Effect of Enhanced External Counterpulsation on Clinical Symptoms, Quality of Life, 6-Minute Walking Distance, and Echocardiographic Measurements of Left Ventricular Systolic and Diastolic Function After 35 Days of Treatment and at 1-Year Follow Up in 47 Patients With Chronic Refractory Angina Pectoris

Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.

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Three-Year Follow-Up on Clinical Symptoms and Health-Related Quality of Life after Reduction Mammaplasty

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000127794.77267.14 ◽

2004 ◽

Vol 114 (1) ◽

pp. 49-54 ◽

Cited By ~ 45

Author(s):

Lennart Blomqvist ◽

Yvonne Brandberg

Keyword(s):

Quality Of Life ◽

Clinical Symptoms ◽

Reduction Mammaplasty ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Efficacy and Safety of PARACHUTE® Device: systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.09.853 ◽

2018 ◽

Vol 64 (9) ◽

pp. 853-860 ◽

Cited By ~ 1

Author(s):

Roberta da Silva Teixeira ◽

Bruna Medeiros Gonçalves de Veras ◽

Kátia Marie Simões e Senna ◽

Rosângela Caetano

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Left Ventricular ◽

Cochrane Library ◽

Efficacy And Safety ◽

Frequent Event

SUMMARY INTRODUCTION Heart failure due to an acute myocardial infarction is a very frequent event, with a tendency to increase according to improvements in the treatment of acute conditions which have led to larger numbers of infarction survivors. OBJECTIVE The aim of this study is to synthesize the evidence, through a systematic review, on efficacy and safety of the device in patients with this basic condition. METHODS Studies published between January 2002 and October 2016 were analysed, having as reference databases Embase, Medline, Cochrane Library, Lilacs, Web of Science and Scopus. The selection of studies, data extraction and methodological quality assessment of studies were examined by two independent reviewers, with disagreements resolved by consensus. RESULTS Only prospective studies without control group were identified. Six studies were included, with averages of 34 participants and follow-up of 13 months. Clinical, functional, hemodynamic and quality of life outcomes were evaluated. The highest mortality rate was 8.4% with 12-month follow-up for unspecified cardiovascular reasons, and heart failure rehospitalization was 29.4% with 36-month follow-up. Statistically significant improvements were found only in some of the studies which evaluating changes in left ventricular volume indices, the distance measured by the six-minute walk test, New York Heart Association functional classification, and quality of life, in pre and post-procedure analysis. CONCLUSIONS The present review indicates that no available quality evidence can assert efficacy and safety of PARACHUTE® in the treatment of heart failure after apical or anterior wall myocardial infarction.

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Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487319854140 ◽

2019 ◽

Vol 27 (9) ◽

pp. 929-952 ◽

Cited By ~ 16

Author(s):

Birna Bjarnason-Wehrens ◽

R Nebel ◽

K Jensen ◽

M Hackbusch ◽

M Grilli ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Relative Risk ◽

Left Ventricular Ejection Fraction ◽

Confidence Interval ◽

Cardiac Rehabilitation ◽

Left Ventricular ◽

Left Ventricular Ejection

Background In heart failure with reduced left ventricular ejection fraction (HFrEF) patients the effects of exercise-based cardiac rehabilitation on top of state-of-the-art pharmacological and device therapy on mortality, hospitalization, exercise capacity and quality-of-life are not well established. Design The design of this study involved a structured review and meta-analysis. Methods Evaluation of randomised controlled trials of exercise-based cardiac rehabilitation in HFrEF-patients with left ventricular ejection fraction ≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or later. Results Out of 12,229 abstracts, 25 randomised controlled trials including 4481 HFrEF-patients were included in the final evaluation. Heterogeneity in study population, study design and exercise-based cardiac rehabilitation-intervention was evident. No significant difference in the effect of exercise-based cardiac rehabilitation on mortality compared to control-group was found (hazard ratio 0.75, 95% confidence interval 0.39–1.41, four studies; 12-months follow-up: relative risk 1.29, 95% confidence interval 0.66–2.49, eight studies; six-months follow-up: relative risk 0.91, 95% confidence interval 0.26–3.16, seven studies). In addition there was no significant difference between the groups with respect to ‘hospitalization-for-any-reason’ (12-months follow-up: relative risk 0.79, 95% confidence interval 0.41–1.53, four studies), or ‘hospitalization-due-to-heart-failure’ (12-months follow-up: relative risk 0.59, 95% confidence interval 0.12–2.91, four studies; six-months follow-up: relative risk 0.84, 95% confidence interval 0.07–9.71, three studies). All studies show improvement of exercise capacity. Participation in exercise-based cardiac rehabilitation significantly improved quality-of-life as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months follow-up: mean difference 1.94, 95% confidence interval 0.35–3.56, two studies), but no significant results emerged for quality-of-life measured by the Minnesota Living with Heart Failure Questionnaire (nine-months or more follow-up: mean difference –4.19, 95% confidence interval –10.51–2.12, seven studies; six-months follow-up: mean difference –5.97, 95% confidence interval –16.17–4.23, four studies). Conclusion No association between exercise-based cardiac rehabilitation and mortality or hospitalisation could be observed in HFrEF patients but exercise-based cardiac rehabilitation is likely to improve exercise capacity and quality of life.

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Systemic Changes in Patients with Chronic Obstructive Pulmonary Disease (COPD): Two Years of Follow-up

Clinical & Investigative Medicine ◽

10.25011/cim.v30i3.1740 ◽

2007 ◽

Vol 30 (3) ◽

pp. 38

Author(s):

Roxana G. Galesanu ◽

Sarah Bernard ◽

Jean Bourbeau ◽

Annie Michaud ◽

François Maltais

Keyword(s):

Quality Of Life ◽

Clinical Outcomes ◽

Lean Body Mass ◽

Body Mass ◽

Walking Distance ◽

Inflammatory Status ◽

Arterial Blood ◽

Systemic Manifestations

Background: There is a lack of information concerning the natural evolution of the systemic manifestations related to COPD. The aim of this study was to observe the evolution of the systemic manifestations (muscle wasting, inflammation) related to COPD over a two-year period and to assess their relationships with clinical outcomes (exacerbations and worsening in quality of life) in a longitudinal prospective cohort. Methods: Forty-eight patients with COPD (FEV1: 42 ± 14 % predicted, lean mass: 49 ± 10 kg, 6-min walking distance: 422 ± 112 m, total SGRQ score: 45 ± 17) were included. Baseline and annual follow-up for body composition by DEXA scan, blood cytokines (CRP, IL-6), arterial blood gases, pulmonary function tests and quality of life were obtained. The number of acute exacerbations was recorded. Results: Overall, FEV1, lean body mass, 6-min walking distance and blood inflammatory markers did not change over the two years. During this time, the SGRQ scores decreased by 4 ± 11 points (P=0.021) and 2.7 ± 2.4 exacerbations per patient were observed. There was no relationship between the changes in physiological measures and the fall in SGRQ or the exacerbation rate. A loss in lean body mass > 3% was observed in 11 (23%) patients but this was not associated with any adverse clinical outcomes nor with further loss in FEV1, walking distance and inflammatory status. Conclusion: This cohort of patients remained remarkably stable over a 2-year follow-up period. A small loss in lean body mass was observed in some patients but this could not be associated with adverse clinical outcomes during this period.

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