Ambulatory Cardiac Rehabilitation Research Articles

Prognostic Role of Left Ventricular Dysfunction in Patients With Coronary Artery Disease After an Ambulatory Cardiac Rehabilitation Program

The relationship between left ventricular ejection fraction (LVEF) and outcomes after cardiac rehabilitation (CR) is not well established; therefore we assessed the prognostic role of LVEF at the end of ambulatory CR program in patients (pts) who received coronary revascularization. LVEF was evaluated at hospital discharge and re-assessed at the end of CR in all ST-elevation myocardial infarction and coronary artery bypass graft pts, while in pts with non-ST-elevation MI or elective percutaneous coronary intervention the echocardiography was repeated if they had an impaired LVEF at discharge. New hospitalizations for cardiovascular causes at 1-year, and cardiovascular mortality during long-term follow-up were analyzed. We enrolled in CR 3078 pts, 86% showed LVEF ≥40% and 9% LVEF <40%. Of those with a discharge LVEF <40%, 56% improved LVEF (LVEF ≥40%) after CR. At 1-year, heart failure was the main cause of new hospitalizations in LVEF <40% group compared with LVEF ≥40% group (5% vs 0.4%, p <0.01). During a mean follow up of 48 ± 25 months, cardiovascular death occurred in 9% of pts with LVEF <40% and in 2% with LVEF ≥40% (p = 0.014). At Cox multivariate analysis, LVEF <40% at the end of CR and age were independent predictors of hospitalization and mortality for cardiovascular causes, while coronary artery bypass graft was a protective factor. In conclusion, during CR the improvement of LVEF occurs in a relevant proportion of patients, the re-assessment of LVEF at the end of the CR is helpful for risk stratification because left ventricle dysfunction at the end of CR is associated with worse cardiovascular outcomes.

Cardiac Exercise Stress Testing: A Safe Tool to Design an Individualized Physical Exercise Training Plan for Older Adults

IntroductionIn the United States about 10% of premature mortality is associated with insufficient physical activity. New 2018 Physical Activity Guidelines (PAG) were announced recently but it is unclear how these guidelines will be implemented in the general population. Recommending an individualized training plan in elderly patients is challenging. Cardiac stress tests are primarily used to evaluate potential underlying cardiovascular disease but can also be used to assess cardiorespiratory fitness (CRT). We hypothesized that treadmill cardiac exercise stress testing in older adults will be safe and useful to initiate an exercise training plan.MethodsWe retrospectively investigated ECG treadmill test results conducted at the Center for Ambulatory Rehabilitation Graz (ZARG), Austria. The Austrian cardiac rehabilitation program consists of three phases; phase I begins during the hospital stay, and phase II (6 weeks, 4 times/week) as well as phase III (up to 13 months, 2 times/week) are conducted in ambulatory cardiac rehabilitation centers and a home‐based training recommended every day of the week. Patients participating in phase II and phase III rehabilitation underwent initial screening and subjects with aortic stenosis, low systolic output (EF% &lt; 45), and dyspnea at rest (NYHA Class IV) were excluded. Male and female patients age 65y–75y (n= 3006) and 75y–90y (n= 2493) were included. The ECG stress test training protocol was conducted, heart rate (HR) monitored continuously, and the HR threshold (HRT) calculated from the whole HR curve over time. We further documented body weight, height, body mass index, resting HR, maximal HR, resting/baseline as well as maximal systolic and diastolic blood pressure, calculated VO2Max, 50Watt HR, 100‐Watt HR, max Watt, and Watt/kg.ResultsBaseline bicycle ergometer exercise was performed until perceived exertion. Protocols used were 10W/10W increments per min (~90% of patients) or 20W/20W/1min (~10% of patients). Treadmill exercise tolerance testing was well tolerated by male and female patients of all ages (total n=5499). No differences between “maximal training capacity (Max Watt)” were found in male and female patients. Further, no difference in exercise capacity was found between the 65–75‐year (n= 3006) and 75–90‐year (n= 2493) age groups due to a wide range of individual exercise capacity amongst all participants. A personal training plan was compiled based on 70% of maximal performance. Patients were encouraged to achieve optimal training heart rates for 30 minutes daily and advised to perform muscle strengthening twice per week.ConclusionTreadmill exercise stress testing in older adults is safe and of great value to implement a home‐based personalized endurance exercise program. Since a direct link between CRT and early mortality has been shown, our data suggest that cardiac exercise stress testing should be routinely performed, not only to document and monitor cardiovascular disease, but also to prescribe a detailed, safe, individual, and home‐based exercise plan to achieve the new 2018 PAG.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Influence of atrial fibrillation on oxygen uptake and exercise tolerance in cardiovascular patients; close association with heart rate response

To investigate the effect of atrial fibrillation (AF) on the oxygen uptake and exercise tolerance, we evaluated cardiopulmonary exercise test (CPET) data in AF patients and heart rate-matched controls with sinus rhythm (cSR) who received ambulatory cardiac rehabilitation. We compared CPET data between AF (N = 27) and cSR patients (N = 106) who had similar HRs at rest and the peak points. Oxygen uptake (VO2)/kg and relative O2 pulse (ml/bpm/kg) at rest and the anaerobic threshold (AT) level was not different between AF and cSR patients, but these parameters above the AT level were significantly lower in AF than in cSR patients. Concisely the parallel increase of relative O2 pulse during exercise was blunted above the respiratory compensation level (Rc) in the AF group. In addition, the HR change during exercise was inversely correlated with the increase of the O2 pulse above the AT level and this inverse correlation was more prominent in AF patients than in cSR patients. In conclusion, the value of VO2 was significantly lower above the AT level in AF patients. The trend of O2 pulse above the AT level was strongly associated with the detrimental response of HR increase and the response was markedly exaggerated in the AF patients.

Corrigendum to: Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study.

Corrigendum to: Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study.

Ambulatory cardiac rehabilitation facilities should be present in every cardiology department.

Ambulatory cardiac rehabilitation facilities should be present in every cardiology department.

Obstructive Sleep Apnea in Cardiac Rehabilitation Patients.

Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity. Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis. Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (-11.6 ± 9.1, P < .001). Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.

Obstructive sleep apnea syndrome in cardiac rehabilitation patients

While regular physical activity improves obstructive sleep apnea (OSA) syndrome in the general population, this was not assessed in post-myocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine if cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity. Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from ECG-derived respiration (AHI EDR ) was obtained through nocturnal Holter ECG recordings. According to AHI EDR , patients were classified as normal, mild, moderate or severe OSA (< 5, 5–14, 15–29, ≥ 30, respectively). Physiological performance (peak VO 2 ) was established though cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis. Out of the 105 CAD patients suffering OSA included (95 men, 55.2 ± 12.4 years), 100 had at least one cardiovascular risk factor (98%) and 51% had an ANS dysfunction. Surprisingly, 65% of these OSA patients were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHI EDR decreased significantly (−9.3 ± 9.5, P < 0.0001) only in severe OSA patients, and the decrease was even greater when peak VO 2 and baroreflex sensibility improved beyond 20% compared to basal values (−11.6 ±9.1, P < 0.001). Severe OSA in CAD patients is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in CAD patients.

Impact of cardiac rehabilitation on exercise oscillatory ventilation in patients with chronic heart failure and reduced left ventricular ejection fraction

Cardiac rehabilitation improves functional status and reduces mortality in patients with chronic heart failure with reduced left ventricular (LV) ejection fraction. The presence of exercise oscillatory ventilation (EOV), characterized by the periods of hyperpnea and hypopnea without interposed apnea, may be assessed using cardiopulmonary exercise test (CPET) and is associated with a poor prognosis. We aim to assess the effect of cardiac rehabilitation on EOV in patients with chronic heart failure. From January 2014 to March 2017, patients with chronic heart failure with ambulatory cardiac rehabilitation program in our center were included. A CPET has been performed in all patients before and after 10-week rehabilitation program. The presence of EOV was defined as duration > 60% of total exercise duration with a cycle length of more 30 s and an amplitude ≥ 15% of the averaged resting value, as recommended. Among 40 patients (mean age: 59 ± 8 years, 33 males, mean LV ejection fraction: 30 ± 9), baseline EOV was found in 26 cases (65%). There was no significant difference between patients with EOV (EOV + ) and those without EOV (EOV − ) regarding risk factors and clinical and demographic data. Before rehabilitation, patients EOV+ had significant lower peak respiratory ratio (1.14 ± 0.07 vs. 1.08 ± 0.081, respectively, P = 0.02) and a trend for lower VE/VCO 2 slope (39.9 ± 5.8 vs. 36.1 ± 4.2, respectively, P = 0.074). After cardiac rehabilitation, EOV reversed in 13 patients (50%, P = 0.001). The thirteen patients who conserved EOV have a decrease of the cycle length (44 ± 10 s vs 36 ± 5 s, P = 0.016). In patients with chronic heart failure with reduced LV ejection fraction, EOV are present in 65% of cases. A 10-week cardiac rehabilitation program reverses EOV in half of patients and decrease EOV cycle length in those with persisting EOV. Further studies are needed to confirm these results and explore the potential prognostic significance of EOV reversal.

Need Assessment for Smartphone-Based Cardiac Telerehabilitation

ObjectivesTo identify the current status of smartphone usage and to describe the needs for smartphone-based cardiac telerehabilitation of cardiac patients.MethodsIn 2016, a questionnaire survey was conducted in a supervised ambulatory cardiac rehabilitation (CR) program in a university affiliated hospital with the participation of heart failure or heart transplantation patients who were smartphone users. The questionnaire included questions regarding smartphone usage, demands for smartphone-based disease education, and home health monitoring systems. Results were described and analyzed according to principal diagnosis.ResultsNinety-six patients (66% male; mean age, 53 ± 11 years), including 56 heart failure and 40 heart transplantation patients, completed the survey (completion rate, 95%). The median daily smartphone usage time was 120 minutes (interquartile range, 60–300), and the most frequently used smartphone function was text messaging (61.5%). Of the patients, 26% stated that they searched for health-related information using their smartphones more than 1 time per week. The major source of health-related information was Internet browsing (50.0%), and the least sought source was the hospital's website (3.1%). Patients with heart failure expressed significantly higher needs for disease education on treatment plan, home health monitoring of blood pressure, and body weight (χ2 = 5.79, 6.27, 4.50, p < 0.05). Heart transplantation patients expressed a significant need for home health monitoring of body temperature (χ2 = 5.25, p < 0.05).ConclusionsHeart failure and heart transplantation patients show high usage of and interest in mobile health technology. A smartphone-based cardiac telerehabilitation program should be developed based on high demand areas and modified to suit to each principal diagnosis.

Ambulatory cardiac rehabilitation in Trieste: protocols of intervention, activities and outcomes

Cardiac rehabilitation (CR) is a model of care proven to reduce mortality and morbidity in patients with coronary artery disease. The aim of this study is to describe the ambulatory CR model of the Cardiovascular Department of Trieste (Italy), analyzing the outcome of the population. We analyzed clinical and instrumental characteristics of all consecutive patients after ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), coronary artery bypass graft with or without valve surgery (CABG/CABGV), or planned percutaneous coronary intervention (PCI), referred for CR from January 1, 2009, to December 31, 2015. All patients were included in a registry. During CR and at 1-year follow-up, the incidence of new hospitalizations due to cardiovascular causes was assessed. Total and cardiovascular mortality was also evaluated at longer follow-up. Overall, 3088 patients (28% female, mean age 70 ± 11 years; 35% older than 75 years) were referred for CR, 30% after STEMI, 23% after NSTEMI, 29% after CABG/CABGV, and 19% after PCI. At enrollment, 9% of patients had an ejection fraction <40%, 76% were hypertensive, 61% dyslipidemic, 19% diabetics, and 27% smokers. CR lasted 5 ± 4 months. At the end of the CR program, 96% of patients were on antiplatelets, 79% on beta-blockers, 73% on angiotensin-converting enzyme inhibitors, 25% on angiotensin II receptor blockers, and 87% on statins with achievement of the following secondary prevention targets: LDL cholesterol 85 ± 30 mg/dl, glycated hemoglobin 7.2 ± 4%, heart rate 64 ± 11 bpm, systolic/diastolic blood pressure 137 ± 32/78 ± 14 mmHg. During CR, new hospitalizations occurred in 11% of patients, 1% within 1 year after CR. At a mean follow-up of 4.4 ± 2 years, 11% of patients died, 3% for cardiovascular causes, 0.7% within 1 year. Cardiovascular mortality was significantly higher in elderly patients (6 vs 2%, p=0.000), women (4 vs 3%, p=0.038), diabetics (5 vs 3%, p=0.004), and in patients with left ventricular dysfunction (8 vs 3%, p=0.000). Our findings show the feasibility of a CR program in an unselected population, characterized by advanced age, risk factors and comorbidities. A critical analysis of the registry data allowed us to achieve good results in secondary prevention and outcomes.

Efficacy and safety of the early use of V2 receptor antagonists in elderly patients with decompensated heart failure.

We recently reported that the early initiation of tolvaptan in congestive heart failure shortened the hospital stay and reduced the rate of in-hospital death. However, whether or not these results apply to elderly patients with congestive heart failure is unclear. We performed a sub-analysis of our previous study. Among the 102 patients in that study, we retrospectively analyzed the elderly patients >75years of age treated with tolvaptan. First, we analyzed the efficacy of early tolvaptan use in these patients. We then compared the efficacy and the safety of all tolvaptan use between elderly and younger patients. There were no significant differences in the baseline clinical parameters between the early- and late-tolvaptan-use elderly patients, except for the serum blood nitrogen urea. However, the early use of tolvaptan was also associated with the earlier initiation of ambulatory cardiac rehabilitation, a shorter hospital stay, and a lower rate of in-hospital death in elderly congestive heart failure patients. Furthermore, there were no significant differences in the occurrence of worsening renal failure and hypernatremia. The early use of tolvaptan in elderly patients was also associated with a shorter hospital stay and reduced mortality. We also confirmed the safety of tolvaptan in elderly patients. It might, therefore, be beneficial to consider administering tolvaptan early in elderly patients with heart failure, just as in younger patients.

Contrôle des facteurs de risque chez les patients coronariens un an après une réadaptation cardiaque

ObjectiveTo assess risk factors monitoring in coronary patients one year after cardiac rehabilitation. MethodFrom 2015 to 2015, cardiac morbidity, total mortality and risk factors data were collected from a 4-week ambulatory cardiac rehabilitation program with a control one year later and were compared with the results of Euroaspire and Reach studies. ResultsOut of 1091 (87%) coronary patients, 746 (68%) were re-examined 12months later (aged 60years (ranging from 20 to 85years), 15% women, 44% hypertensive, 36% smokers, 17% diabetics, 74% with dyslipidemia). At the end of the program, management of CV risk factors was improved (BP ≤ 140/90mmHg and BMI > 30: 80 and 20% vs 65 and 25% at the beginning of the program; LDL < 0.7g/L: 42% and smoking: 4% vs 18% when hospitalized for their cardiac event). Unfortunately, this benefit decreased significantly at one year (BP ≤ 140/90mmHg: 63%, LDL < 0.7g/L: 27%; smoking: 6%) but it remains better than in Euroaspire IV study: 57, 20 et 16% respectively). While 54% had insufficient physical activity before cardiac rehabilitation, they were only 23% at 1-year vs 60% in Euroaspire study. We reported a total mortality of 0.6% vs 2.9% in Reach study and 12% cardiac hospitalization (53% for a new coronary event). ConclusionParticipation of coronary patients in a cardiac rehabilitation program significantly improves management of CV risk factors, morbidity and mortality. However, the control obtained at the end of the program decreases at one year.

PATHway I: design and rationale for the investigation of the feasibility, clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform

IntroductionExercise-based cardiac rehabilitation (CR) independently alters the clinical course of cardiovascular diseases resulting in a significant reduction in all-cause and cardiac mortality. However, only 15%–30% of all eligible patients participate...

Cardiac patients show high interest in technology enabled cardiovascular rehabilitation.

BackgroundCardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR.MethodsA technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations.ResultsOf 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = −0.16; p = 0.005).ConclusionsCVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0329-9) contains supplementary material, which is available to authorized users.

0239: Short-term impact of a 4-week ambulatory cardiac rehabilitation program on quality of life and anxiety-depression

If the positive impact of cardiac rehabilitation on metabolic profile and exercise tolerance is well documented in the literature very few studies evaluated the impact of these rehabilitation programs on some dimensions of quality of life. To date, no study has documented the short-term effects of an ambulatory cardiac rehabilitation program on quality of life. The main objective of this study was to determine if a short and ambulatory 4-week cardiac rehabilitation program could yield a positive impact on different quality of life parameters such as anxiety, depression, as well as physical and mental health. It is a cohort study which was conducted at the Leopold Bellan hospital, cardiovascular rehabilitation unit. Patients consecutively referred to our institution after an acute cardiac event. It lasted 04 weeks and that included 20 educational and exercise sessions. Psychological wellbeing and quality of life evaluation was conducted by a psychologist using SF-12 questionnary and HAD test. One hundred and eighty four cardiac patients, mean age 60.48±11.6, participated in this study. Analysing the scores obtained on the SF-12 questionnaire revealed an improvement of physical and mental components after ambulatory 4 weeks cardiac rehabilitation program. (P<0.001). Furthermore, the HAD scale decreased significantly at the end of the cardiac rehabilitation program. (P<0.001). A 4-week ambulatory cardiac rehabilitation program had a positive impact on quality of life and anxiety-depression. The quick efficacy reported by our study could be explained by the multidisciplinary rehabilitation approach (adapted physical activity sessions, personalized dietary follow-up, psychological and therapeutic care).

0238: Short-term impact of an ambulatory cardiac rehabilitation program on arterial rigidity

If the positive impact of cardiac rehabilitation on metabolic profile and exercise tolerance is well documented in the literature, very few studies evaluated the impact of these rehabilitation programs on arterial rigidity. The main objective of this study was to determine if a short and intense 4-week cardiac rehabilitation program could yield a positive impact on arterial rigidity. A cohort study was performed on Leopold Bellan foundation. One hundred and ninety eight cardiac patients referred for cardiac rehabilitation program after acute events were included in this study. Arterial stiffness is defined by a VPWV value greater or equal to 10. At the beginning, 59% of our patients have rigid arteries. After 20 sessions of cardiac rehabilitation, this number is significantly reduced to 51% (p=0, 12). Patients with arterial stiffness have accumulated more major cardiovascular risk factors, and have had less exercise capacity than others. However they benefit similarly from the cardiovascular rehabilitation program. We observed that arterial stiffness, as reflected by the PWV, tends to decrease after short-term ambulatory cardiac rehabilitation program. Short ambulatory cardiac rehabilitation program for cardiac patient after an acute event has a positive effect on arterial rigidity.

0236: Association of chronic kidney disease and cardiovascular disease in ambulatory cardiac rehabilitation center

Chronic kidney disease (CKD) is a frequent co morbidity among elderly patients and those with cardiovascular disease. CKD carries prognostic relevance. A goal of the present study was to describe patient characteristics and functional capacity of patients in cardiac rehabilitation (CR), differentiated by presence or absence of CKD. Between June 2011 and July 2013, 304 patients were consecutively referred to our institution after an acute event (cardiac surgery, acute coronary syndrome or acute heart failure). Our CR program consists of 4 sessions per week for 5 weeks (total of 20 sessions) and includes both exercise and health and nutrition education sessions. Glomerular filtration rate (GFR) was calculated based on the Modification of diet in renal disease (MDRD) formula and CKD was defined as estimated GFR <60ml/min/1.73m 2 . Patients were divided into two groups according to their renal function. The prevalence of CKD, in our ambulatory cardiac rehabilitation center was 17% (53 patients). Compared with non-CKD patients, CKD patients were significantly older (68±8 versus 59±11years; p=0.01), had more arterial hypertension (81% versus 51%; p=0.000), and mean low density lipoprotein cholesterol (LDL-C), and total cholesterol were significantly higher (p=0.01). Exercise capacity was much lower in CKD patients (W peak (watt): 74 vs. 94; (p=0.000), VO2 peak/kg (ml/kg): 16 vs 20 (p=0.000)). In CKD patients, mean low density lipoprotein cholesterol (LDL-C), and total cholesterol were significantly higher than in non-CKD ones. At discharge, blood pressure, lipid profile and physical fitness on exercise testing improved substantially in both groups. Within a short period of 5 weeks, CR led to substantial improvements in key risk factors such as lipid profile, blood pressure, and physical fitness for all patients, even if CKD was present.

0240: Cardiac rehabilitation in diabetic patients

Diabetes mellitus (DM) is increasing in prevalence in France and is now more common in patients entering cardiac rehabilitation (CR). Only a few studies have focused on the effects of cardiac rehabilitation in patients with DM but it is still unclear if they gain the same benefit from a CR program as do non diabetics. The aim of this study was to compare the effects of exercise-based CR on cardiac risk factors and exercise parameters in a series of diabetic and non diabetic individuals. Between 2009 and 2013, 386 patients were consecutively referred to our institution after an acute cardiac event. Our CR program consists of 4 sessions per week for 5 weeks (total of 20 sessions) and includes both exercise and health and nutrition education sessions. Patients were divided into two groups according to their diabetic status. The prevalence of diabetis, in our ambulatory cardiac rehabilitation center was 29% (113 patients). Hypertension, obesity, and dyslipidemia were more common in diabetic vs non diabetic participants (P<0.001 for all). Diabetic patients had increased SBP, triglyceride concentrations, weight and carotid femoral pulse wave velocity (PWV), but decreased HDL concentrations compared with non diabetics at the start of CR (P<0.05 for all). Initial exercise capacity parameters (Wpeak, VO2 peak/kg, 6 minute walk test) were lower in diabetics vs nondiabetics (P<0.001). Both diabetics and non diabetics showed significant improvement in quality of life, SBP, DBP, lipid profile, and exercise capacity after CR. This study emphasizes similar beneficial effects of multidisciplinary CR program on exercice capacity and quality of life in patient with or without type 2 diabetes mellitus. A significant benefit can be seen after 5 weeks (20 sessions) of CR program.

Early use of V2 receptor antagonists is associated with a shorter hospital stay and reduction in in-hospital death in patients with decompensated heart failure.

Tolvaptan is an oral antagonist of arginine vasopressin receptor 2 that has been approved in Japan to reduce congestive symptoms in patients with heart failure refractory to loop diuretics. However, it is unknown whether the early use of tolvaptan results in better clinical outcomes. We retrospectively analyzed 102 consecutive patients with decompensated heart failure treated with tolvaptan at our hospital. A given patient was defined as a responder when the maximum urine volume was greater than 150% of that observed before tolvaptan use. A logistic regression analysis revealed that the early use of tolvaptan (within 3days after admission) was an independent factor associated with tolvaptan responsiveness. There were no significant differences in the baseline clinical parameters between the early and late tolvaptan use groups. However, the early use of tolvaptan was associated with higher tolvaptan responsiveness, a shorter duration of carperitide infusion, earlier initiation of ambulatory cardiac rehabilitation, shorter hospital stay, lower rate of in-hospital death. The early use of tolvaptan was associated with a shorter hospital stay and reduced mortality in our retrospective cohort. It might therefore be beneficial to consider administering tolvaptan earlier in patients with heart failure.

Impact à court terme d’un programme de réadaptation cardiaque ambulatoire sur la rigidité artérielle

BackgroundIf the positive impact of cardiac rehabilitation on metabolic profile and exercise tolerance is well documented in the literature, very few studies evaluated the impact of these rehabilitation programs on arterial rigidity. PurposeThe main objective of this study was to determine if a short and intense 4-week cardiac rehabilitation program could yield a positive impact on arterial rigidity. MethodA cohort study was performed on Leopold Bellan Foundation. All patients referred for cardiac rehabilitation program after an acute event (surgery, technical gesture or acute decompensate heart failure) were included in this study. Our CR program consists of four sessions per week for five weeks (total of 20 sessions) and includes both exercise and health and nutrition education sessions. In addition to clinical and therapeutic data collection, biochemical analysis for carbohydrate and lipid metabolism and exercise capacity measurements, carotid femoral pulse wave velocity (PWV) were measured in a quiet room in the morning of their first and last day prior to any exercise. ResultsOne hundred and ninety-eight cardiac patients have participated in this study, of which 79% were male, mean age 60±10, 50 (25%) were diabetic, 103 (52%) were hypertensive, 60 (30%) were current smokers, 98 (50%) had dyslipidemia, and 140 (71%) were referred for cardiac rehabilitation after acute coronary syndrome. Arterial stiffness is defined by a VPWV value greater or equal to 10. At the beginning, 59% of our patients have rigid arteries. After 20 sessions of cardiac rehabilitation, this number is significantly reduced to 51% (P=0.12). Patients with arterial stiffness have accumulated more major cardiovascular risk factors, and have had less exercise capacity than others. However they benefit similarly from the cardiovascular rehabilitation program. ConclusionIn the present study, we observed that arterial stiffness, as reflected by the PWV, tends to decrease after short-term ambulatory cardiac rehabilitation program.