The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study.

BACKGROUND: Resistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9). AIM: To evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR). METHODS: In this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis. RESULTS: Following completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (ß = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (ß = 28.2 m, 95% CI 2.4-53.9, p = 0.033), aerobic capacity (ß = 0.9 Mets, 95% CI 0.1-1.7, p = 0.021), and WHO-5 well-being index (ß = 8.1, 95% CI 2.0-14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels. CONCLUSION: Resistance training in CR significantly reduced PCSK-9 levels and increases patient's functional capacity and quality of life. (NCT02674659 04/02/2016).

Predicting the Risk of Severity and Readmission in Patients with Heart Failure in Indonesia: A Machine Learning Approach.

OBJECTIVES: In Indonesia, the poor prognosis and high hospital readmission rates of patients with heart failure (HF) have yet to receive focused attention. However, machine learning (ML) approaches can help to mitigate these problems. We aimed to determine which ML models best predicted HF severity and hospital readmissions and could be used in a patient self-monitoring mobile application. METHODS: In a retrospective cohort study, we collected the data of patients admitted with HF to the Siloam Diagram Heart Center in 2020, 2021, and 2022. Data was analyzed using the Orange data mining classification method. ML support algorithms, including artificial neural network (ANN), random forest, gradient boosting, Naïve Bayes, tree-based models, and logistic regression were used to predict HF severity and hospital readmissions. The performance of these models was evaluated using the area under the curve (AUC), accuracy, and F1-scores. RESULTS: Of the 543 patients with HF, 3 (0.56%) were excluded due to death on admission. Hospital readmission occurred in 138 patients (25.6%). Of the six algorithms tested, ANN showed the best performance in predicting both HF severity (AUC = 1.000, accuracy = 0.998, F1-score = 0.998) and readmission for HF (AUC = 0.998, accuracy = 0.975, F1-score = 0.972). Other studies have shown variable results for the best algorithm to predict hospital readmission in patients with HF. CONCLUSIONS: The ANN algorithm performed best in predicting HF severity and hospital readmissions and will be integrated into a mobile application for patient self-monitoring to prevent readmissions.

Current Evidence and Future Directions of Omega-3 Supplementation and Cardiovascular Disease Risk.

Omega-3 supplementation has a controversial role in the secondary prevention of cardiovascular diseases. Despite large clinical trials published over the years, the evidence of omega-3 in preventing cardiovascular diseases, especially coronary heart disease, is still inconclusive. However, recent clinical trials using higher dose of omega-3 or highly purified esters of omega-3 shows promising result, with reduction in cardiovascular death and incidence of cardiovascular disease. This review aims to summarize the possible mechanism of omega-3 in preventing cardiovascular disease and future directions of research regarding the benefit of omega-3 in cardiovascular disease.

The Effect of Omega-3 Supplementation on Heart Failure Outcome: A Meta-Analysis of Randomized Clinical Trial.

The effect of omega-3 supplementation on cardiovascular (CV) disease has been widely studied in several large clinical trials. However, the evidence of the effect of omega-3 supplementation in patients with heart failure (HF) remains controversial. This meta-analysis investigated the effects of omega-3 supplementation on patients with HF. We conducted a literature search on MEDLINE, Embase, and Cochrane databases for clinical trials and preprints of relevant articles. Following a literature search and critical appraisal, 5 studies were included in the meta-analysis. The pooling of the result of the studies shows that there were no significant association between omega-3 supplementation and CV mortality (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.84-1.05, p=0.16) nor hospitalization due to HF (OR, 0.94; 95% CI, 0.88-1.02; p=0.13). Our systematic review and meta-analysis showed that omega-3 supplementation has no beneficial effect in patients with HF.

Smartphone-Based Cardiac Rehabilitation Program Improves Functional Capacity in Coronary Heart Disease Patients: A Systematic Review and Meta-Analysis.

Cardiac rehabilitation (CR) reduces mortality and morbidity in coronary heart disease (CHD); however, patients show a lack of adherence to CR. Alternatively, telehealth interventions have shown promising results for improving target outcomes in CR. This study aimed to review the effect of smartphone-based CR on the functional capacity of CHD patients. A literature search was performed using PubMed, MEDLINE, Embase, and Cochrane Library on 21 March, 2022 to find randomised controlled trials on smartphone usage in CR to improve functional capacity. Outcomes included maximal oxygen consumption (VO2 max), a 6-min walk test (6-MWT), quality of life, smoking cessation, and modifiable risk factors. Eleven trials recruiting CHD patients were reviewed. Wearable devices connected to smartphone- or chat-based applications were commonly used for CR delivery. Most trials managed to provide exercise prescriptions, education on medication adherence and controlling risk factors, and psychosocial counselling through the intervention. Functional capacity improved significantly following smartphone-based CR in CHD patients compared to control groups, as measured by VO2 max and 6-MWT; patients were more likely to quit smoking. Compared to traditional care, smartphones that delivered CR to CHD patients demonstrate superior outcomes regarding increasing functional capacity. There is no significant improvement on lipid profile, blood pressure, HbA1C, body mass index, and quality of life. It can be used either alone or as an adjunct. Ultimately, the patients' preferences and circumstances should be considered.

Cardiovascular Protection Variables Based on Exercise Intensity in Stable Coronary Heart Disease Patients After Coronary Stenting: A Comparative Study.

PURPOSE: Our study aimed at determining and comparing the mechanism of cardiovascular protection variables in moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with stable coronary heart disease (CHD) after coronary stenting. PARTICIPANTS AND METHODS: This experimental study used the same subject and cross-over design, involving eleven stable CHD patients after coronary stenting. These were randomly divided into two groups; MICT for 29 minutes at 50-60% heart rate reserve and HIIT with 4x4 minute intervals at 60-80% heart rate reserve, each followed by three minutes of active recovery at 40-50% heart rate reserve. These were conducted three times a week for two weeks. The participants' levels of adrenaline, noradrenaline, endothelial nitric oxide synthase (eNOS), extracellular superoxide dismutase (EC-SOD) activity assayed, and flow-mediated dilatation (FMD) were examined before and after treatments were completed. RESULTS: The HIIT significantly increased the levels of noradrenaline and eNOS compared with MICT (p<0.05). Also, HIIT was better in maintaining EC-SOD activity and FMD compared with MICT (p<0.05). Through the noradrenalin pathway, HIIT had a direct and significant effect on eNOS and FMD (p<0.05) but MICT, through the noradrenaline pathways, had a direct and significant effect on eNOS (p<0.05), and through the EC-SOD activity pathways had a direct and significant effect on FMD (p<0.05). MICT reduced EC-SOD activity and also decreased the FMD value. CONCLUSION: HIIT is superior to MICT in increasing cardiovascular protection by increasing the concentrations of noradrenalin and eNOS, maintaining EC-SOD activity, and FMD in stable CHD patients after coronary stenting.

Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction.

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF). The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients. This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well. Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise ( p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly ( p = 0.001). Quality of life improved significantly during exercise ( p < 0.001). Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.