Cardiac telerrehabilitation: a safe and effective alternative in patients with coronary artery disease

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Ferrer Internaciona Groupl, S.A

Background

Center-based cardiac rehabilitation programs (CRP) have shown to reduce morbidity and mortality after an ischemic cardiac event, but their vastly underutilized. Home-based CRP seems to improve patient’s adherence, but there is still scarce evidence, especially in elderly patients and women.

Purpose

To develop a holistic home-based CRP for ischemic heart disease patients and evaluate its safety and impact on functional capacity, adherence to a heart-healthy lifestyle and quality of life.

Methods

The 8-week home-based CRP will include 60 patients (50% women) with no age limit who have suffered an acute myocardial infarction in the previous 3 months, with LVEF ≥40% and a tablet/mobile device. The CRP (Picture 1) includes 3 weekly exercise sessions combining tailored aerobic and strength training and 1 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment.

Results

Between January and October 2021, 56 patients were included: 2 were rejected for presenting ventricular arrhythmias in the initial stress test and 4 due to technological barrier; 14 patients are currently performing the CRP. The preliminary results from the 36 patients who have completed the CRP show a significant increase in functional capacity, muscle strength, weekly training volume, adherence to Mediterranean diet, emotional state (anxiety) and quality of life (Picture 2). There have been no complications and patient’s adherence has been excellent for both exercise (85%) and educational (80%) sessions.

Conclusion

A holistic telematic CRP dedicated to patients after an ischemic cardiac event, including patients of both gender and of no age-limit, seems to be a feasible, safe and effective in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with the Mediterranean diet and emotional state.

Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking in a cohort of highly trained endurance athletes

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Plan Nacional I.D., Del Programa Estatal de Fomento De La Investigación Científica y Técnica de Excelencia, Subprograma De Generación Del Conocimiento, Ministerio de Economía y Competitividad 2013.

Background

 Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of the ventricular remodelling patterns induced by cumulative effects of intensive exercise. Feature tracking(FT) can measure myocardial deformation from cardiac magnetic resonance(CMR) cine sequences; however, its accuracy is still scarcely validated.

Purpose

 Our aim was to compare FT’s accuracy and reproducibility to speckle tracking echocardiography (STE) in highly trained endurance athletes (EAs).

Methods

 93 EAs (>12 hours training/week during the last 5 years, 52% male, 35 ± 5.1 years) and 72 age-matched controls underwent a resting CMR and a transthoracic echocardiography to assess biventricular exercise-induced remodelling and biventricular global longitudinal strain (GLS) by CMR-FT and STE.

Results

  High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and mildly reduced systolic function of both ventricles (p < 0,05). Strain values (both by CMR-FT and STE) proportionally decreased with increasing ventricular volumes potentially depicting the increased volume and functional biventricular reserve that characterize EAs heart. Strain values were lower when assessed by CMR-FT as compared to STE (p < 0.001), with good reproducibility for the LV (bias = 3.94%, LOA= ± 4.27%) but wider variability for RV strains (Figure 2).

Conclusions

  Biventricular longitudinal strain values were lower when assessed by FT compared to STE. Both methods were comparable when measuring LV strain but not RV strain. These differences might be justified by FT’s lower in-plane spatial and temporal resolution, which is particularly relevant for the complex anatomy of the RV.

Abstract Figure. Fig 1. Bland-Altman plots; FT vs STE.

Aortic stiffness and distensibility in elite athletes: impact of discipline and gender

Background

Aortic remodeling in athletes is variable among sports disciplines with more ascending aorta (Asc Ao) dilatation in endurance (EAs) as compared to power athletes (PAs). Nevertheless, the impact of this differential remodeling on the Asc Ao functional properties is not well established. The aim of this study was to assess the distensibility and stiffness of the ascending aorta in endurance and power elite athletes in order to evaluate if this aortic remodeling implies functional changes.

Methods

119 elite athletes (61 EA and 58 PA, 49% female sex, mean age: 18.7±7.1 years) underwent standardized pre-participation screening with 12 lead ECG, transthoracic echocardiography and maximum stress test. Asc Ao diameter was measured from parasternal long axis views in 2D echocardiography. The aortic distensibility index (ADi) was calculated as 2 × (systolic Asc Ao diameter − diastolic Asc Ao diameter) / (diastolic Asc Ao diameter) × (pulse pressure) (cm–2 dyn–1 10–6). Aortic stiffness (AS) index was defined as Ln (systolic blood pressure/diastolic blood pressure) / (systolic Asc Ao diameter − diastolic Asc Ao diameter)/diastolic proximal Asc Ao diameter.

Results

Globally, EA presented larger AscAO, both in absolute and indexed values, than PA (28±3.0 vs 26±3.0cm, p<0.001 and 16.4±1.5 vs 15.7±1.9cm, p<0.05, while were no differences in AS or ADi) (Figure 1A). Nevertheless, ADi in male EAs was higher than in male PAs (ADi: 4.3±1.7 vs 3.2±1.3 cm2/dyn/10–6, p<0.05) and AS was lower (AS: 4.7±1.7 vs 6.3±3.8, P<0.005) (Figure 1B and 1C). Female athletes presented higher ADi (ADi: 4.7±1.9 vs 4.0±1.6 cm, p<0.05) and a trend towards lower AS (4.8±2.9 vs 5.1±2.6, p: 0.4) than male athletes. There were no differences in AS or ADi between female EAs and PAs.

Conclusion

Male EAs showed an increased aortic distensibility with lower stiffness as compared to that observed in male PAs. This difference was not observed in female EAs and PAs, potentially due to better baseline distensibility with less room for improvement with endurance training.

Funding Acknowledgement

Type of funding source: None

Left atrial performance during exercise in endurance athletes: the impact of gender

Background

High-intensity endurance training is associated with an increased risk of atrial fibrillation (AF) in male athletes while it seems to have a protective effect for the development of atrial arrhythmias in female athletes. Mechanisms underlying this fact are unknown but a differential atrial adaptation to exercise may be involved.

Aim

To evaluate left atrial (LA) performance during exercise in endurance athletes (EAs) of both sexes.

Methods

Highly-trained (>10 hours training/week) EAs performed a maximal cardiopulmonary exercise test. LA evaluation was performed at rest and immediately after exercise. LA analysis consisted of standard and speckle-tracking assessment: atrial contractile, reservoir and conduction strain.

Results

80 EAs (55% women, 34.8±5.8 years) were enrolled. Baseline LA size and functional parameters were similar in both sexes (Table 1). Compared to men, women achieved a higher predicted VO2max (Δchange+11.9%, p<0.01) but a similar increase of systolic blood pressure (Δ+63 vs +66%, p=0.58). Exercise induced a mild decrease in LA size but of similar amplitude for both sexes. LA strain parameters of EAs improved with exercise, but a significantly greater improvement in LA reservoir and conduit function was noted in women compared to men. In EAs with marked atrial remodelling (LA ≥35ml/m2), the same trend of greater improvement of LA reservoir and conduit function in women persisted.

Conclusion

In highly-trained EAs, premenopausal women have better LA function profile during exercise compared to men, even when the LA is significantly dilated. This discriminatory LA adaptation in female EAs could at least partly explain the dichotomous relationship between AF and exercise regarding sexes and warrants further studies to clarify the underlying mechanism.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Government of Spain - Plan Nacional I+D, Ministerio de Economia y Competitividad