Adaptações hemodinâmicas e cardiorrespiratórias ao treinamento físico em transplantados do coração com versus sem evidências de reinervação cardíaca
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Data
2016
Autores
Ciolac, Emmanuel Gomes
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Universidade Estadual Paulista (Unesp)
Resumo
A denervação cardíaca pós transplante do coração (TX) resulta em prejuízo da resposta hemodinâmica em repouso e exercício, tendo sido associada à maior incidência de hipertensão arterial sistêmica e baixa capacidade cardiorrespiratória. Embora há evidência de reinervação cardíaca (RC) parcial ao longo do tempo, a mesma não ocorre em todos os indivíduos. O objetivo do presente estudo foi investigar as adaptações hemodinâmicas e cardiorrespiratórias ao treinamento físico em indivíduos transplantados do coração com versus sem evidências de RC (SEMRC). Trinta e três voluntários com TX (idade = 45,5 ± 2,2 anos; tempo de TX = 6,7 ± 0,7 anos), alocados em grupo RC (N = 16) e SEMRC (N = 17), de acordo com resposta da frequência cardíaca à teste de esforço cardiopulmonar (TCP), foram submetidos a um programa de treinamento com 3 sessões semanais de exercício (5 minutos de aquecimento, 30 minutos de exercício aeróbio, 1 série de 10 a 15 repetições em 5 exercícios resistidos e 5 minutos de alongamento), durante 12 semanas. Monitorização ambulatorial da pressão arterial (PA) durante 24 horas (24-h) e medida da velocidade de onda de pulso (VOP) carótido-femoral foi realizado antes e após as 12 semanas de seguimento. TCP também foi repetido após 12 semanas de seguimento. O grupo RC apresentou melhor resposta (P < 0,05) da frequência cardíaca, PA e tolerância ao exercício durante o TCP pré e pós-seguimento. Após o treinamento, o grupo RC reduziu (P < 0,01) a PA sistólica 24-h (7 ± 2 mmHg) e de vigília (9 ± 2 mmHg), bem como a PA diastólica 24-h (9 ± 2 mmHg), de vigília (10 ± 2 mmHg) e sono (6 ± 2 mmHg). O grupo SEMRC reduziu apenas (P < 0,05) a PA diastólica 24-h (5 ± 2 mmHg), de vigília (5 ± 2 mmHg) e sono (6 ± 2 mmHg), sendo esta redução de menor magnitude e ocorrendo em um número menor de horas do dia, quando comparado ao grupo RC. O grupo RC também melhorou (P < 0,001) a capacidade cardiorrespiratória (VO2PICO = 10,8 ± 1,8 %) e a tolerância ao exercício (13,4 ± 4,4 %). O grupo SEMRC melhorou a tolerância ao exercício (9,9 ± 3,5 %), mas não a capacidade cardiorrespiratória. Não houve alteração significativa na VOP de ambos os grupos durante o seguimento. Em suma, a PA ambulatorial melhorou em ambos os grupos após 12 semanas de treinamento físico, mas a melhora foi de maior magnitude no grupo RC que no SEMRC. A capacidade cardiorrespiratória também melhorou no grupo RC, mas não no SEMRC. Estes resultados sugerem que a RC pode afetar as adaptações hemodinâmicas e cardiorrespiratórias ao treinamento em indivíduos com TX.
Cardiac denervation induced by heart transplantation (HTx) results in impaired hemodynamic response at rest and exercise, and has been associated with increased incidence of hypertension and low levels of cardiorespiratory fitness. Although there is some degree of cardiac reinnervation (CR) over time, it does not occurs in all patients. Thus, our purpose was to investigate the hemodynamic and cardiorespiratory adaptations to exercise training in HTx patients with versus without evidence of CR (NOCR group). Thirty-three sedentary HTx patients (age = 45.5 ± 2.2 years; time elapsed since surgery = 6.7 ± 0.7 years), divided into CR (N = 16) and NOCR (N = 17) group according to their heart rate response to cardiopulmonary exercise testing (CPX), were submitted to a thriceweekly exercise program (5 min of warm-up, 30 min of aerobic exercise, 1 set of 10-15 reps in 5 resistance exercises, and 5 min of cool-down) for 12 weeks. 24-hour (24-h) ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (PWV) were performed before and after exercise intervention. CPX was also performed after exercise intervention. CR group displayed improved (P < 0,05) heart rate, BP and exercise tolerance to CPX both before and after intervention. CR group showed traininginduced reductions (P < 0,01) on 24-h (7 ± 2 mmHg) and daytime (9 ± 2 mmHg) systolic BP, as well as 24-h (9 ± 2 mmHg), daytime (10 ± 2 mmHg) and nighttime (6 ± 2 mmHg) diastolic BP. NOCR group showed training-induced reductions (P < 0,05) only on 24-h (5 ± 2 mmHg), daytime (5 ± 2 mmHg) and nighttime (6 ± 2 mmHg) diastolic BP, which were lower and less consistent than in CR group. CR group also improved cardiorespiratory fitness (VO2PEAK = 10.8 ± 1.8 %) and exercise tolerance (13.4 ± 4.4 %). NOCR group improved exercise tolerance (9.9 ± 3.5 %), but not cardiorespiratory fitness. There was no significant change on PWV in both groups during follow-up. In summary, ambulatory BP improved in both groups after 12 weeks of exercise training, but there was greater improvement in CR than NOCR patients. Cardiorespiratory fitness improved in CR patients, but not in NOCR patients. These results suggest that cardiac reinnervation may affects hemodynamic and cardiorespiratory adaptations to exercise training in HTx patients.
Cardiac denervation induced by heart transplantation (HTx) results in impaired hemodynamic response at rest and exercise, and has been associated with increased incidence of hypertension and low levels of cardiorespiratory fitness. Although there is some degree of cardiac reinnervation (CR) over time, it does not occurs in all patients. Thus, our purpose was to investigate the hemodynamic and cardiorespiratory adaptations to exercise training in HTx patients with versus without evidence of CR (NOCR group). Thirty-three sedentary HTx patients (age = 45.5 ± 2.2 years; time elapsed since surgery = 6.7 ± 0.7 years), divided into CR (N = 16) and NOCR (N = 17) group according to their heart rate response to cardiopulmonary exercise testing (CPX), were submitted to a thriceweekly exercise program (5 min of warm-up, 30 min of aerobic exercise, 1 set of 10-15 reps in 5 resistance exercises, and 5 min of cool-down) for 12 weeks. 24-hour (24-h) ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (PWV) were performed before and after exercise intervention. CPX was also performed after exercise intervention. CR group displayed improved (P < 0,05) heart rate, BP and exercise tolerance to CPX both before and after intervention. CR group showed traininginduced reductions (P < 0,01) on 24-h (7 ± 2 mmHg) and daytime (9 ± 2 mmHg) systolic BP, as well as 24-h (9 ± 2 mmHg), daytime (10 ± 2 mmHg) and nighttime (6 ± 2 mmHg) diastolic BP. NOCR group showed training-induced reductions (P < 0,05) only on 24-h (5 ± 2 mmHg), daytime (5 ± 2 mmHg) and nighttime (6 ± 2 mmHg) diastolic BP, which were lower and less consistent than in CR group. CR group also improved cardiorespiratory fitness (VO2PEAK = 10.8 ± 1.8 %) and exercise tolerance (13.4 ± 4.4 %). NOCR group improved exercise tolerance (9.9 ± 3.5 %), but not cardiorespiratory fitness. There was no significant change on PWV in both groups during follow-up. In summary, ambulatory BP improved in both groups after 12 weeks of exercise training, but there was greater improvement in CR than NOCR patients. Cardiorespiratory fitness improved in CR patients, but not in NOCR patients. These results suggest that cardiac reinnervation may affects hemodynamic and cardiorespiratory adaptations to exercise training in HTx patients.
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Palavras-chave
Aptidão cardiorrespiratória, Exercício físico, Pressão arterial, Reabilitação, Rigidez vascular, Transplante de coração, Blood pressure, Cardiorespiratory fitness, Exercise, Heart transplantation, Rehabilitation, Vascular stiffness