ABSTRACT
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients.
ABSTRACT
PURPOSE: To analyze the changes in cardiorespiratory fitness (CRF) and body composition following 2 different (low-volume vs high-volume) high-intensity aerobic interval training (HIIT) programs with Mediterranean diet (Mediet) recommendations in individuals after myocardial infarction (MI) and compared with an attention control group (AC). METHODS: Body composition and CRF were assessed before and after a 16-wk intervention in 70 participants (58.4 ± 8.5 yr) diagnosed with MI. All participants received Mediet recommendations and were randomly assigned to the AC group (physical activity recommendations, n = 14) or one of the 2 supervised aerobic exercise groups (2 d/wk training): high-volume (40 min) HIIT (n = 28) and low-volume (20 min) HIIT (n = 28). RESULTS: Following the intervention, no significant changes were seen in the AC group and no differences between HIIT groups were found in any of the studied variables. Only HIIT groups showed reductions in waist circumference (low-volume HIIT, Δ = -4%, P < .05; high-volume HIIT, Δ = -2%, P < .001) and improvements in CRF (low-volume HIIT, Δ = 15%, P < .01; high-volume HIIT, Δ = 22%; P < .001) with significant between-group differences (attention control vs HIIT groups). CONCLUSIONS: Results suggest that a 16-wk intervention (2 d/wk) of different HIIT volumes with Mediet recommendations could equally improve CRF and waist circumference after MI. Low-volume HIIT may be a potent and time-efficient exercise training strategy to improve functional capacity.
Subject(s)
Body Composition/physiology , Cardiorespiratory Fitness/physiology , High-Intensity Interval Training/methods , Myocardial Infarction/rehabilitation , Diet, Mediterranean , Female , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology , Pilot Projects , Single-Blind Method , Treatment OutcomeABSTRACT
BACKGROUND: Exercise therapy has long been used for rehabilitation purposes after myocardial infarction (MI) and the benefit of regular physical exercise is also well-established. High-intensity interval training (HIIT) has been proposed to be more effective than continuous exercise for improving exercise capacity and health-related adaptations to low-volume (LV) and HIIT are also known. Furthermore, the Mediterranean diet (Mediet) has been widely reported to be a model of healthy eating for its contribution to a favorable health status and a better quality of life, reducing overall mortality. This study will investigate the effects of different HIIT programs (high-volume [HV] vs LV) and Mediet recommendations in clinical condition, cardiorespiratory fitness, biomarkers, ventricular function, and perception of quality of life after MI, and compared to an attention control group that is recommended to Mediet and physical activity without supervision sessions. METHODS/DESIGN: In this randomized controlled trial, cardiorespiratory fitness, anthropometry, central and peripheral cardiovascular variables, biochemical and nutritional condition, and quality of life will be assessed before and after 16 weeks of intervention in 177 participants diagnosed with MI type 1. All participants will be randomly (1:1:1) assigned to the attention control group or two exercise groups (Mediet recommendations plus supervised aerobic exercise two days/week: (1) HV (40 min) HIIT group and (2) LV (20 min) HIIT group. DISCUSSION: This study will be the first clinical trial comparing the effects of two different volumes of HIIT programs with Mediet recommendations for people after MI. The results of this study will provide good evidence for physical rehabilitation in this population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02876952 . Registered on 24 August 2016.
Subject(s)
Cardiac Rehabilitation/methods , Diet, Healthy , Diet, Mediterranean , High-Intensity Interval Training , Myocardial Infarction/rehabilitation , Cardiac Rehabilitation/adverse effects , Cardiorespiratory Fitness , Diet, Healthy/adverse effects , Diet, Mediterranean/adverse effects , Female , Health Status , High-Intensity Interval Training/adverse effects , Humans , Male , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Prospective Studies , Quality of Life , Randomized Controlled Trials as Topic , Recovery of Function , Spain , Time Factors , Treatment Outcome , Ventricular Function, LeftABSTRACT
Introducción y objetivos: La eficacia de la administración conjunta de suero salino isotónico y N-acetilcisteína presenta resultados dispares en la prevención de la nefropatía por contraste yodado. Nuestro objetivo fue valorar la posible eficacia de esta estrategia combinada en pacientes con alto riesgo de desarrollar nefropatía inducida por contraste, ingresados y sometidos a intervencionismo coronario percutáneo por síndrome coronario agudo sin elevación del segmento ST en nuestro centro. Método: Se aplicó esta estrategia en los pacientes referidos, con al menos un factor de alto riesgo para desarrollar la nefropatía inducida por contraste: mayores de 80 años, diabetes mellitus, creatinina basal mayor de 1,5 mg/dl o alto volumen de contraste (mayor de 400 ml). El protocolo se aplicó durante 12 meses (pacientes que recibieron el protocolo de prevención) y se comparó con similares pacientes en los 12 meses previos que no recibieron profilaxis. Resultados: Un total de 30 pacientes (24 por ciento) desarrollaron nefropatía inducida por contraste. El porcentaje fue significativamente mayor en el grupo que no recibió profilaxis: 35,9 por ciento vs. 11,5 por ciento (p = 0.003). Conclusiones: La combinación de N-acetilcisteína por vía oral e hidratación parenteral en pacientes de alto riesgo, con síndrome coronario agudo sin elevación de ST, podría ser beneficiosa para evitar la aparición de la nefropatía inducida por contraste(AU)
