ABSTRACT
Several competing geometric and hemodynamic factors are suggested as contributing mechanisms for functional mitral regurgitation [MR] in heart failure patients. We aimed to study the relationships between the severity of MR and the QRS duration and dyssynchrony markers in patients with ischemic or dilated cardiomyopathy. We prospectively evaluated 251 heart failure patients with indications for echocardiographic evaluation of possible cardiac resynchronization therapy. All the patients were subjected to transthoracic echocardiography and tissue Doppler imaging to evaluate the left ventricular [LV] synchronicity. The patients were divided into two groups according to the severity of MR: /= moderate MR. The effects of different dyssynchrony indices were adjusted for global and regional left ventricular remodeling parameters. From the 251 patients [74.5% male, mean age = 53.38 +/- 16.68 years], 130 had /= moderate MR. There were no differences between the groups regarding the mean age, frequency of sex, and etiology of cardiomyopathy. The LV systolic and diastolic dimensions were greater in the patients with >/= moderate MR [all p values < 0.001]. Among the different echocardiographic factors, the QRS duration [150.75 +/- 34.66 vs. 126.77 +/- 29.044 ms; p value = 0.050] and interventricular mechanical delay [41.60 +/- 29.50 vs. 35.00 ms +/- 22.01; p value = 0.045] were significantly longer in the patients with
ABSTRACT
Enhanced external counterpulsation [EECP] is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris. Twenty consecutive patients with refractory angina pectoris were treated with EECP, and their symptoms, echocardiographic measures, treadmill exercise test parameters, and Canadian Cardiovascular Society Class were evaluated before and immediately after EECP. The patients were followed up for 6months post treatment. There were significant differences regarding total exercise time before and after treatment [p value < 0.001]. The patients showed a significant reduction in angina classes III and IV immediately after EECP [p value < 0.001]; for most of the patients, these beneficial effects were sustained for 6 months [p value = 0.010]. There was no significant improvement in the echocardiographic parameters. EECP decreased symptoms and increased total exercise time in our study population. These beneficial effects were sustained for 6 months
Subject(s)
Humans , Female , Male , Counterpulsation , Exercise Test , EchocardiographyABSTRACT
Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery [CABG]. However, the effect of this program on right ventricular function following CABG is unclear.The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular [RV] function in a cohort of patients who underwent CABG. A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Significant increase of RV function parameters were observed in both rehabilitation group [RG] and control group [CG] at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution [RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm], tricuspid annular peak systolic velocity [RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s], and tricuspid annular late diastolic velocity [RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s].The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. The R Vfunction parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program
ABSTRACT
Systolic blood pressure recovery [rSBP] is of prognostic value for predicting the survival and co-morbidity rate in patients with coronary artery disease [CAD]. This study investigated the association between rSBP and exercise indices after complete cardiac rehabilitation program [CR] in a population-based sample of patients undergoing coronary artery bypass grafting [CABG]. The sample population consisted of 352 patients who underwent pure CABG. The patients underwent standard symptom-limited exercise testing immediately before and also after the completion of the CR sessions. rSBP was defined the ratio of the systolic blood pressure at 3 minutes in recovery to the systolic blood pressure at peak exercise. An abnormal baseline rSBP after exercise was a strong predictor of exercise parameters in the last session, including metabolic equivalents [beta = -0.617, SE = 0.127, p value < 0.001] and peak O2 consumption [beta = 1.950, SE = 0.363, p value < 0.001] measured in the last session adjusted for baseline exercise characteristics, demographics, function class, and left ventricular ejection fraction. The current study strongly emphasizes the predictive role of baseline rSBP after exercise in evaluating exercise parameters following CR. This baseline index can predict abnormal METs value, peak O2 consumption, post-exercise heart rate, and heart rate recovery after a 24-session CR program