Silvia Marinho Martins

Chest wall regional volume in heart failure patients during inspiratory loaded breathing.

Were evaluated individuals divided into two groups: we studied chronic heart failure (CHF) (19 patients with CHF plus cardiomegaly) and control (12 healthy volunteers) during performance of inspiratory loaded breathing (ILB). We evaluated: spirometry, functional capacity through the six-minute walk test (6MWT), and distribution of thoracoabdominal volumes via optoelectronic plethysmography (OEP), namely volume variations of pulmonary rib cage (Vrc,p), abdominal rib cage (Vrc,a), and abdomen (Vab). In each compartment, the percentage contributions of right and left sides were also calculated. During ILB, patients with heart failure were characterized by a significant reduction of the Vrc,a volume variations compared to the control group. Correlations were found between left %Vrc,a on the left side measured during ILB and left ventricular ejection fraction (r=0.468; p=0.049), and dyspnea after the 6MWT (r=-0.878; p<0.01).Then, patients with CHF and cardiomegaly are characterized by a reduced mobility in left part of the lower part of the rib cage, that contributes leading to increased perception of dyspnea during submaximal exercise.

Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

Background Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score. Methods This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76). Conclusions CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

Manejo não farmacológico de pacientes com insuficiência cardíaca descompensada: estudo multicêntrico - EMBRACE

Objective: To identify the prescription and execution of non-pharmacological care in the medical or nursing prescriptions in three reference centers for the treatment of patients with heart failure. Methods: A study using a quantitative, cross-sectional approach of a multicenter cohort. It included: patients admitted for decompensated heart failure, New York Heart Association function III / IV; any etiology; age of 18 years or older; and both genders. Results: The study included 562 patients; among non-pharmacological care, salt restriction was the most prescribed (95.4%), followed by the control of diuresis (48%). The proportion of treatment prescribed and performed was higher in the third, and in the other two centers the difference between the prescribed and the performed was higher than 20%. Conclusions: Non-pharmacological care interventions are not fully incorporated into clinical practice. Strategies that can mobilize the multidisciplinary team with a view to the interventions and achievements of this care merit study.

Non-pharmacological management of patients with decompensated heart failure: a multicenter study - EMBRACE

Objective: To identify the prescription and execution of non-pharmacological care in the medical or nursing prescriptions in three reference centers for the treatment of patients with heart failure. Methods: A study using a quantitative, cross-sectional approach of a multicenter cohort. It included: patients admitted for decompensated heart failure, New York Heart Association function III / IV; any etiology; age of 18 years or older; and both genders. Results: The study included 562 patients; among non-pharmacological care, salt restriction was the most prescribed (95.4%), followed by the control of diuresis (48%). The proportion of treatment prescribed and performed was higher in the third, and in the other two centers the difference between the prescribed and the performed was higher than 20%. Conclusions: Non-pharmacological care interventions are not fully incorporated into clinical practice. Strategies that can mobilize the multidisciplinary team with a view to the interventions and achievements of this care merit study.

Fatores precipitantes de descompensação da insuficiência cardíaca relacionados a adesão ao tratamento: estudo multicêntrico-EMBRACE

OBJECTIVE To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment. METHODS Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment. RESULTS A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment. CONCLUSION The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.Objetivo: Descrever os fatores precipitantes de descompensacao da insuficiencia cardiaca entre pacientes aderentes e nao aderentes ao tratamento. Metodos: Estudo transversal de uma coorte multicentrica. Pacientes acima de 18 anos com insuficiencia cardiaca descompensada (classe funcional III/IV) foram elegiveis. Para a coleta dos dados foi utilizado um questionario estruturado avaliando os motivos da descompensacao. O uso irregular de medicacao previo a internacao, controle inadequado de sal e liquidos foram considerados como grupo de ma adesao ao tratamento. Resultados: Foram incluidos 556 pacientes, com idade media de 61±14 anos, 362(65%) homens. O principal fator de descompensacao foi a ma adesao, representando 55% da amostra. Os pacientes que referiram o uso irregular das medicacoes na ultima semana apresentaram 22% mais risco de internacao por ma adesao quando comparados aos pacientes aderentes. Conclusao: O estudo EMBRACE demonstrou que em pacientes com insuficiencia cardiaca, a ma adesao mostrou-se como o principal fator de exacerbacao. Palavras-chave: Insuficiencia cardiaca. Estudo multicentrico. Fatores desencadeantes.

Obstructive Sleep Apnea is Common and Associated with Heart Remodeling in Patients with Chagas Disease

Background Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (β = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions OSA is independently associated with atrial and ventricular remodeling in patients with CD.

Noninvasive Ventilation Before Maximum Exercise Test Increases Exercise Tolerance in Subjects With Heart Failure: A Crossover Study

OBJECTIVE To evaluate the effect of noninvasive ventilation (NIV) on exercise performance in individuals with heart failure (HF). DESIGN Crossover, blind, randomized controlled trial with allocation concealment. SETTING University-based research laboratory. PARTICIPANTS Participants (N=24) with New York Heart Association class II and III left heart failure and with a mean age of 51.8±10.2 years (women: n=8; men: n=16). INTERVENTIONS Ventilatory support attached to the face of the individual via a facemask prior to cardiopulmonary exercise test (CPET) was administered at 2 pressure levels for 30 minutes. Inspiratory pressure of 15cmH2O and expiratory pressure of 5cmH2O were applied. MAIN OUTCOME MEASURES Maximal oxygen uptake, maximum heart rate, variation between the initial and maximum heart rates, CPET duration, and recovery time oxygen consumption. RESULTS Differences were observed in maximal oxygen consumption (nonintervention phase: 18.3±4.4mL·kg-1·min-1 vs NIV phase: 20.6±4.9mL·kg-1·min-1, P=.01), heart rate (nonintervention phase: 127.3±20.9 beats per minute vs NIV phase: 134.7±19.5 beats per minute, P=.04), and heart rate variation (nonintervention phase: 63.3%±19.3% vs NIV phase: 69.7%±16.6%, P=.02). Moreover, differences in cardiopulmonary exercise time (nonintervention phase: 7.4±1.5min vs NIV phase: 8.3±1.7min, P=.01) and oxygen consumption recovery time (nonintervention phase: 2.8±1.0min vs NIV phase: 2.4±0.8min, P=.01) were observed. CONCLUSIONS NIV elicited beneficial effects in the HF population that included increased exercise tolerance, recovery time optimization, and improved chronotropic and respiratory reserves.

Manejo no farmacológico de pacientes con insuficiencia cardíaca descompensada: estudio multicéntrico - EMBRACE

Objective: To identify the prescription and execution of non-pharmacological care in the medical or nursing prescriptions in three reference centers for the treatment of patients with heart failure. Methods: A study using a quantitative, cross-sectional approach of a multicenter cohort. It included: patients admitted for decompensated heart failure, New York Heart Association function III / IV; any etiology; age of 18 years or older; and both genders. Results: The study included 562 patients; among non-pharmacological care, salt restriction was the most prescribed (95.4%), followed by the control of diuresis (48%). The proportion of treatment prescribed and performed was higher in the third, and in the other two centers the difference between the prescribed and the performed was higher than 20%. Conclusions: Non-pharmacological care interventions are not fully incorporated into clinical practice. Strategies that can mobilize the multidisciplinary team with a view to the interventions and achievements of this care merit study.