Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Heart failure"

Navegando por Palavras-chave "Heart failure"

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Acesso aberto (Open Access)
Ablação por radiofreqüência do ventrículo esquerdo no rato: um novo modelo de insuficiência cardíaca com tamanhos de infarto do miocárdio semelhantes e baixa mortalidade
(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Antonio, Ednei Luiz [UNIFESP]; Tucci, Paulo José Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The Myocardial Infarction (MI) in rodents is the most frequently used animal model to reproduce experimentally the Congestive Heart Failure (CHF) in humans. Surgical closure of the anterior descending coronary artery (ADCA) is the method traditionally used to obtain the experimental MI decades. This model is well validated to simulate CHF, as evidenced by the large number of publications that provide relevant information significantly. The coronary artery ligation in rats is inherently associated with infarcts of variable size, and in some cases, absence of myocardial necrosis. Another unfavorable factor is the high rate of mortality after coronary occlusion (CO). The purpose of this study was to standardize a new model of CHF secondary to MI by applying radio frequency electric current in the left ventricle (LV), and analyze the characteristics of the model. To this end, we used 210 Wistar-EPM, male and female, in groups, operated by the traditional method of coronary occlusion, and radiofrequency ablation without surgical intervention or control group. After the promotion of MI, animals were separated into groups of one and four weeks for evaluation, which were anesthetized and sequentially assessed by echocardiography (ECHO), hemodynamic, myocardial mechanics, and pathological. The transmural infarction occurred in all cases operated ablation with immediate mortality of 7.5%. CO animals were included only MI> 40% LV. The variability in the size of the MI were lower in rats Ab (x ± SD: 45 ± 8%) when compared with coronary occlusion (CO, 40 ± 19% SD). The echocardiography and hemodynamic study showed comparable increases in the sizes of the LV end-diastolic pressure and pulmonary water content in one and four weeks post-MI. Myocardial mechanics six weeks post-MI were compatible in the inotropic and lusitropic dysfunction. Histopathological evaluations were identified lesions similar to those that occurred after CO, with complete healing phase in four weeks. Ab IM VE originated with similar size and low mortality. Resulted in histopathological changes, and ventricular dilation, mechanical dysfunction and myocardial failure. Results reproducing the IM by CO.
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Acute effects of low-level laser therapy irradiation on blood lactate and muscle fatigue perception in hospitalized patients with heart failure-a pilot study
(Springer London Ltd, 2016) Bublitz, Caroline [UNIFESP]; Renno, Ana Claudia Muniz [UNIFESP]; Ramos, Rodrigo Santin [UNIFESP]; Assis, Livia [UNIFESP]; Sellera, Carlos Alberto Cyrillo; Trimer, Renata; Borghi-Silva, Audrey; Arena, Ross; Guizilini, Solange [UNIFESP]
The objective of the present study is to evaluate the acute effects of low-level laser therapy (LLLT) on functional capacity, perceived exertion, and blood lactate in hospitalized patients with heart failure (HF). Patients diagnosed with systolic HF (left ventricular ejection fraction <45 %) were randomized and allocated prospectively into two groups: placebo LLLT group (n = 10)—subjects who were submitted to placebo laser and active LLLT group (n = 10)—subjects who were submitted to active laser. The 6-min walk test (6MWT) was performed, and blood lactate was determined at rest (before LLLT application and 6MWT), immediately after the exercise test (time 0) and recovery (3, 6, and 30 min). A multi-diode LLLT cluster probe (DMC, São Carlos, Brazil) was used. Both groups increased 6MWT distance after active or placebo LLLT application compared to baseline values (p = 0.03 and p = 0.01, respectively); however, no difference was observed during intergroup comparison. The active LLLT group showed a significant reduction in the perceived exertion Borg (PEB) scale compared to the placebo LLLT group (p = 0.006). In addition, the group that received active LLLT showed no statistically significant difference for the blood lactate level through the times analyzed. The placebo LLLT group demonstrated a significant increase in blood lactate between the rest and recovery phase (p < 0.05). Acute effects of LLLT irradiation on skeletal musculature were not able to improve the functional capacity of hospitalized patients with HF, although it may favorably modulate blood lactate metabolism and reduce perceived muscle fatigue.
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Aerobic exercise training in heart failure: impact on sympathetic hyperactivity and cardiac and skeletal muscle function
(Assoc Bras Divulg Cientifica, 2011-09-01) Brum, Patricia Chakur; Bacurau, Aline Villa Nova; Medeiros, Alessandra [UNIFESP]; Ferreira, Julio Cesar Batista; Vanzelli, Andréa Somolanji; Negrao, Carlos Eduardo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Stanford Univ
Heart failure is a common endpoint for many forms of cardiovascular disease and a significant cause of morbidity and mortality. Chronic neurohumoral excitation (i.e., sympathetic hyperactivity) has been considered to be a hallmark of heart failure and is associated with a poor prognosis, cardiac dysfunction and remodeling, and skeletal myopathy. Aerobic exercise training is efficient in counteracting sympathetic hyperactivity and its toxic effects on cardiac and skeletal muscles. In this review, we describe the effects of aerobic exercise training on sympathetic hyperactivity, skeletal myopathy, as well as cardiac function and remodeling in human and animal heart failure. We also discuss the mechanisms underlying the effects of aerobic exercise training.
Acesso aberto (Open Access)
Análise do diagnóstico de enfermagem controle ineficaz da saúde em pessoas com insuficiência cardíaca
(Universidade Federal de São Paulo (UNIFESP), 2015-07-29) Carneiro, Camila de Souza [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Bachion, Maria Márica [UNIFESP]; http://lattes.cnpq.br/8503907944360635; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/4677250050350394; Universidade Federal de São Paulo (UNIFESP)
Introdução: A insuficiência cardíaca (IC) é uma doença progressiva que compromete a qualidade de vida dos pacientes. O controle adequado do regime terapêutico pelas pessoas com IC deve ser investigado pelos enfermeiros, por meio do diagnóstico de enfermagem Controle Ineficaz da Saúde da NANDA-I. Objetivos: Geral: analisar o diagnóstico de enfermagem (DE) Controle Ineficaz da Saúde (NANDA-I) em pessoas com IC crônica. Específicos: construir definições conceituais e operacionais para as CD e FR do DE Controle Ineficaz da Saúde para pessoas com IC; verificar a aplicabilidade clínica das definições conceituais e operacionais das CD e FR do DE Controle Ineficaz da Saúde em pessoas com IC. Método: Primeira etapa: estudo metodológico, por meio de revisão integrativa de literatura para elaborar as definições conceituais e operacionais das características definidoras e fatores relacionados do diagnóstico em estudo, foi realizado nas bases de dados LILACS, CINAHL e Medline. Segunda etapa: estudo piloto, transversal, descritivo, analítico, realizado nos seguintes ambulatórios: miocardiopatia, valvulopatia, cardiogeriatria e de coronariopatias do Hospital São Paulo, de Outubro a Dezembro de 2014. A amostra não randomizada foi de 33 pessoas. Para coleta de dados aplicou-se um instrumento de avaliação sociodemográfica e clínica, um roteiro com base nas definições conceituais e operacionais elaboradas, - instrumento de avaliação do conhecimento e de avaliação da impotência. Para a identificação do DE Controle Ineficaz da Saúde, utilizou-se como critério a presença de pelo menos uma das CD e um FR. Na análise utilizaram-se procedimentos de estatística descritiva e medidas de tendência central. Resultados: Elaborou-se as definições conceituais e operacionais das características definidoras e dos fatores relacionados do diagnóstico Controle Ineficaz da Saúde e identificou-se novos FR além daqueles contidos na NANDA-I. No estudo piloto com 33 pessoas com insuficiência cardíaca crônica em tratamento ambulatorial, verificou-se ocorrência expressiva do DE Controle Ineficaz da Saúde (96,96%), tendo como fator relacionado a impotência (93,9%), e evidenciado principalmente por escolhas ineficazes na vida diária para atender ao objetivo de saúde, falha em incluir um regime de tratamento à vida diária, falha em agir para reduzir fator de risco e dificuldade com o regime prescrito. Conclusão: As definições conceituais e operacionais de características definidoras e fatores relacionados do diagnóstico Controle Ineficaz da Saúde, mostraram aplicabilidade na prática clínica, confirmando a sua validade e utilidade na identificação do diagnóstico de enfermagem em pessoas com insuficiência cardíaca, com a ressalva de que os fatores relacionados suscetibilidade percebida, benefício percebido, gravidade da condição percebida da forma como estão redigidos podem gerar confusão para o estabelecimento deste diagnóstico. Nesse sentido, apresenta-se na tese uma proposta de reformulação dos mesmos.
Acesso aberto (Open Access)
Ansiedade, estresse e depressão de familiares de pacientes com insuficiência cardíaca em tratamento ambulatorial
(Universidade Federal de São Paulo (UNIFESP), 2016) Lacerda, Marianna Sobral [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; http://lattes.cnpq.br/1478157388713375; http://lattes.cnpq.br/3811883349833442; Universidade Federal de São Paulo (UNIFESP)
To analyze the level of anxiety and stress as well as the symptoms of depression in relatives accompanying patients with Heart Failure under outpatient treatment; to describe the sociodemographic and clinical characteristics of relatives accompanying patients with HF under outpatient treatment, and also those related to the way of life and burden; to verify whether there is correlation among the scores of scales of anxiety, depression and stress and verify whether there are differences in the scores of scales of anxiety, depression and stress according to sociodemographic and clinical characteristics, as well as those related to the way of life and burden of relatives and the degree of independence with regard to activities of daily living of patients. Method: This is a cross-sectional and descriptive study, which was performed between April 2014 and February 2015 in the Cardiomyopathy Outpatient Clinic of the São Paulo Hospital. The sample was composed by 100 relatives of patients with Heart Failure. The anxiety, the depression and the stress were evaluated by means of Beck Anxiety Inventory, Beck Depression Inventory and Perceived Stress Scale - 10, respectively. The other variables were obtained by means of an instrument containing the sociodemographic and clinical variables, the self-rated health, the Index of Independence in Activities of Daily Living and Caregiver Burden Scale. Results: The average age of surveyed subjects was 45.43±13.53 years, most were female (81%), white (63%) and married (61%). The score of depression showed an average of 8.24±7.14, the anxiety was 7.95±7.61 and the stress scale was 17.43±7.15, thereby demonstrating the lack of these symptoms in most relatives of patients with HF. As for the degree of independence, 82% of patients were independent for all activities of daily living, and there was no burden of caregiver (17,9±14,21). The correlation coefficient among the scales was 0.53 between depression and anxiety, and between depression and stress, and 0.66 between anxiety and stress. Female gender (p=0.002; p=0.031), smoking (p=0.05; p=0.011), sedentariness (p=0.023; p=0.001) and regular/bad selfrated health (p=0.012; p=0.013) showed a relationship with anxiety and stress. The family income less than 5 minimum wages (p=0.012) and the regular/bad health selfassessment (p=0.001) were associated with depression. Conclusion: Relatives did not show high levels of stress, anxiety and depression. The scales showed correlation with each other, but the scales of stress and anxiety showed greater correlation strength. Self-rated health, physical activity, smoking and gender were the factors that showed a relationship with stress and anxiety, and family income and self-rated health were factors related to symptoms of depression.
Acesso aberto (Open Access)
Associação de betabloqueadores e treinamento físico na insuficiência cardíaca de camundongos
(Sociedade Brasileira de Cardiologia - SBC, 2010-09-01) Vanzelli, Andréa Somolanji; Medeiros, Alessandra [UNIFESP]; Sirvente, Raquel De Assis; Salemi, Vera Maria Cury; Mady, Charles; Brum, Patricia Chakur; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
BACKGROUND: Currently there are several types of interventions for the treatment of heart failure (HF). Among these are beta-blocker therapy (BB) and physical training (PT). However, the effects of the combination of these therapies are poorly studied. OBJECTIVE: To investigate the effects of BB treatment with metoprolol (M) and carvedilol (C) associated with PT in mice with HF. METHODS: We used a genetic model of sympathetic hyperactivity-induced heart failure in mice. Initially, we divided the HF animals into three groups: sedentary (S); trained (T); treated with M (138 mg/kg) (M); or C (65 mg/kg) (C). In the second part, we divided the groups into three subgroups: sedentary (S); trained and treated with M (TM); and trained and treated with C (CT). The PT consisted of aerobic training on a treadmill for 8 weeks. Exercise tolerance was assessed by maximal graded test, and fractional shortening (FS) was assessed by echocardiography. Cardiomyocyte diameter and collagen volume fraction were evaluated by histological analysis. Data were compared by one way ANOVA and post hoc Duncan test. The significance level was set at p < 0.05. RESULTS: As to FS and cardiac remodeling, we found that, in isolation, T, M, and C showed an improvement of the variables analyzed. As to therapy combination, after the intervention period, we observed an increase in exercise tolerance in MT and CT (43.0% and 33.0% respectively). There was also a reduction in cardiomyocyte diameter (10.0% and 9.0% respectively) and in collagen volume fraction (52.0% and 63.0%) after the intervention. However, only CT significantly improved FS. CONCLUSION: The association of PT with M or C therapies provided benefits on cardiac function and remodeling in HF mice.
Acesso aberto (Open Access)
Avaliação de fatores prognósticos da insuficiência cardíaca em pacientes encaminhados para avaliação de transplante cardíaco
(Sociedade Brasileira de Cardiologia - SBC, 2007-06-01) Areosa, Cleópatra Medina Noronha [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVES: To evaluate the survival of patients with heart failure submitted to cardiac transplantation screening as well as identify poor prognostic factors using a risk score to identify patients with higher death risk. METHODS: 330 male and female patients aged 12 to 74 years old, referred for heart transplantation from January 1986 to November 2001 were evaluated. Clinical, laboratory, electrocardiographic, Holter monitoring, echocardiographic and radionuclide ventriculography data were analyzed. RESULTS: The median follow up period was 5 years; patients' survival rate was 84.5% in the first year, 74.3% in the second year, 68.9% in the third year and 60.5% in the fifth year. The prognostic variables selected through the univariate analysis were: age, Chagas' disease etiology for cardiomyopathy, NYHA functional classes III and IV, orthopnea, systolic blood pressure, mean blood pressure, pulse pressure, plasma urea, sodium, glucose, albumin, bilirubin, hemoglobin, and mean heart rate. The prognostic variables at the multivariate analysis were: ejection fraction, blood urea, and hemoglobin. The risk score: RR=exp[(-0.0942401 x ejection fraction) + (0.0105207 x blood urea) + (-0.2974991 x hemoglobin) + (-0.0132898 x age) + (-0.0099115 x blood glucose)] discriminated the population with a higher death risk. CONCLUSION: Patients' survival was satisfactory despite heart failure severity, suggesting they can be maintained on optimized clinical treatment until persistent clinical deterioration takes place. Ejection fraction, ventricular diameters, and clinical functional class alone should not be used as an indication for heart transplantation. The risk score could help discriminate the population with the poorest prognosis.
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Avaliação do teste da caminhada de seis minutos com acompanhamento em pacientes com insuficiência cardíaca
(Universidade Federal de São Paulo (UNIFESP), 2000) Peres, Paulo Alberto Tayar [UNIFESP]; Jardim, José Roberto de Brito [UNIFESP]
Introdução: O teste da caminhada de seis minutos vem sendo empregado na avaliação e acompanhamento de pacientes com insuficiência cardíaca, e tem demostrado ser eficaz não só como exame complementar na análise da capacidade ao exercício como também na correlação com prognóstico e mortalidade. Objetivos: Primeiro, analisar se o teste da caminhada de seis minutos, quando aplicado com acompanhamento (examinador andando junto ao paciente e incentivando-o verbalmente), estima o desenvolvimento de um esforço má3dmo nos pacientes com insuficiência cardíaca; segundo, comparar o consumo de oxigênio pico obtido pelo teste ergoespirométrico com o estimado pelas três equações de Cahalin et al.(1996) propostas para o teste da caminhada sem acompanhamento. Casuística e Métodos: Foram estudados 16 pacientes com insuficiência cardíaca, os quais realizaram um teste ergoespirométrico e dois testes da caminhada com acompanhamento. Resultados: Houve correlação significante entre a distancia percorrida no segundo teste da caminhada (mediana=536,5 m) com a distancia percorrida no teste ergoespirométrico (mediana=540,5 m) (p O,0001; rho = O,84) e o consumo de oxigênio pico (VO2 PICO) (p O,001; rho = O,76). Houve, também semelhança (p=O,50) e correlação entre as freqüências cardíacas máximas do teste ergoespirométrico e do teste da caminhada (p=O,0001; rho = O,83); não houve diferença na percepção ao esforço (Escala de Borg) no final dos dois testes (p=O,79). A comparação entre VO2 pico obtido no teste ergoespirométrico e o previsto pela equação de Cahalin et al. (l996), que inclui apenas a distancia percorrida no teste da caminhada de seis minutos, e ainda com a que inclui variáveis antropométricas e o duplo produto, não apresentaram diferenças significante (p=O,44; p=1,77). Entretanto, houve diferença significante (p=O,0014) entre OS VO2 pico do teste e o estimado pela equação que inclui as variáveis acima mais a capacidade vital e o volume expiratório forçado no primeiro segundo. Fixando-se um valor de 10 por cento de diferença entre OS VO2 pico obtidos e estimados como sendo aceitáveis, observou-se que a maioria dos valores previstos pelas três equações estavam acima ou abaixo deste limite. Conclusões: Nossos resultados sugerem que a técnica de acompanhamento de um examinador junto ao paciente com insuficiência cardíaca no teste da caminhada, faz com que ele , ao final do teste, atinja níveis cronotrôpicos iguais aos atingidos no teste ergoespirométrico...(au).
Acesso aberto (Open Access)
Avaliação e seguimento em médio prazo em candidatos a transplante cardíaco submetidos a exercício de baixa intensidade
(Sociedade Brasileira de Cirurgia Cardiovascular, 2010-09-01) Yoshimori, Darlene Yuri [UNIFESP]; Cipriano Junior, Gerson [UNIFESP]; Mair, Vanessa [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Brasília
OBJECTIVE: To study cardiovascular behavior and safety regarding a low-intensity exercise program for heart transplant candidates with severe heart failure. METHODS: Twenty-one patients with severe heart failure on the transplant list of the UNIFESP university hospital (Brazil) were studied. Following evaluation, the patients were monitored during an exercise program with six progressive phases (1 - upper limbs; 2 - lower limbs; 3 - walking; 4 - ½ flight of stairs; 5 - walking 200 m; and 6 - whole flight of stairs), with the intensity estimated at two to six metabolic equivalents (1 MET = 3.5 ml of O2/kg/min.). The patients were prospectively followed up for approximately 17 months for the occurrence of clinical complications and death. RESULTS: Three patients were unable to perform the complete program; BMI, maximal respiratory pressure (Pimax and Pemax, cmH2O) and number of previous hospitalizations were considered predictors for this subgroup. Heart rate (HR, bpm), double product (DP, bpm x mmHg) and Borg perceived exertion scale (PE) underwent the greatest oscillation during exercise, especially in phase 5 (HMETS), and are considered the best markers related to exertion. Blood pressure (BP, mmHg) oscillated little. There was no increase in the incidence of arrhythmia (Kappa=0.552) during exercise. There was a moderate positive correlation between PE and BP (r=0.4; P=0.02) in phase 5 (walking 200 m). The patients who died had low Pimax values upon the initial evaluation. During the exercise program, there was a reduction in BP response and an increase in HR response. CONCLUSION: Regarding cardiovascular behavior, the exercise program proved safe and well tolerated, but there is a need for monitoring. Information obtained upon the initial evaluation and during exercise program is associated to decompensation and death. Such information could assist in determining the stage of the disease.
Acesso aberto (Open Access)
Características definidoras e fatores relacionados do diagnóstico de enfermagem “Perfusão Tissular Renal Ineficaz” em pacientes com insuficiência cardíaca
(Universidade Federal de São Paulo (UNIFESP), 2018-07-26) Zhao, Li Men [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Santos, Vinícius Batista [UNIFESP]; http://lattes.cnpq.br/4234078077590338; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/7264692550392657; Universidade Federal de São Paulo (UNIFESP)
Objective: to identify the prevalence of the Nursing Diagnosis (ND) “Ineffective Renal Tissue Perfusion” (IRTP) in patients with Decompensated Chronic Heart Failure (HF). Methods: This is an observational, descriptive, crosssectional and retrospective study performed in a large public hospital, specialized in Cardiology in the city of São Paulo. The period for data collection was from August to December 2016. Sociodemographic and clinical data were collected through an instrumental developed by the researcher. The sample was consisted of 379 medical records of adult patients, admitted to the emergency department with decompensated chronic HF from January to December 2015. The sample was divided into two groups: those with IRTP (n=251, IRTP Group), and those without IRTP (n=128, Control Group). The criteria considered for the presence IRTP were: reduced Glomerular Filtration Rate (GFR), this is, GFR <60 mL/min/1.73m² and the presence of at least one or more related factors (ReF) of IRTP. The data are presented by means of descriptive statistics. For the qualitative measures were used through Fisher’s or ChiSquare tests and for the quantitative measures, the Student’st test or MannWhitney, being considered statistically significant when the p value was < 0.05. Results: the prevalence of ND “Ineffective Renal Tissue Perfusion” was 66% in patients with decompensated chronic HF. The DCs identified in the group of patients with decompensated chronic HF and the “Ineffective Renal Tissue Perfusion” were: elevated Creatinine and Urea rates (100%), reduced GFR (100%), oliguria (23,5%), and albuminuria (21,9%). The main related factors (ReFs) in the IRTP group were: the presence of comorbidities (98.4%), kidney disease (96.8%), advanced age (79.7%) and change in metabolism (27.9%). The main characteristics presented by patients of the IRTP group were: the average age 69 years, Dyslipidemia, Chronic Kidney Failure, Hypothyroidism, and using a pacemaker or implantable cardioverter defibrillator as personal background; prevalence of ischemic and chagasic etiologies of HF; inappetence, decreased urine output and the presence of nausea and vomiting as the main admission complaints; the physical examination findings were drowsiness and slow tissue perfusion; reduction in vital parameter values (blood pressure and heart rate); reduction in laboratory values of platelets and increase in potassium values, creatinine and urea levels; on chest radiography, cardiomegaly; left ventricular dysfunction by Transthoracic Echocardiography; and home use of carvedilol. There were longer hospital stays and mortality in the IRTP group. In the multiple regression analysis, it was observed that age, chronic kidney disease, nausea and vomiting, cardiomegaly and the levels of urea were clinical characteristics of great relevance for the identification of ND IRTP. Conclusions: There is a high prevalence of ND IRTP and its DCs and ReFs are indicators that should be evaluated by the nurse in these patients with decompensated chronic HF.
Acesso aberto (Open Access)
Cardiac resynchronization therapy in patients with heart failure: systematic review
(Associação Paulista de Medicina - APM, 2009-01-01) Lemos Júnior, Hernani Pinto de [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Brazilian Cochrane Center Researcher; Universidade Federal de São Paulo (UNIFESP); Brazilian Cochrane Center Director; Associação Paulista de Medicina Scientific Director
CONTEXT AND OBJECTIVE: Cardiac resynchronization therapy (CRT) has emerged as the predominant electrical treatment strategy for patients on pharmacological therapy who present heart failure with wide QRS and low ejection fraction. The objective of this study was to investigate whether cardiac resynchronization therapy improved mortality and morbidity among patients with heart failure. METHODS: This was a systematic review using the Cochrane Collaboration's methodology. The online search strategy included the Cochrane Library, Medline (Medical Literature Analysis and Retrieval System Online), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) and cardiology congresses from 1990 to 2006. The criteria for considering studies for this review were as follows:-types of studies: randomized controlled trials; types of interventions: cardiac resynchronization therapy compared with other therapies; types of participants: patients with heart failure with low ejection fraction and wide QRS; outcomes: death or hospitalization. RESULTS: Seven trials met the selection criteria. The risk of death due to congestive heart failure was nonsignificant: relative risk (RR), 0.79; 95% confidence interval (CI): 0.60 to 1.03. There was an absolute risk reduction of 4% in all-cause mortality for the experimental group #&091;RR 0.70; CI: 0.60 to 0.83; number needed to treat (NNT) 25#&093;; sudden cardiac death showed a statistically significant difference favoring the experimental group, with absolute risk reduction of 1% (CI: 0.46 to 0.96; RR 0.67; NNT 100). There was an absolute risk reduction of 9% for hospitalization due to heart failure (RR 0.64; CI: 0.50 to 0.80; NNT 11) in the experimental group. CONCLUSIONS: Patients receiving CRT had a significantly lower risk of hospitalization due to heart failure, but death rates due to heart failure were similar.
Acesso aberto (Open Access)
Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease
(Elsevier B.V., 2013-10-09) Ritt, Luiz Eduardo Fonteles [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Feitosa, Gilson Soares; Pinho-Filho, Joel Alves; Andrade, Marcus Vinicius Santos; Feitosa-Filho, Gilson Soares; Newby, L. Kristin; Lopes, Renato Delascio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Izabel Hosp; Brazilian Clin Res Inst; Duke Clin Res Inst
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Changes in GABAergic inputs in the paraventricular nucleus maintain sympathetic vasomotor tone in chronic heart failure
(Elsevier B.V., 2012-11-02) Carillo, Bruno de Arruda [UNIFESP]; Oliveira-Sales, Elizabeth Barbosa de [UNIFESP]; Andersen, Monica Levy [UNIFESP]; Tufik, Sergio [UNIFESP]; Hipólide, Débora Cristina [UNIFESP]; Santos, A. A. [UNIFESP]; Tucci, Paulo José Ferreira [UNIFESP]; Bergamaschi, Cassia Toledo [UNIFESP]; Campos, Ruy Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The paraventricular nucleus (PVN) of the hypothalamus is an important region of the brain involved in the regulation of sympathetic vasomotor tone. Accumulating evidence supports the idea that a change in hypothalamic gamma-aminobutyric acid (GABA)-ergic inhibitory and glutamatergic excitatory inputs contribute to the exacerbated sympathetic drive in chronic heart failure (HF). the purpose of this study was to determine whether a possible imbalance between glutamatergic and GABAergic inputs to the PVN contributes to increased sympathetic outflow in HF in two different sympathetic territories. Renal (RSNA) and splanchnic sympathetic nerve activity (SSNA), mean arterial blood pressure (MAP) and heart rate were recorded from urethane-anesthetized HF or sham rats. the NMDA-glutamate and GABA-A receptor densities within the PVN were quantified in HF and sham rats by autoradiography. Bilateral microinjection of kynurenic acid (4 nmol) into the PVN decreased MAP and RSNA and SSNA in HF but not in sham rats. Furthermore, in response to GABA-A blockade in the PVN by bicuculline (400 pmol), hypertension and SSNA were reduced in HF compared to sham. the quantification of ionotropic NMDA receptors and GABA-A receptors in the PVN showed a significant reduction of GABA-A in HF rats; however, the NMDA density in the PVN did not differ between groups. Thus, this study provides evidence that the sympathoexcitation is maintained by an imbalance between GABAergic and glutamatergic inputs in the PVN in HF. the reduced GABAergic input results in relatively augmented glutamatergic actions in the PVN of HF rats. (C) 2012 Elsevier B.V. All rights reserved.
Acesso aberto (Open Access)
Color Doppler imaging of the ophthalmic artery in patients with chronic heart failure
(Conselho Brasileiro de Oftalmologia, 2011-10-01) Almeida-Freitas, Daniela B. [UNIFESP]; Meira-Freitas, Daniel [UNIFESP]; Melo Jr, Luiz Alberto Soares de [UNIFESP]; Paranhos Junior, Augusto [UNIFESP]; Iared, Wagner [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: To evaluate the ophthalmic artery hemodynamics in patients with chronic heart failure. Methods: Doppler parameters of ophthalmic artery of 18 patients with chronic heart failure in different stages of the disease were compared with 21 healthy volunteers (control group). These parameters were also correlated with echocardiographic assessments and clinical cardiologic status. Results: Mean diastolic velocity was 5.14 ± 2.4 cm/s in the chronic heart failure group and 7.44 ± 3.5 cm/s in the control group (p=0.007). Mean resistance index of the ophthalmic artery was 0.76 ± 0.08 in the chronic heart failure group and 0.70 ± 0.08 in the control group (p=0.04). Mean systolic velocity of the ophthalmic artery was 22.03 ± 7.7 cm/s in the chronic heart failure group and 25.32 ± 9.2 cm/s in the control group (p=0.24). There was a negative correlation between the resistance index of the ophthalmic artery and systemic blood pressure of patients with chronic heart failure (r= -0.47, p=0.007). Diastolic velocity of the ophthalmic artery correlated positively with systemic blood pressure (r=0.44, p=0.02). Conclusion: Lower diastolic velocity and higher resistance index were observed in the ophthalmic artery of chronic heart failure patients when compared to the control group, which probably reflects the presence of orbital vasoconstriction in response to low cardiac output. Therefore, the influence of these findings on the structure and function of the optic nerve head deserves investigation.
Acesso aberto (Open Access)
Comportamento da VE/VCO2 e OUES durante exercício progressivo máximo em pacientes com insuficiência cardíaca
(Universidade Federal de São Paulo, 2019-12-06) Aguillar, Iago Nunes [UNIFESP]; Medeiros, Alessandra [UNIFESP]; Silva, Alexandre Galvão da; http://lattes.cnpq.br/5559173432304001; http://lattes.cnpq.br/0071198026371230; http://lattes.cnpq.br/6973762855519517; Universidade Federal de São Paulo (UNIFESP)
Introdução: A insuficiência cardíaca é síndrome clínica complexa que se origina de diversas etiologias resultando em comprometimento cardiorrespiratório durante o esforço físico, aumentando o risco de morte desses indivíduos. Objetivo: Comparar o comportamento das variáveis cardiorrespiratórias, inclinação da eficiência de absorção de oxigênio (OUES) e a relação entre a ventilação pulmonar e a produção de dióxido de carbono (VE/VCO2) entre indivíduos com insuficiência cardíaca e indivíduos saudáveis. Métodos: Foram avaliados 61 indivíduos (61,2 ± 7,8 anos) do sexo masculino, que foram separados em dois grupos: Grupo IC – Pacientes com Insuficiência Cardíaca (n =40) e Grupo C - Controle (n = 21), todos os pacientes realizaram avaliações dos seguintes parâmetros antropométricos: idade, altura, massa corporal e índice de massa corporal (IMC), também foi realizado o teste ergoespirométrico, que consiste na execução de exercício graduado em esteira rolante com análise direta dos gases respiratórios: VE/VCO2, VO2pico, PetCO2, OUES e as variáveis hemodinâmicas: Frequência cardíaca máxima, Frequência cardíaca de recuperação após o 1º minuto e o ecocardiograma para análises da Fração de Ejeção. Foi realizado o teste Kolmorovsminoff para normalidade, os dados foram expressos em média e erro-padrão e a análise inferencial realizada com os Testes Anova e Post-Hoc de Scheffé, considerando p≤0,05. Resultados: Os resultados antropométricos, hemodinâmicos e das variáveis respiratórias para o grupo IC e C são: idade = 61±8,2 vs. 61,5±7,4 anos (p>0,05), altura = 1,72±5,8 vs. 1,72±6,8cm (p>0,05), massa corporal = 77,3±9,9 vs. 78,3±9,0kg (p>0,05), IMC = 26,5±3,0 vs. 26,2±2,8 kg/m2 (p>0,05), fração de ejeção = 31,2±4,1 vs. 64,7±3,9mL (p<0,001), frequência cardíaca máxima = 128,6±22,9 vs. 143,6±15,5bpm (p<0,02), frequência cardíaca de recuperação após o 1º minuto = -17,4±5,4 vs. -25,0±4,9bpm (p<0,05), VE/VCO2slope = 38,8±5,6 vs. 28,2±3,9L/min (p<0,003), VO2pico = 20,0±4,0 vs. 36,7±5,5ml/kg/min (p<0,05), PetCO2 = 29,5±3,0 vs. 31,7±2,4mmHg (p<0,05) e OUES = 1,81±0,4 vs 2,3±0,3 (p<0,05). Conclusão: Pacientes com insuficiência cardíaca apresentaram elevados valores da VE/VCO2 e baixos valores do OUES o que repercute em limitação da capacidade funcional e início precoce de acidose metabólica.
Somente Metadadados
Content Validation of the Operational Definitions of the Nursing Diagnoses of Activity Intolerance, Excess Fluid Volume, and Decreased Cardiac Output in Patients With Heart Failure
(Wiley-Blackwell, 2014-06-01) Souza, Vanessa de [UNIFESP]; Zeitoun, Sandra Salloum; Lopes, Camila Takao [UNIFESP]; Dias de Oliveira, Ana Paula [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Estadual Paulista; Universidade de São Paulo (USP)
Objectives To consensually validate the operational definitions of the nursing diagnoses activity intolerance, excessive fluid volume, and decreased cardiac output in patients with decompensated heart failure. Method Consensual validation was performed in two stages: analogy by similarity of defining characteristics, and development of operational definitions and validation with experts. Results A total of 38 defining characteristics were found. Operational definitions were developed and content-validated. One hundred percent of agreement was achieved among the seven experts after five rounds. Ascites was added in the nursing diagnosis excessive fluid volume. Conclusion the consensual validation improves interpretation of human response, grounding the selection of nursing interventions and contributing to improved nursing outcomes. Implications for Practice Support the assessment of patients with decompensated heart failure. Objetivos Realizar a validacAo consensual das definicoes operacionais dos diagnosticos de enfermagem Intolerancia a atividade, Volume de liquidos excessivo e Debito cardiaco diminuido em pacientes com insuficiencia cardiaca descompensada. Metodo ValidacAo consensual em duas etapas: Analogia de semelhanca das caracteristicas definidoras e desenvolvimento de definicoes operacionais e validacAo com expertst. Resultados Foram encontradas 38 caracteristicas definidoras para os diagnosticos de enfermagem. Suas definicoes operacionais foram desenvolvidas e seu conteudo validado. Os resultados mostram que houve 100% de concordancia entre os sete experts apos cinco rodada. As definicoes operacionais foram classificadas com base no nivel de concordanica. Ascite foi acrescentada ao diagnostico Volume de liquidos excessivo. ConclusAo A validacAo consensual melhora a interpretacAo das respostas humanas, embasando a selecAo de intervencoes de enfermagem e contribuindo para melhorar os resultados. Implicacoes Para A Pratica Apoio a avaliacAo dos pacientes com insuficiencia cardiaca descompensada.
Somente Metadadados
Correlations between stress, anxiety and depression and sociodemographic and clinical characteristics among outpatients with heart failure
(W B Saunders Co-Elsevier Inc, 2018) Cirelli, Melissa Alves [UNIFESP]; Lacerda, Marianna Sobral [UNIFESP]; Lopes, Camila Takao [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]
Aim To describe and investigate correlations among anxiety, stress and depression and identify their relationship with sociodemographic and clinical characteristics of patients with heart failure. Methods: This is an analytical cross-sectional study. Sociodemographic and clinical characteristics were collected, along with levels of anxiety, stress and depression from 309 outpatients. Results: The mean levels of stress, anxiety and depression were correlated but low. Time since diagnosis, the disease's functional class, family income, and smoking influenced stress. Functional class and Chagas disease influenced anxiety and depression. Being unemployed and smoking influenced anxiety, while being a homeowner influenced depression. Conclusion: These findings should be considered when planning nursing interventions.
Somente Metadadados
Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?
(Lippincott Williams & Wilkins, 2016) Alencar, Maria Clara Noman de [UNIFESP]; Arbex, Flavio Ferlin [UNIFESP]; Souza, Aline [UNIFESP]; Mazzuco, Adriana; Sperandio, Priscila Abreu [UNIFESP]; Rocha, Alcides [UNIFESP]; Hirai, Daniel Müller [UNIFESP]; Mancuso, Frederico José Neves [UNIFESP]; Berton, Danilo Cortozi [UNIFESP]; Borghi-Silva, Audrey; Almeida, Dirceu Rodrigues de [UNIFESP]; O'Donnell, Denis Eunan; Neder, Jose Alberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(V) over dot(E)]-carbon dioxide output [(V) over dotCO(2)] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% +/- 17% predicted, ejection fraction = 35% +/- 6%) were prospectively followed up during 412 +/- 261 days for major cardiac events. RESULTS: Fourteen patients (46%) had a negative outcome. Patients who had an event had lower echocardiographically determined right ventricular fractional area change (RVFAC), greater ventilatory inefficiency (higher (V) over dot(E)/(V) over dotCO(2) nadir), and lower end-tidal CO2 (PETCO2) (all P < .05). Multivariate Cox models revealed that (V) over dot(E)/(V) over dotCO(2) nadir > 36, Delta P-ET CO2(PEAK-REST)>= 2 mm Hg, and PETCO2PEAK <= 33 mm Hg added prognostic value to RVFAC <45%. Kaplan-Meyer analyses showed that although 18% of patients with RVFAC > 45% had a major cardiac event after 1 year, no patient with RVFAC > 45% and (V) over dot(E)/ (V) over dotCO(2) nadir = 36 (or PETCO2PEAK>33 mm Hg) had a negative event. Conversely, although 69% of patients with RVFAC <= 45% had a major cardiac event after 1 year, all patients with RVFAC <= 45% and. PETCO2(PEAK-REST)>= 2 mm Hg had a negative event. CONCLUSION: Ventilatory inefficiency remains a powerful prognostic marker in HF despite the presence of mechanical ventilatory constraints induced by COPD. If these preliminary findings are confirmed in larger studies, optimal thresholds for outcome prediction are likely greater than those traditionally recommended for HF patients without COPD.
Acesso aberto (Open Access)
Efetividade das intervenções de enfermagem em pacientes com insuficiência cardíaca e o diagnóstico de enfermagem “controle ineficaz da saúde”
(Universidade Federal de São Paulo (UNIFESP), 2016-12-21) Oliveira, Ana Paula Dias de [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/9197375315890263; Universidade Federal de São Paulo (UNIFESP)
Objective: To assess the effectiveness of interventions of the Nursing Intervention Classification (NIC) ?Teaching: Disease Process?, ?Health Education? and ?Cardiac Care? in improving the outcomes of patients with HF and the nursing diagnosis (ND) ?Ineffective Health Maintenance?. Method: retrospective cohort study conducted in a nursing outpatient clinic providing health education in São Paulo, SP, Brazil. Fourteen patients with HF monitored over the course of one year who received six in-person consultations every two months intercalated by telephone consultations once a month, were included. An instrument based on NANDA international was applied in the first consultation to confirm the ND ?Ineffective Health Maintenance, after which the 12 indicators of the outcomes ?Self-management: Heart Failure? and ?Adherence Behavior? of the Nursing Outcome Classification (NOC) were assessed and NIC interventions were implemented: ?Teaching: Disease Process?, ?Health Education?, and ?Cardiac Care?. Patients were reassessed during in-person consultations and two expert nurses assessed the indicators. The effectiveness of interventions was verified by changing NOC scores using the Friedman non-parametric test and non-parametric repeated measures ANOVA; level of significance was 5%. Results: The ND ?Ineffective Health Maintenance? was prevalent in 100% of the patients. The selected interventions were implemented in all the consultations; only the activities varied. The scores of the two outcomes improved significantly through the fourth consultation (p<0.001) and the same profile was maintained up to the last consultation. Conclusions: The NIC interventions were effective and improved the NOC outcomes of patients with HF and the ND ?Ineffective Health Maintenance.? The results suggest that the selected interventions encourage self-management and health behaviors.
Acesso aberto (Open Access)
Effects of Zolpidem CR on Sleep and Nocturnal Ventilation in Patients with Heart Failure
(Amer Acad Sleep Medicine, 2016) Gatti, Rodrigo Castiglia [UNIFESP]; Burke, Patrick Rademaker [UNIFESP]; Otuyama, Leonardo Jun [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Tufik, Sergio [UNIFESP]; Poyares, Dalva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Study Objective: This study aimed to evaluate the effects of zolpidem CR (controlled release) on sleep and nocturnal ventilation in patients with congestive heart failure, a population at risk for insomnia and poor sleep quality. Methods: Fifteen patients with heart failure (ischemic cardiomyopathy) and ejection fraction ≤ 45% in NYHA functional class I or II were evaluated with full polysomnography in a placebo-controlled, double-blind, randomized trial. Patients underwent three tests: (1) baseline polysomnography and, after randomization, (2) a new test with zolpidem CR 12.5 mg or placebo, and after 1 week, (3) a new polysomnography, crossing the “medication” used. Results: A 16% increase in total sleep time was found with the use of zolpidem CR and an increase in stage 3 NREM sleep (slow wave sleep). The apnea hypopnea index (AHI) did not change with zolpidem CR even after controlling for supine position; however, a slight but significant decrease was observed in lowest oxygen saturation compared with baseline and placebo conditions (83.60 ± 5.51; 84.43 ± 3.80; 80.71 ± 5.18, P = 0.002). Conclusion: Zolpidem CR improved sleep structure in patients with heart failure, did not change apnea hypopnea index, but slightly decreased lowest oxygen saturation.

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