bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical activity and heart failure: a forgotten indicator
Authors: Barradas M , Duarte F , Coutinho Dos Santos I , Resendes De Oliveira L , Serena C , Xavier Fontes A , Viveiros Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D
Published: October 2022

Introduction

Low physical activity may be associated with comorbidities, sedentary lifestyle or clinical worsening in heart failure (HF) patients. Cardiovascular implantable electronic devices (CIEDs) detect and analyse physical activity data that is often integrated in multifactorial algorithms for predicting HF decompensations, but its potential is probably underestimated.

Purpose

We hypothesized that low physical-activity levels, obtained from remote monitoring of CIEDs, help predict clinical outcomes in HF patients, independently from multifactorial algorithms.

Methods

We retrospectively evaluated consecutive patients with HF and CIEDs through clinical assessments and remote monitoring (two monitoring systems were used). Low activity was defined as <1 hour/day of physical activity and two groups of patients were defined: patients with low activity alerts (group 1) and patients without low activity alerts (group 2). Primary outcome was defined as death by all causes and secondary outcome as HF hospitalizations and sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes.

Results

From 121 patients with RPM, physical activity data was obtained in 104 (85,9%). Mean age was 63,98±12,44 years, 70,2% were males and follow-up was 59,19±38,491 months. Fifty-four (51,9%) had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 46 (44,2%) transvenous implantable cardioverter defibrillator (ICD), and 4 (3,8%) CRT pacemaker (CRT-P). The aetiology was idiopathic in 42,5% and ischemic in 40,2%. Mean left ventricular ejection fraction was 34,08±11,40% and mean physical activity duration was 2,25±1,84 hours/day. Forty-eight (53,7%) had low activity alerts (group 1) and 56 (46,3%) had no low activity alerts (group 2). In group 1 mean period of low activity was 52,978±15,75 days/year. Patients from group 1 were older (p=0,001), had more oncological disease (p=0,041) and peripheral artery disease (p=0,028). Three deaths occurred in total, all in group 1 (p=0,039) and HF hospitalizations were more frequent in group 1 (1,68±2,59 vs 0,69±1,32, p=0,005). Low activity burden was also associated with atrial fibrillation burden (r=0,473, p<0,05) and number of episodes of VT or VF (r=0,267, p=0,007). A decrease of 50% or more in mean duration of physical activity, but above 1 hour/day, was associated with increase HF hospitalizations (1,83±2,13 vs 1,05±1,95, p=0,006).

Conclusion

Low physical activity data obtained from CIEDs was associated with HF hospitalizations, arrhythmic events and death by all causes, independently of multifactorial algorithms. A decrease in basal activity even above alert threshold, was associated with HF hospitalizations and may be an even earlier sign of HF decompensations.

Funding Acknowledgement

Type of funding sources: None.
Association of usual walking with mortality in oldest old adults aged 85 years and older: a nationwide senior cohort study
Authors: Jin M , Yang P , Yu H , Kim T , Lee H , Pak H , Lee M , Joung B
Published: October 2022

Background

Current guidelines recommend moderate to vigorous intensity physical activity (MVPA) for health benefit in adults. However, it is difficult to meet the recommended minimum MVPA in “oldest old” aged over 85. Although walking is simple and easy exercise for oldest old, research on the association between walking and mortality in oldest old are lacking.

Purpose

To investigate the association between walking and the risk of all-cause and cardiovascular mortality among older adults aged 85 years and older.

Methods

7047 participants aged 85 or older underwent the Korean National Health Screening Program, including self-administered questionnaire for physical activity. Reported frequency per week of walking for at least 30 minutes increment was used to classify hours of walking per week. We computed multivariable-adjusted hazard ratios for walking and mutually adjusted for MVPA in relation to all-cause and cardiovascular mortality.

Results

The proportions of participants who engaged in walking, moderate- and vigorous-intensity physical activity were 42.5% (2996/7047), 14.7% (1037/7047) and 11.0% (773/7047), respectively. Only 7.6% (538/7047) of participants met the guidelines recommended minimum MVPA. Compared to inactive individuals, those who walked at least 1 hour per week had lower all-cause (HR 0.60 [95% CI, 0.50–0.74]) and cardiovascular mortality risk (HR 0.61 [95% CI, 0.42–0.89]). Walking 1 hour per week was still significant associated with reduction of risk for all-cause (HR 0.50 [95% CI, 0.40–0.61]) and cardiovascular mortality (HR 0.46 [95% CI, 0.30–0.70]) among participants who reported only walking without any MVPA.

Conclusions

1 hour a week of walking might be of benefit for all-cause and cardiovascular mortality in aged over 85 years, even without MVPA. Promoting walking may be a way to help oldest old avoid inactivity and encourage an active lifestyle for all-cause and cardiovascular mortality risk reduction.

Funding Acknowledgement

Type of funding sources: None.
Effect of exercise training on HDL subclasses and cholesterol transfers to HDL in elderly individuals
Authors: Senger Braga P G , Tavoni T M , Baroni R V , Aldin M N , Alves M J N N , Rocha G A , Bachi A L L , Negrao C E , Vaisberg M W , Freitas F R , Figueiredo Neto A M , Damasceno N R T , Maranhao R C
Published: October 2022

Introduction

Lifestyle habits play a crucial role on coronary artery disease (CAD) prevention. Exercise training promotes increase of HDL-C and decrease of plasma triglycerides is an important tool against atherogenesis. HDL-C determination evaluates only partially the HDL status and anti-atherosclerotic potential. A number of other parameters also relates HDL metabolism and function with CAD, such as HDL subclass distribution and cholesterol transfer to HDL, that have been reported as impaired in CAD. It is known that exercise training can improve those parameters in young individuals, but it has not been explored whether this effect can also be obtained in elderly subjects undergoing moderate training.

Purpose

Investigate the effects of regular practice of moderate exercise training on cholesterol transfer to HDL and HDL subclasses distribution in elderly compared to young subjects.

Methods

111 healthy subjects were enrolled in this study, as divided in four groups paired by sex: active elderly (AE, n=25), inactive elderly (IE, n=21), active young (AY, n=40) and inactive young (IY, n=25). All subjects performed cardiopulmonary test to determine VO2 peak and answered a questionnaire about exercise practice; only subjects practicing regular training for at least one year were selected to the 2 “active” groups. Blood samples were collected to determine lipid and apolipoprotein profile. Lipid subfractions were measured using the Lipoprint system. Cholesterol transfer to HDL was performed by incubating plasma with a donor lipoprotein-like nanoparticle containing radioactively labeled unesterified (UC) and esterified cholesterol (EC), followed by chemical precipitation and radioactive count.

Results

Data are shown on Table 1. Higher VO2 peak in both active groups confirmed the effectiveness of the training. HDL-C was higher in AE and AY than in IE and IY; apo A-I was higher in AY than in IY, but AE and IE were equal. UC transfer was higher in AE and AY than in IE and IY, but EC was higher AY than in IY, AE and IE were equal. Large HDL subfraction was higher in AY than in IY, but AE and IE were equal. The intermediate HDL subfraction was higher in AE than in IE. Comparing AE with AY, no differences in UC and EC, as well as HDL subfractions were observed.

Conclusion

Training had the ability to improve parameters of HDL metabolism not only in young but also in elderly subjects and it is remarkable that, despite their lower VO2 peak, in the AE group the cholesterol transfers and the HDL subfraction profile were similar to those of the AY group. Those results confirm the effectiveness of training to improve HDL anti-atherosclerotic features in the elderly.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo
Effects of resistance exercise in the cardiac remodeling of myocardial infarction rats
Authors: Rodrigues E , Souza L M , Pontes T H D , Gomes M J , Pagan L U , Murata G M , Damatto F C , Rego A B G C , Lima A R R , Reyes D R A , Zornoff L A M , Okoshi K , Okoshi M P
Published: October 2022

Introduction

Exercise is an important therapeutic strategy for heart failure (HF). However, the myocardial effects of resistance exercise during HF are not completely understood. In this study, we investigated the influence of resistance exercise on cardiac remodeling and molecular myocardial changes of rats with myocardial infarction (MI)-induced HF.

Methods

Three months after MI induction or simulated surgery, Wistar rats were divided into three groups: Sham (n=14); MI (n=9); and MI subjected to resistance exercise (MI-R, n=13). Exercised rats trained 3 times a week during 12 weeks performing four climbs in a ladder with progressive loads. Cardiac structure and left ventricular function were assessed by echocardiogram. Myocyte diameters were measured in histological sections. Energy metabolism, lipid hydroperoxide, antioxidant enzymes activity, malondialdehyde, and protein carbonylation were evaluated by spectrophotometry. NADPH oxidase subunits (Nox2, Nox4, p22phox and p47phox) gene expression was assessed by RT-PCR. Statistical analysis: ANOVA and Tukey test or Dunn's test.

Results

Mortality did not differ between MI-R and MI groups. MI-R and MI presented dilated left atrium and left ventricle with systolic and diastolic dysfunction. Exercise improved maximum carrying load with no changes in cardiac structure or left ventricle function. Myocyte diameter was lower in MI than Sham and MI-R. Lactate dehydrogenase and creatine kinase activities were lower in MI than Sham. Activity of citrate synthase and catalase was lower in MI and MI-R than Sham. Lipid hydroperoxide concentration was lower in MI-R than MI. Nox2 and p22phox gene expression was higher in MI-R than Sham. Gene expression of Nox4 was higher in both infarcted groups and gene expression of p47phox was lower in MI than Sham.

Conclusion

Resistance exercise is safe and well tolerated by infarcted rats. Exercise increases maximum carrying load and reduces myocardial oxidative stress with no changes in cardiac structure or left ventricle function of infarcted rats.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CNPq - National Council for Scientific and Technological Development
Influence of moderate and high intensity interval training on infarcted rat diaphragm
Authors: Ruiz Lima A R , Janini Gomes M , Urbano Pagan L , Zucoloto L H , Damatto R L , Damatto F C , Mamede Zornoff L A , Okoshi K , Politi Okoshi M
Published: October 2022

Background

Respiratory muscle dysfunction is commonly observed in heart failure (HF) patients and contributes to early fatigue and dyspnea. As there is no specific pharmacological therapy to treat skeletal muscle changes, physical exercise is considered an important strategy to prevent HF-associated skeletal myopathy. However, which exercise type is better during HF is unsettled.

Purpose

To evaluate the effects of aerobic and high intensity interval (HIIT) training on diaphragm morphometric, biochemical, and molecular parameters in infarcted rats.

Methods

Three months after inducing myocardial infarction (MI), male Wistar rats were assigned into three groups: sedentary MI (MI-Sed, n=8), MI subjected to aerobic exercise (MI-A, n=8), and MI subjected to HIIT (MI-HIIT, n=8). Results were compared to a Sham group (n=8). Exercise was performed in treadmill three times a week for three months. Functional capacity test and echocardiogram were performed before and after exercise protocols. Myosin heavy chain (MyHC) isoforms were analyzed by electrophoresis; diaphragm mitogen activated protein kinases (MAPK), NF-κB, TNF-α, and Pax-7 protein expression was evaluated by Western-blot. Statistical analysis: ANOVA.

Results

Functional capacity was similarly improved by both exercise protocols. Infarction size evaluated by histological analysis did not differ between groups (MI-Sed 27.7±10.8; MI-A 29.6±12.9; MI-HIIT 27.4±12.2% of total left ventricle area; p=0.91). Echocardiographic parameters did not differ between MI groups before and after exercise. Cross sectional area of diaphragm fibers (Sham 1922±230; MI-Sed 1808±264; MI-A 1926±209; MI-HIIT 2007±286 μm2), collagen interstitial fractional area (Sham 4.93±1.76; MI-Sed 5.01±1.88; MI-A 4.55±1.18; MI-HIIT 3.94±1.15%), and percentage of MyHC isoforms did not differ between groups. Pax-7 expression was lower in MI-HIIT than MI-Sed and MI-A [Sham 1.15 (0.58–1.44), MI-Sed 1.19 (0.90–2.85), MI-A 1.46 (0.77–2.14), MI-HIIT 0.46 (0.29–0.66) arbitrary units]. Total p-38 expression was higher in MI-Sed than the other groups and lower in MI-HIIT than Sham [Sham 1.00±0.52; MI-Sed 1.77±0.47; MI-A 0.66±0.22; MI-HIIT 0.46±0.31 arbitrary units]. The other proteins did not differ between groups.

Conclusion

Both aerobic and high intensity interval training improves functional capacity with no influence on diaphragm of rats with myocardial infarction.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): FAPESP (São Paulo Research Foundation)
Omega 3 fatty acid supplementation improves physical performance: a systematic review and meta-analysis of RCTs
Authors: Davis I , McCullough D , Banach M , Mazidi M
Published: October 2022

Background

Omega 3 polyunsaturated fatty acids (n-3, PUFA) show promise for improving muscle mass, strength and measures of physical performance that may ameliorate sarcopenia.

Purpose

To perform an updated meta-analysis of n-3 interventions with detailed subgroup analysis on physical performance/strength and muscle mass, with sub-group analysis on duration, age, BMI, sex, and location, amongst others.

Methods

We followed The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) –checklist for systematic reviews and meta-analysis. Literature was searched (ISI, Scopus and PubMed databases up to October 2021) with terms related to n-3 (alpha linolenic acid, docosahexaenoic acid, eicosapentaenoic acid, fish oil etc.) muscle mass, strength and physical performance (using the 30 s Chair Stand Test [30CST] for muscle strength and endurance and the Timed Up an Go Test [TUG] for physical performance; both are useful and simple tools that can be used to assess sarcopenia). Human n-3 randomised controlled trials (RCTs) were included and assessed for methodological quality (Cochrane quality assessment tool). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and random-effect model analysis, and I-squared (I2) statistic were used to assess outcomes and heterogeneity respectively. Subgroup and sensitivity analysis were performed, and Begg's and Egger's tests evaluated publication bias. Statistical analysis used STATA 11 software and a p-value of <0.05 was considered statistically significant.

Results

The primary meta-analyses for functional performance (TUG, 7 RCTs, 8 interventions, n=259) and strength (30CST, 5 RCTs, 6 interventions, n=180), favoured n-3 PUFA (p<0.001). TUG (weighted mean change (WMD): −0.35 s; 95% CI: −0.53, −0.18; I2=0.0%) (Figure 1A) and 30CST (WMD: 2.23 repetitions; 95% CI: 1.34, 3.32; I2=67.6%) (Figure 1B). Subgroup analysis for TUG was significant for female sex (WMD: 2.92 reps; 95% CI: 2.37, 3.46; I2=33.1%), BMI ≥25 kg/m2 (WMD: −0.36 s; 95% CI: −0.58, −0.17; I2=16.9%), and for 30CST by duration ≥16 weeks (WMD: 2.60 reps; 95% CI: 1.37, 3.83; I2=0.0%) (all p<0.001). There were no significant effects on muscle mass and handgrip strength, and subgroup analysis showed negligible influence. Publication bias was minimal and sensitivity analysis did not influence findings.

Conclusions

We showed novel favourable effects of n-3 PUFA on specific measures of strength and physical performance in some populations but not on measures of muscle mass and other strength tests. The beneficial effects of n-3 on these measures may be due to various mechanisms that regulate muscle quality (rather than quantity). Further studies are needed to elucidate the dose, duration and other influential variables.

Funding Acknowledgement

Type of funding sources: None.
CAVI (cardio-ankle vascular index) as an independent predictor of hypertensive response to exercise
Authors: Wuttichaipradit C , Tunhasiriwet A , Yodwut C , Hengrussamee K , Sukhum P
Published: October 2022

Objectives

Hypertensive response to exercise (HRE) always acts as a relative indication to terminate exercise during treadmill stress test and prohibit the interpretation of inadequate result. We supposed the CAVI (Cardio-ankle vascular index) might be an initial clue to predict hypertensive response to exercise.

Material and methods

Retrospective chart review in cardiology unit, patients who attended health preventive program in our heart hospital, and performed both CAVI and treadmill stress test in the same day between June 2018 and December 2018. Variables for prediction of HRE were analyzed, using univariate analysis and significant variables were entered in multiple logistic regression. ROC curve was created to test the sensitivity and specificity when used CAVI >8 as a cut-point of increased arterial stiffness.

Results

285 patients (157 females, 55.1%) were enrolled in this study. 58 patients (20.4%) who matched with HRE definition (SBP ≥210 mmHg or DBP ≥100 mmHg in male, SBP ≥190 mmHg or DBP ≥95 mmHg in female), mean age 46.4±12.8 years. In univariate analysis; age, diabetes mellitus, hypertension, dyslipidemia, history taking beta-blocker, and CAVI result were statistically significant. Multiple logistic regression revealed only CAVI result was statistically significant predictor of HRE (OR 5.8, 95% CI: 3.5–10.9, P<0.001). ROC curve analysis of the CAVI revealed AUC 0.827 (95% CI: 0.76–0.89, p<0.001) and the sensitivity and specificity of cut-point CAVI ≥8 were 53% and 92% respectively.

Conclusion

This study demonstrated CAVI is an independent predictor for hypertensive response to exercise. CAVI ≥8 is not the sensitive tool but quite specific to detect HRE.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): Bangkok Dusit Medical services
Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography
Authors: Mansour M , Chammas E , Winkler M , Aljaroudi W
Published: October 2022

Background

Many hemodynamic parameters are used during exercise stress testing but provide limited information regarding obstructive coronary artery disease (CAD) when exercise is suboptimal. Hemodynamic gain index (HGI) is a recently developed and sensitive indicator of ischemia which has been associated with increased mortality.

Purpose

This study sought to evaluate the clinical impact of HGI in patients who underwent concomitant exercise testing and coronary computed tomography angiography (CCTA).

Methods

Consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) and systolic blood pressure (SBP) were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI [(HRpeak × SBPpeak) − (HRrest × SBPrest)] / (HRrest × SBPrest) were calculated. The latter was divided into quartiles. The presence or absence of any CAD on CCTA was confirmed. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD.

Results

There were 284 patients (mean age 53 years, 83% male). Mean HGI was 1.74±0.67, with severely blunted HGI cut-off of ≤1.25 (Quartile 4). Patients with blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD showed lower HGI when compared to control (1.36±0.53 vs. 1.77±0.67, P-value 0.005) and had more prevalence of severely blunted HGI ≤1.25 (44% vs. 22%, P-value 0.019). In the multivariate analysis, after adjusting for traditional risk factors, HGI remained independent predictor of obstructive CAD while severely blunted HGI ≤1.25 was associated with 3-fold increased odds of obstructive CAD (P-value 0.05). Using artificial intelligence analysis, blunted HGI remained an independent predictor of obstructive CAD an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models.

Conclusions

Among patients who underwent concomitant exercise testing and CCTA, blunted HGI ≤1.25 was strongly associated with obstructive CAD after adjusting for traditional risk factors. HGI is robust, practical, and allows clinicians to reclassify patients, change management, and thus improve prognosis.

Funding Acknowledgement

Type of funding sources: None.
Value of cardiopulmonary exercise test submaximal parameters in the assessment of aortic stenosis patients
Authors: R Santos R , Paiva M , Gomes D , Presume J , Custodio P , Andrade M J , Raposo L , Durazzo A , Moreno L , Mendes M
Published: October 2022

Background

Exercise test is recommended for risk stratification of asymptomatic patients with severe aortic stenosis (AS), although a significant number of patients can't perform a maximal exercise test, increasing the potential value of sub-maximal parameters for the assessment of these patients.

Aim

To assess which parameters could be useful for risk stratification in case of a submaximal Cardiopulmonary Exercise Testing (CPET) in asymptomatic patients with severe AS.

Methods

Retrospective evaluation of adult patients with asymptomatic severe AS, in a single center, who underwent CPET between December 2016 and November 2021. All patients underwent a treadmill CPET using an exercise protocol with progressive increase in workload. Patients were divided in group A (maximal CPET) or group B, respectively, if respiratory exchange ratio (RER) was >1.10 at peak exercise or below this value. Known parameters accessed in a submaximal CPET were evaluated: mean minute ventilation/carbon dioxide production slope (VE/VCO2), VO2 value in first ventilatory threshold (VT1), peak circulatory power, and oxygen uptake efficiency slope (OUES).

Results

CPET was performed in 25 patients with severe asymptomatic AS (80 years ± 7 years, 56% male), median AVA was 0.86 cm2 [IQR 0.65–0.95 cm2] and transaortic pressure gradient was 46 mmHg [IQR 41–55 mmHg]. The most used protocol was a ramp slope. Nineteen patients (76%) didn't reach a RER>1.10 (group B) due to respiratory (26%) or peripheral limitation (53%). Comparing both groups, group B patients showed a shorter duration of exercise of (8±3 min vs. 9±4 min, p=0.422), and a lowest mean peak VO2 (16.3±3.6 vs. 20.5±6.9 ml/kg/min, p=0.207). In our population, bivariate analyses demonstrated that OUES was the only submaximal parameter that could discriminate both groups: Group B patients had the lowest values (1.53 [IQR 1.47–1.70] vs. 1.94 [IQR 1.56–2.11], p=0.042). ROC curve analysis of OUES values revealed an AUC of 0.78 (p=0.042) for maximal CPET prediction. The cut-off point with most sensitivity (S) and specificity (E) obtained using the Youden index (0.62) was 1.9 (S≈67%; E≈95%) (Figure 1).

Conclusions

In our cohort of asymptomatic AS patients, even with submaximal CPET, OUES accurately identify patients with higher degrees of functional limitation. Whether OUES is useful as prognostic marker to the workflow treatment of AS it's worth to be assessed prospectively.

Funding Acknowledgement

Type of funding sources: None.
Independent prognostic value of ventricular premature complexes during exercise and recovery in asymptomatic patients: a meta-analysis of observational studies
Authors: Gupta K , Zahedi S , Kakar T S , Zweig B
Published: October 2022

Introduction

Ventricular premature contractions (VPCs) are a common finding during a cardiac stress test. The independent prognostic value of these findings in asymptomatic participants is not clear.

Purpose

To investigate the cumulative independent prognostic value of VPC for adverse outcomes.

Methods

We conducted a systematic review and meta-analysis of observational studies in the following databases: MEDLINE, Embase®, and Cochrane Central from inception till January 28, 2022. The primary outcome was the cumulative hazard of all-cause mortality with VPCs during exercise or recovery in asymptomatic participants. The secondary outcome was cardiovascular mortality. We stratified results based on VPC during exercise or recovery.

We included studies with participants with no known CV disease and known CV disease. If there was known CV disease at baseline, the study should have adjusted for at least ≥1 known confounder. If a study reported low risk or higher risk VPCs, we included outcomes with higher risk VPCs to make the data comparable across literature. Random effect meta-analyses were used to predict cumulative hazard ratios. The review was registered with PROSPERO (registration number CRD42022297028)

Results

We found 10 studies with 47,497 participants that met our inclusion criteria (8 studies with all-cause and CV mortality, 2 studies with CV mortality only). Three studies included patients with baseline CV disease (proportion 12–33%). Follow-up duration ranged from 5.3 to 20.3 years. Definition of VPCs differed in the individual studies.

Both VPCs during exercise and recovery were associated with a higher hazard of all-cause mortality (HR 1.21, 95% confidence interval [CI] 1.07, 1.34 and 1.32, 95% CI 1.06, 1.58, p<0.001 and low heterogeneity for both, respectively, Figure 1A). There was no small study treatment effect bias.

Similarly, both VPCs during exercise and recovery were associated with a higher hazard of CV mortality (HR 1.63, 95% CI 1.30, 1.96 and 1.68, 95% CI 1.00, 2.35, p<0.001, and low heterogeneity for both, respectively, Figure 1B).

The presence of VPC had a numerically stronger association with CV mortality than all-cause mortality. VPCs during recovery seem to have more prognostic value than VPC during rest.

Conclusion

After adjusting for known confounders, VPCs during exercise and recovery predict a higher risk of all-cause and CV mortality. The risk is higher with VPCs during recovery.

Funding Acknowledgement

Type of funding sources: None.
A phase 2a trial investigating ninerafaxstat – a novel cardiac mitotrope for the treatment of diabetic cardiomyopathy (IMPROVE-DiCE)
Authors: Hundertmark M , Siu A G , Matthews V , Lewis A J , Grist J T , Patel J , Chamberlin P , Sarwar R , Yavari A , Frenneaux M P , Valkovic L , Miller J J J J , Neubauer S , Tyler D J , Rider O J
Published: October 2022

Background

Type 2 diabetes (T2D) is a significant, independent contributor to the development of heart failure (HF), driven by energetic, metabolic, structural and functional myocardial changes. The T2D heart is characterised by over-reliance on fatty acid utilisation, shows reduced glucose oxidation and inhibition of pyruvate dehydrogenase (PDH). This results in a diminished myocardial energy reserve and blunted adenosine triphosphate (ATP) generation as well as cardiac steatosis, contributing to lipotoxicity, and diastolic dysfunction.

Purpose

We assessed the effects of ninerafaxstat – a novel cardiac mitotrope designed to shift myocardial substrate utilisation in favour of glucose and thus, restore myocardial energy homeostasis – on cardiac metabolism & diastolic function in patients with T2D and obesity.

Methods

In this open-label, mechanistic phase 2a trial, we enrolled 21 patients with T2D & obesity (HbA1c median 7.0% (IQR 6.6, 7.8), weight 97kg (90, 102)) and subsequently treated them with 200mg ninerafaxstat twice daily for 4 or 8 weeks; (Fig. 1). Cardiac metabolism and function were assessed pre- & post-treatment using magnetic resonance imaging (MRI), 31P-, 1H- and, in a subset of n=9, hyperpolarized [1-13C]pyruvate MR spectroscopy.

Results

T2D patients at baseline presented with impaired myocardial energetics with a markedly reduced PCr/ATP (1.6 [1.4, 2.1]), myocardial steatosis (myocardial triglycerides 2.2% [1.5, 3.2]) left ventricular (LV) hypertrophy (LV mass 130g [98, 152]), and diastolic dysfunction (peak diastolic strain rate 0.86 1/s [0.82, 1.06]). Ninerafaxstat significantly improved myocardial energetics (PCr/ATP median by 32%, p<0.01), reduced myocardial triglyceride content (by 34%, p=0.03) and improved LV diastolic function (peak circumferential diastolic strain rate by 10%, peak LV filling rate by 11%, both p<0.05) (Fig. 2). PDH flux was increased in 7/9 subjects (mean 45%, p=0.08), consistent with improved glucose utilisation. Left ventricular volumes and mass, heart rate and blood pressure remained unchanged.

Conclusions

Treatment with ninerafaxstat significantly improves myocardial energetics, reduces myocardial steatosis and improves diastolic function in patients with T2D and obesity.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Imbria Pharmaaceuticals
Silent ischemia in exercise test in patients with stable coronary artery disease, what does it mean?
Authors: Virosta Gil E , Tojal Sierra L , Soria Navarro R , Apodaca Arrizabalaga M J , Beltran De Guevera Sainz-Pardo A , Saez De Buruaga Corrales E , Manzabal Gonzalez C , Gomez Corcuera E , Conde Lagartos A I , Fernandez Fernandez De Leceta Z , Cortes Urrutxi A , Para Barbero E , Pasalodos Heras L M , Alonso Gomez A M , Bello Mora M C
Published: October 2022

Introduction

The benefit of cardiac rehabilitation programs (CRP) in ischemic patients is well known and is included as an IA indication in European Cardiology guidelines. At the end of CRP phase II, it is not uncommon to get an isolated electric positive result (silent ischemia) which has an unknown significance as clinical marker. This finding could be more challenging in patients without complete revascularization.

Purpose

To study whether silent ischemia (SI) and incomplete revascularization acted as markers of future events in patients who participated in a CRP after coronary revascularization.

Methods

A retrospective descriptive analysis of consecutive patients who were part of a CRP between January 2019 and March 2020 was performed. We analyzed the relationship between the presence of SI (defined as ST-segment depression > or = 1 mm in two or more contiguous leads in the absence of clinical symptoms) in the routine exercise test at the end of CRP phase II and the occurrence of events within first year (defined as: emergency room visits, cardiac complication without admission, admission for non-cardiac cause, admission for cardiac cause or death). Cardiovascular risks factors and type of revascularization (incomplete vs complete) were analyzed as modifiers of outcomes.

Results

Of the 380 patients analyzed 79 presented some event in the first year. The mean age was 63±10 and 78% were male. The demographic characteristics are shown in Table 1. The presence of SI at the final exercise routine test of phase II CRP was observed more frequently in the group of patients who suffered an event within first year (p 0.030). Although there was a statistically significant correlation between the presence of incomplete revascularization (IR) and the presence of SI (p 0.002), there was no significant relationship between the presence of IR and events (p 0.082). The detailed results are shown in Table 2.

Conclusions

Among our population, exercise tests is useful for detecting patients at an increased risk of events during the first year after coronary revascularization. However, the incomplete revascularization did not appear to be a prognostic factor. The exercise test seems to be useful for detecting patients in whom intensify preventive efforts.

Funding Acknowledgement

Type of funding sources: None.
Peak ventilation during treadmill cardiopulmonary exercise testing: applicability analysis of the FRIEND registry prediction equation in a Brazilian healthy sample
Authors: Milani M , Milani J G P O , Cipriano G F B , Cipriano Junior G
Published: October 2022

Background

Peak ventilation (VEpeak) measured by cardiopulmonary exercise testing (CPX) is a valuable clinical information, especially in patients with pulmonary diseases. Measured values can be compared to maximal voluntary ventilation or to predicted VEpeak calculated by nonexercise equations. However, the FRIEND Registry prediction equation has never been assessed for portability in a Brazilian population sample.

Purpose

To analyze the applicability of the FRIEND registry prediction equation for VEpeak during treadmill CPX in a Brazilian healthy sample.

Methods

Cross-sectional study of subjects assessed by CPX in the Brazilian Midwest region between January/2011 to March/2020. The inclusion criteria were CPX performed on treadmill in healthy individuals aged 20 years or older, and with respiratory exchange ratio ≥1.0. The exclusion criteria were any history of cardiovascular or pulmonary disease, presence of cardiovascular risk factors (such as hypertension, diabetes mellitus, current smoking, and obesity) and abnormalities on CPX. Measured VEpeak values were compared with predicted values calculated using age, sex, and height, according to the FRIEND Registry prediction equation. Variables were described as median and interquartile range. Statistical comparisons between measured and predicted VEpeak were performed using Spearman correlation test, Wilcoxon signed rank test, and Blant-Altman agreement analysis.

Results

During the study period 7,843 CPX were performed and included for study eligibility. After the inclusion and exclusion criteria were applied, 3,544 healthy individuals' assessments were included [1,574 females and 1,970 males, age 39 (33, 47) years]. The measured and predicted VEpeak were, respectively, 76.8 (66.7, 87.4) and 76.2 (68.5, 83.0) L min–1 in females, with significant difference (p=0.004). In males, the measured and predicted VEpeak were, respectively, 123.0 (107.3, 137.3) and 114.8 (107.5, 120.7) L min–1, also with statistical difference (p<0.001). Correlations were significant (p<0.001) for both sexes (r2=0.424 for females and .421 for males) (Figure 1). Average error was lower for females than males, with bias of 1.22 L min–1 (95% limits of agreement: - 26.95 to 29.39) in females and bias of 8.41 L min–1 (95% limits of agreement: −33.04 to 49.87) in males (Figure 2).

Conclusion

Measured VEpeak median values were greater than predicted median values for both sexes, with lower average error in females than in males. The significant average error in males limits the prediction equation applicability in the Brazilian population. Thus, the development of a new Brazilian prediction equation is necessary to better evaluate the variable response during CPX in Brazil.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
Cardiopulmonary exercise test and heart failure biomarkers results after comprehensive rehabilitation of LVAD patients
Authors: Chwyczko T , Smolis-Bak E , Zalucka L , Segiet-Swiecicka A , Piotrowicz E , Was J , Niedolistek M , Kowalik I , Sobieszczanska-Malek M , Zielinski T , Szymanski J , Kusmierczyk M , Piotrowicz R , Dabrowski R
Published: October 2022

Background

The novel method of comprehensive rehabilitation after left ventricular assist device (LVAD) implantation was developed in our institution. Cardiopulmonary exercise test was used to program the training and to assess the results of rehabilitation.

Study group

47 consecutive LVAD (32 Heart Mate III, 15 HeartWare) recipients (19–68 years, mean 58.7 years, 43 men) participated in the rehabilitation program. Proposed 4–5 week program included supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). It was followed by individual exercises performed at home. 6-minute walk test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of rehabilitation program.

Results

See Table 1. Increase of 6MWT distance, higher maximal workload, peak VO2 and upward shift of anaerobic threshold (AT) in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitation.

Conclusions

Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of functional tests and biomarkers of heart failure.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development
Effects of adding high- vs low-intensity resistance training to endurance training in patients with heart failure: preliminary results of a randomized controlled trial
Authors: Gojevic T , Turri Da Silva N , Gelade K , Jacobs G , Pirlotte R , Tulleneers B , Duchateau A , Mullens W , Hansen D
Published: October 2022

Background

In current ESC/EAPC guidelines, adding resistance training to endurance training is advised for patients with heart failure (HF), but the optimal intensity of the resistance training is unknown (40–80% of 1RM is advised).

Purpose

To investigate the effects of high- vs low-intensity resistance training as an adjunct to endurance training on: aerobic capacity (primary outcome), walking capacity, muscle strength and quality of life in patients with HF.

Methods

Forty patients with HF were consecutively recruited in the cardiac rehabilitation center of the Hospital East-Limburg in Belgium. Patients were block-randomized (by age and sex) by an independent researcher to receive maximally 45 supervised sessions (3x/week) of high-intense (HI: 3 exercises, 3x12 repetitions, 55–70%1RM) or low-intense resistance training (LI: 3 exercises, 3x22 repetitions, 35–40%1RM) as an adjunct to endurance training (30 min/session; 50–75% VO2max). The aerobic capacity (VO2max) was measured by a blinded assessor with a ramp cardiopulmonary cycling test (+5–30W/min). Walking distance was assessed with a 6-minute walk test (6MWT), maximal strength with 1RM (leg-press, pull-down and dip), and quality of life with the Minnesota questionnaire. An unpaired t-test, Mann-Whitney U test or ANCOVA were used for between-group analysis, and paired t-test or Wilcox sign-rank test for the within-group analysis.

Results

Both groups had similar baseline characteristics and training adherence (HI vs LI; 20 vs 20 subjects; Age: 62±9 vs 59±13 years; Sex: 76% vs 79%male; BMI: 27±58 vs 29±4 kg/m2; LVEF: 35±10 vs 38±6%; Adherence: 33±10 vs 36±10 sessions; p>0.05). There were no adverse events. Both groups had significant within-group improvements in aerobic and walking capacity (VO2max: LI (n=20) vs HI (n=19), p≤0.010; 6MWT distance: p≤0.007) (Figure 1), but these improvements did not differ between groups (VO2max: p=0.855; 6MWT distance: p=0.854). The LI group improved significantly more in muscle strength than the HI group (dip and leg-press: p<0.001). Although the LI group significantly improved in the quality of life (Minnesota score reduction: p=0.028), the quality of life did not differ between groups (Minnesota score: p=0.756).

Conclusions

Both low-and high-intense resistance training are similarly beneficial for improving aerobic and walking capacity in patients with HF. Surprisingly, low-intense resistance training seems superior to high-intense training in improving muscle strength.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University
Understanding HCP views about delivering a rehabilitation programme for people living with atrial fibrillation
Authors: Alhotye M , Evans R , Orme M , Ng G A , Singh S J
Published: October 2022

Background

People living with Atrial Fibrillation (AF) can experience symptoms such as palpitation, dyspnea, fatigue and dizziness which lead to reduced physical activity levels and quality of life [1,2]. Current management of AF mainly focus on pharmacological treatments and invasive procedures, while no routine prescription of exercise or rehabilitation programme is offered.

Purpose

To assess the views and opinions of healthcare professionals about delivering a tailored exercise/cardiac rehabilitation programme to people living with AF, and to explore the barriers in referral to this programme.

Methods

A cross-sectional survey was conducted online between April and September 2021 for healthcare professionals who are involved in the care for adults with AF in UK. A range of professions were targeted, including general practitioners, cardiac physicians, physiotherapists and nurses. The survey comprised twelve questions designed to explore healthcare professional views about rehabilitation programmes for adults with AF, factors influencing their decision to recommend rehabilitation and barriers to the referral process.

Results

Overall, n=209 participants responded from a wide range of disciplines (57% female, 43% specialist arrhythmia nurses). The majority of participants agreed that a rehabilitation programme would be beneficial to support patients to perform daily activities (127, 61%), with n=123, 58% agreeing that rehabilitation programme would be beneficial in reducing breathlessness and would reduce other symptoms such as palpitation (108, 52%).

Nearly all the healthcare professional (n=206/99%) suggested that a tailored programme should include information about AF (206, 99%), weight management and symptom management (n=197, 94%) aside from exercise. The factors that strongly influence their decision to refer to a rehabilitation programme included patients with low physical activity levels (n=166, 80%) and low exercise tolerance (n=157, 76%). The main barrier in referring to the programme was transportation problems (n=128, 62%) (Figure 1). The majority reported that home based programme would be the best way to deliver the programme (166, 79%) (Figure 2).

Conclusions

The responses indicate the enthusiasm for a programme targeting people with AF, poor activity levels was the main reason for referral.

Funding Acknowledgement

Type of funding sources: None.
Changes in functional capacity after a cardiac rehabilitation program in Spain: defining the profile of those who improve
Authors: Sestayo Fernandez M , Alonso Vazquez M , Gonzalez Maestro A , Gonzalez Salvado V , Diaz Balboa E , Rabade Castedo C , Neiro Rey M C , Gonzalez Juanatey J R , Pena Gil C
Published: October 2022

Background

Improvement in functional capacity (FC) is one of the most notable benefits patients experience after cardiac rehabilitation (CR) and it is highly important as low levels of FC are associated with a high risk of cardiovascular (CV) disease and all cause mortality.

Purpose

To study the changes in FC after a CR program in Spain and to define the profile of those patients that improve.

Methods

Single-centre observational study from 793 patients with ischaemic heart disease (15.3% women, age 61.79±10.70 years), participating in a CR program from 2015 to 2020 with a stress test performed, both at beginning of CR (conventional stress test, n=436; CPET, n=340; imaging stress test, n=17) and at end of CR (conventional stress test, n=468; CPET, n=322; imaging stress test, n=3). A comparative analysis of patients with “improved FC” and “non-improved FC” at end of CR, was performed. Relevant clinical improvement was defined as a 10% increase of VO2, in accordance with reviewed literature. Additionally, a descriptive analysis of patient exercise capacity parameters was performed at beginning of CR and at end CR, for the complete sample.

Results

A total of 1586 exercise tests were analysed. All exercise capacity parameters analysed showed significant improvement at end of CR, with p values <0.01, (Graph 1). Clinically relevant FC improvement was observed in 54.2% of patients that participated in CR; 45.5% of all women and 55.8% of all men.

Patients that improved FC completed significantly more CR training sessions (p<0.05) than those who did not improve FC (21.39±4.53, 20.37±5.84). Those who improved FC were significantly older (62.74±10.90), presented with significantly more STEMI (n=197, 45.8%), and achieved significantly less METS (7.42±3.01) at baseline, (p<0.05, Table 1).

Conclusions

Our CR rehabilitation program improves patient's functional capacity significantly.

Patients with clinically relevant functional capacity improvement, are significantly older patients with STEMI as diagnosis at CV event, complete significantly more CR training sessions and showed significantly worst physical performance (METS) at baseline.

Funding Acknowledgement

Type of funding sources: None.
Differential associations of emotional and physical domains of the MacNew Heart with changes in 6-minute walking test
Authors: Jellestad L , Meier V G , Bierbauer W , Bermudez T , Auschra B , Gunther M P , Scholz U , Von Kanel R , Hermann M , Euler S
Published: October 2022

Aims

Cardiac rehabilitation (CR), a key component of secondary prevention in cardiac patients, contributes fundamentally to improved cardiovascular health outcomes. Health-related quality of life (HRQOL) represents a widely employed outcome measure in CR, yet, its predictive properties on exercise capacity change during CR are poorly understood. Aim of this study was to examine the association between baseline HRQOL and its subdomains on improvement of exercise capacity during CR.

Methods

Study participants were 13,717 inpatients of six Swiss CR clinics from 2012 to 2018. We measured HRQOL at admission to CR with the MacNew Heart (MNH) questionnaire and exercise capacity at admission and discharge using the six-minutes walking test (6MWT). Following factorial analyses, we performed univariate and multivariate analyses to test the predictive properties of baseline global HRQOL and its domains for improvement in exercise capacity, adjusting for demographic and clinical characteristics.

Results

Mean improvement in 6MWT was 114 meters (SD=90), achieved after 17.4 days (SD=5.5). Lower emotional HRQOL (b=7.85, p≤0.001, 95% CI [−5.67, 10.03]) and higher physical HRQOL (b=−5.23, p<0.001, 95% CI [−6.56, −3.90]) were associated with less improvement in the 6MWT. Global MNH and social HRQOL showed no association with exercise capacity improvement.

Conclusion

Patients entering CR with low emotional and high physical HRQOL are at risk for a lower gain in exercise capacity during CR. Global MNH alone does not provide a reliable assessment of HRQOL; thus a focus on specific domains of HRQOL is needed.

Funding Acknowledgement

Type of funding sources: None.