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Background: The positive role of rehabilitation programmes for some cardiac patient populations (e.g. coronary artery disease, heart failure, transcatheter aortic valve replacement, and heart transplantation) is now well-known. However, the feasibility and outcomes of rehabilitation, prior to or immediately after percutaneous mitral valve reconstruction, using a clamping procedure have been poorly reported, especially among frail elderly patients. Case summary: An 85-year-old woman with acute heart failure symptoms (New York Heart Association functional class III), who had acute myocardial infarction 3 months ago, was hospitalized. An ultrasound cardiogram showed severe mitral regurgitation, and after a multidisciplinary discussion, transcatheter edge-to-edge repair (TEER) was considered the safest treatment option. Even then, though, due to her poor health status, it was still too risky for the patient to undergo without significant prior preparation. Thus, we decided to begin pre- and post-surgery cardiac rehabilitation (CR) to prepare her for TEER, comprising medicinal, nutritional, and psychological support, as well as exercise and smoking cessation. After pre-operative assessment and rehabilitation, the patient underwent TEER, followed by post-operative reassessment, and continued rehabilitation. Discussion: Our case study demonstrates that CR, both pre- and post-TEER, aids in improving the conditions of elderly patients with poor health, to minimize their risk for developing TEER-related complications. This case provides one possible CR regimen for those patients.
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Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.
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BACKGROUND: Coronary artery disease (CAD) has become the most common cause of death worldwide. However, the negative effects of CAD are able to be alleviated via exercises, possibly via increased production of meteorin-like protein (Metrnl). In this study, we aim to evaluate the connection between Metrnl production during exercise with lowered CAD risk and severity. METHODS: Two age and gender-matched groups of 60 human patients, one with CAD, and one without were randomly recruited. The CAD group were subjected to continuous training exercises. Mice were exercised by using a treadmill, establishing an animal exercise model. ELISA was used to measure plasma Metrnl and inflammatory factors. To determine the impact of Metrnl on glucose metabolism, oxygen consumption and extracellular acid rates were taken for untreated, palmitic acid (PA)-treated, and PA+Metrnl co-treated human umbilical vein endothelial cells. Western blot was used to measure expression levels for the NLR family pyrin domain containing 3 inflammasome. RESULTS: CAD patients had lower Metrnl levels compared to non-CAD controls. Furthermore, higher Metrnl levels post-exercise were inversely associated with LDL, inflammatory cytokines, and CAD severity, as well as being positively associated with HDL. Metrnl was able to counteract against PA-induced HUVEC glucose metabolic dysfunction via reducing ROS production, which in turn lowered NLRP3 inflammasome expression, thereby serving as the basis behind the inverse correlation between Metrnl and inflammatory cytokines. CONCLUSIONS: Exercise was able to increase Metrnl production from skeletal muscle among CAD patients, and subsequently improve patient atherosclerosis via counteracting against endothelial metabolic dysfunction and pro-inflammatory activities.