Pubblicazioni recenti - cardiac rehabilitation
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Italian Cardiological Guidelines (COCIS) for Competitive Sport Eligibility in athletes with heart disease: update 2020.
J Cardiovasc Med (Hagerstown)2021 Apr;():. doi: 10.2459/JCM.0000000000001186.
Delise Pietro, Mos Lucio, Sciarra Luigi, Basso Cristina, Biffi Alessandro, Cecchi Franco, Colivicchi Furio, Corrado Domenico, D'Andrea Antonello, Di Cesare Ernesto, Di Lenarda Andrea, Gervasi Salvatore, Giada Franco, Guiducci Vincenzo, Inama Giuseppe, Leoni Loira, Palamà Zefferino, Patrizi Giampiero, Pelliccia Antonio, Penco Maria, Robles Antonio Gianluca, Romano Silvio, Romeo Francesco, Sarto Patrizio, Sarubbi Berardo, Sinagra Gianfranco, Zeppilli Paolo,
Abstract
Since 1989, SIC Sport and a FMSI, in partnership with leading Italian Cardiological Scientific Associations (ANCE, ANMCO and SIC) have produced Cardiological Guidelines for Completive Sports Eligibility for athletes with heart disease (COCIS -- 1989, 1995, 2003, 2009 and 2017). The English version of the Italian Cardiological Guidelines for Competitive Sports Eligibility for athletes with heart disease was published in 2013 in this Journal. This publication is an update with respect to the document previously published in English in 2013. It includes the principal innovations that have emerged over recent years, and is divided into five main chapters: arrhythmias, ion channel disorders, congenital heart diseases, acquired valve diseases, cardiomyopathies, myocarditis and pericarditis and ischemic heart disease. Wherever no new data have been introduced with respect to the 2013 publication, please refer to the previous version. This document is intended to complement recent European and American guidelines but an important difference should be noted. The European and American guidelines indicate good practice for people engaging in physical activity at various levels, not only at the competitive level. In contrast, the COCIS guidelines refer specifically to competitive athletes in various sports including those with high cardiovascular stress. This explains why Italian guidelines are more restrictive than European and USA ones. COCIS guidelines address 'sports doctors' who, in Italy, must certify fitness to participate in competitive sports. In Italy, this certificate is essential for participating in any competition.
Copyright © 2021 Italian Federation of Cardiology. All rights reserved.
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How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR.
BMJ Open2021 Apr;11(4):e046051. doi: 10.1136/bmjopen-2020-046051.
O'Doherty Alasdair F, Humphreys Helen, Dawkes Susan, Cowie Aynsley, Hinton Sally, Brubaker Peter H, Butler Tom, Nichols Simon,
Abstract
OBJECTIVE:
To investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.
DESIGN:
A mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.
SETTING:
International survey of exercise-based cardiac rehabilitation programmes.
PARTICIPANTS:
Healthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.
MAIN OUTCOME MEASURES:
The proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.
RESULTS:
Three hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.
CONCLUSIONS:
The rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Factors contributing to exercise capacity in chronic thromboembolic pulmonary hypertension with near-normal hemodynamics.
J Heart Lung Transplant2021 Mar;():. doi: S1053-2498(21)02222-1.
Tobita Kazuki, Goda Ayumi, Nishida Yuichiro, Takeuchi Kaori, Kikuchi Hanako, Inami Takumi, Kohno Takashi, Yamada Shin, Soejima Kyoko, Satoh Toru,
Abstract
BACKGROUND:
Despite improved survival for patients with chronic thromboembolic pulmonary hypertension (CTEPH) due to progressive medical and interventional treatment, impaired exercise capacity remains common due to poorly understood mechanisms. We aimed to clarify the exercise capacity of CTEPH patients with near-normal pulmonary hemodynamics and evaluate its determinants among the hemodynamic, peripheral (e.g., oxygen use by the peripheral tissues), and muscular (e.g., skeletal muscle strength) factors.
METHODS:
Three hundred and twenty-nine patients with CTEPH (mean age, 63 ± 12 years; men/women, 73/256) with a near-normal mean pulmonary artery pressure (?30 mm Hg) at rest were enrolled. We assessed exercise capacity by peak oxygen consumption (peak VO) using cardiopulmonary exercise testing with a right heart catheter. We also measured the 6-minute walk distance (6MWD) and quadriceps muscle strength.
RESULTS:
The mean pulmonary artery pressure was 19 ± 4 mmHg and mean cardiac output was 4.8 ± 1.5 L/min at rest. The mean 6MWD was 444 ± 101 m, while the mean peak VO was 14.4 ± 3.9 mL/min/kg. A multivariate model that predicted 6MWD included quadriceps strength (??=?0.45, p < 0.001) and peak arterial venous oxygen difference (??=?0.29, p < 0.001). In contrast, the peak VO was best correlated with mPAP-CO slope (??=?-0.30, p < 0.001), followed by quadriceps strength and peak arterial venous oxygen difference.
CONCLUSIONS:
The 6MWD performance may be significantly influenced by peripheral oxygen use and muscular factors, while peak VO is influenced by hemodynamic and peripheral factors in CTEPH patients with near-normal hemodynamics.
Copyright © 2021. Published by Elsevier Inc.
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Comorbidity of depression and anxiety leads to a poor prognosis following angina pectoris patients: a prospective study.
BMC Psychiatry2021 Apr;21(1):202. doi: 10.1186/s12888-021-03202-5.
Bai Bingqing, Yin Han, Guo Lan, Ma Huan, Wang Haochen, Liu Fengyao, Liang Yanting, Liu Anbang, Geng Qingshan,
Abstract
BACKGROUND:
Depression and anxiety are two common mood problems among patients with cardiovascular disease (CVD) and are associated with poor cardiac prognoses. The comorbidity of depression and anxiety is considered to be a more severe psychological status than non-comorbid mood disorders. However, little is known about the relationship between depression or anxiety and noncardiac readmission. We conducted a prospective study on the prognostic impact of depression, anxiety, and the comorbidity of the two among angina pectoris (AP) patients.
METHOD:
In this prospective study, 443 patients with AP were included in the analysis. Follow-up assessments were performed 1?year, and 2?years after patient discharges. Clinical outcomes of interest included noncardiac readmission, major adverse cardiovascular events (MACEs), and composite events. Depression and anxiety symptom scores derived from the patient health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7 (GAD-7) questionnaire were used to assess mood symptoms at baseline. Participants with symptom scores of ?10 on both the depression and anxiety questionnaires formed the clinical comorbidity subgroup. We used multivariable Cox proportional hazards models to evaluate the impact of individual mood symptom and comorbidity on clinical outcomes.
RESULTS:
Among all the AP patients, 172 (38. 9%) were determined to have depression symptoms, 127 (28.7%) patients had anxiety symptoms and 71 (16.0%) patients suffered from their comorbidity. After controlling covariates, we found that patients who endured clinical depression (hazard ratio [HR]?=?2.38, 95% confidence interval [CI] 1.06-5.33, p?=?0.035) and anxiety ([HR] 2.85, 95% [CI] 1.10-7.45, p?=?0.032) had a high risk of noncardiac readmission. Compared to participants with no mood symptoms, those with clinical comorbidity of depression and anxiety presented a greater risk of noncardiac readmission ([HR] 2.91, 95% [CI] 1.03-8.18, p?=?0.043) MACEs ([HR] 2.38, 95% [CI] 1.11-5.10, p?=?0.025) and composite event ([HR] 2.52, 95% [CI] 1.35-4.69, p?=?0.004).
CONCLUSION:
Depression and anxiety were found to have predictive value for noncardiac readmission among patients with AP. Furthermore, prognoses were found to be worse for patients with comorbidity of depression and anxiety than those with single mood symptom. Additional attention needs to be focused on the initial identification and long-term monitoring of mood symptom comorbidity.
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Echocardiographic evaluation of paravalvular aortic regurgitation of a patient with recurrent aortic valve replacements.
Monaldi Arch Chest Dis2021 Apr;():. doi: 10.4081/monaldi.2021.1765.
Cannata Lorenzo, Zocco Ramazzo Camilla,
Abstract
Paravalvular regurgitation (PVR) is a serious complication after surgical valve replacement. Echocardiography is the gold standard technique to assess the severity of PVR with an integrated approach. A 48-year-old male underwent aortic valve replacement due to infective endocarditis (IE). During in-hospital cardiac rehabilitation after a redo surgery for a new IE three years later, an echo-free anterior space around the valve with several PVRs through transthoracic echocardiography (TTE) was identified. On transesophageal echocardiography (TOE) a double PVR (anterior and posterior) with abscessual cavity was detected. The patient's conditions worsened within six months with hemodynamic instability: a massive PVR due to a large abscess cavity next to the right cusp was confirmed by TTE and TOE and a third surgery was carried out. On the third admission at our Rehabilitation Unit the echo features were normal. Patient did not report any cardiovascular symptoms at 1 year follow-up.
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Prognostic utility of dynapenia in patients with cardiovascular disease.
Clin Nutr2021 Apr;40(4):2210-2218. doi: S0261-5614(20)30522-7.
Uchida Shota, Kamiya Kentaro, Hamazaki Nobuaki, Nozaki Kohei, Ichikawa Takafumi, Nakamura Takeshi, Yamashita Masashi, Maekawa Emi, Reed Jennifer L, Yamaoka-Tojo Minako, Matsunaga Atsuhiko, Ako Junya,
Abstract
BACKGROUND:
Dynapenia, defined as age-associated loss of skeletal muscle strength, is associated with increased mortality rate, poor activities of daily living, and reduced quality of life. Therefore, dynapenia appears to be a better independent predictor of mortality than sarcopenia in the elderly. However, the prognostic utility of dynapenia in patients with cardiovascular disease (CVD) is not clear. This study was performed to examine the prognostic utility of dynapenia defined by the criteria of Manini et al. in patients with CVD.
METHODS:
The findings of 4192 consecutive patients ?30 years old (median [interquartile range (IQR)] age 69 [60-76] years, 2874 males) with CVD were reviewed. Grip strength and quadriceps isometric strength (QIS) were measured just before hospital discharge, and low grip strength (<26 kg in males and <18 kg in females), low QIS (<45.0% body mass [BM] and <35.0% BM in males and females, respectively) were considered to indicate dynapenia. The endpoint was all-cause mortality.
RESULTS:
A total of 507 deaths occurred during follow-up (median 2.0 years, IQR 0.8-4.4 years). The overall prevalence of dynapenia was 33.6% and increased with age (p for trend < 0.01). Females showed a significantly higher prevalence rate of dynapenia than males (43.3% vs. 29.2%, respectively; p < 0.01). Patients with dynapenia showed higher all-cause mortality rate than non-dynapenia patients (adjusted hazard ratio: 1.84; 95% confidence interval: 1.51-2.23; p < 0.01).
CONCLUSIONS:
Dynapenia has a high prevalence among patients with CVD and is associated with increased mortality rate.
Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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A Nationwide pilot project to develop rehabilitation services for patients with cardiovascular diseases: The russian experience (RSCD pilot project).
J Rehabil Med2021 Apr;():. doi: 10.2340/16501977-2833.
Bubnova Marina, Aronov David, Barbarash Olga, Lyamina Nadezhda, Pomeshkina Svetlana, Chumakova Galina,
Abstract
OBJECTIVE:
To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases.
METHODS:
Seventeen hospital and outpatient medical centres from 13 regions of the Russian Federation participated in a pilot rehabilitation project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation.
RESULTS:
The pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients' stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017.
CONCLUSION:
Despite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.
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Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019).
Acta Myol2021 Mar;40(1):8-42. doi: 10.36185/2532-1900-045.
Rao Fabrizio, Garuti Giancarlo, Vitacca Michele, Banfi Paolo, Racca Fabrizio, Cutrera Renato, Pavone Martino, Pedemonte Marina, Schisano Matteo, Pedroni Stefania, Casiraghi Jacopo, Vianello Andrea, Sansone Valeria A,
Abstract
Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).
©2021 Gaetano Conte Academy - Mediterranean Society of Myology, Naples, Italy.
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Nurse-managed education: the effectiveness of secondary prevention after acute coronary syndromes and the prevalence and predictors of dropout from a cardiac rehabilitation programme.
Postepy Kardiol Interwencyjnej2021 Mar;17(1):46-53. doi: 10.5114/aic.2021.104767.
S?awska Agnieszka, Siudak Zbigniew,
Abstract
Introduction:
Education programmes are now very often used to limit the consequences associated with a steady increase in the incidence of cardiovascular disease. It is important to assess the effectiveness of these programmes and the reasons why people drop out.
Aim:
To evaluate the effects of intensive education of patients undergoing acute invasive cardiology procedures compared to the control group (patients educated in a classical way).
Material and methods:
Randomized trial. Measurements of body weight and body composition: during hospital stay, at 45 and 180 days after acute coronary syndrome. We used a self-prepared questionnaire, LOR-T and a TANITA BC1000 body composition analyser.
Results:
The sample consisted of 73 patients aged 48 to 89 years. Men constituted 58.9% of the participants. 43.8% of the respondents appeared for a follow-up visit after 45 days, and after 180 days 32.8% came. Body weight, body mass index (BMI), and health condition of the patients did not change significantly during the study. 67.1% of respondents dropped out from the nurse-managed cardiac education programme. People who were in better health, smoking, without comorbidities, having a heart attack, living far from the place of education more often dropped out from follow-up visits.
Conclusions:
Patient education proved ineffective. Body weight, BMI, and health condition of the subjects, both at the time of inclusion and during the long-term evaluation, were very unfavourable.
Copyright: © 2021 Termedia Sp. z o. o.
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Response: Commentary: Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety.
Front Physiol2021 ;12():665568. doi: 10.3389/fphys.2021.665568.
Kambic Tim, Jug Borut, Lainscak Mitja,
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High-Intensity Interval Training in Patients with Pulmonary Embolism: A Randomized Controlled Trial.
Med Sci Sports Exerc2021 Apr;():. doi: 10.1249/MSS.0000000000002680.
Ghram Amine, Jenab Yaser, Soori Rahman, Choobineh Siroos, Hosseinsabet Ali, Niyazi Sepideh, Shirani Shapoor, Shafiee Akbar, Jalali Arash, Lavie Carl J, Wislűff Ulrik,
Abstract
PURPOSE:
High-intensity interval training (HIIT) appears to be safe and effective in cardiovascular diseases. However, there is a paucity of data on the effect of HIIT for patients with acute pulmonary embolism (PE). The present randomized controlled trial (RCT) therefore examined the efficiency and safety of HIIT in patients with acute PE.
METHODS:
In single-center parallel open-label RCT, 24 patients (5 women) discharged recently with a diagnosis of intermediate-high risk acute PE were randomized (1:1) to supervised HIIT (n = 12) or control (n = 12) group. The primary outcomes were exercise capacity evaluated in terms of the estimated maximal oxygen uptake (eVO2max), lung function (forced expiratory volume in 1 second, FEV1), right ventricular (RV) function, (RV/left ventricle diameter (LV) ratio) and health related quality of life (HRQoL). Safety was the secondary outcome.
RESULTS:
8-weeks of HIIT improved eVO2max (+65%, p < 0.001), FEV1 (%) (+17%, p = 0.031), and RV/LV ratio diameter (-27%, p = 0.005), as well as HRQoL. All patients in the HIIT group tolerated exercise training without serious adverse events. The control group did not improve (p > 0.05) eVO2max, RV/LV ratio diameter, or HRQoL; however, FEV1 (%) was slightly reduced (-6%, p = 0.030).
CONCLUSION:
The present RCT of a tailored center based HIIT intervention provides preliminary evidence that this intervention could improve exercise capacity, lung function, RV function, and HRQoL without serious adverse events, which could provide marked clinical benefits following PE. Further larger multicenter randomized controlled studies are needed to confirm these promising findings.
Copyright © 2021 American College of Sports Medicine.
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Impact of Exercise-Based Cardiac Rehabilitation on the Mid-Term Outcomes of Patients After Acute Myocardial Infarction Treated With Current Acute-Phase Management and Optimal Medical Therapy.
Heart Lung Circ2021 Apr;():. doi: S1443-9506(21)00380-2.
Kyuno Etsushi, Iso Yoshitaka, Tsujiuchi Miki, Maeda Atsuo, Miyazawa Ryo, Kowaita Hitoshi, Kitai Hitomi, Sato Tokutada, Ebato Mio, Sambe Takeyuki, Suzuki Hiroshi,
Abstract
BACKGROUND:
Early reported beneficial effects of cardiac rehabilitation (CR) have recently been disputed. The present study aimed to investigate the clinical impact of CR on the mid-term outcomes of patients following ST-segment elevation myocardial infarction (STEMI) treated with currently available management.
METHODS:
This study reviewed 145 consecutive patients who underwent primary coronary intervention and were discharged without any disability after STEMI during 2013-2015.
RESULTS:
Among the patients, 66 (45.5%) completed an outpatient CR program (CR group) and 79 were their non-CR counterparts or patients who dropped out of the program (N-D group). There were no between-group differences in patient demographics and clinical profiles, including door-to-balloon times and prescriptions. A total of 27 patients developed major adverse cardiac and cerebrovascular events (MACCE) during follow-up. The MACCE-free survival rates were 88% and 76% in the CR and N-D groups, respectively (log-rank, p=0.04). Cox proportional analysis demonstrated that inclusion in the N-D group was a significant predictor of MACCEs (HR, 2.36; 95% CI, 1.07-5.74; p=0.03). In the CR group, peak oxygen consumption and ventilatory efficiency determined by cardiopulmonary exercise testing significantly improved after the program (p<0.01).
CONCLUSIONS:
The impact of CR on the mid-term prognosis of patients with STEMI, even in the current myocardial infarction management era, was beneficial.
Copyright © 2021 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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SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes.
Circulation2021 Apr;():. doi: 10.1161/CIRCULATIONAHA.121.054824.
Moulson Nathaniel, Petek Bradley J, Drezner Jonathan A, Harmon Kimberly G, Kliethermes Stephanie A, Patel Manesh R, Baggish Aaron L, ,
Abstract
Cardiac involvement among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is common and associated with adverse outcomes. The objective of this study was to determine the prevalence and clinical implications of SARS-CoV-2 cardiac involvement in young competitive athletes. In this prospective multicenter observational cohort study with data from 42 colleges/universities, we assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020 to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Among 19,378 athletes tested for SARS-CoV-2 infection, 3018 (mean age 20 years [SD,1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least one element of cardiac 'triad' testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21/2999,0.7%), cardiac troponin (24/2719,0.9%), and TTE (24/2556,0.9%). Definite, probable, or possible SARS-COV-2 cardiac involvement was identified in 21/3018 (0.7%) athletes, including 15/2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6/198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-COV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15/119,12.6%) versus a primary screening CMR (6/198,3.0%). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR:3.1,95% CI:1.2,7.7) or at least one abnormal triad test (OR:37.4,95% CI:13.3,105.3). Five (0.2%) athletes required hospitalization for non-cardiac complications of SARS-CoV-2. During clinical surveillance (median follow-up 113 days [IQR=90,146]), there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection. SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short term follow-up.
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Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry.
JACC Cardiovasc Interv2021 Apr;():. doi: S1936-8798(21)00188-6.
Attinger-Toller Adrian, Ferrari Enrico, Tueller David, Templin Christian, Muller Olivier, Nietlispach Fabian, Toggweiler Stefan, Noble Stéphane, Roffi Marco, Jeger Raban, Huber Christoph, Carrel Thierry, Pilgrim Thomas, Wenaweser Peter, Togni Mario, Cook Stéphane, Heg Dik, Windecker Stephan, Goy Jean-Jacques, Stortecky Stefan,
Abstract
OBJECTIVES:
The aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study.
BACKGROUND:
TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups.
METHODS:
Data from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios.
RESULTS:
Between February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.18 to 1.77; 1-year HR: 1.12; 95% CI: 1.01 to 1.24), cerebrovascular accidents (30-day HR: 1.35; 95% CI: 1.09 to 1.66; 1-year HR: 1.21; 95% CI: 1.02 to 1.45), and pacemaker implantation (30-day HR: 1.23; 95% CI: 1.12 to 1.34; 1-year HR: 1.19; 95% CI: 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI: 9.06 to 17.58), 4.09 (95% CI: 3.56 to 4.74), 1.63 (95% CI: 1.50 to 1.78), and 0.93 (95% CI: 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ?90 years of age, respectively.
CONCLUSIONS:
Increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250).
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Low Awareness of Cardiovascular Risk Factor Among Patients Admitted in Cardiac Rehabilitation: New Data for Further Implementation of Cardiovascular Rehabilitation Program.
High Blood Press Cardiovasc Prev2021 Apr;():. doi: 10.1007/s40292-021-00451-z.
Maloberti Alessandro, Monticelli Massimiliano, Bassi Ilaria, Riccobono Salvatore, Giannattasio Cristina,
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Exercise capacity improvement after cardiac rehabilitation following myocardial infarction and its association with long-term cardiovascular events.
Eur J Cardiovasc Nurs2021 Apr;():. doi: zvab015.
Novakovi? Marko, Novak Tja?a, Vi?intin Cuderman Tja?a, Krevel Barbara, Tasi? Jerneja, Rajkovi? Uro?, Fras Zlatko, Jug Borut,
Abstract
AIMSâ:
Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity improvement and different clinically relevant cardiovascular events.
METHODS AND RESULTSâ:
This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2-3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56?±?10?years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ?2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858?days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791?days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791?days). Exercise capacity improvement of ?2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models.
CONCLUSIONâ:
This study has shown that exercise improvement of ?2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial.
JMIR Form Res2021 Apr;5(4):e20468. doi: 10.2196/20468.
Park Linda G, Elnaggar Abdelaziz, Lee Sei J, Merek Stephanie, Hoffmann Thomas J, Von Oppenfeld Julia, Ignacio Nerissa, Whooley Mary A,
Abstract
BACKGROUND:
Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months.
OBJECTIVE:
The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR.
METHODS:
During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months.
RESULTS:
We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise.
CONCLUSIONS:
This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313.
©Linda G Park, Abdelaziz Elnaggar, Sei J Lee, Stephanie Merek, Thomas J Hoffmann, Julia Von Oppenfeld, Nerissa Ignacio, Mary A Whooley. Originally published in JMIR Formative Research (http://formative.jmir.org), 16.04.2021.
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Harnessing artificial intelligence in cardiac rehabilitation, a systematic review.
Future Cardiol2021 Apr;():. doi: 10.2217/fca-2021-0010.
Sotirakos Sara, Fouda Basem, Mohamed Razif Noor Adeebah, Cribben Niall, Mulhall Cormac, O'Byrne Aisling, Moran Bridget, Connolly Ruairi,
Abstract
This systematic review aims to evaluate the current body of research surrounding the efficacy of artificial intelligence (AI) in cardiac rehabilitation. Presently, AI can be incorporated into personal devices such as smart watches and smartphones, in diagnostic and home monitoring devices, as well as in certain inpatient care settings. The PRISMA guidelines were followed in this review. Inclusion and exclusion criteria were set using the Population, Intervention, Comparison and Outcomes (PICO) tool. Eight studies meeting the inclusion criteria were found. Incorporation of AI into healthcare, cardiac rehabilitation delivery, and monitoring holds great potential for early detection of cardiac events, allowing for home-based monitoring, and improved clinician decision making.
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Identification of a Novel Copy Number Variation of EYA4 Causing Autosomal Dominant Non-Syndromic Hearing Loss.
Otol Neurotol2021 Apr;():. doi: 10.1097/MAO.0000000000003169.
Ishino Takashi, Ogawa Yui, Sonoyama Toru, Taruya Takayuki, Kono Takashi, Hamamoto Takao, Ueda Tsutomu, Takeno Sachio, Moteki Hideaki, Nishio Shin-Ya, Usami Shin-Ichi, Nagano Yuka, Yoshimura Akiko, Yoshikawa Kohei, Kato Mikako, Ichimoto Masaya, Watanabe Rina,
Abstract
OBJECTIVE:
Eyes absent 4 (EYA4) is the causative gene of autosomal dominant non-syndromic hereditary hearing loss, DFNA10. We aimed to identify a copy number variation of EYA4 in a non-syndromic sensory neural hearing loss pedigree.
FAMILY AND CLINICAL EVALUATION:
A Japanese family showing late-onset and progressive hearing loss was evaluated. A pattern of autosomal dominant inheritance of hearing loss was recognized in the pedigree. No cardiac disease was observed in any of the individuals.
METHODS:
Targeted exon sequencing was performed using massively parallel DNA sequencing (MPS) analysis. Scanning of the array comparative genomic hybridization (aCGH) was completed and the copy number variation (CNV) data from the aCGH analysis was confirmed by matching all CNV calls with MPS analysis. Breakpoint detection was performed by whole-genome sequencing and direct sequencing. Sequencing results were examined, and co-segregation analysis of hearing loss was completed.
RESULTS:
We identified a novel hemizygous indel that showed CNV in the EYA4 gene from the position 133,457,057 to 133,469,892 on chromosome 6 (build GRCh38/hg38) predicted as p.(Val124_Pro323del), and that was segregated with post-lingual and progressive autosomal dominant sensorineural hearing loss by aCGH analysis.
CONCLUSION:
Based on the theory of genotype-phenotype correlation with EYA4 mutations in terms of hearing loss and comorbid dilated cardiomyopathy, the region of amino acids 124 to 343 is hypothesized not to be the pathogenic region causing dilated cardiomyopathy. Additionally, the theory of genotype-phenotype correlation about the prevalence of dilated cardiomyopathy is thought to be rejected because of no correlation of deleted amino acid region with the prevalence of dilated cardiomyopathy. These results will help expand the research on both the coordination of cochlear transcriptional regulation and normal cardiac gene regulation via EYA4 transcripts and provide information on the genotype-phenotype correlations of DFNA10 hearing loss.
Copyright © 2021 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company.
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Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients.
BMC Res Notes2021 Apr;14(1):139. doi: 10.1186/s13104-021-05564-1.
Lee Brendan, Clay Adam, Sy Eric,
Abstract
OBJECTIVES:
To evaluate the number of out-of-hospital cardiac arrest (OHCA) patients eligible for extracorporeal cardiopulmonary resuscitation (ECPR) in Saskatchewan and their clinical outcomes, including survival and neurological outcomes at discharge. ECPR eligibility was assessed, using clinical criteria from the University of British Columbia (UBC, Canada), University of Michigan (UM, United States), University of California (UC, United States) and a restrictive ECPR criteria.
RESULTS:
We performed a retrospective cohort study of 200 OHCA patients (August 1, 2017-May 31, 2019) in Regina, Saskatchewan. Sixty-one (30%) were female, the median age was 64 years (interquartile range [IQR], 52-78), the median CPR duration was 30 min (IQR 12-47), and 20% survived to discharge. Two (1%) patients received ECPR but did not meet any ECPR criteria. Nineteen (10%), thirty (15%), twenty-two (11%), and seven (4%) patients were ECPR-eligible, using the UBC, UM, UC, and restrictive criteria. However, none of these patients had received ECPR. Only two (11%), two (7%), two (9%), and one (14%) of these patient(s) survived to discharge, respectively. Neurological outcomes were unfavourable among all ECPR-eligible patients. Future study at our centre will be necessary on how to implement ECPR program to further improve these outcomes.
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