Pubblicazioni recenti - cardiac rehabilitation
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Prevalence and Risk Factors for Cerebral Palsy in Children With Congenital Heart Disease Based on Risk of Surgical Mortality.
Pediatr Neurol2024 Mar;155():133-140. doi: 10.1016/j.pediatrneurol.2024.02.011.
Ghosh Suman, Lien Ing Grace, Martinez Kerstin, Lin Tracy, Bleiweis Mark S, Philip Joseph, Jordan Lori C, Pavlakis Steven G,
Abstract
BACKGROUND:
Children with congenital heart disease (CHD) have a higher prevalence of motor impairment secondary to brain injury, resulting in cerebral palsy (CP). The purpose of this study is to determine the prevalence of CP in CHD in a single-center cohort, stratify risk based on surgical mortality using Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categories and identify risk factors.
METHODS:
Retrospective cohort study of pediatric patients registered in the University of Florida (UF) Society of Thoracic Surgeons Congenital Heart Surgery database from 2006 to 2017 with a diagnosis of CHD who continued follow-up for more than two years at UF.
RESULTS:
A total of 701 children with CHD met inclusion criteria. Children identified to have CP were 54 (7.7%). Most common presentation was spastic hemiplegic CP with a Gross Motor Function Classification System of level 2. Analysis of surgical and intensive care factors between the two groups showed that children with CHD and CP had longer time from admission to surgery (P = 0.003), higher STAT categories 4 and 5 (P = 0.038), and higher frequency of brain injury and seizures (P
CONCLUSIONS:
In our cohort, 7.7% children with CHD develop CP; this is significantly higher than the 2010 US population estimate of 0.3%. Our study suggests higher STAT categories, brain injury, and seizures are associated with developing CP in children with CHD.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Impact of Early Rehabilitation Nursing on Postoperative Cardiac Function and Quality of Life in Patients with Atrial Fibrillation.
Altern Ther Health Med2024 Apr;():. doi: AT10252.
Wei Wei, Ma Chunrogng, Tian Zirong, Bu Mengmei, Liu Wei, Song Ming,
Abstract
BACKGROUND:
Background ? Radiofrequency ablation, a widely utilized minimally invasive surgery for atrial fibrillation treatment, has certain latent risks, including a high postoperative recurrence rate and various complications. Therefore, nursing intervention plays a pivotal role in the rehabilitation process after radiofrequency ablation.
BACKGROUND:
Objective ? This study aims to investigate the impact of rehabilitation nursing on postoperative cardiac function and quality of life in patients with atrial fibrillation.
BACKGROUND:
Methods ? A total of 156 atrial fibrillation patients who underwent radiofrequency ablation and were admitted to our hospital from June 2018 to June 2023 were randomly assigned to either the control group or the research group. The control group received routine nursing, while the research group received early rehabilitation nursing in addition to routine care. A comparative analysis was conducted on cardiac function, hospital stay, incidence of complications, emotional well-being, sleep quality, overall quality of life, and nursing satisfaction between the two groups.
BACKGROUND:
Results ? In comparison to the control group, the research group exhibited an elevation in left ventricular ejection fraction, along with a reduction in left ventricular end-systolic diameter and left ventricular end-diastolic dimension (P
BACKGROUND:
Conclusions ? Early rehabilitation nursing emerges as a valuable intervention, expediting the recovery of postoperative cardiac function and enhancing the overall quality of life in atrial fibrillation patients. These findings emphasize its clinical significance.
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A Practical Tool for Measuring Home-Based Cardiac Rehabilitation Self-Management Behavior: A Multiphase Cross-Sectional Study.
J Am Heart Assoc2024 Apr;():e034486. doi: 10.1161/JAHA.124.034486.
Yang Zhen, Hu Na, Zhang Fengpei, Gao Yu, Zhang Chunqi, Wang Aiping,
Abstract
BACKGROUND:
Optimal self-management is the key to home-based cardiac rehabilitation for patients with heart disease. At present, there is a lack of a specific assessment tool to evaluate the home-based cardiac rehabilitation self-management behavior in patients with heart disease. Therefore, the aim of this study was to develop the Home-Based Cardiac Rehabilitation Self-Management Scale and validate its psychometric properties among patients with coronary heart disease.
METHODS AND RESULTS:
A multiphase cross-sectional study was conducted that study covered 3 phases: (1) item generation and revision, (2) item evaluation and preliminary exploration, and (3) assessment of the psychometric properties of the scale. A scale with 21 items was developed to measure the home-based cardiac rehabilitation self-management behavior. The content validity index of the scale was 0.980. In exploratory factor analysis, the 5-factor structure supported by eigenvalues and screen plot explained 74.326% of the total variation. In confirmatory factor analysis, all fitting indicators were acceptable, further supporting the construct validity of the scale. The criterion validity of the scale was 0.783. In the reliability analysis, the Cronbach's ? coefficient of the scale was 0.882, with a dimensionality range of 0.780 to 0.936. The split-half reliability coefficient and test-retest reliability coefficient were 0.774 and 0.770, respectively.
CONCLUSIONS:
This study is the first to develop and validate a practical tool. This scale can comprehensively and accurately assess the self-management behavior of patients with heart disease in a home-based cardiac rehabilitation environment.
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Chronic sleep fragmentation impairs brain interstitial clearance in young wildtype mice.
J Cereb Blood Flow Metab2024 Apr;():271678X241230188. doi: 10.1177/0271678X241230188.
Deng Saiyue, Hu Yusi, Chen Simiao, Xue Yang, Yao Di, Sun Qian, Nedergaard Maiken, Wang Wei, Ding Fengfei,
Abstract
Accumulating evidence shows that most chronic neurological diseases have a link with sleep disturbances, and that patients with chronically poor sleep undergo an accelerated cognitive decline. Indeed, a single-night of sleep deprivation may increase metabolic waste levels in cerebrospinal fluid. However, it remains unknown how chronic sleep disturbances in isolation from an underlying neurological disease may affect the glymphatic system. Clearance of brain interstitial waste by the glymphatic system occurs primarily during sleep, driven by multiple oscillators including arterial pulsatility, and vasomotion. Herein, we induced sleep fragmentation in young wildtype mice and assessed the effects on glymphatic activity and cognitive functions. Chronic sleep fragmentation reduced glymphatic function and impaired cognitive functions in healthy mice. A mechanistic analysis showed that the chronic sleep fragmentation suppressed slow vasomotion, without altering cardiac-driven pulsations. Taken together, results of this study document that chronic sleep fragmentation suppresses brain metabolite clearance and impairs cognition, even in the absence of disease.
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Rationale and design of the ELEANOR trial early aortic valve surgery versus watchful waiting strategy in severe asymptomatic aortic regurgitation, ACRONYM: ELEANOR.
Heliyon2024 Apr;10(8):e29470. doi: e29470.
Ko?ková Radka, Vojá?ek Jan, Bedá?ová Helena, Fila Petr, Skalský Ivo, ?áková Daniela, Klán Michal, Míková Barbora, M?dílek Karel, Tuna Martin, Fialová Monika, Dvo?áková Radka, Hlubocká Zuzana, Panovský Roman, Slabý Kry?tof, Kelen de Oliveira Elayne, Casselman Filip, P?ni?ka Martin,
Abstract
BACKGROUND:
The optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimodality imaging has brought new tools for the accurate selection of asymptomatic patients at risk of early clinical deterioration, however, prospective and randomized data are pending. Cardiac magnetic resonance (CMR)-derived AR quantification along with LV remodeling assessment appears to be the most accurate tool for a selection of such patients at risk.
TRIAL DESIGN:
The objective of our prospective and multicenter study is to determine whether patients at risk of early clinical deterioration as per CMR assessment will benefit from early surgical treatment. The study is designed as a superiority trial to demonstrate that early surgical treatment is safe and more effective than the standard treatment. A total of 217 asymptomatic patients with severe AR, but without current guidelines-based surgical indication, will be enrolled across all centers. We expect 24 % of patients identified as high clinical risk and therefore eligible for 1:1 randomization to early surgical treatment within 3 months or a watchful waiting strategy. Follow-up will be annual. We expect a complete restoration of LV size and function along with improved quality of life and physical performance in a short-term follow-up of 12 months. The primary endpoint will be a composite safety and efficacy with all criteria mandatory: 15 % or larger reduction of baseline CMR-derived LV end-diastolic volume index, LV ejection fraction >50 %, and no major adverse cardiovascular events. The annual follow-up will continue for a minimum of 4 years until the required number of endpoints is achieved to show a statistically significant difference in cardiovascular morbidity and mortality in early surgically treated patients.
CONCLUSION:
The ELEANOR trial is the first multicenter randomized controlled study to compare early surgical treatment with a watchful waiting strategy in asymptomatic patients with chronic severe AR at high risk of early clinical deterioration as per CMR assessment but without guidelines-based indications for surgical treatment.
© 2024 The Authors. Published by Elsevier Ltd.
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Extending heart preservation to 24?h with normothermic perfusion.
Front Cardiovasc Med2024 ;11():1325169. doi: 1325169.
Spencer Brianna L, Wilhelm Spencer K, Stephan Christopher, Urrea Kristopher A, Palacio Daniela Pelaez, Bartlett Robert H, Drake Daniel H, Rojas-Pena Alvaro,
Abstract
Cold static storage (CSS) for up to 6?h is the gold standard in heart preservation. Although some hearts stored over 6?h have been transplanted, longer CSS times have increased posttransplant morbimortality. Transmedics® Organ Care System (OCS?) is the only FDA-approved commercial system that provides an alternative to CSS using normothermic heart perfusion (NEHP) in resting mode with aortic perfusion (Langendorff method). However, it is also limited to 6?h and lacks an objective assessment of cardiac function. Developing a system that can perfuse hearts under NEHP conditions for >24?h can facilitate organ rehabilitation, expansion of the donor pool, and objective functional evaluation. The Extracorporeal Life Support Laboratory at the University of Michigan has worked to prolong NEHP to >24?h with an objective assessment of heart viability during NEHP. An NEHP system was developed for aortic (Langendorff) perfusion using a blood-derived perfusate (leukocyte/thrombocyte-depleted blood). Porcine hearts (?=?42) of different sizes (6-55?kg) were divided into five groups and studied during 24?h NEHP with various interventions in three piglets (small-size) heart groups: (1) Control NEHP without interventions (?=?15); (2) NEHP?+?plasma exchange (?=?5); (3) NEHP?+?hemofiltration (?=?10) and two adult-size (juvenile pigs) heart groups (to demonstrate the support of larger hearts); (4) NEHP?+?hemofiltration (?=?5); and (5) NEHP with intermittent left atrial (iLA) perfusion (?=?7). All hearts with NEHP?+?interventions (?=?27) were successfully perfused for 24?h, whereas 14 (93.3%) control hearts failed between 10 and 21?h, and 1 control heart (6.6%) lasted 24?h. Hearts in the piglet hemofiltration and plasma exchange groups performed better than those in the control group. The larger hearts in the iLA perfusion group (?=?7) allowed for real-time heart functional assessment and remained stable throughout the 24?h of NEHP. These results demonstrate that heart preservation for 24?h is feasible with our NEHP perfusion technique. Increasing the preservation period beyond 24?h, infection control, and nutritional support all need optimization. This proves the concept that NEHP has the potential to increase the organ pool by (1) considering previously discarded hearts; (2) performing an objective assessment of heart function; (3) increasing the donor/recipient distance; and (4) developing heart-specific perfusion therapies.
© 2024 Spencer, Wilhelm, Stephan, Urrea, Palacio, Bartlett, Drake and Rojas-Pena.
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Positive effect of deep diaphragmatic breathing training on gastroesophageal reflux-induced chronic cough: a clinical randomized controlled study.
Respir Res2024 Apr;25(1):169. doi: 10.1186/s12931-024-02783-5.
Niu Shanshan, Zhang Tongyangzi, Li Wanzhen, Wen Siwan, Dong Lei, Wang Shengyuan, Shi Wenbo, Shi Cuiqin, Shen Yuqin, Huang Qianchun, Tan Yaling, Xu Xianghuai, Yu Li,
Abstract
BACKGROUND AND OBJECTIVE:
To explore the efficacy of deep diaphragmatic breathing training (DEP) in patients with gastroesophageal reflux-induced chronic cough (GERC).
METHODS:
A randomized controlled study was conducted involving 60 GERC patients who were divided into the intervention group and the control group (each with 30 patients). Both groups received routine medication treatment for GERC, while the intervention group received DEP training additionally. Both groups were evaluated by cough symptom scores, Hull airway reflux questionnaire (HARQ), gastroesophageal reflux diagnostic questionnaire (GerdQ), generalized anxiety disorder scale-7 (GAD-7), patient health questionnaire-9 (PHQ-9), Pittsburgh sleep quality index (PSQI), the Leicester cough questionnaire (LCQ), as well as capsaicin cough sensitivity testing, B-ultrasound and surface electromyography (sEMG) of the diaphragmatic muscles before and after treatment. The cough resolution rate and changes of the above indictors was compared between the two groups after eight weeks of treatment.
RESULTS:
After eight weeks of treatment, cough symptoms improved in both groups, but the cough resolution rate in the intervention group of 94% was significantly higher than that in the control group of 77% (??=?6.402, P?=?0.041). The intervention group showed significant improvements to the control group in GerdQ (6.13(0.35) VS 6.57(0.77)), GAD-7 (0(0;1) VS 1(0;3)), PSQI (2(1;3) VS 4(3;6)), LCQ (17.19(1.56) VS 15.88(1.92)) and PHQ-9 (0(0;0) VS 0(0;3)) after treatment. Compared to control group, sEMG activity of the diaphragmatic muscle was significantly increased in the intervention group after treatment, measured during DEP (79.00(2.49) VS 74.65 (1.93)) and quiet breathing (72.73 (1.96) VS 67.15 (2.48)).
CONCLUSION:
DEP training can improve cough symptoms as an adjunctive treatment in GERC patients.
TRIAL REGISTRATION:
The protocol was registered in February 2, 2022 via the Chinese Clinical Trials Register ( http://www.chictr.org.cn/ ) [ChiCTR2200056246].
© 2024. The Author(s).
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Surveillance of adults with congenital heart disease: Current guidelines and actual clinical practice.
Int J Cardiol2024 Apr;():132022. doi: 10.1016/j.ijcard.2024.132022.
Roos-Hesselink Jolien W, Pelosi Chiara, Brida Margarita, De Backer Julie, Ernst Sabine, Budts Werner, Baumgartner Helmut, Oechslin Erwin, Tobler Daniel, Kovacs Adrienne H, Di Salvo Giovanni, Kluin Jolanda, Gatzoulis Michael A, Diller Gerhard P,
Abstract
BACKGROUND AND AIM:
Congenital heart disease (CHD) is the most common birth defect with prevalence of 0.8%. Thanks to tremendous progress in medical and surgical practice, nowadays, >90% of children survive into adulthood. Recently European Society of Cardiology (ESC), American College of Cardiology (ACC)/ American Heart Association (AHA) issued guidelines which offer diagnostic and therapeutic recommendations for the different defect categories. However, the type of technical exams and their frequency of follow-up may vary largely between clinicians and centres. We aimed to present an overview of available diagnostic modalities and describe current surveillance practices by cardiologists taking care of adults with CHD (ACHD).
METHODS AND RESULTS:
A questionnaire was used to assess the frequency cardiologists treating ACHD for at least one year administrated the most common diagnostic tests for ACHD. The most frequently employed diagnostic modalities were ECG and echocardiography for both mild and moderate/complex CHD. Sixty-seven percent of respondents reported that they routinely address psychosocial well-being.
CONCLUSION:
Differences exist between reported current clinical practice and published guidelines. This is particularly true for the care of patients with mild lesions. In addition, some differences exist between ESC and American guidelines, with more frequent surveillance suggested by the Americans.
Copyright © 2024. Published by Elsevier B.V.
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Extracorporeal membrane oxygenation (ECMO) during aplasia: A bridge towards myopericarditis recovery after autologous hematopoietic stem cell transplant for systemic sclerosis and recent Coronarovirus disease (COVID-19) vaccination.
Curr Res Transl Med2024 Apr;72(3):103449. doi: 10.1016/j.retram.2024.103449.
Cacciatore Carlotta, Baudet Mathilde, Jean Estelle, Presente Simona, Para Marylou, Sonneville Romain, Arangalage Dimitri, Ait Abdallah Nassim, Sicre de Fontbrune Flore, Prata Pedro Henrique, Crichi Benjamin, Hervier Baptiste, Parquet Nathalie, Soulat Gilles, Mousseaux Elie, Burt Richard K, Farge Dominique,
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease (AD), characterised by early diffuse vasculopathy, activation of the immune response and progressive skin and internal organ fibrosis. In severe progressive diffuse SSc (dSSc), autologous hematopoietic stem cell transplantation (aHSCT) improves survival, despite its own risk of complications and transplant related mortality (TRM). We present herein the case of a dSSc patient undergoing aHSCT with low dose cyclophosphamide conditioning and sudden acute myopericarditis and cardiogenic shock, four weeks after a second mRNA SARS-CoV-2 vaccine (Pfizer) injection. Four days of extracorporeal membrane oxygenation (ECMO) support during the aplasia period, allowed to observe full cardiac function recovery and progressive SSc rehabilitation with sustained disease response at 30 months follow-up. This report illustrates, for the first time to our knowledge, that ECMO can be indicated despite aplasia during aHSCT and successfully used as a bridge towards heart function recovery in highly selected and fragile AD patients. We review the factors that may contribute to endothelial and myocardial stunning and acute reversible cardiac failure in SSc and aggravate intrinsic endothelial injury during the aHSCT procedure. These classically include: cyclophosphamide drug toxicity, viral infections and autoimmune activation with disease flair per se. In the COVID-19 pandemic times, acute myocarditis due to recent viral infection or mRNA vaccine per se, must also be considered.
Copyright © 2024. Published by Elsevier Masson SAS.
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Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation.
Eur J Prev Cardiol2024 Apr;():. doi: zwae149.
Milani Juliana Goulart Prata Oliveira, Milani Mauricio, Machado Felipe Vilaça Cavallari, Wilhelm Matthias, Marcin Thimo, D'Ascenzi Flavio, Cavigli Luna, Keytsman Charly, Falter Maarten, Bonnechere Bruno, Meesen Raf, Braga Fabrício, Cipriano Graziella França Bernardelli, Cornelissen Veronique, Verboven Kenneth, Junior Gerson Cipriano, Hansen Dominique,
Abstract
AIMS:
To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains.
METHODS:
Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC).
RESULTS:
HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines.
CONCLUSION:
Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
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Therapeutic education of patients with coronary heart disease: Impact of digital platform monitoring in preventing major cardiovascular events in Tunisia: Study protocol.
PLoS One2024 ;19(4):e0300250. doi: 10.1371/journal.pone.0300250.
Ghali Hela, El Hraiech Aymen, Ben Souda Hend, Karray Majdi, Pavy Bruno, Zedini Chekib,
Abstract
BACKGROUND:
Faced with the increase in the number of chronic diseases with the aging of the population, and with the observation of the insufficiency of therapeutic control, a new need has emerged, that of having a patient as a partner in care.
METHODS:
This study is a randomized controlled trial. Patients with coronary heart disease will be recruited from one clinical site and randomly assigned into two groups: the intervention group and the control group. All participants will be followed up for a total of one year (with three-time points for data collection). Patients who are assigned to the intervention group will receive therapeutic education at first. The digital platform will then allow healthcare providers to accompany them outside the hospital walls. The primary outcome is the incidence of major cardiovascular events within one year of discharge. Main secondary outcomes include changes in health behaviors, medication adherence, and quality of life score. The digital platform is a multi-professional telemonitoring platform that allows care teams to accompany the patient outside the hospital walls. It allows the collection and transmits information from the patient's home to the therapeutic education team. All data will be secured at a certified host. The patient application provides data on compliance, adherence to physical activity (number of steps taken per day), adequate diet (weight gain, food consumed during the meal, compliance with low-salt or salt-free diet, diabetic diet), smoking cessation, as well as medication adherence. Access to educational tools (digital media) is provided to all initial program participants. These tools will be updated annually by the rehabilitation team on the recommendations. The platform also offers the possibility of organizing an individual or group remote educational session (videoconference modules allowing group and individual sessions), a secure integrated caregiver-patient messaging system. The control group will receive the usual controls at the hospital.
DISCUSSION:
To offer a complete solution of care to our patients, we have thought of setting up a digital platform that aims to monitor the patient and strengthen their abilities to manage their condition daily. This pilot experience could be generalized to several services and disciplines. It could be used in several research works.
TRIAL REGISTRATION:
Trial registered with the Pan African Clinical Trial Registry (PACTR202307694422939). URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24247.
Copyright: © 2024 Ghali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Clinical application of virtual reality in patients with cardiovascular disease: state of the art.
Front Cardiovasc Med2024 ;11():1356361. doi: 1356361.
Micheluzzi Valentina, Navarese Eliano Pio, Merella Pierluigi, Talanas Giuseppe, Viola Graziana, Bandino Stefano, Idini Chiara, Burrai Francesco, Casu Gavino,
Abstract
Virtual reality offers a multisensory experience to patients, allowing them to hear, watch, and interact in a virtual environment. Immersive virtual reality is particularly suitable for the purpose of completely isolating patients from the external environment to transport them away from the suffering related to the disease. On this state of the art, we summarize the available literature on the effectiveness of virtual reality on various physical and psychological outcomes in patients with atherosclerotic cardiovascular disease. Virtual reality has been employed in the cardiovascular field in various settings such as cardiac rehabilitation, interventional cardiology, and cardiac surgery. This technology offers promising opportunities to improve several outcomes related to cardiovascular disease, but further research is needed to entirely capture its benefits and to standardize the intervention.
© 2024 Micheluzzi, Navarese, Merella, Talanas, Viola, Bandino, Idini, Burrai and Casu.
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Abnormal heart rate responses to exercise in non-severe COPD: relationship with pulmonary vascular volume and ventilatory efficiency.
BMC Pulm Med2024 Apr;24(1):183. doi: 183.
Shi Minghui, Qumu Shiwei, Wang Siyuan, Peng Yaodie, Yang Lulu, Huang Ke, He Ruoxi, Dong Feng, Niu Hongtao, Yang Ting, Wang Chen,
Abstract
BACKGROUND:
Despite being a prognostic predictor, cardiac autonomic dysfunction (AD) has not been well investigated in chronic obstructive pulmonary disease (COPD). We aimed to characterise computed tomography (CT), spirometry, and cardiopulmonary exercise test (CPET) features of COPD patients with cardiac AD and the association of AD with CT-derived vascular and CPET-derived ventilatory efficiency metrics.
METHODS:
This observational cohort study included stable, non-severe COPD patients. They underwent clinical evaluation, spirometry, CPET, and CT. Cardiac AD was determined based on abnormal heart rate responses to exercise, including chronotropic incompetence (CI) or delayed heart rate recovery (HRR) during CPET.
RESULTS:
We included 49 patients with FEV1 of 1.2-5.0 L (51.1-129.7%), 24 (49%) had CI, and 15 (31%) had delayed HRR. According to multivariate analyses, CI was independently related to reduced vascular volume (VV; VV???median; OR [95% CI], 7.26 [1.56-33.91]) and low ventilatory efficiency (nadir VE/VCO2???median; OR [95% CI], 10.67 [2.23-51.05]). Similar results were observed for delayed HRR (VV???median; OR [95% CI], 11.46 [2.03-64.89], nadir VE/VCO2???median; OR [95% CI], 6.36 [1.18-34.42]).
CONCLUSIONS:
Cardiac AD is associated with impaired pulmonary vascular volume and ventilatory efficiency. This suggests that lung blood perfusion abnormalities may occur in these patients. Further confirmation is required in a large population-based cohort.
© 2024. The Author(s).
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Comprehensive Cardiac Rehabilitation Following Acute Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity.
Circ J2024 Apr;():. doi: 10.1253/circj.CJ-23-0668.
Hiruma Takashi, Nakayama Atsuko, Sakamoto Junko, Hori Kentaro, Nanasato Mamoru, Hosoda Toru, Isobe Mitsuaki,
Abstract
BACKGROUND:
Reduced exercise capacity is a prognostic indicator of adverse outcomes in patients with acute myocardial infarction (AMI). However, few studies have evaluated the effectiveness of comprehensive cardiac rehabilitation (CR) in this population. This study aimed to clarify the efficacy of comprehensive CR in patients with AMI and reduced exercise capacity.Methods?and?Results: This cohort study included 610 patients with AMI who underwent percutaneous coronary intervention. Major adverse cardiovascular events (MACE) were compared between patients who participated in comprehensive outpatient CR for 150 days (CR group; n=430) and those who did not (non-CR group; n=180). During the mean (±SD) follow-up period of 6.1±4.0 years, the CR group exhibited a lower incidence of MACE (log-rank P=0.002). Multivariable analysis revealed that Killip classification, diuretics at discharge, and participation in comprehensive CR were independently associated with MACE. The CR group was further divided into 2 groups, namely reduced exercise capacity (% predicted peak V?O
CONCLUSIONS:
Comprehensive CR in patients with AMI effectively reduced the incidence of MACE regardless of initial exercise capacity. Cardiologists should actively encourage patients with low exercise capacity to participate in comprehensive CR.
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The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support.
Physiol Behav2024 Apr;280():114560. doi: 10.1016/j.physbeh.2024.114560.
Redondo-Rodríguez Celia, Villafaina Santos, Ramos-Fuentes María Isabel, Fuentes-García Juan Pedro,
Abstract
BACKGROUND:
This study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program.
METHOD:
The sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program.
RESULTS:
The experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value
CONCLUSIONS:
A cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.
Copyright © 2024. Published by Elsevier Inc.
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Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.
Clin Rehabil2024 Apr;():2692155241236998. doi: 10.1177/02692155241236998.
Beleigoli Alline, Dafny Hila Ariela, Pinero de Plaza Maria Alejandra, Hutchinson Claire, Marin Tania, Ramos Joyce S, Suebkinorn Orathai, Gebremichael Lemlem G, Bulamu Norma B, Keech Wendy, Ludlow Marie, Hendriks Jeroen, Versace Vincent, Clark Robyn A,
Abstract
OBJECTIVE:
To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion.
DESIGN:
We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study.
SETTING:
Economically disadvantaged areas in rural Australia.
PARTICIPANTS:
Patients (?18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status.
MAIN MEASURES:
A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n?=?28).
RESULTS:
Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p?0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p?=?0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p?=?0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p?=?0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p?0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion.
CONCLUSIONS:
Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.
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Missed opportunities in heart failure diagnosis and management: study of an urban UK population.
ESC Heart Fail2024 Apr;():. doi: 10.1002/ehf2.14766.
Migas Sylwia, Ellis Michelle Louise, Wrona Bozydar, Rivero Sanz Elena, Brownrigg Jack, Strauss Otto, Ahmed Fozia Zahir,
Abstract
AIMS:
This study aimed to examine the diagnostic pathways and outcomes of patients with heart failure (HF), stratified by left ventricular ejection fraction (EF), and to highlight deficiencies in real-world HF diagnosis and management.
METHODS AND RESULTS:
We conducted a retrospective cohort study in Salford, United Kingdom, utilizing linked primary and secondary care data for HF patients diagnosed between January 2010 and November 2019. We evaluated characteristics, diagnostic patterns, healthcare resource utilization, and outcomes. Patients were categorized according to baseline (the latest measure prior to or within 90 days post-diagnosis) as having HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), or preserved EF (HFpEF). The data encompassed a 2 year period before diagnosis and up to 5 years post-diagnosis. A total of 3227 patients were diagnosed with HF between January 2010 and November 2019. The mean follow-up time was 2.6 [±1.9 standard deviation (SD)] years. The mean age at diagnosis was 74.8 (±12.7 SD) years, and 1469 (45.5%) were female. HFpEF was the largest cohort (46.6%, n = 1505), HFmrEF constituted 16.1% (n = 520), and HFrEF 18.5% (n = 596) of the population, while 18.8% (n = 606) of patients remained unassigned due to insufficient evidence to support categorization. At baseline, measurement of natriuretic peptide (NP; brain NP and N-terminal pro-B-type NP) and echocardiographic report data were available for 592 (18.3%) and 2621 (81.2%) patients, respectively. A total of 2099 (65.0%) of the HF cohort had access to a cardiology-led outpatient clinic prior to the HF diagnosis, and 602 (18.7%) attended cardiac rehabilitation post-diagnosis. The 5 year crude survival rate was 37.8% [95% confidence interval (CI) (35.2-40.7%)], 42.3% [95% CI (38.0-47.2%)], and 45.5% [95% CI (41.0-50.4%)] for HFpEF, HFrEF, and HFmrEF, respectively.
CONCLUSIONS:
Low survival rates were observed across all HF groups, along with suboptimal rates of NP testing and specialist assessments. These findings suggest missed opportunities for timely and accurate HF diagnosis, a pivotal first step in improving outcomes for HF patients. Addressing these gaps in diagnosis and management is urgently needed.
© 2024 Pfizer Ltd. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Association of Sports Practice in Childhood and Adolescence with Cardiac Autonomic Modulation in Adulthood: A Retrospective Epidemiological Study.
Sports Med Open2024 Apr;10(1):41. doi: 41.
Christofaro Diego Giulliano Destro, Tebar William R, Mota Jorge, Delfino Leandro D, Santos Amanda B, Ritti-Dias Raphael M, Fernandes Rômulo A, Ferrari Gerson, Vanderlei Luiz Carlos M,
Abstract
BACKGROUND:
Practicing sports during childhood and adolescence provides benefits to cardiac autonomic modulation (CAM) at these stages of life. However, it is not known whether these benefits to CAM persist into adulthood. Therefore, the objective of this study was to analyze the association of early sports practice (sports practice in childhood and/or adolescence) with CAM in adult life, regardless of habitual moderate-to-vigorous PA.
METHODS:
The sample of the present study consisted of 242 adults (141 women and 101 men; age: 41.99?±?16.24). The assessment of CAM was performed using heart rate variability indices. Sports practice in childhood and adolescence was assessed using a questionnaire. The intensity of physical activity was assessed using accelerometry. To analyze the association between previous sports practice (childhood and/or adolescence) and CAM, the Generalized Linear Model was adopted, considering CAM indices as continuous variables and early sports practice as a 3-fold factor (no sports practice; sports practice in childhood or adolescence; and sports practice in both childhood and adolescence) adjusted by sex, age, socioeconomic condition, and moderate to vigorous PA.
RESULTS:
Sports practice in childhood was associated with the average standard deviation of all normal RR intervals expressed in milliseconds (SDNN): ??=?5.89; 95%CI: 0.25;11.52, and the standard deviation of the long-term intervals between consecutive heartbeats (SD2): ??=?7.63; 95%CI:1.04; 14.23 indices. Sports practice in adolescence was associated in adulthood with the SD2 index: ??=?7.37; 95%CI: 0.71;14.04. Sports practice in at least one of the periods (childhood or adolescence) was significantly associated with the square root of the mean square of the differences between adjacent normal RR intervals for a period of time expressed in milliseconds (RMSSD) (??=?8.86; 95%CI?=?0.71;17.01), and the standard deviation of the instantaneous beat to beat variability (SD1) (??=?6.21; 95%CI?=?0.45;11.97). Sports practice at both stages of life was significantly associated with better SDNN (??=?7.70; 95%CI?=?1.16;14.23) and SD2 (??=?10.18; 95%CI?=?2.51;17.85).
CONCLUSION:
Early sports practice was associated with better CAM in adulthood, independently of the current physical activity level. Based on these findings, sports practice is encouraged from childhood and adolescence, for benefits to CAM in adult life.
© 2024. The Author(s).
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The mechanisms of exercise improving cardiovascular function by stimulating Piezo1 and TRP ion channels: a systemic review.
Mol Cell Biochem2024 Apr;():. doi: 10.1007/s11010-024-05000-5.
Duan Xinyan, Liu Renhan, Xi Yue, Tian Zhenjun,
Abstract
Mechanosensitive ion channels are widely distributed in the heart, lung, bladder and other tissues, and plays an important role in exercise-induced cardiovascular function promotion. By reviewing the PubMed databases, the results were summarized using the terms "Exercise/Sport", "Piezo1", "Transient receptor potential (TRP)" and "Cardiovascular" as the keywords, 124-related papers screened were sorted and reviewed. The results showed that: (1) Piezo1 and TRP channels play an important role in regulating blood pressure and the development of cardiovascular diseases such as atherosclerosis, myocardial infarction, and cardiac fibrosis; (2) Exercise promotes cardiac health, inhibits the development of pathological heart to heart failure, regulating the changes in the characterization of Piezo1 and TRP channels; (3) Piezo1 activates downstream signaling pathways with very broad pathways, such as AKT/eNOS, NF-?B, p38MAPK and HIPPO-YAP signaling pathways. Piezo1 and Irisin regulate nuclear localization of YAP and are hypothesized to act synergistically to regulate tissue mechanical properties of the cardiovascular system and (4) The cardioprotective effects of exercise through the TRP family are mostly accomplished through Ca and involve many signaling pathways. TRP channels exert their important cardioprotective effects by reducing the TRPC3-Nox2 complex and mediating Irisin-induced Ca influx through TRPV4. It is proposed that exercise stimulates the mechanosensitive cation channel Piezo1 and TRP channels, which exerts cardioprotective effects. The activation of Piezo1 and TRP channels and their downstream targets to exert cardioprotective function by exercise may provide a theoretical basis for the prevention of cardiovascular diseases and the rehabilitation of clinical patients.
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Study on the hemodynamic effects of different pulsatile working modes of a rotary blood pump using a microfluidic platform that realizes cell culture effectively.
Lab Chip2024 Apr;():. doi: 10.1039/d4lc00159a.
Liang Lixue, Wang Xueying, Chen Dong, Sethu Palaniappan, Giridharan Guruprasad A, Wang Yanxia, Wang Yu, Qin Kai-Rong,
Abstract
Rotary blood pumps (RBPs) operating at a constant speed generate non-physiologic blood pressure and flow rate, which can cause endothelial dysfunction, leading to adverse clinical events in peripheral blood vessels and other organs. Notably, pulsatile working modes of the RBP can increase vascular pulsatility to improve arterial endothelial function. However, the laws and related mechanisms of differentially regulating arterial endothelial function under different pulsatile working modes are still unclear. This knowledge gap hinders the optimal selection of the RBP working modes. To address these issues, this study developed a multi-element endothelial cell culture system (ECCS), which could realize cell culture effectively and accurately reproduce blood pressure, shear stress, and circumferential strain in the arterial endothelial microenvironment. Performance of this proposed ECCS was validated with numerical simulation and flow experiments. Subsequently, this study investigated the effects of four different pulsation frequency modes that change once every 1-4-fold cardiac cycles (80, 40, 80/3, and 20 cycles per min, respectively) of the RBP on the expression of nitric oxide (NO) and reactive oxygen species (ROS) in endothelial cells. Results indicated that the 2-fold and 3-fold cardiac cycles significantly increased the production of NO and prevented the excessive generation of ROS, potentially minimizing the occurrence of endothelial dysfunction and related adverse events during the RBP support, and were consistent with animal study findings. In general, this study may provide a scientific basis for the optimal selection of the RBP working modes and potential treatment options for heart failure.
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