Dyspnea, left ventricular performance and quality of life in hipertensive patients without heart failure

Orientadores: Roberta Cunha Matheus Rodrigues, Wilson Nadruz JuniorTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Dispnéia é um sintoma freqüente entre pacientes hipertensos e tem impacto negativo sobre a qualidade de vida relacionada à saúde (QVRS). O objetivo deste estudo foi verificar as correlações entre função ventricular esquerda (FVE), dispnéia e QVRS em pacientes hipertensos, sem insuficiência cardíaca. Noventa e oito sujeitos foram avaliados quanto à caracterização clínica, antropometria, pressão arterial, variáveis metabólicas e inflamatórias, Doppler tecidual e ecocardiografia convencional. A QVRS foi mensurada com o ¿Short Form¿ SF-36. Pacientes com dispnéia apresentaram maiores índices de massa corpórea (IMC), níveis mais elevados de proteína-C reativa, menor tempo de escolaridade e escores de QVRS significativamente mais baixos na maioria dos domínios do SF-36, em comparação com aqueles sem dispnéia. Não foram observadas diferenças nos parâmetros funcionais da FVE entre os subgrupos, embora os pacientes com dispnéia tenham apresentado maiores índices de massa e hipertrofia de ventrículo esquerdo (HVE). A análise de correlação parcial, ajustada para idade, sexo e IMC, mostrou correlação positiva entre a FVE sistólica e diastólica e o item de transição de saúde, no grupo sem dispnéia. Por outro lado, pacientes com dispnéia apresentaram correlações positivas e de maior magnitude entre os padrões de FVE sistólica e diastólica e os domínios de QVRS, bem como correlações negativas entre massa VE e diâmetro diastólica final de ventrículo esquerdo e QVRS. Concluindo, os resultados sugerem que dispnéia pode ser um marcador de pior QVRS em hipertensos que não preenchem todos os critérios para o diagnóstico de insuficiência cardíaca e um limiar para o desenvolvimento de relações significativas entre o desempenho da FVE e QVRS nestes pacientesAbstract: Dyspnea is a frequent symptom in hypertensive patients and negatively impacts on health related quality of life (HRQL). The aim of this report is to verify the correlations between left ventricular (LV) function, dyspnea and HRQL in hypertensive patients without overt heart failure. Ninety eight patients not fulfilling criteria for systolic or diastolic heart failure were evaluated by medical history, anthropometry, blood pressure measurement, dosage of metabolic and inflammatory parameters as well as conventional and tissue Doppler echocardiography. HRQL was assessed by the Short Form SF-36. Patients experiencing dyspnea presented higher body mass index, increased C-Reactive Proteins levels, fewer years of schooling and significant lower scores of HRQL in most of the SF-36 domains in comparison to patients with no breathlessness. No significant differences were observed on LV functional parameters between the subgroups, although dyspnea patients presented increased LV mass index and more LV hypertrophy. Partial correlation analyses adjusted for age, sex and body mass index revealed a direct correlation between systolic and diastolic parameters and the Health Transition Item in the group without dyspnea. Conversely, patients with dyspnea displayed stronger direct relationships between systolic and diastolic function and quality of life domains as well as inverse correlations between LV mass and LV end-diastolic diameter and HRQL. Overall, these results suggest that dyspnea might be a valuable marker of worse quality of life in hypertensive not fulfilling criteria for heart failure and a threshold to the development of significant relationship between LV performance and HRQL in such patientsDoutoradoCiencias BiomedicasDoutor em Ciências Médica

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation

Objective: To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). Methods: From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow ''Peak Flow'', 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. Results: 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1–9). A decreasing in the right and left dynamometry (p  ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p  = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. Conclusion: Cardiorespiratory rehabilitation can preserve functional capacity and quality of life

Six-minute walk test as a tool for assessing the quality of life in patients undergoing coronary artery bypass grafting surgery

OBJETIVO: Avaliar a utilidade do teste de caminhada de seis minutos como indicador prognóstico de qualidade de vida em pacientes submetidos a revascularização do miocárdio. MÉTODO: Estudo prospectivo observacional em pacientes submetidos a operação de revascularização do miocárdio. Foram avaliadas as características clínicas, teste de caminhada de seis minutos (TC6) e questionário para avaliação de qualidade de vida, o questionário SF-36. Os pacientes foram avaliados no pré-operatório e divididos em dois grupos, conforme a distância percorrida no TC6: grupo que caminhou mais de 350 metros e grupo que caminhou menos de 350 metros. RESULTADOS: Foram incluídos no estudo 87 pacientes. A idade média semelhante em ambos os grupos (59 ± 9,5 anos vs. 61 ± 9,3 anos; P = 0,24). Os pacientes do grupo > 350 metros caminharam mais no TC6 após dois meses de operação (436 ± 78 metros vs. 348 ± 87 metros; P 350 metros, no período pré-operatório, nos domínios: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos sociais. A qualidade de vida melhorou após dois meses, em ambos os grupos. CONCLUSÕES: O TC6 no pré-operatório tem correlação com a qualidade de vida após dois meses de revascularização do miocárdio. A qualidade de vida melhorou de forma geral em todos pacientes, sendo maior a melhora da qualidade de vida naqueles que caminharam menos que 350 metros no pré-operatório.OBJECTIVE: To assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test. METHODS: Prospective observational study with patients who undergoing CABG. The clinical variables, the sixminute walk test, and the SF-36 test were recorded. The patients were assessed at the preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group walked more than 350 meters (> 350 meters Group) and the group walked less than 350 meters ( 350 meters distance was higher than the 350 meters group in the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. CONCLUSIONS: The six-minute walk test at the preoperative time is associated with the quality of life after two months of coronary artery bypass grafting. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time

Six-minute walk test as a tool for assessing the quality of life in patients undergoing coronary artery bypass grafting surgery

OBJECTIVE: To assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test. METHODS: Prospective observational study with patients who undergoing CABG. The clinical variables, the sixminute walk test, and the SF-36 test were recorded. The patients were assessed at the preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group walked more than 350 meters (&gt; 350 meters Group) and the group walked less than 350 meters (< 350 meters Group) at the preoperative time. RESULTS: Eight-seven patients were included. Age was comparable in both groups (59 ± 9.5 years vs. 61 ± 9.3 years; respectively, P = 0.24). The group walked &gt; 350 meters distance was higher than the < 350 meters group after 2 months of operation (436 ± 78 meters vs. 348 ± 87 meters; P <0.01). The quality of life was lower in the < 350 meters group compared to the &gt; 350 meters group in the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. CONCLUSIONS: The six-minute walk test at the preoperative time is associated with the quality of life after two months of coronary artery bypass grafting. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time.OBJETIVO: Avaliar a utilidade do teste de caminhada de seis minutos como indicador prognóstico de qualidade de vida em pacientes submetidos a revascularização do miocárdio. MÉTODO: Estudo prospectivo observacional em pacientes submetidos a operação de revascularização do miocárdio. Foram avaliadas as características clínicas, teste de caminhada de seis minutos (TC6) e questionário para avaliação de qualidade de vida, o questionário SF-36. Os pacientes foram avaliados no pré-operatório e divididos em dois grupos, conforme a distância percorrida no TC6: grupo que caminhou mais de 350 metros e grupo que caminhou menos de 350 metros. RESULTADOS: Foram incluídos no estudo 87 pacientes. A idade média semelhante em ambos os grupos (59 ± 9,5 anos vs. 61 ± 9,3 anos; P = 0,24). Os pacientes do grupo &gt; 350 metros caminharam mais no TC6 após dois meses de operação (436 ± 78 metros vs. 348 ± 87 metros; P<0,01) quando comparado ao grupo < 350 metros. Observamos que a qualidade de vida era inferior no grupo < 350 metros em relação ao grupo &gt; 350 metros, no período pré-operatório, nos domínios: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos sociais. A qualidade de vida melhorou após dois meses, em ambos os grupos. CONCLUSÕES: O TC6 no pré-operatório tem correlação com a qualidade de vida após dois meses de revascularização do miocárdio. A qualidade de vida melhorou de forma geral em todos pacientes, sendo maior a melhora da qualidade de vida naqueles que caminharam menos que 350 metros no pré-operatório.23123