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Tiemeier L, Nikolaidis PT, Chlíbková D, Wilhelm M, Thuany M, Weiss K, Knechtle B. Ultra-Cycling- Past, Present, Future: A Narrative Review. Sports Med Open 2024; 10:48. [PMID: 38679655 PMCID: PMC11056358 DOI: 10.1186/s40798-024-00715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Ultra-endurance events are gaining popularity in multiple exercise disciplines, including cycling. With increasing numbers of ultra-cycling events, aspects influencing participation and performance are of interest to the cycling community. MAIN BODY The aim of this narrative review was, therefore, to assess the types of races offered, the characteristics of the cyclists, the fluid and energy balance during the race, the body mass changes after the race, and the parameters that may enhance performance based on existing literature. A literature search was conducted in PubMed, Scopus, and Google Scholar using the search terms 'ultracycling', 'ultra cycling', 'ultra-cycling', 'ultra-endurance biking', 'ultra-bikers' and 'prolonged cycling'. The search yielded 948 results, of which 111 were relevant for this review. The studies were classified according to their research focus and the results were summarized. The results demonstrated changes in physiological parameters, immunological and oxidative processes, as well as in fluid and energy balance. While the individual race with the most published studies was the Race Across America, most races were conducted in Europe, and a trend for an increase in European participants in international races was observed. Performance seems to be affected by characteristics such as age and sex but not by anthropometric parameters such as skin fold thickness. The optimum age for the top performance was around 40 years. Most participants in ultra-cycling events were male, but the number of female athletes has been increasing over the past years. Female athletes are understudied due to their later entry and less prominent participation in ultra-cycling races. A post-race energy deficit after ultra-cycling events was observed. CONCLUSION Future studies need to investigate the causes for the observed optimum race age around 40 years of age as well as the optimum nutritional supply to close the observed energy gap under consideration of the individual race lengths and conditions. Another research gap to be filled by future studies is the development of strategies to tackle inflammatory processes during the race that may persist in the post-race period.
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Affiliation(s)
- Lucas Tiemeier
- Centre for Rehabilitation & Sports Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, 61669, Brno, Czech Republic
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Katja Weiss
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001, St. Gallen, Switzerland.
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Vetsch T, Eggmann S, Jardot F, von Gernler M, Engel D, Beilstein CM, Wuethrich PY, Eser P, Wilhelm M. Ventilatory efficiency as a prognostic factor for postoperative complications in patients undergoing elective major surgery: a systematic review. Br J Anaesth 2024:S0007-0912(24)00144-2. [PMID: 38644158 DOI: 10.1016/j.bja.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO2). The aim of this systematic review was to summarise evidence regarding VE/VCO2 as a prognostic factor for postoperative complications in patients undergoing major surgery. METHODS A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies. RESULTS From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains 'study confounding' and 'statistical analysis'. VE/VCO2 was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO2 was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO2 from the final multivariable regression owing to data-driven model-building approaches. CONCLUSIONS This systematic review identifies VE/VCO2 as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022369944).
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Affiliation(s)
- Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - François Jardot
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc von Gernler
- Medical Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Milani JGPO, Milani M, Machado FVC, Wilhelm M, Marcin T, D'Ascenzi F, Cavigli L, Keytsman C, Falter M, Bonnechere B, Meesen R, Braga F, Cipriano GFB, Cornelissen V, Verboven K, Junior GC, Hansen D. Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation. Eur J Prev Cardiol 2024:zwae149. [PMID: 38636093 DOI: 10.1093/eurjpc/zwae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
AIMS To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains. METHODS Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). RESULTS HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines. CONCLUSION Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.
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Affiliation(s)
- Juliana Goulart Prata Oliveira Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - Mauricio Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Felipe Vilaça Cavallari Machado
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thimo Marcin
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bruno Bonnechere
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, University of Hasselt, Diepenbeek, Belgium
- Centre of expertise in Care Innovation, Department of PXL - Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Raf Meesen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Braga
- Laboratório de Performance Humana, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Graziella França Bernardelli Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Programme, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Kenneth Verboven
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Gerson Cipriano Junior
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Dominique Hansen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
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Wilhelm M, Bauer S, Feldhege J, Wolf M, Moessner M. Alleviating the burden of depression: a simulation study on the impact of mental health services. Epidemiol Psychiatr Sci 2024; 33:e19. [PMID: 38563188 PMCID: PMC11022261 DOI: 10.1017/s204579602400012x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS Depressive disorders are ranked as the single leading cause of disability worldwide. Despite immense efforts, there is no evidence of a global reduction in the disease burden in recent decades. The aim of the study was to determine the public health impact of the current service system (status quo), to quantify its effects on the depression-related disease burden and to identify the most promising strategies for improving healthcare for depression on the population level. METHODS A Markov model was developed to quantify the impact of current services for depression (including prevention, treatment and aftercare interventions) on the total disease burden and to investigate the potential of alternative scenarios (e.g., improved reach or improved treatment effectiveness). Parameter settings were derived from epidemiological information and treatment data from the literature. Based on the model parameters, 10,000,000 individual lives were simulated for each of the models, based on monthly transition rates between dichotomous health states (healthy vs. diseased). Outcome (depression-related disease burden) was operationalized as the proportion of months spent in depression. RESULTS The current healthcare system alleviates about 9.5% (95% confidence interval [CI]: 9.2%-9.7%) of the total disease burden related to depression. Chronic cases cause the majority (83.2%) of depression-related burden. From a public health perspective, improving the reach of services holds the largest potential: Maximum dissemination of prevention (26.9%; CI: 26.7%-27.1%) and treatment (26.5%; CI: 26.3%-26.7%) would result in significant improvements on the population level. CONCLUSIONS The results confirm an urgent need for action in healthcare for depression. Extending the reach of services is not only more promising but also probably more achievable than increasing their effectiveness. Currently, the system fails to address the prevention and treatment of chronic cases. The large proportion of the disease burden associated with chronic courses highlights the need for improved treatment policies and clinical strategies for this group (e.g., disease management and adaptive or personalized interventions). The model complements the existing literature by providing a new perspective on the depression-related disease burden and the complex interactions between healthcare services and the lifetime course.
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Affiliation(s)
- M. Wilhelm
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - S. Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - J. Feldhege
- Asklepios Science & Research, Research Institute, Hamburg, Germany
| | - M. Wolf
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - M. Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
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López-Fernández T, Farmakis D, Ameri P, Asteggiano R, de Azambuja E, Aznar M, Barac A, Bayes-Genis A, Bax JJ, Bergler-Klein J, Boriani G, Celutkiene J, Coats A, Cohen-Solal A, Córdoba R, Cosyns B, Filippatos G, Fox K, Gulati G, Inciardi RM, Lee G, Mamas MA, Novo G, Plummer C, Psyrri A, Rakisheva A, Suter T, Tini G, Tocchetti CG, Toutouzas K, Wilhelm M, Metra M, Lyon AR, Rosano GMC. European Society of Cardiology Core Curriculum for cardio-oncology. Eur J Heart Fail 2023. [PMID: 38059343 DOI: 10.1002/ejhf.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
Cardio-oncology is a rapidly growing field of cardiovascular (CV) medicine that has resulted from the continuously increasing clinical demand for specialized CV evaluation, prevention and management of patients suffering or surviving from malignant diseases. Dealing with CV disease in patients with cancer requires special knowledge beyond that included in the general core curriculum for cardiology. Therefore, the European Society of Cardiology (ESC) has developed a special core curriculum for cardio-oncology, a consensus document that defines the level of experience and knowledge required for cardiologists in this particular field. It is structured into 8 chapters, including (i) principles of cancer biology and therapy; (ii) forms and definitions of cancer therapy-related cardiovascular toxicity (CTR-CVT); (iii) risk stratification, prevention and monitoring protocols for CTR-CVT; (iv) diagnosis and management of CV disease in patients with cancer; (v) long-term survivorship programmes and cardio-oncology rehabilitation; (vi) multidisciplinary team management of special populations; (vii) organization of cardio-oncology services; (viii) research in cardio-oncology. The core curriculum aims at promoting standardization and harmonization of training and evaluation in cardio-oncology, while it further provides the ground for an ESC certification programme designed to recognize the competencies of certified specialists.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Riccardo Asteggiano
- Faculty of Medicine, Insubria University, Varese, Italy
- LARC (Laboratorio Analisi e Ricerca Clinica), Turin, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, VA, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris Cite University, INSERM U-942, Paris, France
| | - Raúl Córdoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute, Instituto de Investigación Sanitaria-Fundación Jiménez-Díaz (IIS-FJD), Madrid, Spain
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kevin Fox
- Imperial College Healthcare NHS Trust; NHS Orkney, Orkney, UK
| | - Geeta Gulati
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Riccardo M Inciardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Chris Plummer
- Department of Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - Amina Rakisheva
- City Cardiolocal Center, Almaty, Kazakhstan
- Qonaev city hospital, Almaty, Kazakhstan
| | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giacomo Tini
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | | | - Matthias Wilhelm
- Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Guys and St. Thomas NHS Foundation Trust, London, UK
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Schneider C, Ryffel C, Stütz L, Rabaglio M, Suter TM, Campbell KL, Eser P, Wilhelm M. Supervised exercise training in patients with cancer during anthracycline-based chemotherapy to mitigate cardiotoxicity: a randomized-controlled-trial. Front Cardiovasc Med 2023; 10:1283153. [PMID: 38111886 PMCID: PMC10725952 DOI: 10.3389/fcvm.2023.1283153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Exercise training (ET) has been shown to mitigate cardiotoxicity of anthracycline-based chemotherapies (AC) in animal models. Data from randomized controlled trials in patients with cancer are sparse. Methods Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres and randomly assigned to 3 months supervised ET. Primary outcome was change in left ventricular global longitudinal strain (GLS) from baseline (before AC) to post AC (AC-end) compared between the EXduringAC group, who participated in an exercise intervention during AC including the provision of an activity tracker, and the control group EXpostAC, who received an activity tracker only. Secondary outcome parameters were changes in high sensitivity Troponin T (hsTnT), NT-pro-brain natriuretic peptide (NT-proBNP), peak oxygen consumption (peak VO2) and objectively measured physical activity (PA) during this same time-period. All assessments were repeated at a 12-week follow-up from AC-end, when also the EXpostAC group had completed the ET, that started after AC. In exploratory analyses, robust linear models were performed to assess the association of PA with changes in echocardiographic parameters and biomarkers of LV function. Results Fifty-seven patients (median age 47 years; 95% women) were randomized to EXduringAC (n = 28) and EXpostAC (n = 29) group. At AC-end, GLS deteriorated in both study groups (albeit insignificantly) with 7.4% and 1.0% in EXduringAC (n = 18) and EXpostAC (n = 18), respectively, and hsTnT and NT-proBNP significantly increased in both groups, without difference between groups for any parameter. Change in peak VO2 (-1.0 and -1.1 ml/kg/min) at AC-end was also similar between groups as was duration of moderate-to-vigorous PA (MVPA) with a median of 33 [26, 47] min/day and 32 [21, 59] min/day in the EXduringAC and EXpostAC group, respectively. In the robust linear model including the pooled patient population, MVPA was significantly associated with a more negative GLS and lesser increase in hsTnT at AC-end. Conclusion In this small scale RCT, supervised ET during AC was not superior to wearing a PA tracker to mitigate cardiotoxicity. The dose-response relationship between PA and cardioprotective effects during AC found in our and previous data supports the notion that PA should be recommended to patients undergoing AC. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03850171.
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Affiliation(s)
- Caroline Schneider
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Laura Stütz
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Thomas M. Suter
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Prisca Eser
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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7
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Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Gil CP, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction-modification with exercise-based cardiac rehabilitation and prognostic value. Front Cardiovasc Med 2023; 10:1219589. [PMID: 37727302 PMCID: PMC10505741 DOI: 10.3389/fcvm.2023.1219589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
Background Inefficient ventilation is an established prognostic marker in patients with heart failure. It is not known whether inefficient ventilation is also linked to poor prognosis in patients with left ventricular dysfunction (LVD) but without overt heart failure. Objectives To investigate whether inefficient ventilation in elderly patients with LVD is more common than in patients without LVD, whether it improves with exercise-based cardiac rehabilitation (exCR), and whether it is associated with major adverse cardiovascular events (MACE). Methods In this large multicentre observational longitudinal study, patients aged ≥65 years with acute or chronic coronary syndromes (ACS, CCS) without cardiac surgery who participated in a study on the effectiveness of exCR in seven European countries were included. Cardiopulmonary exercise testing (CPET) was performed before, at the termination of exCR, and at 12 months follow-up. Ventilation (VE), breathing frequency (BF), tidal volume (VT), and end-expiratory carbon dioxide pressure (PETCO2) were measured at rest, at the first ventilatory threshold, and at peak exercise. Ventilatory parameters were compared between patients with and without LVD (based on cardio-echography) and related to MACE at 12 month follow-up. Results In 818 patients, age was 72.5 ± 5.4 years, 21.9% were women, 79.8% had ACS, and 151 (18%) had LVD. Compared to noLVD, in LVD resting VE was increased by 8%, resting BF by 6%, peak VE, peak VT, and peak PETCO2 reduced by 6%, 8%, and 5%, respectively, and VE/VCO2 slope increased by 11%. From before to after exCR, resting VE decreased and peak PETCO2 increased significantly more in patients with compared to without LVD. In LVD, higher resting BF, higher nadir VE/VCO2, and lower peak PETCO2 at baseline were associated with MACE. Conclusions Similarly to patients with HF, in elderly patients with ischemic LVD, inefficient resting and exercise ventilation was associated with worse outcomes, and ExCR alleviated abnormal breathing patterns and gas exchange parameters.
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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8
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Morales R, Spiering A, Wilhelm M, Yang Q, Zhang C. Bootstrapping Elliptic Feynman Integrals Using Schubert Analysis. Phys Rev Lett 2023; 131:041601. [PMID: 37566863 DOI: 10.1103/physrevlett.131.041601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 08/13/2023]
Abstract
The symbol bootstrap has proven to be a powerful tool for calculating polylogarithmic Feynman integrals and scattering amplitudes. In this Letter, we initiate the symbol bootstrap for elliptic Feynman integrals. Concretely, we bootstrap the symbol of the twelve-point two-loop double-box integral in four dimensions, which depends on nine dual-conformal cross ratios. We obtain the symbol alphabet, which contains 100 logarithms as well as nine simple elliptic integrals, via a Schubert-type analysis, which we equally generalize to the elliptic case. In particular, we find a compact, one-line formula for the (2,2) coproduct of the result.
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Affiliation(s)
- Roger Morales
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Anne Spiering
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Matthias Wilhelm
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Qinglin Yang
- CAS Key Laboratory of Theoretical Physics, Institute of Theoretical Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Chi Zhang
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
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9
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Tessitore E, Schmid JP, Hermann M, Schmied C, Wilhelm M, Meyer P. Cardiovascular Rehabilitation Delivery and Outcomes in Switzerland in More Than a Hundred Thousand Patients Over the Last Decade. J Cardiopulm Rehabil Prev 2023; 43:305-307. [PMID: 36857104 PMCID: PMC10287049 DOI: 10.1097/hcr.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Elena Tessitore
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Jean-Paul Schmid
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Matthias Hermann
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Christian Schmied
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Matthias Wilhelm
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Philippe Meyer
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
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10
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Valenzuela PL, Ruilope LM, Santos-Lozano A, Wilhelm M, Kränkel N, Fiuza-Luces C, Lucia A. Exercise benefits in cardiovascular diseases: from mechanisms to clinical implementation. Eur Heart J 2023:7099688. [PMID: 37005351 DOI: 10.1093/eurheartj/ehad170] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
There is a pandemic of physical inactivity that appears to parallel the widespread prevalence of cardiovascular disease (CVD). Yet, regular physical activity (PA) and exercise can play an important role not only in primary cardiovascular prevention but also in secondary prevention. This review discusses some of the main cardiovascular effects of PA/exercise and the mechanisms involved, including a healthier metabolic milieu with attenuation of systemic chronic inflammation, as well as adaptations at the vascular (antiatherogenic effects) and heart tissue (myocardial regeneration and cardioprotection) levels. The current evidence for safe implementation of PA and exercise in patients with CVD is also summarized.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
- Department of Systems Biology, University of Alcala, Madrid 28871, Spain
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid 28041, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
- i+HeALTH Research Group, Department of Health Sciences, European University Miguel de Cervantes, Valladolid 47012, Spain
| | - Matthias Wilhelm
- Medical Division Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Nicolle Kränkel
- Department of Cardiology, Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- Friede Springer-Centre of Cardiovascular Prevention @ Charité, Charité University Medicine Berlin, Berlin 10117, Germany
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital 12 de Octubre ('imas12'), 7 Planta, Bloque D., Av. de Córdoba s/n, Madrid 28041, Spain
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid 28007, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
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11
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Dixon LJ, Gürdoğan Ö, Liu YT, McLeod AJ, Wilhelm M. Antipodal Self-Duality for a Four-Particle Form Factor. Phys Rev Lett 2023; 130:111601. [PMID: 37001100 DOI: 10.1103/physrevlett.130.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 06/19/2023]
Abstract
We bootstrap the symbol of the maximal-helicity-violating four-particle form factor for the chiral part of the stress-tensor supermultiplet in planar N=4 super-Yang-Mills theory at two loops. When minimally normalized, this symbol involves only 34 letters and obeys the extended Steinmann relations in all partially overlapping three-particle momentum channels. In addition, the remainder function for this form factor exhibits an antipodal self-duality: It is invariant under the combined operation of the antipodal map defined on multiple polylogarithms-which reverses the order of the symbol letters-and a simple kinematic map. This self-duality holds on a four-dimensional parity-preserving kinematic hypersurface. It implies the antipodal duality recently noticed between the three-particle form factor and the six-particle amplitude in this theory.
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Affiliation(s)
- Lance J Dixon
- SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94309, USA
| | - Ömer Gürdoğan
- School of Physics and Astronomy, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Yu-Ting Liu
- SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94309, USA
- Kavli Institute for Theoretical Physics, UC Santa Barbara, Santa Barbara, California 93106, USA
| | - Andrew J McLeod
- CERN, Theoretical Physics Department, 1211 Geneva 23, Switzerland
- Mani L. Bhaumik Institute for Theoretical Physics, Department of Physics and Astronomy, UCLA, Los Angeles, California 90095, USA
| | - Matthias Wilhelm
- Niels Bohr International Academy, Niels Bohr Institute, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
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12
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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13
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Beilstein CM, Krutkyte G, Vetsch T, Eser P, Wilhelm M, Stanga Z, Bally L, Verra M, Huber M, Wuethrich PY, Engel D. Multimodal prehabilitation for major surgery in elderly patients to lower complications: protocol of a randomised, prospective, multicentre, multidisciplinary trial (PREHABIL Trial). BMJ Open 2023; 13:e070253. [PMID: 36596634 PMCID: PMC9815025 DOI: 10.1136/bmjopen-2022-070253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The global volume of surgery is growing and the population ageing, and economic pressure is rising. Major surgery is associated with relevant morbidity and mortality. Postoperative reduction in physiological and functional capacity is especially marked in the elderly, multimorbid patient with low fitness level, sarcopenia and malnutrition. Interventions aiming to optimise the patient prior to surgery (prehabilitation) may reduce postoperative complications and consequently reduce health costs. METHODS AND ANALYSIS This is a multicentre, multidisciplinary, prospective, 2-arm parallel-group, randomised, controlled trial with blinded outcome assessment. Primary outcome is the Comprehensive Complications Index at 30 days. Within 3 years, we aim to include 2×233 patients with a proven fitness deficit undergoing major surgery to be randomised using a computer-generated random numbers and a minimisation technique. The study intervention consists of a structured, multimodal, multidisciplinary prehabilitation programme over 2-4 weeks addressing deficits in physical fitness and nutrition, diabetes control, correction of anaemia and smoking cessation versus standard of care. ETHICS AND DISSEMINATION The PREHABIL trial has been approved by the responsible ethics committee (Kantonale Ethikkomission Bern, project ID 2020-01690). All participants provide written informed consent prior to participation. Participant recruitment began in February 2022 (10 and 8 patients analysed at time of submission), with anticipated completion in 2025. Publication of the results in peer-reviewed scientific journals are expected in late 2025. TRIAL REGISTRATION NUMBER NCT04461301.
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Affiliation(s)
- Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Gabija Krutkyte
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital University Hospital, Bern, Switzerland
| | - Martin Verra
- Institute of Physiotherapy, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
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14
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Tessitore E, Schmid JP, Hermann M, Capoferri M, Kiencke S, Schmied C, Tschanz H, Wilhelm M, Meyer P. Cardiovascular rehabilitation delivery and outcomes in Switzerland: data from a national database over the last decade. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation (CR) is a multidisciplinary, comprehensive, exercise-based intervention strongly recommended by current guidelines to improve symptoms and quality of life and to reduce cardiovascular adverse outcomes, mainly in patients with coronary artery disease and heart failure. CR activities have not been reported on a Swiss national base so far.
Purpose
To report CR outcome variables from a Swiss national base.
Methods
As part of the Swiss working group for cardiovascular prevention, rehabilitation, and sports cardiology (SCPRS) quality standards, all Swiss CR centres provide yearly a quality indicator report on an online questionnaire. Annual data from 2010 to 2019 were transferred as medians or means of all individual patients' data from each centre. We used the t-Student test to compare changes of outcome variables between entry and exit of the programme.
Results
A total of 133,060 CR patients were included (68,690 inpatients and 64,370 outpatients) with a progressive increase reaching its climax with 14'909 patients/year in 2018. Mean age ± standard deviation (SD) in outpatient and inpatient programmes was 60±1 and 68±1 years, and women percentage 21% and 32%, respectively. The most common CR indication was acute coronary syndrome (51%) in outpatient, whereas cardiovascular surgery of various types (60%) was the main indication in inpatient programmes. Mean improvement ± SD of functional capacity was 38% ±3.6 using the six-minute walk test in inpatient (p<0.001) and 21% ±2 using cycle-ergometer maximal exercise testing in outpatient programmes (p<0.001). Quality of life mainly assessed with the 12-item Short Form Survey (SF-12) in outpatient CR improved by 13% ±4.5. MacNew Heart questionnaire systematically performed in inpatient programmes showed significant improvement at emotional level by 12% ±0.4, at physical level by 30% ±0.9, and at social level by 18% ±0.6.
Conclusion
Even if still underutilised in certain groups of patients such as women or heart failure, CR has gained growing importance in Switzerland during the last decade. Functional capacity, as well as quality of life, was significantly improved. Individual CR patient data should be collected in the future to improve assessment of outcome parameters and benchmarking of centres.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Tessitore
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
| | - J P Schmid
- Clinic Gais, Department of Cardiology , Gais , Switzerland
| | - M Hermann
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - M Capoferri
- Cardiocentro Ticino, Department of Cardiology , Lugano , Switzerland
| | - S Kiencke
- Kardiologische Gemeinschaftspraxis , Bern , Switzerland
| | - C Schmied
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - H Tschanz
- Berner Reha Zentrum , Heiligenschwendi , Switzerland
| | - M Wilhelm
- University of Bern, Department of Cardiology , Bern , Switzerland
| | - P Meyer
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
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15
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Eser P, Marcin T, Prescott E, Prins L, Kolkmanm E, Bruins W, Van Der Welde A, Pena Gil C, Illou MC, Ardission D, Zeymer U, Meindersma EP, Van't Hof AJ, De Kluiver E, Wilhelm M. Breathing patterns and ventilatory efficiency in elderly cardiac patients with and without left ventricular dysfunction before and after exercise-based cardiac rehabilitation: the EU-CaRE study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Coronary artery disease (CAD) may progress to left ventricular dysfunction (LVD) and chronic heart failure. A reduced ventilatory efficiency in these patients is associated with worse outcome. However, breathing patterns at rest and during exercise and their change during exercise-based cardiac rehabilitation (exCR) have been poorly described in this population. We aimed to analyse respiratory and gas-exchange parameters in elderly patients with CAD included in a multicentre study on effectiveness of exCR across seven European countries (EU-CaRE).
Methods
Patients aged 65 years and older with acute (ACS) and chronic coronary syndromes (CCS) who participated in exCR were included. Cardiopulmonary exercise testing (CPET) was performed before (T0) and at termination of exCR (T1), and 12 months after start of exCR (T2). Ventilation (VE), breathing frequency (BF), and end-expiratory carbon dioxide pressure (PetCO2) were measured at rest, at first ventilatory threshold and peak exercise. Ventilatory efficiency, expressed as VE/VCO2 slope and the nadir of VE/VCO2 ratio were measured during the ramp test. Peak oxygen uptake was averaged over 30 s. Breathing parameters over time were compared between patients without and with left ventricular dysfunction (LVD, defined as LV ejection fraction <45%) by mixed linear models corrected for age, sex and body mass index.
Results
818 out of 1633 patients of the EU-CaRE study fulfilled inclusion criteria, 151 (18%) had LVD, of these, 86% were in New York Heart Association (NYHA) functional class I. Mean age was 72.5±5.4 years, 21.9% were women, and 79.8% had acute ACS. Compared to patients without LVD, in patients with LVD resting VE was increased 9%, VE/VCO2 slope 14%, and nadir VE/VCO2 ratio 9%, while PetCO2 was reduced at rest and peak exercise by 6%. From before to after exCR, resting ventilation and breathing frequency, as well as VE/VCO2 slope and nadir VE/VCO2 during exercise decreased significantly more in patients with LVD compared to patients without, while improvement in peak oxygen uptake was similar (Figure 1).
Conclusions
In contrast to their own perception based on NYHA class, patients with LVD had exaggerated breathing at rest and as response to exercise with consistently reduced PetCO2 and ventilatory efficiency. Abnormal breathing patterns may be an early and clinically relevant sign of LVD and linked to increased chemosensitivity and/or abnormal ergoreflex. Exercise-based CR may contribute to improvements of breathing patterns and ventilator efficiency in this population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation program and Swiss State Secretariat for Education, Research and Innovation for the Swiss consortium partner
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Affiliation(s)
- P Eser
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne , Berne , Switzerland
| | - T Marcin
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne , Berne , Switzerland
| | - E Prescott
- Bispebjerg University Hospital, Cardiology , Copenhagen , Denmark
| | - L Prins
- Isala Hospital, Cardiology , Zwolle , The Netherlands
| | - E Kolkmanm
- Isala Hospital, Cardiology , Zwolle , The Netherlands
| | - W Bruins
- Isala Hospital, Cardiology , Zwolle , The Netherlands
| | | | - C Pena Gil
- University Hospital of Santiago de Compostela, Cardiology , Santiago de Compostela , Spain
| | - M C Illou
- Hospital of Peupliers, Cardiac Rehabilitation , Paris , France
| | - D Ardission
- University of Parma, Cardiology , Parma , Italy
| | - U Zeymer
- Klinikum Ludwigshafen, Cardiology , Ludwigshafen , Germany
| | - E P Meindersma
- Radboud University Nijmegen, Cardiology , Nijmegen , The Netherlands
| | - A J Van't Hof
- Maastricht University Medical Centre (MUMC), Cardiology , Maastricht , The Netherlands
| | - E De Kluiver
- Isala Hospital, Cardiology , Zwolle , The Netherlands
| | - M Wilhelm
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne , Berne , Switzerland
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16
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Gonzalez-Jaramillo N, Eser P, Casanova F, Bano A, Franco OH, Windecker S, Räber L, Wilhelm M. Prognostic impact of physical activity patterns after percutaneous coronary intervention. Protocol for a prospective longitudinal cohort. The PIPAP study. Front Cardiovasc Med 2022; 9:976539. [PMID: 36247455 PMCID: PMC9561622 DOI: 10.3389/fcvm.2022.976539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Current guidelines recommend wearable activity trackers to detect insufficient physical activity (PA) and help increase PA to prevent or ameliorate cardiovascular disease. However, there is a paucity of data regarding how objectively measured PA trajectories, patterns, and sedentary time, are associated with mortality and recurrent events after percutaneous coronary intervention (PCI) in patients with established coronary artery disease (CAD). Additionally, it remains unclear if early PA and sedentary time after PCI are associated with such outcomes. Therefore, in the present study (ClinicalTrials.gov Identifier: NCT04663373), we aim to establish the associations of objectively measured PA with major adverse cardiac events and mortality at one-year follow-up. Methods and analysis In this single-centre observational study, patients with CAD will be prospectively recruited immediately after PCI. All the information from the clinical history, baseline characteristics, and outcomes during follow-up will be obtained from the CARDIOBASE registry. Accelerometer data will be collected for 18 days following hospital discharge and 14 days at one-year follow-up. PA trajectories will be identified by group-based trajectory modeling. Major adverse cardiac events and mortality will be prospectively monitored up to 1 year after PCI. All data will be collected using Research Electronic Data Capture.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Flurina Casanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Eser P, Gonzalez-Jaramillo N, Weber S, Fritsche J, Femiano R, Werner C, Casanova F, Bano A, Franco OH, Wilhelm M. Objectively measured adherence to physical activity among patients with coronary artery disease: Comparison of the 2010 and 2020 World Health Organization guidelines and daily steps. Front Cardiovasc Med 2022; 9:951042. [PMID: 36247452 PMCID: PMC9554404 DOI: 10.3389/fcvm.2022.951042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Tailored recommendations for patients after percutaneous coronary interventions (PCI) need physical activity (PA) to be objectively measured and assessed for adherence to guidelines. The recent WHO guidelines removed the daily recommended bout duration, while the potential impact of this change on patients after PCI remains unclear. Aim We evaluated prevalence estimates of adherence to PA recommendations among patients after PCI across the 2010 [≥30 min moderate- to vigorous-intensity PA (MVPA) at ≥ 10-min bout duration] and 2020 WHO guidelines (≥30 min of MVPA of any bout duration), as well as 7,500 and 10,000 steps. Methods We conducted an observational longitudinal single-center study with patients after PCI for chronic or acute coronary syndrome (ACS); maximal age 80 years. Wrist-worn accelerometers recorded participants’ PA data from the evening of hospital discharge over the next 18 days. Results We analyzed data from 282 participants with sufficient minimum wear time (7 days of ≥12 h), including 45 (16%) women; and 249 (88%) with ACS. Median wear time was 18 (17, 18) days. Median participant age was 62 (55, 69) years. Fifty-two participants (18.4%) fulfilled 2010 WHO guidelines and 226 (80.1%) fulfilled the 2020 WHO guidelines. Further, 209 (74.1%) participants achieved ≥7,500 steps/day and 155 (55.0%) performed ≥10,000 steps/day. Conclusion Among participants after PCI, most MVPA was accumulated in bouts <10 min, leading to a fourfold discrepancy between participants fulfilling the 2010 and 2020 WHO PA recommendations. The number of steps/day may be a valid proxy to recent WHO PA recommendations as it is not dependent on the bout-length definition. Clinical trial registration [ClinicalTrials.gov], identifier [NCT04663373].
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Prisca Eser,
| | - Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Selina Weber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jan Fritsche
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Riccardo Femiano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Charlotte Werner
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Flurina Casanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Frundi DS, Kettig E, Popp LL, Hoffman M, Dumartin M, Hughes M, Lamy E, Fru YJW, Bano A, Muka T, Wilhelm M. Physical performance and glycemic control under SGLT-2-inhibitors in patients with type 2 diabetes and established atherosclerotic cardiovascular diseases or high cardiovascular risk (PUSH): Design of a 4-week prospective observational study. Front Cardiovasc Med 2022; 9:907385. [PMID: 35935634 PMCID: PMC9354468 DOI: 10.3389/fcvm.2022.907385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with limitation in physical performance. Results from animal studies report enhancement of physical performance in T2D rodents treated with sodium glucose cotransporter 2 inhibitors (SGLT2is). However, in human patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or high cardiovascular risk, the impact of guideline directed SGLT2i medication on physical performance has not been sufficiently examined. Objectives The main objectives of this study are thus firstly, to assess the changes in physical performance after 4 weeks of exercise therapy in patients with established ASCVD or high cardiovascular risk categorized into three groups according to their glycemic control at baseline. Secondly, to investigate the association of glycemic control at baseline and new guideline directed antidiabetic treatment (inadequate glycemic control and diabetes + new SGLT2i vs. adequate glycemic control and diabetes vs. no diabetes) with change in physical performance. Methods and design This is a 4-week prospective observational study of 450 participants with established ASCVD or high cardiovascular risk with or without T2D and without previous SGLT2i medication undergoing exercise therapy during inpatient rehabilitation in a single center in Switzerland. Upon admission, participants are categorized into 3 groups of 150 participants each according to their glycemic control. Group I consisting of participants with inadequately controlled T2D defined as mean fasting plasma glucose (FPG) of ≥7 mmol/L, who are consequently administered new treatment with an SGLT2i. Group II comprises of participants with adequately controlled T2D with mean FPG of <7 mmol/L requiring no antidiabetic medication change. Group III consists of participants with no diabetes and mean FPG of ≤ 5.5 mmol/L. Primary outcomes are 6-min walk distance and rate of perceived exertion. Secondary outcomes are echocardiographic parameters (left ventricular mass index; global longitudinal strain average; end-diastolic volume), fatigue, muscle, metabolic, and anthropometric measures. Ethics and dissemination This study is conducted in accordance with the Declaration of Helsinki with ethical approval from the Cantonal Ethical Commission of Bern, Switzerland. The results will be published in a peer-reviewed journal. The implementation and reporting will be according to the SPIRIT guidelines. Study protocol registration https://www.clinicaltrials.gov/, identifier: NCT03422263.
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Affiliation(s)
- Devine S. Frundi
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
- Permanence Médicale, Hôpital de Sierre, Sierre, Switzerland
- *Correspondence: Devine S. Frundi
| | - Eva Kettig
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Lena Luise Popp
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Melanie Hoffman
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Marine Dumartin
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Magali Hughes
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Edgar Lamy
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | | | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
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Schneider C, González-Jaramillo N, Marcin T, Campbell KL, Suter T, Bano A, Wilhelm M, Eser P. Time-Dependent Effect of Anthracycline-Based Chemotherapy on Central Arterial Stiffness: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:873898. [PMID: 35865379 PMCID: PMC9295862 DOI: 10.3389/fcvm.2022.873898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Anthracycline-based chemotherapy (ANTH-BC) has been proposed to increase arterial stiffness, however, the time-dependency of these effects remain unclear. This systematic review and meta-analysis aimed to investigate the time-dependent effect of ANTH-BC on markers of central aortic stiffness, namely aortic distensibility (AD) and pulse-wave-velocity (PWV) in cancer patients. Methods An extensive literature search without language restrictions was performed to identify all studies presenting longitudinal data on the effect of ANTH-BC on either AD and/or central PWV in cancer patients of all ages. An inverse-variance weighted random-effect model was performed with differences from before to after chemotherapy, as well as for short vs. mid-term effects. Results Of 2,130 articles identified, 9 observational studies with a total of 535 patients (mean age 52 ± 11; 73% women) were included, of which four studies measured AD and seven PWV. Short-term (2–4 months), there was a clinically meaningful increase in arterial stiffness, namely an increase in PWV of 2.05 m/s (95% CI 0.68–3.43) and a decrease in AD (albeit non-significant) of −1.49 mmHg-1 (−3.25 to 0.27) but a smaller effect was observed mid-term (6–12 months) for PWV of 0.88 m/s (−0.25 to 2.02) and AD of −0.37 mmHg-1 (−1.13 to 0.39). There was considerable heterogeneity among the studies. Conclusions Results from this analysis suggest that in the short-term, ANTH-BC increases arterial stiffness, but that these changes may partly be reversible after therapy termination. Future studies need to elucidate the long-term consequences of ANTH-BC on arterial stiffness, by performing repeated follow-up measurements after ANTH-BC termination. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42019141837].
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Affiliation(s)
- Caroline Schneider
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nathalia González-Jaramillo
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Prisca Eser,
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Marco Guazzi M, Wilhelm M, Halle M, Van Craenenbroeck E, Kemps H, de Boer RA, Coats AJ, Lund L, Mancini D, Borlaug B, Filippatos G, Pieske B. Exercise Testing in HFpEF: an Appraisal Through Diagnosis, Pathophysiology and Therapy A Clinical Consensus Statement of the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Heart Fail 2022; 24:1327-1345. [PMID: 35775383 PMCID: PMC9542249 DOI: 10.1002/ejhf.2601] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/10/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance have not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, neither by European nor US groups. The current Clinical Consensus Statement by the HFA and EAPC Association of the ESC aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implication of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis on the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echo and/or invasive hemodynamic evaluation is here provided. This will lead to improved quality of diagnosis when applying the proposed scores and may also help useful to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype-specific treatments.
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Affiliation(s)
- M Marco Guazzi
- Division of Cardiology, University of Milano School of Medicine, San Paolo Hospital, Milano
| | - Matthias Wilhelm
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Halle
- Department of Prevention and Sports Medicine, Faculty of Medicine, University Hospital 'Klinikum rechts der Isar', Technical University Munich, Munich, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), partner site Munich, Munich Heart Alliance, Munich, Germany
| | - Emeline Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, Eindhoven, Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Rudolph A de Boer
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | | | - Lars Lund
- Solna, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Donna Mancini
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barry Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55902, United States
| | | | - Burkert Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany, German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany, German Heart Center, Berlin, Germany
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21
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Eser P, Trachsel LD, Marcin T, Herzig D, Freiburghaus I, De Marchi S, Zimmermann AJ, Schmid JP, Wilhelm M. Short- and Long-Term Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Left Ventricular Remodeling in Patients Early After ST-Segment Elevation Myocardial Infarction—The HIIT-EARLY Randomized Controlled Trial. Front Cardiovasc Med 2022; 9:869501. [PMID: 35783836 PMCID: PMC9247394 DOI: 10.3389/fcvm.2022.869501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Aim Due to insufficient evidence on the safety and effectiveness of high-intensity interval training (HIIT) in patients early after ST-segment elevation myocardial infarction (STEMI), we aimed to compare short- and long-term effects of randomized HIIT or moderate-intensity continuous training (MICT) on markers of left ventricular (LV) remodeling in STEMI patients receiving optimal guideline-directed medical therapy (GDMT). Materials and Methods Patients after STEMI (<4 weeks) enrolled in a 12-week cardiac rehabilitation (CR) program were recruited for this randomized controlled trial (NCT02627586). During a 3-week run-in period with three weekly MICT sessions, GDMT was up-titrated. Then, the patients were randomized to HIIT or isocaloric MICT for 9 weeks. Echocardiography and cardiopulmonary exercise tests were performed after run-in (3 weeks), end of CR (12 weeks), and at 1-year follow-up. The primary outcome was LV end-diastolic volume index (LVEDVi) at the end of CR. Secondary outcomes were LV global longitudinal strain (GLS) and cardiopulmonary fitness. Results Seventy-three male patients were included, with the time between STEMI and start of CR and randomization being 12.5 ± 6.3 and 45.8 ± 10.8 days, respectively. Mixed models revealed no significant group × time interaction for LVEDVi at the end of CR (p = 0.557). However, there was a significantly smaller improvement in GLS at 1-year follow-up in the HIIT compared to the MICT group (p = 0.031 for group × time interaction). Cardiorespiratory fitness improved significantly from a median value of 26.5 (1st quartile 24.4; 3rd quartile 1.1) ml/kg/min at randomization in the HIIT and 27.7 (23.9; 31.6) ml/kg/min in the MICT group to 29.6 (25.3; 32.2) and 29.9 (26.1; 34.9) ml/kg/min at the end of CR and to 29.0 (26.6; 33.3) and 30.6 (26.0; 33.8) ml/kg/min at 1 year follow-up in HIIT and MICT patients, respectively, with no significant group × time interactions (p = 0.138 and 0.317). Conclusion In optimally treated patients early after STEMI, HIIT was not different from isocaloric MICT with regard to short-term effects on LVEDVi and cardiorespiratory fitness. The worsening in GLS at 1 year in the HIIT group deserves further investigation, as early HIIT may offset the beneficial effects of GDMT on LV remodeling in the long term.
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas D. Trachsel
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Research Department, Berner Reha Zentrum, Heiligenschwendi, Switzerland
| | - David Herzig
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University Clinic for Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Irina Freiburghaus
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefano De Marchi
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas J. Zimmermann
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Matthias Wilhelm
- Department of Cardiology, Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Matthias Wilhelm,
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22
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D'Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med 2022; 56:bjsports-2021-105261. [PMID: 35680397 DOI: 10.1136/bjsports-2021-105261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
| | | | | | | | - Martin Halle
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
- DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
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23
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Aktaa S, Gencer B, Arbelo E, Davos CH, Désormais I, Hollander M, Abreu A, Ambrosetti M, Bäck M, Carballo D, Crawford C, Deaton C, Dendale P, Eijsvogels TMH, Galbraith M, Piepoli MF, Salzwedel A, Smulders Y, Wilhelm M, Biondi-Zoccai G, Mach F, Visseren FLJ, Gale CP. European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology. Eur J Prev Cardiol 2022; 29:1060-1071. [PMID: 34687540 DOI: 10.1093/eurjpc/zwab160] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/07/2021] [Indexed: 02/05/2023]
Abstract
AIMS To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. METHODS AND RESULTS The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. CONCLUSION We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9LU, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9LU, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Baris Gencer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Ileana Désormais
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France
| | - Monika Hollander
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands
| | - Ana Abreu
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, (CHULN) Lisboa, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Rivolta D'Adda Hospital, Rivolta D' Adda, Italy
| | - Maria Bäck
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Carballo
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | | | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - Paul Dendale
- Heart Centre Hasselt and Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, and University pof Parma, Piacenza, Italy
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Yvo Smulders
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - François Mach
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9LU, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9LU, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Eser P, Gonzalez-Jaramillo N, Weber S, Femiano R, Werner C, Casanova F, Bano A, Franco OH, Wilhelm M. Comparison of the 2010 and 2020 World Health Organization guidelines on physical activity in patients with percutaneous coronary interventions early after hospital discharge. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss heart foundation
Background
Physical activity (PA) is inversely associated with mortality and adverse outcome in patients with cardiovascular disease, and can be objectively measured by accelerometry. In 2020, the World Health Organization (WHO) has updated their recommendations on PA for adults including those with chronic conditions, omitting the 10 min bout criterion.[1] The aim of this study was to determine the proportions of cardiac patients immediately after hospital discharge from percutaneous coronary interventions (PCI) who fulfil the old [2] and updated WHO PA criteria, and compare the results with established step-based cut-off values.
Methods
Patients after PCI for acute or chronic coronary syndrome with a maximal age of 80 and eligible for ambulatory cardiac rehabilitation were recruited for this observational single centre study. They were provided with a wrist-worn tri-axial accelerometer without display that recorded movement data starting from the day following hospital discharge for the subsequent 18 days. Acceleration data was analysed with the widely used free GGIR package. The proportions of patients fulfilling recommendations for moderate to vigorous PA (MVPA) were determined according to the 2010 and 2020 WHO guidelines as well as 7,500 [3] and 10,000 steps.[4]
Results
159 patients (41%) participated in this study. Data from 135 patients (85%), who had at least 7 days of ≥12 h wear-time were included in the analyses. Their median age was 62 (1st quartile 56, 3rd quartile 68), 22 (16%) were women, and 15 and 120 patients had a CCS and ACS, respectively. Their median wear time was 18 (16, 18) days. 102 (75.6%) had at least 30 min of MVPA on an average day and hence fulfilled the 2020 WHO guidelines. When MVPA was determined using the 2010 WHO guidelines, which only counted MVPA of bouts of at least 10 min, only 23 patients (17.8%) achieved at least 30 min of MVPA on an average day (Figure 1). 67.4% of our patients achieved ≥7,500 steps/d and 71 patients (52.6%) performed ≥10,000 steps/d.
Conclusion
In cardiac patients early after PCI most of the MVPA was accumulated in bouts shorter than 10 min. Applying the 2010 and 2020 WHO PA criteria to objectively measured PA led to a fourfold discrepancy. The 7,500 step cut-off corresponded with the 2020 WHO recommendations. Since achievement of intensity- or step-based cut-offs is greatly dependent on device type, wearing location, data sampling and analysis, it is currently poorly defined and not suited for patient classification and counselling. The clinical implication of this observation will be assessed in a cardiovascular outcome analysis.
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Affiliation(s)
- P Eser
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland
| | - N Gonzalez-Jaramillo
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - S Weber
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - R Femiano
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - C Werner
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Rehabilitation Engineering Laboratory, Zurich, Switzerland
| | - F Casanova
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland
| | - A Bano
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - OH Franco
- University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland
| | - M Wilhelm
- Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, University Hospital Berne, Berne, Switzerland
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Schneider C, Reimann S, Schmid J, Bernhard J, Campbell KL, Wilhelm M, Eser P. Facilitators and barriers to centre- and home-based exercise training in breast cancer patients - a swiss tertiary centre experience. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Cancer Research
Background
Exercise is an effective therapy for cancer patients to reduce fatigue and to improve health-related quality of life and physical function. Yet, cancer patients often do not meet physical activity guidelines.
Purpose
To understand why recommendations are not met, we aimed at identifying facilitators and barriers to supervised, centre-based exercise within a cardio-oncologic rehabilitation (CORE) programme and to unsupervised, home-based exercise as well as strategies used to manage these barriers.
Methods
Breast cancer patients who had completed a CORE programme at a Swiss tertiary centre were recruited. Semi-structured interviews were conducted with subsequent thematic analysis.
Results
Of 37 eligible breast cancer patients, 19 patients (mean age 48.9±9.7 years) participated to our invitation. Facilitators for centre-based exercise were social support, committedness and provision of structured exercise. Barriers towards centre-based exercise included physical and environmental barriers, while psychological barriers were reported predominantly for home-based exercise. Strategies to manage barriers included the adaptation of training circumstances, behaviour change strategies and strategies to deal with side effects.
Conclusions
Our results support the importance of providing CORE programmes and suggest that a special focus should be directed at the transition from supervised to self-organized exercise in order to enhance long-term exercise participation.
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Affiliation(s)
- C Schneider
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Reimann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Schmid
- University of Bern, Institute of Sport Science, Bern, Switzerland
| | - J Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - KL Campbell
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - M Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Gonzalez-Jaramillo N, Wilhelm M, Arango-Rivas AM, Gonzalez-Jaramillo V, Mesa-Vieira C, Minder B, Franco OH, Bano A. Systematic Review of Physical Activity Trajectories and Mortality in Patients With Coronary Artery Disease. J Am Coll Cardiol 2022; 79:1690-1700. [PMID: 35483757 DOI: 10.1016/j.jacc.2022.02.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. OBJECTIVES The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. METHODS Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression. RESULTS A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results. CONCLUSIONS This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Valentina Gonzalez-Jaramillo
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Cristina Mesa-Vieira
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Arjola Bano
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Pahud de Mortanges A, Sinaci E, Salvador D, Bally L, Muka T, Wilhelm M, Bano A. GLP-1 Receptor Agonists and Coronary Arteries: From Mechanisms to Events. Front Pharmacol 2022; 13:856111. [PMID: 35370744 PMCID: PMC8964343 DOI: 10.3389/fphar.2022.856111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) lower plasma glucose through effects on insulin and glucagon secretion and by decelerating gastric emptying. GLP-1 RAs have many beneficial effects beyond glycemic control, including a protective role on the cardiovascular system. However, underlying mechanisms linking GLP-1 RAs with coronary artery disease are complex and not fully elucidated. In this mini-review, we discuss these mechanisms and subsequent clinical events. Data Sources: We searched PubMed and Google Scholar for evidence on GLP-1 RAs and coronary events. We did not apply restrictions on article type. We reviewed publications for clinical relevance. Synopsis of Content: In the first part, we review the current evidence concerning the role of GLP-1 RAs on potential mechanisms underlying the development of coronary events. Specifically, we discuss the role of GLP-1 RAs on atherosclerosis and vasospasms of epicardial coronary arteries, as well as structural/functional changes of coronary microvasculature. In the second part, we summarize the clinical evidence on the impact of GLP-1 RAs in the prevention of acute and chronic coronary syndromes and coronary revascularization. We conclude by discussing existing gaps in the literature and proposing directions for future research.
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Affiliation(s)
| | - Eldem Sinaci
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Dante Salvador
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bourara A, Németh Z, Methnani J, Wilhelm M. Effect of exhaustion on dynamic balance of professional padel players. Sport Sci Health 2022. [DOI: 10.1007/s11332-022-00926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractPadel is an intermittent multidirectional racket sport that uses tennis’ rules and its scoring system. The popularity of padel has seen exponential growth; becoming one of the most practiced sports in the world. Balance constitutes a central component of racquet sports competitive demands. The aim of this study was exploring the effect of an exhaustive exercise on dynamic balance in elite padel players. 34 first division padel players with national rankings (age: 31.6 ± 7.9 years, height: 181.1 cm ± 5.26 cm; body mass: 81.1 kg ± 9.95 kg) volunteered for this study. Subjects were first tested for dynamic balance using the Y balance test. Then, they performed a volitional exhaustion test, followed by a dynamic balance retest. A significant main effect of condition for all balance variables was detected (all p < 0.03) except for the postero-lateral distance. A significant main effect of time was only found for the anterior distance (p < 0.001). Significant condition*time interaction was found for all variables (p < 0.02) except for the posterolateral distance. Posthoc analysis of the condition × time interaction indicated that compared to the control condition, exhaustive exercise deteriorated balance as showed by the significant decrease in the composite score (p = 0.05) and in the anterior direction (p < 0.001). This makes us focus on elaborating novel training systems in padel to improve the anterior direction distance after fatigue, being the reason of the decrease of dynamic balance capacity. This will boost the possibilities of scoring during a competitive situation.
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29
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Dixon LJ, Gürdoğan Ö, McLeod AJ, Wilhelm M. Folding Amplitudes into Form Factors: An Antipodal Duality. Phys Rev Lett 2022; 128:111602. [PMID: 35363002 DOI: 10.1103/physrevlett.128.111602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
We observe that the three-gluon form factor of the chiral part of the stress-tensor multiplet in planar N=4 super-Yang-Mills theory is dual to the six-gluon MHV amplitude on its parity-preserving surface. Up to a simple variable substitution, the map between these two quantities is given by the antipode operation defined on polylogarithms (as part of their Hopf algebra structure), which acts at symbol level by reversing the order of letters in each term. We provide evidence for this duality through seven loops.
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Affiliation(s)
- Lance J Dixon
- SLAC National Accelerator Laboratory, Stanford University, Stanford, California 94309, USA
| | - Ömer Gürdoğan
- School of Physics and Astronomy, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Andrew J McLeod
- CERN, Theoretical Physics Department, 1211 Geneva 23, Switzerland
- Mani L. Bhaumik Institute for Theoretical Physics, Department of Physics and Astronomy, UCLA, Los Angeles, California 90095, USA
- Niels Bohr International Academy, Niels Bohr Institute, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Matthias Wilhelm
- Niels Bohr International Academy, Niels Bohr Institute, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
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30
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Ryffel CP, Eser P, Marcin T, Herrsche D, Brugger N, Trachsel LD, Wilhelm M. Young endurance training starting age in non-elite athletes is associated with higher proximal aortic distensibility. Open Heart 2022; 9:openhrt-2021-001771. [PMID: 35264414 PMCID: PMC8915284 DOI: 10.1136/openhrt-2021-001771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/09/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Decreased proximal aortic distensibility (AD) is known to significantly predict all-cause mortality and cardiovascular events among individuals without overt cardiovascular disease. This cross-sectional study investigated the association of endurance training (ET) parameters, namely, ET starting age, ET years and yearly ET volume with AD in non-elite endurance athletes. Methods Healthy, normotensive, male Caucasian participants of a 10-mile race were assessed with a 2D echocardiogram and comprehensive interview. Ascending aortic diameters were measured simultaneously with pulse pressure. Aortic strain, AD and aortic stiffness index were calculated. Predictors of AD were investigated among training parameters by linear regression models corrected for age, resting heart rate, stroke volume index and mean blood pressure. Results Ninety-two of 121 athletes (aged 42±8 years) had sufficient echocardiogram quality and were used for analysis. ET starting age (range 6–52 years) and years of ET (range 2–46 years) were highly collinear and used in two separate models for AD. Significant factors for AD were ET starting age, 10-mile race time and resting heart rate in model I, and age, years of ET, 10-mile race time and heart rate in model II (all p<0.01). Conclusions In our cohort of healthy, non-elite, middle-aged runners, AD was significantly higher in athletes with younger ET starting age or more years of ET (in the model adjusted for confounders). In the model with years of ET, age had a negative contribution to AD, suggesting that with older age, the benefit of more years of ET on AD decreased. Future studies assessing the effect of exercise training on arterial properties should include training starting age.
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Affiliation(s)
- Christoph P Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dario Herrsche
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas D Trachsel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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31
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Servatius H, Raab S, Asatryan B, Haeberlin A, Branca M, de Marchi S, Brugger N, Nozica N, Goulouti E, Elchinova E, Lam A, Seiler J, Noti F, Madaffari A, Tanner H, Baldinger SH, Reichlin T, Wilhelm M, Roten L. Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes' Hearts. J Clin Med 2022; 11:jcm11051316. [PMID: 35268407 PMCID: PMC8910879 DOI: 10.3390/jcm11051316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.
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Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
- Correspondence: ; Tel.: +41-31-664-17-01
| | - Simon Raab
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Mattia Branca
- CTU Bern, University of Bern, 3010 Bern, Switzerland;
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Samuel H. Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
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Wilhelm M, Abreu A, Adami PE, Ambrosetti M, Antonopoulou M, Biffi A, Cavarretta E, D'Ascenzi F, Gibson I, Grobbee DE, Iliou MC, Koskinas K, Marques-Vidal P, Nixdorff U, Papadakis M, Piepoli MF, Vassiliou V, Wood D, Dendale P, Halle M. EAPC Core Curriculum for Preventive Cardiology. Eur J Prev Cardiol 2022; 29:251-274. [PMID: 33791783 DOI: 10.1093/eurjpc/zwab017] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.
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Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Ana Abreu
- Servico de Cardioologia, Hospital Universitario de Santa Maria/Centro Hospitalar Universitario Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco Principality, 6-8 Quai Antoine 1er, 98007 Monaco, Monaco
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST, Via Medaglie D'Oro, 9, 26013 Crema, Italy
| | - Maria Antonopoulou
- Spili Primary Care Centre, Regional Health System of Crete, 740 53 Spili, Greece
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 97, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, and University Medical Center Utrecht, 3584 CX Utrech, The Netherlands
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Parvis Corentin Celton 4, 92130 Issy-les-Moulineaux, Paris, France
| | - Konstantinos Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Uwe Nixdorff
- European Prevention Center c/o Medical Center Düsseldorf, Luise-Rainer-Straße 6-10, 40235 Düsseldorf, Germany
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK
| | - Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121 Piacenza, Italy
| | - Vass Vassiliou
- Department of Cardiovascular Medicine, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, University Road, Galway H91 TK33, Ireland
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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Femiano R, Werner C, Wilhelm M, Eser P. Validation of open-source step-counting algorithms for wrist-worn tri-axial accelerometers in cardiovascular patients. Gait Posture 2022; 92:206-211. [PMID: 34864486 DOI: 10.1016/j.gaitpost.2021.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/15/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate quantification of daily steps in a cardiovascular patient population is of high importance for primary and secondary prevention. While sensor derived step counts have been sufficiently validated for hip-worn devices and commercial wrist-worn devices, there is a lack of knowledge on validity of freely available step counting algorithms for raw acceleration data collected at the wrist. RESEARCH QUESTION How accurate are step-counting algorithms for wrist worn tri-axial accelerometers in a cardiac rehabilitation training setting? METHODS Two step counting algorithms (Windowed Peak Detection, Autocorrelation) for tri-axial accelerometers (Axivity AX-3), were tested. Steps were recorded by chest-mounted GoPro video cameras as gold standard. Cardiovascular patients without neurological impairments enrolled in an ambulatory rehabilitation program were recruited. Recordings were performed during one 45-90 min outdoor physical therapy session of which 5-min segments of six movement categories, namely Walking, Running, Nordic, Stairs, Arm Movement [AM] With [+] and Without [-] Walking [W] were identified and analyzed. Mean absolute difference and mean absolute percentage error [MAPE] with regard to true steps measured from video are reported to report accuracy. RESULTS Training sessions of 22 patients were recorded and analyzed. Steps were overestimated during AM-W and underestimated during Walking, Running and Stairs. Windowed Peak Detection algorithm was more accurate during AM+W and AM-W and Autocorrelation performed better during Nordic. A MAPE of close or below 10% was achieved by both algorithms for the categories: Walking, Running, Stairs and Nordic. SIGNIFICANCE Both algorithms provided accurate results for estimation of step counts in a controlled setting of a cardiovascular patient population. The quantification of daily number of steps recorded by wrist-worn accelerometers delivering raw data analyzed by freely available algorithms is a cost-effective option for research studies.
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Affiliation(s)
- Riccardo Femiano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; ETH Zuirich, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Charlotte Werner
- ETH Zuirich, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Heidbuchel H, Adami PE, Antz M, Braunschweig F, Delise P, Scherr D, Solberg EE, Wilhelm M, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions: Part 1: Supraventricular arrhythmias. A position statement of the Section of Sports Cardiology and Exercise from the European Association of Preventive Cardiology (EAPC) and the European Heart Rhythm Association (EHRA), both associations of the European Society of Cardiology. Eur J Prev Cardiol 2021; 28:1539-1551. [PMID: 32597206 DOI: 10.1177/2047487320925635] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/02/2023]
Abstract
Symptoms attributable to arrhythmias are frequently encountered in clinical practice. Cardiologists and sport physicians are required to identify high-risk individuals harbouring such conditions and provide appropriate advice regarding participation in regular exercise programmes and competitive sport. The three aspects that need to be considered are: (a) the risk of life-threatening arrhythmias by participating in sports; (b) control of symptoms due to arrhythmias that are not life-threatening but may hamper performance and/or reduce the quality of life; and (c) the impact of sports on the natural progression of the underlying arrhythmogenic condition. In many cases, there is no unequivocal answer to each aspect and therefore an open discussion with the athlete is necessary, in order to reach a balanced decision. In 2006 the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology published recommendations for participation in leisure-time physical activity and competitive sport in individuals with arrhythmias and potentially arrhythmogenic conditions. More than a decade on, these recommendations are partly obsolete given the evolving knowledge of the diagnosis, management and treatment of these conditions. The present document presents a combined effort by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and the European Heart Rhythm Association to offer a comprehensive overview of the most updated recommendations for practising cardiologists and sport physicians managing athletes with supraventricular arrhythmias, and provides pragmatic advice for safe participation in recreational physical activities, as well as competitive sport at amateur and professional level. A companion text on recommendations in athletes with ventricular arrhythmias, inherited arrhythmogenic conditions, pacemakers and implantable defibrillators is published as Part 2 in Europace.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Paolo E Adami
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
| | - Matthias Antz
- Department of Electrophysiology, Hospital Braunschweig, Germany
| | | | | | - Daniel Scherr
- Department of Medicine, Medical University of Graz, Austria
| | | | | | - Antonio Pelliccia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
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Kristensson A, Wilhelm M, Zhang C. Elliptic Double Box and Symbology Beyond Polylogarithms. Phys Rev Lett 2021; 127:251603. [PMID: 35029423 DOI: 10.1103/physrevlett.127.251603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
We study the elliptic double-box integral, which contributes to generic massless QFTs and is the only contribution to a particular 10-point scattering amplitude in N=4 SYM theory. Based on a Feynman parametrization, we express this integral in terms of elliptic polylogarithms. We then study its symbol, finding a rich structure and remarkable similarity with the nonelliptic case. In particular, the first entry of the symbol is expressible in terms of logarithms of dual-conformal cross ratios, and elliptic letters only occur in the last two entries.
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Affiliation(s)
- Alexander Kristensson
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Matthias Wilhelm
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
| | - Chi Zhang
- Niels Bohr International Academy, Niels Bohr Institute, Copenhagen University, Blegdamsvej 17, 2100 Copenhagen Ø, Denmark
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Gonzalez-Jaramillo N, Marcin T, Matter S, Eser P, Berlin C, Bano A, Heg D, Franco OH, Windecker S, Räber L, Wilhelm M. Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study. Eur J Prev Cardiol 2021; 29:1093-1103. [PMID: 34894217 DOI: 10.1093/eurjpc/zwab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 12/28/2022]
Abstract
AIMS Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes. METHODS AND RESULTS We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6-9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27-0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57-0.86)] and older adults [0.32 (0.27-0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03-0.37)] and CVD mortality [0.1 (0.02-0.7)], but not with MACE [1.08 (0.8-1.4)]. CONCLUSION Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Sophia Matter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
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Alijla F, Buttia C, Reichlin T, Razvi S, Minder B, Wilhelm M, Muka T, Franco OH, Bano A. Association of diabetes with atrial fibrillation types: a systematic review and meta-analysis. Cardiovasc Diabetol 2021; 20:230. [PMID: 34876114 PMCID: PMC8653594 DOI: 10.1186/s12933-021-01423-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications. Diabetes contributes to AF initiation, yet its role in AF maintenance is unclear. We conducted a systematic review and meta-analysis to summarize the evidence regarding the association of diabetes with AF types. Methods We searched 5 databases for observational studies investigating the association of diabetes with the likelihood of an AF type (vs another type) in humans. Study quality was evaluated using the Newcastle–Ottawa Scale. Studies classifying AF types as paroxysmal (reference) and non-paroxysmal were pooled in a meta-analysis using random effects models. Results Of 1997 articles we identified, 20 were included in our systematic review. The population sample size ranged from 64 to 9816 participants with mean age ranging from 40 to 75 years and percentage of women from 24.8 to 100%. The quality of studies varied from poor (60%) to fair (5%) to good (35%). In the systematic review, 8 studies among patients with AF investigated the cross-sectional association of diabetes with non-paroxysmal AF (vs paroxysmal) of which 6 showed a positive association and 2 showed no association. Fourteen studies investigated the longitudinal association of diabetes with “more sustained” AF types (vs “less sustained”) of which 2 showed a positive association and 12 showed no association. In the meta-analysis of cross-sectional studies, patients with AF and diabetes were 1.31-times more likely to have non-paroxysmal AF than those without diabetes [8 studies; pooled OR (95% CI), 1.31 (1.13–1.51), I2 = 82.6%]. The meta-analysis of longitudinal studies showed that for patients with paroxysmal AF, diabetes is associated with 1.32-times increased likelihood of progression to non-paroxysmal AF [five studies; pooled OR (95% CI), 1.32 (1.07–1.62); I2 = 0%]. Conclusions Our findings suggest that diabetes is associated with an increased likelihood of non-paroxysmal AF rather than paroxysmal AF. However, further high quality studies are needed to replicate these findings, adjust for potential confounders, elucidate mechanisms linking diabetes to non-paroxysmal AF, and assess the impact of antidiabetic medications on AF types. These strategies could eventually help decrease the risk of non-paroxysmal AF among patients with diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01423-2.
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Affiliation(s)
- Fadi Alijla
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Chepkoech Buttia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland. .,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Pahud de Mortanges A, Salvador D, Laimer M, Muka T, Wilhelm M, Bano A. The Role of SGLT2 Inhibitors in Atherosclerosis: A Narrative Mini-Review. Front Pharmacol 2021; 12:751214. [PMID: 34803693 PMCID: PMC8602558 DOI: 10.3389/fphar.2021.751214] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/01/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: Sodium glucose cotransporter 2 inhibitors (SGLT2-is) are antidiabetic drugs that improve glycemic control by limiting urinary glucose reuptake in the proximal tubule. SGLT2-is might suppress atherosclerotic processes and ameliorate the prognosis of patients with diabetes mellitus diagnosed with or at high risk of atherosclerotic cardiovascular disease (ASCVD). In this mini review, we examine the role of SGLT2-is in the development and progression of atherosclerosis throughout its spectrum, from subclinical atherosclerosis to ASCVD. Data Sources—PubMed and Google Scholar were searched for publications related to SGLT2-is and atherosclerosis. All types of articles were considered, including clinical trials, animal studies, in vitro observations, and reviews and meta-analyses. Data were examined according to their impact and clinical relevance. Synopsis of Content—We first review the underlying mechanisms of SGLT2-is on the development and progression of atherosclerosis, including favorable effects on lipid metabolism, reduction of systemic inflammation, and improvement of endothelial function. We then discuss the putative impact of SGLT2-is on the formation, composition, and stability of atherosclerotic plaque. Furthermore, we evaluate the effects of SGLT2-is in subclinical atherosclerosis assessed by carotid intima media thickness and pulse wave velocity. Subsequently, we summarize the effects of SGLT2-is in ASCVD events, including ischemic stroke, angina pectoris, myocardial infarction, revascularization, and peripheral artery disease, as well as major adverse cardiovascular events, cardiovascular mortality, heart failure, and chronic kidney disease. Moreover, we examine factors that could modify the role of SGLT2-is in atherosclerosis, including sex, age, diabetes, glycemic control, ASCVD, and SGLT2-i compounds. Additionally, we propose future directions that can improve our understanding of SGLT2-is and atherosclerosis.
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Affiliation(s)
| | - Dante Salvador
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arjola Bano
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Perrin T, Trachsel L, Hagemeyer D, Casagrande D, Wilhelm M, Benaim C, Pirrello T, Albrecht S, Schmied C, Mivelaz Y, Tercier S, Baggish A, Gabus V. Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes. J Sci Med Sport 2021; 25:281-286. [PMID: 34895837 DOI: 10.1016/j.jsams.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.
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Affiliation(s)
- M Albiński
- Division of Paediatrics, Lausanne University Hospital, Switzerland.
| | - M Saubade
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland; Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Menafoglio
- Department of Cardiology, San Giovanni Hospital Bellinzona, Switzerland
| | - P Meyer
- Service of Cardiology, University Hospital Geneva, Switzerland
| | - B Capelli
- Department of Cardiology, Cardiocentro Ticino, Switzerland
| | - T Perrin
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - L Trachsel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Hagemeyer
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Casagrande
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - M Wilhelm
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - C Benaim
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland
| | - T Pirrello
- Swiss Federal Institute of Sports, Switzerland
| | - S Albrecht
- Swiss Federal Institute of Sports, Switzerland
| | - C Schmied
- Department of Cardiology, University Heart Centre Zurich, University of Zurich, Switzerland
| | - Y Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Switzerland
| | - S Tercier
- SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Baggish
- Division of Cardiology, Massachusetts General Hospital, United States of America
| | - V Gabus
- Department of Cardiology, Lausanne University Hospital, Switzerland
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Gonzalez N, Wilhelm M, Arango A, Gonzalez V, Mesa C, Minder B, Franco O, Bano A. Physical activity trajectories are associated with the risk of all-cause and cardiovascular disease mortality in patients with coronary heart disease. A systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current guidelines recommend that adults with chronic health conditions should engage in regular physical activity (PA), and avoid inactivity. Yet, the exact role of PA trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear.
Purpose
We aimed to perform a systematic review and meta-analysis on the association of longitudinal trajectories of PA with all-cause and cardiovascular disease (CVD) mortality in patients with CHD.
Methods
We performed a systematic review and meta-analysis based on PRISMA statement. Six electronic databases were searched for cohort studies that analysed the association of PA trajectories (inactive over time, active over time, increased activity over time, and decreased activity over time) with the risk of all-cause and CVD mortality in patients with CHD. Study quality was evaluated by the Newcastle Ottawa scale. We used the inverse variance weighted method to combine summary measures using random-effects models to minimize the effect of between-study heterogeneity. The study is registered in PROSPERO.
Results
We meta-analyzed nine longitudinal cohorts involving 33,576 patients (25010 acute CHD, 8566 chronic CHD, mean age 62.5 years, 34% women, median follow-up duration 7.2 years), according to four PA trajectories. All studies assessed PA through validated questionnaires. The definitions of activity and inactivity at baseline and follow-ups were in agreement with current PA guidelines. Trajectories were calculated based on comparison of activity status at baseline and follow-up. All the studies defined increased activity over time as moving from the inactive to the active category, and decreased activity over time as moving from the active to the inactive category. Compared to patients remaining inactive over time, the lowest risk of all-cause and CVD mortality was observed in patients remaining active over time (HR [95% CI]: 0.50 [0.39–0.63] and 0.48 [0.35–0.68], respectively), followed by patients who increased their PA over time (HR [95% CI]:0.55 [0.44–0.7] and 0.63 [0.51–0.78], respectively), and patients who decreased activity over time (HR [95% CI]: 0.80 [0.64–0.99] and 0.91 [0.67–1.24], respectively). These results were consistent both in the acute and chronic CHD settings. The overall risk of bias was low, and no evidence of publication bias was observed. Multiple sensitivity analyses provided consistent results.
Conclusions
In patients with CHD, the risk of all-cause and CVD mortality is progressively reduced from being inactive over time, to decreased activity over time, to increased activity over time, to being active over time. These findings highlight the benefits of adopting a more physically active lifestyle in patients with chronic and acute CHD, independent of previous PA levels. Future studies should clarify the complex interactions between motivations and disease severity as potential drivers for PA trajectories
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Bern
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Affiliation(s)
| | - M Wilhelm
- University Hospital, Department of Cardiology, Inselspital, Bern, Switzerland
| | - A Arango
- Universidad Pontificia Bolivariana, Internal Medicine, Medellin, Colombia
| | | | - C Mesa
- University of Bern, Bern, Switzerland
| | - B Minder
- University of Bern, Bern, Switzerland
| | - O Franco
- University of Bern, Bern, Switzerland
| | - A Bano
- University of Bern, Bern, Switzerland
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Scherrenberg M, Zeymer U, Schneider S, Van der Velde AE, Wilhelm M, Van't Hof AWJ, Kolkman E, Prins LF, Prescott E, Iliou MC, Peña-Gil C, Ardissino D, De Kluiver EP, Dendale P. EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly? Int J Cardiol 2021; 340:1-6. [PMID: 34419529 DOI: 10.1016/j.ijcard.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO2peak when compared with no CR. OBJECTIVE To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. METHODS Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. RESULTS The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. CONCLUSION From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.
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Affiliation(s)
- M Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.
| | - U Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - S Schneider
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - M Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - A W J Van't Hof
- Isala Heart Centre, Zwolle, the Netherlands; MUMC+, Dpt of Cardiology, Maastricht, the Netherlands; CArdiovascular Research Institute, Maastricht (CARIM), University of Maastricht, the Netherlands; Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - M C Iliou
- Cardiac Rehabilitation Department, Corentin Celton Hospital, Assistance Publique Hôpitaux de Paris Centre, Issy les Mx, France
| | - C Peña-Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Spain
| | - D Ardissino
- Department of Cardiology, Parma University Hospital, Italy
| | | | - P Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
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Marcin T, Eser P, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Peña Gil C, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. PLoS One 2021; 16:e0255477. [PMID: 34343174 PMCID: PMC8330933 DOI: 10.1371/journal.pone.0255477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO2) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (≥65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy. Trial registration Netherlands Trial Register, Trial NL5166.
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Affiliation(s)
- Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Santiago, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P. Meindersma
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, RoosHesselink JW, Stuart AG, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Russ J Cardiol 2021. [DOI: 10.15829/1560-4071-2021-4488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)
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Affiliation(s)
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George’s, University of London
| | - Sabiha Gati
- National Heart & Lung Institute, Imperial College;
United Kingdom and Cardiology, Royal Brompton & Harefield Hospital NHS Foundation Trust
| | - Maria Bäck
- Linköping University;
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital
| | - Mats Börjesson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital;
Center for Health and Performance, Department of Food, Nutrition and Sports Science, Gothenburg University
| | | | - Jean-Philippe Collet
- Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêetrière (Assistance Publique-Hôpitaux de Paris) (AP-HP)
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University of Munich
| | - Dominique Hansen
- Hasselt University, BIOMED/REVAL/Heart Centre Hasselt, Jessa Hospital
| | - Hein Heidbuchel
- Cardiology, University Hospital Antwerp and Antwerp University
| | | | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University;
Ludwig Boltzmann Institute for Digital Health and Prevention
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George’s, University of London
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Stuart AG, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease. Rev Esp Cardiol (Engl Ed) 2021; 74:545. [PMID: 34020769 DOI: 10.1016/j.rec.2021.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scherrenberg M, Wilhelm M, Hansen D, Völler H, Cornelissen V, Frederix I, Kemps H, Dendale P. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021; 28:524-540. [PMID: 32615796 PMCID: PMC7928994 DOI: 10.1177/2047487320939671] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
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Affiliation(s)
- Martijn Scherrenberg
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
| | - Matthias Wilhelm
- />Department of Cardiology, University Hospital of Bern, Switzerland
| | - Dominique Hansen
- />Faculty of Rehabilitation Sciences, UHasselt – Hasselt University, Belgium
- />BIOMED/REVAL (Rehabilitation Research Centre), Belgium
- />Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Heinz Völler
- />Department of Rehabilitation Medicine, University of Potsdam, Germany
- />Rehabilitation Centre for Internal Medicine, Klinik am See, Germany
| | | | - Ines Frederix
- />Faculty of Medicine and Health Sciences, Antwerp University, Belgium
- />Intenisve Care Unit, Antwerp University Hospital, Belgium
| | - Hareld Kemps
- />Department of Cardiology, Máxima Medical Center, The Netherlands
- />Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Paul Dendale
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 651] [Impact Index Per Article: 217.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Marcin T, Bengel C, Goldberg T, Peterhans J, Eser P, Wilhelm M. Patient interest in mHealth as part of cardiac rehabilitation in Switzerland. Swiss Med Wkly 2021; 151:w20510. [PMID: 34000738 DOI: 10.4414/smw.2021.20510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Smartphone-based health interventions (mHealth) offer the potential to overcome barriers to accessibility of cardiac rehabilitation. We aimed (1) to examine patients’ interest in mHealth as part of the outpatient cardiac rehabilitation (phase II) and long-term aftercare (phase III) and (2) to identify the influence of sociodemographic and clinical patient characteristics on interest in mHealth. METHODS A questionnaire was consecutively handed out to 2041 patients concluding outpatient cardiac rehabilitation between March 2013 and December 2018 at the University Hospital Bern. Multivariate logistic models were used to identify influencing factors (age, sex, smartphone ownership, year, compliance with cardiac rehabilitation, physical fitness, body mass index, diabetes mellitus, German speaking) for mHealth interest. RESULTS The questionnaire was returned by 1025 patients (50.2% response rate). Seventy-one percent of the responding patients preferred the cardiac rehabilitation as offered with three weekly centre-based sessions, whereas 12% preferred and 17% considered replacing two out of the three centre-based sessions per week with mHealth. Forty-eight percent were interested in continuing exercise training using mHealth after completion of cardiac rehabilitation. Smartphone ownership was the most important indicator for patient interest in mHealth (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.53–4.23), whereas age (per year) was not independently associated with mHealth interest for phase II (OR 0.99, 95% CI 0.98–1.01) and only weakly associated with phase III (OR 0.98, 95% CI 0.96–0.99). CONCLUSION In a Swiss urban region with easy access to cardiac rehabilitation, patients who participated in a centre-based cardiac rehabilitation programme between 2013 and 2018 showed little interest in mHealth during phase II. However, almost half of them expressed interest in continuing training with mHealth during phase III.
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Affiliation(s)
- Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Bengel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tabea Goldberg
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland / Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Switzerland
| | - Judith Peterhans
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland / Clinic Barmelweid, Department of Cardiology, Barmelweid, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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