Efeitos da reabilitação cardíaca em pacientes com insuficiência cardíaca portadores de ressincronizador cardíaco
INTRODUCTION. Cardiac resynchronization therapy (CRT) is indicated for patients with severe ventricular dysfunction, advanced stages of heart failure (HF) and refractory to conventional treatment. It is an artificial cardiac pacing modality that aims to correct electromechanical dysfunctions of t...
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| Formato: | doctoralThesis |
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/28787 |
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| Resumo: | INTRODUCTION. Cardiac resynchronization therapy (CRT) is indicated for patients
with severe ventricular dysfunction, advanced stages of heart failure (HF) and refractory
to conventional treatment. It is an artificial cardiac pacing modality that aims to correct
electromechanical dysfunctions of the heart, reduce morbidity and mortality and reverse
remodeling in individuals with HF. It has been widely used in recent years, showing
improvement in symptomatology, exercise capacity and ventricular function. Central
adaptations derived from CRT are accepted as beneficial in the treatment of HF with
severe ventricular dysfunction. However, it is known that the cause of exercise
intolerance in HF is multifactorial, and central alterations, with low cardiac reserve,
peripheral alteration with skeletal muscle dysfunction and low pulmonary reserve
contribute to the low exercise capacity. AIM. To evaluate and compare the effects of a
cardiac rehabilitation program on HF patients with CRT. METHODS. The patients were
referred to the cardiac rehabilitation outpatient clinic by the cardiologist and included in
the research those who had a diagnosis of HF, cardiac resynchronizer implantation for at
least three months, with functional class I, II and III, according to the New York Heart
Association (NYHA) and with reduced and preserved LVEF. These patients comprised
the IC+CRT group. A retrospective analysis of patients with HF without cardiac
resynchronizer or any type of implantable cardiac device who underwent cardiac
rehabilitation from October 2014 to February 2018 was included in the study and these
comprised the HF group. First, all patients underwent clinical, anthropometric and
spirometric evaluation. In a second moment they performed the cardiopulmonar exercise
test (CPET) using a conventional treadmill. Ventilation (VE-minute ventilation, VE/VO2-
oxygen equivalent, VE/VCO2- ventilatory equivalent of carbon dioxide, RER- gas
exchange ratio) and metabolic (VO2-consumption of oxygen, VCO2-carbon dioxide
output of breath-by-breath with Cortex-Biophysik-Metamax3B system, and VE/VCO2
slope and oxygen uptake efficiency slope (OUES). Cardiac rehabilitation sessions were
performed three times a week for 12 weeks as a prescription for individualized exercise.
A new TECP was performed after the training period. The software SPSS version 20.0
was used for statistical analysis and a value of 5% was assigned to test the hypotheses. In
addition, the effect size (ES) of each variable analyzed was calculated. RESULTS.
Eighteen patients with HF with CRT were eligible for the study and 8 were excluded
because they did not participate in all stages of the study, totaling 10 individuals analyzed. For the HF group 69 patients were eligible, however 47 were excluded, totaling 22
patients analyzed. The patients had a mean age of 52±13 years, with male prevalence
(68.7%), with mean EF of 34±5% and 46.8% of ischemic etiology. After cardiac
rehabilitation the mean increase in exercise duration was 136.9 (p <0.001) seconds in the
HF group and 142.8 (p = 0.004) seconds in the HF+CRT group. After cardiac
rehabilitation, patients in the HF group presented a mean increase of 4.9mL/kg/min
(p<0.001) of peak VO2 and patients in the HF+CRT group increased 2.19mL/kg/min
(p=0.02) and the average predicted percentage of VO2 peak increased from 61 to 76%
and from 57 to 67%, respectively. In addition, patients in the HF group had an increase
in peak VO2 in AT (15.7±5 to 18±5.5 mL/kg/min, p=0.006) and in AT duration (252±92
to 366±102 seconds, p=0.004). Additionally, the HF group showed improvement in
ventilatory efficiency, reflected by the values VE/VCO2 slope (Δ-3.4,p=0.03) and OUES
(Δ98.27mL/min, p=0.04), while the IC + CRT group showed significant increase only in
OUES (Δ146.12mL/min, p=0.01). CONCLUSION. HF patients with cardiac
resynchronizer benefited from the cardiac rehabilitation program with increased exercise
capacity, reflected by peak VO2, improved ventilatory efficiency, demonstrated by OUES
values, and improved quality of life. |
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