Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Filtros adicionais











País/Região como assunto
Intervalo de ano
1.
Eur Heart J ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31424503

RESUMO

AIMS: Although loop diuretics are widely used to treat heart failure (HF), there is scarce contemporary data to guide diuretic adjustments in the outpatient setting. METHODS AND RESULTS: In a prospective, randomized and double-blind protocol, we tested the safety and tolerability of withdrawing low-dose furosemide in stable HF outpatients at 11 HF clinics in Brazil. The trial had two blindly adjudicated co-primary outcomes: (i) symptoms assessment quantified as the area under the curve (AUC) of a dyspnoea score on a visual-analogue scale evaluated at 4 time-points (baseline, Day 15, Day 45, and Day 90) and (ii) the proportion of patients maintained without diuretic reuse during follow-up. We enrolled 188 patients (25% females; 59 ± 13 years old; left ventricular ejection fraction = 32 ± 8%) that were randomized to furosemide withdrawal (n = 95) or maintenance (n = 93). For the first co-primary endpoint, no significant difference in patients' assessment of dyspnoea was observed in the comparison of furosemide withdrawal with continuous administration [median AUC 1875 (interquartile range, IQR 383-3360) and 1541 (IQR 474-3124), respectively; P = 0.94]. For the second co-primary endpoint, 70 patients (75.3%) in the withdrawal group and 77 patients (83.7%) in the maintenance group were free of furosemide reuse during follow-up (odds ratio for additional furosemide use with withdrawal 1.69, 95% confidence interval 0.82-3.49; P = 0.16). Heart failure-related events (hospitalizations, emergency room visits, and deaths) were infrequent and similar between groups (P = 1.0). CONCLUSIONS: Diuretic withdrawal did not result in neither increased self-perception of dyspnoea nor increased need of furosemide reuse. Diuretic discontinuation may deserve consideration in stable outpatients with no signs of fluid retention receiving optimal medical therapy. CLINICALTRIALS.GOV IDENTIFIER: NCT02689180.

2.
Am Heart J ; 194: 125-131, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29223430

RESUMO

AIMS: Furosemide is commonly prescribed for symptom relief in heart failure (HF) patients. Although few data support the continuous use of loop diuretics in apparently euvolemic HF patients with mild symptoms, there is concern about safety of diuretic withdrawal in these patients. The ReBIC-1 trial was designed to evaluate the safety and tolerability of withdrawing furosemide in stable, euvolemic, chronic HF outpatients. This multicenter initiative is part of the Brazilian Research Network in Heart Failure (ReBIC) created to develop clinical studies in HF and composed predominantly by university tertiary care hospitals. METHODS: The ReBIC-1 trial is currently enrolling HF patients in NYHA functional class I-II, left ventricular ejection fraction ≤45%, without a HF-related hospital admission within the last 6 months, receiving a stable dose of furosemide (40 or 80 mg per day) for at least 6 months. Eligible patients will be randomized to maintain or withdraw furosemide in a double-blinded protocol. The trial has two co-primary outcomes: (1) dyspnea assessment using a visual-analogue scale evaluated at 4 time points and (2) the proportion of patients maintained without diuretics during the follow-up period. Total sample size was calculated to be 220 patients. Enrolled patients will be followed up to 90 days after randomization, and diuretic will be restarted if clinical deterioration or signs of congestion are detected. Pre-defined sub-group analysis based on NT-proBNP levels at baseline is planned. PERSPECTIVE: Evidence-based strategies aiming to simplify HF pharmacotherapy are needed in clinical practice. The ReBIC-1 trial will determine the safety of withdrawing furosemide in stable chronic HF patients.


Assuntos
Tolerância a Medicamentos , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Pacientes Ambulatoriais , Idoso , Biomarcadores/sangue , Deterioração Clínica , Diuréticos/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Resultado do Tratamento
3.
Cardiovasc Ther ; 31(2): 100-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21884030

RESUMO

BACKGROUND: The origin of dyspnea in chronic heart failure (HF) is multifactorial, and excessive ventilation is thought to play a role in inducing this symptom. Chemosensivity is augmented in HF, correlates with increased pulmonary ventilation (VE), and is an adverse prognostic marker. Despite increased blood levels of natriuretic peptides in clinical conditions associated with dyspnea, their effect on pulmonary VE and chemoreceptor activity remains unexplored. METHODS: We tested in a prospective, placebo-controlled, three-way cross-over, double-blind randomized study the effects of the recombinant form of the natural human B-type natriuretic peptide (R-BNP) in comparison with placebo and levosimendan on chemoreflex sensitivity at rest, as well as their effects on pulmonary VE, systemic blood pressure, heart rate and sympathetic serum activity both at rest and during exercise. RESULTS: Eleven stable chronic HF patients were randomized to sessions of 6-min treadmill-walking tests during placebo, or levosimendan or R-BNP intravenous infusion in the following conditions: room air, hypoxia, and hypercapnia. R-BNP administration determined higher pulmonary ventilatory response at rest and during exercise (P < 0.001) consequent to a boost of respiratory rate (P < 0.001) under room air and hypoxia conditions. Norepinephrine blood levels increased from rest to exercise in all conditions without differences among placebo, levosimendan, and R-BNP effects. BNP blood levels remained unchanged. CONCLUSIONS: The novelty of the present findings is that R-BNP infusion in HF patients can boost pulmonary ventilatory response at rest and during exercise.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Células Quimiorreceptoras/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Hidrazonas/uso terapêutico , Hiperventilação/tratamento farmacológico , Pulmão/efeitos dos fármacos , Peptídeo Natriurético Encefálico/uso terapêutico , Piridazinas/uso terapêutico , Adulto , Brasil , Fármacos Cardiovasculares/administração & dosagem , Células Quimiorreceptoras/metabolismo , Doença Crônica , Estudos Cross-Over , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Hidrazonas/administração & dosagem , Hipercapnia/sangue , Hipercapnia/fisiopatologia , Hiperventilação/sangue , Hiperventilação/diagnóstico , Hiperventilação/fisiopatologia , Hipóxia/sangue , Hipóxia/fisiopatologia , Infusões Intravenosas , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/administração & dosagem , Estudos Prospectivos , Piridazinas/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Taxa Respiratória/efeitos dos fármacos , Simendana , Fatores de Tempo , Resultado do Tratamento
6.
Arq. bras. cardiol ; 95(3): 381-391, set. 2010. graf, tab
Artigo em Português | LILACS | ID: lil-560560

RESUMO

FUNDAMENTO: Insuficiência cardíaca (IC) está associada com aumento da quimio-sensibilidade periférica e central em repouso, que pode estar correlacionada com um aumento na resposta ventilatória durante exercício. Entretanto, SUS sensibilidade na IC durante o exercício ainda não foi reportada. OBJETIVO: Testar se o estímulo dos quimiorreceptores centrais e periféricos em pacientes com IC pode modular respostas ventilatórias, cronotrópicas e neurohormonais durante exercício submáximo. MÉTODOS: Investigamos a quimio-sensibilidade central e periférica em 15 pacientes com insuficiência cardíaca (IC) e 7 controles normais (C), comparando a resposta durante 3 testes de caminhada de 6 minutos (TC6M), realizado em esteira ergométrica com: ar ambiente, em hipóxia e em hipercapnia (em ordem randômica). RESULTADOS: FR em ar ambiente nos grupos C e IC foi 17±2 e 22±2 (p<,0001); em hipóxia, foi 17±1 e 23±2 (p<,02); com CO25 por cento foi 20±2 e 22±5 (p<,02). Volume tidal (VT) ou corrente em ar ambiente foi 1,25±0,17 e 1,08±0,19 (p<,01); em hipóxia 1,65±0,34 e 1,2±0,2(p<,0001); com CO25 por cento 1,55±0,46 e 1,29±0,39 (p<,0001). Em repouso, o aumento na IC foi maior para VE (C 33±40 por cento, IC 62±94 por cento, p<,01), FC(C 7±10 por cento, IC 10±10 por cento, p<0,05) em repouso. Durante a hipóxia, o aumento durante o exercício na IC foi maior para FR (C 1±4, IC 11±6,p<,05), FC (C 12±2, IC 14±3, p<,05), VE/VO2 (C -4±18 por cento, IC 24±21 por cento, p<,01), FC/VO2 (C -26±11 por cento, IC 11±5 por cento, p<,01), VE/DC (C 36±10 por cento, 46±14, p<,05 por cento ) and FC/DC (C 18±8 por cento, HF 29±11, p<,01). Durante exercício em hipóxia no grupo IC, o NO diminuiu e os níveis de IL-6 e aldosterona aumentaram. Os níveis neurohormonais permaneceram inalterados no grupo C. CONCLUSÃO: A quimio-sensibilidade central e a periférica durante o exercício estão aumentadas na IC e podem modular padrões respiratórios, cronotrópicos cardíacos e atividade neurohormonal durante exercício.


BACKGROUND: Heart failure (HF) is associated with resting increased peripheral and central chemosensitivity which may correlate with an increased ventilatory response to exercise. However, its sensitivity in HF during exercise was never really reported. OBJECTIVE: We tested if stimulation of central and peripheral chemoreceptors in HF patients could modulate ventilatory, chronotropic, and neurohormonal response during submaximal exercise. METHODS: We investigated central and peripheral chemosensitivity in 15 HF and 7 control (C) comparing response through three 6 minute walking tests conducted in a treadmill with : room air, hypoxia, and hypercapnia (in a randomic order). RESULTS: RR at room air C and HF was 17±2 and 22±2 (p<.0001); at hypoxia 17±1 and 23±2 (p<.02); at CO25 percent was 20±2 and 22±5 (p<.02). Tidal volume (TV) at room air was 1.25±0.17 and 1.08±0.19 (p<.01); at hypoxia 1.65±0.34 and 1.2±0.2 (p<.0001); at CO25 percent 1.55±0.46 and 1.29±0.39 (p<.0001). At rest the increment in HF was higher for VE (C 33±40 percent, HF 62±94 percent, p<.01), HR(C 7±10 percent, HF 10±10 percent, p<0.05) at rest. During hypoxia exercise increment in HF was higher for RR (C 1±4, HF 11±6,p<.05), HR (C 12±2, HF 14±3, p<.05), VE/VO2 (C -4±18 percent, HF 24±21 percent, p<.01), HR/VO2 (C -26±11 percent, HF 11±5 percent, p<.01), VE/WD (C 36±10 percent, 46±14, p<.05 percent) and HR/WD (C 18±8 percent, HF 29±11, p<.01). During HF hypoxia exercise NO reduced, and IL-6, aldosterone levels increased. Neurohormonal levels unchanged in C. CONCLUSION: Exercise peripheral and central chemosensitivity are increased in HF and may modulate respiratory pattern, cardiac chronotropic, and neurohormonal activity during exercise.


FUNDAMENTO: La insuficiencia cardíaca (IC) está asociada con aumento de la quimiosensibilidad periférica y central en reposo, que puede estar correlacionada con un aumento en la respuesta ventilatoria durante ejercicio. Mientras tanto, SUS sensibilidad en la IC durante el ejercicio aun no fue reportada. OBJETIVO: Verificar si el estímulo de los quimiorreceptores centrales y periféricos en pacientes con IC puede modular respuestas ventilatorias, cronotrópicas y neurohormonales durante ejercicio submáximo. MÉTODOS: Investigamos la quimiosensibilidad central y periférica en 15 pacientes con insuficiencia cardíaca (IC) y 7 controles normales (C), comparando la respuesta durante 3 tests de caminata de 6 minutos (TC6M), realizado en cinta ergométrica con: aire ambiente, en hipoxia y en hipercapnia (en orden randómico). RESULTADOS: FR en aire ambiente en los grupos C y IC fue 17±2 y 22±2 (p<,0001); en hipoxia, fue 17±1 y 23±2 (p<.02); con CO25 por ciento fue 20±2 y 22±5 (p<,02). Volumen tidal (VT) o corriente en aire ambiente fue 1,25±0,17 y 1,08±0,19 (p<,01); en hipoxia 1,65±0,34 y 1,2±0,2 (p<,0001); con CO25 por ciento 1,55±0,46 y 1,29±0,39 (p<,0001). En reposo, el aumento en la IC fue mayor para VI (C 33±40 por ciento, IC 62±94 por ciento, p<,01), FC(C 7±10 por ciento, IC 10±10 por ciento, p<0,05) en reposo. Durante la hipoxia, el aumento durante el ejercicio en la IC fue mayor para FR (C 1±4, IC 11±6, p<.05), FC (C 12±2, IC 14±3, p<.05), VI/VO2 (C -4±18 por ciento, IC 24±21 por ciento, p<.01), FC/VO2 (C -26±11 por ciento, IC 11±5 por ciento, p<.01), VI/DC (C 36±10 por ciento, 46±14, p<.05 por ciento) y FC/DC (C 18±8 por ciento, HF 29±11, p<.01). Durante ejercicio en hipoxia en el grupo IC, el NO disminuyó y los niveles de IL-6 y aldosterona aumentaron. Los niveles neurohormonales permanecieron inalterados en el grupo C. CONCLUSIÓN: La quimiosensibilidad central y la periférica durante el ejercicio están aumentadas en la IC y pueden modular estándares respiratorios, cronotrópicos cardíacos y actividad neurohormonal durante ejercicio.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Células Quimiorreceptoras/fisiologia , Teste de Esforço/métodos , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Neurotransmissores/sangue , Respiração , Ar , Hipóxia/fisiopatologia , Métodos Epidemiológicos , Descanso/fisiologia , Caminhada/fisiologia
7.
Arq Bras Cardiol ; 95(3): 381-91, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20721516

RESUMO

BACKGROUND: Heart failure (HF) is associated with resting increased peripheral and central chemosensitivity which may correlate with an increased ventilatory response to exercise. However, its sensitivity in HF during exercise was never really reported. OBJECTIVE: We tested if stimulation of central and peripheral chemoreceptors in HF patients could modulate ventilatory, chronotropic, and neurohormonal response during submaximal exercise. METHODS: We investigated central and peripheral chemosensitivity in 15 HF and 7 control (C) comparing response through three 6 minute walking tests conducted in a treadmill with : room air, hypoxia, and hypercapnia (in a randomic order). RESULTS: RR at room air C and HF was 17±2 and 22±2 (p<.0001); at hypoxia 17±1 and 23±2 (p<.02); at CO25% was 20±2 and 22±5 (p<.02). Tidal volume (TV) at room air was 1.25±0.17 and 1.08±0.19 (p<.01); at hypoxia 1.65±0.34 and 1.2±0.2 (p<.0001); at CO25% 1.55±0.46 and 1.29±0.39 (p<.0001). At rest the increment in HF was higher for VE (C 33±40%, HF 62±94%, p<.01), HR(C 7±10%, HF 10±10%, p<0.05) at rest. During hypoxia exercise increment in HF was higher for RR (C 1±4, HF 11±6,p<.05), HR (C 12±2, HF 14±3, p<.05), VE/VO2 (C -4±18%, HF 24±21%, p<.01), HR/VO2 (C -26±11%, HF 11±5%, p<.01), VE/WD (C 36±10%, 46±14, p<.05%) and HR/WD (C 18±8%, HF 29±11, p<.01). During HF hypoxia exercise NO reduced, and IL-6, aldosterone levels increased. Neurohormonal levels unchanged in C. CONCLUSION: Exercise peripheral and central chemosensitivity are increased in HF and may modulate respiratory pattern, cardiac chronotropic, and neurohormonal activity during exercise.


Assuntos
Células Quimiorreceptoras/fisiologia , Teste de Esforço/métodos , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Neurotransmissores/sangue , Respiração , Adulto , Ar , Métodos Epidemiológicos , Feminino , Humanos , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Descanso/fisiologia , Caminhada/fisiologia
9.
Arq Bras Cardiol ; 93(3): 312-5, 2009 Sep.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-19851661

RESUMO

A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.


Assuntos
Doença da Artéria Coronariana/patologia , Sífilis Cardiovascular/patologia , Adulto , Aorta Torácica/patologia , Humanos , Masculino
10.
Arq. bras. cardiol ; 93(3): 312-315, set. 2009. ilus
Artigo em Inglês, Espanhol, Português | LILACS | ID: lil-529180

RESUMO

Paciente de 27 anos, portador de sífilis terciária, manifestando isquemia miocárdica, com angina instável, secundária à oclusão do tronco da coronária esquerda. O diagnóstico foi confirmado pelos achados da sorologia e da patologia do fragmento da aorta.


A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.


Paciente de 27 años, portador de sífilis terciaria, manifestando isquemia miocárdica, con angina inestable, secundaria a la oclusión del tronco de la coronaria izquierda. El diagnóstico fue confirmado por los resultados de la serología y de la patología del fragmento de la aorta.


Assuntos
Adulto , Humanos , Masculino , Doença da Artéria Coronariana/patologia , Sífilis Cardiovascular/patologia , Aorta Torácica/patologia
15.
São Paulo; s.n; 2005. [178] p. ilus, tab, graf.
Tese em Português | LILACS | ID: lil-415058

RESUMO

A dispnéia na insuficiência cardíaca(IC) é complexa, com possível envolvimento de quimioreceptores periféricos(QP) e centrais(QC). Avaliamos a resposta de QP e QC no exercício submáximo em 15 pcts com IC e 7 ind. normais em testes ergoespirométricos de caminhada de 6 min: hipóxia isocápnica(HPX),hipercapnia hiperóxica(HPC) e ar ambiente. HPX aumentou ventilação (VE) com resposta aguda(RVA), freq. cardíaca(FC) e volume de O2 / Heart failure(HF) dyspnea is complex with potential enrolment of central(CC) and peripheric chemoreceptors(PC).We investigated CC and CP behavior through submaximal exercise in 15 HF patients and 7 normal subjects in treadmill 6-minute cardiopulmonary walking tests:isocapnic hypoxia(HPO), hypercapnia hyperoxic(HCP) and room air.HPO increased:ventilation(VE) with acute ventilatory response(AVR), heart rate (HR) and O2 uptake and reduced dead space...


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Células Quimiorreceptoras , Insuficiência Cardíaca/fisiopatologia , Exercício
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA