Intra-pulmonary Shunting Moderates Rises in Pulmonary Vascular Resistance with Exercise in Endurance Athletes—A Novel Description of Exercise Physiology

Abstract

Methods: ACS survivors not accessing cardiac rehabilitation were randomly allocated to conventional care (n= 72) or a modular risk factor reduction program (n= 72) packaged as a clinic visit plus telephone support. Risk factors were blindly assessed at baseline and 12 months and compared with the frequency of GP and Cardiologist consultations. Results: Most control and modular patients saw their GP ≥5 times (85% vs. 90%) and their Cardiologist at least once (65% vs. 57%). Modular patients were more likely than controls to see a Cardiologist ≥3 times (46% vs. 28%, p= 0.04) and had significantly lower levels for major risk factors at 12months. Controls hadno significant reduction in either TC or SBP irrespective of medical visit frequency including those who saw their Cardiologist ≥3 times. In the modular group, the significant reduction in TC was unrelated to medical visit frequency but the reduction in SBP was only significant in patients who saw their GP≥ 5 versus those who saw their GP≥ 4 times (−7.4± 15.9 vs. 7.8± 18.1mmHg, p< 0.001) or their Cardiologist at least once compared to no Cardiologist visits (−6.8± 17.8 vs. −2.1± 15.8mmHg, p< 0.01). Conclusion: Despite most ACS survivors in the control group seeing their doctors frequently they had no significant improvement in risk factors over 12months.Modular patients significantly reduced TC independent of medical visit frequency but SBP was reduced only in patients who s