Relação entre imagem adrenérgica cardíaca e teste ergométrico na insuficiência cardíaca

Messias, Leandro Rocha; Carreira, Maria Angela Magalhães de Queiroz; Miranda, Sandra Marina Ribeiro de; Azevedo, Jader Cunha de; Gava, Isabela Ambrósio; Rodrigues, Ronaldo Campos; Maróstica, Elizabeth; Nóbrega, Antônio Cláudio Lucas da; Mesquita, Cláudio Tinoco

doi:10.1590/s0066-782x2011005000044

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…30 , 31 . Our group 32 evaluated patients with HREF and observed that those with a low WR rate, even while on beta-blocker, presented a better FC and chronotropic response when compared with patients with a high WR rate. The current literature has limited data about beta-blocker therapy in HFNEF.…”

Section: Discussionmentioning

confidence: 96%

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Messias¹,

Ferreira²,

Miranda³

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundMore than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties.ObjectivesTo evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF.MethodsTwenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months.ResultsAfter treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters.ConclusionDespite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

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Section: Discussionmentioning

confidence: 96%

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Messias¹,

Ferreira²,

Miranda³

et al. 2016

Arquivos Brasileiros De Cardiologia

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“…In our results HRR was significantly lower in HD group in every minute of recovery. Slow recovery of HR post-exercise reflects an inadequate return of cardiac vagal activity, and has proved to be a good marker of cardiovascular events in both heart disease patients and in healthy individuals [ 36 , 37 ], and also such as a predictor of mortality, independently of the angiographic severity of coronary disease [ 38 ]. Reduced HRR had already been reported in chronic kidney disease patients far before renal replacement therapy [ 39 ] consistent with the knowledge that the sympathetic hyperactivity starts early in the course of chronic kidney disease [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Detection of Autonomic Dysfunction in Hemodialysis Patients Using the Exercise Treadmill Test: The Role of the Chronotropic Index, Heart Rate Recovery, and R-R Variability

et al. 2015

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Autonomic dysfunction is highly prevalent in hemodialysis patients and has been implicated in their increased risk of cardiovascular mortality.ObjectiveTo evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients.MethodsCross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed.ResultsForty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5).ConclusionThe exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.

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“…This finding reinforces the hypothesis that the reduction in functional aerobic capacity is strongly associated with the presence and severity of dysautonomia. 23 The stress resulting from exercise requires substantial changes of the autonomic nervous system, facilitating recognition of disturbances that otherwise could remain undetectable.…”

Section: Discussionmentioning

confidence: 99%

“…Exercise SDNN was independently associated with FAI in all models tested, except for the one in which serum levels of hemoglobin were included. Several authors 23 - 27 have reported that the reduction of serum levels of hemoglobin causes a significant reduction in CRF and that the higher the reduction, the greater the FAI. 23 Furthermore, red cell transfusion 23 , 24 or administration of erythropoietin 25 - 27 was associated with a significant improvement in functional aerobic capacity, with a 6%-18% increase in VO 2 peak in different series and protocols.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

Carreira¹,

Nogueira²,

Pena³

et al. 2015

Arquivos Brasileiros De Cardiologia

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BackgroundAutonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality.ObjectiveTo correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls.MethodsCross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods.ResultsForty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels.ConclusionNo association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls.

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Relação entre imagem adrenérgica cardíaca e teste ergométrico na insuficiência cardíaca

Abstract: Backgrounds: The exercise treadmill test can be used in ventricular dysfunction patients for functional capacity or predicting prognosis. The cardiac image with 123I MIBG shows cardiac sympathetic activation.

Cited by 8 publications

References 27 publications

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Detection of Autonomic Dysfunction in Hemodialysis Patients Using the Exercise Treadmill Test: The Role of the Chronotropic Index, Heart Rate Recovery, and R-R Variability

Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

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