Avaliação da capacidade funcional da musculatura esquelética como preditora de remodelação após o infarto do miocárdio
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Data
2017-08-28
Autores
Najas, Cláudio Spínola
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Universidade Estadual Paulista (Unesp)
Resumo
O infarto agudo do miocárdio (IAM) é responsável por grande número de hospitalizações e óbitos em todo o mundo. Nos últimos anos, outro fator que vem ganhando destaque na literatura como preditor de má evolução após o IAM é a remodelação ventricular. Na fase aguda do infarto, há desintegração do colágeno interfibrilar. A perda desse tecido de sustentação torna a região mais propensa à distensão e, consequentemente, mais susceptível às deformações, denominada de expansão do infarto. Na fase crônica estudos revelam que a reversão da dilatação, por outro lado, pode ocorrer entre 30 e 60% dos pacientes estando associada à melhora na evolução. Diversos estudos têm demonstrado que medicamentos ou procedimentos que modificam a remodelação ventricular, prevenindo ou retardando a dilatação cardíaca, estão associadas à melhor evolução dos pacientes como a remodelação cardíaca reversa. Outro fator importante é a força de preensão palmar no IAM, diversos estudos mostram que a força do músculo esquelético, se altera em associação com eventos cardíacos, já a composição corporal demonstra que em indivíduos portadores de maior peso magro, tem significativamente maior força que os indivíduos portadores de menor peso magro. No entanto os resultados demonstram a correlação entre peso magro e percentual de gordura pode indicar uma melhor ou pior condição para realizar o esforço isométrico de preensão manual. Objetivo: Avaliar a força da musculatura esquelética e a composição corporal como preditoras de remodelação ventricular, remodelação reversa e disfunção ventricular após o infarto agudo do miocárdio de parede anterior. Metodologia: A análise da força muscular esquelética foi obtida pela técnica de Handgrip, feita por meio de aparelho específico, Hand Dinamometer T-18. Todas as medidas realizadas na mão não dominante, com o paciente sentado, e o cotovelo apoiado na cama. Foi utilizado o método de impedância bioelétrica para a avaliação da composição corporal, principalmente quanto ao volume e percentual de água. Para a remodelação cardíaca, foi realizado o ecocardiograma para avaliar a parede anterior do ventrículo esquerdo. Todas as análises foram realizadas entre o 3º e 5º dia após o infarto. A estatística foi analisada por meio do teste do χ2, o teste t de Student, o teste de Mann-Whitney, considerando nível de significância adotado de 5% para todos os testes. Resultados: Em relação a força muscular e composição corporal, não foram detectadas diferenças significativas entre os grupos avaliados para remodelação cardíaca e disfunção com fração de ejeção ˂ 50% (p ˃ 0,05). Resultados semelhantes foram observados na remodelação cardíaca reversa que também não foram encontradas diferenças significativas para os parâmetros de força muscular e composição corporal (p ˃ 0,05). Para as análises de regressão multivariada, o percentual de massa magra mostrou-se como preditora para a remodelação cardíaca reversa quando ajustado por sexo, idade e enzimas CK-MB ( OR= 0,876; p= 0,019 ), assim como o percentual de gordura ajustados para as mesmas variáveis ( OR= 1,145; p= 0,027 ).
Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricular remodeling, reverse remodeling, and ventricular dysfunction after acute myocardial infarction of the anterior wall. Methodology: Analysis of skeletal muscle strength was obtained through the Handgrip technique, carried out by means of a specific device, the Hand Dinamometer T-18. All measurements were taken on the non-dominant hand, with the patient seated, and the elbow resting on the bed. The bioelectrical impedance method was used to evaluate body composition, principally regarding the volume and percentage of water. For cardiac remodeling, an echocardiogram was performed to evaluate the left ventricular anterior wall. All analyzes were performed between the 3rd and 5th day after the infarction. The statistics were analyzed using the χ2 test, the Student t test, and the Mann-Whitney test, considering a significance level of 5% for all tests. Results: Regarding muscle strength and body composition, no significant differences were detected between the evaluated groups for cardiac remodeling or dysfunction, with ejection fraction ˂ 50% (p ˃ 0.05). Similar results were observed in the reverse cardiac remodeling, also with no significant differences found for the parameters muscle strength and body composition (p ˃ 0.05). For the multivariate regression analyzes, the percentage of lean mass was shown to be a predictor for reverse cardiac remodeling when adjusted by sex, age, and CK-MB enzymes (OR = 0.876, p = 0.019), as well as the percentage of fat adjusted for the same variables (OR = 1.145, p = 0.027).
Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricular remodeling, reverse remodeling, and ventricular dysfunction after acute myocardial infarction of the anterior wall. Methodology: Analysis of skeletal muscle strength was obtained through the Handgrip technique, carried out by means of a specific device, the Hand Dinamometer T-18. All measurements were taken on the non-dominant hand, with the patient seated, and the elbow resting on the bed. The bioelectrical impedance method was used to evaluate body composition, principally regarding the volume and percentage of water. For cardiac remodeling, an echocardiogram was performed to evaluate the left ventricular anterior wall. All analyzes were performed between the 3rd and 5th day after the infarction. The statistics were analyzed using the χ2 test, the Student t test, and the Mann-Whitney test, considering a significance level of 5% for all tests. Results: Regarding muscle strength and body composition, no significant differences were detected between the evaluated groups for cardiac remodeling or dysfunction, with ejection fraction ˂ 50% (p ˃ 0.05). Similar results were observed in the reverse cardiac remodeling, also with no significant differences found for the parameters muscle strength and body composition (p ˃ 0.05). For the multivariate regression analyzes, the percentage of lean mass was shown to be a predictor for reverse cardiac remodeling when adjusted by sex, age, and CK-MB enzymes (OR = 0.876, p = 0.019), as well as the percentage of fat adjusted for the same variables (OR = 1.145, p = 0.027).
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Palavras-chave
handgrip, ecocardiografia, bioimpedância, remodelação ventricular, ventricular remodeling, echocardiography, handgrip, bioimpedance