P366 EFFECTS OF EXERCISE REHABILITATION IN PATIENTS WITH LONG COVID–19

Moving from the first COVID–19 pandemic to the chronic phase of COVID–19, more than 50 long–term detrimental effects have been recognized in the so–called long COVID–19 syndrome. The exact mechanisms underlying the exercise capacity reduction and functional limitations are unknown, however, rehabilitation could play a pivotal role. The aim of this study was to evaluate whether a combination of aerobic and resistance training performed in the same session for 8 weeks could be well–tolerated and effective in long COVID–19 patients with reduced exercise capacity [(<85% of predicted peak aerobic capacity (VO2peak)] at 3–month from hospital discharge after COVID–19. The exercise training program included 3 exercise sessions per week. Each session included: a) aerobic exercise (starting at 30 min and increasing to 60 min) with 5 min warm–up and 5–min cool down; b) nine major muscle group resistance exercises (for the lower extremity: leg extension/flexion, abduction/adduction, and leg press; for the upper extremity: push–up/pull–down; for the core muscles: abdomen, back). The intensity of aerobic exercise was defined according to VO2peaktest results targeting the 80% level of lactate threshold in Watts. Resistance training load was determined for each muscle groups according to the results of the maximal dynamic strength testing (1RM; one repetition maximum) and was confirmed and updated after 4 weeks by defining new 1RM values. Resistance training prescription loading was defined as 40% of 1RM, 2 sets (3 sets for last two weeks) and 12 repetitions for each muscle group. The duration of a single training session was approximately 90 min. Out of 220 patients screened, 50 patients (aged 55.8±9.7 years, 15 women, body mass index 26.6±5.2 kg/m2) were enrolled. Mean exercise training sessions was 66.1±34.0; none of the patients dropped out from the study. VO2peak increased 15% and peak ventilation 9% (p < 0.001 for both). After the training program, mean percentage of VO2peak significantly increased (+14.2%, p < 0.001). Muscle strength increased markedly for all major muscle groups ranging from 16% to 33% increase (p < 0.010). An exercise rehabilitation with combined aerobic and resistance exercises for 8 weeks increases markedly both cardiorespiratory and musculoskeletal fitness in long COVID–19 patients. These results may highlight the importance of regular exercise rehabilitation aiming to promote daily activities, independent living, and better quality of life.

Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up

Background

Long-term effects of Coronavirus Disease of 2019 (COVID-19) and their sustainability are of the utmost relevance. For the chronic phase, the main concerns are the development of pulmonary interstitial disease and/or lingering cardiovascular involvement. How to intercept, assess, and treat these patients with long-term consequences of COVID-19 remains uncertain.

Purpose

We aimed to determine: 1) functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) those characteristics associated with CPET performance; 3) safety and tolerability of CPET.

Methods

We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 discharged alive at a single hospital in northern Italy. At 3-month from hospital discharge, complete clinical evaluation, trans-thoracic echocardiography, cardiopulmonary exercise testing (CPET), pulmonary function test (PFT), and dominant leg extension (DLE) maximal strength evaluation were performed.

Results

From 225 patients discharged from March to November 2020 we excluded 12 incomplete/missing cases, and 13 unable to perform CPET leading to a final population of 200 patients. At PFT all median parameters were within normality range.

Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3–103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value (indicating normality).

Sixteen (16.2%) patients had respiratory, 28 (28.9%) cardiac, 21 (21.2%) mixed-cardiopulmonary, and 34 (34.3%) non-cardiopulmonary limitation of exercise. One-hundred sixty (80.0%) patients complain at least one symptom, without relationship with peakVO2.

Multivariate linear regression analysis showed percent-predicted forced expiratory volume in one-second (β=5.29, p=0.023), percent-predicted diffusing capacity of lungs for carbon monoxide (β=6.31, p=0.001), and DLE maximal strength (β=14.09, p=0.008) independently associated with peakVO2.

At sensitivity analysis, the results of previous multivariate linear regression analysis were also similar among sub-groups of patients with no previous significant disease in anamnesis (cardiovascular disease except for arterial hypertension, respiratory disease, kidney disease, or cancer) and of those with a length of hospital stay ≤7 days.

None major event was reported during/after CPET, whereas only two cases (1.0%) had a mild symptomatic hypotension post exercise. None of the involved health professionals developed COVID-19.

Conclusions

CPET after COVID-19 is safe and about 1/3rd of COVID-19 survivors show functional capacity limitation mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.

Funding Acknowledgement

Type of funding sources: None.

Acute kidney injury after transcatheter aortic valve replacement: predictors and prognostic impact from a single, high-volume centre

Background

Acute kidney injury (AKI) represents a common complication of transcatheter aortic valve replacement (TAVR), occurring in a variable proportion (from 10% to 30%) and being associated with an increased length of hospital stay and a 2- to 6-fold higher risk of mortality.

Purpose

We sought to identify pre-procedural and procedural variables independently associated with AKI and to analyze AKI impact on 1-month and 1-year all-cause mortality.

Methods

We prospectively collected consecutive patients undergoing TAVR at our centre. AKI was defined according to the Valve Academic Research Consortium (VARC)-2 criteria, as an increase of at least 0.3 mg/dL in serum creatinine or a urine output worsening (<0.5 mL/kg for <12 hours) occurring within 7 days after the procedure.

Results

From 664 consecutive TAVR conducted between January 2010 and December 2018 we excluded 19 (2.9%) patients for unsuccessful procedure according to VARC-2 criteria leading to a population of 645 patients.

The mean follow-up was 9.6±4.3 months, age was 83.2±5.3, 270 (41.9%) were men. AKI complicated TAVR procedure in 141 (21.9%) patients. All-cause mortality occurred in 14 (2.2%) at 1-month and 51 (7.9%) patients at 1-year.

AKI was more likely to complicate TAVR in patients who died within 1-month (4.7% vs. 0.8%, p=0.003) and 1-year (14.1% vs. 5.3%, p<0.001) follow-up period.

Multivariable regression analysis showed that baseline creatinine (OR: 1.46, 95% CI: 1.20–1.78, p<0.001) and VARC-2 bleeding complications (OR: 1.49, 95% CI: 1.04–2.12, p=0.029) were independently associated with AKI incidence, while non-significant covariates were: age, gender, contrast volume, use of self-expandable valve and peri-procedural rapid pacing.

Multivariable analysis adjusted for age and sex showed that AKI (HR: 3.02, 95% CI: 1.03–8.90, p=0.045) and chronic obstructive pulmonary disease (COPD) (HR: 4.12, 95% CI: 1.37–12.40, p=0.012) were independently associated with 1-month all-cause mortality. After 1 month, landmark analysis adjusted for age and sex showed that AKI (HR: 2.41, 95% CI: 1.17–4.96, p=0.017) and peri-procedural myocardial injury (HR: 2.36, 95% CI: 1.05–5.31, p=0.037) were independent predictors of 1-year all-cause mortality, while COPD, non-transfemoral route, and bleeding complications were not independently associated.

Conclusions

In a contemporary cohort of consecutive patients undergoing TAVR, AKI complicated ∼1 out of 5 procedures and is linked with about 4-fold adjusted risk of short-term death at 1-month and about 2-fold adjusted risk of subsequent death events up to 1-year follow-up. Baseline creatinine and bleeding complications, but not contrast volume were independently associated with AKI incidence.

Landmark analysis for 1-year mortality

Funding Acknowledgement

Type of funding source: None

P2801Hard events after orsiro sirolimus-eluting stent (HEROES) in STEMI: a multicenter registry

Background

Primary percutaneous coronary intervention (pPCI) using drug-eluting stents (DES) is the treatment of choice for the ST segment elevation Myocardial infarction (STEMI). Specific DES platforms, as well the strategies used to control drug release, may influence mid-to-long term pPCI success rate.

Orsiro, a third generation hybrid sirolimus eluting stent with a biodegradable polymer, may potentially cause less stent malapposition, stent-induced inflammation and mechanical damage, ultimately reducing the thrombogenicity of the stent.

Purpose

The aim of the HEROES Registry is: 1) to evaluate the safety and efficacy of the Orsiro stent in STEMI patients undergoing pPCI; 2) to capture data that reflect the “real-world” use of Orsiro stents in pPCI and provide insights into patient characteristics, comorbid conditions, patterns of care, quality of care and performance measurements.

Methods

From January 2012 to March 2018 we prospectively enrolled all patients diagnosed with STEMI who have received one or more Orsiro stents in the target vessel of pPCI at 9 Italian centres.

The primary end-point of the study was a device-oriented composite end-point (DOCE) of cardiac death, any myocardial infarction (MI) clearly attributable to the intervention culprit vessel (TVMI) and ischemic-driven target lesion revascularization (ID-TLR) at 1-year follow up.

Secondary end-points were: 1) DOCE at 6-month and 3-year follow-ups; 2) any definite/probable stent thrombosis; 3) any TIMI major bleeding (in-hospital, within 7 days after pPCI and at follow-up).

Results

Study cohort comprised 338 patients with a mean age of 64.9±12.0 years; 255 (75.4%) were men, 69 (20.4%) had diabetes and 59 (17.5%) chronic kidney disease. Median follow-up was 10.5 (range 0–67) months. Culprit vessel was the left anterior descending (LAD) in 167 (49.4%), right coronary (RCA) in 97 (28.7%), left circumflex artery (LCX) in 42 (12.4%) and other vessels in 32 (9.5%). Multivessel disease was present in 178 (52.7%); 106 (31.4%) had bifurcation lesion as a culprit. In 155 (45.9%) the culprit lesion was proximal, in 154 (45.6%) mid-vessel. Stent per lesion ratio was 1.3±0.6. Thrombus grade was 0–2 in 236 (69.8%) and 3–5 in 102 (30.2%).

At 1-year follow-up we observed a 4.4% cumulative incidence of DOCE, consisting of 13 (3.8%) cardiac deaths, 1 (0.3%) TVMI and 1 (0.3%) ID-TLR. Definite stent thrombosis occurred in only 1 (0.3%) patient during hospital stay. There were only 4 major bleedings (1.2%), all during follow-up.

Kaplan-Meier analysis showed a DOCE-free survival at 6 months of 95.9%, and at 1 and 3 years of 95.6 and 95%, respectively.

DOCE-free survival curve

Conclusions

Orsiro stent seems to be effective and safe in contemporary pPCI. The optimal features of Orsiro contribute to the few adverse events observed during follow-up and to an event-free survival that compares favorably with similar registries of modern DES.