Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a ra
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RESEARCH ARTICLE
Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a randomized controlled trial Adriana Oliveira Sarmento1 · Ligia M. Antunes‑Correa1 · Maria J. N. N. Alves1 · Aline V. N. Bacurau2 · Keila C. B. Fonseca1 · Fernanda G. Pessoa1 · Denise M. L. Lobo1 · Leila D. P. Moreira1 · Ivani C. Trombetta3 · Maria U. P. B. Rondon2 · Eduardo Rondon2 · Marcelo L. C. Vieira1 · Felix J. A. Ramires1 · Maria Socorro do Brasileiro‑Santos4 · Patricia C. Brum2 · Charles Mady1 · Carlos E. Negrao1,2 · Scott Thomas5 · Barbara M. Ianni1 Received: 30 December 2019 / Accepted: 18 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Patients with chronic chagasic cardiomyopathy with preserved ventricular function present with autonomic imbalance. This study evaluated the effects of exercise training (ET) in restoring peripheral and cardiac autonomic control and skeletal muscle phenotype in patients with subclinical chronic chagasic cardiomyopathy. Methods This controlled trial (NCT02295215) included 24 chronic chagasic cardiomyopathy patients who were randomized www.random.org/lists/ into two groups: those who underwent exercise training (n = 12) and those who continued their usual activities (n = 12). Eight patients completed the exercise training protocol, and 10 patients were clinically followed up for 4 months. Muscular sympathetic nerve activity was measured by microneurography and muscle blood flow (MBF) using venous occlusion plethysmography. The low-frequency component of heart rate variability in normalized units (LFnuHR) reflects sympathetic activity in the heart, and the low-frequency component of systolic blood pressure variability in normalized units reflects sympathetic activity in the vessels. The infusion of vasoactive drugs (phenylephrine and sodium nitroprusside) was used to evaluate cardiac baroreflex sensitivity, and a vastus lateralis muscle biopsy was performed to evaluate atrogin-1 and MuRF-1 gene expression. Results The baroreflex sensitivity for increases (p = 0.002) and decreases (p = 0.02) in systolic blood pressure increased in the ET group. Muscle blood flow also increased only in the ET group (p = 0.004). Only the ET group had reduced resting muscular sympathetic nerve activity levels (p = 0.008) and sympathetic activity in the heart (LFnu; p = 0.004) and vessels (p = 0.04) after 4 months. Regarding skeletal muscle, after 4 months, participants in the exercise training group presented with lower atrogin-1 gene expression than participants who continued their activities as usual (p = 0.001). The reduction in muscular sympathetic nerve activity was positively associated with reduced atrogin-1 (r = 0.86; p = 0.02) and MuRF-1 gene expression (r = 0.64; p = 0.06); it was negatively associated with improved baroreflex sensitivity both for increases (r = –0.72; p = 0.020) and decreases (r = –0.82; p = 0.001) in blood pressure. Conclusions ET improved cardiac and peripheral autonomic function in p
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