Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Original Article

Peripheral vascular insufficiency impairs functional capacity in patients with heart failure

Insuficiência vascular periférica compromete a capacidade funcional no paciente com insuficiência cardíaca

Renato Murayama; Laura Dutra Carraro; Thalissa Galvanin; Nilo Mitsuru Izukawa; Iracema Umeda; Mayron Faria Oliveira

Downloads: 0
Views: 212


INTRODUCTION: Heart failure (HF) is a complex syndrome in which effort limitation is associated with deterioration of peripheral musculature. Improving survival rates among these patients have led to the appearance of cases in which other pathologies are associated with HF, such as peripheral vascular insufficiency (PVI). The combination of these two pathologies is common, with significant repercussions for affected patients.OBJECTIVE: To compare functional limitations and quality of life between patients with HF in isolation or HF + PVI.METHOD: Twelve patients with HF+PVI were paired to 12 patients with HF in isolation. All had ejection fraction <40%. The following were conducted: 6 minute walk test (6MWT), chair test (CT), step test (ST), one repetition maximum test (1RM) and quality of life questionnaire.RESULTS: The results for the 6MWT (311±27 vs. 447±29), ST (49±3 vs. 81±10) and CT (17±1 vs. 21±1) were lower in the HF+PVI group than in the HF group (p<0.05). The HF+PVI group exhibited a reduction in the number of steps taken from the first to the second minute of the ST, in relation to the HF group. The HF group exhibited better HR recovery than the HF+PVI group (50±4 vs. 26±3; p<0.05). No differences were found in results for the Borg scale, the peripheral muscle strength test (1RM) or the questionnaires (p>0.05).CONCLUSIONS: The study participants who had mixed disease exhibited a greater degree of functional impairment than the group with HF, without reporting worsened quality of life.


heart failure, peripheral vascular insufficiency, quality of life, 6-minute walk test, physiotherapy


INTRODUÇÃO: A insuficiência Cardíaca (IC) é uma síndrome complexa e a limitação ao esforço está associada à piora da musculatura periférica. Devido à melhora na sobrevida destes pacientes, observa-se o surgimento de patologias associadas à IC, como a insuficiência vascular periférica (IVP). A associação das duas patologias é comum e com grandes prejuízos aos pacientes acometidos.OBJETIVO: Comparar as limitações funcionais e a qualidade de vida em IC isolada e IC + IVP.MÉTODO: Doze pacientes com IC+IVP foram pareados a 12 pacientes com IC isolada. Todos possuíam fração de ejeção <40%. Foram realizados: teste da caminhada de seis minutos (TC6M), teste da cadeira (TCAD), teste do degrau (TD), teste de uma repetição máxima (1RM) e questionário de qualidade de vida.RESULTADOS: Os valores obtidos nos testes TC6M (311±27 vs. 447±29), TD (49±3 vs. 81±10) e TCAD (17±1 vs. 21±1) no grupo IC+IVP foram menores do que no grupo IC (p<0,05), respectivamente. O grupo IC+IVP obteve redução do número de degraus alcançados entre o primeiro e o segundo minuto do TD em relação ao grupo IC. O grupo IC apresentou melhor recuperação da FC em relação ao grupo IC+IVP (50±4 vs. 26±3; p<0,05). Não foi encontrada diferença na escala de Borg, na força muscular periférica (1RM) e nos questionários aplicados (p>0,05).CONCLUSÃO: No presente estudo, os participantes com doença mista apresentaram maior comprometimento funcional em relação ao grupo com IC, sem demonstrar piora na qualidade de vida.


insuficiência cardíaca, insuficiência vascular periférica, qualidade de vida, teste de caminhada de seis minutos, fisioterapia


Raposo L, Aguiar C, Ferreira J, Gonçalves PA, Ferreira A, Silva JA. Myocardial revascularization reverses adverse outcome in non-ST-elevation acute coronary syndromes complicated by heart failure. Rev Port Cardiol. 2010;29(7-8):1131-42.

Fiuza M. Metabolic syndrome and coronary artery disease. Rev Port Cardiol. 2012;31(12):779-82.

Bocchi EA, Braga FG, Ferreira SM. III Brazilian Guidelines on Chronic Heart Failure. Arq Bras Cardiol. 2009;93(1):3-70.

Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30-41.

Ribeiro F, Alves AJ, Teixeira M. Exercise training enhances autonomic function after acute myocardial infarction: a randomized controlled study. Rev Port Cardiol. 2012;31(2):135-41.

Richardson TE, Kindig CA, Musch TI, Poole DC. Effects of chronic heart failure on skeletal muscle capillary hemodynamics at rest and during contractions. J Appl Physiol. 2003;95(3):1055-62.

Hebert K, Lopez B, Michael C. The prevalence of peripheral arterial disease in patients with heart failure by race and ethnicity. Congest Heart Fail. 2010;16(3):118-21.

Bradberry JC. Peripheral arterial disease: pathophysiology, risk factors, and role of antithrombotic therapy. J Am Pharm Assoc. 2004;44(2):S37-44.

Hilleman DE. Management of peripheral arterial disease. Am J Health Syst Pharm. 1998;55(19):S21-7.

McGuigan MR, Bronks R, Newton RU. Muscle fiber characteristics in patients with peripheral arterial disease. Med Sci Sports Exerc. 2001;33(12):2016-21.

Askew CD, Green S, Walker PJ. Skeletal muscle phenotype is associated with exercise tolerance in patients with peripheral arterial disease. J Vasc Surg. 2005;41(5):802-7.

Sharma R, Davidoff MN. Oxidative stress and endothelial dysfunction in heart failure. Congest Heart Fail. 2002;8(3):165-72.

ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7.

Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.

Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1992;32(6):719-27.

Carvalho VO, Guimarães GV, Carrara D, Bacal F, Bocchi EA. Validation of the Portuguese version of the minnesota living with heart failure questionnaire. Arq Bras Cardiol. 2009;93(1):39-44.

Mitchell RG, Duscha BD, Robbins JL. Increased levels of apoptosis in gastrocnemius skeletal muscle in patients with peripheral arterial disease. Vasc Med. 2007;12(4):285-90.

McDermott MM, Guralnik JM, Albay M, Bandinelli S, Miniati B, Ferrucci L. Impairments of muscles and nerves associated with peripheral arterial disease and their relationship with lower extremity functioning: the InCHIANTI Study. J Am Geriatr Soc. 2004;52(3):405 10.

Laghi Pasini F, Pastorelli M, Beermann U. Peripheral neuropathy associated with ischemic vascular disease of the lower limbs. Angiology. 1996;47(6):569-77.

Stewart KJ, Hiatt WR, Regensteiner JG, Hirsch AT. Exercise training for claudication. N Engl J Med. 2002;347(24):1941-51.

Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol. 2012;60(16):1521-8.

Drexler H, Riede U, Münzel T, König H, Funke E, Just H. Alterations of skeletal muscle in chronic heart failure. Circulation. 1992;85(5):1751-9.

Piepoli MF, Kaczmarek A, Francis DP. Reduced peripheral skeletal muscle mass and abnormal reflex physiology in chronic heart failure. Circulation. 2006;114(2):126-34.

Ponikowski PP, Chua TP, Francis DP, Capucci A, Coats AJ, Piepoli MF. Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure. Circulation. 2001;104(19):2324-30.

Lahiri MK, Kannankeril PJ, Goldberger JJ. Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol. 2008;51(18):1725-33.

Goernig M, Schroeder R, Roth T. Peripheral arterial disease alters heart rate variability in cardiovascular patients. Pacing Clin Electrophysiol. 2008;31(7):858-62.

Sperandio PA, Borghi-Silva A, Barroco A, Nery LE, Almeida DR, Neder JA. Microvascular oxygen delivery-to-utilization mismatch at the onset of heavy-intensity exercise in optimally treated patients with CHF. Am J Physiol Heart Circ Physiol. 2009;297(5):H1720-8.

Sperandio PA, Oliveira MF, Rodrigues MK. Sildenafil improves microvascular O2 delivery-to-utilization matching and accelerates exercise O2 uptake kinetics in chronic heart failure. Am J Physiol Heart Circ Physiol. 2012;303(12):H1474-80.

5ddd841a0e8825ef401da3e9 jvb Articles

J Vasc Bras

Share this page
Page Sections