Cancer, Cardiotoxicity, Heart Failure, Insufficiency;Cardiac
Conditions
Keywords
autonomic dysfunction, baroreflex control, ergorreflex control, muscle myopaty
Brief summary
New therapies for cancer increased patient survival, but led to the recognition of adverse effects associated with cancer treatment, such as the use of chemotherapy. Cardiotoxicity is the most significant adverse effect, which affect the functional capacity and quality of life and is associated with high morbidity and mortality, regardless of the oncological prognosis. One of the manifestations of cardiotoxicity is ventricular dysfunction that can lead to heart failure. Neuro humoral hyperactivation with increased sympathetic nerve activity is a typical manifestation of heart failure and is associated with worse prognosis. Studies have shown that physical training significantly reduces sympathetic nerve activity in addition to improving muscle blood flow, reversing effects on skeletal muscle and improving quality of life. The hypothesis is that physical training may reduce sympathetic nerve activity and vasoconstrictor status in patients with heart failure caused by anthracyclines, as well as improving baroreflex and chemoreflex sensibility, mechanoreflex and metaborreflex control and skeletal myopathy.
Detailed description
The investigators included patients\> 18 years, left ventricular ejection fraction \<= 0.55, functional class (NYHA) I-III, under medical treatment for heart failure. Patients with coronary artery disease, moderate to severe valve disease, positive Chagas serology, inability to participate in an exercise program are excluded. Primary outcome: Muscle sympathetic nerve activity Secondary outcome: arterial baroreflex sensitivity, peripheral chemorreflex sensitivity, mecanic and muscuclar metaborreflex control, ubiquitin proteasome system activity. Patients were divided into 2 groups-trained (n = 10) and non-trained (n = 10). Patients in the trained group will complete 16 weeks of aerobic training. Evaluation of cardiac function, functional capacity, quality of life and biochemical evaluation (troponin, hs-CRP and BNP). For muscle evaluation will be performed biopsy of the vastus lateralis muscle
Interventions
OTHERexercise training
Patients undergo 16 weeks of physical training
Sponsors
InCor Heart Institute
Cancer Institute of Sao Paulo
Hospital Sirio-Libanes
University of Sao Paulo General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
randomized controlled clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age 18 years old * Funcional Class I-III (NYHA) * Ejection fraction \< o,55 * treated for heart failure
Exclusion criteria
* Coronary artery disease * Moderate to major valve disease * Positive serology for Chagas * Inability to perform physical exercises
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measure muscular sympathetic nervous activity | 16 weeks | The sympathetic nervous activity is assessed by the microneurography technique |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate baroreflex activity | 16 weeks | Evaluation of muscular sympathetic nervous activity at rest by the technique of microneurography, evaluation of the muscular blood flow by venous occlusion plethysmography technique |
| Evaluate quimiorreflex sensibility | 16 weeks | Evaluation of muscular sympathetic nervous activity at rest by the technique of microneurography, evaluation of the muscular blood flow by venous occlusion plethysmography technique |
| Evaluate Mecanorreflex control | 16 weeks | Evaluation of muscular sympathetic nervous activity at rest by the technique of microneurography, evaluation of the muscular blood flow by venous occlusion plethysmography technique |
| Evaluate metaborreflex control | 16 weeks | Evaluation of muscular sympathetic nervous activity at rest by the technique of microneurography, evaluation of the muscular blood flow by venous occlusion plethysmography technique |
| Evaluation of skeletal myopathy | 16 weeks | muscle biopsy |
Countries
Brazil
Contacts
Primary ContactAmanda Gonzales Rodrigues
Backup ContactCarlos Eduardo Negrao, PHD
Outcome results
None listed