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2.
ESC Heart Fail ; 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33734611

RESUMO

AIMS: Despite of recent advances in the pharmacological treatment, heart failure (HF) maintains significant morbidity and mortality rates. While serum potassium disorders are common and associated with adverse outcomes, the exact recommended potassium level for patients with HF are not entirely established. We aimed to investigate the prognostic role of potassium levels on a cohort of patients with symptomatic chronic HF. METHODS AND RESULTS: Patients with symptomatic chronic HF were identified at the referral to 6 min walking test (6MWT) and were prospectively followed up for cardiovascular events. Clinical and laboratorial data were retrospectively obtained. The primary endpoint was the composite of cardiovascular death, hospitalization due to HF, and heart transplantation. The cohort included 178 patients with HF with the mean age of 51 ± 12.76 years, 39% were female, 85% of non-ischaemic cardiomyopathy, and 38% had New York Heart Association Class III with a relatively high Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score (12.91 ± 6.6). The mean left ventricular ejection fraction was 39.98 ± 15.79%, and the mean 6MWT distance was 353 ± 136 m. After a median follow-up of 516 days, there were 22 major cardiovascular events (4 cardiovascular deaths, 13 HF admissions, and 5 heart transplants). Patients were stratified according to cut-point level of serum potassium of 4.7 mmol/L to predict combined cardiac events based on receiver operating characteristic analysis. Individuals with higher potassium levels had worse renal function (glomerular filtration rate, K ≤ 4.7: 102.8 ± 32.2 mL/min/1.73 m2 vs. K > 4.7: 85.42 ± 36.2 mL/min/1.73 m2 , P = 0.004), higher proportion of New York Heart Association Class III patients (K ≤ 4.7: 28% vs. K > 4.7: 48%, P = 0.0029), and also higher MAGGIC score (K ≤ 4.7: 12.08 ± 5.7 vs. K > 4.7: 14.9 ± 7.9, P = 0.0089), without significant differences on the baseline pharmacological HF treatment. Both potassium levels [hazard ratio (HR) 4.26, 95% confidence interval (CI) 1.59-11.421, P = 0.003] and 6MWT distance (HR 0.99, 95% CI 0.993-0.999, P = 0.01) were independently associated with the primary outcome. After adjustments for MAGGIC score and 6MWT distance, potassium levels > 4.7 mmol/L maintained a significant association with outcomes (HR 3.57, 95% CI 1.305-9.807, P = 0.013). Patients with K > 4.7 mmol/L were more likely to present clinical events during the follow-up (log rank = 0.005). Adding potassium levels to the model including 6MWT and MAGGIC significantly improved the prediction of events over 2 years (integrated discrimination index 0.105, 95% CI 0.018-0.281, P = 0.012 and net reclassification index 0.447, 95% CI 0.077-0.703, P = 0.028). CONCLUSIONS: Potassium levels were independently associated with worse outcomes in patients with chronic symptomatic HF, also improving the accuracy model for prognostic prediction when added to MAGGIC score and 6MWT distance. The potassium levels above 4.7 mmol/L might identify those patients at an increased risk of cardiovascular events.

7.
Curr Treat Options Oncol ; 21(5): 36, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32328845

RESUMO

OPINION STATEMENT: Cardiac amyloidosis is associated with a high mortality rate, a long delay between the first signs and the diagnosis but a short interval between diagnosis and death. This scenario has changed recently due to improved disease awareness among doctors and significant progress in diagnosis thanks to multimodal imaging and a multidisciplinary approach. Therefore, during the last few years, we have had access to specific therapies for those patients. Those therapies are quite different depending on the type of amyloidosis, but there has been real progress. Systemic light chain amyloidosis (AL) with cardiac involvement is the most common form of cardiac amyloidosis. The severity of heart disease dictates the prognosis in AL amyloidosis. Advances in chemotherapy and immunotherapy that suppress light chain production have improved the outcomes. These recent improvements in survival rates have enabled therapies such as implanted cardiac defibrillators and heart transplantation that were usually not indicated for patients with advanced light chain amyloid cardiomyopathy to now be applied in selected patients. For transthyretin amyloidosis (ATTR), the second most common form of amyloidosis with cardiac involvement, there is also significant progress in treatment. Until recently, we had no specific therapy for ATTR cardiomyopathy (ATTR-CM), though now disease-modifying therapies are available. Therapies that stabilize transthyretin, such as tafamidis, have been shown to improve outcomes for patients with ATTR-CM. Modern treatments that stop the synthesis of TTR through gene silencing, such as patisiran and inotersen, have shown positive results for patients with TTR amyloidosis. Significant progress has been made in the treatment of amyloid cardiomyopathy, and hopefully, we will see even more progress with the spread of those treatments. We now can be optimistic about patients with this disease.

8.
Physiother Res Int ; 25(3): e1830, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31883223

RESUMO

BACKGROUND: Circulatory (CP) and ventilatory power (VP) have been used to improve the prognostic accuracy of cardiopulmonary exercise tests in cardiovascular disease, such as coronary artery disease. However, the effects of combined resistance and aerobic exercise program on VP and CP, especially in type 2 diabetes patients, have not been adequately investigated. Thus, this new parameter can be useful to prescribe exercise programs more assertive for this population. The present study aimed to assess the effect of 3 months of combined resistance and aerobic exercise training (CET) on CP and VP in patients with type 2 diabetes. METHODS: A randomized controlled trial was conducted involving 48 diabetic patients with an average age of 52.4 (±8.01) years old. The subjects were randomized into two groups: sedentary (SG, n = 15) and the CET group (n = 19). Cardiopulmonary exercise testing (symptom-limited incremental) was performed on a cycle ergometer, and the following parameters were measured: relative VO2 , VE /VCO2 slope, linear relationship between oxygen uptake and minute ventilation, and VCO2 . CET was performed with 30-min aerobic and 30-min resistance exercises three times a week for 12 weeks. RESULTS: Significant (p < .05) and clinical (d ≥ .80) differences were observed that favoured CET compared with SG for the following variables: heart rate, workload, VO2 relative peak, circulatory power peak, and VCO2 peak. Although no statistical difference was observed for ventilatory power, there was a clinical difference (p > .05 and d ≥ 0.80) that favoured CET. CONCLUSION: Three months of combined exercise training improved VP and CP indices in patients with type 2 diabetes when compared with a sedentary group.

10.
Clin Nutr ESPEN ; 32: 145-152, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31221280

RESUMO

BACKGROUND: We tested the hypothesis that a normal sodium diet could be associated with preservation of serum sodium during treatment of acute decompensated heart failure (ADHF). METHODS AND RESULTS: Forty-four patients hospitalized for ADHF were blindly randomized by using block method to a low sodium diet (LS: 3 g/day of dietary sodium chloride; n = 22, 59.5 ± 11.9 y.o., 50% males. LVEF = 30.0 ± 13.6%); and a normal sodium diet (NS: 7 g/day; n = 22, 56.4 ± 10.3 y.o., 68% males; LVEF = 27.8 ± 11.7%), and both groups were submitted to fluid restriction of 1.000 mL/day. At the 7th day of intervention 16 patients of LS group and 15 patients of NS group were assessed for difference in serum sodium. Both groups had equivalent decongestion, reflected by similar percent reduction of body weight (LS: -5.0 ± 4.7% vs NS: -4.5 ± 5.2%. p = 0.41). Reduction of the N terminal fragment of type B natriuretic peptide (NT-proBNP) was significant only in the NS (-1497.0 [-18843.0 - 1191.0]. p = 0.04). The LS group showed lower levels of serum sodium (135.4 ± 3.5 mmol/L) compared to the NS group (137.5 ± 1.9 mmol/L; p = 0.04). Four cases of hyponatremia were observed only in the LS group (22%). The NS group exhibited higher mean blood pressure values (79.4 ± 2.4 mmHg vs 75.5 ± 3.0 mmHg. p = 0.03), and lower heart rate (73.2 ± 1.6 bpm vs 75.5 ± 2.1 bpm. p = 0.02). CONCLUSIONS: These results suggest that a normal sodium diet, when compared to a low sodium diet, is associated with similar degrees of decongestion, but with higher levels of natremia, blood pressure and lower neurohormonal activation during ADHF treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier no. NCT03722069.


Assuntos
Dieta Hipossódica , Insuficiência Cardíaca/terapia , Sódio/sangue , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
Q J Nucl Med Mol Imaging ; 63(3): 302-310, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28299921

RESUMO

BACKGROUND: Patients with primary microvascular angina (PMA) commonly exhibit abnormal left ventricular function (LVF) during exercise, potentially owing to myocardial ischemia. Herein, we investigated in PMA patients the effect of the reduction of myocardial perfusion disorders, by using aerobic physical training, upon LVF response to exercise. METHODS: Overall, 15 patients (mean age, 53.7±8.9 years) with PMA and 15 healthy controls (mean age, 51.0±9.4 years) were studied. All subjects were subjected to baseline resting and exercise ventriculography, myocardial perfusion scintigraphy (MPS), and cardiopulmonary testing. PMA group members then participated in a 4-month physical training program and were reevaluated via the same methods applied at baseline. RESULTS: Baseline left ventricular ejection fraction (LVEF) determinations by ventriculography were similar for both groups (PMA, 67.7±10.2%; controls, 66.5±5.4%; P=0.67). However, a significant rise in LVEF seen in control subjects during exercise (75.3±6.2%; P=0.0001) did not materialize during peak exercise in patients with PMA (67.7±10.2%; P=0.47). Of the 12 patients in the PMA group who completed the training program, 10 showed a significant reduction in reversible perfusion defects during MPS. Nevertheless, LVEF at rest (63.5±8.7%) and at peak exercise (67.3±15.9%) did not differ significantly (P=0.30) in this subset. CONCLUSIONS: In patients with PMA, reduced left ventricular inotropic reserve observed during exercise did not normalize after improving myocardial perfusion through aerobic physical training.


Assuntos
Exercício Físico , Angina Microvascular/diagnóstico por imagem , Angina Microvascular/fisiopatologia , Imagem de Perfusão do Miocárdio , Função Ventricular Esquerda , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventriculografia com Radionuclídeos , Estudos Retrospectivos
12.
Arq Bras Cardiol ; 111(3): 436-539, 2018 09.
Artigo em Português | MEDLINE | ID: mdl-30379264
13.
Pediatr Exerc Sci ; 30(2): 251-258, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29485935

RESUMO

PURPOSE: We analyzed the evolution and pattern of heart rate (HR) during the 12-minute wheelchair propulsion field test (WPFT) and compared the peak HR (HRpeak) from the WPFT to the HRpeak obtained in the progressive cardiopulmonary exercise test on arm cranking ergometer (ACT). We aimed to determine if the field test detects the HRpeak consistently and could be used in clinical practice. METHODS: Eleven wheelchair-using children and adolescents with myelomeningocele (aged 8-15 y) performed a maximal ACT and a 12-minute WPFT. HR was recorded continuously at rest, during each minute of the tests, and at recovery. Mixed analysis of variance was used to compare the variables at rest and peak. Bland-Altman plot and Lin's concordance correlation coefficient were used to show agreement between the tests. RESULTS: During minute 2 of the WPFT, participants reached 73%-96% of the HRpeak values recorded in the ACT. From minutes 4 to 12, participants reached HRpeak values ranging 86%-109% of the values recorded in the ACT. There is agreement between the ACT and the WPFT tests. CONCLUSION: WPFT with minimal duration of 4 minutes may be an alternative tool to obtain HRpeak in children and adolescents with myelomeningocele.


Assuntos
Frequência Cardíaca , Meningomielocele/fisiopatologia , Cadeiras de Rodas , Adolescente , Criança , Ergometria , Teste de Esforço , Feminino , Humanos , Masculino
16.
Mayo Clin Proc ; 92(3): 460-466, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28259231

RESUMO

The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death. At autopsy, a pseudotumoral form of ZIKV meningoencephalitis was confirmed. Zika virus infection was documented by reverse trancriptase-polymerase chain reaction, immunohistochemistry, and immunofluorescence and electron microscopy of the brain parenchyma and cerebral spinal fluid. The sequencing of the viral genome in this patient confirmed a Brazilian ZIKV strain. In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.


Assuntos
Transplante de Coração/efeitos adversos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Meningoencefalite/virologia , Infecção por Zika virus/complicações , Zika virus/isolamento & purificação , Doença Aguda , Adulto , Líquido Cefalorraquidiano/virologia , Evolução Fatal , Imunofluorescência/métodos , Genoma Viral , Humanos , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/imunologia , Neuroimagem , Tecido Parenquimatoso/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Zika virus/genética , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/imunologia
17.
Heart Fail Clin ; 11(1): 73-82, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25432475

RESUMO

Heart failure (HF) is an important public health issue in South America. Economic impacts are substantial. Chagas heart disease is a prevalent HF etiology; it is caused by the protozoan Trypanosoma cruzi. Cardiac rehabilitation (CR) is an integral component of HF care. The benefits of CR in HF patients need to be assessed. The effectiveness and safety of CR delivery, such as home-based interventions, should be explored. Strategies to improve adherence in CR are imperative. We describe past and current CR trends for HF patients and discuss the future of this important intervention.


Assuntos
Terapia por Exercício/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/reabilitação , Humanos , Morbidade/tendências , América do Sul/epidemiologia
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 22(4): 15-24, out.-dez. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-684199

RESUMO

A Insuficiência Cardíaca (IC) refratária pode ser definida como uma condição clínica crônica, como sintomas limitantes, acentuando comprometimento hemodinâmico e elevada mortalidade. Nesse contexto, a disfunção Ventricular Direita (VD)pode ser um aspecto clínico saliente, comumente dominando o quadro clínico. Em contraste com a falência ventricular esquerda, a disfunção do VD permanece praticamente ignorada, com escassas orientações em diretrizes para o manejo dessa condição clínica. Um dos mais importantes fatores determinantes da disfunção ventricular direita neste cenário é o aumento da pós-carga ventricular direita devido à hipertensão arterial pulmonar, que, por sua vez, é secundária à congestão pulmonar venosa crônica atribuída à falência ventricular esquerda. Essa disfunção de VD possui forte correlação com aumento da mortalidade. Apesar da falta de recomendações nas diretrizes, é um conceito embasado em aspectos clínicos e fisiopatológicos que o tratamento otimizado da IC esquerda é o primeiro passo necessário no manejo da disfunção do VD. Não existe terapia especificamente direcionada para o tratamento da insuficiência cardíaca direita, mas a terapêutica recomendada para o tratamento da disfunção do VE promove redução da pressão capilar pulmonar, da pressão da artéria pulmonar e consequente melhora da disfunção do VD, sendo estes pontos mais efetivos do tratamento. O racional do tratamento da disfunção do VD contempla três elementos da fisiologia cardiovascular: a pré-carga, a contratilidade e a pós-carga. Além disso, novas alternativas terapêuticas têm emergido, como inibidores de fosfodiesterase-5, terapia de ressincronização e dispositivos de assistência ventricular, mas que ainda carecem de estudos mais amplos para a implementação na prática clínica.


Advanced Heart Failure (HF) can be defined as a chronic medical, conditions, whit limiting symptons, severe hemodynamic impairment and high mortality. In this context, the Right Ventricular (RV) dysfunction can be a salient clinical aspect, and commonly dominate the clinical scenario. In contrast to left ventricular failure, RV dysfunction remains largely ignored, with little recommendations in the guidelines for the management of this conditions. one of the most important determinats of right ventricular dysfunction in this scenario is the increased right ventricular afterload due to pulmonary arterial hypertension, which is secondary to chronic pulmonary venous congestion attribuited to left ventricular failure. This form of RV dysfunction is strongly carrelated with increased mortality. Despite the lack of recommendations in the guidelines, it is a concept based on clinical and pathophysiological aspects that optimal treatment of left ventricular failure is the first necessary step in the management of RV failure. There is no specifically targeted for the treatment of right heart failure, but the recommended therapy for the treatment of LV dysfunction causes a reduction in pulmonary capillary wedge pressure, pulmonary artery pressure and consequent improvement in RV dysfunction, which are the most effective points of the treatment of RV dysfunction has three elements of cardiovascular physiology: the preload, contractility and afterload. Furthermore, new therapieshave recently emerged such as phosphodiesterase-5 inhibitors, cardiac resynchronization therapy and ventricular assist devices, but they still require further studies for implementation in clinical practice.


Assuntos
Humanos , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Ecocardiografia/métodos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Radiografia/métodos , Radiografia
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