Cristiano Gonçalves Cruz

Suporte ventilatório na capacidade funcional de pacientes com insuficiência cardíaca: estudo piloto

BACKGROUND Heart failure (HF) is an important public health problem, of which main clinical symptoms are dyspnea and fatigue. Noninvasive ventilatory support has been used as adjuvant therapy in cardiac rehabilitation in order to improve the functional capacity of patients. OBJECTIVE To evaluate the functional capacity of patients with HF submitted to ventilatory support. METHODS We evaluated the sociodemographic information, as well as data on quality of life, blood pressure (BP), peripheral oxygen saturation (SpO2), dyspnea, lactate concentration before and after the 6-minute walk test (6MWT) and the distance walked by patients of both sexes with chronic heart failure (CHF), with left ventricular ejection fraction (LVEF) < 45.0% , randomized in two groups: control and CPAP (the group used CPAP - 10 cmH2O for 30 minutes). RESULTS A total of 12 patients, of which 8 were males, with CHF functional class II and III (NYHA) participated in the study. The patients had mean LVEF of 35.3 ± 8.7 and mean age was 46.3 ± 10.3 years. When comparing the control group with the CPAP group at the end of the 6th minute, there was a significant difference between the groups regarding SpO2 values ( CONTROL 93.6 ± 1.5 % vs CPAP: 96.1±1.8%; p = 0.027), index of dyspnea ( CONTROL 13.1 ± 1.16 vs CPAP: 11 ± 0.8; p = 0.009), lactate concentration ( CONTROL 3.3 ± 0.7 mmol/l vs CPAP: 2.3 ± 0.5 mmol/l; p = 0.025) and distance walked at the 6MWT (CONTROL: 420.6 ± 73.8 m vs CPAP: 534 ± 89.91 m; p = 0.038). CONCLUSION The previous use of the CPAP had beneficial effects on SpO2, index of dyspnea, lactate concentration, double product and the distance walked at the 6MWT in patients with CHF when performing the 6MWT.FUNDAMENTO: A insuficiencia cardiaca e um importante problema de saude publica, apresentando a dispneia e a fadiga como principais sintomas clinicos. A utilizacao do suporte ventilatorio nao invasivo vem atuando como coadjuvante da reabilitacao cardiaca na tentativa de melhorar a capacidade funcional dos pacientes. OBJETIVO: Avaliar a capacidade funcional de pacientes com insuficiencia cardiaca submetidos ao suporte ventilatorio. METODOS: Foram avaliados dados sociodemograficos, qualidade de vida, FC, pressao arterial (PA), saturacao periferica de oxigenio (SpO2), dispneia, concentracao de lactato, antes e depois do teste de caminhada de 6 minutos, e a distância percorrida de pacientes com insuficiencia cardiaca cronica (ICC), de ambos os sexos, com fracao FEVE < 45,0%, randomizados em dois grupos: controle e CPAP (utilizou CPAP 10 cmH2O por 30 minutos). RESULTADOS: Participaram 12 pacientes com ICC classe funcional II e III (NYHA), com media de fracao de ejecao do ventriculo esquerdo (FEVE, %) de 35,3 ± 8,7, sendo que 8 eram do sexo masculino. A media de idade foi de 46,3 ± 10,3 anos. Na comparacao entre os grupos Controle e CPAP, no final do 6o min, foi encontrada diferenca significativa nos valores de SpO2% entre os grupos (Controle: 93,6 ± 1,5 % vs CPAP: 96,1 ± 1,8%; p = 0,027), dispneia (Controle: 13,1 ± 1,16 vs CPAP: 11 ± 0,8; p = 0,009), concentracao de lactato (Controle: 3,3 ± 0,7 mmol/l vs CPAP: 2,3 ± 0,5 mmol/l; p = 0,025), e distância percorrida no TC6 (Controle: 420,6 ± 73,8 m vs CPAP: 534 ± 89,91 m; p = 0,038). CONCLUSAO: A realizacao previa do CPAP apresentou efeitos beneficos na SpO2, na dispneia, na concentracao de lactato, no duplo produto e na distância percorrida no TC6 de pacientes com ICC na realizacao do TC6.

Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

Background Aging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology. Methodology/Principal Findings We performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients. Conclusions/Significance Chagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies.

Effect of ventilatory support on functional capacity in patients with heart failure: a pilot study

BACKGROUND Heart failure (HF) is an important public health problem, of which main clinical symptoms are dyspnea and fatigue. Noninvasive ventilatory support has been used as adjuvant therapy in cardiac rehabilitation in order to improve the functional capacity of patients. OBJECTIVE To evaluate the functional capacity of patients with HF submitted to ventilatory support. METHODS We evaluated the sociodemographic information, as well as data on quality of life, blood pressure (BP), peripheral oxygen saturation (SpO2), dyspnea, lactate concentration before and after the 6-minute walk test (6MWT) and the distance walked by patients of both sexes with chronic heart failure (CHF), with left ventricular ejection fraction (LVEF) < 45.0% , randomized in two groups: control and CPAP (the group used CPAP - 10 cmH2O for 30 minutes). RESULTS A total of 12 patients, of which 8 were males, with CHF functional class II and III (NYHA) participated in the study. The patients had mean LVEF of 35.3 ± 8.7 and mean age was 46.3 ± 10.3 years. When comparing the control group with the CPAP group at the end of the 6th minute, there was a significant difference between the groups regarding SpO2 values ( CONTROL 93.6 ± 1.5 % vs CPAP: 96.1±1.8%; p = 0.027), index of dyspnea ( CONTROL 13.1 ± 1.16 vs CPAP: 11 ± 0.8; p = 0.009), lactate concentration ( CONTROL 3.3 ± 0.7 mmol/l vs CPAP: 2.3 ± 0.5 mmol/l; p = 0.025) and distance walked at the 6MWT (CONTROL: 420.6 ± 73.8 m vs CPAP: 534 ± 89.91 m; p = 0.038). CONCLUSION The previous use of the CPAP had beneficial effects on SpO2, index of dyspnea, lactate concentration, double product and the distance walked at the 6MWT in patients with CHF when performing the 6MWT.FUNDAMENTO: A insuficiencia cardiaca e um importante problema de saude publica, apresentando a dispneia e a fadiga como principais sintomas clinicos. A utilizacao do suporte ventilatorio nao invasivo vem atuando como coadjuvante da reabilitacao cardiaca na tentativa de melhorar a capacidade funcional dos pacientes. OBJETIVO: Avaliar a capacidade funcional de pacientes com insuficiencia cardiaca submetidos ao suporte ventilatorio. METODOS: Foram avaliados dados sociodemograficos, qualidade de vida, FC, pressao arterial (PA), saturacao periferica de oxigenio (SpO2), dispneia, concentracao de lactato, antes e depois do teste de caminhada de 6 minutos, e a distância percorrida de pacientes com insuficiencia cardiaca cronica (ICC), de ambos os sexos, com fracao FEVE < 45,0%, randomizados em dois grupos: controle e CPAP (utilizou CPAP 10 cmH2O por 30 minutos). RESULTADOS: Participaram 12 pacientes com ICC classe funcional II e III (NYHA), com media de fracao de ejecao do ventriculo esquerdo (FEVE, %) de 35,3 ± 8,7, sendo que 8 eram do sexo masculino. A media de idade foi de 46,3 ± 10,3 anos. Na comparacao entre os grupos Controle e CPAP, no final do 6o min, foi encontrada diferenca significativa nos valores de SpO2% entre os grupos (Controle: 93,6 ± 1,5 % vs CPAP: 96,1 ± 1,8%; p = 0,027), dispneia (Controle: 13,1 ± 1,16 vs CPAP: 11 ± 0,8; p = 0,009), concentracao de lactato (Controle: 3,3 ± 0,7 mmol/l vs CPAP: 2,3 ± 0,5 mmol/l; p = 0,025), e distância percorrida no TC6 (Controle: 420,6 ± 73,8 m vs CPAP: 534 ± 89,91 m; p = 0,038). CONCLUSAO: A realizacao previa do CPAP apresentou efeitos beneficos na SpO2, na dispneia, na concentracao de lactato, no duplo produto e na distância percorrida no TC6 de pacientes com ICC na realizacao do TC6.

Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados

BACKGROUND Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p <0.001) and renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

Addition of non-invasive ventilatory support to combined aerobic and resistance training improves dyspnea and quality of life in heart failure patients: a randomized controlled trial:

Objective: To test the hypothesis that combined aerobic and resistance training and non-invasive ventilatory support result in additional benefits compared with combined aerobic and resistance training alone in heart failure patients. Design: A randomized, single-blind, controlled study. Setting: Cardiac rehabilitation center. Participants: A total of 46 patients with New York Heart Association class II/III heart failure were randomly assigned to a 10-week program of combined aerobic and resistance training, plus non-invasive ventilatory support (n = 23) or combined aerobic and resistance training alone (n = 23). Methods: Before and after intervention, results for the following were obtained: 6-minute walk test, forced vital capacity, forced expiratory volume at one second, maximal inspiratory muscle pressure, and maximal expiratory muscle pressure, with evaluation of dyspnea by the London Chest Activity of Daily Living scale, and quality of life with the Minnesota Living With Heart Failure questionnaire. Results: Of the 46 included patients, 40 completed the protocol. The combined aerobic and resistance training plus non-invasive ventilatory support, as compared with combined aerobic and resistance training alone, resulted in significantly greater benefit for dyspnea (mean change: 4.8 vs. 1.3, p = 0.004), and quality of life (mean change: 19.3 vs. 6.8, p = 0.017). In both groups, the 6-minute walk test improved significantly (mean change: 45.7 vs. 44.1, p = 0.924), but without a statistically significant difference. Conclusion: Non-invasive ventilatory support combined with combined aerobic and resistance training provides additional benefits for dyspnea and quality of life in moderate heart failure patients. Trial registration: ClinicalTrials.gov identifier: NCT02384798. Registered 03 April 2015.

Neuromuscular electrical stimulation in a patient with chronic heart failure due to chagas disease: a case report

A 65-year-old sedentary male patient with 10 years ofCHF symptoms due to Chagas disease was referred to theDepartment of Cardiac Rehabilitation of the Ana NeriHospital - UFBA in August of 2009. The diagnosis of Chagasdisease was defined by the positive result of two serologicaltests [indirect immunofluorescence and enzyme-linkedimmunosorbent assay (ELISA)]. To exclude the possibilityof an ischemic heart disease, the patient underwent cardiaccatheterization, followed by angiography. The studiedpatient was in New York Heart Association (NYHA)functional class IV and had a left ventricular ejectionfraction of 40%. An evaluation of patient exercise capacityby a cardiopulmonary exercise test was initially attempted;however, the patient could not tolerate the testing becauseof excessive fatigue in the first minute of the exam. Instead,a six-minute walking test in a 30-m corridor was performedto evaluate the patient’s exercise capacity. For this test,previously standardized instructions were followed.

Soporte ventilatorio en la capacidad funcional de pacientes con insuficiencia cardiaca: estudio piloto

BACKGROUND Heart failure (HF) is an important public health problem, of which main clinical symptoms are dyspnea and fatigue. Noninvasive ventilatory support has been used as adjuvant therapy in cardiac rehabilitation in order to improve the functional capacity of patients. OBJECTIVE To evaluate the functional capacity of patients with HF submitted to ventilatory support. METHODS We evaluated the sociodemographic information, as well as data on quality of life, blood pressure (BP), peripheral oxygen saturation (SpO2), dyspnea, lactate concentration before and after the 6-minute walk test (6MWT) and the distance walked by patients of both sexes with chronic heart failure (CHF), with left ventricular ejection fraction (LVEF) < 45.0% , randomized in two groups: control and CPAP (the group used CPAP - 10 cmH2O for 30 minutes). RESULTS A total of 12 patients, of which 8 were males, with CHF functional class II and III (NYHA) participated in the study. The patients had mean LVEF of 35.3 ± 8.7 and mean age was 46.3 ± 10.3 years. When comparing the control group with the CPAP group at the end of the 6th minute, there was a significant difference between the groups regarding SpO2 values ( CONTROL 93.6 ± 1.5 % vs CPAP: 96.1±1.8%; p = 0.027), index of dyspnea ( CONTROL 13.1 ± 1.16 vs CPAP: 11 ± 0.8; p = 0.009), lactate concentration ( CONTROL 3.3 ± 0.7 mmol/l vs CPAP: 2.3 ± 0.5 mmol/l; p = 0.025) and distance walked at the 6MWT (CONTROL: 420.6 ± 73.8 m vs CPAP: 534 ± 89.91 m; p = 0.038). CONCLUSION The previous use of the CPAP had beneficial effects on SpO2, index of dyspnea, lactate concentration, double product and the distance walked at the 6MWT in patients with CHF when performing the 6MWT.FUNDAMENTO: A insuficiencia cardiaca e um importante problema de saude publica, apresentando a dispneia e a fadiga como principais sintomas clinicos. A utilizacao do suporte ventilatorio nao invasivo vem atuando como coadjuvante da reabilitacao cardiaca na tentativa de melhorar a capacidade funcional dos pacientes. OBJETIVO: Avaliar a capacidade funcional de pacientes com insuficiencia cardiaca submetidos ao suporte ventilatorio. METODOS: Foram avaliados dados sociodemograficos, qualidade de vida, FC, pressao arterial (PA), saturacao periferica de oxigenio (SpO2), dispneia, concentracao de lactato, antes e depois do teste de caminhada de 6 minutos, e a distância percorrida de pacientes com insuficiencia cardiaca cronica (ICC), de ambos os sexos, com fracao FEVE < 45,0%, randomizados em dois grupos: controle e CPAP (utilizou CPAP 10 cmH2O por 30 minutos). RESULTADOS: Participaram 12 pacientes com ICC classe funcional II e III (NYHA), com media de fracao de ejecao do ventriculo esquerdo (FEVE, %) de 35,3 ± 8,7, sendo que 8 eram do sexo masculino. A media de idade foi de 46,3 ± 10,3 anos. Na comparacao entre os grupos Controle e CPAP, no final do 6o min, foi encontrada diferenca significativa nos valores de SpO2% entre os grupos (Controle: 93,6 ± 1,5 % vs CPAP: 96,1 ± 1,8%; p = 0,027), dispneia (Controle: 13,1 ± 1,16 vs CPAP: 11 ± 0,8; p = 0,009), concentracao de lactato (Controle: 3,3 ± 0,7 mmol/l vs CPAP: 2,3 ± 0,5 mmol/l; p = 0,025), e distância percorrida no TC6 (Controle: 420,6 ± 73,8 m vs CPAP: 534 ± 89,91 m; p = 0,038). CONCLUSAO: A realizacao previa do CPAP apresentou efeitos beneficos na SpO2, na dispneia, na concentracao de lactato, no duplo produto e na distância percorrida no TC6 de pacientes com ICC na realizacao do TC6.