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Pubblicazioni recenti - cardiac rehabilitation
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Treatment strategies for thromboembolism-in-transit with pulmonary embolism.
Interact Cardiovasc Thorac Surg2022 Jun;():. doi: ivac183.
Sakai Hiroki, Uchida Takayuki, Matsumoto Takashi,
Abstract
A 46-year-old obese woman undergoing treatment for bipolar disorder presented with acute shortness of breath, chest pain, and palpitations. She was tachypnea and tachycardia, but blood pressure was stable. Computed tomography angiogram revealed bilateral pulmonary embolism. Echocardiogram revealed thrombus in transit. She underwent surgical embolectomy only for thrombus-in-transit and closure of the patent foramen ovale (PFO). However, pulmonary hypertension worsened, hemodynamical instability prolonged and hepatic congestion progressed. After veno-arterial extracorporeal membrane oxygenation (VA-ECMO) insertion, we performed thrombectomy by catheter and anticoagulation therapy. One month later, the patient was transferred to another hospital for rehabilitation.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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Editorial: Frontiers in Cardiovascular Medicine: Rising Stars 2021.
Front Cardiovasc Med2022 ;9():928981. doi: 10.3389/fcvm.2022.928981.
Wang Lijun, Xu Gui-E, Pan Longlu, Aikawa Elena, Aikawa Masanori, Xiao Junjie, Huang Ngan F,
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Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients.
Arch Rehabil Res Clin Transl2022 Jun;4(2):100178. doi: 10.1016/j.arrct.2022.100178.
Zhang Shangming, Lin Dan, Wright Megan E, Swallow Nicole,
Abstract
Objectives:
(1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes.
Design:
Retrospective cohort study.
Setting:
Freestanding inpatient rehabilitation facility.
Participants:
A total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270).
Interventions:
Not applicable.
Main Outcome Measures:
Functional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC).
Results:
Among 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ?27] vs 67.2% [total FIM gain
Conclusions:
Among 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.
© 2022 The Authors.
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Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review.
Arch Rehabil Res Clin Transl2022 Jun;4(2):100189. doi: 10.1016/j.arrct.2022.100189.
Buryk-Iggers Stephanie, Mittal Nimish, Santa Mina Daniel, Adams Scott C, Englesakis Marina, Rachinsky Maxim, Lopez-Hernandez Laura, Hussey Laura, McGillis Laura, McLean Lianne, Laflamme Camille, Rozenberg Dmitry, Clarke Hance,
Abstract
Objective:
To conduct a systematic review examining the effect of exercise and rehabilitation in people with Ehlers-Danlos syndrome (EDS).
Data Sources:
The following databases were systematically searched: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health. The final time point captured by the search is November 27, 2020.
Study Selection:
Eligible study designs included case-control, case-series, prospective cohort, retrospective cohort, and intervention studies of structured exercise or rehabilitation interventions. Eligible populations included adults (18 years or older) with EDS (all subtypes) and hypermobility spectrum disorders. The search was restricted to articles published in English.
Data Extraction:
Data were extracted by 2 independent reviewers. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (RCTs) and Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Reporting quality of RCTs was assessed using the Consolidated Standards for Reporting of Trials statement with the harms extension. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.
Data Synthesis:
The search yielded 10 eligible studies including 330 participants. The study designs included 5 RCTs, 1 cohort, 2 single-arm interventions, 1 retrospective, and 1 feasibility study. All studies showed some improvement in a physical and/or psychological outcome after the intervention period. One adverse event (nonserious) potentially related to the intervention was reported. Of the 5 RCTs, 2 were rated as high quality with low risk of bias using PEDro, and the majority of non-RCTs were rated as critical risk of bias by ROBINS-I.
Conclusions:
The results suggest that exercise and rehabilitation may be beneficial for various physical and psychological outcomes. Adequately powered and rigorous RCTs of exercise and rehabilitation interventions for people with EDS are needed.
Crown Copyright © 2022 Published by Elsevier Inc. on behalf of American Congress of Rehabilitation Medicine.
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Trunk stabilising exercises promote sternal stability in patients after median sternotomy for heart valve surgery: a randomised trial.
J Physiother2022 Jun;():. doi: S1836-9553(22)00052-2.
Essam El-Sayed Felaya El, Abd Al-Salam Eman Hassan, Shaaban Abd El-Azeim Alshaymaa,
Abstract
QUESTION:
What is the effect of trunk stabilising exercises on sternal stability in women who have undergone heart valve surgery via median sternotomy?
DESIGN:
Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
PARTICIPANTS:
Thirty-six women aged 40 to 50 years who had undergone heart valve surgery via median sternotomy 7 days before enrolment.
INTERVENTION:
All participants in both groups received cardiac rehabilitation during hospitalisation and three times per week for 4 weeks after discharge. In addition, participants in the experimental group were prescribed a regimen of trunk stabilising exercises to be performed three times per week for 4 weeks. At each exercise session, each of 11 exercises were to be performed with five to ten repetitions.
OUTCOME MEASURES:
The primary outcome was sternal separation (the distance between the two halves of the bisected sternum). The secondary outcome was the Sternal Instability Scale from 0 (no instability) to 3 (an unstable sternum with substantial movement or separation). Measures were taken before and after the 4-week intervention period.
RESULTS:
After the 4-week intervention period, the experimental group had a greater decrease in sternal separation by 0.09 cm (95% CI 0.07 to 0.11). The experimental group was twice as likely to improve by at least one grade on the Sternal Instability Scale by 4 weeks (RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three times as likely to have a clinically stable sternum (grade 0 on the Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04).
CONCLUSION:
Trunk stabilising exercises were an effective and feasible method of promoting sternal stability in women who underwent heart valve surgery via median sternotomy.
TRIAL REGISTRATION:
NCT04632914.
Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.
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Pick your threshold: a comparison among different methods of anaerobic threshold evaluation in heart failure prognostic assessment.
Chest2022 Jun;():. doi: S0012-3692(22)01184-9.
Salvioni Elisabetta, Mapelli Massimo, Bonomi Alice, Magrì Damiano, Piepoli Massimo, Frigerio Maria, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Badagliacca Roberto, Filardi Pasquale Perrone, Senni Michele, Correale Michele, Cicoira Mariantonietta, Perna Enrico, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Sinagra Gianfranco, Parati Gianfranco, Cattadori Gaia, Bandera Francesco, Bussotti Maurizio, Re Federica, Vignati Carlo, Lombardi Carlo, Scardovi Angela B, Sciomer Susanna, Passantino Andrea, Emdin Michele, Passino Claudio, Santolamazza Caterina, Girola Davide, Zaffalon Denise, De Martino Fabiana, Agostoni Piergiuseppe, ,
Abstract
BACKGROUND:
In clinical practice, anaerobic threshold (AT), is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). VOAT has been reported as absolute value (VOATabs), as percentage of predicted peak VO (VOAT%peak_pred) or as percentage of observed peak VO value (VOAT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing.
RESEARCH QUESTION:
What is the prognostic power of these different ways to report AT?
STUDY DESIGN AND METHODS:
Observational cohort study. We screened data of 7746 HF patients with history of reduced ejection fraction (
RESULTS:
In this study we considered 6157HF patients with identified AT. Follow up was 4.2 years (1.9-5.0). Both VOATabs (823(305 mL/min)) and VOAT%peak_pred (39.6(13.9%)) but not VOAT%peak_obs (69.2(17.7%)) well stratified the population as regards prognosis (composite endpoint: cardiovascular death, urgent heart transplant or left ventricular assist device). Comparing AUC values, VOATabs (0.680) and VOAT%peak_pred (0.688) performed similarly, while VOAT%peak_obs (0.538) was significantly weaker (P
INTERPRETATION:
In HF, VOAT%peak_pred is the best way to report VO at AT in relation to prognosis, with a prognostic power comparable to that of peak VO and, remarkably, in severe HF patients.
Copyright © 2022. Published by Elsevier Inc.
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Prevention of sudden death in heart failure with reduced ejection fraction: Do we still need ICD for primary prevention?
Eur J Heart Fail2022 Jun;():. doi: 10.1002/ejhf.2594.
Abdelhamid Magdy, Rosano Giuseppe, Metra Marco, Adamopoulos Stamatis, Böhm Michael, Chioncel Ovidiu, Filippatos Gerasimos, Jankowska Ewa A, Lopatin Yury, Lund Lars, Milicic Davor, Moura Brenda, Ben Gal Tuvia, Ristic Arsen, Rakisheva Amina, Savarese Gianluigi, Mullens Wilfried, Piepoli Massimo, Bayes-Genis Antoni, Thum Thomas, Anker Stefan D, Seferovic Petar, Coats Andrew J S,
Abstract
Sudden death (SD) is a devastating complication of heart failure (HF). Current guidelines recommend implantable cardioverter-defibrillator (ICD) for prevention of sudden death in patients with HF and reduced ejection fraction (HFrEF) specifically those with an LVEF ?35% after at least 3 months of optimized HF treatment. The benefit of ICD in patients with symptomatic HFrEF caused by coronary artery disease has been well documented, however, the evidence for a benefit of prophylactic ICDs in patients with HFrEF of non-ischaemic aetiology is less strong. ACE inhibitors or ARBs, beta-adrenergic receptor blockers (BB), and mineralocorticoid receptor antagonists (MRA) block the deleterious actions of angiotensin II, norepinephrine, and aldosterone, respectively. Neprilysin inhibition potentiates the actions of endogenous natriuretic peptides that mitigate adverse ventricular remodeling. BB, MRA, ARNI have a favorable effect of reduction of SCD in HFrEF. Recent data suggest a beneficial effect of SGLT2 inhibitors in reducing serious ventricular arrhythmias and SCD in patients with HFrEF. So, in the current era of new drugs for HFrEF and with the optimal use of disease- modifying therapies (BB, MRA, ARNI &SGLT2i), we might need to reconsider the need and timing for use of ICD as primary prevention of SD, especially in HF of non- ischaemic aetiology. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Resuming Training in High-Level Athletes After Mild COVID-19 Infection: A Multicenter Prospective Study (ASCCOVID-19).
Sports Med Open2022 Jun;8(1):83. doi: 10.1186/s40798-022-00469-0.
Chevalier Laurent, Cochet Hubert, Mahida Saagar, S Sylvain Blanchard, Benard Antoine, Cariou Tanguy, Sridi-Cheniti Soumaya, Benhenda Samy, Doutreleau Stéphane, Cade Stéphane, Guerard Sylvain, Guy Jean-Michel, Trimoulet Pascale, Picard Stéphane, Dusfour Bernard, Pouzet Aurelie, Roseng Stéphanie, Franchi Marco, Jaïs Pierre, Pellegrin Isabelle, ,
Abstract
BACKGROUND:
There is a paucity of data on cardiovascular sequelae of asymptomatic/mildly symptomatic SARS-Cov-2 infections (COVID).
OBJECTIVES:
The aim of this prospective study was to characterize the cardiovascular sequelae of asymptomatic/mildly symptomatic COVID-19 among high/elite-level athletes.
METHODS:
950 athletes (779 professional French National Rugby League (F-NRL) players; 171 student athletes) were included. SARS-Cov-2 testing was performed at inclusion, and F-NRL athletes were intensely followed-up for incident COVID-19. Athletes underwent ECG and biomarker profiling (D-Dimer, troponin, C-reactive protein). COVID(+) athletes underwent additional exercise testing, echocardiography and cardiac magnetic resonance imaging (CMR).
RESULTS:
285/950 athletes (30.0%) had mild/asymptomatic COVID-19 [79 (8.3%) at inclusion (COVID(+)); 206 (28.3%) during follow-up (COVID(+))]. 2.6% COVID(+) athletes had abnormal ECGs, while 0.4% had an abnormal echocardiogram. During stress testing (following 7-day rest), COVID(+) athletes had a functional capacity of 12.8?±?2.7 METS with only stress-induced premature ventricular ectopy in 10 (4.3%). Prevalence of CMR scar was comparable between COVID(+) athletes and controls [COVID(+) vs. COVID(-); 1/102 (1.0%) vs 1/28 (3.6%)]. During 289?±?56 days follow-up, one athlete had ventricular tachycardia, with no obvious link with a SARS-CoV-2 infection. The proportion with troponin I and CRP values above the upper-limit threshold was comparable between pre- and post-infection (5.9% vs 5.9%, and 5.6% vs 8.7%, respectively). The proportion with D-Dimer values above the upper-limit threshold increased when comparing pre- and post-infection (7.9% vs 17.3%, P?=?0.01).
CONCLUSION:
The absence of cardiac sequelae in pauci/asymptomatic COVID(+) athletes is reassuring and argues against the need for systematic cardiac assessment prior to resumption of training (clinicaltrials.gov; NCT04936503).
© 2022. The Author(s).
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Assessing Physician's Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test.
JMIR Med Educ2022 Jun;8(2):e31489. doi: 10.2196/31489.
Gosselin Boucher Vincent, Bacon Simon, Voisard Brigitte, Dragomir Anda I, Gemme Claudia, Larue Florent, Labbé Sara, Szczepanik Geneviève, Corace Kimberly, Campbell Tavis, Vallis Michael, Garber Gary, Rouleau Codie, Diodati Jean G, Rabi Doreen, Sultan Serge, Lavoie Kim, ,
Abstract
BACKGROUND:
Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context.
OBJECTIVE:
The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC-the Motivational Communication Competency Assessment Test (MC-CAT).
METHODS:
Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students.
RESULTS:
The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (?=.78).
CONCLUSIONS:
The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases.
©Vincent Gosselin Boucher, Simon Bacon, Brigitte Voisard, Anda I Dragomir, Claudia Gemme, Florent Larue, Sara Labbé, Geneviève Szczepanik, Kimberly Corace, Tavis Campbell, Michael Vallis, Gary Garber, Codie Rouleau, Jean G Diodati, Doreen Rabi, Serge Sultan, Kim Lavoie, Network For Health Behavior Change And Promotion (CAN-Change). Originally published in JMIR Medical Education (https://mededu.jmir.org), 24.06.2022.
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Correlation of Computed Tomographic Angiography in Patients Undergoing Coronary Artery Bypass Grafting and Effect of Standardized Rehabilitation Nursing.
Comput Intell Neurosci2022 ;2022():6184061. doi: 10.1155/2022/6184061.
Liu Mingming,
Abstract
This study aimed to explore the clinical application of computed tomographic angiography (CTA) and standardized rehabilitation nursing in patients with coronary artery bypass grafting (CABG). CTA image was segmented by reconstruction algorithm and finally assembled into a whole image. Three-dimensional reconstruction of the coronary artery was then performed. 52 patients were selected as the research objects, and standardized rehabilitation nursing was carried out after surgery to analyze the vascular lesion rate of arterial bridge and venous bridge and compare their nursing satisfaction. The results showed that the CTA images were clearer after reconstruction. The number of male patients with venous and arterial lesions was significantly higher than that of the female patients, and the difference between the two groups was obvious (
Copyright © 2022 Mingming Liu.
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A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain.
Medicina (Kaunas)2022 Jun;58(6):. doi: 812.
Viseux Frédéric J F, Simoneau Martin, Billot Maxime,
Abstract
Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.
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Coagulation Factor XIII Val34Leu Polymorphism in the Prediction of Premature Cardiovascular Events-The Results of Two Meta-Analyses.
J Clin Med2022 Jun;11(12):. doi: 3454.
Sarecka-Hujar Beata, ?oboda Danuta, Paradowska-Nowakowska El?bieta, Go?ba Krzysztof S,
Abstract
BACKGROUND:
Polymorphisms within the gene that encodes for coagulation factor XIII (FXIII) have been suggested to be involved in the pathogeneses of ischemic stroke (IS) and myocardial infarction (MI). The Val34Leu polymorphism is one of the most commonly analysed polymorphisms. However, studies on the role of the Val34Leu polymorphism in the aetiology of vascular diseases often show contradictory results. In the present meta-analysis, we aimed to pool data from available articles to assess the relationship between the Val34Leu polymorphism and the susceptibilities to IS of undetermined source and premature MI in patients aged below 55 years.
METHODS:
We searched databases (PubMed, Embase, Google Scholar, SciELO, and Medline) using specific keywords (the last search was in January 2022). Eventually, 18 studies (627 cases and 1639 controls for IS; 2595 cases and 4255 controls for MI) met the inclusion criteria. Data were analysed using RevMan 5.4 and StatsDirect 3 link software. The relation between Val34Leu polymorphism and disease was analysed in five genetic models, i.e., dominant, recessive, additive, heterozygous, and allelic.
RESULTS:
No relation between Val34Leu polymorphism and IS in young adults was observed in all analysed genetic models. For premature MI, significant pooled OR was found between the carrier state of the Leu allele (Val/Leu + Leu/Leu vs. Val/Val) and a lack of MI, suggesting its protective role (OR = 0.80 95%CI 0.64-0.99, = 0.04). A similar finding was observed for the heterozygous model in MI (Val/Leu vs. Val/Val) (OR = 0.77 95%CI 0.61-0.98, = 0.03). No relation was found for the recessive, additive, and allelic models in MI.
CONCLUSIONS:
In the population of young adults, no positive correlation was found between the Val34Leu polymorphism and IS of undetermined source in any of the analysed genetic models. In turn, the carrier state of the 34Leu allele as well as heterozygotes themselves were found to play a protective role in relation to premature MI.
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Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview.
J Clin Med2022 Jun;11(12):. doi: 3323.
De Ponti Roberto, Marazzi Raffaella, Vilotta Manola, Angeli Fabio, Marazzato Jacopo,
Abstract
Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings.
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Comprehensive Care after Myocardial Infarction (CCMI): Long-Term Investment in the Health of Polish Citizens.
Int J Environ Res Public Health2022 Jun;19(12):. doi: 7518.
Kubielas Grzegorz, Hydzik Paulina, Rypicz ?ukasz,
Abstract
The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawa?) has been in effect continuously since October 2017. Within the bundle of services financed by the Polish National Health Fund (NHF), patients receive a diagnosis, conservative and invasive treatment, early cardiac rehabilitation and follow-up visits for 12 months. The existing model of managing patients after myocardial infarction (MI) implements all crucial aspects of care recommended by the European Society of Cardiology (ESC), emphasised many times. The purpose of this paper was to report and describe the course of the implementation of the unique concept-CCMI model, including the scope of the introduced changes and the implementation and structural evaluation of its effects over the period 2017-2021. Our preliminary study reported that the CCMI programme reduces the risk of patient death in the first year after MI by 29%. Furthermore, the authors point out the strict cause and effect relationship between the cardiovascular disease prevention programme since 2004 as the key instrument for the primary systemic prevention implemented outside the CCMI model.
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Expression of the Endothelin-1 Gene and Its Type a Receptor including Physical Activity among Patients with Acute Myocardial Infarction.
Int J Environ Res Public Health2022 Jun;19(12):. doi: 7289.
D?bek Józefa, Piotrkowicz Joanna, G?ogowska-Ligus Joanna, Domagalska-Szopa Ma?gorzata, Szopa Andrzej, Schreiber Lutz,
Abstract
Cardiovascular diseases are the most common causes of death, in both Poland and the world. Their development and progression are largely influenced by the lifestyle with the presence/occurrence of classic, modifiable risk factors. Among them, low physical activity plays a significant role. The aim of the study was to evaluate the expression of the endothelin-1 gene and its type A receptor, taking into account physical activity (International Physical Activity Questionnaire-IPAQ) among patients with acute myocardial infarction. A total of 234 patients with acute myocardial infarction were examined, including 167 patients undergoing early post-hospital cardiac rehabilitation and 67 not participating in it. All of them were assessed with the IPAQ questionnaire and the quantitative real-time polymerase reaction method (QRT-PCR). Physical activity in the group of patients after early post-hospital cardiac rehabilitation increased after rehabilitation. Transcriptional activity of the endothelin-1 (ET-1) gene in both studied group of patients increased significantly, but in a group of patients not participating in early post-hospital cardiac rehabilitation more than in a group of patients participating in it. In our study, the expression of ET-1 was also significantly higher in the group of patients with acute myocardial infarction with ST-segment elevation, without diabetes, with lipid disorders, smoking, with normal body weight. Expression of the ENDRA (Endothelin receptor A) gene increased with age. These results prove the beneficial effect of rehabilitation and may indicate another pathomechanism of pro-atherogenic activity of above-mentioned factors.
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Cardiac Rehabilitation and Mortality Risk Reduction in Peripheral Artery Disease at 6-Month Outcome.
Diagnostics (Basel)2022 Jun;12(6):. doi: 1500.
Anghel Razvan, Adam Cristina Andreea, Mitu Ovidiu, Marcu Dragos Traian Marius, Onofrei Viviana, Roca Mihai, Costache Alexandru Dan, Miftode Radu Stefan, Tinica Grigore, Mitu Florin,
Abstract
The management of patients with peripheral artery disease (PAD) is integrative and multidisciplinary, in which cardiac rehabilitation (CR) plays a prognostic role in terms of functional status, quality of life, and long-term impact on morbidity and mortality. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a prognostic index developed to stratify long-term mortality risk in PAD patients, we divided the cohort into two groups: low and low-intermediate risk group (45 cases) and high-intermediate and high risk group (52 cases). We analyzed demographics, clinical parameters, and paraclinical parameters in the two groups, as well as factors associated with cardiological reassessment prior to the established deadline of 6 months. Obesity ( = 0.048), renal dysfunction ( < 0.001), dyslipidemia ( < 0.001), tobacco use ( = 0.048), and diabetes mellitus ( < 0.001) are comorbidities with long-term prognostic value. Low-density lipoprotein cholesterol ( = 0.002), triglycerides ( = 0.032), fasting glucose ( = 0.011), peak oxygen uptake ( = 0.005), pain-free walking distance ( = 0.011), maximum walking time ( < 0.001), and maximum walking distance ( = 0.002) influence the outcome of PAD patients by being factors associated with clinical improvement at the 6-month follow-up. PAD patients benefit from enrollment in CR programs, improvement of clinical signs, lipid and carbohydrate profile, and weight loss and maintenance of blood pressure profile within normal limits, as well as increased exercise capacity being therapeutic targets.
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Thoracic Aortic Dilation: Implications for Physical Activity and Sport Participation.
Diagnostics (Basel)2022 Jun;12(6):. doi: 1392.
Monda Emanuele, Verrillo Federica, Rubino Marta, Palmiero Giuseppe, Fusco Adelaide, Cirillo Annapaola, Caiazza Martina, Guarnaccia Natale, Mauriello Alfredo, Lioncino Michele, Perna Alessia, Diana Gaetano, D'Andrea Antonello, Bossone Eduardo, Calabrò Paolo, Limongelli Giuseppe,
Abstract
Thoracic aortic dilatation is a progressive condition that results from aging and many pathological conditions (i.e., connective tissue, inflammatory, shear stress disorders, severe valvular heart disease) that induce degenerative changes in the elastic properties, leading to the loss of elasticity and compliance of the aortic wall. Mild aortic root enlargement may be also observed in athletes and is considered as a normal adaptation to regular exercise training. On the other hand, high-intensity physical activity in individuals with a particular genetic substrate, such as those carrying gene variants associated with Marfan syndrome or other inherited aortopathies, can favor an excessive aortic enlargement and trigger an acute aortic dissection. The evaluation of the aortic valve and aortic root diameters, as well as the detection of a disease-causing mutation for inherited aortic disease, should be followed by a tailored decision about sport eligibility. In addition, the risk of aortic complications associated with sport in patients with genetic aortic disease is poorly characterized and is often difficult to stratify for each individual athlete. This review aims to describe the relationship between regular physical activity and aortic dilation, focusing on patients with bicuspid aortic valve and inherited aortic disease, and discuss the implications in terms of aortic disease progression and sport participation.
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The Pathogenesis of Cardiac Arrhythmias in Vitamin D Deficiency.
Biomedicines2022 May;10(6):. doi: 1239.
Barsan Maria, Brata Anca Monica, Ismaiel Abdulrahman, Dumitrascu Dinu Iuliu, Badulescu Andrei-Vlad, Duse Traian Adrian, Dascalescu Stefana, Popa Stefan Lucian, Grad Simona, Muresan Lucian, Maerescu Carmen Maria, Cismaru Gabriel, Brata Vlad Dumitru,
Abstract
The global prevalence of vitamin D deficiency is more than 20%, and the main causes include insufficient intake, reduced absorption, abnormal metabolism, or resistance to its effects. The levels of serum vitamin D appear to influence cardiovascular risk, and the mechanism involved is linked to the transient outward current and the ultrarapid delayed rectifier K+ current densities, activated through the nuclear vitamin D receptor and Akt pathway. A significant number of studies have correlated vitamin D deficiency with an increased risk of developing cardiac arrhythmias and sudden cardiac death. For this reason, the purpose of this review is to analyze the relation between vitamin D deficiency and the pathogenesis of cardiac arrhythmias. Atrial fibrillation, increased QT interval, and QT dispersion were the most common findings associated with vitamin D deficiency. Due to the heterogeneity among existing studies, further research is necessary to confirm the existing data and to analyze its relationship with other types of arrhythmias.
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Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol.
BMJ Open2022 Jun;12(6):e059945. doi: 10.1136/bmjopen-2021-059945.
Antoniou Varsamo, Xanthopoulos Andrew, Giamouzis Gregory, Davos Constantinos, Batalik Ladislav, Stavrou Vasileios, Gourgoulianis Konstantinos I, Kapreli Eleni, Skoularigis John, Pepera Garyfallia,
Abstract
INTRODUCTION:
Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness.
METHODS AND ANALYSIS:
A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20?min plus 20?min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6?min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks).
ETHICS AND DISSEMINATION:
The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations.
TRIAL REGISTRATION NUMBER:
NCT05019157.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Physical activity and the heart: from well-established cardiovascular benefits to possible adverse effects.
Trends Cardiovasc Med2022 Jun;():. doi: S1050-1738(22)00088-3.
Zilio Filippo, Di Fusco Stefania Angela, Flori Marco, D'Aquino Marco Malvezzi Caracciolo, Pollarolo Luigi, Ingianni Nadia, Lucà Fabiana, Riccio Carmine, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio,
Abstract
The favorable effects of physical activity on the cardiovascular system have been well described in scientific literature. Physical activity reduces cardiovascular morbidity and mortality in both healthy subjects and in patients with cardiovascular disease. However, different intensity levels of physical activity have a different impact on the cardiovascular system. Some data support the hypothesis of a "physical activity paradox": repetitive exposure to vigorous physical activity may induce biological effects that counteract the benefits of moderate intensity levels of physical activity. In this review, we report the main effects of acute and chronic physical activity on the cardiovascular system and we summarize the biochemical mechanisms that may explain these effects.
Copyright © 2022. Published by Elsevier Inc.
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