New Scientic Advances in Cardiac Rehabilitation No disclosures

Transcription

1 New Scientic Advances in Cardiac Rehabilitation No disclosures Massimo F Piepoli Cardiac Rehabilitation Section, EACPR 1

2 Section Cardiac Rehabilitation, EACPR promoting cardiac rehabilitation in Europe

3 European J Cardiovasc Prev Rehab 2010; 17: 1-17

4 - Israel European Cardiac Rehabilitation Inventory Survey (ECRIS) Birna Bjarnason-Wehrens AnnDorthe Zwisler - Austria - Belgium - Belarus - Croatia - Cyprus - Czech Republic - Denmark - France - Finland - Germany - Iceland - Ireland - Italy - Lithuania - Luxembourg - Netherlands - Norway - Poland - Portugal - Romania - Russian Fed. - Serbia - Slovak Rep. - Spain - Sweden - Switzerland - United Kingdom Results from the European Cardiac Rehabilitation Inventory Survey (ECRIS) 4

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8 Dr Werner Benzer

9 A Policy Statement from the EACPR. Practical Recommendation on How to Implement CV Prevention in Clinical Practice: Consensus Document on Components, Standards and Outcome Measures for the Referral to and the Delivery of Preventive Cardiology Aims 1. To provide detailed descriptions of the components, the standards and the outcome measures 2. To promote systematic interventions capable to influence outcomes in the general population, 3. To favor the development of Preventive Cardiology initiatives, based on life style and cardio protective drug interventions

10 Endothelial Progenitor Cells and inflammation after cardiac rehabilitation on ACS patients after PCI F Cesari, R Marcucci, F Sofi, C Burgisser, S Luly, R Abbate, GF Gensini, F Fattirolli. University of Florence; Ospedaliero-Universitaria Careggi; Don Carlo Gnocchi Foundation Onlus 55 patients (45M; 10F); median age: 58 (41-74) years Four weeks exercise-based cardiac rehabilitation programme Massimo F Piepoli

11 Cells X 10 6 events EPCs modifications at the end of the rehabilitation period (n=55) A significant increase in EPCs number was observed after the CR p=0.01 Pre CR Post CR CD34+/KDR+ CD133+/KDR+ CD34+/133+/KDR+ Massimo F Piepoli

12 Correlation analyses between EPCs and cardiopulmonary parameters EPCs Watt max VO 2max CD34+/KDR r=0.30 p=0.03 r=0.30 p=0.03 CD133+/KDR+ r=0.30 p=0.03 r=0.30 p=0.03 CD34+/CD133+/KDR+ r=0.30 p=0.03 r=0.32 p=0.02 EPCs Δ Watt max Δ VO 2max Δ CD34+/KDR r=0.30 p=0.02 r=0.30 p=0.23 Δ CD133+/KDR+ r=0.30 p=0.03 r=0.30 p=0.12 Δ CD34+/CD133+/KDR+ r=0.30 p=0.05 r=0.30 p=0.05 Massimo F Piepoli

13 Effects of exercise training on high mobility group box-1 levels after AMI F Giallauria, PL Cirillo, M D Agostino, G Petrillo, A Vitelli, M Pacileo, M Chiariello, C Vigorito Federico II University of Naples, Italy BACKGROUND: Post-infarction LV remodeling is an important predictor of mortality High mobility group box-1 (HMGB1) protein, a critical inflammatory mediator involved in the healing process after MI, is a novel candidate predictor of adverse postinfarction clinical outcome AIM: To evaluate the effect of exercise training on HMGB1 levels HMGB1 levels relationship with cardiopulmonary functional capacity, autonomic control and LV remodeling Massimo F Piepoli

14 HMGB1 levels (ng/ml) Results Baseline and 6-month HMGB1 levels in the total study population, in trained (n=37) and untrained (n=38) patients Total Population Trained Untrained p= p= p=0.153 ΔHMGB1 Beta P value Age ΔVO 2peak ΔVE/VCO 2slope ΔHRR ΔLVEDV ΔWMSI baseline p= mo baseline 6-mo baseline 6-mo Trained Massimo F Piepoli

15 Safety and tolerance of high altitude exposure (3454 m) in non-acclimatized patients with stable chronic heart failure Daniel Nobel, Jan Novak, Nicolas Brugger, Patricia Palau, Anja Trepp, Hugo Saner, Jean-Paul Schmid

16 Ascent to Jungfraujoch, 3454m Start at 7:00h a.m. from the plain (540m) Arrival 10:30h a.m. with public transport Stay during 4-5h at the Jungfrau-joch ; sightseeing, small meal

17 Results: All patients completed the trial and both, rapid ascent and a 4 to 5h stay at 3454 m were well tolerated None of the subjects had to return prematurely to low-land No exercise induced cardiac ischemia, severe dyspnoea or symptomatic hypotension occurred

18 Combined Aerobic/Resistance/Inspiratory Muscle Training in Patients with CHF. The Ideal Exercise Program for CHF? I D. Laoutaris, A Manginas, S Adamopoulos, MS. Kallistratos, DV. Cokkinos, A Dritsas Onassis Cardiac Surgery Center, Athens, Greece Aerobic/Resistance/Inspiratory (ARIS) group (n=5) - Aerobic training (AT): 30 min using a bike at 70-80% of maximal heart rate (HR) - Resistance training (RT): 15 min of the quadriceps at 50% of 1 repetition maximum combined with upper body exercises using light weights - Inspiratory Muscle Training (IMT) 20 min high intensity at 60% of sustained maximal inspiratory pressure (SPimax), Aerobic Training (AT) group (n=5) 45 min using a bike at 70-80% of maximal HR No Training (NT) group (n=5)

19 MLwHF questionnaire SPimax (cmh2o/s/1000) peakvo2 (ml/kg/min) Lower limb muscle strength (Nwm/kg) VO2 peak p=0.04 QUADRICEPS MUSCLE STRENGTH p= pre post pre post ARIS group AT group NT group 0 ARISgroup ATgroup NTgroup Minnesota Living with Heart Failure questionnaire p=0.04 pre post ARISgroup ATgroup NTgroup INSPIRATORY MUSCLE ENDURANCE p= ARISgroup ATgroup NTgroup pre post Higher benefits of Aerobic/Resistance/Inspiratory training in muscle strength, inspiratory indices, exercise tolerance and quality of life in patients with CHF

20 Exercise training to treat Diastolic Dysfunction in the Elderly M. Sandri, N Mangner, V Adams, R Hoellriegel, R Hambrecht, G Schuler, S Gielen

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22 Reproducibility of the six minute walk test in patients with CHF or COPD Karlsdottir A.E., Gudjonsdottir M., et al., University of Iceland. Methods Criteria Number Gender Age CHF EF < 35% 25 23M /2F 55 ± 9.5 years COPD FEV 1 < 50% 25 11M/14F 64.2 ± 8.8 years Both patient groups underwent four 6MWT pre and four 6MWT post a inpatient CR program (5.8±0.8 weeks). All tests were performed with at least one hour interval between tests. Massimo F Piepoli

23 % 7 Changes from test to test pre and post rehabilitation 6 For both CHF and COPD a minimum of 4 tests 5 are needed to overcome the learning effect both pre and post rehabilitation: 4 There is a continuing trend towards better and 3better performance but it does not reach stability. 2 CHF pre CHF post COPD pre COPD post 1 0 T1 T2 T2 T3 T3 T4 0 0,5 1 1,5 2 2,5 3 3,5 Massimo F Piepoli

24 Close relationships and the risk of death in patients with cardiovascular disease: findings from the DANREHAB trial H. Kornerup 1, A. Zwisler 2 and E. Prescott 1 (1) Bispebjerg University Hospital, Copenhagen (2) Rigshospital University Hospital, Copenhagen To describe whether social network and diversity of close relationships predicts the 5 year mortality of patients with congestive heart failure, ischemic heart disease or high risk for ischemic heart disease.

25 Do you have any close relationships/confidants? Spouse Parents Children Other family members Friends Colleagues Neighbours Nobody Cumulative survival curve Present of a spouse reduces risk of death for patients. A wide social network seems to decrease risk of death Analysis time in days Close relationship to spouse No Yes Emotional support or something else? Adjusted for age, gender and diagnose A measure of severity of disease?

26 Massimo F Piepoli m.piepoli@alice.it Cardiac Rehabilitation Section, EACPR Massimo F Piepoli