bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of heart failure in type 2 diabetes by exercise intervention: protocol and design of the PROTECTION study
Authors: Michielsen M , Gojevic T , De Craemer M , Claessen G , Cornelissen V , Hansen D
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): research Foundation - Flanders (FWO)

Introduction

Cardiac dysfunction is highly prevalent in patients with type 2 diabetes mellitus (T2DM), leading to increased risk of cardiac morbidity and premature death. Previous research underscored the high prevalence of a disturbed global longitudinal strain (GLS), a marker to predict this cardiac dysfunction, in both symptomatic and asymptomatic T2DM patients. Exercise-based therapy is recommended in the management of patients with type 2 diabetes. However, it remains unclear i) which type of exercise therapy to have the biggest effect on GLS and ii) which factors modify the effect of exercise therapy on GLS.

Purpose

The PROTECTION study will i) investigate the impact of exercise volume and intensity on GLS to optimize exercise prescription in T2DM and will ii) assess which patient-specific factors influence the change in GLS and physical fitness as a result of exercise intervention in T2DM.

Methods and analyses

The PROTECTION study is composed of two work packages (WP). In WP 1, 100 T2DM adults (50% male, aged 30-75 years) will be randomized to a usual care group or one of the three supervised exercise intervention groups (see Table 1) for a duration of 26 weeks. Outcome measures will be performed at baseline, 13, 26 and 52 weeks of follow-up. The primary outcomes are GLS and cardiac dimensions. Secondary outcomes include health-related physical fitness, blood biomarkers and physical activity behavior. Data will be analyzed by two-way ANOVA repeated measures. A two-tailed P-value <0.05 will be considered statistically significant.

Parallel with the randomized controlled trial, a longitudinal intervention study (WP2) involving 107 adults (50% male, aged 30-75 years) with T2DM will be conducted. All participants will engage in a supervised intervention for 26 weeks, including a high volume of moderate intense physical activity (see Table 1). The main objective of this work package is to define determinants of change in GLS during an exercise intervention. Moreover, the interaction between diet-exercise, habitual physical activity-exercise and phenotype-exercise on change in GLS will be studied in great detail. Patient-specific data will be analyzed by multivariate regression analysis. A two-tailed P-value <0.05 will be considered statistically significant.

Conclusion

It is anticipated that the PROTECTION study will contribute to a better understanding on i) which exercise characteristics are preferred to maximally improve GLS in T2DM and on ii) the determinants of the responsiveness of GLS and physical fitness to exercise in T2DM.
Coronary computed tomography angiography improves coronary risk prediction in general population
Authors: Vilades D , Degano IR , Subirana I , Descalzo M , Padilla M , Mundet X , Carreras F , Alomar X , Camps-Vilaro A , Elosua R , Marrugat J , Leta R
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute and the European Regional Development FundAgency for Management of University and Research Grants

Introduction

In the next decades, it is expected an increasing incidence of acute coronary syndrome in the Spanish population. Identify high-risk patients could be the most cost-effective way to reduce its incidence and morbi-mortality burden. We studied the effect of adding coronary artery calcification (CAC) and the extent of atherosclerotic disease (SIS score) to classical cardiovascular (CV) risk factors in coronary risk prediction.

Methods

This was a prospective cohort study of 325 asymptomatic patients recruited between 2013-2017. Demographic characteristics and CV risk factors were obtained and all participants underwent a coronary computed tomography angiography exam in which CAC and SIS were determined. The cohort was followed-up (median= 4 years) for a composite endpoint that included CV death, myocardial infarction, coronary angiography and/or revascularization. Improvement in discrimination and in reclassification by the inclusion of CAC/SIS in the Framingham-REGICOR function were examined with the Sommer's D index and with the Net reclassification index (NRI) (categorical and continuous), respectively.

Results

Nine of the 251 individuals included in the study had an event in the follow-up. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0. These participants had no events. The addition of SIS or of SIS and CAC scores to the Framigham-REGICOR risk function increased significantly the discrimination capacity from 0.71 to 0.88 (Table 1). Reclassification measured by the continuous NRI also improved significantly from 69.5 to 112.4/115.5 when SIS or both scores were included (Table 2).

Conclusions

CAC and SIS scores were associated to 4-year CV event incidence, independently of coronary risk estimation. Discrimination and reclassification of the Framigham-REGICOR coronary function were significantly improved by both indexes, but SIS overrode the effect of CAC.
Relationship of 5-year changes in inflammatory, metabolic and oxidative biomarkers with cardiovascular diseases incidence at 10-years
Authors: Camps-Vilaro A , Subirana I , Fito M , Ramos R , R Degano I , Marrugat J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Carlos III Health Institute and the European Regional Development Fund Government of Catalonia through the Agency for Management of University and Research Grants

Background

Early stratification of cardiovascular (CV) risk saves thousands of lives every year. There is a debate about the value of determining genetic or plasma biochemical biomarkers, related to atherosclerosis process, to improve the prediction of an incident CV disease. While, single measurements of some of these biomarkers have been associated with an increased risk of CV disease, the change of the levels of these biomarkers over time could also improve the prediction of CV events and drive the identification of new biological pathways and therapeutic targets.

Purpose

This study aimed to examine the relationship between 5-year change in the levels of biomarkers of inflammation (TNF-α, IL-10, IL-6, MCP-1, and CRP), glucidic metabolism (adiponectin, leptin, and insulin) and oxidation (GHS-Px), and the incidence of CV events at 10 years in a population without previous CV disease.

Methods

This was a cohort study nested in a large population cohort. Participants were randomly selected from the REGICOR cohort (North-Eastern Spain) recruited in 2005 (6.352 participants). Biomarkers were measured at baseline and in a re-examination in 2010. Participants were followed until 2020 for a composite CV disease endpoint including fatal and non-fatal first occurrence of coronary artery disease, stroke and peripheral artery disease. Baseline characteristics were compared between participants with and without CV events with standard parametric and non-parametric methods, as required. We used Cox regression to analyse the effect of the 5-year change of the biomarker levels on the occurrence of the composite endpoint adjusted for age, sex, baseline levels of each biomarker and classical CV risk factors.

Results

We included 419 individuals aged 35 to 74 years. Overall, 6.2% developed an incident CV disease within the 10-year follow-up. Characteristics of participants, who had or not a CV event, are compared in Table 1. Cases had a more adverse CV and anthropometric risk profile. Compared to individuals with sustained IL-6 and insulin levels, those with increased IL-6 or insulin after five years were at higher independent risk of CV disease at ten years. After adjusting for potential confounders, an increased IL-6 and insulin at the 5-year follow-up were independently associated with CV disease at 10-years (Table 2). Each rise of IL-6 or insulin in 1pg/mL or 10pg/mL, respectively, increased 32% (IL-6) and 2% (insulin) the risk of developing a CV event at 10-years.

Conclusions

Increasing IL-6 and insulin levels over five years indicates a higher risk of CV disease ten years thereafter, independently of classical risk factors.
Prognostic role of advanced retinopathy of vascular etiology in coronary artery disease in very long-term follow-up
Authors: Aguila Gordo D , Marina Breysse M , Piqueras Flores J , Mateo Gomez C , Cubides Novoa AF , Soto Perez M , Negreira Caamano M , Munoz Garcia M , Arizon Munoz JM , Salas Bravo D , Martinez Del Rio J , Moron Alguacil A , Blanco Lopez E , Soto Martin P
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although an association between some forms of vascular retinopathy and cardiovascular disease has been described, its predictive role in ischemic heart disease has not been sufficiently clarified.

Methods

Prospective cohort of 107 patients with medical indication for coronary angiography who underwent funduscopic examination to assess the presence of retinopathy. We recorded the occurrence of new acute coronary syndromes, the detection of perfusion defects in ischemia tests, the need for new catheterization and revascularization, and hospital readmission for cardiovascular causes with a median follow-up of 10 years.

Results

The median age was 67 years. A total of 39.3% were women, and 91.2% presented some cardiovascular risk factor, the most frequent being arterial hypertension in 78.5%, followed by dyslipidemia in 57% and diabetes in 32.7%. At the start of follow-up, 84.1% had some type of vascular retinopathy, with 46.3% of patients having high-grade retinopathy. In coronary angiography, up to 55% presented significant coronary artery disease, and angioplasty was performed in 39% of cases. During follow-up, only 2.9% of patients suffered ACS, 15% presented pathological myocardial SPECT, up to 14% underwent a new coronary angiography and 6.5% required new myocardial revascularization. The presence of advanced vascular retinopathy was associated with a higher rate of defects on Tc99 perfusion scintigraphy (p=0.002); a higher rate of coronary angiography (p=0.001) and myocardial revascularization (p=0.045). In addition, in the survival analysis, ischemia development was observed in earlier SPECT (103.13±4 vs 116.3±1.9 p=0.01), as well as earlier myocardial revascularization (109.72±3.5 vs 118.8±0.1 p=0.03) than in the rest of patients.

Conclusions

High-grade vascular retinopathy is associated with more and earlier inducible ischemia as well as more need for revascularization. The performance of fundus imaging in patients with suspected ischemic heart disease may be useful for long-term stratification.
Cardiovascular risk scores and vascular age before and after concurrent exercise training in adults with schizophrenia: CORTEX-SP study
Authors: Maldonado-Martin S , Tous-Espelosin M , Iriarte-Yoller N , Sanchez PM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Economy and Competitiveness “Fondo de Investigación Sanitaria del Insti-tuto de Salud Carlos III”

Background

Individuals with schizophrenia (SP) have a greater risk for cardiometabolic risk factors, cardiovascular diseases and mortality. This risky profile may be explained by the adverse effects of antipsychotic medications and an unhealthy lifestyle (i.e., low physical activity, smoking and poor diet). In the general population, physical activity has been shown to be the optimal strategy to improve both cardiometabolic parameters and cardiorespiratory fitness levels. These findings strongly suggest that targeting a comprehensive approach that includes non-pharmacological interventions, such as exercise and/or cognitive rehabilitation, could be effective and beneficial in the evolution of the disease.

Purpose

To estimate cardiovascular risk factors (CVR) and vascular age (VA) profiles before and after a concurrent exercise training intervention in adults with schizophrenia.

Methods

Participants (n=97, 20.4% women, 41.3±10.0 yr old) with SP had their CVR and VA determined using the SCORE2, relative risk and the Framingham method (FHS). The participants were randomly assigned into a control group (usual care) or a supervised exercise group (concurrent training, 3 days/week, 20-weeks). The variables for the CVR determination were: age, systolic blood pressure (SBP), total cholesterol (TC), non high-density lipoprotein (non HDL-C) cholesterol, HDL-C, diabetes mellitus, antihypertensive medication, and smoking status.

Results

At baseline, exercise group presented lower values (P<0.05) compared to control group in SBP (113.4 vs. 120.5 mmHg), whereas in the rest of the values no significant between-groups differences were found (P>0.05). In accordance with guidelines on cardiovascular disease prevention, considering SCORE2, both groups were classified as low risk; but taking into account FHS and relative chart, were considered to have moderate risk. At follow-up, there was no overall change for either group and between groups in the magnitude of change in any of the studied variables.

Conclusion(s)

People with SP presented a moderate CVR. A comprehensive approach including not only exercise but also nutrition intervention could be more effective in managing CVR in this population.
It takes more than a coronary event to make me be physically active
Authors: Flammer F , Marques-Vidal P
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Background

Physical activity (PA) is indicated to prevent recurrence after a coronary event. Whereas patients increase their PA after a coronary event has seldom been assessed.

Methods

Data from a prospective study conducted in Switzerland. We assessed PA before and after a first coronary event: self-reported PA the last 4 weeks using data from the first (2009-2012) and second (2014-2017) follow-up, and accelerometry-assessed PA for 2 weeks using data from the second and the third (2018-2021) follow-up. Sedentary, light, moderate and vigorous PA were computed as percentage of daily activity and expressed as median and [interquartile range].

Results

For reported PA, data from 85 patients (34 women, 63±9 years) was used. No differences were found for all PA levels before and after the event (see table). Comparison with age- and gender-matched healthy controls (ratio 3 controls : 1 case) showed no differences regarding trends in reported PA (not shown). For accelerometry-assessed PA, data from 34 patients (17 women, 66±9 years) was used. Again, no differences were found for all PA levels before and after the event (see table).

Conclusion

Patients do not seem to change their PA levels after a first coronary event. Our results should be confirmed in larger samples.
Meta-analysis of randomized controlled trials examining the safety and efficacy of bempedoic acid
Authors: Borgatta L , Sturts A , Zaman N , Grewal S , Nudy M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Bempedoic acid (BA), an inhibitor of ATP citrate lyase, has emerged as a new therapy for patients with dyslipidemia. The objective of this study was to perform a meta-analysis of BA's safety and cholesterol lowering efficacy.

Methods

A meta-analysis was performed using RCTs testing the safety and efficacy of BA versus placebo. The primary analysis calculated the odds ratio (OR) and 95% confidence interval (CI) of any adverse events, muscular-related AEs including myopathy, muscle weakness, and myalgias, as well as serious AEs as self-defined by the individual RCT. Additionally, we evaluated the mean difference (MD) and CI of low density lipoprotein-cholesterol (LDL-C), non-high density lipoprotein-cholesterol (non-HDL-C), total cholesterol (TC), and apolipoprotein B (ApoB) at 12 weeks, as well as LDL-C at 24 weeks of BA use as compared to placebo.

Results

Four RCTs were identified comparing BA to placebo. There was no increased risk of any AE [OR 1.04; 95%CI 0.89, 1.22], serious AE [OR 1.07; 95%CI 0.87, 1.34], or muscular-related AE [OR 1.25; 95%CI 0.98, 1.58] with BA use compared to placebo. BA resulted in a significant reduction in LDL-C [MD -21.06; 95%CI -24.49, -17.62], TC [MD -16.02; 95%CI -19.09, -12.93], non-HDL-C [MD -17.84; 95%CI -21.34, -14.34], and ApoB [MD -14.19; 95%CI -17.18, -11.21] at 12 weeks, and LDL-C at 24 weeks [MD -16.42; 95%CI -18.15, -14.69] compared to placebo.

Conclusion

In this meta-analysis testing BA versus placebo, BA significantly reduced levels of LDL-C, TC, non-HDL-C, and ApoB at 12 weeks and LDL-C at 24 weeks, and was not associated with an increased risk of any AE, muscular-related AE or serious AE. Further studies with longer time of follow up are needed to confirm the safety and long term cholesterol effects of BA.
Should we be afraid of watching sport events?
Authors: Ferraz LM , Martins JL , Afreixo V , Carvalho P , Adrega T , Faustino A , Neves A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Behavioral and emotional factors may trigger cardiovascular events (CVE). Watching sports when there is an emotional connection between the supporters and the supportive team, is believed to be potentially associated with CVE. However, epidemiological studies have been inconsistent, with several studies showing an increase in CVE, while others reporting a protective effect.

Purpose

To assess the effect of watching sport events on the incidence of cardiovascular events.

Methods

Pubmed, and Embase were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant articles. To be included, articles had to assess the association between CVE and sport events supporters (adeptos). Pooled association measures, using random effects analysis, were calculated for mortality; arrhythmias; myocardial infarction (MI). Subgroup analysis was conducted based on gender. Publication bias and between-study heterogeneity were evaluated.

Results

There were nineteen studies included in the analysis. The pooled relative risks for mortality, arrhythmias and MI were 1.45(0.98-2.15; 95%CI; I2=70%; p=0.02); 1.31(0.98-1.77; 95%CI; I2=85%; p<0.01); 1.11(0.98-1.24; 95%CI; I2=91%; p<0.01) respectively (Figure 1A). The null association persisted in the subgroup analyses by gender for mortality (Figure 1B) as well as for MI and for the combined endpoint MI/stroke (non significant relative risks).

Conclusions

Overall this analysis suggests that watching sport events does not increase cardiovascular events regardless of gender.
Coronavirus-related stress, anxiety, and obsessive thinking in patients undergoing cardiac rehabilitation during the COVID19 pandemic
Authors: Jug B , Farkas Lainscak J , Sedlar N , Stojnic D , Lainscak M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency and Ministry of Health of the Republic of Slovenia

Background

The coronavirus (COVID19) pandemic has disrupted the provision of health care, including cardiac rehabilitation. Reduced healthcare provision has been associated with reduced accessibility, wheares patients’ perspectives – such as COVID19-related anxiety, stress and obsessive thinking – have been less thouroghly addressed.

Methods

This was a cross-sectional study of COVID19-related anxiety, stress and obsessive thinking in consecutive patients undergoing outpatient cardiac rehabilitation after myocardial infarction at two centres — a general hospital catering a predominantly rural area and a university hospital in an urban area. From April to October 2021 we captured patients’ clinical and socio-economic characteristics, and resposes to the Hospital Anxiety and Depression Scale (HADS) as well as to three dedicated COVID19-related questionnaires – the Coronavirus Anxiety Scale, the Obsession with COVID-19 Scale and a customized COVID-19 Stress Scale.

Results

We included 109 patients (mean age 59±10 years, 20% women). Fifteen (13.8%) and eleven (11%) patients reached a HADS treshold for depression and anxiety, respectively. Pateints expressed most concenrs regarding the safety of COVID19 vaccinces (60.6%) on the COVID19 Stress Scale, sleeping disturbances (14.8%) on the Coronavirus Anxiety Scale, and fear of interacting with infected people (30.3%) on the Obsession with COVID-19 Scale. No significant differences were observed between respondents from the general and the university hospital. HADS score and social status—but not age, sex and clinical characteristics—were associated with scores on the COVID-19-specific questionnaires; HADS-anxiety domain score remained an independent predictor of COVID19-related stress (p=0.009), obsessive thinking (p<0.001) and anxiety (p=0.009) after multivariate adjustment.

Conclusions

Patients undergoing cardiac rehabilitation expressed relatively low levels of COVID19-related stress and anxiety. Higher levels of COVID19-related stress, anxiety, and obsessive thinking were observed in patients with higher levels of anxiety, but not in association with demographic or clinical characteristics.
The effect of hemoglobin level on the prognostic value of peak exercise oxygen uptake differs between obese and non-obese patients with heart failure
Authors: Bhat S , Laffin L , Kondoleon N , Van Iterson E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Obesity and low hemoglobin content (Hgb <13 and <12 g/dL, men/women, respectively) are commonly observed in patients with heart failure and reduced ejection fraction (HFrEF). This overlap typically yields reductions in peak exercise oxygen uptake (V̇O2peak) which exceed those observed in both non-obese and obese patients exhibiting normal Hgb levels. However, when matched for body size, non-obese patients exhibiting low Hgb levels also demonstrate worse V̇O2peak impairment than normal Hgb level counterparts. To date, it is unclear whether the effect of Hgb level on V̇O2peak also affects the association between V̇O2peak and mortality risk in both non-obese and obese patients.

Purpose

To assess whether V̇O2peak that is predictive of mortality risk is directly impacted by Hgb level regardless of whether a patient is non-obese or obese.

Methods

Adults with HFrEF (n=346; LVEF ≤40%; 76% men) completed cardiopulmonary exercise testing (CPET) as part of routine clinical management. The majority of patients performed Naughton or Modified Naughton CPET protocols. Patients with a BMI ≥30 kg/m2 were classified as obese (n=135; 81% men). Patients were followed up to one-year for the endpoint of all-cause mortality.

Results

Age (63±7 vs 61±8 yrs), total body weight (77±13 vs 107±15 kg), BMI (25.2±3.0 vs 34.5±4.0 kg/m2), and Hgb (12.6±1.8 vs 13.1±1.8 g/dL) differed between non-obese and obese patients (all P<0.01), respectively. There were no significant differences between non-obese and obese patients for % men (73 vs 81 %), % ischemic etiology (46 vs 42 %), and LVEF (23±8 vs 24±9 % (all P>0.05), respectively. Peak exercise RER (1.13±0.12 vs 1.10±0.11), V̇O2peak (13.0±3.8 vs 11.9±3.3 mL/kg/min), and absolute V̇O2peak (1.01±0.37 vs 1.28±0.40 L/min) differed between non-obese and obese patients (all P<0.02), respectively. Over the 1-year tracking period, 25 and 13 deaths were observed and crude survival was 85% and 88% in non-obese and obese patients (Log-rank, P=0.465), respectively. In obese patients, V̇O2peak and Hgb interacted (χ2=4.855, P=0.028), resulting in up to a 22% reduction in all-cause mortality risk per 1.0 mL/kg/min rise in V̇O2peak for Hgb levels ≤13.1 g/dL. In non-obese patients, V̇O2peak and Hgb did not interact (χ2=0.001, P=0.977), and when Hgb was removed from the Cox regression, this resulted in up to a 29% reduction in all-cause mortality risk per 1.0 mL/kg/min rise in V̇O2peak (χ2=23.618, P<0.001).

Conclusion

Demonstrating low Hgb and V̇O2peak levels yields comparable effects on all-cause mortality risk in non-obese and obese patients. However, at normal Hgb levels, V̇O2peak loses prognostic value in the obese, suggesting for these patients other CPET variables should be used to complement V̇O2peak when CPET is built into risk stratification models.
Are there correlations between lung volume and exercise capacity in children and adolescents with native Ebstein's anomaly?
Authors: Hock J , Nagdyman N , Meierhofer C , Ewert P , Hager A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with Ebstein’s Anomaly (EA) represent a wide clinical range with patients needing surgery in infancy and others needing no surgery throughout life. Exercise capacity in EA is often impaired. However, lung function is rarely investigated.

Purpose

This study examines lung volumes in native EA and their correlation with exercise capacity.

Methods

This retrospective study investigated 35 children with native EA (14 ± 4 years, 17 female), who underwent a cardiopulmonary exercise test (CPET) including spirometry to examine peak oxygen uptake (peakV’O2), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and its ratio (FEV/FVC). Percentage in peakV’O2 <80% represents a reduced exercise capacity, and values <60% are defined as impaired. Z-scores below -1.64 categorize restrictive (FVC) or obstructive (FEV1/FVC) patterns. To analyse correlations between CPET and lung volumes Spearman’s rank test was performed.

Results

Reduced exercise capacity was found in 17 children (47%), and further seven (20%) children showed impaired exercise capacity. Seven patients (20%) had a restrictive lung volume pattern and three patients (9%) showed obstructive patterns. One patient showed both. Eleven (92%) patients with an impaired lung function had at least a reduced exercise capacity with a median of 64 [53;73] %predicted. Lung volumes correlate significantly with %peakV’O2 (z-FVC: r=0.500, p=0.002 and z-FEV1: r=0.443, p=0.008).

Conclusions

Most young patients with native EA have impaired results in exercise capacity and a third has reduced lung volumes. Low lung volumes correlate with worse exercise capacity. Thus, the lung function should also be taken into consideration when looking at the performance of these and medical aftercare.
Cardiac Optimal Point: Identifying high risk patients for an optimal approach
Authors: Brito J , Silva P , Aguiar-Ricardo I , Cunha N , Pinto R , Raposo M , Gregorio C , Sousa P , Caldeira E , Miguel S , Abreu A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values > 30 conveyed worse prognosis.

Purpose

To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term.

Methods

Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview.

Results

A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%).

A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p<0.001, r= 0.450) and on follow-up CPET (p= 0.39, r= 0.303).

COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP>30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size).

Conclusion

COP values > 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.
Comparison of inpatient and outpatient cardiac rehabilitation following myocardial infarction
Authors: Jankowski P , Topor-Madry R , Pinkas J , Gasior M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) following myocardial infarction (MI) improves prognosis. Models of second phase CR differ across countries. The aim of the study was to compare outcomes in MI survivors participating in outpatient and inpatient CR programmes.

Methods

We included all patients hospitalized due to acute MI in Poland between October 2017 and December 2018 (n=96634). Among them 4411 patients were referred to and commenced outpatient CR, whereas 11626 patients started inpatient CR within 30 days following discharge. All the patients were the subject of prospective follow-up. The primary endpoint was defined as death from any cause.

Results

The mean follow-up was 332.8±128.1 days. Younger age, male sex, and a cancer in the history were related to higher probability, whereas diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, and myocardial revascularization were related to lower probability of participation in the outpatient CR. Participation in outpatient CR was related to the risk of all-cause mortality both in univariable (hazard ratio [95% confidence intervals] 0.37 [0.26-0.51]) and multivariable analysis (0.53 [0.38-0.74]). Participation in the outpatient CR was also related to the lower risk of death or MI or stroke (0.57 [0.48-0.67] and 0.72 [0.61-0.84]) and a lower risk of death or hospitalization due to cardiovascular reasons: 0.78 (0.73-0.84) and 0.85 (0.80-0.91) for the univariable and multivariable analyses respectively. The analysis of propensity score matched groups confirmed the results.

Conclusion

Outpatient CR following MI may be related to improved prognosis compared to the inpatient programme.
Physical and psychological reconditioning in long covid syndrome patients: results of a structured physical exercise program
Authors: Palermi S , Compagno S , Pescatore V , Brugin E , Tegon G , Sarto M , Marin R , Calzavara V , Nizzetto M , Scevola M , Albertin C , Biffi A , Giada F
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatments of this syndrome is still poorly understood. In literature there is currently a lack of data on the real effectiveness of a multidisciplinary rehabilitation program based on structured physical exercise (SPE) in these patients.

Purpose

To evaluate safety, effectiveness and feasibility of a structured individualized rehabilitation program in improving physical and psychological parameters in patients with LCS.

Methods

Twenty-eight patients with LCS (19 males, mean age 57 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET), muscular strength assessment, quality of life (QoL), psychological assessment and counselling, before and after a 12-sessions SPE program.

Results

At baseline, all LCS patients showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during training session. After the rehabilitation program, significant improvement in CPET parameters, upper and lower limb muscular strength, perceived physical and mental health, body composition, depression and anxiety and Covid residual symptoms was observed.

Conclusions

The present study confirms severe impairment of patients with LCS and suggest that a multidisciplinary rehabilitation program based on SPE could promote their physical and psychological recovery.
Reduced psychological distress three months after intensive group-based cognitive therapy in cardiac patients
Authors: Holdgaard A , Eklo Kjesbu I , Eckhardt-Hansen C , Funch Lassen C , Prescott E , Kruuse Rasmusen H
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): TrygFondenHelseFonden

Background/Introduction

Patients with coronary artery disease (CAD) and valvular heart disease (VHD) often suffer from psychological distress, which in turn leads to impaired quality of life, delayed return to work and increased morbidity and mortality. Manageable interventions addressing psychological distress in cardiac patients are needed.

Purpose

To develop an efficient and cost-effective model for cardiac patients to reduce psychological distress.

Methods

A multi-centre, prospective, randomized clinical trial in patients with newly diagnosed CAD and/or surgically treated VHD and concomitant psychological distress defined as Hospital Anxiety and Depression (HADS A(Anxiety) or D(Depression) ≥8) and part of the work force. The patients were randomized to either usual out-patient cardiac rehabilitation (CR) comprising an 8-week multidisciplinary program or usual care supplemented by five group-based cognitive therapy sessions performed by trained CR nurses. The primary outcome was total HADS score at three months.

Results

We included 147 patients with HADS score >=8; mean age was 55, 74% were male and 92% had CAD (Table 1). At three months, total HADS score improved by 8 (CI: 8.0-10.7) in the intervention versus 3,9 (CI: 11.8-15.4) in the usual care group (p for difference <0.001). Both subscales, anxiety and depression improved significantly more in the intervention group (Figure 1).

Conclusion

Brief cognitive behavioral therapy provided by cardiac nurses to patients with a high HADS score significantly reduced psychological destress after 3 months when compared to usual care.

Baseline demographic and clinical characteristics

Table 1

SD: Standard deviation, IQR: Interquartile range, CAD: Coronary artery disease, PCI Percutaneous Coronary intervention, CABG: coronary artery bypass graft, LVEF: Left ventricular ejection fraction
Novel equation for skeletal muscle mass estimation is useful for predicting mortality in patients with heart failure
Authors: Honma S , Katano S , Nagaoka R , Numazawa R , Kouzu H , Ohori K , Nishikawa R , Ohwada W , Nagano N , Koyama M , Katayose M , Kobayashi C , Yoshioka N , Hashimoto A , Yano T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Skeletal muscle mass in heart failure (HF) patients is closely related to exercise tolerance and prognosis. Although the dual-energy X-ray absorptiometry (DEXA) method is a standard method for measuring skeletal muscle mass, it is not suitable in a daily clinical setting since it is a costly and hospital-based modality. We recently reported that an equation for appendicular skeletal muscle mass index (ASMI) estimation using anthropometric parameters predicted DEXA-measured ASMI in HF patients with reasonable accuracy. Here, we examined the prognostic impacts of ASMI predicted by the equation (predicted ASMI) in HF patients.

Methods

Data for 539 patients with HF ( 73 ± 14 years old, 43% female) who received the DEXA method and measurements of calf circumference (CC) and mid-arm circumference (MAC) between August 1, 2015, to August 31, 2020, were used for analyses. DEXA measured-appendicular skeletal muscle (ASM) was calculated as the sum of bone-free lean masses in the arms and legs, and ASMI was defined as ASM/height². Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m²) = [0.214 × weight (kg) + 0.217 × CC (cm) - 0.189 × MAC (cm) + 1.098 (male = 1, female = -1) + 0.576]/height² (m²). Low ASMI was defined as <7.0 kg/m² in males and <5.4 kg/m² in females, respectively. The primary endpoint was all-cause death. Multiple imputation using chained equations was used for the substitution of missing values.

Results

The median follow-up period was 1.75 years (interquartile range, 0.96 to 2.37 years), and 73 patients (15%) has died. Kaplan-Meier survival curves showed that patients with low DEXA measured-ASMI and patients with low predicted ASMI had significantly lower survival rates than those with high ASMI (Figure 1). In a multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B-type natriuretic peptide, cystatin C based-estimated glomerular filtration rate, and gait speed, DEXA-measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967 to 0.988; p<0.001] and predicted ASMI (HR, 0.979; 95% CI, 0.962 to 0.996; p=0.018) were independent predictors of all-cause mortality, respectively. Inclusion of predicted ASMI into the adjustment model improved the accuracy of prediction of the mortality after discharge [continuous net reclassification improvement, 0.338, p<0.01; integrated discrimination improvement, 0.020, p < 0.05] (Figure 2).

Conclusions

ASMI estimated by an equation using CC and MAC predicted the prognosis of HF patients at a similar level of accuracy to DEXA-measured ASMI, and it can be applied to the assessment of skeletal muscle mass in a daily clinical setting and in large population-based studies.
Telerehabilitation in patients with recent hospitalization due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial
Authors: Van Leunen M , Spee RF , Lu Y , Kemps HMC
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/introduction

Cardiac rehabilitation (CR) has favourable effects in chronic heart failure (CHF) patients on exercise capacity, the risk at hospital (re-)admission and quality of life. Although CR is generally recommended, it is still under-utilized in the daily clinical practice partly due to logistics reasons, limited availability, and patient-related barriers. Cardiac telerehabilitation (CTR) could solve some of these barriers, and have the same favourable outcomes.

Purpose

The aim of this study is to investigate if CTR in recently hospitalized CHF patients improves their physical functional capacity when compared to no rehabilitation.

Methods

This randomised controlled trial compares CTR with no rehabilitation after hospitalization for acute decompensated heart failure (ADHF). 64 patients will be included during hospitalization, and start with Remote Patient Management (RPM). After a short period of stable CHF, the patients will be randomised for RPM combined with CTR (intervention group), or RPM alone (control group). The intervention group will start with an 18-weeks program with exercise training, supported by a (remote) technology-assisted dietary intervention and mental health guiding. The training program starts with three centre-based and two home-based video training sessions followed by video coaching sessions. The primary endpoint is physical functional capacity, evaluated using the Short Physical Performance Battery (SPPB) score. Secondary endpoints are recovery after submaximal exercise by evaluating VO2 recovery kinetics (τ-rec), subjective health status, health related quality of life, compliance and acceptance, and readmission rate.

Future implications

This will be the first study to use an CTR program with integrated RPM after hospitalization for ADHF.
Effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure: preliminary results from a randomized clinical trial
Authors: Gojevic T , Turri Da Silva N , Gelade K , Jacobs G , Pirlotte R , Tulleneers B , Kissembeek B , Duchateau A , Mullens W , Hansen D
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University

Background

Adding resistance training on top of endurance training is recommended in the rehabilitation of patients with heart failure. However, it is unknown which intensity of resistance training should be preferred.

Purpose

To compare the effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure.

Methods

Nineteen patients with heart failure were block randomized (by gender and sex) in a combined high-intensity resistance and endurance group (HIG; n=8, age=61±12y, 7 males, LVEF=38±10%) vs. combined low-intensity resistance and endurance group (LIG; n=9, age=68±21y, 8 males, LVEF=38±13%). Patients trained 3x/week for 45 sessions. The resistance exercises were volume-matched between groups and consisted of three sets of leg press, pull down and dip exercises, separated by 30s of rest, done at 55-70% 1RM in HIG vs. 35-40% 1RM in LIG. Both groups did moderate-intense endurance training on a bicycle, cross-trainer, treadmill and arm ergometer for 30 min per training. Maximal oxygen consumption was evaluated with an incremental cardiopulmonary cycling test and muscle strength by 1-RM testing, while quality of life was assessed with the Minnesota questionnaire, and walking distance by a 6-minute walking test. Mann-Whitney U test was used for analyzing differences between groups in all variables and Wilcoxon signed-rank test for evaluating pre-post difference of the entire sample. P values <0,05 (2-tailed) were considered statistically significant.

Results

Training adherence was similar in both groups (LIG vs HIG: 41±6 vs 37±9 sessions, p=0,370; Table 1). Overall, the intervention improved maximal oxygen consumption, walking capacity and muscle strength (p<0,05), but the between-group changes in maximal oxygen consumption (LIG vs HIG: 3±2 vs 3±4 ml/kg/min, p=0,963), quality of life (LIG vs HIG: -8±23 vs -1±5 points, p=0,931) and muscle strength (LIG vs HIG: Dip 34±34 vs 18±20kg, p=0,481; Leg press, 66±87 vs 47±53kg, p=0,486; Pull down, 9±6 vs 9±7kg, p=0,574) were similar.

Conclusion

Adding either high- or low-intensity resistance training on top of endurance training seems equally effective for improving aerobic capacity and walking performance in patients with heart failure. The study is ongoing.
The efficacy of high-load resistance training in combination with aerobic training in patients with coronary artery disease: a dose-dependent randomised, controlled clinical trial
Authors: Kambic T , Hadzic V , Sarabon N , Lainscak M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background

The combination of resistance training (RT) and aerobic training (AT) was shown to be superior compared to AT, although most studies applied only low-loads (LL) to moderate-loads in RT. Therefore, it remains to be elucidated whether high-load (HL) RT elicits greater improvement in maximal aerobic capacity and maximal muscle strength compared to low-load (LL) RT in combination to AT in patients with coronary artery disease (CAD).

Purpose

The aim of our study was to investigate the effects of HL-RT and LL-RT combined with AT in comparison to AT on maximal aerobic capacity, muscle strength and health-related quality of life.

Methods

We randomised 79 patients with CAD to HL-RT+AT (70 %-80% of one repetition maximum [1-RM]), LL-RT+AT (35%-40% of 1-RM) or AT group and 59 patients with mean (SD) age 61 (8) years and left ventricular ejection fraction 53 (9) % completed 12 weeks (36 training sessions) of the study. After the initial ambulatory screening by cardiologist and cardiopulmonary exercise test, patients were familiarised with proper lifting and breathing technique, and performed 1-RM test on leg press machine. During the training, the RT load progressively increased from 70% of 1-RM (6–11 repetitions per set) to 80% of 1-RM (6–8 reps per set) in HL-RT group and from 35% of 1-RM (12–22 reps per set) to 40% of 1-RM (12–16 reps per set) in LL-RT group in the first seven weeks of the intervention. Following re-evaluation of 1-RM, the training load in HL-RT group was progressed from 70% 1-RM (11 reps per set) to 80% 1-RM (6–8 reps per set), and the load in LL-RT group was progressed from 35% 1-RM (22 reps per set) to 40% 1-RM (12–16 reps per set). All patients performed AT consisted of 3-5 min of work-load interval cycling separated by 2 min of unloaded cycling progressing from 50% to 80% maximal workload achieved at baseline cardiopulmonary exercise test. We measured maximal aerobic capacity (VO2 max), maximal voluntary contraction (MVC) and quality of life at baseline and post-training.

Results

Exercise training was safe and associated with improvement in VO2 max (p < 0.01) in all training groups, whereas only LL-RT and HL-RT group improved MVC (both p < 0.001). Following training, VO2 max increased more in HL-RT group compared to AT group (+18 %, p = 0.032), and MVC increased more in HL-RT group compared to LL-RT group (+7 %, p = 0.018) and AT group (+16 %, p < 0.001). HL-RT group improved mental functioning component of short form 12-item quality of life questionnaire (+6 points, p = 0.003), with no significant difference compared to other training modalities.

Conclusions

RT on top of routine CR management, is safe and efficacious training modality for patients with CAD enrolled in cardiac rehabilitation.