Efeitos de um programa de reabilitação cardíaca nas variáveis independentes do esforço máximo em pacientes com insuficiência cardíaca crônica
Introduction: The effects of Cardiac Rehabilitation (CR) in patients with chronic heart failure (HF) are evaluated during maximal exercise and are mainly translated by changes in oxygen uptake at peak effort (VO2peak). However, in severely limited patients, this measure may be compromised by the...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/30425 |
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| Resumo: | Introduction: The effects of Cardiac Rehabilitation (CR) in patients with chronic
heart failure (HF) are evaluated during maximal exercise and are mainly translated
by changes in oxygen uptake at peak effort (VO2peak). However, in severely
limited patients, this measure may be compromised by the inability to sustain
maximum loads of physical exercise. Thus, other variables, since they are
employed independently of the maximum effort, have been studied such as the
Anaerobic Limit - LA, relationship between minute ventilation and carbon
dioxide production -VE / VCO2Slope, ventilatory efficiency - OUES and ventilatory
oscillation - OV . In addition, the use of these variables analyzed together can
provide important clinical elements on stratification of prognostic risk and cardiac
event. Objective: To evaluate the effects of Cardiac Rehabilitation (CR) on the
independent variables of maximum effort (LA, VE / VCO2slope, OUES and OV)
and on risk stratification in patients with chronic HF, as well as to evaluate
whether and how OUES and VO2LA are correlate with the aerobic capacity of
patients with chronic HF and determine which parameters are associated with
VO2LA and OUES in patients with chronic HF. Materials and Method: This is a
series of cases with patients with compensated chronic HF. Clinical, spirometric
and physical stress test assessments (ergometry and/or ergospirometry) were
performed before the CR program. Then, the patients referred to the CR program
that included a dose of 36h / patient of clinical exercises, individualized (aerobic
and resistance) and supervised, 3 times/week for 12 weeks, with weekly load
readjustment, being reassessed as for the exercise test. physical effort after the 12-
week CR period. Results and discussion: 45 patients with chronic HF with an
average age of 49.8 ± 12.97 years and an Ejection Fraction (EF) of 39.0 ± 15.8%
were evaluated. An increase of 124 seconds (p <0.001) was identified in the
average of the total test time and 24.1% in the workload in the pre and post-CR
comparison. Regarding the metabolic analysis, we had an increase of 18.3% in
VO2peak after CR, as well as an increase of 12.9% VO2 at the time of LA and
20.14% in OUES75%, in addition to a reduction in the mean VE/VCO2Slope and the presence of OV, which improved the risk stratification of 4 patients. It was also
possible to conclude that OUES is able to identify patients with chronic HF with
different aerobic capacities (<or> 70% predicted VO2) such as LA (ASC = 0.865,
p = <0.0001; ASC = 0.800, p = 0.002, respectively), and there is no significant
difference in the comparison between the receiver operating characteristic (ROC)
curves. The regression analysis identified cardiovascular and pulmonary factors
(EF, diastolic diameter and volume, forced vital capacity and maximum voluntary
ventilation) related to both variables. Conclusion: It is concluded that the
independent variables of maximum effort are able to identify the effects of CR
with an individualized dose of exercise and readjusted weekly as well as those
dependent on maximum effort. And that the variables OUES75% and VO2LA
correlate with aerobic capacity and are effective in differentiating patients with
chronic HF from their aerobic capacity. In addition, the measurements are
associated with cardiovascular and pulmonary parameters. |
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