Nonfatal reinfarction as an independent riskfactor for subsequent mortality in post-myocardial infarction patients

Pericas, Enric;Ordóñez, Estrell

Effects of two behavioral cardiac rehabilitation interventions on physical activity:A randomized controlled trial

Background: Standard cardiac rehabilitation (CR) is insufficient to help patients achieve an active lifestyle. The effects of two advanced and extended behavioral CR interventions on physical activity (PA) and sedentary behavior (SB) were assessed.Methods: In total, 731 patients with ACS were randomized to 1) 3 months of standard CR (CR-only); 2) 3 months of standard CR with three pedometer-based, face-to-face PA group counseling sessions followed by 9 months of after care with three general lifestyle, face-to-face group counseling sessions (CR+F); or 3) 3 months of standard CR, followed by 9 months of aftercare with five to six general lifestyle, telephonic counseling sessions (CR + T). An accelerometer recorded PA and SB at randomization, 3 months, 12 months, and 18 months.Results: The CR+ F group did not improve their moderate-to-vigorous intensity PA (MVPA) or SB time compared to CR-only (between-group difference= 0.24% MVPA, P= 0.349; and 0.39% SB, P= 0.529). However, step count (between-group difference = 513 steps/day, P = 0.021) and time in prolonged MVPA (OR = 2.14, P= 0.054) improved at 3 months as compared to CR-only. The improvement in prolonged MVPA was maintained at 18 months (OR = 1.91, P = 0.033). The CR + T group did not improve PA or SB compared to CR-only.Conclusions: Adding three pedometer-based, face-to-face group PA counseling sessions to standard CR increased daily step count and time in prolonged MVPA. The latter persisted at 18 months. A telephonic after-care program did not improve PA or SB. Although after-care should be optimized to improve long-term adherence, face-to-face group counseling with objective PA feedback should be added to standard CR. (C) 2017 Elsevier B.V. All rights reserved

Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 6Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The NetherlandsBackground: Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD) because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta-blockers and health-related quality of life (HRQOL) in patients with peripheral arterial disease and COPD.Methods: Of the original cohort of 3371 vascular surgery patients, 1310 had COPD of whom 469 survived during long-term follow-up. These COPD patients were sent the Short Form-36 (SF-36) health-related quality of life questionnaire, which was completed and returned by 326 (70%) patients.Results: No significant differences in any of the SF-36 domains were observed between COPD patients who did and did not use beta-blockers (p > 0.05 for all). Furthermore, beta-blockers were not associated with any impairment in HRQOL among patients with COPD.Conclusion: Beta-blockers had no material impact on the HRQOL of patients with peripheral arterial disease who also had COPD. This suggests that beta-blockers can, in most circumstances, be administered to patients with COPD without impairment in HRQOL. Keywords: beta-blockers, chronic obstructive pulmonary disease, vascular surgery, health-related quality of lif

Early detection of left ventricular diastolic dysfunction using conventional and speckle tracking echocardiography in a large animal model of metabolic dysfunction

Left ventricular (LV) diastolic dysfunction is one of the important mechanisms responsible for symptoms in patients with heart failure. The aim of the current study was to identify parameters that may be used to detect early signs of LV diastolic dysfunction in diabetic pigs on a high fat diet, using conventional and speckle tracking echocardiography. The study population consisted of 16 healthy Göttingen minipigs and 18 minipigs with experimentally induced metabolic dysfunction. Echocardiography measurements were performed at baseline and 3-month follow-up. The ratio of peak early (E) and late filling velocity (E/A ratio) and the ratio of E and the velocity of the mitral annulus early diastolic wave (E/Em ratio) did not change significantly in both groups. Peak untwisting velocity decreased in the metabolic dysfunction group (− 30.1 ± 18.5 vs. − 23.4 ± 15.5 °/ms) but not in controls (− 38.1 ± 23.6 vs. − 42.2 ± 23.0 °/ms), being significantly different between the groups at the 3-month time point (p < 0.05). In conclusion, whereas E/A ratio and E/Em ratio did not change significantly after 3 months of metabolic dysfunction, peak untwisting velocity was significantly decreased. Hence, peak untwisting velocity may serve as an important marker to detect early changes of LV diastolic dysfunction.</p

Prognostic value of dobutamine stress echocardiography in patients with diabetes

WSTĘP. Celem badania była ocena rosnącej wartości echokardiografii obciążeniowej z dobutaminą (DSE, dobutamine stress echocardiography) dla stratyfikacji ryzyka chorych na cukrzycę, którzy nie są w stanie wykonać odpowiedniego, wysiłkowego testu obciążeniowego. Wydolność fizyczna chorych na cukrzycę jest często zmniejszona. Dotychczas nie określono dobrze roli farmakologicznej echokardiografii obciążeniowej w stratyfikacji ryzyka u chorych na cukrzycę. MATERIAŁ I METODY. Przebadano 396 chorych na cukrzycę (średnia wieku 61 &plusmn; 11 lat, 252 mężczyzn &#8212; 64%) z ograniczoną wydolnością wysiłkową, u których wykonano DSE, by ocenić rozpoznaną lub podejrzewaną chorobę wieńcową (CAD, coronary artery disease). Kryteriami oceny badania były ciężkie epizody kardiologiczne (śmierć sercowa i zawał serca niezakończony zgonem) oraz zgon bez względu na przyczynę. WYNIKI. Podczas badania trwającego średnio 3 lata zmarło 97 pacjentów (24%) (55 zgonów z powodu śmierci sercowej), a u 27 chorych stwierdzono zawał serca niezakończony zgonem. W analizowanym, przyrostowym, wielozmiennym modelu, predyktorami klinicznymi ciężkich epizodów sercowych były: zastoinowa niewydolność serca w wywiadzie, wcześniejszy zawał serca, hipercholesterolemia oraz frakcja wyrzutowa w spoczynku. Odsetek niedokrwionych odcinków serca przyrastał w stosunku do modelu klinicznego w prognozowaniu ciężkich epizodów sercowych (c2 = 37 vs. 18, p < 0,05). Klinicznymi predyktorami zgonów bez względu na przyczynę były: zastoinowa niewydolność serca w przeszłości, wiek, hipercholesterolemia oraz frakcja wyrzutowa w spoczynku. Wskaźnik punktowy ruchomości ściany serca na szczycie obciążenia przyrastał w stosunku do modelu klinicznego w prognozowaniu umieralności (c2 = 52 vs. 43, p < 0,05). WNIOSKI. Echokardiografia obciążeniowa z dobutaminą dostarcza istotnych danych dotyczących prognozowania umieralności oraz ciężkich epizodów sercowych u chorych na cukrzycę, u których nie można przeprowadzić odpowiedniego testu stresowego.INTRODUCTION. The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined. MATERIAL AND METHODS. We studied 396 diabetic patients (mean age 61 &plusmn; 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality. RESULTS. During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (c2 = 37 vs. 18, P < 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (c2 = 52 vs. 43, P < 0.05). CONCLUSIONS. DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test

No relationship between left ventricular radial wall motion and longitudinal velocity and the extent and severity of noncompaction cardiomyopathy

<p>Abstract</p> <p>Background</p> <p>Noncompaction cardiomyopathy (NCCM) is characterized by a prominent trabecular meshwork and deep intertrabecular recesses. Although systolic dysfunction is common, limited information is available on differences in wall motion of the normal compacted and noncompacted segments. The purpose of this study was to assess radial wall motion and longitudinal wall velocity in patients with NCCM, according to the extent and severity of noncompaction.</p> <p>Methods</p> <p>The study comprised 29 patients in sinus rhythm (age 41 ± 15 years, 15 men), who fulfilled stringent diagnostic criteria for NCCM and compared to 29 age and gender matched healthy controls. Segmental radial wall motion of all compacted and noncompacted segments was assessed with the standard visual wall motion score index and longitudinal systolic (Sm) wall velocity with tissue Doppler imaging of the mitral annulus. For each LV wall a normalized Sm value was calculated. The extent and severity of NC in each LV segment was assessed both in a qualitative and quantitative manner.</p> <p>Results</p> <p>Heart failure was the primary clinical presentation in half of the patients. NCCM patients had a wall motion score index of 1.68 ± 0.43 and a normalized Sm of 82 ± 20%. The total and maximal noncompaction scores were not related to the wall motion score index and the normalized Sm. NCCM patients with and without heart failure had similar total and maximal noncompaction scores.</p> <p>Conclusions</p> <p>In NCCM patient's radial wall motion and longitudinal LV wall velocity is impaired but not related to the extent or severity of noncompaction.</p