Exercise training reduces high mobility group box-1 protein levels in women with breast cancer: findings from the DIANA-5 study.

PURPOSE: To determine whether exercise training might exert anti-inflammatory effect by reducing HMGB1 levels in women with breast cancer (BC). METHODS: We analyzed monocentric data from the DIANA (DIET AND ANDROGENS)-5 PROJECT. Study population consisted of 94 patients randomized into two groups: 61 patients (53 +/- 8 yrs, training group) were assigned to a structured exercise training intervention (3 times/week for the first 3 months, and once /week for the following 9 months); whereas 33 patients (52 +/- 7 yrs, control group) followed only the general indications to adhere to the life-style intervention suggestions of the DIANA protocol. At study entry and after 12 months, all patients underwent cardiopulmonary exercise testing, biochemical as- sessment [HMGB1, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6)]; and lipid and glycemic profile. RESULTS: There were no significant differences between groups in baseline clinical and inflammatory profile. Among the training group, only 19/61 patients had high adherence to the exercise intervention. After stratifying the study population according to the level of adhesion to the exer- cise intervention, 1-year HMGB1 levels were lower among patients more adherent to exercise (p for trend = 0.001). Further adjusting for age, body mass index and baseline values, 1-year HMGB1 levels remained significantly and inversely associated to the level of adhesion to the exercise intervention (B = -0.97, SE = 0.43, p = 0.01). CONCLUSIONS: Moderate intensity exercise training in BC survivors is associated with reduced HMGB1 levels that are proportional to the level of adhesion to the exercise intervention, independently from other classical inflammatory molecules, suggesting an exercise-induced anti-inflammatory effect mediated by HMGB1.

Exercise training improves erectile dysfunction (ED) in patients with metabolic syndrome on phosphodiesterase-5 (PDE-5) inhibitors.

INTRODUCTION: Erectile dysfunction (ED) affects about 50% of males aged 40-70 years old. ED shares with atherosclerotic disease several common risk factors; therefore, it may be considered a surrogate marker of atherosclerosis. Since phosphodiesterase-5 inhibitors are well known pharmacologic agents capable of significant improvement in ED, we designed this study to evaluate whether exercise training is of added value in patients with ED who are already on PDE-5 inhibitors. METHODS: We recruited 20 male patients affected by ED with metabolic syndrome. At baseline, all patients underwent Cardio-Pulmonary Exercise Testing (CPET) and the International Index of Erectile Function (IIEF) test. After the initial evaluation, patients were subdivided into two groups: tadalafil group (group T, n = 10), who were maintained only on tadalafil therapy, and a tadalafil/exercise training group (T/E group, n = 10) who continued tadalafil but in addition underwent a2-month structured exercise training program. RESULTS: Basal anthropometric characteristics of study population showed no significant differences. Although both-groups showed at 2 months an improvement of the IIEF score, this was more evident in the T/E group (T group: 11.2 vs 14.2, P = 0.02; T/E group: 10.8 vs 20.1, P < 0.001). There was an improvement of oxygen consumption at peak exercise (VO(2peak)) only in the T/E group patients (T group: 13.63 +/- 2.03 vs 14.24 +/- 2.98 mL/kg/min; P = 0.521; T/E group: 13.41 +/- 2.97 vs 16.58 +/- 3.17 mL/kg/min; P = 0.006). A significant correlation was found between the changes in VO(2peak) and the modifications in IIEF score (r = 0.575; P = 0.001). CONCLUSION: Exercise training in ED patients treated with PDE-5 inhibitors is of added value since further improves ED, as evaluated by IIEF score, and increases functional capacity.

Vulnerable personality and Takotsubo cardiomyopathy consequent to emotional stressful events: a clinical case report.

INTRODUCTION: Although the onset of Takotsubo cardiomyopathy (TTC) can be triggered by an acute, intense emotional stress, the exact pathogenic mechanisms still remain undefined. PRESENTATION: A 58-year-old female was sent by ambulance to the Emergency Department (ED) for chest pain and ST elevations on ECG. Her chest pain began 3 hours before on admission after a domestic argument. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20%. Cardiac catheterization revealed no significant coronary artery disease. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments. A diagnosis of Takotsubo Cardiomyophaty (TTC) was made according to the Mayo Clinic 2008 criteria. The patient evolved with improvement of her condition and, therefore, was discharged from the hospital. Follow-up echocardiogram seven days later showed normal LV size and function with ejection fraction (EF) of 43%. Paykel Life Stress Event Scale identified as emotional trigger a domestic argument occurred 3 hours before symptom onset. History showed a major life stress event, death of a loved one, six months before symptoms. The patient underwent psychological assessment after hospital discharge by Emotional Regulation Questionnaire and BDI showing high suppression/ low reappraisal profile and moderate depression. CONCLUSION: This case highlights the hypothesis of a possible link between cognitive emotional processing and vulnerability to Takotsubo syndrome.

[Takotsubo syndrome in a young woman during puerperium: case report]. / Sindrome di Takotsubo nel puerperio: caso clinico.

INTRODUCTION: Takotsubo syndrome is a reversibile cardiomyopathy that often occurs during an emotional stress and is more frequent in post-menopausal women. CASE PRESENTATION: We describe a clinic case of a 42 years old woman, admitted to our emergency unit because of a thoracic pain. The ECG showed ST-T elevation in V1-V4, the echocardiography revealed akinesia of apical segment of left ventricle. Coronary arteries were free from significant stenosis and ventriculography showed akinesia of apical segment of left ventricle. In the following days, ECG evolved toward a normalization of ST-T segment with appearance of negative T wave in V2-V6, and also the echocardiography showed a normalized LV wall motion. The patient was discharged and ECG and echocardiography were normal at two months follow up. CONCLUSION: In this case report, a young woman during puerperium presented with a Takotsubo syndrome. We speculate that the high Prolactin level and her emotional state contributed to the clinical manifestation of the syndrome.

Inflammatory markers and visceral fat are inversely associated with maximal oxygen consumption in women with polycystic ovary syndrome (PCOS).

BACKGROUND: We investigated whether several different inflammatory markers including C-reactive protein (CRP) and fibrinogen and white blood cells (WBCs) count, are associated with maximal oxygen consumption (VO(2 max)) in women with polycystic ovary syndrome (PCOS). METHODS: In PCOS women (n = 124, 24.1 +/- 4.5 year-old) VO(2 max) was measured during symptom-limited cardiopulmonary exercise test. Abdominal fat distribution was determined by ultrasound. Physical activity level was assessed by a standardized questionnaire. CRP was measured by immunoassays, fibrinogen by the Clauss method, and WBCs count with a Coulter counter. RESULTS: Pearson's analysis showed a significant correlation between VO(2 max) and logCRP (r = -0.437, P < 0.001), fibrinogen (r = -0.479, P < 0.001), and WBCs count (r = -0.438, P < 0.001). Multivariable logistic regression model showed that age (beta = -0.127, P = 0.005), AUC(INS )(beta = -0.335, P < 0.001), HDL-C (beta = 0.390, P < 0.001), physical activity score (beta = 0.238, P = 0.002), visceral fat (beta =-0.184), P = 0.023), FAI (beta = -0.291, P = 0.028); CRP (beta = -0.216, P = 0.011), fibrinogen (beta = -0.113, P = 0.008) and WBCs count (beta = -0.177, P < 0.001) were significantly associated with VO(2 max). CONCLUSIONS: Acute-phase reactants, such as CRP and fibrinogen, and WBCs count were independently and inversely associated with a direct measure of cardiorespiratory fitness (VO(2 max)) in women with PCOS, even after adjustment for physical activity level and other potential confounding factors. These findings add to the growing body of evidence linking inflammation to cardiorespiratory fitness in PCOS women.

Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS).

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common female reproductive-age endocrine disease predominantly characterized by chronic anovulation, hyperandrogenism, insulin-resistance and low-grade inflammatory status. Exercise training (ET) favourably modulates cardiopulmonary function and insulin-sensitivity markers in PCOS women. The present study investigated the effects of ET on autonomic function and inflammatory pattern in PCOS women. STUDY DESIGN: Prospective baseline uncontrolled clinical study. METHODS: One-hundred and eighty five PCOS women referred to our department were screened for the inclusion into the study protocol from March 2004 to July 2007. One-hundred and twenty four PCOS women met the criteria for the inclusion into the study protocol and were subdivided into two groups each composed of 62 patients: PCOS-T (trained) group underwent 3-month ET program, whereas PCOS-UnT (untrained) group did not. At baseline and at 3-month follow-up, hormonal and metabolic profile, cardiopulmonary parameters, autonomic function (as expressed by heart rate recovery, HRR) and inflammatory pattern [as expressed by C-reactive protein (CRP) and white blood cells (WBCs) count] were evaluated. RESULTS: PCOS-T showed a significant (P < 0.05) improvement in maximal oxygen consumption (VO(2max)) and in post-exercise HRR, and a significant (P < 0.001) decrease in CRP and WBCs; whereas no statistically significant changes of the same parameters were observed in PCOS-UnT. Multiple linear regression analysis showed that 3-month HRR is linearly related to the inclusion in training group (beta = 0.316, P < 0.001), VO(2max) (beta = 0.151, P = 0.032) and the ratio between glucose and insulin area under curve (AUC) (beta = 0.207, P = 0.003), and inversely related to body mass index (beta = -0.146, P = 0.046), insulin AUC (beta = -0.152, P = 0.032), CRP (beta = -0.165, P < 0.021), and WBCs count (beta = -0.175, P = 0.039). CONCLUSIONS: Exercise training improves autonomic function and inflammatory pattern in PCOS women.

Abnormal heart rate recovery after maximal cardiopulmonary exercise stress testing in young overweight women with polycystic ovary syndrome.

OBJECTIVE: Heart rate recovery (HRR) is a measure derived from exercise test, defined as the fall in heart rate during the first minute after maximal exercise. Abnormal HRR is a measure of autonomic dysfunction associated with an increased mortality. This study was performed to evaluate the HRR in polycystic ovary syndrome (PCOS). DESIGN: Prospective controlled clinical study. PATIENTS: Seventy-five PCOS women compared to 75 healthy women matched for age (21.7 +/- 2.1 years vs. 21.9 +/- 1.8 years, respectively) and body mass index (BMI) (29.0 +/- 2.6 kg/m(2) vs. 29.1 +/- 2.9 kg/m(2), respectively). MEASUREMENTS: Subjects were studied for their hormonal and metabolic profile, and underwent cardiopulmonary exercise test (CPX). RESULTS: PCOS women showed a significantly reduced HRR (12.9 +/- 1.8 vs. 20.4 +/- 3.1 beats/min, P < 0.001) compared to healthy controls, an impairment in maximal oxygen consumption (18.0 +/- 2.3 ml/kg/min vs. 29.3 +/- 3.9 ml/kg/min) and in oxygen consumption at anaerobic threshold (13.6 +/- 2.6 ml/kg/min vs. 24.2 +/- 3.0 ml/kg/min). In PCOS women, abnormal HRR was inversely correlated to BMI (r = -0.582, P < 0.001) and to the area under the curve for insulin (r = -0.596, P < 0.001). CONCLUSIONS: Our data demonstrate an abnormal HRR after maximal CPX in young overweight PCOS patients, and that HRR should be investigated as a further potential marker of increased cardiovascular risk in PCOS.

Patterns and determinants of functional and absolute iron deficiency in patients undergoing cardiac rehabilitation following heart surgery.

Background Anaemia and iron deficiency are frequent following major surgery. The present study aims to identify the iron deficiency patterns in cardiac surgery patients at their admission to a cardiac rehabilitation programme, and to determine which perioperative risk factor(s) may be associated with functional and absolute iron deficiency. Design This was a retrospective study on prospectively collected data. Methods The patient population included 339 patients. Functional iron deficiency was defined in the presence of transferrin saturation <20% and serum ferritin ≥100 µg/l. Absolute iron deficiency was defined in the presence of serum ferritin values <100 µg/l. Results Functional iron deficiency was found in 62.9% of patients and absolute iron deficiency in 10% of the patients. At a multivariable analysis, absolute iron deficiency was significantly ( p = 0.001) associated with mechanical prosthesis mitral valve replacement (odds ratio 5.4, 95% confidence interval 1.9-15) and tissue valve aortic valve replacement (odds ratio 4.5, 95% confidence interval 1.9-11). In mitral valve surgery, mitral repair carried a significant ( p = 0.013) lower risk of absolute iron deficiency (4.4%) than mitral valve replacement with tissue valves (8.3%) or mechanical prostheses (22.5%). Postoperative outcome did not differ between patients with functional iron deficiency and patients without iron deficiency; patients with absolute iron deficiency had a significantly ( p = 0.017) longer postoperative hospital stay (median 11 days) than patients without iron deficiency (median nine days) or with functional iron deficiency (median eight days). Conclusions Absolute iron deficiency following cardiac surgery is more frequent in heart valve surgery and is associated with a prolonged hospital stay. Routine screening for iron deficiency at admission in the cardiac rehabilitation unit is suggested.

Efficacy of telecardiology in improving the results of cardiac rehabilitation after acute myocardial infarction.

BACKGROUND: This study was addressed to verify if Telecardiology (TC) improves the results of Cardiac Rehabilitation in patients following a home-based Cardiac Rehabilitation Program (CRP) after acute myocardial infarction (AMI). MATERIALS AND METHODS: We studied three groups of patients after AMI: Group A (control group): 15 patients, who followed a standard in-hospital CRP of 3 weekly sessions of 2 months duration; Group B (study group): 15 patients, who were enrolled in a home-based CRP of similar duration and were monitored by TC with the aid of an ecg-device (Sorin Life Watch CG 6106); Group C (second control group): 15 patients, who followed a home-based CRP without ecg-monitoring by TC. All patients performed a symptom-limited exercise testing at the beginning of the CRP. Psychometric data (STAI-Y1, STAI-Y2, BDI) were also evaluated. At the end of the CRP all patients underwent repeated exercise testing and psychometric evaluation. RESULTS: TC applied to the home-based CRP was associated with a good compliance to the program. Compared to Group C, in Group B we observed an increase of maximal heart rate, exercise duration, maximal work-load, and an improvement of anxiety, a trend to reduction of depression, and an improvement of quality of life. These results were very similar to Group A patients following a hospital-based CRP. CONCLUSIONS: TC improves compliance, functional capacity and psychological profile of patients undergoing a home-based CRP, compared to patients enrolled in a home-based CRP without ecg-monitoring by Telecardiology.

Exercise training improves cardiopulmonary and endothelial function in women with breast cancer: findings from the Diana-5 dietary intervention study.

To investigate whether exercise training (ET) improves cardiopulmonary and endothelial function in women with breast cancer (BC). Fifty-one female patients (aged between 39 and 72 years) with a history of primary invasive BC within the previous 5 years and enrolled in the Mediterranean diet-based DIANA (diet and androgens)-5 Trial were subdivided into 2 groups: an ET group (n = 25) followed a formal ET program of moderate intensity (3 session/week on a bicycle at 60-70 % VO2peak for 3 months, followed by one session/week until 1-year follow-up), while a control group (n = 26) did not perform any formal ET. At baseline and at 1-year follow-up, all patients underwent cardiopulmonary exercise stress test (CPET) and measurements of vascular endothelial function by peripheral artery tonometry (Reactive Hyperemia Index, RHI). There were no significant differences between the groups in baseline anthropometrical, BC characteristics, and metabolic profile. No differences in baseline CPET and RHI parameters were found. Peak oxygen consumption (VO2peak) significantly increased in ET group (from 12.4 ± 2.9 to 14.3 ± 3.3 mL/kg/min, p < 0.001) compared to the control group (from 12.8 ± 2.5 to 12.6 ± 2.8 mL/kg/min, p = 0.55; p < 0.001 between groups). Compared to the control group (from 2.0 ± 0.4 to 1.9 ± 0.4, p = 0.62), the ET group showed a significant improvement of RHI after 1 year (from 2.1 ± 0.7 to 2.5 ± 0.8, p < 0.001). Changes in VO2peak were correlated with changes in RHI (ΔVO2peak vs. ΔRHI: r = 0.47, p = 0.017). In BC survivors, ET program improves cardiopulmonary functional capacity and vascular endothelial function after 12 months. Whether these changes may favorably modulate some of the pathophysiological mechanisms implied in cancer evolution should be investigated.

Effect of duration of data averaging interval on reported peak VO2 in patients with heart failure.

AIM: To describe the effect of the duration of the data averaging interval on the calculated peak oxygen uptake (VO2) reported from a symptom-limited maximal exercise test in patients with heart failure. METHODS: Maximal exercise test results from 275 patients diagnosed with stable heart failure due to left ventricular systolic dysfunction (ejection fraction<45%; age: 45-75 years; peak VO2: 8.0-20.0mL/kg/min), were examined. Sampling rates of 10, 20, 30 and 60s were used to calculate peak VO2, which was identified as the highest interval value that occurred during the final minute of exercise or the first interval in immediate recovery. RESULTS: Mean peak VO2 (mL/kg/min) across the four sampling periods was as follows: 14.0±3.0 (10s), 13.7±3.0 (20s), 13.5±3.0 (30s) and 13.2±2.9 (60s) and there was a significant reduction with increasing averaging duration (p<0.0001). Peak VO2 was significantly different between the 10s and 60s sampling times (p<0.0001). Peak respiratory exchange ratio (RER) was also significantly different between 10 and 60s sampling rates (p<0.0001). Sub-analyses showed peak VO2 values in those people achieving RER>1.05 to be +0.8±0.7mL/kg/min higher than those who had not achieved RER values>1.05; similar findings, +0.8±0.7mL/kg/min, were seen in those patients achieving RER>1.10 versus those who did not. CONCLUSIONS: Sampling rate method has a significant effect on calculated peak VO2 and RER. We suggest that laboratories standardize their sampling rate method to ensure consistency.

Exercise training improves heart rate recovery in women with breast cancer.

PURPOSE: To determine whether exercise training improves autonomic function in women with breast cancer (BC). METHODS: Fifty-one patients (aged between 39 and 72 years) with a history of primary invasive BC within the previous 5 years and enrolled in the Mediterranean diet-based DIANA (Diet and Androgens)-5 Trial were subdivided in two groups: a ET group (n = 25) followed a formal ET program of moderate intensity (3 session/week on a bicycle at 60-70% VO2peak for 3 months, followed by one session/week until 1-year follow-up), while a control group (n = 26) did not perform any formal ET. At baseline and after 1-year, all patients underwent cardiopulmonary exercise stress test (CPET). Heart rate recovery (HRR) was calculated as the difference between heart rate at peak exercise and heart rate at first minute of the cool-down period. RESULTS: There were no significant differences between groups in baseline anthropometrical, BC characteristics, metabolic profile, CPET parameters and HRR. Compared to controls, at 1-year follow-up ET group showed a significant improvement in VO2peak (from 12.6 ± 3.0 to 14.5 ± 3.3 ml/kg/min, p < 0.001; p < 0.001 between groups); and in HRR (from 17.6 ± 6.4 to 23.0 ± 8.3 beats/min, p < 0.001; p < 0.001 between groups). In ET group the changes in HRR directly correlated with changes in VO2peak (r = 0.58, p = 0.002). CONCLUSIONS: Moderate intensity exercise training in BC survivors is associated with improvement of autonomic function. Whether the improvement of sympatho-vagal balance may favorably modulate some of the pathophysiological mechanisms implied in cancer evolution need further investigation.

Effects of exercise training started within 2 weeks after acute myocardial infarction on myocardial perfusion and left ventricular function: a gated SPECT imaging study.

BACKGROUND: Several studies suggested that exercise training might improve myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. However, these findings were obtained in patients with chronic coronary artery disease using thallium-201 myocardial perfusion scintigraphy. We evaluated whether a long-term exercise-based cardiac rehabilitation (CR) started early (9 ± 3 days) after ST elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function, evaluated by gated single-photon emission computed tomography (SPECT) imaging. DESIGN: Randomized controlled study. METHODS: Fifty patients with recent STEMI were randomized into two groups: 24 enrolled in a 6-month exercise-based CR programme (group T) and 26 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and gated SPECT within 3 weeks after STEMI and at 6-month follow up. RESULTS: At follow up, group T showed a significant reduction of stress-induced ischaemia (p < 0.01) and an improvement in resting and post-stress wall motion (both p < 0.005) and resting (p < 0.05) and post-stress wall thickness (p < 0.005) score indexes. At follow up, group T showed an improvement in peak oxygen consumption (p < 0.0001), O(2) pulse (p < 0.05), and in the slope of increase in ventilation over carbon dioxide output (p < 0.001). No changes in myocardial perfusion parameters, LV function, and cardiopulmonary indexes were observed in group C at follow up. CONCLUSIONS: Six months of exercise training early after STEMI reduces stress-induced ischaemia and improves LV wall motion and thickness. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with the improvement of cardiovascular functional capacity.

A statewide quality collaborative for process improvement: internal mammary artery utilization.

BACKGROUND: The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative is a voluntary, surgeon-directed quality initiative involving all cardiac surgery programs in Michigan. Understanding that internal mammary artery (IMA) use during coronary artery bypass grafting is an important process measure associated with improved outcomes, this analysis reviews our methodology to understand IMA use and increase appropriate IMA use statewide. METHODS: Adult cardiac Society of Thoracic Surgeons data were collected at each Michigan site and submitted quarterly to the Duke Clinical Research Institute and the MSTCVS. Seven cardiac surgery programs with IMA use less than 90% in isolated coronary artery bypass grafting were identified as low IMA users. An improvement plan was adopted at the state level and included quarterly monitoring of IMA use, documenting the rationale for IMA exclusion, evidence-based lectures, feedback letters to sites, and physician-led site visits if no improvement was noted. RESULTS: From 2005 through 2008, 29,114 patients underwent coronary artery bypass grafting in Michigan. Internal mammary artery utilization varied widely at the beginning of this investigation, ranging from 66.2% to 98.4%. Seven Michigan programs were identified as low IMA users. Using the MSTCVS Quality Collaborative's process-improvement plan, collectively the seven low IMA users increased IMA grafting from 82.0% to 92.7% (p < 0.0001). Michigan IMA use increased from 91.9% to 95.8% (p < 0.0001) and is now higher than The Society of Thoracic Surgeons' average. CONCLUSIONS: The MSTCVS Quality Collaborative identified programs with low IMA use and created an environment to enhance IMA utilization during coronary artery bypass grafting, a significant operative process. These findings illustrate the value of a statewide surgeon-directed quality initiative in improving processes and outcomes for patients.

Favourable effects of exercise-based Cardiac Rehabilitation after acute myocardial infarction on left atrial remodeling.

BACKGROUND: Left atrial enlargement is an important predictor of cardiovascular outcomes in patients after acute myocardial infarction. While the favourable effect of exercise exercise-based Cardiac Rehabilitation (CR) on postinfarction LV remodeling has been well documented, those on LA remodeling have yet to be defined. This study investigated the effects of CR on LA remodeling in postinfarction patients with moderate left ventricular (LV) dysfunction. METHODS: Sixty postinfarction patients were randomised randomized into two groups, each composed of 30 patients: group T (LV ejection fraction (EF) 43.7+/-4.2%, mean+/-SD) entered a 6-month CR program, whereas group C (EF 44.7+/-4.4%, P=ns) did not. Doppler echocardiography and cardiopulmonary exercise test were performed upon enrolment and at 6-month. RESULTS: At 6-month, trained patients showed a significant (P<0.001) improvement in peak oxygen consumption (DeltaVO(2peak)=+5.2+/-2.1 ml/kg/min) and a reduction in LA (DeltaLAV(MAX)=-1.9+/-3.7 ml/m(2)) and in LV volumes (DeltaLVEDV=-3.6+/-4.4 ml/m(2)). At 6-month, untrained patients showed LAV(MAX) (+3.6+/-4.4 ml/m(2), P<0.001) and LV dilation (+4.2+/-5.1 ml/m(2), P<0.001; group T vs. C, P<0.001); whereas no significant changes in VO(2peak) were observed. Multiple linear regression analysis showed that age (beta=0.442, P<0.001), inclusion in the training group (beta=-0.599, P<0.001), E/A ratio (beta=-0.210, P=0.038), LVEDV (beta=0.376, P<0.001), and LVEF (beta=-0.279, P=0.007) are significant predictors of LA remodeling. CONCLUSIONS: Six-month exercise-based CR in postinfarction patients with mild to moderate LV dysfunction induced a favourable LA remodeling.

Two-year multicomprehensive secondary prevention program: favorable effects on cardiovascular functional capacity and coronary risk profile after acute myocardial infarction.

BACKGROUND: Cardiac rehabilitation includes interventions aimed at facilitating physical, psychological and emotional recovery following the acute phase of myocardial infarction (AMI). To date, optimal cardiac rehabilitation program duration and frequency of patient contact has yet to be identified. OBJECTIVE: The present study was performed to evaluate the effects of two different strategies of secondary prevention (2 years, multifactorial continued educational and behavioral intervention versus usual care) implemented into a cardiac rehabilitation setting on several cardiovascular endpoints indicating cardiovascular functional exercise capacity and coronary risk profile in patients with recent AMI. METHODS: This was a prospective randomized study including 52 postinfarction patients. Initially, all patients were enrolled in a 3-month outpatient cardiac rehabilitation program. Thereafter, they were randomly subdivided into two groups (I = intervention group; C = control group), each composed of 26 patients, and followed for 24 months. RESULTS: At the end of the 3-month outpatient cardiac rehabilitation program, both groups showed a significant (P < 0.05) improvement in cardiopulmonary parameters (maximal oxygen consumption, maximal workload) and in cardiovascular risk profile (BMI, lipid profile). During the 24-month study period, group I showed stabilization or even improvement (P < 0.05) of both cardiopulmonary parameters and cardiovascular risk profile, whereas group C patients showed a deterioration or significant impairment (P < 0.05) of the same parameters. Clinical events occurred in 27% of patients in the control group (n = 7) and in 11% in the training group (n = 3) (P < 0.05). CONCLUSION: Long-term, multifactorial educational and behavioral intervention maintained for 2 years in a multicomprehensive cardiac rehabilitation setting represents a valid strategy for improving long-term cardiovascular functional capacity and cardiovascular risk profile in postinfarction patients.