Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial.

BACKGROUND: Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk. METHODS: A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life. RESULTS: No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme. CONCLUSIONS: The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life. TRIAL REGISTRATION: Retrospectively registered NCT02796404 (May 23, 2016).

Effects of exercise on inflammation in cardiac rehabilitation.

BACKGROUND: Programs of weight loss and a healthy diet are recommended for patients with cardiovascular risk but the effectiveness of these programs in decreasing cardiovascular mortality is controversial. AIM: To examine the acute and long-term effects of a 2-month cardiac rehabilitation program on chemokines related to inflammation in subjects with cardiovascular disease. DESIGN: Prospective cohort study. METHODS: Twenty-six patients with cardiovascular disease enrolled in a cardiac rehabilitation program based on nutritional and exercise interventions were studied. Lifestyle and clinical, metabolic and inflammatory variables were analysed. RESULTS: 88.5% were men and the mean age was 54.9 ± 7.8 years. At the end of the cardiac rehabilitation program the levels of carbohydrate and lipid metabolism were lower, except for high density lipoprotein cholesterol which was higher. The levels of uric acid, interleukin-6, interleukin-1Beta, adiponectin and leptin remained stable. Interleukin-6 correlated positively with levels of C-reactive protein and negatively with blood glucose. Interleukin-1Beta correlated positively with C-reactive protein levels and negatively with blood pressure figures. Significant correlations were seen between the changes in levels of interleukin-6 and interleukin-1Beta and changes in metabolic equivalents, and in C-reactive protein levels before and after the cardiac rehabilitation program. No significant correlations were observed with weight, waist circumference or fat mass. CONCLUSIONS: A cardiac rehabilitation program decreased anthropometric variables and blood pressure figures, and improved lipid metabolism and ergometry data. However, no changes regarding the inflammatory state were observed.

Introducción: a los pacientes con riesgo cardiovascular se les recomiendan programas de pérdida de peso y dieta saludable, pero la eficacia de estos programas a la hora de reducir la mortalidad es controvertida. Objetivo: examinar los efectos agudos y a largo plazo de un programa de rehabilitación cardíaca de dos meses de duración sobre las quemocinas relacionadas con la inflamación en pacientes con enfermedad cardiovascular. Diseño: estudio de cohortes prospectivo. Métodos: se estudiaron 26 pacientes con enfermedad cardiovascular inscritos en un programa de rehabilitación cardíaca basado en intervenciones nutricionales y de ejercicio. Se analizaron el estilo de vida y variables clínicas, metabólicas e inflamatorias. Resultados: 88,5% eran hombres y la edad media fue de 54,9 ± 7,8 años. Al final del programa de rehabilitación cardíaca las variables del perfil glucémico y lipídico descendieron, excepto el colesterol de lipoproteínas de alta densidad, que aumentó. Ácido úrico, interleucina-6, interleucina-1 beta, adiponectina y leptina se mantuvieron estables. Interleucina-6 correlacionó positivamente con proteína C reactiva y negativamente con glucosa en sangre. Interleucina-1 beta correlacionó positivamente con proteína C-reactiva y negativamente con las cifras de presión arterial. Encontramos correlaciones significativas entre los cambios en interleucina-6 e interleucina- 1 beta y los cambios en los equivalentes metabólicos y proteína C-reactiva, antes y después del programa de rehabilitación cardíaca. No se observaron correlaciones significativas con peso, circunferencia de cintura o masa grasa. Conclusiones: la rehabilitación cardiaca mejora las variables antropométricas, las cifras de presión arterial, así como el perfil de lípidos y los resultados de la ergometría. Sin embargo, no se observaron cambios con respecto al estado inflamatorio.

Effects of exercise on inflammation in cardiac rehabilitation / Efectos del ejercicio sobre la inflamación en rehabilitación cardíaca

Background: programs of weight loss and a healthy diet are recommended for patients with cardiovascular risk but the effectiveness of these programs in decreasing cardiovascular mortality is controversial. Aim: to examine the acute and long-term effects of a 2-month cardiac rehabilitation program on chemokines related to inflammation in subjects with cardiovascular disease. Design: prospective cohort study. Methods: twenty-six patients with cardiovascular disease enrolled in a cardiac rehabilitation program based on nutritional and exercise interventions were studied. Lifestyle and clinical, metabolic and inflammatory variables were analysed. Results: 88.5% were men and the mean age was 54.9 ± 7.8 years. At the end of the cardiac rehabilitation program the levels of carbohydrate and lipid metabolism were lower, except for high density lipoprotein cholesterol which was higher. The levels of uric acid, interleukin-6, interleukin-1Beta, adiponectin and leptin remained stable. Interleukin-6 correlated positively with levels of C-reactive protein and negatively with blood glucose. Interleukin-1Beta correlated positively with C-reactive protein levels and negatively with blood pressure figures. Significant correlations were seen between the changes in levels of interleukin-6 and interleukin-1Beta and changes in metabolic equivalents, and in C-reactive protein levels before and after the cardiac rehabilitation program. No significant correlations were observed with weight, waist circumference or fat mass. Conclusions: a cardiac rehabilitation program decreased anthropometric variables and blood pressure figu res, and improved lipid metabolism and ergometry data. However, no changes regarding the inflammatory state were observed (AU)

Introducción: a los pacientes con riesgo cardiovascular se les recomiendan programas de pérdida de peso y dieta saludable, pero la eficacia de estos programas a la hora de reducir la mortalidad es controvertida. Objetivo: examinar los efectos agudos y a largo plazo de un programa de rehabilitación cardíaca de dos meses de duración sobre las quemocinas relacionadas con la inflamación en pacientes con enfermedad cardiovascular. Diseño: estudio de cohortes prospectivo. Métodos: se estudiaron 26 pacientes con enfermedad cardiovascular inscritos en un programa de rehabilitación cardíaca basado en intervenciones nutricionales y de ejercicio. Se analizaron el estilo de vida y variables clínicas, metabólicas e inflamatorias. Resultados: 88,5% eran hombres y la edad media fue de 54,9 ± 7,8 años. Al final del programa de rehabilitación cardíaca las variables del perfil glucémico y lipídico descendieron, excepto el colesterol de lipoproteínas de alta densidad, que aumentó. Ácido úrico, interleucina-6, interleucina-1 beta, adiponectina y leptina se mantuvieron estables. Interleucina-6 correlacionó positivamente con proteína C reactiva y negativamente con glucosa en sangre. Interleucina-1 beta correlacionó positivamente con proteína C-reactiva y negativamente con las cifras de presión arterial. Encontramos correlaciones significativas entre los cambios en interleucina-6 e interleucina-1 beta y los cambios en los equivalentes metabólicos y proteína C-reactiva, antes y después del programa de rehabilitación cardíaca. No se observaron correlaciones significativas con peso, circunferencia de cintura o masa grasa. Conclusiones: la rehabilitación cardiaca mejora las variables antropométricas, las cifras de presión arterial, así como el perfil de lípidos y los resultados de la ergometría. Sin embargo, no se observaron cambios con respecto al estado inflamatorio (AU)

Hereditary patterns of bicuspid aortic valve in a hundred families.

BACKGROUND: To study the following characteristics of bicuspid aortic valves (BAVs): 1) the recurrence rate in our population, 2) patterns of hereditary transmission in different BAV morphologies and 3) the aortic dimensions of BAVs in first-degree relatives (FDRs). METHODS: A cross-sectional, prospective study of 100 consecutive families of BAV patients attending a university hospital. The following aortic valve morphologies were analysed and categorised: fusion of the right and left coronary cusps (BAV type A), right and noncoronary cusps (type B) and of the left and noncoronary cusps (type C). RESULTS: There were 553 subjects studied, 100 cases with a BAV (46.8±15 years, 66% male, type 67% A, 32% B and 1% C; 42% with aortic dilatation), 348 FDRs (44.8% male), and 105 healthy control subjects (50% male). We detected 16 BAVs among 348 FDRs. The recurrence rates were 15% for families, 4.6% for FDRs, 7.05% in men and 2.60% in women. The morphologic concordance in family members was 68.8%. The aortic dimensions in 270 adult FDRs with a tricuspid aortic valve were significantly smaller compared with BAV patients (sinus index diameter 1.60±0.19 cm/m(2) vs. 1.82±0.29 cm/m(2), p<0.001; tubular index diameter 1.51±0.23 cm/m(2) vs. 2.00±0.45 cm/m(2), p<0.001) and similar to 103 control subjects(sinus index diameter 1.60±0.19 cm/m(2) vs. 1.59±0.17 cm/m(2), p=0.600 and tubular index diameter 1.51±0.23 cm/m(2) vs. 1.53±0.18 cm/m(2), p=0.519). CONCLUSIONS: In our population, the BAV recurrence rate in FDRs was low (4.6%). The hereditary transmission of morphologic BAV types seems by chance, and the aortic dimensions in tricuspid FDRs are normal.

Influence of cardiac rehabilitation on natriuretic peptides.

OBJECTIVE: Cardiac rehabilitation programmes result in reduced morbidity and mortality and improvement of functional class. Behaviour of natriuretic peptides coupled to these programmes is not well established. Our study's objective is to evaluate the behaviour of natriuretic peptides in a sample of patients undergoing a cardiac rehabilitation programme. METHODS AND RESULTS: Moderate to high-risk patients undergoing a cardiac rehabilitation programme were included. Demographic and clinical characteristics were recorded. We performed four N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma determinations: on the first and last programme day, before and after training. To evaluate functional capacity, a stress test before and after the exercise programme was performed. Eighty-three patients were included. Exercise produces increased levels of NT-proBNP, although in the last exercise session the increase was lower (35.91 vs. 31.49 ng/ml (P = 0.71)). Patients with left ventricular dysfunction present higher NT-proBNP levels. After the rehabilitation programme we observed a significant improvement of functional capacity by 1.5 METS on average (P = 0.001), but not in the subgroup with lower NT-proBNP levels. CONCLUSIONS: Basal levels of peptides did not change significantly after the programme but rose with the workout, especially in patients with left ventricular dysfunction. Patients with higher baseline levels obtained greater functional recovery. We conclude that NT-proBNP measurement may be useful in selecting patients to perform a cardiac rehabilitation programme.

Reincorporación laboral de trabajadores con cardiopatía, según el tipo de trabajo y la realización de un programa de rehabilitación cardiaca en Málaga / Return to work of workers with heart disease according to the type of work and attendance to a cardia rehabilitation program in Málaga

Justificación y objetivos: Las enfermedades más comunes asociadas al trabajo son los trastornos músculo-esqueléticos, las enfermedades dermatológicas y la alergia ocupacional. No obstante, las enfermedades cardiovasculares provocan la cuarta parte de accidentes de trabajo mortales que se producen en los centros de trabajo(1). Además son causas importantes de incapacidad laboral permanente, en pacientes con edad comprendida entre los 40 y 65 años, es decir, en pleno auge profesional. Los programas de rehabilitación cardiaca (PRC) han demostrado con creces su beneficio(2) en favor de una reincorporación laboral temprana y segura(3). El presente estudio pretende conocer la prevalencia de reincorporación laboral tras un evento cardia co, según el trabajo que desempeñan, en población laboral de Málaga; además del posible beneficio que aportan los PRC que siguen muchos de los pacientes que acuden por este motivo a unos de los dos grandes hospitales de la capital malagueña, y manifestar las posibles diferencias en reincorporación con pacientes similares y de la de la misma población pero que no tienen la oportunidad de participar en un PRC. Conclusiones: La reincorporación laboral, sobre todo en pacientes con riesgo medio-alto, fue mayor en el grupo que siguió un PRC, aunque la diferencia no resultó estadísticamente significativa. En cambio, sí hubo asociación entre reincorporación laboral y otras variables incluidas en el estudio, relacionadas con la enfermedad, factores socioeconómicos y características del trabaj (AU)

Justification and objetives: Most common diseases at work are skeletal muscle disorder, dermatological diseases and occupational allergy. However, cardiovascular diseases cause 25% of the mortal accidents in the companies during working hours(1). Besides, they are important causes of permanent labour disability, for patients who are 40-65 years old (i.e., during their highest professional time). Cardiac rehabilitation programs (CRP) have been proven as very benefitial(2) for a quick and safe labour reincorporation(3). This analysis tries to find out the prevalence of labour reincorporation after a cardiac event over the working population of Málaga (depending upon their roles at work) as well as the potential benefits given by the CRP followed by most of the patients assisted in one of the largest hospital in the city, and manifest the potential differences in reincorporation with similar patients from the same place who have no opportunity to participate in a CRP. Conclusions: Labour reincorporation, especially on medium to high risk patients, was higher in the group that followed a CRP although the difference was not significant enough. On the other hand, there was a link between labour reincorporation and other variables used in the analysis which were related to disease, socio-economic factors and job characteristics (AU)

Dobutamine stress echocardiography identifies patients with angina and dynamic left ventricular outflow obstruction in physiological exercise.

BACKGROUND AND METHODS: To determine whether patients with no heart disease who develop dynamic left ventricular outflow obstruction (DLVOTO) during dobutamine echocardiography (DE) reproduce the phenomenon during exercise echocardiography (EE), DE and EE were performed in 78 patients (59 +/- 9 years) with effort angina and no alterations in SPECT. Thirty-eight (48.7%) patients had DLVOTO during DE and 15 (19.2%) during EE. This phenomenon during EE was reproducible in 39.4% of the patients with DLVOTO on DE, and 100% of the patients with DLVOTO during EE had it during DE. Independent factors predicting DLVOTO during EE were the LVOT diameter (OR 0.33 (0.14-0.74)) and the left ventricular (LV) mass index (OR 1.05 (1.01-1.08)). No cardiovascular events were noted after 26+/-3 months. The reproducibility of DLVOTO during EE in patients with unexplained angina and with DLVOTO on DE is associated with the size of the LVOT and the LV mass index. The long-term prognosis is excellent.

Comunicación interventricular con gradiente elevado y fenómeno de recuperación de presiones / No disponible

No disponible

Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise.

BACKGROUND: In patients who present with angina, dynamic left ventricular outflow tract obstruction may be responsible of symptoms. The aim of our study was to evaluate the effect of negative inotropic therapy on ventricular physiology and symptoms of patients with dynamic left ventricular outflow tract obstruction induced by exercise in the absence of hypertrophic cardiomyopathy. METHODS: Seventy eight patients with symptoms of angina, normal exercise SPECT test and normal resting left ventricular systolic function were prospectively analysed with exercise echocardiography. Fifteen of them developed high outflow tract velocities (greater than 2.57 m/s) on effort. After treatment with bisoprolol (mean dose 6.9+/-3.5 mg) in these patients, symptoms and dynamic left ventricular outflow tract obstruction during exercise were re-evaluated. RESULTS: After negative inotropic therapy, there was a significant reduction of 86.6% in the development of intracavitary gradient (15 to 2 patients). In all patients the left ventricular outflow tract velocities decreased (2.91+/-0.4 m/s to 1.92+/-0.46 m/s, p=0.001). However, the oxygen consumption during exercise was higher (7.3+/-1.7 METs to 8.5+/-1.8 METs, p=0.005), and symptoms improved significantly following therapy, with a reduction in mean NYHA class from 1.9+/-0.5 to 1.0+/-0.0 (p=0.001). CONCLUSIONS: Negative inotropic therapy may represent a beneficial therapeutic approach in selected patients with dynamic left ventricular outflow tract obstruction induced by exercise and identified during exercise echocardiography.

[Treatment of heart failure due to systolic dysfunction]. / Tratamiento médico de la insuficiencia cardiaca por disfunción sistólica.

Heart failure due to systolic dysfunction is a clinical syndrome that is characterized by the appearance of the signs or symptoms of heart failure in the presence of structural heart disease that has led to decreased left ventricular contractility. Current clinical practice guidelines emphasize the importance of diagnosing and treating left ventricular dysfunction in patients without symptoms of heart disease. It is essential that currently available scientific findings are taken into account when treating all patients seen with this condition, from dietary advice to use of the most sophisticated devices. We do not know the precise treatment responses of patient belonging to subgroups that were underrepresented in large clinical trials. The present article, written after the recent publication of European and American clinical practice guidelines, provides a summary of recommended medical treatment for patients with heart failure due to systolic dysfunction.

Tratamiento médico de la insuficiencia cardiaca por disfunción sistólica / Treatment of heart failure due to systolic dysfunction

La insuficiencia cardiaca por disfunción sistólica hace referencia a un síndrome clínico caracterizado por signos y/o síntomas de insuficiencia cardiaca en el contexto de una enfermedad estructural cardiaca que provoca una disminución de la función contráctil del ventrículo izquierdo. En las guías de tratamiento actuales se insiste en la importancia del diagnóstico y el tratamiento de la disfunción ventricular izquierda sin síntomas de insuficiencia cardiaca. Se hace necesaria la implementación de la evidencia científica disponible en el tratamiento de todos los pacientes atendidos por esta enfermedad, desde el consejo dietético hasta los dispositivos más complejos. Desconocemos con exactitud la respuesta al tratamiento en subgrupos de pacientes infrarrepresentados en los grandes ensayos clínicos. Tras la reciente publicación de las guías europeas y americanas, en el presente capítulo se hace una revisión del tratamiento médico indicado en los pacientes con insuficiencia cardiaca por disfunción sistólica (AU)

Heart failure due to systolic dysfunction is a clinical syndrome that is characterized by the appearance of the signs or symptoms of heart failure in the presence of structural heart disease that has led to decreased left ventricular contractility. Current clinical practice guidelines emphasize the importance of diagnosing and treating left ventricular dysfunction in patients without symptoms of heart disease. It is essential that currently available scientific findings are taken into account when treating all patients seen with this condition, from dietary advice to use of the most sophisticated devices. We do not know the precise treatment responses of patient belonging to subgroups that were underrepresented in large clinical trials. The present article, written after the recent publication of European and American clinical practice guidelines, provides a summary of recommended medical treatment for patients with heart failure due to systolic dysfunction (AU)