P2686Endothelial reaction mediates enhanced external counterpulsation effects in post-MI cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D V Shishkin ◽  
S L Mikheev ◽  
V V Neznanov
Keyword(s):  
Endothelial Function ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Exercise Tolerance ◽  
Main Group ◽  
Control Group ◽  
External Counterpulsation ◽  
Nitrite Level ◽  
Enhanced External Counterpulsation

Abstract Introduction The mechanisms mediating benefits of enhanced external counterpulsation (EECP) are disputable since the origin of the method. One of the possible explanations presumes increased diastolic flow leads to changes of endothelial function and plays a crucial role in alleviating the symptoms of angina and heart failure; the exact mechanisms of action are still under investigation, though the endothelial hypothesis possesses strong evidence. Purpose To reveal the impact of repeated EECP on endothelial function of patients undergoing cardiac rehabilitation program after myocardial infarction (MI) and to identify possible clinical implications of these changes. Methods The randomized sham-controlled study included 46 patients with coronary artery disease who suffered from ST-elevation MI (STEMI) 4–8 weeks prior to enrollment in 2017–2018. All patients had undergone primary PCI due to STEMI in 2–24 hours after the event. Echo parameters, exercise tolerance and the levels of ADMA and nitric oxide (NO) metabolites (total content, nitrite and nitrate) in plasma were determined at the enrollment stage and at three month follow-up. Patients were randomized and given 35 h of active counterpulsation (main group, n=24) or inactive counterpulsation (control group, n=22) over a six-week period after enrollment. Results The analysis showed no significant difference between groups at baseline: mean ejection fraction was 46% in the main group and 45% in the control group, no difference in exercise tolerance. The mean characteristics of endothelial function at baseline were similar in both main and control groups: total NO metabolites (17.3±2.14 μmol/L vs. 19.6±3.31, p=0. 42), nitrite level (0.76±0.17 μmol/L vs. 0.75±0.21, p=0. 36), ADMA level (0.78±0.15 μmol/L vs. 0.81±0.20, p=0. 22). At three month follow up 41,7% of patients of the main group showed improvement of one class of NYHA classification compared to 22,7% in the control group (U=122.3, p=0.012), agreed with improved exercise tolerance: average +2.8 MET in main group in opposite to only +0.8 MET in the controls (U=104, p=0.007). Control group demonstrated no significant dynamics of NO metabolites concentration comparing to baseline values, while in the main group there was a significant decrease of ADMA – 0.57±0.11 μmol/L (Z=r=−2.46, p=0.013) and increase of nitrite level – 1,12±0. 18 μmol/L (Z=r=−2.57, p=0.011), with no changes in total NO metabolites content. The further analysis demonstrated strong correlation between exercise capacity gain and ADMA decrease (R=r=−0.52, p=0.008) or nitrite elevation (R=0.48, p=0.012), with ADMA/nitrite ratio being the strongest predictor of clinical improvement (R=0.68, p=0.002). Conclusion Active EECP improves exercise capacity and heart failre symptoms in patients undergoing post-MI rehabilitation, with those effects being associated with endothelial function enhancement.

scholarly journals Effectiveness of Text Messaging as an Incentive to Maintain Physical Activity after Cardiac Rehabilitation: A Randomized Controlled Pilot Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6645
Author(s):  
Giulia Foccardi ◽  
Marco Vecchiato ◽  
Daniel Neunhaeuserer ◽  
Michele Mezzaro ◽  
Giulia Quinto ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiac Rehabilitation ◽  
Exercise Testing ◽  
Text Messages ◽  
Control Group ◽  
Stand Test ◽  
Randomized Controlled ◽  
Sit To Stand ◽  
Significant Difference

Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term.

scholarly journals Procedure of complex braided wrapping of ascending aorta in her poststenotic dilation while doing correction of aortal stenosis

2020 ◽  
Vol 87 (9-10) ◽  
pp. 18-21
Author(s):  
V. V. Popov ◽  
A. A. Bolshak
Keyword(s):  
Ascending Aorta ◽  
Main Group ◽  
Surgical Correction ◽  
Control Group ◽  
Valve Prosthesis ◽  
Original Procedure ◽  
Aortal Valve ◽  
The Moment ◽  
Aorta Diameter

Objective. To study clinical possibilities of original procedure of the ascending aorta braid-like bandage for her poststenotic dilation while performance of the aortal stenosis surgical correction. Materials and methods. To the main Group 196 patients were included those, who were operated on for prevailing aortal stenosis, conjoined with poststenotic dilation of ascending aorta. In accordance to the echocardiographic investigation data the ascending aorta diameter preoperatively have constituted (47.7 ± 1.7) mm. In all the patients the aortal valve prosthesis was performed together with complex braided wrapping of ascending aorta. Into the control group 121 patients were included, in whom Bentall intervention was accomplished with vascular prosthesis of ascending aorta. Results. Hospital lethality in the main group have constituted 0.5%. Diameter of ascending aorta in the moment of hospital discharge have constituted (39.1 ± 1.5) mm, and in late follow-up period - (40.3 ± 1.1) mm. Conclusion. Basing on clinical experience gained, it is expedient to recommend the original procedure of braided wrapping of ascending aorta in presence of her poststenotic dilation while performing surgical correction of prevailing aortal stenosis.

Abstract 16117: Nonresponders to Cardiac Rehabilitation and Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alban De Schutter ◽  
Carl Lavie ◽  
Eiman Jahangir ◽  
Arthur Menezes ◽  
Homeyar Dinshaw ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Poor Prognosis ◽  
Cardiopulmonary Exercise Testing ◽  
Significant Risk ◽  
Metabolic Equivalent ◽  
Cardiopulmonary Exercise ◽  
Before And After

Introduction: Studies of coronary heart disease (CHD) and cardiac rehabilitation (CR) have traditionally focused on increasing enrollment in CR. We examine here the prognosis of patients who enrolled and completed CR, but saw no significant improvement in exercise capacity [nonresponders (NR)]. Hypothesis: Nonresponders have a poor prognosis. Methods: 780 CHD patients who completed CR with cardiopulmonary exercise testing (CPX) before and after the intervention were divided according to improvement in exercise tolerance (ET; no change or decline vs improvement in metabolic equivalent). Mortality was tracked post CR for all patients; 1 to 161 months of follow-up (mean 6.4 years). Results: 243 (31%) subjects were NR. After adjustment for body mass index, age, gender, ejection fraction and baseline ET, lack of improvement in exercise capacity was associated with a statistically significant 55% increase in mortality (p=0.03; Figure 1). Higher age (OR 1.02; p 0.05) and baseline ET (OR 1.07; p 0.001) was significantly associated with being a NR, but depression, gender and ejection fraction were not significant risk factors. Conclusions: A substantial proportion of subjects referred to CR have no improvement in ET and comparatively demonstrate a poor prognosis. Further investigation into the identifying characteristics of this population is needed to examine if their prognosis can be altered.

scholarly journals Effects of individualized follow-up with a smartphone-application after cardiac rehabilitation: protocol of a randomized controlled trial

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pernille Lunde ◽  
Asta Bye ◽  
Astrid Bergland ◽  
Birgitta Blakstad Nilsson
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Rehabilitation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Smartphone Application ◽  
Control Group ◽  
Power Calculation ◽  
Large Sample Size ◽  
Randomized Controlled

Abstract Background Cardiac rehabilitation (CR) programs are evidence-based and widely recommended. However, benefits from CR are likely lost among individuals who discontinue their regular exercise routines and healthy habits. One possible approach to enhance adherence to lifestyle advice after completion of CR, may be individualized follow-up enabled by a smartphone application (app). Methods A protocol of a single-blinded, pragmatic randomized controlled trial. The study will take place in the eastern part of Norway, and will include heart patients who have completed CR. Participants will be recruited from two CR centers. Based on power calculation, 113 participants will be included. The intervention group will receive individualized follow-up through an app on a weekly basis throughout a year. The app will be set up with the participant’s own goals, and the follow-up will be based on these individual goals. The control group will receive usual care, including general advice regarding physical activity, exercise and diet. The participants will be assessed at baseline (at completion of CR) and 12 months after baseline. Primary outcome of the study will be peak oxygen uptake. Secondary outcomes include exercise performance, quality of life, health status, health literacy, self-perceived goal achievement, exercise habits, body weight, blood pressure as well as lipids and triglycerides. Discussion To our knowledge, this will be the first study to examine the effects of individualized follow-up with an app for one year, in patients completing CR. Hence, it is reasonable to assume that the study may be groundbreaking. Due to the large sample size and the theoretically based intervention, the study has the potential to generate new knowledge that may improve the design of future technology-based follow-up interventions of patients that have completed rehabilitation. Trial registration ClinicalTrials.gov. NCT03174106. First registration, 19/05/2017.

Improved quality of life with cardiac rehabilitation for post-myocardial infarction patients in Korea

2007 ◽  
Vol 6 (3) ◽  
pp. 166-171 ◽  
Author(s):  
Jina Choo ◽  
Lora E. Burke ◽  
Kyung Pyo Hong
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Supervised Exercise

Background Health-related quality of life (HRQOL) has been used as a primary health outcome in cardiac rehabilitation programs (CRP). Aims This study aimed to evaluate the effects of an 8-week CRP on HRQOL and exercise capacity in myocardial infarction (MI) patients in Korea. Methods After matching on gender, age, and left ventricular ejection fraction, 60 subjects with a first acute MI were allocated to either a CRP group ( n =31) or a Control group ( n =29). The 8-week CRP included hospital-based, supervised exercise training (three times per week, average intensity of 65% VO2peak) and individual education sessions. The Control group was instructed on a home-based exercise regimen without contact during the 8 weeks. At baseline and 8 weeks, HRQOL was assessed by the Quality of Life Index (QLI)–cardiac version III; exercise capacity by a treadmill test. Results After adjusting for education level, the overall QLI, health/functioning and psycho/spiritual scores showed greater increases in the CRP group than the Control group ( p=.014, p=.016, and p=.036, respectively). We observed significant improvements in VO2peak ( p<.0001), anaerobic threshold ( p<.0001), and maximal exercise duration ( p<.0001) in the CRP group, compared to the Control group. Conclusions These findings suggest that the Korean CRP can lead to significant improvements in HRQOL outcomes and exercise capacity.

scholarly journals PERIOPERATIVE ANESTHESIA: TO DO OR NOT TO DO?

2018 ◽  
Vol 25 (2) ◽  
pp. 36-40
Author(s):  
S. A. Firsov ◽  
A. S. Lepilov ◽  
R. P. Matveev ◽  
V. S. Savinkin
Keyword(s):  
Hip Arthroplasty ◽  
Motor System ◽  
Main Group ◽  
Narcotic Analgesic ◽  
Control Group ◽  
Control Groups ◽  
Treatment Results ◽  
Analog Scale ◽  
And Control

Introduction. In patients with chronic loco-motor system diseases the pain often persists after arthroplasty and does not respond to symptomatic therapy.Purpose of study: to evaluate the efficacy of perioperative use of Meloxicam in patients after hip arthroplasty. Patients and methods. The follow-up covered 120 patients (mean age 64.4±5.23 years) after hip arthroplasty. In the main group (n=60) Meloxicam was given 7 days prior to and 3 weeks after surgery; after intervention narcotic analgesic was used on the request. In control group (n=60) the patients were only on narcotic analgesic on request after operation. Treatment results were assessed by 100-millimeter visual analog scale (VAS) and D’Aubigné-Postel Score.Results. Seven days before the surgery the pain severity in the main and control groups was comparable: 85±2.3 and 84±2.1, respectively. In 2 days after operation the pain relief was more pronounced in the main group — 69±2.1 mm versus 82±3.4 mm in the control group (p0.05). In 3 months those indices made up 10±2.1 and 35±12.6 mm (p0.001), respectively. In the main group the result was assessed as the excellent and good in 22 patients, in the rest of patients as satisfactory by d’Aubigné-Postel Score. In the control group the good result was recorded in 9, satisfactory — in 47 and poor — in 4 cases.Conclusion. Meloxicam may be considered as an effective perioperative analgesic in large joints arthroplasty.

scholarly journals Effect of Home-Based Cardiac Rehabilitation Program on Exercise Capacity in Open Heart Surgery Patients at Naresuan University Hospital

2017 ◽  
Vol 35 (4) ◽  
pp. 285
Author(s):  
Phavinee Paorod ◽  
Weerapong Chidnok ◽  
Jarun Sayasathid
Keyword(s):  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Rehabilitation Program ◽  
University Hospital ◽  
Open Heart ◽  
Cardiac Rehabilitation Program ◽  
Home Based

Objective: To investigate the effects of home-based cardiac rehabilitation program on exercise capacity using the six-minute walk test (6-MWT) in open heart surgery patients, Naresuan University Hospital.Material and Method: In a quasi-experimental study design, seventy patients who were diagnosed with heart diseases and received open heart surgery at Cardiac Center, Naresuan University Hospital were enrolled and collected data from October 2015 - September 2016 (n=70). The patients completed 8-12 weeks home-based cardiac rehabilitation program. The patients were performed the 6-MWT before hospital discharge, the first and second follow up time point. Data were expressed as average mean and chi-square test were used to determine the relationships among outcome parameters.Results: There was a significant within-group in 6-MWT distance after completed home-based cardiac rehabilitation program (377.0±69.0 meters) compared to before hospital discharge (209.0±62.0 meters) and the first follow up time point (4-8 weeks) (306.0±88.0 meters) (p-value<0.050).Conclusion: The 8-12 weeks home-based cardiac rehabilitation program exhibited significant positive effects on exercise capacity in open heart surgery patients, Naresuan University Hospital.

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