Comportamento hemodinâmico e autonômico vagal durante e na fase de recuperação pós teste de resistência muscular periférica em pacientes cirróticos

Abstract

Introduction: Liver cirrhosis has multisystemic involvement and is associated with hyperdynamic circulation and autonomic dysfunction. Physical exercise is a stressful physiological maneuver that generates hemodynamic and autonomic responses, which can have a prognostic impact and potentially relevant clinical application. Objective: To analyze the hemodynamic and autonomic vagal behavior during and in the post-test recovery period of peripheral muscle resistance in patients with liver cirrhosis. Methods: 50 cirrhotic patients (Cirrhotic Group) and 40 individuals without cirrhosis (Control Group) matched for age and BMI (59±13 years vs. 57±13 years, p=0,58 and 28±5 Kg/m² vs. 28±4 Kg/m², p=0,94, respectively) were evaluated. Both groups perform a dynamic test of peripheral muscle resistance using the EGM® digital handgrip dynamometer, with a force of 45% of the maximum voluntary contraction at the rate of 60 contraction/relaxation cycles per minute until failure, characterized by three contractions consecutive without reaching the target force. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), in addition to heart rate (HR), were recorded by the multi-parameter monitor DIXTAL®, before, during and after the peripheral muscle resistance test. The autonomous vagal evaluation was performed on a subsample of 32 cirrhotics and 24 controls, at pre-exercise (10 minutes), during the exercise and post-exercise protocol (10 minutes) by the Polar® V800 cardiofrequency meter. Subsequently, in the Kubius program, an analysis of heart rate variability (HRV) was performed and the RMSSD30s index, indicator of vagal autonomic modulation, was calculated. We used 2-factor ANOVA for repeated measures followed by Bonferroni's post hoc. p was considered significant. Results: SBP increased at peak exercise in relation to rest (time effect, p<0.01) and returned to baseline values in the first minute of recovery (time effect, p=1.00) in a similar way between groups (group effect, p=0.07). In both groups, DBP and MAP increased at peak exercise in relation to rest (time effect, p<0.01) and remained increased in recovery compared to rest (time effect, p<0.01) similarly between groups (group effect, p=0.18). The RMSSD30 index decreased at peak exercise in relation to rest (time effect, p<0.01) and returned to baseline values in the first minute of recovery (time effect, p=0.29) in a similar way between groups (effect group, p=0.64). Conclusion: Cirrhotic patients have preserved hemodynamic and autonomic responses during and in the post-test recovery period of peripheral muscle resistance. However, they have reduced absolute values of DBP and MBP compared to the control group.