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Pubblicazioni recenti - cardiac rehabilitation
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Efficacy of internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial.
Internet Interv2020 Sep;21():100324. doi: 10.1016/j.invent.2020.100324.
Schneider L H, Hadjistavropoulos H D, Dear B F, Titov N,
Abstract
Depression and anxiety are common among people who have experienced an acute coronary event (e.g., heart attack). Multidisciplinary cardiac rehabilitation programs often focus on reducing risk factors associated with future cardiac events, however, mental health interventions are not routinely available. Given known difficulties with access to mental health treatment, the present study sought to explore the efficacy and acceptability of an Internet-delivered cognitive behavioural therapy program () among participants who experienced an acute coronary event. The five-lesson course was delivered over eight weeks and was provided with brief weekly contact, via telephone and secure email with a guide. Participants were randomized to the ( = 25) or waiting-list control group ( = 28). Symptoms were assessed at pre-treatment, post-treatment, and four-week follow-up. Completion rates (84%) and satisfaction ratings (95%) were high. Statistically significant between-group improvements were observed for the treatment group on primary measures of general anxiety (Cohen's = 1.62; 67% reduction), depression (Cohen's = 1.09; 61% reduction), and physical activity levels (Cohen's = 0.27; 70% increase). Statistically significant improvements were also observed on secondary measures of distress (Cohen's = 0.98; 51% reduction), cardiac anxiety (Cohen's = 0.92; 34% reduction), and mental-health quality of life (Cohen's = 0.23; 24% improvement). The changes were maintained at four-week follow-up. The current findings add to the existing literature and highlight the potential of Internet-delivered cognitive behavioural therapy programs among participants who have experienced an acute coronary event.
© 2020 The Authors.
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BAG3 Myopathy Presenting With Prominent Neuropathic Phenotype and No Cardiac or Respiratory Involvement: A Case Report and Literature Review.
J Clin Neuromuscul Dis2020 Jun;21(4):230-239. doi: 10.1097/CND.0000000000000300.
Malatesta Lindsay, Arya Kapil, Gokden Murat, Stefans Vikki, Veerapandiyan Aravindhan,
Abstract
Bcl-2-associated athanogene 3 (BAG3) myopathy is a rare myofibrillar myopathy characterized by toe walking and clumsiness in the first decade with rapid progression to cardiomyopathy and restrictive lung disease in the second decade. Most patients (18 patients) have the c.626C >T (p.Pro209Leu) mutation. We describe BAG3 myopathy due to p.Pro209Leu in a 13-year-old girl with initial prominent neuropathic phenotype and no cardiac or respiratory involvement. Parents reported toe walking and clumsiness since 3 years old. Examination at the age of 13 years showed findings suggestive of Charcot-Marie-Tooth disease. Nerve conduction studies revealed demyelinating polyneuropathy. Next-generation sequencing panel for inherited neuropathies was unrevealing. Whole exome sequencing identified a de novo mutation in BAG3. Muscle biopsy confirmed myofibrillar myopathy. No cardiac involvement or symptoms of respiratory involvement at the age of 14 years. This case emphasizes the phenotypic variability of BAG3 myopathy and the importance of thorough electrophysiological examination and muscle pathology for establishing a precise diagnosis.
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A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers.
Eur Arch Otorhinolaryngol2020 May;():. doi: 10.1007/s00405-020-06064-x.
Rahne Torsten, Skarzynski Piotr Henryk, Hagen Rudolf, Radeloff Andreas, Lassaletta Luis, Barbara Maurizio, Plontke Stefan K, Mlynski Robert,
Abstract
PURPOSE:
To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus.
METHODS:
Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS).
RESULTS:
Bone conduction threshold changes of more than 10 dB in 4PTA were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTA of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types.
CONCLUSION:
Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.
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Inflammatory Cytokines During Cardiac Rehabilitation After Heart Surgery and Their Association to Postoperative Atrial Fibrillation.
Sci Rep2020 May;10(1):8618. doi: 10.1038/s41598-020-65581-1.
Racca Vittorio, Torri Anna, Grati Paola, Panzarino Claudia, Marventano Ivana, Saresella Marina, Castiglioni Paolo,
Abstract
Inflammation is associated with atrial fibrillation (AF), but little is known about the association of AF with the inflammatory serum cytokines after the acute postoperative phase. Thus, we aimed to explore how plasma cytokines concentrations modify during a 3-week cardiac rehabilitation after heart surgery, comparing patients who developed postoperative AF (POAF) and those with permanent AF with patients free from AF (NoAF group). We enrolled 100 consecutive patients and 40 healthy volunteers as a control group. At the beginning of cardiac rehabilitation, 11 days after surgery, serum levels of MPO, PTX3, ADAM17, sST2, IL-25, and IL-33 were dramatically higher, whereas TNF? and IL-37 levels were much lower in NoAF, POAF, and permanent AF patients than in the healthy volunteers. After rehabilitation, most of the cytokines changed tending towards normalization. POAF patients (35% of the total) had higher body mass index and abdominal adiposity than NoAF patients, but similar general characteristics and risk factors for POAF. However, ADAM-17 and IL-25 were always lower in POAF than in NoAF patients, suggesting a protective role of IL-25 and ADAM 17 against POAF occurrence. This finding could impact on therapeutic strategies focusing on the postoperative prophylactic antiarrhythmic interventions.
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Do underlying cardiovascular diseases have any impact on hospitalised patients with COVID-19?
Heart2020 May;():. doi: heartjnl-2020-316909.
Zhang Jixiang, Lu Shimin, Wang Xiaoli, Jia Xuemei, Li Jiao, Lei Hongbo, Liu Zhengru, Liao Fei, Ji Mengyao, Lv Xiaoguang, Kang Jian, Tian Shan, Ma Jingjing, Wu Dandan, Gong Yang, Xu Yu, Dong Weiguo,
Abstract
OBJECTIVES:
An outbreak of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has sickened thousands of people in China. The purpose of this study was to explore the early clinical characteristics of COVID-19 patients with cardiovascular disease (CVD).
METHODS:
This is a retrospective analysis of patients with COVID-19 from a single centre. All patients underwent real-time reverse transcription PCR for SARS-CoV-2 on admission. Demographic and clinical factors and laboratory data were reviewed and collected to evaluate for significant associations.
RESULTS:
The study included 541 patients with COVID-19. A total of 144 (26.6%) patients had a history of CVD. The mortality of patients with CVD reached 22.2%, which was higher than that of the overall population of this study (9.8%). Patients with CVD were also more likely to develop liver function abnormality, elevated blood creatinine and lactic dehydrogenase (p<0.05). Symptoms of sputum production were more common in patients with CVD (p=0.026). Lymphocytes, haemoglobin and albumin below the normal range were pervasive in the CVD group (p<0.05). The proportion of critically ill patients in the CVD group (27.8%) was significantly higher than that in the non-CVD group (8.8%). Multivariable logistic regression analysis revealed that CVD (OR: 2.735 (95% CI 1.495 to 5.003), p=0.001) was associated with critical COVID-19 condition, while patients with coronary heart disease were less likely to reach recovery standards (OR: 0.331 (95% CI 0.125 to 0.880), p=0.027).
CONCLUSIONS:
Considering the high prevalence of CVD, a thorough CVD assessment at diagnosis and early intervention are recommended in COVID-19 patients with CVD. Patients with CVD are more vulnerable to deterioration.
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Effects of Cardiac Rehabilitation on Cognitive Impairments in Patients with Cardiovascular Diseases: A Systematic Review"Effects of Cardiac Rehabilitation on Cognitive Impairments in Patients with Cardiovascular Diseases: A Systematic Review".
Int J Neurosci2020 May;():1-15. doi: 10.1080/00207454.2020.1773823.
Dabbaghipour Narges, Javaherian Mohammad, Attarbashi Moghadam Behrouz,
Abstract
BACKGROUND:
One of the most common problems associated with cardiovascular diseases (CVDs) is cognitive impairments (CIs) leading to reduced quality of life and treatment adherence in patients. The aim of this systematic review was to examine the effects of cardiac rehabilitation (CR) on cognitive function in CVD patients.PubMed, Scopus, Web of Science and Ovid MEDLINE databases were searched for identification the relevant studies without language restriction. We included the studies published from root to August 2019, evaluating the effects of CR on at least one type of cognitive functions through valid neuropsychological tests. Finally, nine studies with different study designs were entered in this systematic review. The full texts of these studies were critically appraised with various quality assessment tools.:Patients were evaluated by different cognitive domains including global cognition, attention, executive function, memory and language prior to and following CR program among included studies. Most of the included studies reported significant cognitive improvement of the attention/executive function and memory domains. Two studies showed statistically significant improvement in global cognition using Modified Mini-Mental State (3MS) and Montreal Cognitive Assessment (MoCA) tools. Similar effects were not found in language domain.It seems that cognitive impairments in CVD patients can be improved with CR program. Because this review is limited by low number of included studies, and there were various study designs without control groups, the results should be generalized cautiously. Further studies is recommended.
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Effects of Whole-Body Electromyostimulation Associated with Dynamic Exercise on Functional Capacity and Heart Rate Variability After Bariatric Surgery: a Randomized, Double-Blind, and Sham-Controlled Trial.
Obes Surg2020 May;():. doi: 10.1007/s11695-020-04724-9.
Ricci Paula Angélica, Di Thommazo-Luporini Luciana, Jürgensen Soraia Pilon, André Larissa Delgado, Haddad Guilherme Focchi, Arena Ross, Borghi-Silva Audrey,
Abstract
PURPOSE:
Bariatric surgery is the most effective treatment for morbid obesity. In association with dietary restrictions, the ability to exercise in the immediate post-surgical phase is limited. In this context, whole-body electromyostimulation (WB-EMS), strategy that stimulates various muscle groups, in conjunction with physical exercise, holds promise for improving functional capacity, and cardiac autonomic control, following surgery. The purpose of this study was to analyze whether a rehabilitation program consisting of WB-EMS with 30 exercise training sessions following bariatric surgery significantly improves functional capacity, body mass and heart rate variability (HRV).
METHODS:
Randomized, double-blind, and sham-controlled trial. Twenty obesity patients were randomized into the WB-EMS (n?=?10) and sham (n?=?10) groups. On average, 7 days after surgery, individuals underwent a six-minute walk test (6MWT), HRV, and body composition analysis at rest. The next day, patients initiated an exercise training protocol, five times per week, over 6 weeks. Walking distance changes (post-pre = ?WD) obtained by 6MWT and HRV indices were determined following the intervention.
RESULTS:
Only WB-EMSG significantly increased WD and body mass index (BMI) after the intervention (p?=?0.002) and ?WD was significantly higher in this group when compared with sham (p?=?0.04). Moreover, both groups demonstrated an improvement in key measures of HRV after the intervention.
CONCLUSION:
An exercise training intervention initiated shortly after bariatric surgery improved functional capacity and cardiac autonomic tone. Improvements in functional capacity and BMI following exercise training were greater with the addition of WB-EMS but did not promote additional improvements in HRV beyond that realized with exercise training alone.
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Effect of preparative rehabilitation on recovery after cardiac surgery: a systematic review.
Ann Phys Rehabil Med2020 May;():. doi: S1877-0657(20)30105-6.
Yau Derek King Wai, Underwood Malcolm John, Joynt Gavin Matthew, Lee Anna,
Abstract
BACKGROUND:
Physical prehabilitation (preparative rehabilitation) programs may have beneficial effects on enhancing physical strength and functional status before surgery, but their effects on postoperative recovery are unclear.
OBJECTIVES:
This systematic review investigated the effectiveness of physical prehabilitation programs before cardiac surgery on postoperative recovery and other perioperative outcomes.
METHODS:
We searched for reports of randomised controlled trials of any prehabilitation programs that included physical activity or an exercise training component in adults undergoing elective cardiac surgery, published in any language, from six bibliographic databases (last search on June 20, 2019). We assessed trials for risk of bias, overall certainty of evidence and quality of intervention reporting using the Cochrane Risk of Bias Assessment Tool, GRADE system and the Template for Intervention Description and Replication checklist and guide, respectively.
RESULTS:
All 7 studies (726 participants) were at high risk of bias because of lack of blinding. The quality of prehabilitation reporting was moderate because program adherence was rarely assessed. The timing of prehabilitation ranged from 5 days to 16 weeks before surgery and from face-to-face exercise prescription to telephone counselling and monitoring. We found uncertain effects of prehabilitation on postoperative clinical outcomes (among the many outcomes assessed): perioperative mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to 5.95; I=0%; low-certainty evidence) and postoperative atrial fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I=50%; very low-certainty evidence). However, prehabilitation may improve postoperative functional capacity and slightly shorten the hospital stay (mean difference -0.66 days, 95% CI -1.29 to -0.03; I=45%; low-certainty evidence).
CONCLUSION:
Despite the high heterogeneity among physical prehabilitation trials and the uncertainty regarding robust clinical outcomes, physical prehabilitation before cardiac surgery seems to enhance selected postoperative functional performance measures and slightly reduce the hospital length of stay after cardiac surgery.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
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Intronic Alternative Polyadenylation in the Middle of the Gene Produces Half-Size N-Terminal Dystrophin with a Potential Implication of ECG Abnormalities of DMD Patients.
Int J Mol Sci2020 May;21(10):. doi: E3555.
Rani Abdul Qawee Mahyoob, Yamamoto Tetsushi, Kawaguchi Tatsuya, Maeta Kazuhiro, Awano Hiroyuki, Nishio Hisahide, Matsuo Masafumi,
Abstract
The gene is one of the largest human genes, being composed of 79 exons, and encodes dystrophin Dp427m which is deficient in Duchenne muscular dystrophy (DMD). In some DMD patient, however, small size dystrophin reacting with antibody to N-terminal but not to C-terminal has been identified. The mechanism to produce N-terminal small size dystrophin remains unknown. Intronic polyadenylation is a mechanism that produces a transcript with a new 3' terminal exon and a C-terminal truncated protein. In this study, intronic alternative polyadenylation was disclosed to occur in the middle of the gene and produce the half-size N-terminal dystrophin Dp427m, Dpm234. The 3'-rapid amplification of cDNA ends revealed 421 bp sequence in the downstream of exon 41 in U-251 glioblastoma cells. The cloned sequence composing of the 5' end sequence of intron 41 was decided as the terminal exon, since it encoded poly (A) signal followed by poly (A) stretch. Subsequently, a fragment from exon M1 to intron 41 was obtained by PCR amplification. This product was named Dpm234 after its molecular weight. However, Dpm234 was not PCR amplified in human skeletal and cardiac muscles. Remarkably, Dpm234 was PCR amplified in iPS-derived cardiomyocytes. Accordingly, Western blotting of cardiomyocyte proteins showed a band of 234 kDa reacting with dystrophin antibody to N-terminal, but not C-terminal. Clinically, DMD patients with mutations in the Dpm234 coding region were found to have a significantly higher likelihood of two ECG abnormal findings. Intronic alternative splicing was first revealed in Dp427m to produce small size dystrophin.
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Combination of eosinophil percentage and high-sensitivity C-reactive protein predicts in-hospital major adverse cardiac events in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
J Clin Lab Anal2020 May;():e23367. doi: 10.1002/jcla.23367.
Ye Liu, Bai Hong-Mei, Jiang Dan, He Bing, Wen Xue-Song, Ge Ping, Zhang Dong-Ying,
Abstract
BACKGROUND:
Eosinophil levels predict prognosis in ST-segment elevation myocardial infarction (STEMI) patients. Both eosinophils and high-sensitivity C-reactive protein (hs-CRP) play a major role in the acute inflammatory response of myocardial infarction. The purpose of this study was to evaluate eosinophil percentage (EOS%) and hs-CRP as prognostic markers for in-hospital adverse events in STEMI patients undergoing primary percutaneous coronary intervention.
METHODS:
We retrospectively analyzed the clinical data of 518 patients. Major adverse cardiac events (MACEs) were defined as cardiac rupture, cardiac arrest, malignant arrhythmia, and cardiac death. Based on the receiver operating characteristic (ROC) analysis, all patients were regrouped into 3 groups (None, One, and Two) according to cutoff EOS% value (?0.3%) and hs-CRP value (>11.8 mg/L). Both Cox regression analyses and the KM (Kaplan-Meier) survival curve were used to examine the prognostic role of combined hs-CRP and EOS% in cardiovascular events.
RESULTS:
Of the 518 STEMI patients, 50 of them developed MACEs. Patients who developed MACEs had a significantly lower EOS% and higher hs-CRP than patients who remained MACE-free. In the multivariable Cox regression analysis, the highest risk of in-hospital MACEs was constantly observed in patients with a combined low EOS% and elevated hs-CRP. Patients with reduced EOS% and high hs-CRP had significantly higher incidence rates of cardiac rupture (P = .001), cardiac arrest (P = .001), and malignant arrhythmia (P < .001); furthermore, they had the worst cumulative survival compared with the other two groups.
CONCLUSION:
Combined reduced EOS% and elevated hs-CRP were valuable tools for identifying patients at risk of in-hospital MACEs.
© 2020 The Authors. Journal of Clinical Laboratory Analysis Published by Wiley Periodicals LLC.
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Exploratory Analyses of Cerebral Gray Matter Volumes After Out-of-Hospital Cardiac Arrest in Good Outcome Survivors.
Front Psychol2020 ;11():856. doi: 10.3389/fpsyg.2020.00856.
Byron-Alhassan Aziza, Tulloch Heather E, Collins Barbara, Quinlan Bonnie, Fang Zhuo, Chakraborty Santanu, Le May Michel, Duchesne Lloyd, Smith Andra M,
Abstract
Background:
Survival rates of cardiac arrest have increased over recent years, however, survivors may still be left with significant morbidity and functional impairment. A primary concern in cardiac arrest survivors is the effect of prolonged hypoxia/ischemia on the brain. The objectives of the present study were threefold: (1) to explore the effect of cardiac arrest on brain gray matter volumes (GMV) in "good outcome" survivors of out-of-hospital cardiac arrest (OHCA), (2) to examine the relationship between GMV, cognitive functioning and arrest factors, and (3) to explore whether OHCA patients differ from a group of patients with myocardial infarction (MI) uncomplicated by cardiac arrest and a group of healthy controls in terms of GMV.
Methods:
Medically stable OHCA survivors with preserved neurological function and who were eligible for magnetic resonance imaging scanning (MRI; = 9), were compared to: (1) patients who had experienced a MI ( = 19) and (2) healthy controls ( = 12). Participants underwent brain MRI on a 3T Siemens Trio MRI scanner and GMV was measured by voxel-based morphometry. A comprehensive neuropsychological assessment was also conducted. Global GMV was compared in the three samples using analyses of variance. The relationships between cognition and GMV were examined within group using correlations.
Results:
The OHCA and MI groups showed a similar pattern of differences compared to the healthy control group. Both groups had decreased GMV in the anterior cingulate cortex, bilateral hippocampus, right dorsolateral prefrontal cortex, right putamen, and bilateral cerebellum. There were no significant differences in global or regional GMV between the OHCA and MI groups. Cognitive functioning was correlated with global GMV in the OHCA group; no such correlation was observed in the MI group.
Conclusion:
Regional atrophy was observed in OHCA and MI survivors, compared to a healthy control group, suggesting a common mechanism, presumably preexisting cardiovascular disease. Although similar regional volume differences were observed between the MI and OHCA groups, the relationship between GMV and cognition was only observed in OHCA survivors. We suggest the acute hypoxia/ischemia ensuing from the arrest may interact with diminished neural reserve in select brain areas to expose occult cognitive dysfunction.
Copyright © 2020 Byron-Alhassan, Tulloch, Collins, Quinlan, Fang, Chakraborty, Le May, Duchesne and Smith.
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Balance performance in patients with heart failure.
Heart Lung2020 May;():. doi: S0147-9563(20)30138-2.
Tanriverdi Aylin, Kahraman Buse Ozcan, Ozsoy Ismail, Acar Serap, Senturk Bihter, Ozpelit Ebru, Akdeniz Bahri, Savci Sema,
Abstract
BACKGROUND:
It has been suggested that patients with heart failure (HF) have an increased fall rate. Although balance is one of the most important risk factors for fall, there is not sufficient information about balance in HF.
OBJECTIVE:
To compare static, dynamic and functional balance between patients with HF and healthy controls.
METHODS:
Twenty-seven patients with HF and 22 healthy controls were recruited in this study. The Unilateral Stance (US) and Limits of Stability (LOS) tests were used to measure static and dynamic balance, respectively. Functional balance was assessed with Berg Balance Scale.
RESULTS:
There was no significant difference in age, gender and body mass index between the groups (p > 0.05). There was a significant difference in US with open eyes between the groups (p < 0.05). Reaction time (backward and left), endpoint excursion (backward), maximum excursion (forward and backward) and directional control (forward and right) variables of LOS were significantly different between the groups (p < 0.05).
CONCLUSIONS:
Patients with HF have impaired static, dynamic and functional balance. Considering the balance impairment, a comprehensive balance assessment performed and balance training should be included in the management of HF as a part of the cardiac rehabilitation program.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Elevated plasma histone H4 level predicts increased risk of mortality in patients with sepsis.
Ann Palliat Med2020 May;():. doi: 10.21037/apm-20-1011.
Lu Nian-Fang, Jiang Li, Zhu Bo, Yang De-Gang, Zheng Rui-Qiang, Shao Jun, Xi Xiu-Ming,
Abstract
BACKGROUND:
Histones play a vital role in the pathogenesis of sepsis. However, studies on histones and the prognosis of sepsis patients are scarce. This study aims to investigate the relationship between histones and other biomarkers of sepsis. Furthermore, we aim to determine the role histones play in the prognosis of sepsis patients to explore the possibility of using them as a potential biomarker of sepsis.
METHODS:
We performed a prospective observational study on 136 patients. One hundred twenty-six of them had sepsis, and 10 were enrolled as healthy controls. Baseline blood samples were collected for plasma histone H4, cardiac troponin I (TnI), N-terminal pro-b-type natriuretic peptide (NT-proBNP), procalcitonin (PCT), and lactate. The site of infection, the use of vasopressor, and assessment scores of sequential organ failure were documented within 24 hours of admission. The duration of ICU stay and mortality was also recorded.
RESULTS:
The mean plasma histone levels of the patients were significantly higher than the healthy controls (P<0.001). Compared with the 89 survivors, the 37 patients who died had a higher rate of sequential organ failure assessment (SOFA) scores (P=0.002), more frequent use of vasopressors (P=0.033), and higher levels of histone H4 (P<0.001). Binary logistic regression analysis showed that high plasma histone H4 levels were independent risk factors for predicting mortality. The area under the receiver operating characteristic curve (0.731) verified that high plasma histone H4 level significantly predicted mortality. Plasma histone H4 levels positively correlated with the SOFA score, and plasma cardiac TnI.
CONCLUSIONS:
For patients with sepsis in the ICU, an elevated level of plasma histone H4 could be a risk factor associated with an increased mortality rate. Therefore, plasma histone H4 may be a useful biomarker for determining the prognosis of these patients.
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Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults.
JAMA Cardiol2020 May;():. doi: 10.1001/jamacardio.2020.1511.
Goss Kara N, Haraldsdottir Kristin, Beshish Arij G, Barton Gregory P, Watson Andrew M, Palta Mari, Chesler Naomi C, Francois Chris J, Wieben Oliver, Eldridge Marlowe W,
Abstract
Importance:
Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.
Objective:
To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).
Design, Setting, and Participants:
This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.
Exposures:
Premature birth (gestational age ?32 weeks) or birth weight less than 1500 g.
Main Outcomes and Measures:
Main study outcomes included MRI measures of biventricular volume, mass, and strain.
Results:
Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P?
Conclusions and Relevance:
In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
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Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study.
J Med Internet Res2020 May;22(5):e17326. doi: 10.2196/17326.
De Canničre Hélčne, Smeets Christophe J P, Schoutteten Melanie, Varon Carolina, Van Hoof Chris, Van Huffel Sabine, Groenendaal Willemijn, Vandervoort Pieter,
Abstract
BACKGROUND:
Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified.
OBJECTIVE:
The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy.
METHODS:
A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated.
RESULTS:
All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HR) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F=8.321, P<.001). Similar results were obtained for the recovery heart rate (HR) values, which increased significantly over time during every minute of recuperation, for the high-response group (HR: P<.001, HR: P<.001, HR: P<.001, HR: P<.001, and HR: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses.
CONCLUSIONS:
This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome.
©Hélčne De Canničre, Christophe JP Smeets, Melanie Schoutteten, Carolina Varon, Chris Van Hoof, Sabine Van Huffel, Willemijn Groenendaal, Pieter Vandervoort. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.05.2020.
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How the COVID-19 infection tsunami revolutionized the work of respiratory physiotherapists: an experience from Northern Italy.
Monaldi Arch Chest Dis2020 May;90(2):. doi: 10.4081/monaldi.2020.1085.
Simonelli Carla, Paneroni Mara, Fokom Aubin Georges, Saleri Manuela, Speltoni Ilaria, Favero Irene, Garofali Francesca, Scalvini Simonetta, Vitacca Michele,
Abstract
Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists' (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidisciplinary panel of physicians, nurses, and RPTs was quickly performed to manage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, pronation and postural changes to improve oxygenation, reconditioning with leg/arm cranking and exercises, initial and final patients' functional assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three "what-to-do" algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy management in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and final functional motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professional skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization.
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Supervised exercise protocol for lower limbs in subjects with chronic venous disease: an evaluator-blinded, randomized clinical trial.
Trials2020 May;21(1):414. doi: 10.1186/s13063-020-04314-1.
Volpe Esther Fernandes Tinoco, Resqueti Vanessa R, da Silva Ana Aline Marcelino, Gualdi Lucien Peroni, Fregonezi Guilherme A F,
Abstract
BACKGROUND:
Chronic venous insufficiency (CVI) causes pathophysiological changes in the lower-limb muscles, particularly the calf muscles, and limits ankle range of motion (ROM). These changes reduce functional activities and decrease quality of life (QOL). Although several studies have shown the benefits of exercise (strengthening the calf muscles to improve calf-muscle pumping and QOL) in patients with CVI, few studies are randomized controlled trials. This has led to a weak indication of exercise for the treatment of patients with CVI. The aim of this study is to analyze the effects of a supervised exercise program to improve calf-muscle endurance as well as QOL in patients with CVI.
METHODS/DESIGN:
This is an evaluator-blind, randomized clinical trial with an 8-week duration and a follow-up evaluation at week 16. A pilot study with subjects with a CVI diagnosis will be performed to calculate sample size. The participants will be randomly allocated (1:1) into a treatment or a control group (usual care/no intervention). The treatment intervention consists of a bi-weekly supervised exercise program of the lower limbs that will include aerobic training, strengthening and cardiovascular exercises. The participants from both groups will participate in a health education lecture. Primary outcomes are changes in calf-muscle endurance and QOL score. Secondary outcomes are changes in exercise capacity, ankle ROM, electrical muscle activity and cardiac output. The first statistical comparison will be performed after 8?weeks' intervention.
DISCUSSION:
Patients with CVI may have an impaired calf-muscle pump and decreased exercise capacity. A randomized controlled trial evaluating a supervised exercise program should provide much needed information on the management of CVI to promote health and independence.
TRIAL REGISTRATION:
This study was registered on the Brazilian Clinical Trials Database (REBEC) (RBR-57xtk7). The results will be disseminated at scientific events, presentations, and publications in peer-reviewed journals.
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Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial.
BMC Pulm Med2020 May;20(1):143. doi: 10.1186/s12890-020-01182-y.
McGregor Gordon, Bruce Julie, Ennis Stuart, Mason James, Lall Ranjit, Ji Chen, Sandhu Harbinder, Seers Kate, Banerjee Prithwish, Canaway Alastair, Booth Katie, Taylor Stephanie J C, Robertson Elizabeth, Pincus Tamar, Singh Sally, Fitzmaurice David, Bowater Sarah, Clift Paul, Underwood Martin,
Abstract
BACKGROUND:
Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) out-patient setting, or with long-term follow-up. The aim of this randomised controlled trial (RCT) is to test the clinical and cost-effectiveness of a supervised exercise rehabilitation intervention with psychosocial support compared to best practice usual care for people with PH in the community/outpatient setting.
METHODS:
This multi-centre, pragmatic, two-arm RCT with embedded process evaluation aims to recruit 352 clinically stable adults with PH (groups 1-5) and WHO functional class II-IV. Participants will be randomised to either the Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) intervention or control. The SPHERe intervention consists of 1) individual assessment and familiarisation sessions; 2) 8-week, twice-weekly, supervised out-patient exercise training; 3) psychosocial/motivational support and education; 4) guided home exercise plan. The control intervention consists of best practice usual care with a single one-to-one practitioner appointment, and general advice on physical activity. Outcomes will be measured at baseline, 4 months (post-intervention) and 12?months by researchers blinded to treatment allocation. The primary outcome is the incremental shuttle walk test at 4 months. Secondary outcomes include health-related quality of life (HRQoL), time to clinical worsening and health and social care use. A purposive sample of participants (n =?20 intervention and n =?20 control) and practitioners (n =?20) will be interviewed to explore experiences of the trial, outcomes and interventions.
DISCUSSION:
The SPHERe study is the first multi-centre clinical RCT to assess the clinical and cost effectiveness of a supervised exercise rehabilitation intervention compared to usual care, delivered in the UK NHS, for people in all PH groups. Results will inform clinicians and commissioners as to whether or not supervised exercise rehabilitation is effective and should be routinely provided for people with PH.
TRIAL REGISTRATION:
ISRCTN no. 10608766, prospectively registered on 18th March 2019.
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CARDIOVASCULAR DEATH RISK IN RECOVERED MID-RANGE EJECTION FRACTION HEART FAILURE: INSIGHTS FROM CARDIOPULMONARY EXERCISE TEST.
J Card Fail2020 May;():. doi: S1071-9164(20)30031-2.
Magrě Damiano, Piepoli Massimo, Corrŕ Ugo, Gallo Giovanna, Maruotti Antonello, Vignati Carlo, Salvioni Elisabetta, Mapelli Massimo, Paolillo Stefania, Filardi Pasquale Perrone, Girola Davide, Metra Marco, Scardovi Angela B, Lagioia Rocco, Limongelli Giuseppe, Senni Michele, Scrutinio Domenico, Emdin Michele, Passino Claudio, Lombardi Carlo, Cattadori Gaia, Parati Gianfranco, Cicoira Mariantonietta, Correale Michele, Frigerio Maria, Clemenza Francesco, Bussotti Maurizio, Guazzi Marco, Badagliacca Roberto, Sciomer Susanna, Lenarda Andrea Di, Maggioni Aldo, Sinagra Gianfranco, Volpe Massimo, Agostoni Piergiuseppe, ,
Abstract
BACKGROUND:
Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains still debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing (CPET).
METHODS AND RESULTS:
We analyzed data of 4,535 HF with reduced EF (HFrEF) and 1,176 rec-HFmrEF outpatients from the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database. The end-point was cardiovascular death at 5 years. The median follow-up was 1,343 days (25th-75th range, 627-2,403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index=0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO) remained associated to the end-point (C-index=0.745). A pVO ?55% of predicted and a ventilatory efficiency ?31 resulted as the most accurate cut-off values in the outcome prediction.
CONCLUSIONS:
Present data support the CPET and, particularly, the pVO, as a useful tool in the rec-HFmrEF prognostic assessment. Peak VO?55% predicted and ventilatory efficiency ?31 might help to identify a high risk rec-HFmrEF subgroup.
Copyright © 2020. Published by Elsevier Inc.
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A multicentre retrospective study on quality and outcomes of cardiac rehabilitation programs in India.
Indian Heart J;72(1):55-57. doi: S0019-4832(20)30044-4.
Chockalingam Priya, Rajaram Anantharaman, Maiya Arun, Contractor Aashish,
Abstract
Cardiac rehabilitation (CR) programs in India are comprehensive in nature, consist of multidisciplinary teams and demonstrate significant improvement in various clinical parameters. However, there is a disparity in patient evaluation, risk assessment, data collection and documentation. CR programs in India need to be streamlined to meet the quality indicators outlined by the international guideline recommendations.
Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
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