BackgroundExercise training (ET) improves functional capacity in chronic heart failure
(HF). However, ET effects in acute HF are unknown.ObjectiveTo investigate the effects of ET alone or combined with noninvasive
ventilation (NIV) compared with standard medical treatment during
hospitalization in acute HF patients.MethodsTwenty-nine patients (systolic HF) were randomized into three groups: control
(Control - only standard medical treatment); ET with placebo NIV (ET+Sham)
and ET+NIV (NIV with 14 and 8 cmH2O of inspiratory and expiratory
pressure, respectively). The 6MWT was performed on day 1 and day 10 of
hospitalization and the ET was performed on an unloaded cycle ergometer
until patients' tolerance limit (20 min or less) for eight consecutive days.
For all analyses, statistical significance was set at 5% (p < 0.05).ResultsNone of the patients in either exercise groups had adverse events or required
exercise interruption. The 6MWT distance was greater in ET+NIV (Δ120
± 72 m) than in ET+Sham (Δ73 ± 26 m) and Control
(Δ45 ± 32 m; p < 0.05). Total exercise time was greater
(128 ± 10 vs. 92 ± 8 min; p < 0.05) and dyspnea was lower
(3 ± 1 vs. 4 ± 1; p < 0.05) in ET+NIV than ET+Sham. The
ET+NIV group had a shorter hospital stay (17 ± 10 days) than ET+Sham
(23 ± 8 days) and Control (39 ± 15 days) groups (p < 0.05).
Total exercise time in ET+Sham and ET+NIV had significant correlation with
length of hospital stay (r = -0.75; p = 0.01).ConclusionExercise training in acute HF was safe, had no adverse events and, when
combined with NIV, improved 6MWT and reduce dyspnea and length of stay.
Nota: Estes posicionamentos se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.
Houve predomínio do sexo masculino em 70% dos casos e a idade variou de 7 a 69 anos, com média de 44,8 anos. Doze (15%) pacientes se encontravam em prioridade, em uso de drogas inotrópicas endovenosas no momento do transplante. As etiologias determinantes da insuficiência cardíaca congestiva grave foram: miocardiopatia dilatada idiopática em 37,5%, miocardiopatia isquêmica em 33,75%, miocardiopatia chagásica em 17,5% e outras causas em 11,25%. Foram realizados 78 transplantes ortotópicos e 2 heterotópicos. A técnica empregada foi bicaval/bipulmonar em 63,75%, atrial em 27,5%, bicaval/ unipulmonar em 6,25% e heterotópico em 2,5%. A mortalidade hospitalar (30 dias) foi de 18,75%.Resultados: A sobrevida para o transplante ortotópico em um ano foi de 72,7%, em cinco anos 61,5% e em sete anos 56,4%. A sobrevida após o transplante foi correlacionada com as variáveis idade, causa de óbito e sexo do doador, e pelo transplante ter sido ou não a primeira cirurgia cardíaca do paciente.
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