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Biomedical subjects

M Wajngarten

Publications and source records attributed to M Wajngarten.

At least 19 recordsLinked to original sources
PubMed1995

Peak oxygen consumption and resting left ventricular ejection fraction changes after cardiomyoplasty at 6-month follow-up.

BACKGROUND: The effects of cardiomyoplasty on cardiopulmonary exercise test characteristics are not fully known. METHODS AND RESULTS: We determined in 19 patients who underwent cardiomyoplasty for treatment of refractory heart failure (New York Heart Association [NYHA] functional class III) before (pre) and at 6-month follow-up (post) maximum oxygen consumption (peak VO2), NYHA functional class, and resting left ventricular ejection fraction (LVEF) (MUGA). We analyzed the results according to pre peak VO2 < or > 14 mL/kg per minute and the correlation between the changes in absolute values of LVEF and peak VO2. Pre- and post-peak VO2 values were 15.9 +/- 4.4 and 18.6 +/- 6.4 mL/kg per minute, respectively (P = .059). In the subgroup with pre-peak VO2 < 14 mL/kg per minute, the peak VO2 increased from 11.1 +/- 1.9 to 16.4 +/- 6.2 mL/kg per minute (P = .02). The subgroup with peak VO2 > 14 mL/kg per minute showed pre- and post-peak VO2 of 19.2 +/- 2.6 and of 20.1 +/- 7 mL/kg per minute, respectively (P = .06). The pre-total exercise time of the entire group increased from 688.4 +/- 222.1 to 833.7 +/- 241.6 seconds (P < .04). For the subgroup with preoperative peak VO2 < 14 mL/kg per minute, exercise time improved from 585 +/- 76.9 to 825 +/- 186.3 seconds (P < .01). In the subgroup with preoperative VO2 > 14 mL/kg per minute, the preexercise and postexercise time was 763.6 +/- 264.4 and 840 +/- 282 seconds, respectively (P = .4). Pre-LVEF increased from 20.6 +/- 3.3% to 24.2 +/- 7.8% at 6 months of follow-up (P = .02). At 6 months of follow-up, 9 patients were in NYHA functional class I and 10 were in class II. There was no correlation between LVEF values and absolute values of peak VO2 before (r = .123, P = .6) and after (r = .27, P = .2) cardiomyoplasty. A weak correlation was observed between the changes in absolute values of peak VO2 and LVEF from the preoperative to the postoperative period (r = .48, P = .048). CONCLUSIONS: Cardiomyoplasty is a useful method for improving NYHA functional class and LVEF in patients with heart failure. Peak VO2 < 14 mL/kg per minute before cardiomyoplasty may be a selection criterion with which to determine improved exercise capacity after surgery. The effects of cardiomyoplasty on LVEF appear to be partially associated with maximum exercise capacity changes.

Adult↗
PubMed1995

[Early physical conditioning of patients surgically treated for myocardial revascularization. Influence on the functional capacity].

PURPOSE: To evaluate the early physical conditioning (PC) effect [initiated 15 days after the myocardial revascularization surgery (MRS)] in the functional capacity. METHODS: Twenty-two male patients (mean-age of 52y-o), divided in two groups (A and B, 11 patients each), were studied. Group A started PC 3 months after MRS (phase III), with a training intensity of about 70% of the maximum heart rate reserve, during three months, three sessions per week with one hour duration. Group B started PC 15 days after the MRS (fase II), with a training intensity up to five metabolic unities, three times a week, 1 hour and 15 duration. The post-MRS period of three months was designated as the time I (beginning of fase III) and six months as time 2. Stress test, Kraus-Weber flexibility test, coxo-femural flexibility test (flexion, elevation and abduction) and scapule-umeral flexibility test (flexion, extension and abduction) were applied. RESULTS: The maximum oxygen uptake and the total work increased significantly from time 1 to time 2 in both groups, but there was no significant difference between the two groups, either in time 1 or 2. Flexibility in the Kraus-Weber test and in the scapule-umeral flexibility test when in flexion, were significantly greater in group B than A, in both times (1 and 2). Other flexibility variables studied show no significant difference, neither between the studied groups nor in the times 1 and 2 of evaluation. CONCLUSION: Early PC after MRS increased the value of two variables that measure flexibility. However, it has not increased other flexibilities variables and the aerobic capacity.

Analysis of Variance↗
PubMed1994

[Cardiopulmonary exercise test in the evaluation of healthy elderly men].

PURPOSE: To study methodological aspects and results of cardiopulmonary exercise tests in elderly. METHODS: Twenty-five men (mean age 65 +/- 5 years) performed a cardiopulmonary exercise test using a bicycle ergometer and a progressive continuous work load increase protocol was employed. A computadorized system (2001 CAD/Net System-MGC), which includes a gas analyser and a pneumotacograph, was used for on line monitoring of oxygen and carbon dioxide expired fraction and also of pulmonary flow. RESULTS: We observed the following values of oxygen uptake, pulmonary ventilation and respiratory gas exchange: rest=4 +/- 1 ml/kg-1/min-1, 11 +/- 2 l/min-1 and 0.80 +/- 0,1, respectively: anaerobic threshold=12 +/- 3 ml/kg-1/min-1, 29 +/- 6 l/min-1 and 0.90 +/- 0.1, respectively: respiratory compensation point=18 +/- 4ml/kg-1/min-1, 47 +/- 1 l/min-1 and 1.07 +/- 0.1, respectively, and peak of exercise = 13 +/- 5 ml/kg-1/min-1, 76 +/- 18 l/min-1 and 1.21 +/- 0.2, respectively. The anaerobic threshold and the respiratory compensation point were achieved at 53 +/- 11 and 77 +/- 9% of peak oxygen uptake respectively. The elderly shown slightly increased values of the relation volume dead/tidal volume at rest with a slightly smaller decrease of its values during exercise in comparison to data obtained from young healthy untrained subjects. The heart rate prescription for exercise based on the heart rate reserve was higher than that based on the cardiorespiratory and metabolic responses (113-126bpm vs 96-114bpm). CONCLUSION: The cardiorespiratory and metabolic responses pattern in the elderly is quite heterogeneous. The heart rate prescription for exercise based on conventional stress tests seems to overestimate cardiorespiratory and metabolic capacity in healthy elderly men. The determination of anaerobic threshold and respiratory compensation point from cardiopulmonary exercise test data optimize exercise prescription for healthy elderly men.

Aged↗
PubMed1993

Left ventricular function during dynamic exercise in untrained and moderately trained subjects.

The influence of exercise training on left ventricular function at rest (R), at anaerobic threshold (AT), and during peak exercise (PE) was evaluated in 12 healthy untrained and 13 trained (T) subjects who underwent Doppler echocardiography at R and radionuclide ventriculography at R and during exercise. The end-diastolic volume and stroke volume were significantly higher in the T group than in the untrained group at R. The ejection fraction rose significantly from R to AT and from AT to PE (80.0 +/- 0.84 vs. 83.6 +/- 0.91%), but no significant difference was observed between groups. The peak diastolic filling rate rose significantly during exercise, with a further significant increase observed in the T group (AT, 6.38 +/- 0.40 vs. 5.01 +/- 0.16 end-diastolic counts/s; PE, 8.24 +/- 0.42 vs. 7.15 +/- 0.35 end-diastolic counts/s). The percent variation of minimal systolic counts fell significantly at AT and PE in relation to R. Our data demonstrate that exercise training produces a significant increase in peak diastolic filling rate but no change in systolic function during exercise and that metabolic acidosis caused by exercise does not limit systolic function.

Acidosis↗
PubMed1993

[Chronotropic and pressoric response in myocardiopathy in patients with heart failure during ergometric test. Correlation of spirometry variables with effort].

PURPOSE: To correlate the variables heart rate (HR), blood pressure (BP) and double product (DP) during the ergometric test with the variables oxygen consumption (VO2) and pulmonary ventilation (VE) of spiroergometry. METHODS: A study was carried out with 40 male patients suffering from cardiomyopathy with heart failure (functional class II-IV of NYHA)-of ischemic (IS), Chagas' disease (CH) and idiopathic (ID) etiology. These three groups were compared to a group of 10 normal individuals (N). The 4 groups were evaluated under 4 different conditions: rest (RES), anaerobic threshold (LA), power peak of exercise (P) and in the fourth minute recovery (REC). The investigation was carried out with the data obtained through spiroergometry (using a treadmill and spiroergometric equipment specific for the effort), as well as data related to HR, BP, DP, VO2 and VE. RESULTS: There were significant differences observed in the ergometric evaluate of the HR, BP and DP responses in the IS, CH and ID groups as compared with the N group. There were significant difference observed in the spirometric evaluation to the VO2 and VE efforts in the IS, CH and ID groups as compared with the N group. CONCLUSION: The HR, BP and DP variables studies, obtained by means of classic ergometry, unaided by direct methodology (spiroergometry) enabled them to infer valuable data for the control and evaluation of cardiomyopathies with IC, taking into consideration the low chronotropic and pressoric responses in the various phases of evaluation during this study, corresponding to the concomitant low performance of O2 consumption and pulmonary ventilation.

Adult↗
PubMed1991

[Clinical and Doppler echocardiographic follow-up of elderly patients subjected to aortic balloon valvuloplasty].

PURPOSE: To evaluate the evolution of patients with critical aortic stenosis (AS) submitted to balloon aortic valvuloplasty (BAV). PATIENTS AND METHODS: sixteen patients (mean age 74.0 +/- 5.1 years), 11 (68.7%) women. The study periods consisted during the 3 rd (post-1) and 15th month (post-2) after dilatation. RESULTS: The functional class of angina and dyspnea persisted in all patients during period post-1, in 75% of the patients, during period post-2 in relation to intra-hospital evaluation. However, in period post-1, 53% of the patients had significant reduction of aortic valve area, trend which remained in period post-2. Simultaneously, progressive (insignificant) elevation of the left ventricular aortic peak to peak gradient was noticed in the periods post-1 and post-2. Two deaths and two aortic valve replacements occurred during the study. CONCLUSION: BAV is associated to maintenance of functional class improvement obtained immediately after dilatation despite the aortic valve restenosis registered by echodopplercardiography.

Aged↗
PubMed1991

[Mononuclear magnesium in elderly hypertensive patients treated with thiazide].

PURPOSE: To study mononuclear magnesium and serum cations (Na, K and Mg) in elderly hypertensive patients treated with hydrochlorothiazide during 90 days. PATIENTS AND METHODS: 15 elderly hypertensive patients treated with hydrochlorothiazide, 25 mg/day or placebo. A method of freezing produced total lysis of the cells; Mg was measured by atomic spectrophotometry. RESULTS: No differences were noted in mononuclear or serum magnesium in the thiazide or placebo treated patients, and the diuretic produced significant decreases in supine systolic and diastolic blood pressure. CONCLUSION: Magnesium supplementation does not seem essential in most patients in this conditions.

Aged↗
PubMed1990

Frequency and significance of cardiac rhythm disturbances in healthy elderly individuals.

The authors examined the prevalence and significance of cardiac rhythm disturbances in healthy elderly individuals. They selected 26 men with active lifestyles, aged 70-81 years, after clinical, routine blood tests, chest radiographs, echocardiography, resting and exercise electrocardiography, and Gated cardiac blood imaging evaluations. The men were submitted to continuous electrocardiographic monitoring during their daily routine. The recording time ranged from 838 to 1,432 min (average = 1,307 +/- 153 min). Clinical follow-up was done every six months. Sinus rhythm predominated in all subjects. The maximal, minimal, and average heart rate ranges (beats/min) were, respectively: during sleeping periods, 60-115 (85.8 +/- 13.2), 42-80 (56.6 +/- 8.7), 51-85 (64.0 +/- 8.8); and during awake periods, 85-150 (118.4 +/- 16.4), 50-85 (64.1 +/- 9.1), 61-90 (75.3 +/- 8.3). The longest sinus pauses were observed during sleep and ranged from 0.8 to 2.5 sec (1.25 +/- 0.34 sec). Atrial ectopic beats were observed in 20 individuals (76.9%). They were frequent in four (15.4%) and repetitive in nine (34.6%) of them. Short-lasting episodes of paroxysmal atrial tachycardia and paroxysmal atrial flutter were observed in one case each. Ventricular ectopic beats were recorded in 20 individuals (76.9%). They were frequent in 6 (23%) and multiform in 13 (50%) of them. Couplets were observed in 5 cases (19.2%) and episodes of nonsustained ventricular tachycardia were present in 3 individuals (11.5%). No symptoms were referred by any individual during recording. No clinical signs of heart disease or symptoms were noticed during the average 40 +/- 7.2 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Lymphocytic and serum magnesium in older healthy and hypertensive subjects].

PURPOSE: To study the lymphocyte and serum magnesium in older patients with and without arterial hypertension. PATIENTS AND METHODS: We studied the lymphocyte and serum Mg in 22 older patients, with diastolic blood pressure between 95 and 120 mmHg, not receiving drug treatment. A method of freezing produced total lysis of the cells. RESULTS: The mean lymphocyte Mg concentration in the older patients was 1.15 +/- 0.74 picomoles per 100 cells, significantly higher (p less than 0.05) than in the control group, that was 0.77 +/- 0.32 picomoles per 100 cells (lymphocyte Mg in older hypertensive patients/control = 1.49); there were no significant differences between groups with regard to serum Mg. Twelve older normotensive men studied also had lymphocyte Mg significantly higher than in the respective control group (lymphocyte Mg in older normotensive men/control = 1.70) and the serum Mg was also significantly higher than in the control group (1.63 +/- 0.12 versus 1.44 +/- 0.22 mEq/l. CONCLUSION: Since the high intracellular Mg concentration in the elderly patients may more accurately reflect the total body Mg status. We suggest to use Mg and Mg sparing diuretics in these patients, both hypertensive and normotensive, cautiously.

Aged↗
PubMed1989

[Myocardial revascularization surgery in an 87-year-old patient. A case report].

A 87 years old patient, with independent life style, presented unstable angina in spite of medication. Cineangiocoronariography demonstrated severe triarterial lesions, with good distal segments and preserved left ventricular contractility. Three saphenous vein grafts were performed. Some clinical measures were employed: a) manitol, furosemide and Ringer solution were infused two hours before and during surgery; the infusion was maintaned during the two postoperative days; b) limited use of nephrotoxic agents; c) adequate doses of medication; d) red cells infusion in spite of higher hematocrit levels than those present in younger patients; e) early start of respiratory physiotherapy and deambulation. Mean arterial pressure was maintained over 80 mm/Hg during surgery. During the period of extracorporeal circulation a hollow capillary membrane oxygenador was employed. Immediate postoperative course, up till six months, was free of coronary insufficiency symptoms. This case demonstrates the benefits of myocardial revascularization in elderly patients, respecting some peculiarities of the geriatric therapeutics.

Age Factors↗
PubMed1989

[Hemodynamic study at the bedside of patients with acute myocardial infarction over 60 years of age].

Aiming to study the hemodynamic behavior of the aged during the first 36 hours after acute myocardial infarction (AMI), 41 patients of at least 60 years at age (63.3 +/- 3) were submitted to a bedside hemodynamic study, through a Swan-Ganz catheter. The results obtained for the different variables (right atrial pressure, right ventricular pressure, pulmonary-arterial pressure, pulmonary-capillary, cardiac index, systolic index, left and right ventricular performance, and systemic pulmonary-arterial resistance) were compared to those of 39 individuals with age less than 60 years (49.6 +/- 1.5). It was also considered the electrocardiographic localization of the infarcted area. Eventual differences in the distribution of frequency of the individuals were also investigated, considering the four clinical-hemodynamic groups proposed by Forrester. Upon separate analysis of the hemodynamic variables, the results did not reveal significant differences between the younger and the older. However, by Forrester's classification, it was observed a significantly higher number of aged patients in group III (hypovolemic). Therefore, there was a tendency in the aged to present hypovolemia during the first 36 hours after myocardial infarction. The difficulties to recognize this status clinically and its prognostic importance justify the performance of hemodynamic bedside study in elderly with acute myocardial infarction with hemodynamic instability.

Aged↗
PubMed1989

[Efficacy of captopril in the treatment of mild and moderate hypertension in patients over 60 years of age].

The response to the use of converting enzyme inhibitor (captopril) either alone or associated to hydrochlorothiazide was evaluated during three months in 128 patients over 60 years old, with mild (79.7%) and moderate (20.3%) hypertension. Seventy (55%) were female and 58 (45%) male, being 64.8% white, 33.6% non-white and 1.6% asiatic. All patients received initially either a single dose of 25 mg of captopril or twice 12.5 mg, and after 1 month those in which hypertension was maintained 25 mg of hydrochlorothiazide was associated. During this period the analysis of the results showed a significant reduction of systolic and diastolic blood pressure (DP), however, there was a marked reduction during the first month. Thus, DP decreased from 101 +/- 8.8 (control) to 93 +/- 8.7 in the first month, to 89.6 +/- 8.2 in the second and 86 +/- 8.2 in the third, all significant at p less than 0.001. Similar distinction with previous treatment were observed when ranges on DP were analysed in patients receiving isolated or associated captopril. There was a small but significant weight and heart rate fall in patients receiving only captopril. Reduction of side effects was observed in 79% of the patients, as compared to previous treatment there being distinct improvement, while 21% showed no alterations and none showed complications. Therefore, we may conclude that use of captopril in elderly hypertensive patients was efficacious in the control of arterial blood without influence on quality of life.

Aged↗
PubMed1989

[Effect of beta blockers with intrinsic sympathomimetic activity on blood pressure and blood lipids in patients with essential hypertension].

The aim of this study was to compare the effects of a beta-blocker (mepindolol) with intrinsic sympathomimetic activity (ISA) to a beta-blocker (metoprolol duriles) without ISA. Hypertensive patients with more than 50 years of age were selected and randomly allocated to receive either 5 mg/day mepindolol (Group A, 10 patients), or 200 mg/day metoprolol duriles (Group B, 9 patients), or placebo (Group C, 10 patients). They were submitted to clinical exam, stress testing and plasma lipids dosage before and after four weeks of treatment. At rest, there were a significant reduction of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in all groups. The mean values for SBP, DBP and HR at rest after treatment were respectively: 154.0, 95.5, 73.7 (Group A); 148.8, 94.4, 70.1 (Group B); 153.0, 96.0, 77.8; (Group C). During stress testing, there were a significant reduction of SBP, HR and double product (DP). The DBP remained unchanged. The mean values for SBP, DBP, HR and DP during stress testing after treatment were respectively; 198.0, 115.5, 124.3, 246.9 (Group A); 198.8, 114.4, 144.6, 283.2 (Group B); 202.2, 119.0, 143.5, 283.4 (Group C). Total cholesterol, HDL-cholesterol, and LDL-cholesterol, have not changed with both beta-blockers. There were a significant increase in plasma triglycerides and VLDL-cholesterol levels after treatment with beta-blockers. In conclusion, both mepindolol and metoprolol were similarly effective in reducing arterial blood pressure of hypertensive patients. There were not significant differences between the beta-blocker with or without ISA in regard to their effects on plasma lipids.

Aging↗