Jiménez DVA, Castillo ML, Orea TA, Asensio LE, Corzo LD, Cano GÁ, Colín RE, Hernández GT, Rebollar GV

Idioma: Español
Referencias bibliográficas: 46
Paginas: 375-385
Archivo PDF: 292.15 Kb.

RESUMEN

Antecedentes: la insuficiencia cardiaca se distingue por la disminución absoluta o relativa del gasto cardiaco. A partir del decenio de 1980 se mencionó que los programas de ejercicio en pacientes con insuficiencia cardiaca pueden ofrecer beneficios sin causar deterioro de la clase funcional.
Objetivo: evaluar el impacto de un programa de ejercicio mixto en pacientes con disfunción sistólica del ventrículo izquierdo, sobre las variables clínicas, ecocardiográficas y de capacidad funcional en pacientes con insuficiencia cardiaca.
Pacientes y métodos: se incluyeron 73 pacientes mayores de 18 años, de uno y otro sexo, con disfunción ventricular sistólica asintomática de más de tres meses de evolución con tratamiento farmacológico convencional. El grupo fue dividido en dos, para realizar o no ejercicio programado. Estos grupos se subdivideron en dos subgrupos, de alto y bajo riesgo, según las características clínicas de cada paciente. Se les vigiló durante seis meses.
Resultados: treinta y seis pacientes se incorporaron al programa de rehabilitación física y treinta y siete al grupo control. Las características de cada grupo fueron similares, salvo porque el grupo control tuvo tensión arterial sistólica mayor que el grupo de ejercicio.
Conclusiones: los programas de ejercicio reducen los síntomas atribuibles a insuficiencia cardiaca crónica, como la disnea y la fatiga, debido a sus efectos cardiovasculares y músculo-esqueléticos. A pesar de las ventajas mostradas, los médicos prescriben muy poco los programas de rehabilitación.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Chávez DR. La cardiopatía en México y su importancia clínica, epidemiológica y preventiva. Arc Cardiol Mex 2003;73:105-14.

2. Tyni-Lenné R, Gordon A, Sylvén C. Skeletal muscle endurance training improves peripheral oxidate capacity, exercise tolerance, and health-related quality of life in women with chronic congestive heart failure secondary to either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy. Am J Cardiol 1997;80:1025-9.

3. Meyer K, Schwaibold M, Roskamm H. Effects of short-term exercise training and activity restriction on functional capacity in patients with severe chronic congestive heart failure. Am J Cardiol 1996;78:1017-22.

4. Coats A, Adamopoulos S. Controlled trial of physical training in chronic heart failure. Circulation 1992;85:2119-31.

5. Demopoulos L. Bijou R, LeJemtel T. Exercise training in patients with severe congestive heart failure: Enhancing peak aerobic capacity while minimizing the increase in ventricular wall stress. J Am Coll Cardiol 1997;29:597-603

6. Meyer K, Schwaibold M, Roskamm H. Effects of exercise training and activity restriction on 6 minute walking test performance in patients with chronic heart failure. Am Heart J 1997;133:447-53

7. Kilavuori K, Toivonen L, Leinonen H. Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. Eur Heart J 1995;16:490-5.

8. Drexler H, Riede U, Munzel T, Koing H, et al. Alterations of skeletal muscle in chronic heart failure. Circulation 1992;85:1751-9.

9. Ohtsubo M, Yonezawa K, Nishijima H, Okita K, et al. Metabolic abnormality of calf skeletal muscle is improved by localized muscle taining without changes in blood flow in chronic heart failure. Heart 1997;78:437-43.

10. Hambrecht R, Fiehn E, Yu J, Niebauer J. Effects of endurance training on mithocondrial ultraestructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol 1997;29:1067-72.

11. Sharpe N, Doughty R. Epidemiology of heart failure and ventricular dysfunction. Lancet 1998;352:(suppl I):37.

12. European Heart Failure Training Group. Experience from controlled trials of physical training in chronic heart failure. Eur Heart J 1998;19:466-75

13. McKelvie RS, Teo KK, Roberts R, McCartney N, et al. Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). Am Heart J 2002;144:23-30.

14. Ilambrecht R, Niebauer J, Fiehm E, Kalberer B, et al. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrasructural abnormalities of leg muscles. J Am Coll Cardiol 1995;25:1239-49.

15. Piepoli MF, Davos C, Francis DP, Coats AJ, ExtraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure (ExtraMATCH). BMJ 2004;328(7433):189

16. O’Connor GT, Buring JE, Yusuf S, Goldhaber SZ, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989:80:234-44.

17. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long term-moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999;99:1173-82.

18. Mancini DM, Eisen H, Kussmaul W, Mull R, et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83:778-86.

19. Laughlin ML, McAllister RM. Exercise training-induced coronary vascular adaptation. J Appl Physiol 1992;73:2209-25.

20. White FC, Roth DM, McKirman D, Carroll SM, Bloor CM. Exercise induced coronary collateral development: a comparison to other models of myocardial angiogenesis. In: Schaper W, Schaper J, editors. Collateral circulation. Norweel: Kluwer Academic, 1993;pp:261-89.

21. Giamnuzzie P, Temporelli PL, Corra U, Gattone M, et al. Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial. Circulation 1997;96:1790-7.

22. Remme WJ, Swedberg K. Task Force Report: Guidelines for the diagnosis and treatment of chronic heart failre. Eur Heart J 2001;22:1527-60.

23. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, et al. ACC/AHA Guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. Circulation 2001;104: 2996-3007.

24. Jin H, Federowicz MS. Thyrotropin-releasing hormone is induced in the left ventricle of rats with heart failure and can provide inotropic support to the failing heart. Circulation 2004;109:220-2245.

25. Isnard R, Pousset F, Trochu J, Chafirovskaia O. Prognostic value of neurohormonal activation and cardiopulmonary exercise testing in patients with chronic heart failure. Am J Cardiol 2000;86:417-21.

26. Hulsmann M, Stanek B, Frey B, Sturm B, et al. Value of cardiopulmonary exercise testing and big endothelin plasma levels to predict short-term prognosis of patients with chronic heart failure. J Am Coll Cardiol 1998;32:1695-700.

27. De Groote P, Millaire A, Pigny P, Nugue O, et al. Plasma levels of atrial natriuretic peptide at peak exercise: a prognostic marker of cardiovascular-related death and heart transplantation in patients with moderate congestive heart failure. J Heart Lung Transplant 1997;16:956-63.

28. Lainchbury JG, Richards AM. Exercise testing in the assessment of chronic congestive heart failure. Heart 2002;88:538-43

29. Kiilavuori K, Naveri H, Leinonen H, Harkonen M. The effect of physical training on hormonal status and exertional hormonal response in patients with chronic congestive heart failure. Eur Heart J 1999;20:456-64.

30. Galindo-Fraga A, Arrieta-Rodríguez O, Castillo-Martínez L, Narváez R, Orea-Tejeda A. Elevation of plasmatic endothelin in patients with heart failure: a multivariated analysis. Arch Med Res 2003;34:367-72.

31. McCully JM, Levitsky S. Alternatives for myocardial protection: adenosine-enhanced ischemic preconditioning. Ann NY Acad Sci 1999;874:295-305.

32. Clark AL. Exercise limitation in chronic heart failure: Central role of the periphery. J Am Coll Cardiol 1996;28:1092-102.

33. Rich MW. Cardiovascular disease in the elderly: heart failure. Cardiol Clin 1999;17(1):123-5.

34. Pearson TA, Mensah GA, Alexander RW, Anderson JL, et al. Markers of inflammation and cardiovascular disease. Circulation 2003;107:499-511.

35. Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increase mortality rates in advanced heart failure. Circulation 2003;108:833-8.

36. LaVecchia LL, Mezzena G, Zanolla L, Paccanaro M, et al. Cardiac troponin I as a diagnostic and prognostic marker in severe heart failure. J Heart Lung Transplant 2000;19:644-52.

37. Sato Y, Yamada T, Taniguchi R, Makiyama T, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001;103:369-74.

38. Missov M, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.

39. Setsuta K, Seino Y, Takahashi N, Ogawa T, et al. Clinical significance of elevated levels of cardiac troponin T in patients with chronic heart failure. Am J Cardiol 1999;84:608-11.

40. Del Carlo CH, O’Connor CM. Cardiac troponins in congestive heart failure. Am Heart J 1999;138:646-53.

41. Mann DL. Mechanisms and models in heart failure. Circulation 1999;100:999-1008.

42. Pina IL, Apstein CS, Balady GJ, Belardinelli R, et al. AHA Scientific Statement: Exercise and Heart Failure. Circulation 2003;107:1210-25.

43. Kostis JB, Rosen RC, Cosgrove NM, Shindler DM, Wilson AC. Nonpharmacologic therapy improves functional and emotional status in congestive heart failure. Chest 1994;106:996-1001.

44. Willenheimer R, Erhardt L, Cline C, Rydberg E, Israelsson B. Exercise training in heart failure improves quality of life and exercise capacity. Eur Heart J 1998;19:774-81.

45. Oka RK, De Marco T, Haskell WL, Botvinick E. Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Am J Cardiol 2000;85:365-9.

46. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 2001;12:892-902.