Efeito da estimulação elétrica neuromuscular nos níveis de marcadores inflamatórios e cardíacos em pacientes com insuficiência cardíaca: uma revisão sistemática com metanálise

Abstract

he chronic nature of ineffective cardiac pumping in heart failure (HF) causes several changes that impact exercise intolerance, peripheral vascular alterations, and inflammation, with increased release of inflammatory and cardiac markers. As an alternative treatment, Neuromuscular Electrical Stimulation (NMES) stimulates biomarkers important for skeletal muscle growth or preservation and positively impacts cardiac function. This research aims to systematically review the effect of NMES on the levels of inflammatory and cardiac markers in patients with HF. This is a systematic review of Randomized Clinical Trials (RCTs), following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) recommendations and registered with PROSPERO (CRD42024623364). The literature search was conducted in the Pubmed, Scopus, PEDro, CENTRAL, EMBASE, and Web of Science databases, and, additionally, in ClinicalTrials.gov, ProQuest, the Brazilian Digital Library of Theses and Dissertations (BDTD), Google Scholar, and manual searches of the references of the included articles. All languages ​​were included, with no time limit on publication date. The descriptors were selected from the Medical Subject Headings (Mesh), namely: . For each database, the descriptors were combined with the operators bo to search for publications. RCTs were included, with adults diagnosed with HF, treated in outpatient clinics or at home, undergoing NMES exclusively or in combination with another intervention, compared to the control group, without NMES or SHAM, analyzing the impact of the therapy on biological markers. The risk of bias was analyzed using the Cochrane Risk of Bias Tool, and the evidence was assessed using the Grading of Recommendations Assessment, Developing, and Evaluation classification. Data were interpreted using Review Manager software (RevMan 5.4.1®, 2020). The studies were developed between 2004 and 2022 and conducted in Greece, Brazil, Spain, and the United Kingdom. A total of 202 patients were evaluated: 94 in the control group (CG) and 108 in the intervention group (IG). The sample consisted of 70% men, with ages ranging from 18 to 82 years, and a predominance of reduced left ventricular ejection fraction (LVEF). The study protocols were applied at home or in an outpatient rehabilitation setting. Interventions varied depending on whether NMES was administered isolated to the quadriceps and calf muscles and/or combined with other therapies. All studies used low-frequency (5 to 50 Hz), direct or pulsed current, at a specific intensity to generate muscle contraction, for 6 to 12 weeks, with assessments at the beginning and end of the protocol. The outcomes involved inflammatory markers in 3 studies and cardiac markers in 4, and generated 4 meta-analyses. Interleukin-6 (IL-6) increased significantly in the control group. Interleukin-10 (IL-10), Tumor Necrosis Factor (TNF-), and Natriuretic Peptide (BNP) did not result in significant changes in either group. Even with the limited power of evidence, . The study reveals the positive effect of NMES on IL-6, after a protocol based on low frequencies, for at least 6 weeks.