Cardiac rehabilitation after catheter ablation of atrial fibrilation

Atrial fibrillation is the most common arrhythmia worldwide. Besides antiarrhythmic drugs and electrical cardioversion, atrial fibrillation can be treated with a newer technique called catheter ablation. Patients suffering a catheter ablation can benefit from an integrated rehabilitation programme like all other patients suffering a cardiac surgery. Physical training and psycho-educative consultations are specific after catheter ablation and integrated rehabilitation can improve mental health, physical capacity and permits return to sports activities

The role of psychosocial factors and physical training for patients with implantable cardioverter defibrillators

Implantable cardioverter defibrillators (ICD) significantly reduce the mortality rate in those at high risk of sudden cardiac death. In contrast to the obvious survival benefits in this category, there are a number of psychosocial and physical-related complications with drastic repercussions on patient quality of life, and eventually on survival. The main post-implantation ICD complications are: anxiety, depression, post-traumatic stress and avoidant behaviors often associated with inactivity. So far, there is no consensus on ICDs post-implant rehabilitation programs despite the evidence proven to reduce anxiety and depression, lowering the risk of arrhythmia and improving the net quality of life. In most studies up to date, cardiac rehabilitation through aerobic exercises and psychotherapeutic interventions are categorized as safe and beneficial; whereas other authors sees it as necessary as cardiovascular recovery after myocardial infarction, by-pass surgery or heart failure

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

Introduction. As the prevalence of peripheral artery disease (PAD) is increasing in developing countries, so are the healthcare and socio-economic costs it brings about. This particular form of atherosclerotic disease is very much age-dependent, and along with the increase in life-expectancy, the lasts decades have seen a sharp rise in PAD prevalence in women. Knowledge regarding gender-specific aspects of the disease are scarce. This has a negative effect on overall outcomes of female PAD patients. Aim. This research aimed to identify gender peculiarities of PAD and evaluate their impact on cardiovascular rehabilitation. Material and methods. This was a retrospective observational study of 104 PAD patients (73 men and 31 women) admitted in 2016 to the Cardiology department of the Rehabilitation Hospital Cluj-Napoca. Demographic, clinical and biological parameters were recorded, as well as the treatment/rehabilitation regimens prescribed. The subjects were divided into to groups according to gender. Statistical analysis was done using the student t-test for unequal variances, hi-square test and the stepwise method for multivariate analysis. Results. The female group had a higher prevalence of diabetes mellitus (45% vs 33%, p=ns), but men were more likely smokers (74% vs 51%- p=0.017). Women had higher median total cholesterol values (p=0.006) and lower HDL-cholesterol levels (p=0.033). More than half of the female patients were already experiencing symptoms of critical limb ischemia on admission (57%), while intermittent claudication was predominant with men (66%). Multivariate analysis identified identified female gender (p=0.028) and ABI (p<0.0001) as sole independent predictors for the severity of the disease. Revascularization using percutaneous techniques was the preferred option for women (35% vs 27%), while surgery was performed more often in men (38% vs 29%)- p=ns. Home-based exercise training was indicated on discharge for more than half of the male group while only 30% of women had physical rehabilitation as a first line of treatment. Discussion. Our research offered similar findings to older studies regarding the gender-specific profile of PAD women, showing they are less exposed to smoking but more likely to experience metabolic disorders. Women had higher rates of critical limb ischemia on admission, suggesting a more advanced disease. Because of a more stable disease in men, this category benefited to a greater extent from exercise training compared to women. Conclusion. Peripheral artery disease has specific gender-related differences that in women have an important impact on both diagnosis and management, impeding rehabilitation and full social reintegration

Cardiac rehabilitation in patients with heart failure and diabetes mellitus

Over the past decades, cardiac rehabilitation has had a spectacular evolution, from the mere monitoring of the patients’ return to physical activity to a multidisciplinary approach focused on patient education, individualized physical exercise, changes in cardiovascular risk factors and, not least, an improvement in patient quality of life. Heart failure represents an important public health problem, and the association of this disease with diabetes mellitus significantly reduces prognosis in these patients, the two disorders potentiating each other. Recent data demonstrate a significant benefit of cardiac rehabilitation in patients with diabetes mellitus and heart failure, with important effects in reducing mortality, increasing exercise capacity and improving symptoms. Unfortunately, cardiac rehabilitation is generally underused, most probably due to the lack of awareness and low adherence of patients, as well as due to insufficiently developed programs at national level

Can Fetuin A Be Utilized in the Evaluation of Elderly Patients with Acute Myocardial Infarction?

Background: Lower baseline Fetuin-A (FA) is associated with left ventricular remodeling and cardiovascular death (CVD) at 4 months after acute myocardial infarction (AMI). However, the association between FA levels, incomplete ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) and early mortality in AMI has not been previously studied. Methods: We enrolled 100 patients with AMI, which we divided in two groups: 21 patients who suffered sudden cardiac death (SCD) in the first 7 days after PCI and 79 controls. We measured FA, NT-proBNP and troponin levels and correlated them with the occurrence of death in the first week after revascularization. We also tested the cut-off value of FA to determine STR at 90 min after PCI. Results: SCD was most frequently caused by pump failure (n = 10, 47.6%) and ventricular arrhythmias (n = 9, 42.5%). Plasma FA levels correlated with NT-proBNP values (r = −0.47, p = 0.04) and were significantly lower in patients presenting SCD (115 (95–175) vs. 180 (105–250) ng/mL, p = 0.03). Among all three biomarkers, FA was the only one associated with incomplete STR after PCI on the multivariate logistic regression (cut-off value of 175 ng/mL, Se = 74%, Sp = 61.1%). Death rate was highest (n = 16/55, 30%) in patients with FA levels below the cut-off value of 175 ng/mL. Conclusion: Lower FA is associated with higher early mortality and incomplete STR after primary percutaneous revascularization in patients with AMI. Measurement of FA levels in addition to NT-proBNP, troponin and STR might enable more accurate identification of high-risk patients

Impact of Three-Dimensional Strain on Major Adverse Cardiovascular Events after Acute Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention—A Pilot Study

Background: Three-dimensional speckle-tracking echocardiography (3D-STE) allows simultaneous assessment of multidirectional components of strain. However, there are few data on its usefulness to predict prognosis in patients with acute myocardial infarction (AMI). The objective of our pilot study was to evaluate the prognostic value of four different 3D-STE parameters (global longitudinal strain (GLS-3D), global circumferential strain (GCS-3D), global radial strain (GRS-3D), and global area strain (GAS)) in AMI, after successful revascularization by primary PCI. Methods: We enrolled 94 AMI patients (66 ± 13 years, 56% men) who underwent coronary angiography. All patients had been 3D-STE assessed and followed-up for 1 year for the occurrence of MACE. Results: A total of 25 MACE were recorded over follow-up. Cut-off values of −17% for GAS (HR = 3.1, 95% CI: 1.39–6.92, p = 0.005), −12% for GCS-3D (HR = 3.06, 95% CI: 1.36–6.8, p = 0.006), −10% for GLS-3D (HR = 3.04, 95% CI: 1.36–6.78, p = 0.006), and 25% for GRS-3D (HR = 2.89, 95% CI: 1.29–6.46, p = 0.009) showed moderate accuracy in MACE prediction. Multivariate regression showed that GAS (HR = 1.1, 95% CI: 1.03–1.16), GLS-3D (HR = 1.13, 95% CI: 1.03–1.26), and GCS-3D (HR = 1.13, 95% CI: 1.03–1.23) remained independent predictors of MACE (HR = 1.07, 95% CI: 1.01–1.14 for GAS, and HR = 1.1, 95% CI: 1.01–1.2 for GCS-3D). However, post hoc power analysis indicated adequate sample size (power of 80%) only for GAS and GCS-3D for the ROC curve analysis and for GAS, GCS-3D, and GRS-3D for the log-rank test. Conclusion: Patients with AMI might benefit from early risk stratification with the aid of 3D-STE measurements, particularly GAS and GCS-3D, but larger studies are necessary to determine the optimal cut-off values to predict MACE