-stroke subjects, performance in the 6MWT may be limited by biomechanical and cardiovascular factors. Our aim is to determine the correlation between the six-minute walk distance (6MWD) and the biomechanical profile of hemiparetic patients. During this cross-sectional controlled study, 10 hemiparetic patients with heart failure underwent 6MWT (ATS protocol). Tonus (Ashworth Scale) and goniometry of the lower limbs were measured. The average of 6MWD in two tests was 279±8 m. There was a negative correlation between the degree of spasticity for both the sural triceps (r=-0.57, P<0.05), quadriceps (r=-0.58, P<0.05) and the limitation in ankle dorsiflexion and the 6MWD (r=-0.76, P<0.05). Also, there was correlation between hip extension and ankle dorsiflexion limitations with 6MWD (r=0.66, P<0.05), (r=0.77, P<0.05). The negative correlation between the highest spasticity in paretic limb and the 6MWD and the correlation between the lower movement range of paretic hip and ankle suggest association with these factors and gait velocity in 6MWT. Loss percentage represents the percentage calculation between distance traveled and the distance predicted achieved by patients. In this study, the negative correlation between the percentage of loss of 6MWD and the limitation in the ankle dorsiflexion movement suggests that for a minor motion arch of the ankle, there is a higher percentage of walking distance loss foretold.