“…The progression of these symptoms, which link
the neurohormonal changes to declining ventricular function during the process of
myocardial and vascular remodeling and also to increasing lung congestion, promotes a
decreased level of physical activity that leads to lack of physical fitness23. Reduced physical fitness contributes to further
worsening of the symptoms, limitations of daily life activities, and exercise
intolerance, progressively reducing functional capacity, which leads to a frequent
clinical condition associated with high costs, disability, and high mortality rates1. …”
Section: Discussionmentioning
confidence: 99%
“…None of the studies included in this review evaluated the
VO 2 max/peak, most likely because they were short-term studies. Furthermore,
no study used NIV associated with an exercise protocol, which could contribute to
increasing the VO 2 max/peak, which is improved by regular physical exercise,
particularly with training intensity sufficient to generate cardiovascular fitness,
especially in the relevant population1
,
34
,
35. …”
Section: Discussionmentioning
confidence: 99%
“…Dyspnea is one of the most important variables analyzed for the diagnosis of
cardiorespiratory disease because it manifests itself when patients perform their
routine activities2 and, in more severe cases,
may progress to dyspnea at rest1. Two studies
included in this review analyzed dyspnea5
,
20, and only Lima et al5 showed that using CPAP for 30 minutes (10 cmH 2 O) could
decrease post-6MWT dyspnea in comparison to the group that did not undergo prior NIV.…”
Section: Discussionmentioning
confidence: 99%
“…Heart failure (HF) is a complex clinical syndrome that results from impaired ventricular
filling or ejection capacity1
,
2, and involvement of the left ventricle occurs
in 60% of cases in adults1. …”
Background: Patients with heart failure (HF) usually develop exercise intolerance. In this
context, noninvasive ventilation (NIV) can help to increase physical performance.
Objective:To undertake a systematic review and meta-analysis of randomized controlled trials
that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy
Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and
MEDLINE. Selection Criteria: This review included only randomized controlled
trials involving patients with HF undergoing NIV, with or without other therapies,
that used exercise tolerance as an outcome, verified by the distance travelled in
the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test,
time spent in testing, and dyspnea. Data Collection and Analysis: The
methodological quality of the studies was rated according to the PEDro scale. Data
were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that
the use of NIV prior to the 6MWT promoted increased distance, [mean difference
65.29 m (95% CI 38.80 to 91.78)]. Conclusions:The use of NIV prior to the 6MWT in patients with HF may promote increased
distance. However, the limited number of studies may have compromised a more
definitive conclusion on the subject.
“…The progression of these symptoms, which link
the neurohormonal changes to declining ventricular function during the process of
myocardial and vascular remodeling and also to increasing lung congestion, promotes a
decreased level of physical activity that leads to lack of physical fitness23. Reduced physical fitness contributes to further
worsening of the symptoms, limitations of daily life activities, and exercise
intolerance, progressively reducing functional capacity, which leads to a frequent
clinical condition associated with high costs, disability, and high mortality rates1. …”
Section: Discussionmentioning
confidence: 99%
“…None of the studies included in this review evaluated the
VO 2 max/peak, most likely because they were short-term studies. Furthermore,
no study used NIV associated with an exercise protocol, which could contribute to
increasing the VO 2 max/peak, which is improved by regular physical exercise,
particularly with training intensity sufficient to generate cardiovascular fitness,
especially in the relevant population1
,
34
,
35. …”
Section: Discussionmentioning
confidence: 99%
“…Dyspnea is one of the most important variables analyzed for the diagnosis of
cardiorespiratory disease because it manifests itself when patients perform their
routine activities2 and, in more severe cases,
may progress to dyspnea at rest1. Two studies
included in this review analyzed dyspnea5
,
20, and only Lima et al5 showed that using CPAP for 30 minutes (10 cmH 2 O) could
decrease post-6MWT dyspnea in comparison to the group that did not undergo prior NIV.…”
Section: Discussionmentioning
confidence: 99%
“…Heart failure (HF) is a complex clinical syndrome that results from impaired ventricular
filling or ejection capacity1
,
2, and involvement of the left ventricle occurs
in 60% of cases in adults1. …”
Background: Patients with heart failure (HF) usually develop exercise intolerance. In this
context, noninvasive ventilation (NIV) can help to increase physical performance.
Objective:To undertake a systematic review and meta-analysis of randomized controlled trials
that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy
Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and
MEDLINE. Selection Criteria: This review included only randomized controlled
trials involving patients with HF undergoing NIV, with or without other therapies,
that used exercise tolerance as an outcome, verified by the distance travelled in
the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test,
time spent in testing, and dyspnea. Data Collection and Analysis: The
methodological quality of the studies was rated according to the PEDro scale. Data
were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that
the use of NIV prior to the 6MWT promoted increased distance, [mean difference
65.29 m (95% CI 38.80 to 91.78)]. Conclusions:The use of NIV prior to the 6MWT in patients with HF may promote increased
distance. However, the limited number of studies may have compromised a more
definitive conclusion on the subject.
“…The inclusion criteria were as follows: men and women who were previously diagnosed with systolic HF; NYHA functional class I-III; LVEF<0.50; receiving optimal pharmacological treatment (11,12); and a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months and the ability to cooperate with the procedures.…”
OBJECTIVE:The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear.METHODS:This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O), while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT) and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854.RESULTS:The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′) after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015). There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020).CONCLUSIONS:Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.
The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. Objective: To compare the effects of a fluid-restricted (maximum fluid intake, 800 mL/d) and sodiumrestricted (maximum dietary intake, 800 mg/d) diet (intervention group [IG]) vs a diet with no such restrictions (control group [CG]) on weight loss and clinical stability during a 3-day period in patients hospitalized with ADHF. Design: Randomized, parallel-group clinical trial with blinded outcome assessments.
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