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Varma PK, Radhakrishnan RM, Gopal K, Krishna N, Jose R. Selecting the appropriate patients for coronary artery bypass grafting in ischemic cardiomyopathy-importance of myocardial viability. Indian J Thorac Cardiovasc Surg 2024; 40:341-352. [PMID: 38681722 PMCID: PMC11045715 DOI: 10.1007/s12055-023-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 05/01/2024] Open
Abstract
Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy.
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Affiliation(s)
- Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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2
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Niebauer J, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Sündermann SH. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol 2024; 31:146-181. [PMID: 37804173 DOI: 10.1093/eurjpc/zwad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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3
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Sündermann SH, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Niebauer J. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Cardiothorac Surg 2023; 64:ezad181. [PMID: 37804175 DOI: 10.1093/ejcts/ezad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
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4
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Iaconelli A, Pellicori P, Dolce P, Busti M, Ruggio A, Aspromonte N, D'Amario D, Galli M, Princi G, Caiazzo E, Rezig AOM, Maffia P, Pecorini G, Crea F, Cleland JGF. Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of randomized trials. Eur J Heart Fail 2023; 25:1094-1104. [PMID: 37211964 DOI: 10.1002/ejhf.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). METHODS AND RESULTS We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79-0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70-0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74-1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed. CONCLUSIONS For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.
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Affiliation(s)
- Antonio Iaconelli
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Matteo Busti
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Aureliano Ruggio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Division of Cardiology, Azienda Ospedaliero Universitaria 'Maggiore della Carità', Novara, Italy
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Princi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisabetta Caiazzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Asma O M Rezig
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pasquale Maffia
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Giovanni Pecorini
- Cardiovascular Internal Medicine Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Liga R, Colli A, Taggart DP, Boden WE, De Caterina R. Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How. J Am Heart Assoc 2023; 12:e026943. [PMID: 36892041 PMCID: PMC10111551 DOI: 10.1161/jaha.122.026943] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 03/10/2023]
Abstract
Background Myocardial revascularization has been advocated to improve myocardial function and prognosis in ischemic cardiomyopathy (ICM). We discuss the evidence for revascularization in patients with ICM and the role of ischemia and viability detection in guiding treatment. Methods and Results We searched for randomized controlled trials evaluating the prognostic impact of revascularization in ICM and the value of viability imaging for patient management. Out of 1397 publications, 4 randomized controlled trials were included, enrolling 2480 patients. Three trials (HEART [Heart Failure Revascularisation Trial], STICH [Surgical Treatment for Ischemic Heart Failure], and REVIVED [REVascularization for Ischemic VEntricular Dysfunction]-BCIS2) randomized patients to revascularization or optimal medical therapy. HEART was stopped prematurely without showing any significant difference between treatment strategies. STICH showed a 16% lower mortality with bypass surgery compared with optimal medical therapy at a median follow-up of 9.8 years. However, neither the presence/extent of left ventricle viability nor ischemia interacted with treatment outcomes. REVIVED-BCIS2 showed no difference in the primary end point between percutaneous revascularization or optimal medical therapy. PARR-2 (Positron Emission Tomography and Recovery Following Revascularization) randomized patients to imaging-guided revascularization versus standard care, with neutral results overall. Information regarding the consistency of patient management with viability testing results was available in ≈65% of patients (n=1623). No difference in survival was revealed according to adherence or no adherence to viability imaging. Conclusions In ICM, the largest randomized controlled trial, STICH, suggests that surgical revascularization improves patients' prognosis at long-term follow-up, whereas evidence supports no benefit of percutaneous coronary intervention. Data from randomized controlled trials do not support myocardial ischemia or viability testing for treatment guidance. We propose an algorithm for the workup of patients with ICM considering clinical presentation, imaging results, and surgical risk.
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Affiliation(s)
- Riccardo Liga
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - Andrea Colli
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
| | - David P. Taggart
- Nuffield Department of Surgical SciencesOxford University John Radcliffe HospitalOxfordUnited Kingdom
| | - William E. Boden
- VA Boston Healthcare SystemBoston University School of MedicineBostonMA
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and Chair of CardiologyUniversity of PisaItaly
- Fondazione VillaSerena per la Ricerca, Città Sant'AngeloItaly
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6
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Brovman EY, Tolis G, Hirji S, Axtell A, Fields K, Muehlschlegel JD, Urman RD, Deseda GAC, Kaneko T, Karamnov S. Association Between Early Extubation and Postoperative Reintubation After Elective Cardiac Surgery: A Bi-institutional Study. J Cardiothorac Vasc Anesth 2022; 36:1258-1264. [PMID: 34980525 DOI: 10.1053/j.jvca.2021.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is unknown if remaining intubated after cardiac surgery is associated with a decreased risk of postoperative reintubation. The primary objective of this study was to investigate whether there was an association between the timing of extubation and the risk of reintubation after cardiac surgery. DESIGN A retrospective, observational study. SETTING Two university-affiliated tertiary care centers. PARTICIPANTS A total of 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 6,609 isolated CABGs and 2,908 isolated AVRs were performed during the study period. Reintubation occurred in 112 patients (1.64%) after CABG and 44 patients (1.5%) after AVR. After multivariate logistic regression analysis, early extubation (within the first 6 postoperative hours) was not associated with a risk of reintubation after CABG (odds ratio [OR] 0.53, 95% CI 0.26-1.06) and AVR (OR 0.52, 95% CI 0.22-1.22). Risk factors for reintubation included increased age in both the CABG (OR per 10-year increase, 1.63; 95% CI 1.28-2.08) and AVR (OR per 10-year increase, 1.50; 95% CI 1.12-2.01) cohorts. Total bypass time, race, and New York Heart Association (NYHA) functional class were not associated with reintubation risk. CONCLUSION Reintubation after CABGs and AVRs is a rare event, and advanced age is an independent risk factor. Risk is not increased with early extubation. This temporal association and low overall rate of reintubation suggest the strategies for extubation should be modified in this patient population.
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Affiliation(s)
- Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - George Tolis
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
| | - Sameer Hirji
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Andrea Axtell
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
| | - Kara Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - J Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gaston A Cudemis Deseda
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Sergey Karamnov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
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Goh ZZS, Chia JMX, Seow TYY, Choo JCJ, Foo M, Seow PS, Griva K. Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants. Br J Health Psychol 2021; 27:844-860. [PMID: 34865298 DOI: 10.1111/bjhp.12577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population. DESIGN Observational cross-sectional study. METHODS Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5). RESULTS Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant. CONCLUSION Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.
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Affiliation(s)
- Zack Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Jace Ming Xuan Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | | | | | | | | | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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8
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Liu L, Ma M, Yang X, Yang Y, Huang X, Meng L, Ming D. Impact of gender and age on 6-Minute Walking Test performance of patients with coronary heart disease compared to healthy elders. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6277-6280. [PMID: 34892548 DOI: 10.1109/embc46164.2021.9630618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The performance of 6-minute walking test (6MWT) of patients with coronary heart disease (CHD) was significantly related to patients' cardiopulmonary functions. The 6MWT may provide prognostic information for patients. However, the impact of gender and age on the 6MWT performance and related cardiopulmonary parameters of patients with CHD compared to the healthy group has not be fully investigated and discussed. In this study, a total of 118 subjects, including 70 CHD patients and 48 healthy elders, were enrolled. The subjects performed the 6MWT while fourteen cardiopulmonary parameters were measured during the task and the walking distance was recorded at the end. Factors of gender, age, and disease on the 6MWT performance were analyzed using multivariate analysis of variance and the parameters between the patients and healthy people in age- and gender-specific subgroups were compared by Pearson's correlation coefficient. Results showed that age (60-65 and ≥65 years) and gender significantly influenced the 6MWT performance of subjects. Featured parameters were observed in older subgroups (≥65 years) between the patients and healthy people while patients aged 60-65 had similar 6MWT performance with the healthy control group. It would be potential to distinguish patients with CHD from healthy elders based on the 6MWT where factors of age and gender should be considered.
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9
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Jaarsma T, Perkiö Kato N, Ben Gal T, Bäck M, Chialà O, Evangelista L, Mårtensson J, Piepoli MF, Vellone E, Klompstra L, Strömberg A. Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure. ESC Heart Fail 2021; 8:4539-4548. [PMID: 34480412 PMCID: PMC8712847 DOI: 10.1002/ehf2.13584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Improvement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3 months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF. METHODS AND RESULTS This secondary analysis of the HF-Wii study analysed baseline and 3 month data of the 6 min walk test (6MWT) from 480 patients (mean age 67 years, 72% male). Data were analysed separately in patients with a pre-defined 6 min walking distance at baseline of <300 m (n = 79) and ≥300 m (n = 401). Among patients with a baseline 6MWT of ≥300 m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self-reported physical activity [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.97], lower baseline levels of cognitive function (OR = 0.87, 95%CI = 0.79-0.96) were significantly associated with lack of improvement in exercise capacity at 3 months. Not randomized to exergaming (OR = 0.63, 95%CI = 0.37-1.09) was likely (P = 0.097) to be associated with lack of improvement in exercise capacity at 3 months. Among the 79 patients with baseline 6MWT of <300 m, 41% (n = 32) did not improve 6MWT distance at 3 months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR = 4.68, 95%CI = 1.08-20.35), higher levels of serum creatinine (OR = 1.02, 95%CI = 1.003-1.03), lower cognitive function (OR = 0.86, 95%CI = 0.75-0.99), and fewer anxiety symptoms (OR = 0.84, 95%CI = 0.72-0.98). CONCLUSIONS Lower self-reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score <300 m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises.
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Affiliation(s)
- Tiny Jaarsma
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, 58183, Sweden
| | - Naoko Perkiö Kato
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, 58183, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Bäck
- Department of Medicine, Health and Caring Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Oronzo Chialà
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Jan Mårtensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Massimo F Piepoli
- Cardiology Unit, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy.,Fondazione Toscana "G Monasterio", Pisa, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Leonie Klompstra
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, 58183, Sweden
| | - Anna Strömberg
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, 58183, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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10
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Baris O, Findik O, Argun Baris S, Benli ED, Duzyol C, Tekeli Kunt A. Multidimensional Evaluation of Pulmonary Function and Exercise Capacity by BODE Index in Patients with On-Pump Coronary Artery Bypass Grafting. Am J Cardiol 2021; 150:55-59. [PMID: 34006373 DOI: 10.1016/j.amjcard.2021.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Coronary artery bypass grafting (CABG) often causes physiological changes in patients. Although functional changes, such as lung function and exercise capacity changes, are observed in patients, there are no detailed studies examining this. The aim was to compare preoperative and postoperative pulmonary function and exercise capacity in patients undergoing on-pump CABG with a multidimensional index (BODE index). Demographic and surgical characteristics of patients were recorded. Pulmonary function test, six-minute walk test (6MWT), and modified Medical Research Council (mMRC) dyspnea score were assessed and BODE index were calculated in preoperative and at six months postoperatively. A total of 75 patients were included with a mean ± standard deviation age of 59.8±10.0 years. The male to female ratio was 57/18. There was a statistically significant decrease in the forced expiratory flow at 25-75% (FEF25-75%) value after CABG. Other pulmonary function test values were also lower in the postoperative period compared to the preoperative period, but these changes were not significant. The mean distance achieved in the 6MWT (p=0.02) and the mMRC dyspnea score (p=0.001) were significantly better postoperatively. The BODE index, which combines these parameters, had increased in the postoperative period. Age (OR 1.09; 95% CI: 1.008-1.181) and postoperative FEF25-75% (OR -0.96; 95% CI: 0.938-0.988) were the independent predictors of BODE score ≥3 in multivariate analysis. Despite the decrease in pulmonary function in patients undergoing CABG, there was an improvement in exercise capacity and dyspnea score.
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11
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Begot I, Gomes WJ, Rocco IS, Bublitz C, Gonzaga LRA, Bolzan DW, Santos VB, Moreira RSL, Breda JR, Almeida DRD, Arena R, Guizilini S. Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation. Braz J Cardiovasc Surg 2021; 36:308-317. [PMID: 33438847 PMCID: PMC8357387 DOI: 10.21470/1678-9741-2020-0344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. METHODS Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. RESULTS Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. CONCLUSION An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.
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Affiliation(s)
- Isis Begot
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Walter J Gomes
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Caroline Bublitz
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laion R A Gonzaga
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Douglas W Bolzan
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | - João R Breda
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Solange Guizilini
- Department of Human Motion Sciences, Federal University of Sao Paulo, São Paulo, Brazil
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12
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Ryan M, Morgan H, Petrie MC, Perera D. Coronary revascularisation in patients with ischaemic cardiomyopathy. Heart 2021; 107:612-618. [PMID: 33436491 DOI: 10.1136/heartjnl-2020-316856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022] Open
Abstract
Heart failure resulting from ischaemic heart disease is associated with a poor prognosis despite optimal medical treatment. Despite this, patients with ischaemic cardiomyopathy have been largely excluded from randomised trials of revascularisation in stable coronary artery disease. Revascularisation has multiple potential mechanisms of benefit, including the reversal of myocardial hibernation, suppression of ventricular arrhythmias and prevention of spontaneous myocardial infarction. Coronary artery bypass grafting is considered the first-line mode of revascularisation in these patients; however, evidence from the Surgical Treatment of Ischaemic Heart Failure (STICH) trial showed a reduction in mortality, though this only became apparent with extended follow-up due to an excess of early adverse events in the surgical arm. There is currently no randomised controlled trial evidence for percutaneous coronary intervention in patients with ischaemic cardiomyopathy; however, the REVIVED-BCIS2 trial has recently completed recruitment and will address this gap in the evidence. Future directions include (1) clinical trials of revascularisation in patients hospitalised with heart failure, (2) defining the role of viability and ischaemia testing in heart failure, (3) studies to enhance the understanding of the mechanistic effects of revascularisation and (4) generating models to refine pre- and post-revascularisation risk prediction.
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Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King's College London, London, UK
- Cardiology Department, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Holly Morgan
- Cardiovascular Division, King's College London, London, UK
- Cardiology Department, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mark C Petrie
- University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
- Cardiology Department, Golden Jubilee National Hospital, Clydebank, UK
| | - Divaka Perera
- Cardiovascular Division, King's College London, London, UK
- Cardiology Department, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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13
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Abulimiti A, Nishitani-Yokoyama M, Shimada K, Kunimoto M, Matsubara T, Fujiwara K, Aikawa T, Ouchi S, Sugita Y, Fukao K, Kadoguchi T, Miyazaki T, Shimada A, Yamamoto T, Takahashi T, Fujiwara T, Asai T, Amano A, Daida H, Minamino T. Prognostic impact of peak oxygen uptake and heart rate reserve in patients after off-pump coronary artery bypass grafting. Clin Cardiol 2021; 44:580-587. [PMID: 33634477 PMCID: PMC8027571 DOI: 10.1002/clc.23579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Peak oxygen uptake (peak VO2 ) and heart rate reserve (HRR) are independent prognostic markers of cardiovascular disease. However, the impact of peak VO2 and HRR on long-term prognosis after off-pump coronary artery bypass grafting (OP-CABG) remains unclear. HYPOTHESIS To determine the prognostic impact of peak VO2 and HRR in patients after OP-CABG. RESULTS We enrolled 327 patients (mean age, 65.1 ± 9.3 years; male, 80%) who underwent OP-CABG and participated in early phase II cardiac rehabilitation. All participants underwent cardiopulmonary exercise testing (CPET) at the beginning of such rehabilitation. Overall, 48 (14.6%) patients died during the median follow-up period of 103 months. The non-survivor had significantly lower levels of peak VO2 (10.6 ± 0.5 vs. 13.7 ± 0.2 ml/kg/min, p < .01) and HRR (24.2 ± 1.8 vs. 32.7 ± 0.8 beats/min, p < .01) than the survivor. In both groups, peak VO2 significantly correlated with HRR (p < .01). Moreover, patients were divided into four groups according to the peak VO2 and HRR levels for predicting total mortality. The low-peak VO2 /low-HRR group had a significantly higher mortality risk than the other groups (hazards ratio, 5.61; 95% confidence interval, 2.59-12.16; p < .01). After adjusted the confounding factors, peak VO2 and HRR were independently associated with total mortality (both p < .05). CONCLUSIONS HRR is a simple parameter of CPET and an important prognostic marker for the risk stratification of total mortality even in patients with low-peak VO2 after OP-CABG.
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Affiliation(s)
- Abidan Abulimiti
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Mitsuhiro Kunimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yurina Sugita
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyasu Kadoguchi
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Toshiyuki Fujiwara
- Faculty of Health Sciences, Juntendo University, Tokyo, Japan.,Department of Rehabilitation Medicine, Juntendo University Hospital, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Faculty of Health Sciences, Juntendo University, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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14
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Moussa O, Ardissino M, Tang A, Edwards J, Heaton T, Khan O, Tsang K, Collins P, Purkayastha S. Long-term cerebrovascular outcomes after bariatric surgery: A nationwide cohort study. Clin Neurol Neurosurg 2021; 203:106560. [PMID: 33618173 DOI: 10.1016/j.clineuro.2021.106560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The proinflammatory state and metabolic changes associated with obesity contribute to cerebrovascular disease. Bariatric surgery can achieve a reliable reduction in body weight and improved metabolic profile in obese patients. However, its impact on cerebrovascular morbidity remains unexplored. This study investigates the effect of bariatric surgery on long-term risk of major cerebrovascular events. METHODS A retrospective cohort study was designed. Data was extracted from the Clinical Practice Research Datalink. 4212 bariatric surgery patients were compared to 4212 age, sex, and BMI-matched controls. The primary composite endpoint was occurrence of any major adverse cerebrovascular event. Secondary endpoints included composite endpoints of ischaemic events, haemorrhagic events, individual components of the primary endpoint alone and all-cause mortality. An adjusted Cox proportional hazards model was implemented to analyse time to event data. RESULTS Mean follow-up length was 11.4 years. The primary endpoint occurred in 73 patients. The bariatric surgery group had significantly lower adjusted major cerebrovascular event rates (HR 0.352, 95 %CI 0.195-0.637). Bariatric surgery was associated with lower rates of ischaemic events (HR 0.315, 95 %CI 0.156-0.635), particularly from transient ischaemic attacks (HR 0.364, 95 %CI 0.171-0.775). There was no difference in the rate of haemorrhagic events (HR 0.442, 95 %CI 0.147-1.330) or acute ischaemic stroke (HR 0.221, 95 %CI 0.046-1.054). In total 229 patients died during follow-up. Overall, all-cause mortality was significantly lower in the bariatric surgery group (HR 0.352, 95 %CI 0.195-0.637). CONCLUSIONS This study identifies an association between bariatric surgery and lower long-term risk of major adverse cerebrovascular events in patients with obesity.
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Affiliation(s)
- Osama Moussa
- Department of Surgery and Cancer, Imperial College, Praed Street, London, W2 1NY, United Kingdom
| | - Maddalena Ardissino
- Department of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom
| | - Alice Tang
- Department of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom
| | - Jonathan Edwards
- Department of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom.
| | - Tobias Heaton
- Department of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom
| | - Omar Khan
- Department of Upper GI and Bariatric Surgery, St George's University of London, London, SW17 0RE, United Kingdom
| | - Kevin Tsang
- Department of Neurosurgery, Imperial College NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Peter Collins
- Department of Medicine, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom; Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, SW3 6NP, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College, Praed Street, London, W2 1NY, United Kingdom
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15
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Long-term incidence and outcomes of obesity-related peripheral vascular disease after bariatric surgery. Langenbecks Arch Surg 2021; 406:1029-1036. [PMID: 33433660 PMCID: PMC8208905 DOI: 10.1007/s00423-020-02066-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Abstract
Background and aims Patients with obesity are at high risk of suffering from arterial and venous peripheral vascular disease (PVD). Bariatric surgery is an effective strategy to achieve weight reduction for patients with obesity. The long-term impact of bariatric surgery on obesity-related morbidity is subject to increasing research interest. This study aimed to ascertain the impact of bariatric surgery on the long-term occurrence of PVD in patients with obesity. Methods The study population was extracted from the Clinical Practice Research Datalink, a nation-wide database containing primary and secondary care records of consenting patients. The intervention cohort was 2959 patients who had undergone bariatric surgery during follow-up; their controls were 2959 propensity-score-matched counterparts. The primary endpoint was development of any PVD: arterial or venous. Secondary endpoints were incident peripheral arterial disease alone, incident peripheral venous disease alone. Results Three hundred forty-six patients suffered a primary endpoint during follow-up. Bariatric surgery did not improve peripheral vascular disease rates as a whole, but it was associated with significantly lower event rates of arterial disease (HR = 0.560, 95%CI 0.327–0.959, p = 0.035) but higher event rates of venous disease (HR = 1.685, 95%CI 1.256–2.262, p < 0.001). Conclusions Bariatric surgery was associated with significantly reduced long-term occurrence of arterial disease but increased occurrence of venous disease in patients with obesity. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-020-02066-9.
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16
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Budnevsky AV, Kravchenko AY, Tokmachev RE, Chernik TA, Tokmachev EV, Letnikova YB. Diagnostic, prognostic and therapeutic potential of 6-minute walk test in patients with heart failure. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The six-minute walk test (6MWT) is a well-known exercise test used in medical practice to assess the functional status of patients with various chronic cardiovascular and respiratory diseases. The results of modern research describe new potential of 6MWT, which allow a more accurate interpretation and predict the course of diseases. Heart failure (HF) is the outcome of many structural and functional heart disorders. To improve the prognosis of patients with HF, early diagnosis, appropriate therapy and effective control of the disease course are important components. This review describes the diagnostic, prognostic and therapeutic potential of 6MWT in patients with HF.
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17
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Matsumoto K, Xiao Y, Homma S, Thompson JLP, Buchsbaum R, Ito K, Anker SD, Qian M, Di Tullio MR. Prognostic impact of 6 min walk test distance in patients with systolic heart failure: insights from the WARCEF trial. ESC Heart Fail 2020; 8:819-828. [PMID: 33377631 PMCID: PMC8006715 DOI: 10.1002/ehf2.13068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aimed to investigate the impact of baseline 6 min walk test distance (6MWTD) on time to major cardiovascular (CV) events in heart failure with reduced ejection fraction (HFrEF) and its impact in clinically relevant subgroups. METHODS AND RESULTS In the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, 6MWTD at baseline was available in 2102 HFrEF patients. Median follow-up was 3.4 years. All-cause death and heart failure hospitalization (HFH) exhibited a significant non-linear relationship with 6MWTD (P = 0.023 and 0.032, respectively), whereas a significant association between 6MWTD and CV death was shown in a linear model [hazard ratio (HR) per 10 m increase, 0.989; P = 0.011]. In linear splines with the best cut-off point at 200 m, the positive effect of a longer 6MWTD on all-cause death and HFH was only observed for 6MWTD > 200 m (HR per 10 m increase, 0.987; P = 0.0036 and 0.986; P = 0.0022, respectively). The associations between 6MWTD and CV outcomes were consistent across clinical subgroups; for age, a significant relationship between 6MWTD and HFH was observed in patients ≥60 years (HR per 10 m increase, 0.98; P < 0.001), but not in patients <60 years (HR per 10 m increase, 1.00; P = 0.98; P = 0.02 for the interaction). CONCLUSIONS In HFrEF, 6MWTD is independently associated with all-cause death, CV death, and HFH. 6MWTD of 200 m is the best cut-off point for predicting these adverse events. The prognostic impact of 6MWTD for HFH was only observed in older patients.
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Affiliation(s)
- Kenji Matsumoto
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Yi Xiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - John L P Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kazato Ito
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marco R Di Tullio
- Division of Cardiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY, 10032, USA
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18
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Sumin AN, Oleynik PA, Bezdenezhnykh AV. Assessment of skeletal muscle in patients with stable coronary artery disease: clinical significance and associations. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2019-895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- A. N. Sumin
- Research Institute for Complex Problems of Cardiovascular Diseases
| | - P. A. Oleynik
- Research Institute for Complex Problems of Cardiovascular Diseases
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19
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Meeker D, Goldberg J, Kim KK, Peneva D, Campos HDO, Maclean R, Selby V, Doctor JN. Patient Commitment to Health (PACT-Health) in the Heart Failure Population: A Focus Group Study of an Active Communication Framework for Patient-Centered Health Behavior Change. J Med Internet Res 2019; 21:e12483. [PMID: 31389339 PMCID: PMC6701162 DOI: 10.2196/12483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/30/2019] [Accepted: 05/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background Over 6 million Americans have heart failure, and 1 in 8 deaths included heart failure as a contributing cause in 2016. Lifestyle changes and adherence to diet and exercise regimens are important in limiting disease progression. Health coaching and public commitment are two interactive communication strategies that may improve self-management of heart failure. Objective This study aimed to conduct patient focus groups to gain insight into how best to implement health coaching and public commitment strategies within the heart failure population. Methods Focus groups were conducted in two locations. We studied 2 patients in Oakland, California, and 5 patients in Los Angeles, California. Patients were referred by local cardiologists and had to have a diagnosis of chronic heart failure. We used a semistructured interview tool to explore several patient-centered themes including medication adherence, exercise habits, dietary habits, goals, accountability, and rewards. We coded focus group data using the a priori coding criteria for these domains. Results Medication adherence barriers included regimen complexity, forgetfulness, and difficulty coping with side effects. Participants reported that they receive little instruction from care providers on appropriate exercise and dietary habits. They also reported personal and social obstacles to achieving these objectives. Participants were in favor of structured goal setting, use of online social networks, and financial rewards as a means of promoting health lifestyles. Peers were viewed as better motivating agents than family members. Conclusions An active communication framework involving dissemination of diet- and exercise-related health information, structured goal setting, peer accountability, and financial rewards appears promising in the management of heart failure.
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Affiliation(s)
- Daniella Meeker
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, United States
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, United States
| | | | - Ross Maclean
- Precision Health Economics, Los Angeles, CA, United States
| | - Van Selby
- Cardiology Division, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jason N Doctor
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
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20
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Hassanabad AF, MacQueen KT, Ali I. Surgical Treatment for Ischemic Heart Failure (STICH) trial: A review of outcomes. J Card Surg 2019; 34:1075-1082. [DOI: 10.1111/jocs.14166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
| | - Kelsey T. MacQueen
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
| | - Imtiaz Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Faculty of MedicineUniversity of Calgary Calgary Canada
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21
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Kristensen SL. Individualizing surgical revascularization in patients with ischaemic heart failure - a further dive into STICHES. Eur J Heart Fail 2019; 21:382-384. [PMID: 30773783 DOI: 10.1002/ejhf.1426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Søren L Kristensen
- Deparment of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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22
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Ambrosy AP, Stevens SR, Al-Khalidi HR, Rouleau JL, Bouabdallaoui N, Carson PE, Adlbrecht C, Cleland JGF, Dabrowski R, Golba KS, Pina IL, Sueta CA, Roy A, Sopko G, Bonow RO, Velazquez EJ. Burden of medical co-morbidities and benefit from surgical revascularization in patients with ischaemic cardiomyopathy. Eur J Heart Fail 2019; 21:373-381. [PMID: 30698316 DOI: 10.1002/ejhf.1404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/03/2018] [Accepted: 11/25/2018] [Indexed: 11/10/2022] Open
Abstract
AIMS The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and the benefit from surgical revascularization has not been previously described in patients with ischaemic cardiomyopathy. METHODS AND RESULTS The STICH trial (ClinicalTrials.gov Identifier: NCT00023595) enrolled patients ≥ 18 years of age with coronary artery disease amenable to coronary artery bypass grafting (CABG) and an EF ≤ 35%. Eligible participants were randomly assigned 1:1 to receive medical therapy (MED) (n = 602) or MED/CABG (n = 610). A modified Charlson co-morbidity index (CCI) based on the availability of data and study definitions was calculated by summing the weighted points for all co-morbid conditions. Patients were divided into mild/moderate (CCI 1-4) and severe (CCI ≥ 5) co-morbidity. Cox proportional hazards models were used to evaluate the association between CCI and outcomes and the interaction between severity of co-morbidity and treatment effect. The study population included 349 patients (29%) with a mild/moderate CCI score and 863 patients (71%) with a severe CCI score. Patients with a severe CCI score had greater functional limitations based on 6-min walk test and impairments in health-related quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire. A total of 161 patients (Kaplan-Meier rate = 50%) with a mild/moderate CCI score and 579 patients (Kaplan-Meier rate = 69%) with a severe CCI score died over a median follow-up of 9.8 years. After adjusting for baseline confounders, patients with a severe CCI score were at higher risk for all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.19-1.74; P < 0.001). There was no interaction between CCI score and treatment effect on survival (P = 0.756). CONCLUSIONS More than 70% of patients had a severe burden of medical co-morbidities at baseline, which was independently associated with increased risk of death. There was not a differential benefit of surgical revascularization with respect to survival based on severity of co-morbidity.
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Affiliation(s)
- Andrew P Ambrosy
- Division of Cardiology, The Permanente Medical Group, San Francisco, CA, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Susanna R Stevens
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jean L Rouleau
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - Peter E Carson
- Department of Cardiology, Washington Veterans Affairs Medical Center, Washington, DC, USA
| | - Christopher Adlbrecht
- 4th Medical Department, Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Hietzing Hospital, Vienna, Austria
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, Scotland, UK
| | - Rafal Dabrowski
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Ileana L Pina
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Carla A Sueta
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - George Sopko
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Hamburger RF. Left Ventricular Dysfunction in Ischemic Heart Disease. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Ng L, Samani NJ, Cleland JG, van Veldhuisen DJ, Voors AA, Zannad F. Clinical correlates and outcome associated with changes in 6-minute walking distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail 2019; 21:218-226. [PMID: 30600578 DOI: 10.1002/ejhf.1380] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a simple and inexpensive way of measuring exercise capacity in patients with heart failure (HF) that predicts morbidity and mortality. However, there are few reports from large multicentre cohorts assessing the predictive value of baseline and changing walk distance. METHODS AND RESULTS In BIOSTAT-CHF, a 6MWT was performed at baseline (n = 1714) and 9 months (n = 1520). Cox proportional hazards models were used to assess the associations between 6MWT distance and the composite of HF hospitalization and/or death. Median follow-up was 21 months. The median (pct25-75 ) of the 6MWT distance at baseline was 300 m (200-388 m). Independent predictors of a shorter 6MWT distance included older age, female sex, higher heart rate, New York Heart Association class III/IV, orthopnoea, ischaemic heart disease, a previous stroke, current malignancy, and higher N-terminal pro-B-type natriuretic peptide (all P < 0.05). Patients in the lowest baseline 6MWT tertile (≤ 240 m) were less likely to receive guideline-recommended doses of disease-modifying therapies (P < 0.05). Compared to patients in the highest baseline 6MWT tertile (> 360 m), those in the lowest and middle tertiles had a worse prognosis [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38-2.18]. Patients with a decrease in the distance walked had a worse prognosis (adjusted HR for each 50 m decrease 1.09, 95% CI 1.06-1.12). 6MWT distance was not modified by treatment up-titration nor the 6MWT improved the BIOSTAT-CHF prognostic models. CONCLUSIONS The 6-minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis but did not improve the prognostic models. 6MWT distance was not modified by treatment up-titration and its use for assessing the benefits of pharmacologic treatment up-titration may be limited.
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Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.,Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - John G Cleland
- National Heart and Lung Institute, Imperial College London, London, UK; and Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Dirk J van Veldhuisen
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
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25
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Stewart R. Cardiovascular Disease and Frailty: What Are the Mechanistic Links? Clin Chem 2019; 65:80-86. [DOI: 10.1373/clinchem.2018.287318] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
Abstract
BACKGROUND
In aging populations, cardiovascular disease (CVD) and frailty are common and often coexist. It is possible that common risk factors and pathophysiological pathways increase the risk of both CVD and frailty.
CONTENT
Frailty is a complex clinical syndrome with multiple causes and contributing factors. It is characterized by multisystem impairment that decreases physiological reserve and increases vulnerability to stress. Diverse methods have been used to evaluate frailty. Most include 1 or several measures related to reduced exercise, physical function, cognition, activities of daily living, comorbidities, deficits and/or markers of physiological dysfunction. CVD and frailty may be linked by several mechanisms. CVD can accelerate frailty, and frailty increases the risk of adverse outcomes in patients with CVD. Common pathophysiological pathways are also important. Low physical activity, poor nutrition, diabetes, hypertension, and smoking may increase the risk of both CVD and frailty. Further research is needed to evaluate whether biomarkers of dysfunction across multiple body systems, which are known to be associated with aging, and with CV and non-CV morbidity and mortality, are also associated with frailty.
SUMMARY
Multiple pathophysiological pathways are associated with both CVD and frailty, which interact to further increase the risk of adverse outcomes.
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Affiliation(s)
- Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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26
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Abouzaki NA, Exaire JE, Guzmán LA. Role of Percutaneous Chronic Total Occlusion Interventions in Patients with Ischemic Cardiomyopathy and Reduced Left Ventricular Ejection Fraction. Curr Cardiol Rep 2018; 20:124. [PMID: 30276495 DOI: 10.1007/s11886-018-1066-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current evidence on the benefit of chronic total occlusion (CTO) revascularization in patients with ischemic cardiomyopathy and propose a systematic approach on how and when to accomplish revascularization in these patients. RECENT FINDINGS Coronary revascularization in patients with reduced ejection fraction (EF) is advocated for to improve left ventricular function and consequently clinical outcomes. Approximately 16-31% of angiograms in patients with advanced CAD are noted to have a concomitant coronary CTO. Its presence is a main predictor of worse outcomes. Over the past 15 years, advancements in interventional technologies and techniques have made it possible to treat CTO lesions percutaneously with success rates exceeding 90%. Different revascularization techniques have been organized into widely used algorithms for systematic CTO lesion crossing and treatment. Patients with reduced EF can be revascularized percutaneously with goal of complete functional revascularization. However, randomized prospective data is needed to justify the increased patient risks and healthcare costs associated with these procedures.
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Affiliation(s)
- Nayef A Abouzaki
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Jose E Exaire
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Luis A Guzmán
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.
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27
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Saji M, Katz MR, Ailawadi G, Welch TS, Fowler DE, Kennedy JLW, Bergin JD, Kuntjoro I, Dent JM, Ragosta M, Lim DS. 6-Minute walk test predicts prolonged hospitalization in patients undergoing transcatheter mitral valve repair by MitraClip. Catheter Cardiovasc Interv 2018; 92:566-573. [PMID: 29656614 DOI: 10.1002/ccd.27600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/29/2018] [Accepted: 02/23/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and is widely employed to assess treatment outcomes. Although mortality with transcatheter mitral valve repair (TMVr) using the MitraClip (Abbott Vascular, Menlo Park, CA) is significantly less than for open mitral valve surgery in high-risk patients, identifying which patient will benefit the most from TMVr remains a concern. There are limited prognostic metrics guiding patient selection and, no studies have reported relationship between prolonged hospitalization and 6MWT. This study aimed to determine if the 6MWT can predict prolonged hospitalization in patients undergoing TMVr by MitraClip. METHODS We retrospectively reviewed 162 patients undergoing 6MWT before TMVr. Patients were divided into three groups according to the 6MWT distance (6MWTD) using the median (6MWTD ≥219 m, 6MWTD <219 m, and Unable to Walk). Multivariate logistic regression model was applied to select the demographic characteristics that were associated with the prolonged hospitalization defined as total length of stay ≥4 days in the study. RESULTS We found that 6MWT (odds ratio 3.64, 95% confidence interval 2.03-6.52, P < 0.001) was independently associated with prolonged hospitalization after adjustment in multivariate analysis. Area under the curve of 6MWT for predicting prolonged hospitalization was 0.79 (95% confidence interval 0.72-0.85). CONCLUSIONS Our study demonstrates that 6MWT was independently associated with prolonged hospitalization in patients with TMVr, and has a good discriminatory performance for predicting prolonged hospitalization.
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Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.,Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Marc R Katz
- Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Gorav Ailawadi
- Advanced Cardiac Valve Center, Department of Surgery, Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
| | - Timothy S Welch
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Dale E Fowler
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Jamie L W Kennedy
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - James D Bergin
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Ivandito Kuntjoro
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.,Department of Cardiology, National University Heart Center of Singapore, Singapore, Singapore
| | - John M Dent
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - D Scott Lim
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
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Ning X, Ye X, Si Y, Yang Z, Zhao Y, Sun Q, Chen R, Tang M, Chen K, Zhang X, Zhang S. Prevalence and prognosis of ventricular tachycardia/ventricular fibrillation in patients with post-infarction left ventricular aneurysm: Analysis of 575 cases. J Electrocardiol 2018; 51:742-746. [PMID: 29803411 DOI: 10.1016/j.jelectrocard.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated the prevalence of ventricular tachycardia/ventricular fibrillation (VT/VF) in Post-infarction left ventricular aneurysm (PI-LVA) patients and analyze clinical outcomes in patients presenting with VT/VF. METHODS 575 PI-LVA patients were enrolled and investigated by logistic regression analysis. Patients with VT/VF were followed up, the composite primary endpoint was cardiac death and appropriate ICD/external shocks. RESULTS The incidence of sustained VT/VF was 11%. Logistical regression analysis showed male gender, enlarged LV end diastolic diameter (LVEDD) and higher NYHA class were correlated with VT/VF development. During follow up of 46 ± 15 months, 19 out of 62(31%) patients reached study end point. Multivariate Cox regression analysis revealed that enlarged LVEDD and moderate/severe mitral regurgitation (MR) were independently predictive of clinical outcome. CONCLUSIONS Male gender, enlarged LVEDD and higher NYHA class associated with risk of sustained VT/VF in PI-LVA patients. Among VT/VF positive patients, enlarged LVEDD and moderate/severe MR independently predicted poor clinical prognosis.
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Affiliation(s)
- Xiaohui Ning
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Xuerui Ye
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Yanhua Si
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Zihe Yang
- Department of Nuclear Medicine, Anzhen Hospital, China
| | - Yunzi Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Min Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Anzhen Hospital, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
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29
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Stewart RAH, Szalewska D, Stebbins A, Al-Khalidi HR, Cleland JGH, Rynkiewicz A, Drazner MH, White HD, Mark DB, Roy A, Kosevic D, Rajda M, Jasinski M, Leng CY, Tungsubutra W, Desvigne-Nickens P, Velazquez EJ, Petrie MC. Six-minute walk distance after coronary artery bypass grafting compared with medical therapy in ischaemic cardiomyopathy. Open Heart 2018. [PMID: 29531766 PMCID: PMC5845417 DOI: 10.1136/openhrt-2017-000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background In patients with ischaemic left ventricular dysfunction, coronary artery bypass surgery (CABG) may decrease mortality, but it is not known whether CABG improves functional capacity. Objective To determine whether CABG compared with medical therapy alone (MED) increases 6 min walk distance in patients with ischaemic left ventricular dysfunction and coronary artery disease amenable to revascularisation. Methods The Surgical Treatment in Ischemic Heart disease trial randomised 1212 patients with ischaemic left ventricular dysfunction to CABG or MED. A 6 min walk distance test was performed both at baseline and at least one follow-up assessment at 4, 12, 24 and/or 36 months in 409 patients randomised to CABG and 466 to MED. Change in 6 min walk distance between baseline and follow-up were compared by treatment allocation. Results 6 min walk distance at baseline for CABG was mean 340±117 m and for MED 339±118 m. Change in walk distance from baseline was similar for CABG and MED groups at 4 months (mean +38 vs +28 m), 12 months (+47 vs +36 m), 24 months (+31 vs +34 m) and 36 months (-7 vs +7 m), P>0.10 for all. Change in walk distance between CABG and MED groups over all assessments was also similar after adjusting for covariates and imputation for missing values (+8 m, 95% CI -7 to 23 m, P=0.29). Results were consistent for subgroups defined by angina, New York Heart Association class ≥3, left ventricular ejection fraction, baseline walk distance and geographic region. Conclusion In patients with ischaemic left ventricular dysfunction CABG compared with MED alone is known to reduce mortality but is unlikely to result in a clinically significant improvement in functional capacity. Trial registration number NCT00023595.
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Affiliation(s)
- Ralph A H Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | | | - Amanda Stebbins
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - John G H Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - Mark H Drazner
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Daniel B Mark
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dragana Kosevic
- Department of Cardiology, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miroslaw Rajda
- Nova Scotia Health Authority, Queen Elizabeth II Health Science Centre, Halifax, Canada
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Chua Yeow Leng
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Eric J Velazquez
- Department of Biostatistics and Bioinformatics (HRA), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiology, Departments of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark C Petrie
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, UK
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Rocco IS, Viceconte M, Pauletti HO, Matos-Garcia BC, Marcondi NO, Bublitz C, Bolzan DW, Moreira RSL, Reis MS, Hossne NA, Gomes WJ, Arena R, Guizilini S. Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery. Disabil Rehabil 2017; 41:534-540. [PMID: 29279000 DOI: 10.1080/09638288.2017.1401673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. METHODS Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery. RESULTS Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51 × 10-3 min2/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics. CONCLUSIONS Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay. Implications for rehabilitation Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression; The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes; Our findings suggest the importance of the rehabilitation in the pre-operative in order to "pre-habilitate" the patients to the surgical procedure; Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.
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Affiliation(s)
- Isadora Salvador Rocco
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Marcela Viceconte
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Hayanne Osiro Pauletti
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Bruna Caroline Matos-Garcia
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Natasha Oliveira Marcondi
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Caroline Bublitz
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Douglas William Bolzan
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Rita Simone Lopes Moreira
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Michel Silva Reis
- c Department of Physical Therapy , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Nelson Américo Hossne
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Walter José Gomes
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil
| | - Ross Arena
- d Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL , USA
| | - Solange Guizilini
- a Cardiology and Cardiovascular Surgery Disciplines , Federal University of Sao Paulo , Sao Paulo , Brazil.,b Department of Human Motion Sciences, Physical Therapy School , Federal University of Sao Paulo , Sao Paulo , Brazil
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Eraballi A, Pradhan B. Quality of life improvement with rehabilitation according to constitution of the World Health Organization for coronary artery bypass graft surgery patients: A descriptive review. Ayu 2017; 38:102-107. [PMID: 30254387 PMCID: PMC6153913 DOI: 10.4103/ayu.ayu_152_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This is a descriptive review focusing on trends of treatments required for postoperative coronary artery bypass graft surgery (CABG) patients to improve the quality of life (QOL). METHODOLOGY The sources of literary research to understand the concepts of coronary artery disease according to Indian scriptures are Ayurveda texts, Bhagavad Gita, Patanjali Yoga Sutra. The data was typed in Sanskrit using Devanagari script and explanation in English was given. As per new research techniques, surgery, physiotherapy rehabilitation and Yoga are serving CABG patient's medical and psychological health better. The World Health Organization (WHO) defines health as physical, mental and social well-being later redefined with additional terms like environmental and spiritual health. This definition is similar to the Panchakosha concept in Yoga and Pancha Mahabhutas in Ayurveda. In cases of emergency or passive treatment, medication serves as a better option for physical health. In circumstances where the person is able to move in daily activities (just after discharge), rehabilitation serves as a better option for physical, mental and social health. Travel and reactions to climatic change serve environmental health. Last strategy, belief, cultural and traditional methods with scientific background serves as the spiritual health. These step-wise treatments are required for CABG patients to get the overall health or QOL. However, surgery and physiotherapy rehabilitation are advanced as per modern era which serves physical, mental, and social health also, but environmental health and spiritual health have yet to be addressed. As an ancient system of medicine, Yoga combines physical, mental, social, environmental and spiritual practices and it should be added as treatment along with surgery and physiotherapy rehabilitation. If all of these therapies were in the treatment protocol for CABG surgery patients, we would observe the changes of QOL and fulfill the requirements of constitution of the WHO. Integrating concepts of Yoga, Ayurveda, modern rehabilitation, surgery and patient cooperation with lifestyle change are the key to QOL improvements after CABG.
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Affiliation(s)
- Amaravathi Eraballi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Balaram Pradhan
- Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
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32
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Mlynarska A, Mlynarski R, Golba KS. Frailty syndrome in patients with heart rhythm disorders. Geriatr Gerontol Int 2016; 17:1313-1318. [DOI: 10.1111/ggi.12868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 05/30/2016] [Accepted: 06/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Agnieszka Mlynarska
- Department of Internal Nursing, Chair of Internal Medicine, School of Health Sciences; Medical University of Silesia; Katowice Poland
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
| | - Rafal Mlynarski
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
| | - Krzysztof S Golba
- Department of Electrocardiology; Upper Silesian Heart Center; Katowice Poland
- Department of Electrocardiology and Heart Failure, School of Health Sciences; Medical University of Silesia; Katowice Poland
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Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart 2016; 102:1494-507. [DOI: 10.1136/heartjnl-2015-308562] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Kim YH, Shim WJ, Kim MA, Hong KS, Shin MS, Park SM, Cho KI, Kim M, Kim S, Kim HL, Yoon HJ, Na JO, Kim SE. Utility of Pretest Probability and Exercise Treadmill Test in Korean Women with Suspected Coronary Artery Disease. J Womens Health (Larchmt) 2016; 25:617-22. [DOI: 10.1089/jwh.2015.5242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yong-Hyun Kim
- Cardiovascular Center, Korea University Ansan Hospital, Ansan, Korea
| | - Wan-Joo Shim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Myung-A Kim
- Cardiovascular Center, Seoul National University Boramae Hospital, Seoul, Korea
| | - Kyung-Soon Hong
- Cardiovascular Center, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Mi-Seung Shin
- Cardiovascular Center, Gachon University Gil Hospital, Incheon, Korea
| | - Seong-Mi Park
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Kyoung Im Cho
- Cardiovascular Center, Kosin University Gospel Hospital, Busan, Korea
| | - Mina Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Sihun Kim
- Cardiovascular Center, Gachon University Gil Hospital, Incheon, Korea
| | - Hak-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hyun-Ju Yoon
- Cardiovascular Center, Chonnam University Hospital, Gwangju, Korea
| | - Jin-Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sung-Eun Kim
- Cardiovascular Center, Kangdong Sacred Heart Hospital, Seoul, Korea
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Briceno N, Perera D. To Revascularise or Not To Revascularise, That Is the Question: the Diagnostic and Management Conundrum of Ischaemic Cardiomyopathy. Curr Cardiol Rep 2016; 18:54. [PMID: 27115418 PMCID: PMC4846708 DOI: 10.1007/s11886-016-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ischaemic cardiomyopathy is an important cardiovascular condition that has differing pathophysiological substrates and clinical manifestations. Contemporary management involves the administration of heart failure pharmacotherapy and device therapy where indicated, which has good prognostic data to support it. Whilst the role of revascularisation is clear in those patients presenting with an acute coronary syndrome or angina, the role in those patients presenting either incidentally, with predominant heart failure symptoms, or in those presenting with acute heart failure with an associated elevated troponin is less well defined and lacks randomised outcome data to support its adoption. The aim of this review is therefore to discuss the challenges in the diagnosis of ischaemic cardiomyopathy with a review of the existing imaging modalities that can facilitate, and to revisit the variety of clinical presentations that can occur, with particular emphasis on the contemporary role of revascularisation in these cohorts of patients.
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Affiliation(s)
- Natalia Briceno
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK.
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New Insights in the Diagnosis and Treatment of Heart Failure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:265260. [PMID: 26634204 PMCID: PMC4637457 DOI: 10.1155/2015/265260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/21/2015] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists.
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Hayes LD, Sculthorpe N, Herbert P, Baker JS, Spagna R, Grace FM. Six weeks of conditioning exercise increases total, but not free testosterone in lifelong sedentary aging men. Aging Male 2015; 18:195-200. [PMID: 26030347 DOI: 10.3109/13685538.2015.1046123] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Advancing age is associated with a gradual decline in circulating androgens, and the putative role of exercise training on systemic androgens remains to be adequately defined. METHODS The present investigation examined the impact of 6 weeks of supervised exercise training on resting levels of systemic hormones in a cohort of lifelong sedentary men [SED (n = 28), 62.5 ± 5.3 years], compared with a positive control group of age-matched lifelong exercisers [LE (n = 20), 60.4 ± 4.7 years, >30 years training history]. Blood hormones were sampled pre- and post-intervention from an antecubital forearm vein and analysed using electrochemiluminescent immunoassay. Cardiorespiratory fitness ([Formula: see text]) was determined via indirect calorimetry during an incremental cycle test to volitional exhaustion. RESULTS Analysis of variance (ANOVA) revealed a lack of significant change in any parameter amongst LE, whilst SED experienced a significant exercise-induced improvement in cardiorespiratory fitness and total testosterone (all p < 0.05). Concurrent increases in sex hormone-binding globulin (SHBG; p < 0.05) resulted in a lack of change to either bioavailable or calculated free testosterone (p > 0.05) amongst SED. CONCLUSIONS Although resting levels of systemic total testosterone increased in response to 6 weeks of exercise training, increases in SHBG negated any potential relationship between calculated-free or bioavailable testosterone. These findings indicate that increases in bioavailable testosterone fraction are not required for cardiorespiratory fitness improvements in aging men.
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Affiliation(s)
- Lawrence D Hayes
- a School of Human Sciences, London Metropolitan University , London , UK
- b Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , UK
| | - Nicholas Sculthorpe
- b Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , UK
| | - Peter Herbert
- c School of Sport, Health and Outdoor Education, Trinity Saint David, University of Wales , Carmatrthen , UK , and
| | - Julien S Baker
- b Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , UK
| | - Roberto Spagna
- d Department of Clinical Biochemistry , Royal Glamorgan Hospital , Pontyclun , Mid Glamorgan , UK
| | - Fergal M Grace
- b Institute of Clinical Exercise and Health Science, University of the West of Scotland , Hamilton , UK
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Bonow RO. Indications for revascularization in patients with left ventricular dysfunction: evidence and uncertainties. J Thorac Cardiovasc Surg 2014; 148:2461-5. [PMID: 25433865 DOI: 10.1016/j.jtcvs.2014.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robert O Bonow
- Department of Medicine, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J 2014; 35:1726-31. [PMID: 24864078 PMCID: PMC4565652 DOI: 10.1093/eurheartj/ehu197] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/20/2014] [Accepted: 04/23/2014] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality. With the ageing population, the prognostic determinants among others include frailty, health status, disability, and cognition. These constructs are seldom measured and factored into clinical decision-making or evaluation of the prognosis of these at-risk older adults, especially as it relates to high-risk interventions. Addressing this need effectively requires increased awareness and their recognition by the treating cardiologists, their incorporation into risk prediction models when treating an elderly patient with underlying complex CVD, and timely referral for comprehensive geriatric management. Simple measures such as gait speed, the Fried score, or the Rockwood Clinical Frailty Scale can be used to assess frailty as part of routine care of elderly patients with CVD. This review examines the prevalence and outcomes associated with frailty with special emphasis in patients with CVD.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, and University of Auckland, Auckland, New Zealand
| | - Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, and University of Auckland, Auckland, New Zealand
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