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Cardiac rehabilitation in patients with refractory angina


Introduction: Refractory angina is a chronic and disabling condition. The cardiac rehabilitation, although considered an alternative therapy, was previously little studied in this population. Objectives: Evaluation of the safety and feasibility of cardiac rehabilitation in patients with refractory angina, as well as its effect on VO2max and myocardial ischemic burden by exercise echocardiography. Secondary objectives: assessment of myocardial effort injury through troponin; effect on the sympathetic modulation and systemic inflammation, muscle blood flow and lipid metabolism; effect on ventricular function by exercise echocardiography; detection of ischemia and arrhythmias identified during rehabilitation sessions via telemetry; assessment of quality of life, functional class of angina (Canadian Cardiovascular Society), the number of angina episodes and daily consumption of sublingual nitrate. Methods: Clinical, prospective randomized controlled study, in patients between 45 and 75 years, who are on optimal medical therapy and are not candidates for revascularization, presence of myocardial ischemia documented by imaging method, and no contraindications to the practice of exercises. Patients will be randomized into 2 groups: 26 patients to optimal medical treatment group (MT) and 26 patients to the MT + exercise training group, for 12 weeks. The clinical, laboratory and imaging evaluation will be performed at inclusion and at the end of the protocol. (AU)

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