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Pubblicazioni recenti - cardiac rehabilitation
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Effect of single nucleotide polymorphisms in SEPS1 and SEPP1 on expression in the protein level in metabolic syndrome in subjects with cardiovascular disease.
Mol Biol Rep2019 Sep;():. doi: 10.1007/s11033-019-05000-5.
Gharipour Mojgan, Ouguerram Khadija, Nazih El-Hassane, Salehi Mansoor, Behmanesh Mehrdad, Razavi Rouzbeh, Gharipour Amin, Diantkhah Minoo, Sadeghi Masoumeh,
Abstract
Metabolic syndrome (MetS) results from the interaction between environmental and genetic factors. Several previous studies considered the role of selenium in developing MetS. Two selenoproteins, selenoprotein S (SelS), and the Selenoprotein P (SePP) play an important role in antioxidative defense and therefore susceptibility to MetS. The involvement of SNPs in SEPP1 and SEPS1 have not been studied in MetS subjects. This study aims to investigate the association between the risk of MetS and four polymorphisms SEPS1 (rs28665122, rs4965373), SEPP1 (rs7579, rs3877899) in an Iranian population. The sample of this case-control study consisted of 132 Iranian patients with cardiovascular disease (71 MetS and 65 non-MetS subjects) from December 2015 to March 2016. Demographic data, medical history, and para-clinical were measured, and Taqman probes were used for allelic discrimination. The level of the SelS and the SePP were measured by the ELIZA method. No significant differences were found in the genotype frequencies of SEPS1 (rs4965373, rs28665122), SEPP1 (rs7579, rs3877899) in patients with MetS and the non-MetS group. The mean of SelS in MetS subjects with SEPS1 (rs4965373) GG genotype is significantly lower than the non-MetS group (4496.99?±?3688.5 vs. 6148.6?±?1127.0, P?=?0.009). The mean of SePP in MetS subjects with SEPP1 (rs3877899) GG genotype is significantly lower than the non-MetS group (40.73?±?8.44 vs.83.91?±?21.33, P?=?0.002). The mean of SePP in MetS subjects with SEPP1 (rs7579) GG genotype is lower than the non-MetS group (55.52?±?16.7 vs. 109.48?±?29.78, P?=?0.01). In summary, the results of this study does not indicate significant differences in the SEPP1 (rs7579, rs3877899) and SEPS1 (rs4965373, rs28665122) genotypes between MetS and non-MetS subjects. However, the results show that the mean of expression of SelS and SePP decreased in the subjects with SEPP1 (rs7579) GG and SEPP1 (rs3877899) GG.
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Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease.
Med Sci Monit2019 Sep;25():7115-7125. doi: 10.12659/MSM.915830.
Sternberg Michael, Pasini Evasio, Chen-Scarabelli Carol, Corsetti Giovannii, Patel Hemang, Linardi Daniele, Onorati Francesco, Faggian Giuseppe, Scarabelli Tiziano, Saravolatz Louis,
Abstract
In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.
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Physical activity for patients with heart failure: Position paper from the heart failure (GICC) and cardiac rehabilitation (GERS-P) Working Groups of the French Society of Cardiology.
Arch Cardiovasc Dis2019 Sep;():. doi: S1875-2136(19)30154-8.
Zores Florian, Iliou Marie-Christine, Gellen Barnabas, Kubas Sophie, Berthelot Emmanuelle, Guillo Pascal, Bauer Fabrice, Lamblin Nicolas, Bosser Gilles, Damy Thibaud, Cohen-Solal Alain, Beauvais Florence,
Abstract
Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.
Copyright © 2019 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Adult -related myopathy carriers: Classification based on deep phenotyping.
Neurology2019 Sep;():. doi: 10.1212/WNL.0000000000008316.
Cocanougher Benjamin T, Flynn Lauren, Yun Pomi, Jain Minal, Waite Melissa, Vasavada Ruhi, Wittenbach Jason D, de Chastonay Sabine, Chhibber Sameer, Innes A Micheil, MacLaren Linda, Mozaffar Tahseen, Arai Andrew E, Donkervoort Sandra, Bönnemann Carsten G, Foley A Reghan,
Abstract
OBJECTIVE:
To better characterize adult myotubularin 1 ()-related myopathy carriers and recommend a phenotypic classification.
METHODS:
This cohort study was performed at the NIH Clinical Center. Participants were required to carry a confirmed mutation and were recruited via the Congenital Muscle Disease International Registry (n = 8), a traveling local clinic of the Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, NIH and Cure CMD (n = 1), and direct physician referral (n = 1). Neuromuscular examinations, muscle MRI, dynamic breathing MRI, cardiac MRI, pulmonary function tests (PFTs), physical therapy assessments including the Motor Function Measure 32 (MFM-32) scale, and X chromosome inactivation (XCI) studies were performed.
RESULTS:
Phenotypic categories were proposed based on ambulatory status and muscle weakness. Carriers were categorized as severe (nonambulatory; n = 1), moderate (minimal independent ambulation/assisted ambulation; n = 3), mild (independent ambulation but with evidence of muscle weakness; n = 4), and nonmanifesting (no evidence of muscle weakness; n = 2). Carriers with more severe muscle weakness exhibited greater degrees of respiratory insufficiency and abnormal signal on muscle imaging. Skeletal asymmetries were evident in both manifesting and nonmanifesting carriers. Skewed XCI did not explain phenotypic severity.
CONCLUSION:
This work illustrates the phenotypic range of -related myopathy carriers in adulthood and recommends a phenotypic classification. This classification, defined by ambulatory status and muscle weakness, is supported by muscle MRI, PFT, and MFM-32 scale composite score findings, which may serve as markers of disease progression and outcome measures in future gene therapy or other clinical trials.
© 2019 American Academy of Neurology.
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Factors associated with return to work among survivors of out-of-hospital cardiac arrest.
Resuscitation2019 Sep;():. doi: S0300-9572(19)30613-6.
Kearney Jason, Dyson Kylie, Andrew Emily, Bernard Stephen, Smith Karen,
Abstract
BACKGROUND:
Although out-of-hospital cardiac arrest (OHCA) is a major cause of global mortality, survival rates have increased over the last decade. As such, there is an increasing need to explore long-term functional outcomes of survivors, such as return to work (RTW).
METHODOLOGY:
We analysed baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for patients that arrested between 2010 and 2016 who were working prior to their arrest. We also conducted more detailed RTW interviews in a subset of OHCA survivors who arrested between July and September 2017. Factors associated with RTW were assessed using multivariable logistic regression analysis.
RESULTS:
A total of 884 previously working survivors were included in the analysis, 650 (73%) of whom RTW. Male sex (AOR 1.80; 95%CI: 1.10-2.94), arrests witnessed by emergency medical services (AOR 2.72; 95%CI: 1.50-9.25), discharge directly home from hospital (AOR 4.13; 95%CI: 2.38-7.18) and favourable 12-month health-related quality of life according to the EQ-5D were associated with RTW. Increasing age (AOR 0.97; 95%CI: 0.95-0.98), traumatic arrest aetiology (AOR 0.18; 95%CI: 0.04-0.77), and labour-intensive occupations (AOR 0.44; 95%CI: 0.29-0.66) were associated with decreased odds of RTW. Of the 23 OHCA survivors that participated in the more detailed RTW telephone-interview, 87% RTW. Flexible work hours or modified duties were offered to 74% of participants. Fatigue was the most frequently reported barrier to RTW.
CONCLUSION:
This is the largest study to collectively examine factors associated with RTW among survivors of OHCA. Although larger qualitative studies are needed, our findings highlight which patients are at risk of not RTW and who may benefit from targeted rehabilitation strategies.
Copyright © 2019 Elsevier B.V. All rights reserved.
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"Future Patient" Telerehabilitation for Patients With Heart Failure: Protocol for a Randomized Controlled Trial.
JMIR Res Protoc2019 Sep;8(9):e14517. doi: 10.2196/14517.
Dinesen Birthe, Dittmann Lars, Gade Josefine Dam, Jørgensen Cecilia Klitgaard, Hollingdal Malene, Leth Soeren, Melholt Camilla, Spindler Helle, Refsgaard Jens,
Abstract
BACKGROUND:
Cardiovascular disease is the leading cause of mortality worldwide, accounting for 13%-15% of all deaths. Cardiac rehabilitation has poor compliance and adherence. Telerehabilitation has been introduced to increase patients' participation, access, and adherence with the help of digital technologies. The target group is patients with heart failure. A telerehabilitation program called "Future Patient" has been developed and consists of three phases: (1) titration of medicine (0-3 months), (2) implementation of the telerehabilitation protocols (3 months), and (3) follow-up with rehabilitation in everyday life (6 months). Patients in the Future Patient program measure their blood pressure, pulse, weight, number of steps taken, sleep, and respiration and answer questions online regarding their well-being. All data are transmitted and accessed in the HeartPortal by patients and health care professionals.
OBJECTIVE:
The aim of this paper is to describe the research design, outcome measures, and data collection techniques in the clinical test of the Future Patient Telerehabilitation Program for patients with heart failure.
METHODS:
A randomized controlled study will be performed. The intervention group will follow the Future Patient Telerehabilitation program, and the control group will follow the traditional cardiac rehabilitation program. The primary outcome is quality of life measured by the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes are development of clinical data; illness perception; motivation; anxiety and depression; health and electronic health literacy; qualitative exploration of patients', spouses', and health care professionals' experiences of participating in the telerehabilitation program; and a health economy evaluation of the program. Outcomes were assessed using questionnaires and through the data generated by digital technologies.
RESULTS:
Data collection began in December 2016 and will be completed in October 2019. The study results will be published in peer-reviewed journals and presented at international conferences. Results from the Future Patient Telerehabilitation program are expected to be published by the spring of 2020.
CONCLUSIONS:
The expected outcomes are increased quality of life, increased motivation and illness perception, reduced anxiety and depressions, improved electronic health literacy, and health economics benefits. We expect the study to have a clinical impact for future telerehabilitation of patients with heart failure.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):
DERR1-10.2196/14517.
©Birthe Irene Dinesen, Lars Dittmann, Josefine Dam Gade, Cecilia Klitgaard Jørgensen, Malene Hollingdal, Soeren Leth, Camilla Melholt, Helle Spindler, Jens Refsgaard. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 19.09.2019.
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Heart Rehabilitation in patients awaiting Open heart surgery targeting to prevent Complications and to improve Quality of life (Heart-ROCQ): study protocol for a prospective, randomised, open, blinded endpoint (PROBE) trial.
BMJ Open2019 Sep;9(9):e031738. doi: 10.1136/bmjopen-2019-031738.
Hartog Johanneke, Blokzijl Fredrike, Dijkstra Sandra, DeJongste Mike J L, Reneman Michiel F, Dieperink Willem, van der Horst Iwan C C, Fleer Joke, van der Woude Lucas H V, van der Harst Pim, Mariani Massimo A,
Abstract
INTRODUCTION:
The rising prevalence of modifiable risk factors (eg, obesity, hypertension and physical inactivity) is causing an increase in possible avoidable complications in patients undergoing cardiac surgery. This study aims to assess whether a combined preoperative and postoperative multidisciplinary cardiac rehabilitation (CR) programme (Heart-ROCQ programme) can improve functional status and reduce surgical complications, readmissions and major adverse cardiac events (MACE) as compared with standard care.
METHODS AND ANALYSIS:
Patients (n=350) are randomised to the Heart-ROCQ programme or standard care. The Heart-ROCQ programme consists of a preoperative optimisation phase while waiting for surgery (three times per week, minimum of 3 weeks), a postoperative inpatient phase (3 weeks) and an outpatient CR phase (two times per week, 4 weeks). Patients receive multidisciplinary treatment (eg, physical therapy, dietary advice, psychological sessions and smoking cessation). Standard care consists of 6 weeks of postsurgery outpatient CR with education and physical therapy (two times per week). The primary outcome is a composite weighted score of functional status, surgical complications, readmissions and MACE, and is evaluated by a blinded endpoint committee. The secondary outcomes are length of stay, physical and psychological functioning, lifestyle risk factors, and work participation. Finally, an economic evaluation is performed. Data are collected at six time points: at baseline (start of the waiting period), the day before surgery, at discharge from the hospital, and at 3, 7 and 12 months postsurgery.
ETHICS AND DISSEMINATION:
This study will be conducted according to the principles of the Declaration of Helsinki (V.8, October 2013). The protocol has been approved by the Medical Ethical Review Board of the UMCG (no 2016/464). Results of this study will be submitted to a peer-reviewed scientific journal and can be presented at national and international conferences.
TRIAL REGISTRATION NUMBER:
NCT02984449.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
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From geriatric cardiology to 'cardio-geriatric' prevention and rehabilitation: Need for a new core curriculum?
Eur J Prev Cardiol2019 Sep;():2047487319876229. doi: 10.1177/2047487319876229.
Pedretti Roberto Fe, Ambrosetti Marco, Sarzi Braga Simona,
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Pulsed intravenous methylprednisolone combined with oral steroids as a treatment for poorly responsive type 2 amiodarone-induced thyrotoxicosis.
Eur J Endocrinol2019 Sep;():. doi: 10.1530/EJE-19-0515.
Campi Irene, Perego Giovanni Battista, Ravogli Antonella, Groppelli Antonella, Parati Gianfranco, Persani Luca, Fugazzola Laura,
Abstract
OBJECTIVES:
Amiodarone induced thyrotoxicosis (AIT) affects up to 3% of treated patients. Type 2 AIT (AIT2) is a destructive thyroiditis and is usually treated with medium-high oral doses of prednisone. As AIT may worsen the underlying heart disease, a rapid control of thyroid function is desirable. We aimed to determine whether a combined intravenous methylprednisolone (IVMP) pulses therapy associated to prednisone in the interpulse period, can represent an efficient and safe alternative to urgent total thyroidectomy in patients withAIT2 not responsive to prednisone alone.
DESIGN AND METHODS:
Patients presenting with a severe AIT2 studied in a tertiary referral Center from August 2018 to April 2019. We included four patients requiring a rapid improvement of thyroid function for their underlying cardiac disorders. The baseline doses of oral prednisone (range 5-12.5 mg/day) and IVMP (range 250-500 twice a week) were determined according to the severity of the thyrotoxicosis and were titrated based on clinicalresponse.
RESULTS:
combined treatment was effective in all patients in the prompt restoration ofeuthyroidism and no major adverse events were reported during the follow-up. In all cases, FT4 and FT3 levels normalized at 3-5 weeks of treatment. A permanent hypothyroidism was observed in one patient, three months after the discontinuation of treatment.
CONCLUSIONS:
we report for the first time that the combined intravenous and oral steroid therapy is effective in patients with AIT2. The treatment is well-tolerated, leads to a rapid improvement of thyroid function, allowing to avoid urgent total thyroidectomy and favoring a quick functional recovery and rehabilitation of cardiac patients.
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Loss of Consciousness and Altered Mental State as Predictors of Functional Recovery Within 6 Months Following Mild Traumatic Brain Injury.
J Neuropsychiatry Clin Neurosci2019 Sep;():appineuropsych18120379. doi: 10.1176/appi.neuropsych.18120379.
Roy Durga, Peters Matthew E, Everett Allen D, Leoutsakos Jeannie-Marie Sheppard, Yan Haijuan, Rao Vani, T Bechtold Kathleen, Sair Haris I, Van Meter Tim, Falk Hayley, Vassila Alexandra, Hall Anna, Ofoche Uju, Akbari Freshta, Lyketsos Constantine, Korley Frederick,
Abstract
OBJECTIVE:
The authors tested the hypothesis that a combination of loss of consciousness (LOC) and altered mental state (AMS) predicts the highest risk of incomplete functional recovery within 6 months after mild traumatic brain injury (mTBI), compared with either condition alone, and that LOC alone is more strongly associated with incomplete recovery, compared with AMS alone.
METHODS:
Data were analyzed from 407 patients with mTBI from injury erum arkers for ssessing esponse to rauma (HeadSMART), a prospective cohort study of TBI patients presenting to two urban emergency departments. Four patient subgroups were constructed based on information documented at the time of injury: neither LOC nor AMS, LOC only, AMS only, and both. Logistic regression models assessed LOC and AMS as predictors of functional recovery at 1, 3, and 6 months.
RESULTS:
A gradient of risk of incomplete functional recovery at 1, 3, and 6 months postinjury was noted, moving from neither LOC nor AMS, to LOC or AMS alone, to both. LOC was associated with incomplete functional recovery at 1 and 3 months (odds ratio=2.17, SE=0.46, p<0.001; and odds ratio=1.80, SE=0.40, p=0.008, respectively). AMS was associated with incomplete functional recovery at 1 month only (odds ratio=1.77, SE=0.37 p=0.007). No association was found between AMS and functional recovery in patients with no LOC. Neither LOC nor AMS was predictive of functional recovery at later times.
CONCLUSIONS:
These findings highlight the need to include symptom-focused clinical variables that pertain to the injury itself when assessing who might be at highest risk of incomplete functional recovery post-mTBI.
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Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study.
J Nucl Cardiol2019 Sep;():. doi: 10.1007/s12350-019-01884-9.
Bokhari Sabahat, Schneider Robert H, Salerno John W, Rainforth Maxwell V, Gaylord-King Carolyn, Nidich Sanford I,
Abstract
BACKGROUND:
Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients.
METHODS:
Fifty-six CHD patients were assigned to CR, CR?+?TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES).
RESULTS:
For 37 patients who completed posttesting, there were MFR improvements in the CR?+?TM group (+20.7%; ES?=?0.64) and the TM group alone (+12.8%; ES?=?0.36). By comparison, the CR-alone and usual care groups showed modest changes (+?5.8%; ES?=?0.17 and -?10.3%; ES?=?-?0.31), respectively. For the combined TM group, MFR increased (+?14%, ES?=?0.56) compared to the combined non-TM group (-?2.0%, ES?=?-?0.08).
CONCLUSIONS:
These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects.
TRIAL REGISTRATION:
ClinicalTrials.gov registration # NCT01810029.
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Statistical comments on "Combined effect of whole-body vibration and ambient lighting on human discomfort, heart rate, and reaction time".
Int Arch Occup Environ Health2019 Sep;():. doi: 10.1007/s00420-019-01474-9.
Amirpour Afshin, Zavar Reihaneh, Ebrahimi Milad,
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Selection of endurance capabilities and the trade-off between pressure and volume in the evolution of the human heart.
Proc Natl Acad Sci U S A2019 Sep;():. doi: 201906902.
Shave Robert E, Lieberman Daniel E, Drane Aimee L, Brown Marcel G, Batterham Alan M, Worthington Steven, Atencia Rebeca, Feltrer Yedra, Neary Jennifer, Weiner Rory B, Wasfy Meagan M, Baggish Aaron L,
Abstract
Chimpanzees and gorillas, when not inactive, engage primarily in short bursts of resistance physical activity (RPA), such as climbing and fighting, that creates pressure stress on the cardiovascular system. In contrast, to initially hunt and gather and later to farm, it is thought that preindustrial human survival was dependent on lifelong moderate-intensity endurance physical activity (EPA), which creates a cardiovascular volume stress. Although derived musculoskeletal and thermoregulatory adaptations for EPA in humans have been documented, it is unknown if selection acted similarly on the heart. To test this hypothesis, we compared left ventricular (LV) structure and function across semiwild sanctuary chimpanzees, gorillas, and a sample of humans exposed to markedly different physical activity patterns. We show the human LV possesses derived features that help augment cardiac output (CO) thereby enabling EPA. However, the human LV also demonstrates phenotypic plasticity and, hence, variability, across a wide range of habitual physical activity. We show that the human LV's propensity to remodel differentially in response to chronic pressure or volume stimuli associated with intense RPA and EPA as well as physical inactivity represents an evolutionary trade-off with potential implications for contemporary cardiovascular health. Specifically, the human LV trades off pressure adaptations for volume capabilities and converges on a chimpanzee-like phenotype in response to physical inactivity or sustained pressure loading. Consequently, the derived LV and lifelong low blood pressure (BP) appear to be partly sustained by regular moderate-intensity EPA whose decline in postindustrial societies likely contributes to the modern epidemic of hypertensive heart disease.
Copyright © 2019 the Author(s). Published by PNAS.
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Exercise-induced laryngeal obstruction: Quality initiative to improve assessment and management.
Int J Pediatr Otorhinolaryngol2019 Sep;127():109677. doi: S0165-5876(19)30430-6.
Campisi Emma S, Schneiderman Jane E, Owen Blythe, Moraes Theo J, Campisi Paolo,
Abstract
INTRODUCTION:
Exercise-induced laryngeal obstruction (EILO) affects 2-3% of the general population and 5.1% of elite athletes. Symptoms arise during high-intensity exercise and resolve at rest. EILO is often misdiagnosed as exercise-induced asthma as both conditions can present with dyspnea, chest tightness and cough. The purpose of this quality initiative was to identify patient characteristics that predict a higher likelihood of EILO, streamline referrals for exercise-endoscopy testing and avoid unnecessary medications.
METHODS:
A retrospective chart review included patients referred to a pediatric tertiary center between 2013 and 2018 for suspected EILO requesting exercise endoscopy. Data was collected from the patient chart and referral letters included age, sex, physical activity, medications, symptoms, and results of pulmonary and cardiac function tests.
RESULTS:
Between 2013 and 2018, 35 patients (9 males and 26 females, aged 5-18 years) were referred. Only 18 patients developed symptoms during an exercise endoscopy test. The majority were female (15/18), older than 10 years (18/18) and were involved in competitive sports (16/18). Stridor was the most common complaint among all patients referred (24/35) and many reported anxiety and high stress (15/35). The majority (63%) were previously treated with asthma medication. Pulmonary and cardiac function testing was not predictive of EILO.
CONCLUSION:
EILO is typically present in adolescent females involved in competitive sports. Anxiety and high stress was commonly noted. The majority were treated with asthma medication even though pulmonary function testing was normal. Recognition of this patient profile should improve timely access to appropriate diagnostic assessments, avoid unnecessary medical treatment, and promote a return to optimal athletic performance.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Outcome measures in a combined exercise rehabilitation programme for adults with COPD and chronic heart failure: A preliminary stakeholder consensus event.
Chron Respir Dis;16():1479973119867952. doi: 10.1177/1479973119867952.
Jones Amy V, Evans Rachael A, Man William D-C, Bolton Charlotte E, Breen Samantha, Doherty Patrick J, Gardiner Nikki, Houchen-Wolloff Linzy, Hurst John R, Jolly Kate, Maddocks Matthew, Quint Jennifer K, Revitt Olivia, Sherar Lauren B, Taylor Rod S, Watt Amye, Wingham Jennifer, Yorke Janelle, Singh Sally J,
Abstract
Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitation were presented by experts at a stakeholder consensus event and all stakeholders ( = 18) were asked to (1) rank in order of importance a list of categories, (2) prioritise outcome measures and (3) prioritise baseline patient evaluation measures that should be assessed in a combined COPD and CHF rehabilitation programme. The tasks were completed anonymously and related to clinical rehabilitation programmes and associated research. Health-related quality of life, exercise capacity and symptom evaluation were voted as the most important categories to assess for clinical purposes (median rank: 1, 2 and 3 accordingly) and research purposes (median rank; 1, 3 and 4.5 accordingly) within combined exercise rehabilitation. All stakeholders agreed that profiling symptoms at baseline were 'moderately', 'very' or 'extremely' important to assess for clinical and research purposes in combined rehabilitation. Profiling of frailty was ranked of the same importance for clinical purposes in combined rehabilitation. Stakeholders identified a suite of multidisciplinary measures that may be important to assess in a combined COPD and CHF exercise rehabilitation programme.
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Commentaries on Viewpoint: Distinct modalities of eccentric exercise: different recipes, not the same dish
J Appl Physiol (1985)2019 09;127(3):884-891. doi: 10.1152/japplphysiol.00496.2019.
Coratella Giuseppe, Longo Stefano, Cè Emiliano, Esposito Fabio, de Almeida Costa Campos Yuri, Pereira Guimarães Miller, Fernandes da Silva Sandro, Dufour Stéphane P., Hureau Thomas J., Lemire Marcel, Favret Fabrice, Elmer Steven J., LaStayo Paul C., Wernbom Mathias, Seynnes Olivier, Paulsen Gøran, Bontemps Bastien, Vercruyssen Fabrice, Gruet Mathieu, Louis Julien, Mourot Laurent, Rakobowchuk Mark, Pageaux Benjamin, Tremblay Jonathan, Peñailillo Luis, Nosaka Kazunori, Hahn Daniel, Raiteri Brent J., ?karabot Jakob, Valenzuela Pedro L., Walsh Joel A., McAndrew Darryl J., Lepers Romuald, Stapley Paul J., Baumert P, Erskine R M, Clos Pierre,
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The effect of cardiac rehabilitation at 4 weeks postoperatively on quality of life in patients treated with totally thoracoscopic ablation.
J Exerc Rehabil2019 Aug;15(4):610-615. doi: 10.12965/jer.1938340.170.
Seo Yong-Gon, Sung Jidong, Shin Mal-Soon, Park Yun-Jin, Min Kyoung-Bin, Kang Gyu-Min, Lee Jong-Min, Kim Myung-Ki,
Abstract
There is a lack of evidence on the effect of exercise-based cardiac rehabilitation (EBCR) in patients treated with total thoracoscopic ablation (TTA) for atrial fibrillation (AF). Our study investigated the efficacy and safety of postoperative exercise intervention in patients recovering from TTA. Twenty-four patients participated in the study, and were divided into the two groups, exercise group (EG) (n=12) and control group (n= 12). Patients in EG performed the exercise intervention including the aerobic and resistance exercise program twice a week for 8 weeks, which was used as a hospital-based cardiac rehabilitation for the out-patient. A cardiopulmonary exercise test was administered to evaluate aerobic exercise capacity, and qualitative aspect of patient's life was assessed using the Short Form 36 questionnaires to compare pre and postoperative wellness of patient's life. Although there was an increase of VO (peak oxygen uptake) after exercise intervention, no significant improvement was found (=0.055). Two of 4 physical health scores (role-physical, =0.013 and general health, =0.05) and three of four mental health scores (vitality, =0.027, social function, =0.016, and mental health, =0.003) were significantly improved after 8 weeks of EBCR. Each summarized scale in the physical (=0.022) and mental (= 0.004) survey section was also significantly improved in postoperative assessment compared to the preoperative one. In this context, we concluded that EBCR initiated at the time point of 4th week after TTA operation can guarantee the secure postoperative physical activity, and the 8 weeks of EBCR can effectively improve the quality of life in AF Patients.
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The association of cardiovascular reactivity during the Trier Social Stress Test with quality of life in coronary artery disease patients.
J Psychosom Res2019 Sep;126():109824. doi: S0022-3999(19)30175-8.
Gecaite Julija, Burkauskas Julius, Bunevicius Adomas, Brozaitiene Julija, Kazukauskiene Nijole, Mickuviene Narseta,
Abstract
OBJECTIVE:
Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD). The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD.
METHODS:
One-hundred and thirty-six patients (84.6% men, age 52?±?8) within 2-3?weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders.
RESULTS:
After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (??=?-0.182; p?=?.03) and SF-36 Vitality scale (??=?-0.203; p?=?.03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST.
CONCLUSION:
In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL.
Copyright © 2019. Published by Elsevier Inc.
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Barriers to Engagement in Chronic Heart Failure Rehabilitation: An Australian Survey.
Heart Lung Circ2019 Aug;():. doi: S1443-9506(19)31375-7.
Palmer Katie, Bowles Kelly-Ann, Lane Rebecca, Morphet Julia,
Abstract
BACKGROUND:
While exercise has been shown to improve quality of life and physical function and reduce hospital admission rates in people with chronic heart failure (CHF), engagement is poor in condition specific rehabilitation programs. This project aims to identify barriers to engagement in rehabilitation, strategies to address these, and comprehensively detail CHF rehabilitation practise in Australia.
METHODS:
An online survey was emailed to all cardiac and chronic heart failure rehabilitation programs in Australia utilising a publicly available database.
RESULTS:
The survey was completed by 165 respondents: Australian Capital Territory (ACT)?=?4, New South Wales (NSW)?=?49, Northern Territory (NT)?=?2, Queensland (Qld)?=?23, South Australia (SA)?=?12, Tasmania (Tas)?=?2, Victoria (Vic)?=?37, Western Australia (WA)?=?12, including metropolitan (37%), regional (47%) and remote (9%) locations. Common barriers were themed into four areas: poor condition-specific health literacy, lack of medical professional support, interrupted health care systems, and personal and external deterrents. Strategies to improve engagement and attendance focussed mostly on the patient, with few strategies aimed at improving patient and health professional knowledge and referral processes. Programs generally appeared to follow current Australian Heart Foundation recommendations for CHF rehabilitation.
CONCLUSIONS:
This survey identifies common barriers that need to be addressed to improve engagement and attendance levels in CHF rehabilitation programs. While patient barriers are already being addressed, strategic planning needs to occur to address poor health literacy including for medical and health professionals, improved flow through the health care system and improving the flexibility of program delivery. Adaptation of home-based and tele-rehabilitation can help with this, while education and advertisement to patients and potential referrers needs to start early in the disease journey.
Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Stroke care in 1960 and now-the case of René Maugras.
Rev Neurol (Paris)2019 Sep;():. doi: S0035-3787(19)30612-5.
André C,
Abstract
BACKGROUND/OBJECTIVE:
Georges Simenon accurately describes, in a novel called Les Anneaux de Bicêtre, the clinical picture and course, and the hospital procedures and treatment of a patient with a large left hemispheric stroke, presumably ischemic.
METHODS:
I here summarize these features and use them as a basis to discuss the marked changes in stroke evaluation and care in the last 60 years.
RESULTS/CASE REPORT:
A 54-year old Newspaper director was admitted shortly after an acute stroke leading to temporary loss of consciousness, to motor aphasia and right hemiplegia and hypoesthesia. Risk factors included hypertension, a sedentary life, smoking, and a previous episode of cardiac arrhythmia possibly related to congenital heart disease. Evaluation included electroencephalography, cerebral arteriography and cerebrospinal fluid analysis. The acute treatment involved prolonged bed rest in a private room, prophylactic antibiotics, and oral anticoagulation. Smoking was allowed. Prolonged in-hospital rehabilitation followed initial passive physical therapy provided by nurses. After many months, the patient was released with persistent motor problems and a marked psychological change.
CONCLUSION:
The entire field of acute stroke care has been revolutionized in the last 60 years. Big data management, telemedicine, software, new brain and vascular imaging techniques, biomarkers, robotics etc., are currently in development and again should lead to new and surprising changes during the next decades.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
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