Heart Rate Recovery in the First Minute at the Six-Minute Walk Test in Patients with Heart Failure

Fundamento: A frequência cardíaca de recuperação no primeiro minuto (FCR1) é um preditor de mortalidade na insuficiência cardíaca (IC), mas seu prognóstico não foi avaliado no teste de caminhada de seis minutos (TC6M) nesses pacientes. Objetivo: Esse estudo teve como objetivo determinar a FCR1 no TC6M em pacientes com IC e sua correlação com a distância percorrida em seis minutos (DP6M). Métodos: Protocolo controlado, transversal, com 161 indivíduos, 126 pacientes com IC sistólica estável, divididos em dois grupos (G1 e G2), que receberam ou não β-bloqueador e 35 voluntários no grupo controle (G3) que tiveram a FCR1 registrada no TC6M. Resultados: A FCR1 e a DP6M foram significativamente diferentes nos três grupos. Os valores médios de FCR1 e DP6M foram: FCR1 = 12 ± 14 bpm G1, 18 ± 16 bpm G2 e 21 ± 13 bpm G3; DP6M = 423 ± 102 m G1, G2 396 ± 101 m e 484 ± 96 m G3 (p < 0,05). Os resultados demonstraram uma correlação entre FCR1 e DP6M no G1 (r = 0,3, p = 0,04) e G3 (r = 0,4, p = 0,03), mas não em G2 (r = 0,12, p = 0,48). Conclusão: A resposta da FCR1 foi atenuada em pacientes em uso de βB e mostrou correlação com o TC6M, refletindo uma melhor tolerância ao exercício. A FCR1 após a DP6M parece representar uma alternativa quando os testes de esforço na esteira não são tolerados

Efeito Agudo da Pressao Positiva Continua sobre a Pressao de Pulso na Insuficiencia Cardiaca Cronica

Fundamento: Pacientes com insufici&#234;ncia card&#237;aca (IC) apresentam disfun&#231;&#227;o ventricular esquerda e redu&#231;&#227;o da press&#227;o arterial m&#233;dia (PAM). O aumento do est&#237;mulo adren&#233;rgico causa vasoconstri&#231;&#227;o e resist&#234;ncia dos vasos, mantendo a PAM, enquanto aumenta a resist&#234;ncia vascular perif&#233;rica e a rigidez dos vasos condutores. O aumento da press&#227;o de pulso (PP) reflete a complexa intera&#231;&#227;o do cora&#231;&#227;o com os sistemas arteriais e venosos. O aumento da PP &#233; um importante marcador de risco em pacientes com insufici&#234;ncia card&#237;aca cr&#244;nica (ICC). A ventila&#231;&#227;o n&#227;o invasiva (VNI) tem sido utilizada para IC aguda descompensada para melhorar a congest&#227;o e a ventila&#231;&#227;o pelos efeitos respirat&#243;rios e hemodin&#226;micos. No entanto, nenhum desses estudos relatou o efeito da VNI na PP. Objetivo: O objetivo deste estudo foi determinar os efeitos agudos da VNI com CPAP (press&#227;o positiva cont&#237;nua nas vias a&#233;reas) sobre a PP em pacientes ambulatoriais com ICC. M&#233;todos: Seguindo um protocolo randomizado, duplo-cego, cruzado e controlado com placebo, 23 pacientes com ICC (17 homens, 60 &#177; 11 anos, IMC 29 &#177; 5 kg/cm2, classes II e III da NYHA) foram submetidos &#224; CPAP via m&#225;scara nasal durante 30 minutos na posi&#231;&#227;o reclinada. A press&#227;o da m&#225;scara foi de 6 cmH2O, enquanto o placebo foi fixado em 0-1 cmH2O. PP e outras vari&#225;veis hemodin&#226;micas n&#227;o invasivas foram avaliadas antes, durante e depois do placebo e do modo CPAP. Resultados: A CPAP diminuiu a frequ&#234;ncia card&#237;aca de repouso (pr&#233;: 72 &#177; 9; p&#243;s 5 min: 67 &#177; 10 bpm , p < 0,01) e PAM (CPAP: 87 &#177; 11; controle 96 &#177; 11 mmHg , p < 0,05 p&#243;s 5 min). A CPAP diminuiu a PP (CPAP: 47 &#177; 20 pr&#233; para 38 &#177; 19 mmHg p&#243;s; controle: 42 &#177; 12 mmHg, pr&#233; para 41 &#177; 18 p&#243;s p < 0,05 p&#243;s 5 min). Conclus&#227;o: A VNI com CPAP diminuiu a press&#227;o de pulso em pacientes com ICC est&#225;vel. Ensaios cl&#237;nicos futuros devem investigar se esse efeito est&#225; associado com melhora no desfecho cl&#237;nico

Fatigue: A Complex Symptom and its Impact on Cancer and Heart Failure

<div><p>Abstract In chronic diseases like cancer and heart failure (HF), fatigue is a common and complex symptom from an etiological and pathophysiological point of view, thus, a relevant issue in the recent area of oncocardiology. Fatigue is prevalent in 80-90% of the oncological patients treated with chemotherapy and/or radiotherapy and affects approximately 50-96% of the individuals with IC. The toxicity attributed to chemotherapeutic agents can determine the patients’ degree of fatigue and may even predict their survival. In recent decades, the advancement of antineoplastic therapies has substantially impacted the survival of patients with cancer, and the risks of harmful effects from these therapies to the cardiovascular system have been increasingly described. Therefore, the cooperation between oncologists and cardiologists has led to the emergence of oncocardiology and the new concept of cardiac surveillance. Cardiotoxicity is one of the clinical complications in the treatment of cancer, and its typical manifestation is left ventricular systolic dysfunction. New diagnostic and therapeutic strategies have been employed in the cardiac surveillance of patients with cancer. Fatigue in these patients has been carefully studied with a multidisciplinary approach and with the development of visual scales to quantify and correlate better its real impact on these individuals’ quality of life and survival. The Fatigue Pictogram and Piper Fatigue Scale are tools increasingly used in research and clinical practice. The mechanisms involved in fatigue, from a conceptual point of view, may be of central (central nervous system) or peripheral (muscular skeletal) origin, both of which may be present in patients with cancer. The present review aims to discuss the new concepts in the assessment of fatigue in oncological patients. These concepts are fundamental to professionals who work in the emerging area of oncocardiology.</p></div

Controlled Study of Correlation of Biomechanical Profile of Hemiparetic Patients with Distance Travelled in Six Minutes

The six-minute walking test (6MWT) is used to assess exercise tolerance that is associated with motor function of the lower limbs in hemiparetic patients. It is suggested that, for post-stroke subjects, performance in the 6MWT may be limited by biomechanical and cardiovascular factors. Our aim is to determine the correlation between the six-minute walk distance (6MWD) and the biomechanical profile of hemiparetic patients. During this cross-sectional controlled study, 10 hemiparetic patients with heart failure underwent 6MWT (ATS protocol). Tonus (Ashworth Scale) and goniometry of the lower limbs were measured. The average of 6MWD in two tests was 279±8 m. There was a negative correlation between the degree of spasticity for both the sural triceps (r=−0.57, P&lt;0.05), quadriceps (r=−0.58, P&lt;0.05) and the limitation in ankle dorsiflexion and the 6MWD (r=−0.76, P&lt;0.05). Also, there was correlation between hip extension and ankle dorsiflexion limitations with 6MWD (r=0.66, P&lt;0.05), (r=0.77, P&lt;0.05). The negative correlation between the highest spasticity in paretic limb and the 6MWD and the correlation between the lower movement range of paretic hip and ankle suggest association with these factors and gait velocity in 6MWT. Loss percentage represents the percentage calculation between distance traveled and the distance predicted achieved by patients. In this study, the negative correlation between the percentage of loss of 6MWD and the limitation in the ankle dorsiflexion movement suggests that for a minor motion arch of the ankle, there is a higher percentage of walking distance loss foretold