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Melo X, Abreu A, Santos V, Cunha P, Oliveira M, Pinto R, Carmo M, Fernhall B, Santa-Clara H. A Post hoc analysis on rhythm and high intensity interval training in cardiac resynchronization therapy. SCAND CARDIOVASC J 2019; 53:197-205. [PMID: 31221002 DOI: 10.1080/14017431.2019.1630747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Evaluate the effects of a 6-month High Intensity Interval Training (HIIT) program on (1) functional capacity and health-related quality of life, (2) multiple blood biomarkers, (3) echocardiographic parameters, and (4) exercise performance, in patients in cardiac resynchronization therapy (CRT) stratified by the presence of atrial fibrillation (AF), targeting the following questions: (1) Does CRT provide similar benefits in patients in AF and sinus rhythm (SR)?; and (2) Does HIIT provides similar benefits in patients in AF and SR? Design. Estimates were available at baseline and 6 months after CRT implantation in 37 patients with heart failure. Patients were randomized after CRT to a 24-week HIIT group or to a usual care group (CON). In this sub-analysis, HIIT (AF = 7; SR = 11) and CON (AF = 9; SR = 10) were stratified by the presence of AF. Results. Patients in AF benefitted to a lesser degree from CRT in functional status than patients in SR (23.8-46.0%). However, HIIT induced superior improvements in patients in AF compared to CON (23.9-61.0%). Decreases in TNF-α (8.5-42.9%), BNP (15.3-34.6%) and left ventricular mass (9.6-26.2%) were only observed in patients in SR, whereas increases in peak oxygen uptake were only observed in patients in AF (19.5-23.2%). HIIT improved exercise capacity (8.8-59.4%) in patients in SR. Conclusions. Patients in AF or SR undergoing CRT demonstrated distinct benefits from device implantation and from HIIT as an adjunctive therapeutic strategy. This suggests that both mainstay and adjunctive therapeutics may need to be managed differently in patients in AF and SR.
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Affiliation(s)
- Xavier Melo
- a Faculdade de Motricidade Humana , Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Portugal , Lisboa , Portugal.,b Ginásio Clube Português, GCP Lab. , Lisboa , Portugal
| | - Ana Abreu
- c Departamento de Cardiologia , Hospital Santa-Marta , Lisboa , Portugal
| | - Vanessa Santos
- a Faculdade de Motricidade Humana , Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Portugal , Lisboa , Portugal
| | - Pedro Cunha
- c Departamento de Cardiologia , Hospital Santa-Marta , Lisboa , Portugal
| | - Mário Oliveira
- c Departamento de Cardiologia , Hospital Santa-Marta , Lisboa , Portugal
| | - Rita Pinto
- a Faculdade de Motricidade Humana , Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Portugal , Lisboa , Portugal
| | - Miguel Carmo
- c Departamento de Cardiologia , Hospital Santa-Marta , Lisboa , Portugal.,d Faculdade de Ciências Médicas , Universidade Nova, CEDOC - Centro de Estudos de Doenças Crónicas , Lisboa , Portugal
| | - Bo Fernhall
- e Integrative Physiology Laboratory , College of Applied Health Sciences - The University of Illinois at Chicago , Chicago , IL , USA
| | - Helena Santa-Clara
- a Faculdade de Motricidade Humana , Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Portugal , Lisboa , Portugal
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Katbeh A, Van Camp G, Barbato E, Galderisi M, Trimarco B, Bartunek J, Vanderheyden M, Penicka M. Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach. Cardiology 2019; 142:116-128. [PMID: 31117077 DOI: 10.1159/000499192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.
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Affiliation(s)
- Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium,
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