bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term cardiovascular risk in post-cardiac rehabilitation patients after one year follow-up using a smartphone application: 4-year post intervention follow-up of a randomized controlled trial
Authors: Lunde P , Bye A , Grimsmo J , Pripp A H , Ritschel V , Jarstad E , Nilsson B B
Published: June 2024

Background

Adherence to healthy behaviour adapted in cardiac rehabilitation (CR) is challenging for many patients. In 2020, we demonstrated that one year of individualized follow-up using a smartphone-application (app) is effective to promote adherence to healthy behaviour post-CR (1). However, long-term data evaluating the effect of mobile health (mHealth) intervention regarding adherence to healthy behaviour are sparse.

Purpose

The purpose of the present study was to assess the effects of individualized follow-up with an app for one year in patients post-CR, four-year post intervention.

Methods

A single-blinded randomized controlled trial lasting for one year with follow-up four-year post-intervention. The intervention group (IG) received follow-up enabled with an app for one year, while the control group (CG) received usual care. After the intervention period, all patients received usual care for the next four years. The primary outcome was difference in peak oxygen uptake (VO2peak). In addition, exercise performance (time to exhaustion at cardiopulmonary exercise test), cardiac events, cholesterol, body weight, quality of life and health status were evaluated. Data were analysed in accordance with the intention-to-treat principle. Linear mixed models for repeated measurements were used to analyse for differences between groups. All tests were two-sided, and p-values ≤0.05 were considered as statistically significant.

Results

A total of 113 patients completing CR (88 med/25 women, mean age 59±8.7 years, 73.4% with coronary artery disease, 16.8 after valve surgery and 9.8% with other heart diseases) were randomly allocated to the IG or CG post-CR (Table 1). As previously reported (1) and presented at ESC Preventive Cardiology 2020, there were statistically significant differences between the groups in favour of the IG in VO2peak and exercise performance at the end of the intervention period (one-year post-CR). At four-year post intervention, 102 patients were assessed. There were no statistically significant differences between the groups in any outcomes evaluated (Table 2). In total, 33 patients experienced a new cardiac event post-CR, 12 (5 in the CG and 7 in the IG) during the first year, and 21 (11 in the CG and 10 in the IG) during the four-year post intervention period.

Conclusion

Individualized follow-up enabled with an app for one year is effective to improve VO2peak, exercise performance and exercise habits in patients post-CR. Despite the positive effects observed one-year post-CR, these benefits have ceased to exist four years post intervention. Results from this study is of significant clinical importance for the future implementation of technology to promote lifelong adherence to healthy behaviour post lifestyle interventions, such as CR.
Non-invasive multiparameter monitoring for detection of decompensated heart failure: an exploratory study
Authors: Herkert C , Van Leunen M , Tang J , Raschella F , Saeed A , Spee R F , Lu Y , Kemps H M C
Published: June 2024

Aims

Telemonitoring strategies in heart failure (HF) patients are often based on manual readings of multiple parameters by the healthcare professional (HCP). In order to improve early prediction of decompensated HF, and to reduce the workload for both the HCP and the patient, there is a need for multiparameter predictive models. These models should preferably be based on parameters measured with a single, non-invasive, easy-to-use device. This exploratory study aimed to evaluate whether a multiparameter prediction model, using a wrist-worn device supplied with a photoplethysmography sensor and a triaxial accelerometer, can be helpful to detect decompensated HF and death in patients with unstable HF.

Methods

17 patients who were admitted to the hospital with acute decompensated HF, regardless of etiology or left ventricular ejection fraction, were provided a with wrist-worn device at the moment of discharge. The device measured heart rate (HR)-related data, respiration rate (RR), activity and sleep stages. Participants were asked to wear the device 24 hours a day for 3 consecutive months. A decision-tree model was developed with the collected data. The combined endpoint of interest was hospital readmission due to decompensated HF, decompensated HF treated at the outpatient clinic by increasing loop diuretic dose, or death as was expected due to HF.

Results

During follow-up, the compliance with wearing the device was 78 (interquartile range 55-81)%. The parameters that were based on accelerometry (energy expenditure and activity counts) performed best with respect to data quality: 72% and 79% of the data was of high quality respectively. For HR 46% of the data was of high quality, whereas only 14% of the RR data was of high quality. Sleep data was lacking in almost all participants. The best model to predict the combined endpoint showed a specificity of 98% and a sensitivity of 4% in the 2 weeks prior to an event (area under the curve: 0.5).

Conclusion

A multi-parameter, non-invasive model using a single device measuring HR, RR, activity and sleep, showed high specificity, but low sensitivity in predicting decompensated HF and death. An important reason for the low sensitivity could be low data quality (specifically HR, RR sleep stages) in a real-life setting in the HF population. Future studies should address this issue and should include larger populations.
Branched chain amino acids and anthropometry: body mass index and waist circumference are oldies, but goldies
Authors: Liu K , Borreggine R , Gallart-Ayala H , Ivanisevic J , Marques-Vidal P
Published: June 2024

Background

Branched chain amino acids (BCAAs, Valine, Leucine, and Isoleucine) are indispensable for skeletal muscle metabolism. However, the association between BCAA and anthropometry is still controversial.

Aims

To assess the associations between BCAA levels and different anthropometric markers, including leptin and adiponectin levels, in a sample of healthy, non-obese participants.

Methods

Cross-sectional study using data from the CoLaus|PsyCoLaus study in our city. Anthropometric markers included conicity index (CI), Body roundness index (BRI), A Body shape index (ABSI), body mass index (BMI), and waist circumference, among others. Grip strength was used as a proxy for muscle mass.

Results

Data from 1929 participants (845 men, 53.2±8.5 years old, BMI<30 kg/m2) Using bivariate analysis, most anthropometric markers were positively correlated with BCAA, while adiponectin levels were negatively correlated with BCAA. The correlations were stronger in men compared to women, except for Conicity index, ABSI, and adiponectin. After multivariable analysis, weight and BMI had the strongest association with BCAA in men, while in women the strongest associations were found for waist and waist to height ratio (table). No significant associations were found between the ABSI and BCAA levels in men, and between grip strength and BCAA levels in women. Stepwise linear regression identified BMI in men and waist in women as the anthropometric markers most associated with BCAA.

Conclusion

We found a significant gender difference in the anthropometric markers associated with BCAA levels. BMI was the anthropometric marker most associated in men, and waist was the anthropometric marker most associated in women.
Branched chain amino acids and body composition in healthy, non-obese women
Authors: Liu K , Borreggine R , Gallart-Ayala H , Ivanisevic J , Marques-Vidal P
Published: June 2024

Background

Branched chain amino acids (BCAAs, Valine, Leucine, and Isoleucine) are indispensable for skeletal muscle metabolism. However, the association between BCAA and body composition (lean and fat mass) have been seldom studied.

Aims

To assess the associations between BCAA levels and body composition as assessed by Dual Energy X-ray Absorption (DEXA) in a sample of healthy, non-obese women.

Methods

Cross-sectional study using data from the OsteoLaus study in our city. Whole body, gynoid, android and appendicular lean and fat mass and percentages were assessed.

Results

Data from 388 women (mean age 58.4±6.4 years, BMI 23.4±2.9 kg/m2) were analysed. After multivariable analysis, the strongest associations were found for all BCAAs with the android %fat/gynoid %fat ratio (beta coefficient=0.263, 0.228 and 0.219 for Valine, Leucine and Isoleucine, respectively) and the trunk fat mass/limb fat mass ratio (beta coefficient=0.257, 0.254 and 0.249 for Valine, Leucine and Isoleucine, respectively), and between Valine with android fat mass and visceral fat mass (table). Stepwise linear regression identified the android %fat/gynoid %fat ratio as the body composition marker most associated with valine levels, and the trunk fat mass/limb fat mass ratio as the body composition marker most associated with leucine and isoleucine.

Conclusion

In healthy middle-age woman, blood BCAAs levels were mainly associated with fat mass and not with lean mass, suggesting that BCAAs might be more related to fat than to muscle metabolism.
Ambient temperature and risk of cardiovascular morbidity and mortality: a nationwide study of vulnerability factors
Authors: Achebak H , Rey G , Lloyd S , Quijal-Zamorano M , Mendez-Turrubiates R F , Ballester J
Published: June 2024

Background

Ambient temperature is a major environmental determinant of cardiovascular health. However, evidence on the association between temperature and cause-specific cardiovascular health outcomes is still limited. Moreover, little is known about the differential effects across population groups and the contextual factors that exacerbate or reduce vulnerability. A comprehensive assessment is therefore needed to fill this literature gap, and thus inform health adaptation policies to best tackle the negative health consequences of climate change in a context of accelerated rising temperatures and population ageing.

Purpose

We assessed the effect of temperature and temperature variability onto cause-specific mortality and emergency hospitalisations from cardiovascular causes of diseases in Spain, as well as the effect modification of this association by individual and contextual factors.

Methods

We collected data on health (hospital admissions and mortality), weather (temperature and relative humidity) and relevant contextual indicators for 48 Spanish provinces during 2004-2019. The statistical analysis was separately performed for the summer (June-September) and winter (December-March) months. We first applied a generalised linear regression model with quasi-Poisson distribution to estimate daily, short-term, province-specific temperature-lag-health associations, and then fitted multilevel multivariate meta-regression models to evaluate the effect modification of contextual factors on heat- and cold-related risks.

Results

Heat did not contribute to the risk of hospitalisation from cardiovascular diseases, but it considerably increased the risk of mortality, with the strongest effect for hypertension (relative risk [RR] at 99th temperature percentile: 1·510 [95% eCI 1·251 to 1·821]) and heart failure (1·528 [1·353 to 1·725]). We found significant risks related to cold for all cardiovascular causes, with heart failure (RR at 1st temperature percentile: 1·537 [1·329 to 1·779]) exhibiting the greatest risk for hospitalisation, and acute myocardial infarction (1·860 [1·546 to 2·238]) for mortality. Women and the elderly were more vulnerable to heat, while people with secondary education were less susceptible to cold compared to those not achieving this educational stage. Results from meta-regression showed that increasing heating access to the highest current provincial value (i.e. 95.6%) could reduce deaths due to cold by 59·5% (57·2 to 63·5).

Conclusions

Exposure to heat and cold was associated with a greater risk of morbidity and mortality from multiple cardiovascular conditions, and heating was the most effective societal adaptive measure to reduce cold-related mortality.
Association of nt-probnp and left ventricular ejection fraction and their utility as predictors of in-hospital mortality among heart failure patients admitted in a tertiary hospital in davao city
Authors: Paulino K , Faderan B S
Published: June 2024

Introduction

N-terminal brain natriuretic peptide (NT-proBNP) levels have been shown to be reliable in diagnosing heart failure. Studies have postulated higher NT-proBNP levels with lower left ventricular ejection fraction and higher in-hospital mortality, necessitating more aggressive interventions and management. This study describes the association between NT-proBNP and ejection fraction and their utility as predictors of in-hospital mortality.

Methods

We evaluated the medical records of patients admitted for heart failure between January 2021 and January 2023 in a tertiary hospital. Pearson-r was used to determine the association between NT-proBNP and ejection fraction. In-hospital mortality was assessed using logistic regression analysis and odds ratio for dichotomous variables.

Results

Of the 147 medical records reviewed, 53.74% were female, the mean age was 64.9 ± 13.5years with ages ranging from 24 to 90 years, average NT-proBNP levels were 5791.3 pg/mL ± 3779.1, and average left ventricular ejection fraction was 49.9% ± 15.1. No age (p=.315) and sex (p=.626) distribution difference was observed. Patients with a higher NT-proBNP quartile had significantly higher systolic (p=0.023) and diastolic blood pressure (p=0.015), worse NYHA functional class (p=0.000), higher creatinine levels (p=0.000), and prevalence of diabetes mellitus (p=0.014). There was a significant difference between the levels of ejection fraction across NT-proBNP quartiles (p<0.03), mortality rates were higher across NT-proBNP quartiles, and NT-proBNP levels and ejection fraction were not predictors of mortality, but a worse NYHA functional class II and III predicted mortality.

Conclusion

High levels of NT-proBNP are linked to lower left ventricular ejection fraction and higher in-hospital mortality rates. In light of this study’s findings, we recommend NT-proBNP as part of the assessment for prediction of in-hospital mortality in heart failure patients.
Metabolomic clusters of new-onset heart failure in general population
Authors: Noordermeer D , Farzaneh A , Van Den Bosch A E , Ghanbari M , Kavousi M
Published: June 2024

Background

Heart failure (HF) is a heterogeneous disorder with sex-specific disease pathophysiology. Identifying metabolomic clusters underlying HF risk may provide insight into HF pathophysiology and prevention for men and women.

Purpose

We aimed to determine the potential of metabolomic profiling in predicting incident HF among community-dwelling men and women.

Methods

1,383 individuals (59% women) without a history of HF from a prospective population-based cohort had available data on 1,087 metabolites. After excluding unknown and highly-correlated (Spearman correlation >0.90) metabolites, analysis was conducted using 765 metabolites. Initially, SHAP values were computed through repeated cross-validation of the XGBoost model to select the, sex-specific, metabolites for survival analyses. The selected metabolites were incorporated into Self-Organizing Maps, along with Kmeans methods, to perform sex-specific clustering, allowing for a nuanced exploration of distinct profiles of HF risk. Extracted distinct clusters were then characterized according to cardiovascular risk factors, echocardiographic, and electrographic variables.

Results

During a median follow-up of 10 years, 306 incident HF occurred. 56 metabolites in men and 46 metabolites in women were selected. The clustering algorithm resulted in three distinct clusters of low-, moderate-, and high-risk based on incident of HF. In men, the incidence rates per 1000 person-years were 15.9 for low-risk, 31.6 for moderate-risk, and 41.2 for high-risk clusters. For women, the corresponding rates were 13.3 for low-risk, 20.0 for moderate-risk, and 29.4 for high-risk clusters. The low-risk cluster in both men and women was characterized by a favorable cardiovascular profile. Men in the moderate-risk cluster exhibited poor cardiovascular profile, based on lower estimated glomerular filtration rate (eGFR), increased left ventricular diastolic diameter, and extended R-to-R interval. The high-risk cluster in men was characterized by larger body mass index, more prevalence of hypertension, and larger left atrial diameter. In women, the high-risk profile was characterized by larger left ventricular diastolic diameter and lower eGFR. Specific metabolites played a role in distinguishing the risk clusters. Salicylate, 4-hydroxyphenylacetylglutamine, and 2,3-dihydroxyisovalerate in men and salicylate, sulfate of piperine metabolite C18H21NO3 (1), and piperine in women were the top 3 metabolites associated with distinct risk clusters.

Conclusion

We identified sex-specific cluster of metabolites characterizing varying HF risk in general population. Each cluster exhibited a unique cardiovascular profile, carrying the potential to improve HF risk management. Survival plot
Comprehensive cardiac rehabilitation in elderly patients with heart failure: age is just a number?
Authors: Adiwinata S , Poetra B , Lampus N S , Joseph V F F , Jim E L , Rampengan S H
Published: June 2024

Background

Growth of older population leads to a high burden of cardiac disease, geriatric syndrome and other comorbidities. Cardiac rehabilitation (CR) is a personalized complex secondary prevention program which improves exercise tolerance, psychological well-being and quality of life. Several studies reported the benefits of CR for several cardiovascular disease, including heart failure (HF), but unfortunately remains underutilized among older patients due to frailty and disability.

Purpose

This study aims to assess the clinical impact of comprehensive phase II CR program among older ((≥60 years) patients with HF.

Methods

This was a prospective study which enrolled 41 patients with HF who have completed 8 supervised CR session, 2 times per week, which consisted of psychological, diet and nutritional counselling, stretching, moderate intensity aerobic and resistance training with heart rate calculated using the Karvonen formula and intensity of 12 to 13 on the Borg Scale as a threshold. The data of medical history including co-morbidities, cardiovascular risk factors and lifestyle were collected. We compared and analysed changes after CR program in metabolic profile (body mass index, lipid, uric acid and A1C profile), autonomic nervous system function (resting heart rate), and quality of life (physical and emotional components) which assessed with Minnesota living with HF questionnaire (MLHFQ). Analysis was done using Statistical Package for the Social Sciences (SPSS) v.22 (IBM-corps, Armonk NY) software. Qualitative variables were compared by chi-square test. Paired sample T-Test was using to compare quantitative variables before and after CR program.

Results

Among 41 patients, there were 18 (44%) older patients and 12 (67%) were males. This study showed significant reductions in older patient’s LDL cholesterol level (126.06±25.9 vs 93.61±17.23, p<0.001). Post training data showed improvement in older patient’s exercise capacity (313.7±72.3 METs vs 385.3±65.3 METs, p<0.001), quality of life which consist of physical component (34.3±1.5 points vs 18.5±1.5 points, p<0.001), emotional component (6.8±1.2 vs 5.17±0.8, p=0.001) and lower resting heart rate (67.3±9.1 vs 63.7±6.9, p=0.141). There were not reported any adverse events in this study.

Conclusions

Elderly patients with HF get benefit from CR program, similarly to younger patients. Under-enrolled of CR in elderly patients remains entrenched. Repeatedly encouragement and individualized exercise prescription must be given to increase the CR enrollment and implementation. Baseline Characteristics of the Study  Comparison of Changes within-group
Addressing educational disparities in hypertension: the unmet needs of older women in VR and traditional learning environments
Authors: Jiravska Godula B , Jiravsky O , Matheislova G
Published: June 2024

Background

Hypertension management is challenged by poor patient education adherence. This randomized study compared traditional physician-led education with virtual reality (VR) education for hypertension, assessing their impact on knowledge retention and satisfaction.

Methods

In this trial, 182 hypertensive patients were assigned to receive either traditional education (n=88) or VR education (n=94) using Oculus Quest 2 headsets. A 29-item questionnaire evaluated knowledge post-intervention. Participants were categorized into low (Q1) and medium-high (Q2-Q4) responders based on their scores.

Results

VR education showed a statistically significant higher median objective score (14 IQR 3) compared to traditional education (10 IQR 5). Subjective satisfaction was similarly high in both groups. Notably, low responders had a higher prevalence of older women (57% vs. 40% female; median age 68 vs. 65 years), highlighting a demographic disparity in educational outcomes.0

Conclusion

VR education surpasses traditional methods in knowledge acquisition for hypertension. However, the contrast between subjective satisfaction and objective knowledge retention, especially among older women, underscores the need for tailored educational strategies in this demographic. These findings emphasize the necessity of addressing educational disparities to improve hypertension management in vulnerable groups.
Obesity and underweight in children who undergo catheterization for congenital heart disease: a retrospective study
Authors: Anagnostopoulou A , Eleftherakis N G , Karanasios E S
Published: June 2024

Background

Τhe number of overweight and obesity in the pediatric population has increased dramatically, a trend that is followed by a corresponding increase in the pediatric population with congenital heart disease. Notwithstanding , children with congenital heart disease seem to follow abnormal growth patterns. The aim of the present study is to determine the prevalence of obesity and underweight in children who undergo cardiac catheterization.

Methodology

This is a retrospective study conducted in the cardiac catheterization laboratory of a large pediatric hospital. in the years 2011-2019. The children’s anthropometric data were collected and the body mass index was calculated, according to the Centers for Diseases Control and Prevention definition. The chi -square test was used to identify any associations between catheterization, heart disease, body habitus, sex and age groups, after which a one way analysis of variance was performed to investigate the effects of the above variables on obesity.

Results

The participants included 378 children from 2 to19 years old who underwent cardiac catheterization in the years 2011-2019. Cumulatively, 18.7% of the children in the study were underweight, 54.76% were normal weight, 11.64% were overweight and 14.81% were children classified as with obesity. Overall, 26.45% of the children weighed more than the 85th centile. The Kolmogorov Smirnoff test was used to test form normality and only the height in cms had a normal distribution.

Children with acyanotic heart disease had a mean median age of 8 years old (IQR 6 years). The percentages of underweight were 16.6%, the ones with healthy weight 53.58%, 12.08% overweight and 17.47% with obesity. Children with cyanotic heart disease had a mean median age of 6.51 6 years (IQR 6) while the respective percentages of underweight, healthy weight, overweight and with obesity were 27.7%, 56.63%, 9.05% and 6.02%. These differences were statistically significant. However, the children who underwent a catheterization for other causes had a median age of 8 years old (IQR 8) and their percentages of underweight were 13.3%, the ones with healthy weight 60% and the ones with overweight or obesity 13.3% each.

Conclusions

There is a significant discrepancy in the rate of obesity between the children with acyanotic and cyanotic heart disease. However, the differences between the children with acyanotic heart disease and children who underwent cardiac catheterization for other causes is not statistically significant.
Real-life data on the empowerment of cardiac patients undergoing rehabilitation by using educational videos
Authors: Mayer Hren P , Tasic J
Published: June 2024

Background/Introduction

Active patient involvement in the rehabilitation process improves clinical outcomes. Empowered patients are more motivated during and after cardiac rehabilitation, regularly take their medication, and follow the recommendations given by medical professionals. Active involvement and participation increase patient’s active role in managing their health and rehabilitation process. Patients undergoing cardiac rehabilitation may benefit from short educational videos sent by the rehabilitation center, enabling them to take a more active role in the empowerment process.

Purpose

To acknowledge patients’ active role in the empowerment process.

Methods

31 consecutive cardiac patients involved in cardiac rehabilitation received 19 different short educational videos via emails during the whole duration of the second phase of the rehabilitation. The videos included information about risk factors, exercise, diet, smoking, traveling, and sexuality. After receiving all the educational videos, we investigated the number of patients who watched them and how the proportion of views changed over the course of six weeks. We utilized a combination of follow-up methods, including automatic return emails and telephone calls.

Results

A total of 31 patients, 5 women and 26 men, involved in cardiac rehabilitation were included in the pilot study. The mean age of the participants was 57 years. Among the 31 patients, 29 had coronary heart disease, 1 was with heart failure, and 1 with hypertensive heart disease. Out of 31 patients, 9 (29 %) watched all educational videos, 12 (39 %) watched some, and 10(32 %) did not watch any. Watching of the videos decreased over time, with the first videos being the most watched, but the number of views declined in the following weeks. However, 95% of the patients who watched at least some of the videos found the provided information useful, while 63% of the patients reported that they gained new knowledge from the videos. Additionally, 95% of the surveyed patients would recommend the videos to other patients involved in cardiac rehabilitation. Patients with higher education levels tended to watch more educational videos. Still, patients with medical backgrounds did not find the videos interesting due to their belief that they had all the necessary knowledge.

Conclusion(s)

Patients involved in cardiac rehabilitation benefit from watching short educational videos thus increasing their active role in the rehabilitation process. All the patients in the rehabilitation center received the same educational materials, information, and support from healthcare workers. However, the success of the empowerment process primarily depends on the patient's inner motivation, regardless of the educational opportunities they are given.
Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: a systematic review and meta-analysis
Authors: Christou G , Christou M , Davos C , Markozannes G , Christou K , Mantzoukas S , Christodoulou D , Kiortsis D , Christou P , Tigas S , Nikoletou D
Published: June 2024

Background

The benefit of an exercise programme in heart failure (HF) patients undergoing cardiac rehabilitation is most commonly assessed through measurement of serial changes in peak oxygen uptake (VO2peak), whereas oxygen uptake at the first ventilatory threshold (VO2VT1) has not been widely applied as an end point of efficacy of cardiac rehabilitation in routine clinical practice.

Purpose

This systematic review and meta-analysis aims to explore in HF patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation: 1) the comparison of temporal changes between VO2peak and VO2VT1, 2) the association of VO2peak and VO2VT1 changes with physiological factors and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1.

Methods

A systematic literature search was conducted in PubMed, CENTRAL, and Scopus. Inclusion criteria: 1) original research articles using exercise-based cardiac rehabilitation, 2) stable HF patients with reduced EF, 3) available values of VO2peak and VO2VT1 (in mL/kg/min) for both baseline and after exercise training with comparison between these time points.

Results

Among the 30 eligible trials, 24 used CAE, 5 IT and one CAE and IT. Multivariable meta-regression with duration of exercise training and percentage of males as independent variables and the change in VO2peak as dependent variable showed that the change in VO2peak was negatively associated with duration of exercise training (coefficient= -0.061, p=0.027), implying the possible existence of a waning effect of exercise training on VO2peak in the long term. Multivariable meta-regression demonstrated that both age (coefficient= -0.140, p<0.001) and EF (coefficient=0.149, p<0.001) could predict the change in VO2VT1, whereas only age (coefficient= -0.095, p=0.022), but not EF (coefficient=0.082, p=0.100) could predict the change in VO2peak. The post-training peak respiratory exchange ratio, as an index of maximum effort during exercise testing, correlated positively with the change in VO2peak (coefficient=0.021, p=0.044). The exercise-induced changes of VO2peak (p=0.438) and VO2VT1 (p=0.474) did not differ between CAE and IT.

Conclusions

The improvement of endurance capacity during cardiac rehabilitation may be detected more accurately with the assessment of VO2VT1 rather than VO2peak, since the exercise training-induced change in VO2peak was greatly influenced by the level of maximum effort at post-training exercise testing and slightly waned in the long term of cardiac rehabilitation, as opposed to a more sustained or even gradually augmented improvement of VO2VT1 during the whole process of cardiac rehabilitation. Graphical Abstract
Chronotropic index, heart rate and exercise capacity in diabetes mellitus: comparing two different high-intensity interval training protocols
Authors: Bozdemir Ozel C , Arikan H , Calik Kutukcu E , Durukan B N , Inal Ince D , Kabakci G , Dagdelen S
Published: June 2024

Background

The chronotropic response is associated with a higher risk of cardiovascular disease and exercise intolerance. It has been reported that poor glycemic control and low exercise capacity are associated with chronotropic insufficiency in type 2 diabetes mellitus (T2DM) patients. The effects of different high-intensity interval training (HIIT) protocols on the chronotropic index, heart rate, and exercise capacity are not apparent in the literature.

Purpose

The aim of study was to compare the effects of different HIIT protocols on the chronotropic index, heart rate, and exercise capacity.

Methods

Thirty individuals with T2DM patients (27F, 3M) participated in this study. Demographic and laboratory values were recorded. Exercise capacity was evaluated using an incremental symptom-limited maximal exercise test on a bicycle ergometer. Heart rate, blood pressure, and perceived exertion were assessed. In addition, the peak heart rate and workload reached by the patients were recorded during the test. Abnormal heart rate and chronotropic index were calculated. The patients were divided into two groups according to randomization. The first group was trained with the short-interval HIIT protocol (SI-HIIT) (30 s x 4, Workload peak 100%), and the second group was trained with the long-interval HIIT protocol (LI-HIIT) (4 min x 4, Workload peak 85%) three times a week for eight weeks.

Results

The ratio of patients having chronotropic insufficiency (<0.80) decreased in SI-HIIT (before 60% vs. after 33.3%; p = 0.42) and LI-HIIT (before 47.7% vs. after 40.8%; p = 0.035) with HIIT training. After training, the peak workload achieved during the cycling test increased within each group (p<0.05). The resting heart rate decreased in both groups compared to baseline (p<0.05). The ratio of patients having chronotropic insufficiency, the ratio of patients having abnormal heart rate peak workload achieved during a cycling test, and resting heart rate were similar between the two groups after training (p > 0.05)

Conclusion

Chronotropic index and resting heart rate improve with HIIT in T2DM. A time-efficient protocol should be chosen to restore cardiac autonomic responses in T2DM, as SI-HIIT and LI-HIIT have similar effects on cardiac function.
Effect of home-based prehabilitation on objectively measured physical activity in patients undergoing elective major cardiac and non-cardiac surgery. Data from a randomized controlled trial
Authors: Vetsch T , Engel D , Beilstein C M , Wuethrich P Y , Eser P , Wilhelm M
Published: June 2024

Background

Low functional capacity in patients undergoing major elective surgery is associated with postoperative complications. Prehabilitation aims to increase functional capacity by increasing preoperative physical activity. Low functional capacity in patients eligible for major surgery is associated with high age and comorbid burden. In this population, center-based prehabilitation is a barrier for participation. Therefore, we developed a multimodal home-based prehabilitation intervention. Data regarding the effectiveness of a home-based prehabilitation intervention to increase physical activity before surgery is limited. We hypothesize that home-based prehabilitation leads to an increase in physical activity in patients undergoing major cardiac and non-cardiac surgery.

Methods

We included patients aged over 65 with a proven low functional capacity and/or ventilatory efficiency measured by preoperative cardiopulmonary exercise testing. Patients were randomized to either standard of care or intervention. The intervention group received a home-based prehabilitation intervention 2-4 weeks before surgery. As part of the multimodal intervention, patients were prescribed a walking regimen according to the physical activity guidelines published by the World Health Organization (WHO). Patients were followed-up with weekly telephone calls by a physiotherapist to increase adherence and motivation. All patients were provided a wrist-worn tri-axial accelerometer at the baseline visit. The accelerometer was collected at the ward once the patient entered the hospital for surgery. Physical activity was estimated by calculating the average Euclidean norm minus one (ENMO, milligravity [mg]) per day. Baseline characteristics were tested by Wilcoxon rank-sum test and a linear model for the primary outcome was performed to adjust for confounders. Data analysis was performed using R Studio.

Results

37 patients scheduled for cardiac and 62 for non-cardiac surgery were included (Table 1).

Mean group difference of daily physical activity levels in non-cardiac surgery patients was 3.01 mg (p = 0.03, 95% CI [0.3, 5.6]). Mean group difference of daily physical activity levels in cardiac surgery patients was 0.27 mg (p = 0.95, 95% CI [-4.1, 5.0]) (Figure 1). Patients undergoing cardiac surgery had higher overall activity levels compared to non-cardiac also when adjusted for age.

Conclusion

Home-based prehabilitation increases preoperative physical activity levels in patients undergoing major non-cardiac surgery, but not in patients undergoing major cardiac surgery. Higher activity levels in cardiac surgery patients was unexpected, but may be explained by previous inclusion of patients with cardiac diseases in exercise-based rehabilitation and physical activity recommendations at routine cardiac follow-up visits. Table 1  Figure 1
Effect of exercise training on cardiac reserve in heart failure with preserved ejection fraction: a substudy from OptimEx-CLIN
Authors: Gevaert A B , Winzer E B , Mueller S , De Schutter S , Beckers P J , Hommel J , Linke A , Wisloff U , Adams V , Pieske B , Halle M , Van Craenenbroeck E M , Van De Heyning C M
Published: June 2024

Aims

Supervised exercise training improves aerobic capacity (V̇O2peak) in patients with heart failure and preserved ejection fraction (HFpEF), but underlying mechanisms remain unclear. We aimed to evaluate whether exercise training could improve parameters of systolic and diastolic function assessed during exercise echocardiography.

Methods

This was a substudy of the multicentre Optimizing Exercise Training in HFpEF (OptimEx-Clin) trial, in which patients with HFpEF were randomized 1:1:1 to guideline control, moderate continuous training, or high intensity interval training. All patients included at 2 centres had exercise echocardiography at baseline and 3 months and were included (n=61).

Results

During baseline exercise echocardiography, E/e’ increased to 19.5 ±6.1 and systolic pulmonary artery pressure (PAPs) to 51 ±11 mmHg (both p<.001). Right ventricular function failed to improve (maximal tricuspid annular plane systolic excursion [TAPSE] 24.7 ±4.0 mm, p=.051 vs baseline; maximal TAPSE/PAPs 0.49 ±0.14 mm/mmHg, p<.001 for decrease vs baseline).

At 3 months, patients randomized to exercise training improved V̇O2peak, and demonstrated small but significant improvements in exercise E/e’ (control 21.7 ± 7.4, training 17.2 ±4.1, p-interaction=.044, Figure) and septal S’ reserve (control 27 ±22 % increase, training 36 ±38 % increase, p-interaction=.034). Echocardiographic changes were not significantly associated with V̇O2peak or training response.

Conclusions

In patients with HFpEF, exercise echocardiography reveals increases in filling pressures during exercise as well as impaired right ventricular reserve. After 3 months of exercise training, HFpEF patients demonstrate small improvements in diastolic reserve (exercise E/e’) and systolic reserve (exercise S’), but these do not explain the improved aerobic capacity. Figure
Long-term exercise program in cardiovascular patients: the impact on quality of life
Authors: Gregorio C , Cravo J , Abrantes A , Martins A M , Garcia A B , Azaredo Raposo M , Bartolo P , Pinto R , Borges M , Lemos Pires M , Sa G , Cunha N , Aguiar-Ricardo I , Pinto F J , Abreu A
Published: June 2024

Introduction

The benefits of Phase 2 cardiac rehabilitation is well-established in terms of improving functional capacity, quality of life, and even prognosis. The impact of a long-term exercise program is less established.

Purpose

To assess the impact of a maintenance exercise program after Phase 2 of cardiac rehabilitation on quality of life.

Methods

A single-center cohort study was conducted, involving patients (pts) who completed a phase 2 CR program at least 6 months prior to the study and answered the 36-Item Short Form Survey (SF-36) telephonically. The participants were categorized into 2 groups based on their progression to phase 3 programs: Group 1, comprising those who continued exercising in a specialized cardiac rehabilitation center or local gym, and Group 2, encompassing those engaging in any form of exercise. Scores were assigned to eight health domains, and overall scores were compared between the two groups.

Results

A total of 110 pts were included (78% male; mean age of 61.5 ± 11 years). They were initially referred for ischemic heart disease (86%). Regarding clinical data, 59% had hypertension, 10% were diabetic, 79% had dyslipidemia and 20% were smokers. Regarding progression to Phase 3 of CR, 51% of pts maintained physical exercise (group 1).

When analyzing each of the eight domains of health, the group 1 had a higher overall score on the following domains: functional capacity (90±14 vs 85±25, p=0.014); bodily pain (100±0 vs 100±25), p=0.026); vitality (68±15 vs 61±16, p=0.021) and mental health (88±12 vs 80±20, p=0.013). Additionally, we noted a tendency for higher scores in the remaining domains, although not statistically significant.

Subgroup analysis of ischemic pts showed similar results in functional capacity (p=0.017), bodily pain (p=0.009) and vitality (p=0.025). These results were independent of gender and body mass index.

Conclusion

Our study highlights the importance of maintaining a physical exercise program after phase 2 of cardiac rehabilitation in terms of quality of life, particularly in domains crucial to daily functioning and mental well-being.
Predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization
Authors: Tiksnadi B B , Marita I , Najiyah H H , Astuti A W , Sastradimaja S B
Published: June 2024

Background

Functional capacity improvement becomes a target therapy after cardiac rehabilitation (CR) program that may improve outcome beyond the quality of life. We aimed to assess the predictors of functional capacity improvement after CR program following coronary revascularization.

Methods

This was a retrospective cohort study included all revascularized CAD patients who underwent CR program phase II, 4-8 weeks (twice weekly), 6–12 sessions, moderate intensity aerobic exercises (ergocycle and/or treadmill) from January 2019–July 2023 in a tertiary hospital. The patient's functional capacity (METs) calculated at maximal stress test prior and after the program. Univariate and multivariate analysis was performed using chi-square and logistic regression analysis, respectively.

Results

A total of 377 patients enrolled, 132 patients completed CR program, 103 patients with complete data [mean age was 56.5±9.4, and 91.2% men] were included in this study. The mean METs prior and after procedure were 9.2±2.6 and 10.05±2.6, respectively. The mean improvement was 0.87±1.95. Of 103 participants, METs was improved in 80 patients (77,6%). Univariate analysis revealed that completeness of exercise program (80.58%), hypertension (40.77%), diabetes mellitus (DM) (31.06%), were significantly associated with METS improvement, while obesity (31.06%) and HFrEF(19.4%) had inversely associated. Other variables including age, sex, smoking, depression, and type of revascularization were not substantially linked. Multivariate analysis showed obesity [OR=0.261 (CI=0.081–0.841) ;p-value=0.024], completeness of exercise program [OR=5.223 (CI=1.472–18.53) ;p-value=0,011], DM [OR=4.98 (CI=1.13–21.90) ;p-value=0,033] and HFrEF [OR=0.234 (CI=0.063–0.87) ;p-value=0,03] were substantially linked with METS improvement.

Conclusion

Completeness of exercise program, obesity, DM and HFrEF were an independent predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization. Baseline Characteristics.  Univariate and multivariate analysis.
Is cardiac rehabilitation useful in our older population?
Authors: Iglesias Colino E , Merchan Gomez S , De Tapia Majado B , Martin Herrero F , Oterino Manzanas A , Velasco Canedo M , Oreja Sanchez C , Gonzalez Abarquero E , Olazar Pardeiro M A , Braccho D , Sanchez Fernandez P L
Published: June 2024

Introduction

Cardiac rehabilitation programs (CRP) are recommended in patients with heart failure and ischemic heart disease with a class I indication. Nevertheless, we know only one third of these patients undertake them, mainly because it’s a limited resource and not available in all centers. In some centers, for this reason, it’s limited to younger patients, in which we could expect a greater benefit. Moreover, older age has been identified as an obstacle for patients to attend these programs.

Purpose

To compare the results of the senior patients (defined as 70 years old or older) in our center to our general results.

Methods

A retrospective analysis of our patients before and after cardiac rehabilitation program was made comparing both groups using SPSS Statistics v23.

Results

Both groups had similar characteristics before the program, except for active smoking, which was significantly more frequent in patients younger than 70, and arterial hypertension which was more frequent in patients over 70.

Several parameters were analyzed in our population before and after CRP in all patients, and in our patients aged 70 or older.

In the first analysis, significant differences were obtained in overweight, glycemic and lipid control, NTproBNP reduction and LVEF. Moreover, the was a significant improvement in functional capacity, quality of life (measured by SF-36 scale) and anxiety.

When analyzing only our senior patients, we observed improvement in most of anthropometric, functional and quality of live parameters, and lab results, even though, probably due to a lower sample, these were only significant in BMI, HbA1c, LDL, NTproBNP, LVEF, functional capacity and quality of life measured by SF-36.

Conclusions

CRP improves clinical, analytical, and functional parameters, and is clearly beneficial in patients of 70 years or more. Therefore, they should be offered to perform it with the same indications as younger patients. Unfortunately, these patients’ assistance is also limited by usually further from hospital residence (rural population) and a frequent caregiver role and might need a higher support in order to assure their enrollment in these programs.
Exercise-based cardiac rehabilitation for patients with atrial fibrillation receiving catheter ablation: associations with long-term clinical outcomes
Authors: Fitzhugh C , Jones H , Foweather L , Lip G Y H , Buckley B J R
Published: June 2024

Background

Catheter ablation is an effective treatment for symptomatic atrial fibrillation (AF) and has superiority over drug treatments. Emerging evidence suggests that exercise-based cardiac rehabilitation (ExCR) can improve the health outcomes of people with AF, but the long-term impact of ExCR on clinical endpoints for patients with AF following catheter ablation is unclear. We investigated 12-month all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction in patients with AF receiving catheter ablation and ExCR versus matched controls receiving catheter ablation only.

Methods and Results

A propensity-matched cohort study was conducted using electronic medical records from a global federated health research network. Patients with AF who received catheter ablation and ExCR were propensity-score matched for age, sex, ethnicity, comorbidities, cardiovascular procedures, and cardiovascular medication with patients with AF who received catheter ablation only.

Using logistic regression, 12-month incidence of all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction were compared. In 6510 AF patients (mean age 66, SD; 11, 26.3% female) who had received catheter ablation, ExCR was associated with lower all-cause mortality (OR 0.73; 95% CI, 0.59-0.92) and hospitalisations (OR 0.77; 95% CI, 0.69-0.85) when compared with propensity-score matched controls. No significant associations were shown for ischaemic stroke (OR 0.88; 95% CI, 0.62-1.25) or myocardial infarction (OR 0.89; 95% CI, 0.67-1.20). Secondary analysis of AF progression from paroxysmal to sustained AF at 12-month follow-up demonstrated proportionally lower AF progression with 10% in the ExCR cohort compared to 15% in the catheter ablation cohort (OR 0.62, 95% CI: 0.56- 0.68).

Conclusions

ExCR in patients with AF who received catheter ablation associated with lower all-cause mortality and hospitalisation at 12-month follow-up compared to those who received catheter ablation alone, as well as less AF progression from paroxysmal to sustained AF at 12-month follow-up.