MARTA FERNANDES LIMA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
2 resultados
Resultados de Busca
Agora exibindo 1 - 2 de 2
- Exercise Training Increases Metaboreflex Control in Patients with Obstructive Sleep Apnea(2019) GUERRA, Renan S.; GOYA, Thiago T.; SILVA, Rosyvaldo F.; LIMA, Marta F.; BARBOSA, Eline R. F.; ALVES, Maria Janieire De N. N.; RODRIGUES, Amanda G.; LORENZI-FILHO, Geraldo; NEGRAO, Carlos Eduardo; UENO-PARDI, Linda M.Introduction/Purpose We demonstrated that patients with obstructive sleep apnea (OSA) have reduced muscle metaboreflex control of muscle sympathetic nerve activity (MSNA). In addition, exercise training increased muscle metaboreflex control in heart failure patients. Objective We tested the hypothesis that exercise training would increase muscle metaboreflex control of MSNA in patients with OSA. Methods Forty-one patients with OSA were randomized into the following two groups: 1) nontrained (OSANT, n = 21) and 2) trained (OSAT, n = 20). Muscle sympathetic nerve activity was assessed by microneurography technique, muscle blood flow (FBF) by venous occlusion plethysmography, heart rate by electrocardiography, and blood pressure with an automated oscillometric device. All physiological variables were simultaneously assessed at rest, during isometric handgrip exercise at 30% of the maximal voluntary contraction, and during posthandgrip muscle ischemia (PHMI). Muscle metaboreflex sensitivity was calculated as the difference in MSNA between PHMI and the rest period. Patients in the OSAT group underwent 72 sessions of moderate exercise training, whereas patients in the OSANT group were clinical follow-up for 6 months. Results The OSANT and OSAT groups were similar in anthropometric, neurovascular, hemodynamic and sleep parameters. Exercise training reduced the baseline MSNA (34 2 bursts per minute vs 25 +/- 2 bursts per minute; P < 0.05) and increased the baseline FBF (2.1 +/- 0.2 mLmin(-1) per 100 g vs 2.4 +/- 0.2 mLmin(-1) per 100 g; P < 0.05). Exercise training significantly reduced MSNA levels and increased FBF responses during isometric exercise. Exercise training significantly increased MSNA responses during PHMI (6.5 +/- 1 vs -1.7 +/- 1 bursts per minute, P < 0.01). No significant changes in FBF or hemodynamic parameters in OSANT patients were found. Conclusions Exercise training increases muscle metaboreflex sensitivity in patients with OSA. This autonomic change associated with increased muscle blood flow may contribute to the increase in exercise performance in this set of patients.
- Shock-Wave Therapy Improves Myocardial Blood Flow Reserve in Patients with Refractory Angina: Evaluation by Real-Time Myocardial Perfusion Echocardiography(2019) CECCON, Conrado L.; DUQUE, Anderson S.; GOWDAK, Luis H.; MATHIAS JR., Wilson; CHIANG, Hsu Po; SBANO, Joao C. N.; LIMA, Marta F.; CESAR, Luis Antonio Machado; CRUZ, Cecilia B. B. V.; DOURADO, Paulo M. M.; MENEGHETTI, Claudio; TSUTSUI, Jeane M.Background: Cardiac shock-wave therapy (CSWT) has been demonstrated as an option for the treatment of patients with refractory angina (RA), promoting immediate vasodilatory effects and, in the long-term, neoangiogenic effects that would be responsible for reducing the myocardial ischemic load. The aim of this study was to determine the effects of CSWT on myocardial blood flow reserve (MBFR) assessed by quantitative real-time myocardial perfusion echocardiography in patients with RA. Methods: Fifteen patients (mean age 61.5 +/- 12.8 years) with RA who underwent CSWT during nine sessions, over 3 months of treatment, were prospectively studied. A total of 32 myocardial segments with ischennia were treated, while another 31 did not receive therapy because of technical limitations. Myocardial perfusion was evaluated at rest and after dipyridamole stress (0.84 mg/kg) before and 6 months after CSWT, using quantitative real-time myocardial perfusion echocardiography. Clinical effects were evaluated using Canadian Cardiovascular Society grading of angina and the Seattle Angina Questionnaire. Results: The ischemic segments treated with CSWT had increased MBFR (from 1.33 +/- 0.22 to 1.74 +/- 0.29, P < .001), a benefit that was not observed in untreated ischemic segments (1.51 +/- 0.29 vs 1.54 +/- 0.28, P = .47). Patients demonstrated increased global MBFR (from 1.78 +/- 0.54 to 1.89 +/- 0.49, P = .017). Senn iquantitative single-photon emission computed tomographic analysis of the treated ischemic segments revealed a score reduction from 2.10 +/- 0.87 to 1.68 +/- 1.19 (P = .024). There was improvement in Canadian Cardiovascular Society score (from 3.20 +/- 0.56 to 1.93 +/- 0.70, P < .05) and in Seattle Angina Questionnaire score (from 42.3 +/- 12.99 to 71.2 +/- 14.29, P < .05). No major cardiovascular events were recorded during follow-up. Conclusions: CSWT improved MBFR in ischemic segments, as demonstrated by quantitative real-time myocardial perfusion echocardiography. These results suggest that CSWT has the potential to increase myocardial blood flow, with an impact on symptoms and quality of life in patients with RA.