Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial.

OBJECTIVES: The objective of this study was to assess the effects of home-based exercise training (HBET) on function and quality of life (QoL) in patients with pulmonary hypertension (PH). METHODS: A prospective, nonblinded, randomized clinical trial was carried out on 84 medically stable patients with PH belonging to any functional class or etiology and of either sex. Patients were randomized to either standard care or HBET. Both groups also received education using the Pulmonary Hypertension Manual (PulHMan). Outcomes included functional capacity from 6-min walk distance (6MWD), QoL using the Medical Outcomes Survey Short Form - 36, functional class (FC), and right heart indices (right ventricular systolic pressure [RVSP] and tricuspid annular plane systolic excursion [TAPSE]) and were assessed at entry and after 12 weeks. RESULTS: HBET improved 6MWD by 48.5 m and 13 m in the experimental and control groups, respectively (p < 0.001). QoL showed statistical improvements after HBET between the groups for the physical and mental components and for the various subdomains (except body pain). Furthermore, FC improved by one grade with HBET (p < 0.001). CONCLUSION: HBET program improved functional capacity, QoL, and FC in patients with PH.

Feasibility of Telecardiology Solution to Connect Rural Health Clinics to a Teaching Hospital.

BACKGROUND: In spite of enormous progress in cardiac care in India, rural communities lack access to even basic cardiac care. One possible solution to this problem is to employ telecardiology. OBJECTIVES: To demonstrate feasibility of telecardiology system to link rural clinics to a teaching hospital. METHODS: Five rural clinics were linked to a teaching hospital, using an inexpensive system of cardiographs and tablet PCs to transmit ECGs to hospital and have them interpreted by cardiologist. RESULTS: Three hundred eighty ECGs were acquired at clinics with 98.9% of them noise-free and transmitted to the hospital with 99.7% success on first attempt. Interpretation of ECG was provided to primary care physician at the clinic on the same day for 95.3% of ECGs. Abnormal ECG findings were seen on 22.6% of these ECGs. CONCLUSION: This system performed well with high success rate of acquisition and transmission. Staff at rural clinics successfully acquired quality ECGs and transmitted them and the staff at the hospital were able to provide timely interpretation of ECGs and advice to patients.

Evaluation of subtle left ventricular systolic abnormalities in adult patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM), an auto-somal dominant disorder due to mutation of genes encoding sarcomeric proteins, leads to left ventricular diastolic dysfunction. Recently, the research in this area suggests that systolic dysfunction exists in the patients with HCM even though traditional measures of systolic dysfunction are normal. So, we carried out this study to determine global systolic dysfunction in patients with HCM. MATERIALS AND METHODS: A total of 18 patients, diagnosed with HCM according to echocardiography parameters, that is thickness of interventricular septum/posterior wall thickness >1.3 or hypertrophy involving apex only with or without left ventricular outflow tract obstruction, were included in the study and were compared with normal age-matched controls. We measured torsion and strain imaging by 2-dimensional echocardiography as well as strain imaging by tissue Doppler echocardiography. RESULT: The results of the study showed that there was considerable increased torsion in patients with HCM as compared to normal subjects (16.61±7.43 vs. 10.42±4.73, p=0.006). Tissue Doppler indices-systolic annular velocity (7.7±0.7 vs. 8.7±1.00, p=0.012) and lateral wall E/E' (12.52±5.27 vs. 6.66±1.67, p<0.001) were significantly different in patients with HCM and normal subjects. The average systolic strain and strain rate as well as diastolic strain rate were significantly different in both the groups when strain imaging was performed by tissue Doppler echocardiography. We also observed significantly reduced global longitudinal, circumferential and radial strain in patients with HCM when strain analysis was carried out with 2-dimensional speckle tracking echocardiography. CONCLUSION: The global subtle systolic dysfunction, as measured by left ventricular torsion and strain imaging, is present in patients with HCM even though traditional measure of systolic dysfunction is normal.