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Belenkov YN, Lishuta AS, Slepova OA, Nikolaeva NS, Khabarova NV, Dadashova GM, Privalova EV. The EXCEL Study: Long-term Observation of the Effectiveness of Drug and Non-drug Rehabilitation in Patients with Ischemic Heart Failure. KARDIOLOGIIA 2024; 64:14-24. [PMID: 38323440 DOI: 10.18087/cardio.2024.1.n2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024]
Abstract
AIM To study the long-term effect of enhanced external counterpulsation (EECP) therapy on exercise tolerance, quality of life (QoL), and indicators of the structural and functional state of the cardiovascular system in patients with stable ischemic heart disease (IHD) complicated by chronic heart failure (CHF). MATERIAL AND METHODS This open randomized EXCEL study included 120 patients with verified IHD complicated by NYHA II-III functional class CHF with reduced or mid-range left ventricular (LV) ejection fraction. Patients were randomized into group 1 (n=40), optimal drug therapy (ODT) and EECP (35 hours, 2 courses per year); group 2 (n=40), ODT and EECP (35 hours, 1 course per year); and group 3 (control; n=40), ODT and placebo counterpulsation (35 h, 1 course per year). All patients underwent a 6-minute walk test (6MWT), evaluation of clinical status, QoL with the MLHFQ and SF-36 questionnaires, structural and functional state of large blood vessels and microvasculature, measurement of brain natriuretic peptide precursor (NT-proBNP), and echocardiography at baseline and after 12 months. RESULTS In groups 1 and 2 after 12 months, the 6MWT distance increased statistically significantly (44.5 and 24.9%, respectively) and the following indexes improved: QoL (SF-36, MLHFQ), the condition of large blood vessels (phase shift, radial augmentation index, central aortic systolic pressure (CASP)) and microvasculature (occlusion index, percentage of perfused capillaries, percentage of capillary recovery), and the LV systolic function (from 40.6±7.5 to 47.5±10.2% and from 41.3± 6.8 to 43.9±10.3%, respectively). The proportion of patients with a >20% increase in the 6MWT at 12 months was 97.5, 72.5, and 7.7%, respectively. A statistically significant decrease in NT-proBNP was observed in all groups. In group 3, the incidence of hospitalizations for CHF and the risk of the composite endpoint were significantly higher. CONCLUSION For the 12-month study period, the effects of EECP in patients with IHD complicated by CHF included improvements in exercise tolerance, QoL, vascular and cardiac functional parameters, and a decrease in the incidence of adverse outcomes.
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Affiliation(s)
- Yu N Belenkov
- Sechenov First Moscow State Medical University, Moscow
| | - A S Lishuta
- Sechenov First Moscow State Medical University, Moscow
| | - O A Slepova
- Sechenov First Moscow State Medical University, Moscow
| | - N S Nikolaeva
- Sechenov First Moscow State Medical University, Moscow
| | - N V Khabarova
- Sechenov First Moscow State Medical University, Moscow
| | | | - E V Privalova
- Sechenov First Moscow State Medical University, Moscow
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Yin Q, Jiang H, Zhang Z, Zhang L, Wu Z, Huang L, Chen X. Influence of enhanced external counterpulsation on endothelial function: a meta-analysis of randomized controlled trials. SCAND CARDIOVASC J 2023; 57:2273223. [PMID: 37876280 DOI: 10.1080/14017431.2023.2273223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Enhanced external counterpulsation (EECP) is an effective and noninvasive treatment for patients with refractory angina and chronic heart failure. However, previous studies evaluating the influence of EECP on endothelial function showed inconsistent results. This systematic review and meta-analysis was conducted to evaluate the effects of EECP on endothelial function measured by brachial artery flow-mediated dilation (FMD). DESIGN PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases were searched for randomized controlled trials comparing the influence of EECP versus usual care on FMD in adult population. A random-effects model incorporating the potential influence of heterogeneity was used to pool the results. RESULTS Nineteen studies with 1647 patients were included in the meta-analysis. Compared with usual care or conventional therapy, additional treatment with EECP for 3-7 weeks was associated with a significantly improved FMD (mean difference [MD]: 1.96%, 95% confidence interval [CI]: 1.57-2.36, p < 0.001, I2 = 52%). Subgroup analysis showed consistent results in patients with coronary artery disease and in patients with other diseases (p for subgroup difference = 0.21). Results of meta-regression analysis showed that the mean baseline FMD level was positively correlated with the influence of EECP on FMD (coefficient = 0.42, p < 0.001). Results of subgroup analysis suggested that the increment of FMD following EECP was larger in patients with baseline FMD ≥ 5% (MD: 2.69, 95% CI: 2.27-3.10, p < 0.001; I2 = 15%) compared to those with baseline FMD < 5% (MD: 1.49, 95% CI: 1.13-1.85, p < 0.001; I2 = 0%; p for subgroup difference < 0.001). CONCLUSIONS EECP may be effective in improving endothelial function measured by FMD.
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Affiliation(s)
- Qiulin Yin
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hua Jiang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China
| | - Zhifeng Zhang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Long Zhang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhiyong Wu
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Li Huang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xuanlan Chen
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Long Term Physical Activity Improves Quality of Life Perception, Healthy Nutrition, and Daily Life Management in Elderly: A Randomized Controlled Trial. Nutrients 2022; 14:nu14122527. [PMID: 35745256 PMCID: PMC9229916 DOI: 10.3390/nu14122527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
Physical activity (PA) is a key element in the management of successful aging. The aim of this paper was to show the effects of PA on the quality of life perception, nutritional status, and daily life management of 178 older adults (aged 63.87 ± 8.17) randomly assigned to an Experimental Group (EG), which performed moderate-to-high intensity aerobic and strengthening training, and a Control Group (CG) which performed low-impact PA, assessed after 6, 12, and 24 months. The Short-Form Health Survey (SF-36), Mini Nutritional Assessment (MNA), and Physical Activity Scale for the Elderly (PASE) were used for the study. In the SF-36 assessment, EG showed a good quality of life perception maintained after 24 months, while CG showed a worsening in the same period (p = 0.018). The EG reported a significant better nutritional status as compared to pre-intervention assessment (p = 0.003) and to CG (p < 0.001). Regarding the PASE, the EG showed a higher level of weekly activities than the CG after 24 months (p = 0.011), while the CG showed a worsening after 12 months (p = 0.008). The prolonged engagement in moderate-to high-intensity PA allowed the maintenance of a good quality of life perception, a good level of nutritional status, and daily life activities.
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Effect of ICD/CRT-D Implantation on Adverse Events and Readmission Rate in Patients with Chronic Heart Failure (CHF). COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8695291. [PMID: 35615439 PMCID: PMC9126666 DOI: 10.1155/2022/8695291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the effect of implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) implantation on adverse events and the readmission rate in patients with chronic heart failure (CHF). Methods Sixty patients with CHF treated in our hospital from April 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group received routine intervention, and the study group received remote management with ICD/CRT-D implantation. Results First of all, we compared the general data of the two groups. There was no significant difference in LVEF, NYHA grade, concomitant disease, and history of arrhythmia (P > 0.05). Secondly, we compared the end-point events. In the study group, 5 cases of heart failure were readmitted, 0 cases died, and 4 cases were admitted to hospital with arrhythmia and ICD events, with a total incidence of 30.0%, while in the control group, 12 cases were rehospitalized with heart failure, 3 cases died, 25 cases were admitted with arrhythmia and ICD events, and the total incidence rate was 56.67% (P < 0.05). In terms of the readmission rate of patients with heart failure in grade NYHAII and grade III, among the patients with grade NYHAII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group (P < 0.05). Among the patients with grade NYHAIII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group. There exhibited no significant difference in the data (P > 0.05). Considering the occurrence of VT and VF events, the study team reported that 14 patients recorded a total of 276 ventricular arrhythmias: 261 ventricular tachycardia and 15 ventricular fibrillations. Among them, 24 VT (9.2%) and 4 VF (26.7%) were determined to be misrecognition of the equipment. A total of 178 ventricular arrhythmias were recorded in 13 patients in the control group, including 152 ventricular tachycardia and 26 ventricular fibrillations. Among them, 10 VT (6.6%) and 8 VF (30.8%) were determined as misrecognition of the device. In regard to the treatment results of the two groups, after admission to the hospital for radio frequency, ablation, and adjustment of drug treatment to reprogram control, the patients did not reappear to have CRT-D misidentification and misdischarged. Finally, we compared the diagnosis time of VT/VE events. The time from VT/VE events to diagnosis in 14 patients in the study group was 2.55 ± 1.41 days, and that in 13 patients in the control group was 37.32 ± 15.31 days. The discovery of ICD events in the study group was significantly earlier compared to that in the routine follow-up group (P < 0.05). This gives doctors enough time to assess the patient's condition and determine a further diagnosis and treatment plan. Conclusion Using ICD/CRT-D implantation to remotely monitor patients with CHF, through remote monitoring of the 24-hour average heart rate and the heart rate at rest and patient activity and other parameters and early intervention, the readmission rate caused by the deterioration of heart failure can be reduced. Compared with routine follow-up, remote monitoring significantly reduced the diagnosis time of VT/VE events.
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Cao RY, Kelle S, Yang J. Editorial: Advances in the Prevention and Rehabilitation of Cardiovascular Diseases via Aerobic Exercise. Front Cardiovasc Med 2022; 9:858785. [PMID: 35360019 PMCID: PMC8964033 DOI: 10.3389/fcvm.2022.858785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard Y. Cao
- Department of Cardiology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, China
- *Correspondence: Richard Y. Cao
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jian Yang
- Department of Rehabilitation, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
- Jian Yang
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Zhao S, Liu S, Wen Y, Qi Q, Huang P. Analysis of the Effect of External Counterpulsation Combined With High-Intensity Aerobic Exercise on Cardiopulmonary Function and Adverse Cardiovascular Events in Patients With Coronary Heart Disease After PCI. Front Surg 2022; 9:851113. [PMID: 35310429 PMCID: PMC8927644 DOI: 10.3389/fsurg.2022.851113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To explore the intervention effect of external counterpulsation (ECP) combined with high-intensity aerobic exercise (HIAT) on patients with coronary heart disease (CHD) after PCI. Methods 124 patients with stable CHD after PCI admitted to our hospital from June 2018 to June 2021 were selected, and all patients were divided into control group and observation group using the random number table method. The control group received conventional treatment, The observation group received ECP combined with HIAT based on the control group. The cardiorespiratory function indexes, exercise endurance indexes, incidence of major cardiovascular adverse events (MACE), Barthel index of the two groups were observed. Results After intervention, METs max, VO2max, VO2max/kg, VO2max/HR, and PP, ED, AT, and Barthel score in both groups were significantly higher than before intervention, and patients in the observation group were significantly higher than those in the control group (P < 0.05). The incidence of MACE in the observation group (3.23%) was lower than in the control group (12.90%) (P < 0.05). Conclusion ECP combined with HIAT can improve the cardiopulmonary function of patients with CHD after PCI, and improve exercise endurance, reduce the incidence of MACE, improve patients' ability of daily living.
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Affiliation(s)
- Shiming Zhao
- Department of Cardiology, Wuhan Hankou Hospital, Wuhan, China
| | - Shaowen Liu
- Department of Cardiology, Wuhan Hankou Hospital, Wuhan, China
| | - Yuan Wen
- Department of Cardiology, Wuhan Hankou Hospital, Wuhan, China
| | - Qiuhuan Qi
- Department of Cardiology, Wuhan Hankou Hospital, Wuhan, China
| | - Peng Huang
- Intensive Care Unit, Emergency Medical Department, Wuhan Hankou Hospital, WuHan, China
- *Correspondence: Peng Huang
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Zeng CM, Zhao YM, Zhong XJ, Wu ZJ, Bai J, Qiu SY, Li YY. Reduction in risk of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus by enhanced external counterpulsation. Front Endocrinol (Lausanne) 2022; 13:973452. [PMID: 36325451 PMCID: PMC9618591 DOI: 10.3389/fendo.2022.973452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of enhanced external counterpulsation (EECP) in the prevention of contrast-induced nephropathy (CIN) in patients with combined chronic kidney disease (CKD) and diabetes mellitus (DM) by comparing the changes in renal function-related indicators in patients before and after coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHODS There were 230 subjects consecutively included in the study. Of these, 30 cases with DM underwent rehydration therapy, and 200 cases underwent EECP therapy in addition to rehydration therapy, comprising 53 patients with DM and 147 patients without. All the patients were tested to measure the renal function indicators before and after CAG/PCI. RESULTS The postoperative results of blood urea nitrogen (BUN), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), B2 microglobulin, and high-sensitivity C-reactive protein in the three groups showed a statistically significant difference (P < 0.05). After EECP therapy, patients with DM showed a significant decrease in BUN (9.1 ± 4.2 vs. 7.2 ± 3.0, t = 3.899, P < 0.001) and a significant increase in eGFR (41.5 ± 12.7 vs. 44.0 ± 15.6, t = -2.031, P = 0.047), while the patients without DM showed a more significant difference (P < 0.001). Patients with DM showed a lower percentage of elevated Scr (66.7% vs. 43.4%, P = 0.042), a higher percentage of elevated eGFR (30.0% vs. 52.8%, P = 0.044), and a lower incidence of CIN (16.7% vs. 3.8%, P = 0.042) after EECP therapy. CONCLUSION Treatment with EECP can reduce Scr in patients with combined CKD and DM post CAG/PCI, increase eGFR, and decrease the incidence of CIN.
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