Banca de DEFESA: JÉSSICA COSTA LEITE

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JÉSSICA COSTA LEITE
DATE: 01/12/2021
TIME: 08:30
LOCAL: videoconferência
TITLE:

Effectiveness of inspiratory muscle training associated with cardiac rehabilitation program in sympathetic activity and in functional capacity in patients with heart failure

KEY WORDS:

Heart failure. Cardiac rehabilitation. Inspiratory muscle training. Functional capacity. Cardiac dysautonomia. GlittreADL-Test.

PAGES: 150
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Introduction: Heart failure (HF) is considered a clinical syndrome with typical signs and symptoms such as dyspnea, low exercise tolerance, fatigue and dysautonomia. It occurs due to structural and functional cardiac changes that generally cause decreased cardiac output and/or increased intracardiac pressures, resulting in systolic and/or diastolic dysfunction. Different treatment approaches are investigated in order to improve the therapeutic management of these patients. Among the treatment modalities, the inclusion of IMT in cardiac Rehabilitation programs has been largely considered a good strategy for clinical improvement of additional findings in patients with (HF). Objectives - Study 1: Evaluate the effectiveness of Inspiratory Muscle Training associated with a cardiac rehabilitation program in functional capacity, exercise tolerance, thickness and mobility of the diaphragm muscle, respiratory muscle strength, quality of life and satisfaction of patients with Heart Failure. Study 2: Evaluate the effectiveness of Inspiratory Muscle Training associated with a cardiac rehabilitation program in the UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br modulation of myocardial sympathetic activity in patients with Heart failure. Study 3: To determine the cutoff point of Glittre ADL-Test that indicates a better functional capacity of individuals with CI and reduced ejection fraction (EF), compared to the cardiopulmonary exercise test (CPX), considered the gold standard test. Also, determine their agreement and reliability, and finally estimate the minimum detectable change. Methods - Study 1: Controlled, randomized, triple blind clinical trial, with 19 sedentary adult individuals aged from 21 to 60 years old, of both genders, diagnosed with systolic CI, with left ventricular ejection fraction less than 45% and inspiratory muscles weakness. Before and after the rehabilitation program, individuals were submitted to evaluation with cardiopulmonary exercise test, ADL-Glittre test, manovacuometry, pulmonary function test, diaphragmatic ultrasound, quality of life and functional capacity and satisfaction questionnaires. The program consisted of 36 sessions, divided into 12 weeks, with three weekly sessions of aerobic exercise, peripheral muscle fitness and inspiratory muscle training (IMT). The IMT was performed seven days a week, at the patient's home, using the POWERBreathe® device, which in the experimental group was calibrated at 30% of the maximum inspiratory pressure and in the control group at 10 cmH2O. Study 2: Series of cases with 11 patients divided into two groups: 06 patients – experimental group and 05 patients – control group (the same protocol as in study 1). Cardiac sympathetic activity was evaluated by scintigraphy with metaiodobenzylguanidine bound to 123 Iodine (123I-mIBG) through the ratio of 123I-mIBG uptake of heart and mediastinum (H/M) early and late and the washout rate. H/M <1.9 and cardiac washout rate of 123I- mIBG >19% characterize cardiac sympathetic hyperactivity and worse cardiovascular prognosis. Study 3: Cross-sectional study conducted with 77 adults aged from 21 to 65 years old, with heart failure and reduced ejection fraction, NYHA II-III. An analysis of Glittre ADL-Test was made and compared to CPX was performed. For comparison between the two tests, Total Time of Glittre ADL-Test and VO2peak of the CPX were used, and cutoff point used for VO2 was 16 ml/Kg/min-1, and according to the Weber classification, results below this value mean low functional capacity and worse prognosis. Through a ROC curve, it was possible to UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br determine the cutoff point with the best sensitivity and specificity, a test-retest reliability, an absolute reliability and a minimum detectable change. Results - Study 1: In both groups, it was possible to verify an increase in functional capacity, exercise tolerance, respiratory muscle strength, diaphragmatic mechanics and quality of life, with the experimental group showing a slightly higher performance, but without statistical significance. Study 2: After the intervention, the average of early H/M was 2.47 (1.94-2.72) versus 2.02 (1.60-2.36) and the late H/M was 2.02 (1.86-2.32) versus 1.64 (1.52-2.33), experimental and control, respectively. The average of washout rate was 27.82% (22.10- 30.65) in the experimental group and 34.49% (26.89-38.10) in the control group. Despite being not statistically significant, results after intervention show better control of cardiac sympathetic activity, with higher H/M and lower washout rate of 123I-mIBG in the experimental group. Study 3: The defined cutoff point was 255 seconds with a sensitivity of 75.76% (95% CI, 57.7-88.9) and specificity of 72.09% (95% CI, 56.3-84, 7), with an area under the curve of 0.773 (95% CI 0.663-0.861 and p<0.0001). The correlation between the tests was 0.83 with an effect size (R2) of 0.69 and p<0.001. The intraclass correlation coefficient between the two tests was 0.841 (95%CI: 0.454 – 0.936, p < 0.001) and Absolute Reliability (intra-subject variability) of 3.17%, the minimum detectable change (MDC95), is 23.07 seconds or 8.78%. Conclusion: Overall, the results found indicate that very low amount of IMT already have the potential to provide additional benefits to the rehabilitation of patients with CI, reduced LVEF and inspiratory muscle weakness. Furthermore, Glittre ADL-Test used as a test of tolerance to submaximal exertion proved to be capable of predicting the prognosis of patients with CI, besides the fact it is easily reproducible and with good stability in repeated tests. The determined cutoff point can be used in clinical practice to identify more severe patients when there is difficulty in performing CPX. Due to the learning effect, two tests are recommended in clinical practice.

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