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Pubblicazioni recenti - cardiac rehabilitation
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Survival of the fittest: Impact of cardiorespiratory fitness on outcomes in men and women with cardiovascular disease.
Clin Ther2020 Feb;():. doi: S0149-2918(20)30050-3.
Safdar Basmah, Mangi Abeel A,
Abstract
Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther. 2020; 42:XXX-XXX) © 2020 Elsevier Inc.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease.
J Cardiopulm Rehabil Prev2020 Feb;():. doi: 10.1097/HCR.0000000000000495.
Bostrom John, Searcy Ryan, Walia Ahana, Rzucidlo Justyna, Banco Darcy, Quien Mary, Sweeney Greg, Pierre Alicia, Tang Ying, Mola Ana, Xia Yuhe, Whiteson Jonathan, Dodson John A,
Abstract
PURPOSE:
Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF).
METHODS:
We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression).
RESULTS:
Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31).
CONCLUSIONS:
Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
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Patient Perspectives on Declining to Participate in Home-Based Cardiac Rehabilitation: A MIXED-METHODS STUDY.
J Cardiopulm Rehabil Prev2020 Feb;():. doi: 10.1097/HCR.0000000000000493.
Schopfer David W, Nicosia Francesca M, Ottoboni Linda, Whooley Mary A,
Abstract
PURPOSE:
A minority of eligible patients participate in cardiac rehabilitation (CR) programs. Availability of home-based CR programs improves participation in CR, yet many continue to decline to enroll. We sought to explore among patients the rationale for declining to participate in CR even when a home-based CR program is available.
METHODS:
We conducted a mixed-methods evaluation of reasons for declining to participate in CR. Between August 2015 and August 2017, a total of 630 patients were referred for CR evaluation during index hospitalization (San Francisco VA Medical Center). Three hundred three patients (48%) declined to participate in CR. Of these, 171 completed a 14-item survey and 10 patients also provided qualitative data through semistructured phone interviews.
RESULTS:
The most common reason, identified by 61% of patients on the survey, was "I already know what to do for my heart." Interviews helped clarify reasons for nonparticipation and identified system barriers and personal barriers. These interviews further highlighted that declining to participate in CR was often due to competing life priorities, no memory of the initial CR consultation, and inadequate understanding of CR despite referral.
CONCLUSION:
We identified that most patients declining to participate in a home-based CR program did not understand the benefits and rationale for CR. This could be related to the timing of the consultation or presentation method. Many patients also indicated that competing life priorities prevented their participation. Modifications in the consultation process and efforts to accommodate personal barriers may improve participation.
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Comparison of the effect of 12- and 24-week cardiac rehabilitation on physical, psychosocial and biomedical factors in ischemic heart disease patients.
Horm Mol Biol Clin Investig2020 Feb;():. doi: 10.1515/hmbci-2019-0023.
Sadeghi Masoumeh, Izadi Abdullah, Mahdi Hadavi Mohammad, Rafati Fard Mohammad, Roohafza Hamidreza,
Abstract
Background Cardiac rehabilitation (CR) is a key component of effective care for patients with a wide spectrum of cardiac problems. It seems that the short-term provision of these services can facilitate their use and meeting of related needs for patients participating in the CR programs. Materials and methods In this interventional study on patients with ischemic heart disease (IHD) referred to the Cardiac Rehabilitation Center of Chamran Hospital, Isfahan, Iran. One-hundred and twelve patients were randomly divided into two groups of 12 and 24 weeks of CR [mean age: 59.2 ± (9.02) and 60.7 ± (9.3) years, respectively] and underwent a CR program. All information was collected in two stages, before the beginning of the program and after completion of 12- and 24-week rehabilitation programs. The data collection tools were demographics questionnaire, the International Physical Activity Questionnaires (IPAQ), McNew Quality of Life Questionnaire, Beck Depression Inventory (BDI), and Zung Self-Rating Anxiety Scale (SAS). Results The results of this study showed that in both groups, total physical activity (PA) and functional capacity increased, and the quality of life (QOL)(SF36) was statistically improved. Comparison of changes in mean differences at the end of the rehabilitation periods between the two groups, showed that only the weight, body mass index (BMI), waist circumference (WC) and high-density lipoprotein (HDL) in the 24-session group significantly decreased compared to the 12-session group and, but no significant difference in other variables was observed. Conclusion Overall, the findings of this study support the overall benefits of the CR program in both the short and the long term. Therefore it can be suggested that a short-term program can still be a valuable option for reducing the risk in cardiac patients and meeting their service needs.
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Short and long term effect of treatment non-pharmacological and lifestyle in patients with metabolic syndrome.
Diabetol Metab Syndr2020 ;12():16. doi: 10.1186/s13098-020-0522-y.
Brandão Ana Denise, da Silva Jeferson Hernandes, Mariane Oliveira Lima Sarah, Lima Leiciane, Loize Bhianca, de Castro Antônio Adolfo Mattos, Kümpel Claudia, Porto Elias Ferreira,
Abstract
Background:
Metabolic syndrome (MS) is a complex disorder represented by a set of cardiovascular risk factors usually related to central fat deposition, insulin resistance, hypertension and dyslipidemia. It is associated with accelerated atherosclerosis in response to chronic inflammation and vascular endothelial dysfunction, increasing overall mortality. The objective to evaluate the short and long term effect of the comprehensive cardiac rehabilitation program and intensive lifestyle intervention in metabolic syndrome patients.
Methods:
This is longitudinal interventional study. All patients underwent a 20-session cardiac rehabilitation program with aerobic and resisted exercises as well as an educational program for lifestyle changes and follow up 1 year.
Results:
Forty seven patients participated in the present study, but only 28 concluded the follow up. 77.7% were females and the majority was older than 60 years (63.1%). After cardiac rehabilitation, the percentage of overweight (0.04) patients who controlled the SBP (0.04) increased, and obesity levels I and II were reduced, as well as a significant reduction in total cholesterol and triglycerides (0.01 and 0.05), all of these variables remained similar after 1 year of follow-up. After cardiac rehabilitation all participants were practicing the five factors of healthy lifestyle, and reduced to 73% after follow up.
Conclusion:
A comprehensive cardiac rehabilitation program and lifestyle change is an effective approach in the treatment of patients with MS mainly, it has positive short and long term effects on weight control, reducing total cholesterol and triglycerides.
© The Author(s) 2020.
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Effects of Matched Intermittent and Continuous Exercise on Changes of Cardiac Biomarkers in Endurance Runners.
Front Physiol2020 ;11():30. doi: 10.3389/fphys.2020.00030.
Li Feifei, Nie Jinlei, Zhang Haifeng, Fu Frank, Yi Longyan, Hopkins Will, Liu Yang, Lu Yifan,
Abstract
Purpose:
Endurance runners training with high-intensity intermittent exercise might experience damage to cardiac muscle. We have therefore compared changes of cardiac biomarkers after workload-matched intermittent and continuous exercise.
Methods:
Twelve endurance runners [11 males, 1 female; means ± SD O, 62.4 ± 5.4 ml kg min; velocity of O (v O), 17.1 ± 1.4 km h] completed an intermittent and continuous exercise trial in random order. Intermittent exercise consisted of running at 90% v O for 2 min followed by 50% v O for 2 min, repeated for 92 min. Continuous exercise was performed at 70% v O for 92 min. Blood samples were drawn before and 0, 2, 4, 24, and 48 h after exercise for assay of various cardiac biomarkers. Changes in concentration of biomarkers were averaged for the comparison of intermittent with continuous exercise after adjustment for baseline concentration and exercise intensity expressed as percent of heart-rate reserve (%HRR); magnitudes were assessed by standardization.
Results:
There were moderate and large increases in high-sensitivity cardiac troponin-I and -T respectively following exercise. The differences between the increases adjusted to the mean intensity of 78 %HRR were trivial, but at 85 %HRR the increases for cardiac troponin-I and -T were moderately higher for intermittent compared with continuous exercise (factor difference, ×/÷90% confidence limits: 3.4, ×/÷1.9 and 2.1, ×/÷1.8 respectively). Differences in the changes in other cardiac biomarkers were trivial.
Conclusion:
Prolonged intermittent exercise is potentially more damaging to cardiac muscle than continuous exercise of the same average running speed at higher average heart rates in endurance runners.
Copyright © 2020 Li, Nie, Zhang, Fu, Yi, Hopkins, Liu and Lu.
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Cost-utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up.
Open Heart2020 ;7(1):e001184. doi: 10.1136/openhrt-2019-001184.
Tayyari Dehbarez Nasrin, Palmhøj Nielsen Camilla, Risør Bettine Wulff, Vinther Nielsen Claus, Lynggaard Vibeke,
Abstract
Objectives:
To enhance adherence to cardiac rehabilitation (CR), a patient education programme called 'learning and coping' (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost-utility of the LC-programme compared with the standard CR-programme.
Methods:
825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3?years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves.
Results:
No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95%?CI -3828 to 12 533) or in QALY (-0.006; 95%?CI -0.053 to 0.042). At a threshold of 40?000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%.
Conclusions:
While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Cardiac rehabilitation in the modern interventional cardiology era.
Eur J Prev Cardiol -
Age and gender differences in clinical outcomes of patients with heavy-calcified coronary artery lesions treated percutaneously with rotational atherectomy.
Adv Clin Exp Med2020 Feb;():. doi: 10.17219/acem/110314.
Januszek Rafa?, Pawlik Artur, Staszczak Bart?omiej, J?drychowska Magdalena, Bartu? Jerzy, Legutko Jacek, Dudek Dariusz, Surdacki Andrzej, Bartu? Stanis?aw,
Abstract
BACKGROUND:
Rotational atherectomy (RA) used in elderly patients treated with percutaneous coronary interventions (PCI) could enable revascularisation or the omission of cardiac surgery. Knowledge about factors affecting the prognosis may improve the results of treatment.
OBJECTIVES:
We aimed to assess the relationship of gender and age with long-term clinical outcomes expressed as major adverse cardiac and cerebrovascular events (MACCEs).
MATERIAL AND METHODS:
The study included 97 consecutive patients treated with PCI and RA at the mean age of 71. The study group contained 73.2% men and 26.8% women, 36.1% of patients older than 75 and 63.9% younger than 75. The mean time of follow-up was 695.3 ±560.9 days. The rate of MACCEs (deaths, myocardial infarctions (MIs), reinterventions, coronary artery by-pass surgeries, or cerebral strokes (CSs)/transient ischemic attacks (TIAs)) in the overall group of patients was calculated at 33.7%.
RESULTS:
The comparison of Kaplan-Meier survival curves did not depict significant differences in the frequency of MACCEs for age (p = 0.36) and gender (p = 0.07). We noticed that the death rate was higher in females than in males and in patients older than 75 compared to those younger, and was statistically significant for age (p = 0.04). The rate of periprocedural complications was significantly higher among women than among men (p = 0.005) and in patients older than 75 compared to the younger ones (p = 0.003).
CONCLUSIONS:
Age and gender are not significantly associated with an increased rate of MACCEs during follow-up in elderly patients treated with PCI and RA.
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Effects of interval training versus continuous training on coronary artery disease: an updated meta-analysis of randomized controlled trials.
Physiother Theory Pract2020 Feb;():1-10. doi: 10.1080/09593985.2019.1706213.
Chen Lei, Tang Lin,
Abstract
: Exercise training-based cardiac rehabilitation is a safe intervention to improve aerobic exercise capacity, metabolic parameters, muscle strength, quality of life, and survival in patients with coronary artery disease (CAD). This study aimed to evaluate the effects of interval training (IT) and continuous training (CT) on CAD for appropriate treatment. : We retrieved 12 high-quality randomized controlled trials (RCTs) till August 13, 2019, focused on the effects of IT and CT on patients with CAD from the Pubmed, Embase, and Cochrane Library databases. The following disease-related parameters were collected: peak oxygen uptake (peak O), peak heart rate (HR), respiratory exchange ratio (RER) at the peak O, heart rate recovery, resting HR, resting systolic blood pressure (SBP), and resting diastolic blood pressure. Additionally, study quality was assessed using the Cochrane risk assessment tool, and heterogeneity was estimated using -statistic and -test. The effect size was presented with weighted mean difference (WMD) and 95% confidence intervals (CIs). : No publication bias was identified in the selected 12 RCTs. The pooled data showed a significant increase in the peak O (WMD = -2.00, < .0001), peak HR (WMD = -5.88, = .0003), and RER at the peak O (WMD = -0.02, = .0001) in the IT group compared to the CT group. SBP (WMD = -3.23, = .0498) showed significant improvement in the IT group compared to the CT group. : IT helps improve cardiorespiratory fitness in patients with CAD because it brings about greater improvement in the peak exercise capacity and resting SBP compared to CT.
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The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: a systematic review.
Diabetes Metab Res Rev2020 Feb;():. doi: 10.1002/dmrr.3301.
Helleputte S, De Backer T, Lapauw B, Shadid S, Celie B, Van Eetvelde B, Vanden Wyngaert K, Calders P,
Abstract
Rigorous glycaemic control - reflected by low HbA1c goals - is of utmost importance in the prevention and management of complications in patients with type 1 diabetes mellitus (T1DM). However, previous studies suggested that short-term glycaemic variability (GV) is important to consider as well, as excessive glucose fluctuations may have an additional impact on the development of diabetic complications. The potential relationship between GV and the risk for cardiovascular autonomic neuropathy (CAN), a clinical expression of cardiovascular autonomic dysfunction, is of increasing interest. This systematic review aimed to summarize existing evidence concerning the relationship between GV and cardiovascular autonomic dysfunction in T1DM. Electronic database search of Medline (Pubmed), Web of Science and Embase was performed, up to October 2019. There were no limits concerning year of publication. Methodological quality was evaluated with the Newcastle Ottawa Scale for observational studies. Six studies (four cross-sectional and two prospective cohorts) were included. Methodological quality of the studies varied from level C to A2. Two studies examined the association between GV and heart rate variability (HRV) and both found significant negative correlations. Regarding cardiovascular autonomic reflex tests (CARTs), two studies did not while two other studies did find significant associations between GV parameters and CART-scores. However, associations were attenuated after adjusting for covariates such as HbA1c, age and disease duration. In conclusion, this systematic review found some preliminary evidence supporting an association between GV and cardiovascular autonomic dysfunction in T1DM. Hence, uncertainty remains whether high GV can independently contribute to the onset or progression of CAN. The heterogeneity in methodological approach made it difficult to compare different studies. Future studies should therefore use uniformly evaluated CGM-derived parameters of GV, while standardised assessment of HRV, CARTs and other potential cardiac autonomic function parameters is needed for an unambiguous definition of CAN. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Cardiac Repair: the intricate crosstalk between the epicardium and the myocardium.
Curr Stem Cell Res Ther2020 Feb;():. doi: 10.2174/1574888X15666200219105448.
Pellegrini Laura, Foglio Eleonora, Pontemezzo Elena, Germani Antonia, Russo Matteo Antonio, Limana Federica,
Abstract
BACKGROUND:
Substantial evidences support the hypothesis that the epicardium has a role in cardiac repair and regeneration in part providing, by epithelial to mesenchymal transition (EMT), progenitor cells that differentiate into cardiac cell types and in part releasing paracrine factors that contribute to cardiac repair. Beside cell contribution, a significant paracrine communication occurs between the epicardium and the myocardium that improves the whole regenerative response. Signaling pathways underlying this communication are multiple as well as soluble factors involved in cardiac repair and secreted both by myocardial and epicardial cells. Most recently, extracellular vesicles, i.e. exosomes, that accumulate in the pericardial fluid (PF) and are able to transport bioactive molecules (cytosolic proteins, mRNAs, miRNAs and other non-coding RNAs), have been also identified as potential mediators of epicardial-mediated repair following myocardial injury.
CONCLUSIONS:
This mini review provides an overview of the epicardial-myocardial signaling in regulating cardiac repair in ischemic heart diseases. Indeed, a detailed understanding of the crosstalk between myocardial and epicardial cells and how paracrine mechanisms are involved in the context of ischemic heart diseases would be of tremendous help in developing novel therapeutic approaches to promote cardiomyocytes survival and heart regeneration following myocardial infarction (MI).
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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Factors influencing the uptake of cardiac rehabilitation by cardiac patients with a comorbidity of stroke.
Int J Cardiol Heart Vasc2020 Apr;27():100471. doi: 10.1016/j.ijcha.2020.100471.
Harrison A S, Gaskins N J, Connell L A, Doherty P,
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Is patient-centred care for women a priority for policy-makers? Content analysis of government policies.
Health Res Policy Syst2020 Feb;18(1):23. doi: 10.1186/s12961-020-0533-z.
Gagliardi Anna R, Dunn Sheila, Foster Angel M, Grace Sherry L, Khanlou Nazilla, Stewart Donna E, Straus Sharon E,
Abstract
BACKGROUND:
Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how government policies recognise and promote PCC for women (PCCW).
METHODS:
We analysed the content of English-language policies published in Canada from 2010 to 2018 on depression and cardiac rehabilitation - conditions featuring known gendered inequities - that were identified on government websites. We extracted data and used summary statistics to enumerate mentions of PCC and women's health.
RESULTS:
We included 30 policies (20 depression, 10 cardiac rehabilitation). Of those, 20 (66.7%) included any content related to PCC (median 1.0, range 0.0 to 5.0), most often exchanging information (14, 46.7%) and making decisions (13, 43.3%). Less frequent domains were enabling self-management (8, 26.7%), addressing emotions (6, 20.0%) and fostering the relationship (4, 13.3%). No policies included content for the domain of managing uncertainty. A higher proportion of cardiac rehabilitation guidelines included PCC content. Among the 30 policies, 7 (23.3%) included content related to at least one women's health domain (median 0.0, range 0.0 to 3.0). Most frequently included were social determinants of health (4, 13.3%). Fewer policies mentioned any issues to consider for women (2, 28.6%), issues specific to subgroups of women (2, 28.6%) or distinguished care for women from men (2, 28.6%). No policies included mention of abuse or violence, or discrimination or stigma. The policies largely pertained to depression. Despite mention of PCC or women's health, policies offered brief, vague guidance on how to achieve PCCW; for example, "Patients value being involved in decision-making" and "Women want care that is collaborative, woman- and family-centered, and culturally sensitive."
CONCLUSIONS:
Despite considerable evidence of need and international recommendations, most policies failed to recognise gendered disparities or promote PCC as a mitigating strategy. These identified gaps represent opportunities by which government policies could be developed or strengthened to support PCCW. Future research should investigate complementary strategies such as equipping policy-makers with the evidence and tools required to develop PCCW-informed policies.
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Early exercise training feasibility after aortic valve repair: A multicentre prospective French survey on behalf of the Aortic Valve repair International Registry (AVIATOR).
Arch Cardiovasc Dis2020 Feb;():. doi: S1875-2136(20)30022-X.
Tabet Jean-Yves, Meurin Philippe, Ben Driss Ahmed, Weber Helene, Dumaine Raphaelle, Renaud Nathalie, Grosdemouge Anne, Defrance Carine, Peyrot Sandrine, Debauchez Mathieu, Lansac Emmanuel,
Abstract
BACKGROUND:
Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair.
OBJECTIVES:
To evaluate the feasibility of an early exercise training programme after aortic valve repair.
METHODS:
Consecutive patients were prospectively included in 13 postoperative centres. Patients underwent an exercise training programme for approximately 3-5 weeks. Transthoracic echocardiography and a cardiopulmonary exercise test were performed before and after the exercise training programme.
RESULTS:
Fifty patients (mean±standard deviation [SD] age: 50±13 years) were included a mean of 13.6±12.0 days after aortic valve repair. The preoperative degree of aortic insufficiency was moderate to severe in 35 patients (70%) and the aortic valve was bicuspid in 24 patients (48%). Valve-sparing root replacement and isolated aortic valve repair (including 10% supracoronary aorta replacement) were performed in 64% and 36% of patients, respectively. We found no aortic insufficiency occurrence or worsening and no adverse clinical events after the exercise training programme. Mean left ventricular ejection fraction increased significantly (from 54%±8% to 57%±9%; P=0.0007). Mean peak oxygen consumption and first ventilatory threshold increased from 17.0±5.3 to 22.5±7.8mL/kg/min (32% increase) and from 12.0±3.9 to 14.3±5.2mL/kg/min (19% increase), respectively (both P<0.05).
CONCLUSION:
Exercise training early after aortic valve repair is safe and seems to significantly improve exercise capacity.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
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Effects of Isometric Handgrip Training in Patients With Peripheral Artery Disease: A Randomized Controlled Trial.
J Am Heart Assoc2020 Feb;9(4):e013596. doi: 10.1161/JAHA.119.013596.
A Correia Marilia, Oliveira Paulo L, Farah Breno Q, Vianna Lauro C, Wolosker Nelson, Puech-Leao Pedro, Green Daniel J, Cucato Gabriel G, Ritti-Dias Raphael M,
Abstract
Background Meta-analyses have shown that isometric handgrip training (IHT) can reduce brachial systolic and diastolic blood pressure (BP) by >6/4 mm Hg, respectively. However, whether IHT promotes these effects among patients with peripheral artery disease, who exhibit severe impairment in cardiovascular function, is currently unknown. This study aimed to evaluate the effects of IHT on the cardiovascular function of patients with peripheral artery disease. Methods and Results A randomized controlled trial with peripheral artery disease patients assigned to either the IHT or control group was conducted. The IHT group performed 3 sessions per week, for 8 weeks, of unilateral handgrip exercises, consisting of 4 sets of isometric contractions for 2 minutes at 30% of maximum voluntary contraction and a 4-minute interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. The primary outcome was brachial BP. The secondary outcomes were central BP, arterial stiffness parameters, cardiac autonomic modulation, and vascular function. The IHT program reduced diastolic BP (75 [10] mm Hg preintervention versus 72 [11] mm Hg postintervention), with no change in the control group (74 [11] mm Hg preintervention versus 74 [11] mm Hg postintervention), with this between-group difference being significant (=0.04). Flow-mediated dilation improved in the IHT group (6.0% [5.7] preintervention versus 9.7% [5.5] postintervention), with no change in the control group (7.6% [5.5] preintervention versus 7.4% [5.1] postintervention), with this between-group difference being significant (=0.04). There was no change in other measured variables over the intervention period. Conclusions IHT reduced brachial diastolic BP and improved local vascular function in patients with peripheral artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02742220.
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State of the Science in Women's Cardiovascular Disease: A Canadian Perspective on the Influence of Sex and Gender.
J Am Heart Assoc2020 Feb;9(4):e015634. doi: 10.1161/JAHA.119.015634.
Norris Colleen M, Yip Cindy Y Y, Nerenberg Kara A, Clavel Marie-Annick, Pacheco Christine, Foulds Heather J A, Hardy Marsha, Gonsalves Christine A, Jaffer Shahin, Parry Monica, Colella Tracey J F, Dhukai Abida, Grewal Jasmine, Price Jennifer A D, Levinsson Anna L E, Hart Donna, Harvey Paula J, Van Spall Harriette G C, Sarfi Hope, Sedlak Tara L, Ahmed Sofia B, Baer Carolyn, Coutinho Thais, Edwards Jodi D, Green Courtney R, Kirkham Amy A, Srivaratharajah Kajenny, Dumanski Sandra, Keeping-Burke Lisa, Lappa Nadia, Reid Robert D, Robert Helen, Smith Graeme, Martin-Rhee Michelle, Mulvagh Sharon L,
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Correction to: Cardiac Rehabilitation Dose Around the World: Variation and Correlates.
Circ Cardiovasc Qual Outcomes -
Safety and efficacy of high intensity interval training in a patient with acute pulmonary embolism.
Prog Cardiovasc Dis2020 Feb;():. doi: S0033-0620(20)30038-4.
Ghram Amine, Shafiee Akbar, Soori Rahman, Choobineh Siroos, Niyazi Sepideh, Shirani Shapoor, Hosseinsabet Ali, Wisløff Ulrik, Jenab Yaser,
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Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies.
Intensive Care Med2020 Feb;():. doi: 10.1007/s00134-019-05907-4.
Slooter Arjen J C, Otte Wim M, Devlin John W, Arora Rakesh C, Bleck Thomas P, Claassen Jan, Duprey Matthew S, Ely E Wesley, Kaplan Peter W, Latronico Nicola, Morandi Alessandro, Neufeld Karin J, Sharshar Tarek, MacLullich Alasdair M J, Stevens Robert D,
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