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1.
Eur J Prev Cardiol ; : 2047487319880650, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604403

RESUMO

PURPOSE: The purpose of this study was to investigate the hemodynamic and cardiorespiratory adaptations to exercise in individuals with heart transplantation with evidence of cardiac reinnervation (cardiac reinnervation group) versus without evidence of cardiac reinnervation (no cardiac reinnervation group). METHODS: Sedentary individuals with heart transplantation (age = 45.5 ± 2.2 years; time elapsed since surgery = 6.7 ± 0.7 years) were divided into the cardiac reinnervation (n = 16) and no cardiac reinnervation (n = 17) groups according to their heart rate response to cardiopulmonary exercise testing. The 24-hour ambulatory blood pressure, carotid-femoral pulse wave velocity, and cardiorespiratory fitness were assessed before and after 12 weeks of a thrice-weekly exercise program (five minutes of warm-up, 30 min of endurance exercise, one set of 10-15 reps in five resistance exercises, and five minutes of cool-down). RESULTS: The cardiac reinnervation group had reduced (p < 0.01) 24-hour systolic/diastolic blood pressure (7/9 mm Hg), daytime systolic/diastolic blood pressure (9/10 mm Hg) and nighttime diastolic blood pressure (6 mm Hg) after training. The no cardiac reinnervation group reduced (p < 0.05) only 24-hour (5 mm Hg), daytime (5 mm Hg) and nighttime (6 mm Hg) diastolic blood pressure after training. Hourly analysis showed that the cardiac reinnervation group reduced systolic/diastolic blood pressure for 10/21 h, while the no cardiac reinnervation group reduced systolic/diastolic blood pressure for only 3/11 h. The cardiac reinnervation group also improved both maximal oxygen consumption (10.8%) and exercise tolerance (13.4%) after training, but the no cardiac reinnervation group improved only exercise tolerance (9.9%). Pulse wave velocity did not change in both groups. CONCLUSION: There were greater improvements in ambulatory blood pressure and maximal oxygen consumption in the cardiac reinnervation than the no cardiac reinnervation group. These results suggest that cardiac reinnervation associates with hemodynamic and cardiorespiratory adaptations to exercise training in individuals with heart transplantation.

2.
Oncotarget ; 8(4): 6994-7002, 2017 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-28052002

RESUMO

Cardiotoxicity is associated with the chronic use of doxorubicin leading to cardiomyopathy and heart failure. Identification of cardiotoxicity-specific miRNA biomarkers could provide clinicians with a valuable prognostic tool. The aim of the study was to evaluate circulating levels of miRNAs in breast cancer patients receiving doxorubicin treatment and to correlate with cardiac function. This is an ancillary study from "Carvedilol Effect on Chemotherapy-induced Cardiotoxicity" (CECCY trial), which included 56 female patients (49.9±3.3 years of age) from the placebo arm. Enrolled patients were treated with doxorubicin followed by taxanes. cTnI, LVEF, and miRNAs were measured periodically. Circulating levels of miR-1, -133b, -146a, and -423-5p increased during the treatment whereas miR-208a and -208b were undetectable. cTnI increased from 6.6±0.3 to 46.7±5.5 pg/mL (p<0.001), while overall LVEF tended to decrease from 65.3±0.5 to 63.8±0.9 (p=0.053) over 12 months. Ten patients (17.9%) developed cardiotoxicity showing a decrease in LVEF from 67.2±1.0 to 58.8±2.7 (p=0.005). miR-1 was associated with changes in LVEF (r=-0.531, p<0.001). In a ROC curve analysis miR-1 showed an AUC greater than cTnI to discriminate between patients who did and did not develop cardiotoxicity (AUC = 0.851 and 0.544, p= 0.0016). Our data suggest that circulating miR-1 might be a potential new biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/genética , Doxorrubicina/efeitos adversos , MicroRNAs/sangue , Biomarcadores , Neoplasias da Mama/sangue , Neoplasias da Mama/genética , Carbazóis , Cardiotoxicidade/sangue , Cardiotoxicidade/fisiopatologia , Carvedilol , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Propanolaminas , Curva ROC , Volume Sistólico/efeitos dos fármacos , Troponina C/metabolismo , Função Ventricular Esquerda/efeitos dos fármacos
3.
Eur J Prev Cardiol ; 24(8): 808-817, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28134562

RESUMO

Background In patients with heart failure, inflammation has been associated with worse functional capacity, but it is uncertain whether it could affect their response to exercise training. We evaluated whether inflammatory biomarkers are related to differential effect of exercise on the peak oxygen uptake (V˙O2) among patients with heart failure. Design Open, parallel group, randomized controlled trial. Methods Patients with heart failure and ejection fraction ≤0.4 were randomized into exercise training or control for 12 weeks. Patients were classified according to: 1) inflammatory biomarkers blood levels, defined as 'low' if both interleukin-6 and tumor necrosis factor-alpha blood levels were below median, and 'high' otherwise; and 2) galectin-3 blood levels, which also reflect pro-fibrotic processes. Results Forty-four participants (50 ± 7 years old, 55% men, 25% ischemic) were allocated to exercise training ( n = 28) or control ( n = 16). Exercise significantly improved peak V˙O2 among participants with 'low' inflammatory biomarkers (3.5 ± 0.9 vs. -0.7 ± 1.1 ml/kg per min, p = 0.006), as compared with control, but not among those with 'high' inflammatory biomarkers (0.4 ± 0.6 vs. -0.2 ± 0.7 ml/kg per min, p = 0.54, p for interaction = 0.009). Similarly, exercise improved peak V˙O2 among participants with below median (2.4 ± 0.8 vs. -0.3 ± 0.9 ml/kg per min, p = 0.032), but not among those with above median galectin-3 blood levels (0.3 ± 0.7 vs. -0.7 ± 1.0 ml/kg per min, p = 0.41, p for interaction = 0.053). Conclusion In patients with heart failure, levels of biomarkers that reflect pro-inflammatory and pro-fibrotic processes were associated with differential effect of exercise on functional capacity. Further studies should evaluate whether exercise training can improve clinical outcomes in patients with heart failure and low levels of these biomarkers.


Assuntos
Terapia por Exercício , Tolerância ao Exercício , Insuficiência Cardíaca/terapia , Mediadores da Inflamação/sangue , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Biomarcadores/sangue , Brasil , Teste de Esforço , Feminino , Fibrose , Galectina 3/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
4.
Ann Med ; 49(2): 165-175, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27763780

RESUMO

INTRODUCTION: Ambient air pollution is associated with adverse cardiovascular events. This meta-analysis aimed to investigate the short-term association between air pollution and cardiovascular effects on healthy volunteers. METHODS: We searched databases to identify randomized trials with controlled human exposures to either of two models for studying ambient particulate matter: diesel-exhaust or concentrated ambient particles. Estimates of size effect were performed using standardized mean difference (SMD). Heterogeneity was assessed with I2 statistics. Outcomes were vascular function estimated by forearm blood flow (FBF), blood pressure, heart rate, and blood analysis. RESULTS: Database searches yielded 17 articles (n = 342) with sufficient information for meta-analyses. High levels of heterogeneity for the some outcomes were analyzed using random-effects model. The pooled effect estimate showed that short-term exposure to air pollution impaired FBF response from 2.7 to 2.5 mL/100 mL tissue/min (SMD 0.404; p = .006). There was an increase in 5000 platelet/mm3 following pollution exposure (SMD 0.390; p = .050) but no significant differences for other outcomes. CONCLUSION: Controlled human exposures to air pollution are associated with the surrogates of vascular dysfunction and increase in platelet count, which might be related to adverse cardiovascular events. Given the worldwide prevalence of exposure to air pollution, these findings are relevant for public health. KEY MESSAGES Controlled exposure to air pollution impairs vasomotor response, which is a surrogate for adverse cardiovascular events. This is the first meta-analysis from randomized clinical trials showing short-term association between air pollution and cardiovascular effects on healthy volunteers. Given the worldwide prevalence of exposure to air pollution, this finding is important for public health.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Material Particulado/envenenamento , Emissões de Veículos/envenenamento , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
5.
JACC Heart Fail ; 4(6): 517-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27256758
6.
Int J Cardiol ; 215: 92-7, 2016 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-27107547

RESUMO

BACKGROUND: Air pollution exposure could mitigate the health benefits of exercise in patients with heart failure (HF). We tested the effects of a respiratory filter on HF patients exposed to air pollution during exercise. METHODS AND RESULTS: Ancillary analysis of the FILTER-HF trial, focused on the exercise outcomes. In a randomized, double-blind, 3-way crossover design, 26 HF patients and 15 control volunteers were exposed to clean air, unfiltered dilute diesel engine exhaust (DE), or filtered DE for 6min during a submaximal cardiopulmonary testing in a controlled-exposure facility. Prospectively collected data included six-minute walking test [6mwt], VO2, VE/VCO2 Slope, O2Pulse, pulmonary ventilation [VE], tidal volume, VD/Vt, oxyhemoglobin saturation and CO2-rebreathing. Compared to clean air, DE adversely affected VO2 (11.0±3.9 vs. 8.4±2.8ml/kg/min; p<0.001); 6mwt (243.3±13.0 vs. 220.8±13.7m; p=0.030); and O2Pulse (8.9±1.0 vs. 7.8±0.7ml/beat; p<0.001) in HF patients. Compared to DE, filtration reduced the particulate concentration from 325±31 to 25±6µg/m(3), and was associated with an increase in VO2 (10.4±3.8ml/kg/min; p<0.001 vs. DE) and O2Pulse (9.7±1.1ml/beat; p<0.001 vs. DE) in patients with HF. Filtration was associated with higher VE and CO2-rebreathing in both groups. VE/VCO2 Slope was higher among patients with HF. CONCLUSION: DE adversely affects exercise capacity in patients with HF. A simple respiratory filter can reduce the adverse effects of pollution on VO2 and O2Pulse. Given the worldwide prevalence of exposure to traffic-related air pollution, these findings are relevant for public health especially in this highly susceptible population. The filter intervention holds great promise that needs to be tested in future studies.


Assuntos
Poluição do Ar/efeitos adversos , Teste de Esforço/métodos , Insuficiência Cardíaca/fisiopatologia , Exposição por Inalação , Dispositivos de Proteção Respiratória , Emissões de Veículos , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Exposição por Inalação/efeitos adversos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Ventilação Pulmonar/fisiologia
7.
JACC Heart Fail ; 4(1): 55-64, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26738952

RESUMO

OBJECTIVES: The goal of this study was to test the effects of a respiratory filter intervention (filter) during controlled pollution exposure. BACKGROUND: Air pollution is considered a risk factor for heart failure (HF) decompensation and mortality. METHODS: This study was a double-blind, randomized to order, controlled, 3-way crossover, single-center clinical trial. It enrolled 26 patients with HF and 15 control volunteers. Participants were exposed in 3 separate sessions to clean air, unfiltered diesel exhaust exposure (DE), or filtered DE. Endpoints were endothelial function assessed by using the reactive hyperemia index (RHi), arterial stiffness, serum biomarkers, 6-min walking distance, and heart rate variability. RESULTS: In patients with HF, DE was associated with a worsening in RHi from 2.17 (interquartile range [IQR]: 1.8 to 2.5) to 1.72 (IQR: 1.5 to 2.2; p = 0.002) and an increase in B-type natriuretic peptide (BNP) from 47.0 pg/ml (IQR: 17.3 to 118.0 pg/ml) to 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml; p = 0.004). Filtration reduced the particulate concentration (325 ± 31 µg/m(3) vs. 25 ± 6 µg/m(3); p < 0.001); in the group with HF, filter was associated with an improvement in RHi from 1.72 (IQR: 1.5 to 2.2) to 2.06 (IQR: 1.5 to 2.6; p = 0.019) and a decrease in BNP from 66.5 pg/ml (IQR: 26.5 to 155.5 pg/ml) to 44.0 pg/ml (IQR: 20.0 to 110.0 pg/ml; p = 0.015) compared with DE. In both groups, DE decreased the 6-min walking distance and arterial stiffness, although filter did not change these responses. DE had no effect on heart rate variability or exercise testing. CONCLUSIONS: To our knowledge, this trial is the first to show that a filter can reduce both endothelial dysfunction and BNP increases in patients with HF during DE. Given these potential benefits, the widespread use of filters in patients with HF exposed to traffic-derived air pollution may have beneficial public health effects and reduce the burden of HF. (Effects of Air Pollution Exposure Reduction by Filter Mask on Heart Failure; NCT01960920).


Assuntos
Exposição Ambiental/efeitos adversos , Insuficiência Cardíaca/fisiopatologia , Dispositivos de Proteção Respiratória , Emissões de Veículos/toxicidade , Biomarcadores/metabolismo , Estudos Cross-Over , Método Duplo-Cego , Endotélio Vascular/fisiologia , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hiperemia/etiologia , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Estudos Prospectivos , Rigidez Vascular/fisiologia , Caminhada/fisiologia
8.
Blood Press Monit ; 18(6): 342-5, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24192849

RESUMO

High blood pressure (BP) increases the risk of cardiovascular diseases, and its control is a clinical challenge. Regular exercise lowers BP in patients with mild-to-moderate hypertension. No data are available on the effects of heated water-based exercise in hypertensive patients. Our objective was to evaluate the effects of heated water-based exercise on BP in patients with resistant hypertension. We tested the effects of 60-min heated water-based exercise training three times per week in 16 patients with resistant hypertension (age 55±6 years). The protocol included walking and callisthenic exercises. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM) before and after a 2-week exercise program in a heated pool. Systolic office BP was reduced from 162 to 144 mmHg (P<0.004) after heated-water training. After the heated-water exercise training during 24-h ABPM, systolic BP decreased from 135 to 123 mmHg (P=0.02), diastolic BP decreased from 83 to 74 mmHg (P=0.001), daytime systolic BP decreased from 141 to 125 mmHg (P=0.02), diastolic BP decreased from 87 to 77 mmHg (P=0.009), night-time systolic BP decreased from 128 to 118 mmHg (P=0.06), and diastolic BP decreased from 77 to 69 mmHg (P=0.01). In addition, BP cardiovascular load was reduced significantly during the 24-h daytime and night-time period after the heated water-based exercise. Heated water-based exercise reduced office BP and 24-h daytime and night-time ABPM levels. These effects suggest that heated water-based exercise may have a potential as a new therapeutic approach to resistant hypertensive patients.


Assuntos
Exercício , Hipertensão/terapia , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Água
9.
PLoS Negl Trop Dis ; 7(4): e2176, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23638197

RESUMO

BACKGROUND: Sudden death has been considered the main cause of death in patients with Chagas heart disease. Nevertheless, this information comes from a period before the introduction of drugs that changed the natural history of heart failure. We sought to study the mode of death of patients with heart failure caused by Chagas heart disease, comparing with non-Chagas cardiomyopathy. METHODS AND RESULTS: We examined the REMADHE trial and grouped patients according to etiology (Chagas vs non-Chagas) and mode of death. The primary end-point was all-cause, heart failure and sudden death mortality; 342 patients were analyzed and 185 (54.1%) died. Death occurred in 56.4% Chagas patients and 53.7% non-Chagas patients. The cumulative incidence of all-cause mortality and heart failure mortality was significantly higher in Chagas patients compared to non-Chagas. There was no difference in the cumulative incidence of sudden death mortality between the two groups. In the Cox regression model, Chagas etiology (HR 2.76; CI 1.34-5.69; p = 0.006), LVEDD (left ventricular end diastolic diameter) (HR 1.07; CI 1.04-1.10; p<0.001), creatinine clearance (HR 0.98; CI 0.97-0.99; p = 0.006) and use of amiodarone (HR 3.05; CI 1.47-6.34; p = 0.003) were independently associated with heart failure mortality. LVEDD (HR 1.04; CI 1.01-1.07; p = 0.005) and use of beta-blocker (HR 0.52; CI 0.34-0.94; p = 0.014) were independently associated with sudden death mortality. CONCLUSIONS: In severe Chagas heart disease, progressive heart failure is the most important mode of death. These data challenge the current understanding of Chagas heart disease and may have implications in the selection of treatment choices, considering the mode of death. TRIAL REGISTRATION: ClinicalTrials.gov NCT00505050 (REMADHE).


Assuntos
Cardiomiopatia Chagásica/mortalidade , Adulto , Morte Súbita Cardíaca , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Int J Cardiol ; 167(1): 34-40, 2013 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-22243938

RESUMO

BACKGROUND: Renal dysfunction is associated with increased mortality in patients with decompensated heart failure. However, interventions targeted to prevention in this setting have been disappointing. We investigated the effects of hypertonic saline solution (HSS) for prevention of renal dysfunction in decompensated heart failure. METHODS: In a double-blind randomized trial, patients with decompensated heart failure were assigned to receive three-day course of 100mL HSS (NaCl 7.5%) twice daily or placebo. Primary end point was an increase in serum creatinine of 0.3mg/dL or more. Main secondary end point was change in biomarkers of renal function, including serum levels of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin-NGAL and the urinary excretion of aquaporin 2 (AQP2), urea transporter (UT-A1), and sodium/hydrogen exchanger 3 (NHE3). RESULTS: Twenty-two patients were assigned to HSS and 12 to placebo. Primary end point occurred in two (10%) patients in HSS group and six (50%) in placebo group (relative risk 0.3; 95% CI 0.09-0.98; P=0.01). Relative to baseline, serum creatinine and cystatin C levels were lower in HSS as compared to placebo (P=0.004 and 0.03, respectively). NGAL level was not statistically different between groups, however the urinary expression of AQP2, UT-A1 and NHE3 was significantly higher in HSS than in placebo. CONCLUSIONS: HSS administration attenuated heart failure-induced kidney dysfunction as indicated by improvement in both glomerular and tubular defects, a finding with important clinical implications. HSS modulated the expression of tubular proteins involved in regulation of water and electrolyte homeostasis.


Assuntos
Hidratação/métodos , Insuficiência Cardíaca/terapia , Nefropatias/prevenção & controle , Nefropatias/fisiopatologia , Solução Salina Hipertônica/administração & dosagem , Adulto , Idoso , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade
11.
Eur J Cardiovasc Prev Rehabil ; 18(6): 824-30, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21450597

RESUMO

Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 ± 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO(2MAX); n = 16), or CME (50-60% of VO(2MAX); n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HR(MAX) and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 ± 4.9 vs. 20.6 ± 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO(2RCP); 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO(2MAX); 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TT(AT); 62.0 vs. 37.7, p = 0.048), TT(RCP) (49.3 vs. 32.9, p = 0.032), and TT(MAX) (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.


Assuntos
Terapia por Exercício , Frequência Cardíaca , Hipertensão/prevenção & controle , Aptidão Física , Respiração , Adulto , Análise de Variância , Brasil , Teste de Esforço , Tolerância ao Exercício , Feminino , Predisposição Genética para Doença , Frequência Cardíaca/genética , Hereditariedade , Humanos , Hipertensão/genética , Hipertensão/fisiopatologia , Consumo de Oxigênio , Linhagem , Estudos Prospectivos , Respiração/genética , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Hypertens Res ; 33(8): 836-43, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20448634

RESUMO

Exercise training has an important role in the prevention and treatment of hypertension, but its effects on the early metabolic and hemodynamic abnormalities observed in normotensive offspring of hypertensive parents (FH+) have not been studied. We compared high-intensity interval (aerobic interval training, AIT) and moderate-intensity continuous exercise training (CMT) with regard to hemodynamic, metabolic and hormonal variables in FH+ subjects. Forty-four healthy FH+ women (25.0+/-4.4 years) randomized to control (ConFH+) or to a three times per week equal-volume AIT (80-90% of VO(2MAX)) or CMT (50-60% of VO(2MAX)) regimen, and 15 healthy women with normotensive parents (ConFH-; 25.3+/-3.1 years) had their hemodynamic, metabolic and hormonal variables analyzed at baseline and after 16 weeks of follow-up. Ambulatorial blood pressure (ABP), glucose and cholesterol levels were similar among all groups, but the FH+ groups showed higher insulin, insulin sensitivity, carotid-femoral pulse wave velocity (PWV), norepinephrine and endothelin-1 (ET-1) levels and lower nitrite/nitrate (NOx) levels than ConFH- subjects. AIT and CMT were equally effective in improving ABP (P<0.05), insulin and insulin sensitivity (P<0.001); however, AIT was superior in improving cardiorespiratory fitness (15 vs. 8%; P<0.05), PWV (P<0.01), and BP, norepinephrine, ET-1 and NOx response to exercise (P<0.05). Exercise intensity was an important factor in improving cardiorespiratory fitness and reversing hemodynamic, metabolic and hormonal alterations involved in the pathophysiology of hypertension. These findings may have important implications for the exercise training programs used for the prevention of inherited hypertensive disorder.


Assuntos
Pressão Sanguínea/fisiologia , Terapia por Exercício/métodos , Exercício/fisiologia , Hipertensão/prevenção & controle , Hipertensão/fisiopatologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Glicemia/metabolismo , Endotelina-1/sangue , Endotélio Vascular/fisiologia , Metabolismo Energético/fisiologia , Feminino , Humanos , Hipertensão/epidemiologia , Insulina/sangue , Lipídeos/sangue , Masculino , Sistemas Neurossecretores/fisiologia , Nitratos/sangue , Nitritos/sangue , Norepinefrina/sangue , Aptidão Física/fisiologia , Fatores de Risco , Sistema Nervoso Simpático/fisiologia , Adulto Jovem
14.
Am Heart J ; 159(1): 90-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20102872

RESUMO

BACKGROUND: Heart failure and diabetes often occur simultaneously in patients, but the prognostic value of glycemia in chronic heart failure is debatable. We evaluated the role of glycemia on prognosis of heart failure. METHODS: Outpatients with chronic heart failure from the Long-term Prospective Randomized Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients (REMADHE) trial were grouped according to the presence of diabetes and level of glycemia. All-cause mortality/heart transplantation and unplanned hospital admission were evaluated. RESULTS: Four hundred fifty-six patients were included (135 [29.5%] female, 124 [27.2%] with diabetes mellitus, age of 50.2 +/- 11.4 years, and left-ventricle ejection fraction of 34.7% +/- 10.5%). During follow-up (3.6 +/- 2.2 years), 27 (5.9%) patients were submitted to heart transplantation and 202 (44.2%) died; survival was similar in patients with and without diabetes mellitus. When patients with and without diabetes were categorized according to glucose range (glycemia < or = 100 mg/dL [5.5 mmol/L]), as well as when distributed in quintiles of glucose, the survival was significantly worse among patients with lower levels of glycemia. This finding persisted in Cox proportional hazards regression model that included gender, etiology, left ventricle ejection fraction, left ventricle diastolic diameter, creatinine level and beta-blocker therapy, and functional status (hazard ratio 1.45, 95% CI 1.09-1.69, P = .039). No difference regarding unplanned hospital admission was found. CONCLUSION: We report on an inverse association between glycemia and mortality in outpatients with chronic heart failure. These results point to a new pathophysiologic understanding of the interactions between diabetes mellitus, hyperglycemia, and heart disease.


Assuntos
Glicemia/análise , Causas de Morte , Diabetes Mellitus/mortalidade , Insuficiência Cardíaca/mortalidade , Hiperglicemia/mortalidade , Adulto , Fatores Etários , Doença Crônica , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/tratamento farmacológico , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Análise Multivariada , Pacientes Ambulatoriais/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Probabilidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo
15.
Int J Cardiol ; 145(1): 75-7, 2010 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-19477026

RESUMO

PURPOSE: Beta-blockers (BB) have shown to improve outcomes among heart failure patients (HF). Adequate risk stratification is still a major concern for HF. The prognostic indexes have been detected, but only few parameters maintain consistently high power in predicting progression of disease and mortality. Peak oxygen consumption (VO(2) peak, ml kg(-1) min(-1)) is traditionally used for risk stratification in HF, however, there is limited evidence regarding predictive value of VO(2) peak in patients taking BB. METHODS: Two hundred twenty nine patients, aged 49 ± 13 years with diagnosed HF for more than 6 months due to ischemic (n=73), idiopathic dilated (n=149) and Chagas disease (n=7) underwent a cardiopulmonary exercise test (CPX). The ejection fraction was 38 ± 10%; clinical stability was defined as no change in the NYHA class or absence of hospitalization for heart failure and stable medical treatment during 3 months prior to CPX. Subjects were tracked for cardiac-related mortality after CPX. RESULTS: The mean follow-up period was 2.5 ± 1.1 years and means value for VO(2) peak was 16.3 ± 4. Current BB therapy included carvedilol (83.4%), metoprolol (7.8%), bisoprolol (3.9%) and others (4.8%). The area under the ROC curve for VO(2) peak was 0.80 (95% CI: 0.69-0.90, optimal threshold: 12.5 and 82% sensitivity/26% specificity, p<0.001). Kaplan-Meier analysis that revealed event-free survival for subjects in < and >12.5 was 28% and 2.8%, respectively (long-rank 34.8; p<0.001). CONCLUSIONS: VO(2) peak seems to maintain prognostic value in HF patients BB therapy. The present study also provides new evidence that optimal threshold value for VO(2) peak in the BB era is 12.5 ml kg(-1) min(-1).


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Teste de Esforço/normas , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Consumo de Oxigênio/efeitos dos fármacos , Antagonistas Adrenérgicos beta/farmacologia , Adulto , Idoso , Teste de Esforço/efeitos dos fármacos , Teste de Esforço/métodos , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Prognóstico , Resultado do Tratamento
16.
Circ Heart Fail ; 3(1): 82-8, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19933408

RESUMO

BACKGROUND: Peculiar aspects of Chagas cardiomyopathy raise concerns about efficacy and safety of sympathetic blockade. We studied the influence of beta-blockers in patients with Chagas cardiomyopathy. METHODS AND RESULTS: We examined REMADHE trial and grouped patients according to etiology (Chagas versus non-Chagas) and beta-blocker therapy. Primary end point was all-cause mortality or heart transplantation. Altogether 456 patients were studied; 27 (5.9%) were submitted to heart transplantation and 202 (44.3%) died. Chagas etiology was present in 68 (14.9%) patients; they had lower body mass index (24.1+/-4.1 versus 26.3+/-5.1, P=0.001), smaller end-diastolic left ventricle diameter (6.7+/-1.0 mm versus 7.0+/-0.9 mm, P=0.001), smaller proportion of beta-blocker therapy (35.8% versus 68%, P<0.001), and higher proportion of spironolactone therapy (74.6% versus 57.8%, P=0.003). Twenty-four (35.8%) patients with Chagas disease were under beta-blocker therapy and had lower serum sodium (136.6+/-3.1 versus 138.4+/-3.1 mEqs, P=0.05) and lower body mass index (22.5+/-3.3 versus 24.9+/-4.3, P=0.03) compared with those who received beta-blockers. Survival was lower in patients with Chagas heart disease as compared with other etiologies. When only patients under beta-blockers were considered, the survival of patients with Chagas disease was similar to that of other etiologies. The survival of patients with beta-blockers was higher than that of patients without beta-blockers. In Cox regression model, left ventricle end-diastolic diameter (hazard ratio, 1.78; CI, 1.15 to 2.76; P=0.009) and beta-blockers (hazard ratio, 0.37; CI, 0.14 to 0.97; P=0.044) were associated with better survival. CONCLUSIONS: Our study suggests that beta-blockers may have beneficial effects on survival of patients with heart failure and Chagas heart disease and warrants further investigation in a prospective, randomized trial. Clinical Trial Registration- clinicaltrials.gov. Identifier: NCT00505050.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Cardiomiopatia Chagásica/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Índice de Massa Corporal , Cardiomiopatia Chagásica/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
17.
Int J Cardiol ; 141(2): 198-200, 2010 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-19106012

RESUMO

Anemia and renal failure (RF) are related to poor prognosis in chronic heart failure (HF). Anemia appear early in the course of RF and its value as predictor of risk in HF may be overlap by the value of RF. We aimed to establish the prognostic value of anemia and RF in a Brazilian HF population.


Assuntos
Anemia/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Renal/mortalidade , Doença de Chagas/mortalidade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco
18.
Congest Heart Fail ; 15(4): 176-80, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19627291

RESUMO

The aim of this study was to evaluate the 24-hour ambulatory blood pressure monitoring (ABPM) response to exercise training (ET) in heart failure (HF) patients. Twelve HF patients and 15 sedentary healthy controls underwent ET for 2 months (3 times per week from 80%-90% of the ventilatory threshold). ABPM was performed before and 2 days after the last exercise season. Despite the fact that ET in HF patients was associated with significant improvements in peak oxygen consumption (pVO2), there were no significant changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). On the other hand, controls decreased 24-hour mean SBP (117+/-8-115+/-9 mm Hg, P=.019) and 24-hour mean DBP (73+/-6-71+/-5 mm Hg, P=.016), mainly at nighttime SBP (107+/-8-103+/-9, P=.0004) and DBP (63+/-5-59+/-5 mm Hg, P<.0001). No changes in HR were found in controls. Values of 24-hour blood pressure did not change with ET in HF patients.


Assuntos
Pressão Sanguínea/fisiologia , Terapia por Exercício , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/reabilitação , Monitorização Ambulatorial da Pressão Arterial , Estudos de Casos e Controles , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Resultado do Tratamento
19.
Int J Cardiol ; 133(3): 381-7, 2009 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-18501444

RESUMO

BACKGROUND: Despite antihypertensive therapy, it is difficult to maintain optimal systemic blood pressure (BP) values in hypertensive patients (HPT). Exercise may reduce BP in untreated HPT. However, evidence regarding its effect in long-term antihypertensive therapy is lacking. Our purpose was to evaluate the acute effects of 40-minute continuous (CE) or interval exercise (IE) using cycle ergometers on BP in long-term treated HPT. METHODS: Fifty-two treated HPT were randomized to CE (n=26) or IE (n=26) protocols. CE was performed at 60% of reserve heart rate (HR). IE alternated consecutively 2 min at 50% reserve HR with 1 min at 80%. Two 24-h ambulatory BP monitoring were made after exercise (postexercise) or a nonexercise control period (control) in random order. RESULTS: CE reduced mean 24-h systolic (S) BP (2.6+/-6.6 mm Hg, p=0.05) and diastolic (D) BP (2.3+/-4.6, p=0.01), and nighttime SBP (4.8+/-6.4, p<0.001) and DBP (4.6+/-5.2 mm Hg, p=0.001). IE reduced 24-h SBP (2.8+/-6.5, p=0.03) and nighttime SBP (3.4+/-7.2, p=0.02), and tended to reduce nighttime DBP (p=0.06). Greater reductions occurred in higher BP levels. Percentage of normal ambulatory BP values increased after CE (24-h: 42% to 54%; daytime: 42% to 61%; nighttime: 61% to 69%) and IE (24-h: 31% to 46%; daytime: 54% to 61%; nighttime: 46% to 69%). CONCLUSION: CE and IE reduced ambulatory BP in treated HPT, increasing the number of patients reaching normal ambulatory BP values. These effects suggest that continuous and interval aerobic exercise may have a role in BP management in treated HPT.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/tendências , Terapia por Exercício/tendências , Exercício/fisiologia , Hipertensão/fisiopatologia , Hipertensão/terapia , Adulto , Ergometria/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
20.
Clinics (Sao Paulo) ; 63(6): 753-8, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19060996

RESUMO

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5+/-8.2 years; Body mass index: 27.8+/-4.7 kg/m(2)) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60% of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126+/-8.6 vs. 123.1+/-8.7 mmHg, p=0.004) and diastolic blood pressure (81.9+/-8 vs. 79.8+/-8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5+/-8.5 vs. 83.9+/-8.8 mmHg, p=0.04), and nighttime S (116.8+/-9.9 vs. 112.5+/-9.2 mmHg, p<0.001) and diastolic blood pressure (73.5+/-8.8 vs. 70.1+/-8.4 mmHg, p<0.001). Post-exercise daytime systolic blood pressure also tended to be reduced (129.8+/-9.3 vs. 127.8+/-9.4 mmHg, p=0.06). These post-exercise decreases in ambulatory blood pressure increased the percentage of patients displaying normal 24h systolic blood pressure (58% vs. 76%, p=0.007), daytime systolic blood pressure (68% vs. 82%, p=0.02), and nighttime diastolic blood pressure (56% vs. 72%, p=0.02). Nighttime systolic blood pressure also tended to increase (58% vs. 80%, p=0.058). CONCLUSION: A single bout of aerobic exercise reduced 24h ambulatory blood pressure levels in long-term-treated hypertensive patients and increased the percentage of patients reaching normal ambulatory blood pressure values. These effects suggest that aerobic exercise may have a potential role in blood pressure management of long-term-treated hypertensive.


Assuntos
Exercício/fisiologia , Hipertensão/reabilitação , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
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