Dinâmica da frequência cardíaca e parâmetros cardiorrespiratórios são eficazes em prever sinais e sintomas durante a reabilitação cardiovascular? Estudo de coorte longitudinal
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Data
2022-11-25
Autores
Takahashi, Carolina
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Exercícios físicos, componentes fundamentais dos programas de reabilitação cardiovascular (PRC), são essenciais para controle e melhora de diversos aspectos físicos, sociais e mentais de indivíduos com doenças cardiovasculares. Contudo, sua prática é associada ao risco de surgimento de sinais e sintomas. Assim, a busca por métodos de monitorização e prognóstico em tal população se torna primordial no âmbito clínico, e apesar de diversos parâmetros cardiorrespiratórios e autonômicos serem amplamente utilizados para tal propósito, ainda existem lacunas quanto à sua capacidade de se correlacionarem e predizerem sinais e sintomas durante o PRC. Objetivos: 1) Comparar a resposta cardiorrespiratória de repouso entre os pacientes em um PRC com diferentes padrões de incidência de sinais/sintomas e correlacionar parâmetros cardiorrespiratórios com sua ocorrência; 2) Analisar os efeitos induzidos por um PRC, ao longo de 8 meses, na dinâmica linear da FC e nos parâmetros cardiorrespiratórios, e se suas alterações influenciam no surgimento de sinais/sintomas; 3) Correlacionar o comportamento da dinâmica não linear da FC em repouso com o surgimento de sinais e sintomas durante os PRC, além de analisar se após um período de 8 meses houve modificação desta dinâmica não linear da FC e se isso influenciou a ocorrência de sinais e sintomas. Metodologia: Foram avaliados aproximadamente 70 pacientes inseridos em um PRC, com diagnóstico clínico de insuficiência coronariana, outras doenças cardíacas ou fatores de risco para o desenvolvimento de tais doenças. Estes pacientes realizaram avaliações em repouso da modulação autonômica cardíaca, para obtenção de índices não lineares e lineares, e de parâmetros cardiorrespiratórios (frequência cardíaca [FC] e respiratória, pressão arterial, saturação de oxigênio, parâmetros espirométricos e de manovacuometria). Em seguida, eles foram acompanhados por 24 sessões do programa, afim de serem obtidos possíveis sinais e sintomas, como alterações na frequência de pulso, anormalidades pressóricas durante o esforço, dor muscular ou fadiga. Para os estudos 2 e 3 todas as avaliações/acompanhamento foram novamente realizadas após 8 meses. Resultados: Piores valores de parâmetros cardiorrespiratórios foram correlacionados com a maior incidência de sinais/sintomas, sendo que quanto menor os valores para CVF, VEF1 e VEF1/CVF (Pre#1), e maior para FC de repouso, maior foi o surgimento dos sinais/sintomas. Em análises dos dados após 8 meses, houve redução expressiva na ocorrência de sinais e sintomas, com uma tendência de melhora nos parâmetros cardíacos e manutenção dos parâmetros respiratórios e autonômicos da dinâmica linear e não linear da FC. Ainda, com exceção de FEV1/FVC e Entropia de Shannon, os deltas de variação das variáveis e dos sinais e sintomas não se correlacionaram. Conclusões: Pacientes com mais sinais e sintomas apresentaram menores valores em suas variáveis cardiorrespiratórias, havendo correlação para CVF, VEF1, VEF1/CVF (Pre#1) e FC. Ademais, não houve alterações significantes para variáveis cardiorrespiratórias e autonômicas lineares e não lineares, indicando a manutenção de tais variáveis ao longo do período de 8 meses no PRC, porém houve redução importante na ocorrência dos sinais/sintomas. Ainda, a variação de FEV1/FVC e Entropia de Shannon se correlacionaram com a variação no surgimento de sinas e sintomas.
Background: Physical exercises, fundamental components of cardiovascular rehabilitation programs (CRP), are essential for controlling and improving several physical, social and mental aspects of individuals with cardiovascular diseases. However, this practice is associated with the risk of the occurrence of signs and symptoms. Thus, the search for monitoring and prognostic methods in such population becomes primordial in the clinical context, and despite the fact that several cardiorespiratory and autonomic parameters are widely used for this purpose, there are still gaps regarding their ability to correlate and predict signs and symptoms during a CRP. Aims: 1) To compare the cardiorespiratory response at rest among patients in a CRP with different patterns of incidence of signs/symptoms and to correlate cardiorespiratory parameters with their occurrence; 2) To analyze the effects induced by a CRP, over 8 months, on the linear dynamics of HR and cardiorespiratory parameters, and whether their alterations influence the occurrence of signs/symptoms; 3) To correlate the behavior of the nonlinear dynamics of HR at rest with the occurrence of signs and symptoms during the CRP, in addition to analyzing whether after a period of 8 months there was a change in the nonlinear dynamics of HR and whether this influenced the occurrence of signs and symptoms. Methodology: Approximately 70 patients enrolled in a CRP, with a clinical diagnosis of coronary insufficiency, other heart diseases or risk factors for the development of such diseases, were evaluated. These patients underwent cardiac autonomic modulation assessments at rest to obtain non-linear and linear indices, and cardiorespiratory parameters (heart rate [HR] and respiratory rate, blood pressure, oxygen saturation, spirometric and manovacuometry parameters). Then, they were accompanied by 24 sessions of the program, in order to obtain possible signs and symptoms, such as changes in pulse rate, pressure abnormalities during exertion, muscle pain or fatigue. For studies 2 and 3 all assessments/follow-up were performed again after 8 months. Results: Worse values of cardiorespiratory parameters were correlated with a higher incidence of signs/symptoms, and the lower the values for FVC, FEV1 and FEV1/FVC (Pre#1), and the higher for resting HR, the greater the occurrence of signs/symptoms. In data analysis after 8 months, there was a significant reduction in the occurrence of signs and symptoms, with a trend of improvement in cardiac parameters and maintenance of respiratory and autonomic parameters of linear and nonlinear HR dynamics. Still, with the exception of FEV1/FVC and Shannon's entropy, the variation deltas of variables and signs and symptoms were not correlated. Conclusions: Patients with more signs and symptoms had lower values in their cardiorespiratory variables, with a correlation for FVC, FEV1, FEV1/FVC (Pre#1) and HR. Furthermore, there were no significant changes for linear and nonlinear cardiorespiratory and autonomic variables, indicating the maintenance of such variables throughout the 8-month period in the CRP, but there was a significant reduction in the occurrence of signs/symptoms. Furthermore, the variation of FEV1/FVC and Shannon's entropy correlated with the variation in the occurrence of signs and symptoms.
Background: Physical exercises, fundamental components of cardiovascular rehabilitation programs (CRP), are essential for controlling and improving several physical, social and mental aspects of individuals with cardiovascular diseases. However, this practice is associated with the risk of the occurrence of signs and symptoms. Thus, the search for monitoring and prognostic methods in such population becomes primordial in the clinical context, and despite the fact that several cardiorespiratory and autonomic parameters are widely used for this purpose, there are still gaps regarding their ability to correlate and predict signs and symptoms during a CRP. Aims: 1) To compare the cardiorespiratory response at rest among patients in a CRP with different patterns of incidence of signs/symptoms and to correlate cardiorespiratory parameters with their occurrence; 2) To analyze the effects induced by a CRP, over 8 months, on the linear dynamics of HR and cardiorespiratory parameters, and whether their alterations influence the occurrence of signs/symptoms; 3) To correlate the behavior of the nonlinear dynamics of HR at rest with the occurrence of signs and symptoms during the CRP, in addition to analyzing whether after a period of 8 months there was a change in the nonlinear dynamics of HR and whether this influenced the occurrence of signs and symptoms. Methodology: Approximately 70 patients enrolled in a CRP, with a clinical diagnosis of coronary insufficiency, other heart diseases or risk factors for the development of such diseases, were evaluated. These patients underwent cardiac autonomic modulation assessments at rest to obtain non-linear and linear indices, and cardiorespiratory parameters (heart rate [HR] and respiratory rate, blood pressure, oxygen saturation, spirometric and manovacuometry parameters). Then, they were accompanied by 24 sessions of the program, in order to obtain possible signs and symptoms, such as changes in pulse rate, pressure abnormalities during exertion, muscle pain or fatigue. For studies 2 and 3 all assessments/follow-up were performed again after 8 months. Results: Worse values of cardiorespiratory parameters were correlated with a higher incidence of signs/symptoms, and the lower the values for FVC, FEV1 and FEV1/FVC (Pre#1), and the higher for resting HR, the greater the occurrence of signs/symptoms. In data analysis after 8 months, there was a significant reduction in the occurrence of signs and symptoms, with a trend of improvement in cardiac parameters and maintenance of respiratory and autonomic parameters of linear and nonlinear HR dynamics. Still, with the exception of FEV1/FVC and Shannon's entropy, the variation deltas of variables and signs and symptoms were not correlated. Conclusions: Patients with more signs and symptoms had lower values in their cardiorespiratory variables, with a correlation for FVC, FEV1, FEV1/FVC (Pre#1) and HR. Furthermore, there were no significant changes for linear and nonlinear cardiorespiratory and autonomic variables, indicating the maintenance of such variables throughout the 8-month period in the CRP, but there was a significant reduction in the occurrence of signs/symptoms. Furthermore, the variation of FEV1/FVC and Shannon's entropy correlated with the variation in the occurrence of signs and symptoms.
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Palavras-chave
Espirometria, Frequência cardíaca, Músculos respiratórios, Pressão arterial, Reabilitação cardíaca, Sinais e sintomas, Sistema nervoso autônomo, Autonomic nervous system, Blood pressure, Cardiac rehabilitation, Heart rate, Respiratory muscles, Signs and symptoms, Spirometry