Abstracts of the Free Communications of the 11th Libyan Cardiac Society Congress (CARDIO-LIBYA 11), November 7–9, 2025, Tripoli, Libya

Unrepaired Transitional Atrioventricular Septal Defect in a 52-Year-Old Patient

Right ventricular (RV) function may be impaired in pulmonary hypertension (PH), congenital heart disease (CHD), and coronary artery disease and in patients with left-sided heart failure (HF) or valvular heart disease. In recent years, many studies have demonstrated the prognostic value of RV function in cardiovascular disease. In the past, however, the importance of RV function has been underestimated. This perception originated from studies on open-pericardium dog models and from the observation that patients may survive without a functional subpulmonary RV (Fontan procedure). In the 1940s, studies using open-pericardium dog models showed that cauterization of the RV lateral wall did not result in a decrease in cardiac output or an increase in systemic venous pressure.1–3 As was later demonstrated, the open-pericardium model did not take into account the complex nature of ventricular interaction. In 1982, Goldstein and colleagues2 showed that RV myocardial infarction (RVMI) in a closed-chest dog model led to significant hemodynamic compromise. These findings were further supported by clinical studies demonstrating an increased risk of death, arrhythmia, and shock in patients with RVMI.4 The study of the RV is a relatively young field. In 2006, the National Heart, Lung, and Blood Institute identified RV physiology as a priority in cardiovascular research.5 The goal of this review is to present a clinical perspective on RV physiology and pathobiology. In the first article of the series, the anatomy, physiology, embryology, and assessment of the RV were discussed. In this second part, we discuss the pathophysiology, clinical importance, and management of RV failure. RV failure is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder that impairs the ability of the RV to fill or to eject blood. The cardinal clinical manifestations of RV failure are (1) fluid retention, which may lead …

Is MRI the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease?

Cardiac rehabilitation (CR) effectively decreases morbidity and mortality in adults after cardiovascular events. Cardiac rehabilitation has been underutilized for patients with congenital heart disease (CHD). The primary objective was to evaluate the inclusion of adolescents and adults with CHD in a CR program by analyzing data from our single-center CR program. The secondary objectives were to evaluate the efficacy and safety of CR as well as referral barriers. This was a retrospective study of patients aged ≥15 yr who were referred to regional CR centers. Data on efficacy and safety were collected. Over a 4-yr period, 36 patients were referred to 23 regional centers: 23 patients completed CR, 12 are currently enrolled or in the referral process, and 1 died before initiation. The median age was 22 yr (range: 15-55). The primary indication was post-surgical (61%), followed by chronic heart failure (30%), and post-transplant (9%). After CR, metabolic equivalent tasks increased by 1.6 (P < .001), maximal heart rate increased by 13 beats/min (P = .026), exercise time increased by 1.35 min (P = .047), and treadmill speed increased by 0.7 mph (P = .007). There were no serious adverse events. All patients who completed CR remain alive at a median follow-up of 17 mo (range: 5-45). Common barriers to CR included accessibility, social circumstances, and cost for phase III CR. In our cohort, CR was effective and safe for adolescents and adults with CHD.

Adult Congenital Heart Surgery: Adult or Pediatric Facility? Adult or Pediatric Surgeon?

The American College of Cardiology (ACC)/American Heart Association (AHA) performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of performance measure development1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including …

Programming Considerations for Including Patients With Heart Failure Into Phase 2 Cardiac Rehabilitation

2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure

SEX DIFFERENCES IN THE IMPACT OF SYMPTOMS OF ANXIETY AND DEPRESSION ON CARDIAC REHABILITATION PARTICIPATION AND OUTCOMES

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease (CVD), including many elderly patients.1 Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression.2,3 The intent of this American Heart Association Scientific Statement is to synthesize and summarize data relevant to sexual activity and heart disease in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity. Recommendations in this document are based on published studies, the Princeton Consensus Panel,4,5 the 36th Bethesda Conference,6–10 European Society of Cardiology recommendations on physical activity and sports participation for patients with CVD,11–13 practice guidelines from the American College of Cardiology/American Heart Association14–16 and other organizations,17 and the multidisciplinary expertise of the writing group. The classification of recommendations in this document are based on established ACCF/AHA criteria (Table). View this table: Table. Applying Classification of Recommendation and Level of Evidence Numerous studies have examined the cardiovascular and neuroendocrine response to sexual arousal and intercourse, with most assessing male physiological responses during heterosexual vaginal intercourse.18–24 During foreplay, systolic and diastolic systemic arterial blood pressure and heart rate increase mildly, with more modest increases occurring transiently during sexual arousal. The greatest increases occur during the 10 to 15 seconds of orgasm, with a rapid return to baseline systemic blood pressure and heart rate thereafter. Men and women have similar neuroendocrine, blood pressure, and heart rate responses to sexual activity.24,25 Studies conducted primarily in young married men showed that sexual activity with a person's usual partner is comparable to mild to moderate physical activity in the range of 3 to …

Greetings. As Editor-in-Chief of JCRP, I was invited to participate in the Second Global Rehabilitation 2030 Meeting, hosted by the World Health Organization (WHO) that took place in the Executive Board Room of the WHO Headquarters in Geneva, Switzerland. I was also invited to stay for a follow-up meeting to initiate “a process of developing a health policy and systems research agenda for rehabilitation.” Larry Hamm attended the launch meeting of WHO's Rehabilitation 2030 initiative in 2017 and provided an excellent summary in JCRP.1 I have agreed to co-author a summary of this year's meeting with other journal editors who attended, which will be co-published in an upcoming issue. However, I think it is worthwhile to share a few key points from the meeting now. One is the need for action related to the growing worldwide burden of non-communicable diseases (NCDs), which are responsible for 71% of all deaths globally.2 The need for rehabilitation is clear and thus is a major point of emphasis, which is especially important for cardiovascular and respiratory diseases as they are the 1st and 3rd leading causes of death, respectively. Since these are 2 of the key focus areas of JCRP and prevention of NCDs is also critical, JCRP can serve as a major vehicle to disseminate research findings on these topics. The second point to mention is that WHO recommends that rehabilitation professionals from different disciplines should unify with a common identity, that being to promote rehabilitation as a health strategy with the objective of optimizing functioning.3 This aligns well with the work of AACVPR professionals as improved function is clearly a major objective of both cardiac and pulmonary rehabilitation programs. September brings the AACVPR annual meeting, to be held this year on the 18th-21st in Portland, Oregon. Our annual JCRP Editors and Editorial Board meetings take place there. I welcome your comments about JCRP and any feedback or recommendations you have related to the Journal. You can communicate those directly to us at [email protected] or by contacting any of the Editors or Editorial Board members (https://journals.lww.com/jcrjournal/Pages/editorialboard.aspx). Or, if you are attending the annual meeting, it would be great to have a conversation there. One of the highlights you will find in the 5th issue of Volume 39 is the Invited Commentary by Arena et al. The authors provide an overview of the TotalCardiology Research Network (TCRN) which is an initiative to provide high-quality clinical research from an outpatient-based cardiac rehabilitation (CR) program. The Commentary overviews the evolvement of their efforts, a summary of their research publications and abstracts, and their inaugural research retreat. This model, with some variations, could be replicated by other CR programs which would allow for meaningful advances in the CR evidence-base and improvements in CR patient outcomes. Also in this issue are three reviews: one by Dal Lago et al on exercise training of patients with heart failure; another by Du et al on exercise training of patients with congenital heart disease; and the third by Steinhaus et al, which focuses on exercise interventions of patients with implantable cardioverter-defibrillators. This issue also contains a number of excellent Original Investigations and Brief Reports related to both cardiac rehabilitation and pulmonary rehabilitation. I continue to ask for your assistance in sharing the information from this issue with your colleagues and collaborators, particularly via your social media outlets. I know the authors of these reviews and studies would be most grateful for your assistance in helping disseminate their research. Also, patients can benefit from these contributions which are advancing the evidence base of both cardiac and pulmonary rehabilitation programs. I hope you find the information provided in this issue to be useful in your work with patients in your rehabilitative programs, your research, or both. Lenny Kaminsky, PhD, FAACVPR, FACSM, FAHA Editor-in-Chief Journal of Cardiopulmonary Rehabilitation and Prevention

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

Why is heart failure in children important? If we just consider the number of individuals affected, adult heart failure is clearly a more compelling public health problem. However, the relatively small numbers belie the overall economic and social impact of pediatric heart failure. When a child is admitted to the hospital for heart failure, the costs are considerably higher for children than adults because of the frequent need for surgical or catheter-based intervention. The demands of medical care can fray the family structure and adversely affect parental economic productivity. When a child dies of heart failure, the economic impact is magnified enormously because of the number of potentially productive years lost per death. For these and other reasons, heart failure in children is a serious public health concern. In addition, growing numbers of children with heart failure are reaching adulthood because of the successful application of medical and surgical heart failure therapies and the improved outcomes of congenital heart surgery. A greater understanding of the pathophysiology of heart failure in childhood may help inform therapeutic strategies once these children become adults. Furthermore, given the recent explosion of research in the impact of cardiac development and cardiogenetics on pediatric cardiovascular disease, it is not outside the realm of possibility for a pediatric discovery to be made that will also benefit adults with heart failure. We may not yet be able to agree on a definition of heart failure, but the cardinal symptoms, dyspnea, anasarca (“dropsy”), and cachexia, were well recognized in antiquity.1 These symptoms were not specific for cardiac pathology, and it was not until the 17th century, when William Harvey definitively identified the heart as an organ that pumped blood rather than generating heat, that the heart could begin to be understood as a source of dyspnea, edema, and …

Current guidelines recommend individually adapted resistance training (RT) as a part of the exercise regime in patients with cardiovascular diseases. The aim of this review was to provide insights into current knowledge and understanding of how useful, feasible, safe, and effective RT is in patients with coronary artery disease (CAD), heart failure (HF), and valvular heart disease (VHD), with particular emphasis on the role of RT in elderly and/or frail patients. A review based on an intensive literature search: systematic reviews and meta-analyses published in 2010 or later; recent studies not integrated into meta-analyses or systematic reviews; additional manual searches. The results highlight the evaluation of effects and safety of RT in patients with CAD and HF with reduced ejection fraction (HFrEF) in numerous meta-analyses. In contrast, few studies have focused on RT in patients with HF with preserved ejection fraction (HFpEF) or VHD. Furthermore, few studies have addressed the feasibility and impact of RT in elderly cardiac patients, and data on the efficacy and safety of RT in frail elderly patients are limited. The review results underscore the high prevalence of age-related sarcopenia, disease-related skeletal muscle deconditioning, physical limitations, and frailty in older patients with cardiovascular diseases (CVD). They underline the need for individually tailored exercise concepts, including RT, aimed at improving functional status, mobility, physical performance and muscle strength in older patients. Furthermore, the importance of the use of assessment tools to diagnose frailty, mobility/functional capacity, and physical performance in the elderly admitted to cardiac rehabilitation is emphasized.

Listing of oral and poster presentations from SIP 10. Opening address L.M. Schoonhoven. Session 1: Central neural bases of host plant recognition. Oral Presentations. Session 2: Chemosensory bases of host plant recognition. Oral presentations. Poster Presentations. Session 3: Integrative studies of insect behaviour. Oral Presentations. Poster Presentations. Session 4: Insect behaviour in tritrophic systems. Oral Presentations. Poster Presentations. Session 5: Plant Defences. Oral Presentations. Poster Presentations. Session 6: Insect life histories and plant growth responses. Oral presentations. Poster Presentations. Session 7: Choosing host plants: mechanisms and evolution. Poster Presentations. Session 8: Microbial partners in insect-plant associations. Poster Presentations. Session 9: Genetic bases of host-plant associations. Oral Presentations. Poster Presentations. Session 10: The phylogeny of insect-plant associations. Oral presentations. Poster Presentation. Closing Address R.F. Chapman.