Role of Exercise on Alleviating Pressure Overload-Induced Left Ventricular Dysfunction and Remodeling via AMPK-Dependent Autophagy Activation.

Cardiac hypertrophy is one of the significant risk factors that result in maladaptive cardiac remodeling and heart failure, and exercise is known to exert cardioprotection. In this research, the cardioprotective function and exercise mechanisms were explored.The rats underwent transverse aortic constriction (TAC) or a sham operation. The rats that received TAC were randomly assigned to five groups: (1) rats subjected to a sham operation as control group (SC), (2) rats that underwent TAC group (TC), (3) TAC and moderate-intensity exercise group (TE), (4) TE plus 3-MA group (TEM), and (5) TE plus Compound C group (TEC). The heart function was measured via echocardiography. Histological analysis and relative protein testing were conducted to analyze collagen deposition and apoptosis. Furthermore, western blot was employed to measure the protein expression of relevant signaling pathways. Impaired cardiac function, interstitial fibrosis, enhanced apoptosis, and ER stress were observed in the TAC-induced left ventricular hypertrophy. Exercise attenuated TAC-induced cardiac dysfunction, interstitial fibrosis, and ER stress-related apoptosis. In addition, exercise significantly improved autophagy and upregulated AMPK phosphorylation. Furthermore, AMPK inhibitor Compound C repressed the activation of AMPK, and autophagy inhibitor 3-methyladenine reversed exercise-induced autophagy. All of these abolished the protection of exercise against cardiac dysfunction and fibrosis induced by TAC.Our results indicated that 4 weeks of treadmill exercise could alleviate pressure overload-induced LV dysfunction and remodeling via an autophagy-dependent mechanism, which was induced by enhancing autophagy through the activation of AMPK.

Participation in an Exercise-Based Cardiac Rehabilitation Program and Functional Improvement of Heart Failure Patients with Preserved Versus Reduced Left Ventricular Systolic Function.

BACKGROUND: About half of all patients with heart failure are diagnosed with heart failure preserved ejection fraction (HFpEF). Until now, studies have failed to show that medical treatment improves the prognosis of patients with HFpEF. OBJECTIVES: To evaluate changes in exercise capacity of patients with HFpEF compared to those with heart failure with reduced ejection fraction (HFrEF) following an exercise training program. METHODS: Patient data was retrieved from a multi-center registry of patients with heart failure who participated in a cardiac rehabilitation program. Patients underwent exercise testing and an echocardiogram prior to entering the program and were retested6  months later. RESULTS: Of 216 heart failure patients enrolled in the program, 170 were diagnosed with HFrEF and 46 (21%) with HFpEF. Patients with HFpEF had lower baseline exercise capacity compared to those with HFrEF. Participating in a 6 month exercise program resulted in significant and similar improvement in exercise performance of both HFpEF and HFrEF patients: an absolute metabolic equivalent (MET) change (1.45 METs in HFrEF patients vs. 1.1 in the HFpEF group, P = 0.3). CONCLUSIONS: An exercise training program resulted in similar improvement of exercise capacity in both HFpEF and HFrEF patients. An individualized, yet similarly structured, cardiac rehabilitation program may serve both heart failure groups, providing safety and efficacy.

High-Intensity Interval Training for Severe Left Ventricular Dysfunction Treated with Left Ventricular Assist Device.

Aerobic training based on anaerobic threshold (AT) is well-known to improve cardiac function, exercise capacity, and long-term outcomes of patients with heart failure. Recent reports suggested that high-intensity interval training (HIIT) for patients with cardiovascular disease may improve cardiopulmonary exercise capacity. We present a 61-year-old male patient of severe left ventricular dysfunction with left ventricular assisted device (LVAD). Following HIIT for 8 weeks, exercise capacity and muscle strength have improved without worsening left ventricular function. Our case showed the possibility that HIIT was feasible and effective even in patients with LVAD.

Relationship of Cardiorespiratory Fitness and Adiposity With Left Ventricular Strain in Middle-Age Adults (from the Dallas Heart Study).

Low cardiorespiratory fitness (CRF) and obesity are significant risk factors for heart failure (HF). However, given the inverse association between CRF and obesity, the independent contributions of low CRF and adiposity toward HF risk are not well established. We evaluated the association of CRF and measures of adiposity with left ventricular (LV) peak systolic strain-a subclinical measure of LV dysfunction-among the Dallas Heart Study phase II participants without cardiovascular disease who had CRF estimated using a submaximal treadmill test and LV systolic circumferential strain assessment by tissue-tagged cardiac magnetic resonance imaging. Peak midwall systolic circumferential strain (Ecc) was determined by harmonic phase imaging. Associations of CRF and adiposity measures with Ecc were determined using adjusted linear regression analysis. A total of 1,617 participants were included in the analysis. After adjustment for baseline risk factors, higher waist circumference (WC) and lower CRF were associated with higher Ecc (WC: ß = 0.07; p = 0.01; CRF: ß = -0.17; p = < 0.0001), whereas % body fat and body mass index were not associated with Ecc. The relationship between WC and Ecc was attenuated completely after additional adjustment for CRF. In contrast, the association between CRF and Ecc did not attenuate after additional adjustment for WC and other measures of LV structure and function (ß = -0.18; p = < 0.0001). Taken together, our study findings suggest that lower CRF, but not measures of adiposity, is associated with greater impairment in LV strain independent of LV mass and ejection fraction.

An exploratory study on the efficacy and safety of a BCAA preparation used in combination with cardiac rehabilitation for patients with chronic heart failure.

BACKGROUND: Sarcopenia is generally complicated with patients with chronic heart failure (CHF) and its presence negatively affects the course of heart failure, however effective nutritional intervention had not been elucidated yet. The primary objective of this study is to explore whether the addition of a branched-chain amino acid (BCAA) preparation for cardiac rehabilitation (CR) of patients with CHF further improves cardiopulmonary functions, skeletal muscle functions, and metabolism in comparison with conventional CR. METHODS: This is a randomized, parallel-group comparative study. The elderly patients that were participated in CR and complicated with left ventricular systolic or diastolic dysfunction are randomized into two groups, CR + BCAA and CR. 20 weeks later, the second randomization is performed, which divide subjects into two groups with and without BCAA intervention without CR. Primary outcome measure is the rate of change of the anaerobic threshold workload from baseline to post-intervention. Secondary outcome include parameters of exercise capacity, cardiac function and psychological status. DISCUSSION: In the current study the effect of a promising new intervention, BCAA, will be assessed to determine whether its addition to CR improve exercise capacity in patients with heart failure, who are generally complicated with sarcopenia. TRIAL REGISTRATION: This clinical trial was registered with the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR; JPRN-UMIN R000022440 ).

Efficacy of an early home-based cardiac rehabilitation program for patients after acute myocardial infarction: A three-dimensional speckle tracking echocardiography randomized trial.

BACKGROUND: The effect of an early short-term home-based cardiac rehabilitation (CR) program on ventricular function in acute myocardial infarction (AMI) patients is not yet clear. The purpose of this study was to evaluate the efficacy of our CR program on the improvement of myocardial function using three-dimensional speckle tracking echocardiography (3D-STE) in AMI patients. METHODS: Fifty-two AMI patients were randomly assigned to 2 groups after discharge: the rehabilitation group, which participated in an early, home-based CR program, and the control group, which received only usual care. All subjects in both groups underwent 3D-STE examinations of the left ventricle within 48 hours of percutaneous coronary intervention and again 4 weeks after discharge. Global longitudinal strain (GLS), global radial strain (GRS), global area strain (GAS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), and segmental strains were computed. The CR program was initially conducted with supervised inpatient training, followed by an unsupervised home-based training program during a 4-week follow-up. RESULTS: We obtained segmental strains from 832 segments, of which 319 were defined as interventional segments, 179 as ischemic segments, and the remaining segments as normal segments. At the 4-week follow-up, when controlling for baseline values, the rehabilitation group showed significant improvements in GLS, GRS, GCS, GAS, LVEF, and in all of the segmental strains of the 3 subgroups compared with the control group (P <0.05). CONCLUSION: Our study suggests that an early, home-based CR program can greatly improve the ventricular function of AMI patients in a short period of time.

The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction.

PURPOSE: The purpose of this study was to determine whether different initiation of exercise training (ET) produces different effect sizes for left ventricular (LV) remodeling and cardiopulmonary rehabilitation in patients with LV dysfunction after myocardial infarction (MI). METHOD: Trials evaluating ET outcomes identified by searches in OVID MEDLINE, EMBASE, PubMed and WEB OF SCIENCE were used. Meta-analysis was conducted with the use of the software STATA 11.0. The results were expressed as the standardized mean difference (SMD), with corresponding 95% CI and p value. RESULTS: The largest changes in LV remodeling and cardiopulmonary capacity rehabilitation were obtained when programs began the acute phase after MI. With the healing of MI, the beneficial effects of ET on LV ejection fraction (LVEF), LV end-systolic diameter (LVDs) and peak VO2 were gradually weakened even worse. The incidence of major adverse cardiac events was not significantly increased in acute phase post-MI. Sensitivity analyses show that ET still had significant effect in reducing LVDs and increasing peak VO2, while ET no longer had statistical effect in increasing LVEF but showed favorable trends when the same research institution's works were excluded. CONCLUSIONS: ET has favorable effects on LV remodeling and cardiopulmonary rehabilitation in LV dysfunction post-MI patients. The greatest benefits are obtained when ET starts at the acute phase following MI. IMPLICATIONS FOR REHABILITATION: Early exercise training is safe and feasible in acute and healing phase after myocardial infarction. Early exercise training could attenuate LV remodeling and improve cardiopulmonary capacity in patients with myocardial infarction after hospital discharge (around one week post-MI). Exercise training has favorable effects on LV remodeling and cardiopulmonary capacity rehabilitation. Exercise training should be treated to have the same roles with drugs in secondary prevention of myocardial infarction.

Efficacy of exercise training in symptomatic patients with hypertrophic cardiomyopathy: results of a structured exercise training program in a cardiac rehabilitation center.

BACKGROUND: Recent data suggest that exercise training (ET) confers significant symptomatic and functional improvements in patients with diastolic dysfunction, and thus may be beneficial in patients with hypertrophic cardiomyopathy (HCM). However, there are no data regarding the safety or efficacy of ET in HCM patients. DESIGN: A prospective non-randomized intervention design was used. METHODS: We enrolled 20 patients with symptomatic HCM, significantly limited in everyday activity, into a supervised cardiac rehabilitation exercise program. RESULTS: Patients were 62 ± 13 years old, in New York Heart Association (NYHA) functional class II (35%) or III (65%), had a mean interventricular septum dimension of 17 ± 5 mm and left ventricular ejection fraction (LVEF) of 53 ± 15%. Left ventricular outflow gradient was present at rest in nine patients (mean 51 ± 24 mm Hg) and six patients had an implantable defibrillator. Exercise prescription was based on heart rate reserve (HRR) determined from a symptom-limited graded exercise stress test. Exercise intensity was gradually increased from 50% to 85% of the HRR over the training period. Patients completed an average of 41 ± 8 hours of aerobic ET. No adverse events or sustained ventricular arrhythmias occurred during the training program. Functional capacity, assessed by a graded exercise test, improved from 4.7 ± 2.2 to 7.2 ± 2.8 metabolic equivalents (METs) (p = 0.01). NYHA functional class improved from baseline by ≥ 1 grade in 10 patients (50%) and none experiencing deterioration during follow-up. CONCLUSIONS: The present study suggests that patients with HCM who remain symptomatic despite medical therapy may achieve considerable functional improvement through a supervised ET program.

The Impacts of Cardiac Rehabilitation Program on Exercise Capacity, Quality of Life, and Functional Status of Coronary Artery Disease Patients with Left Ventricular Dysfunction.

PURPOSE: To determine the impacts of cardiac rehabilitation on exercise capacity, quality of life (QOL), and functional status in patients with coronary artery disease (CAD). DESIGN: Self-controlled clinical trial. METHODS: CAD patients with mild to moderate left ventricular dysfunction participated in an exercise-based rehabilitation program for eight consecutive weeks. Subjects underwent an exercise test before and 8 weeks after rehabilitation. QOL was assessed with the SF-36 questionnaire. Functional status was assessed in terms of sleep time, walking, cycling, exercise, and working duration. FINDINGS: Seventy patients (age=57.5±10.2 years, 77.1% male) were studied. After rehabilitation, peak exercise capacity increased from 8.00±2.56 to 10.08±3.00 METs (p<.001) and exercise duration increased from 14.17±5.27 to 17.21±5.85 minutes (p<.001). Patients' QOL improved in physical and psychological dimensions (p<.05). Cycling, walking, and exercising status significantly increased after the study (p<.05). CONCLUSIONS: Cardiac rehabilitation improves exercise capacity, QOL, and functional status of CAD patients with mild to moderate left ventricular dysfunction. CLINICAL RELEVANCE: Cardiac rehabilitation practitioners should encourage patients to attend to and be compliant in the rehabilitation programs.

[Role of controlled physical activity as a method of therapy in patients with heart failure after invasive treatment of angina pectoris]. / Rola kontrolowanego wysilku fizycznego jako metody terapii u chorych z niewydolnoscia serca po inwazyjnym leczeniu dlawicy piersiowej.

UNLABELLED: Due to the aging of the population is an increase in the incidence of heart failure. According to the current guidelines for conduct in the treatment of cardiovascular diseases, rehabilitation is introduced in the first treatment period. Individually matched to the severity of illness of each patient, increases the quality of life of patients and reduces mortality in this group of patients. The aim of the study was to evaluate the effect of controlled exercise on left ventricular systolic function of heart and change the level of concentration of natriuretic peptide NT-pro-BNP in patients with heart failure after invasive treatment of angina pectoris. MATERIAL AND METHODS: The study group consisted of 87 patients, men and women aged 35 to 85 years (mean age 65.6 +/- 10.4) with a diagnosis of heart failure. Patients were divided into 3 groups. I group numbering 19 patients (67.3 +/- 7.8) were subjected to two-week cardiac rehabilitation program, representing 46. Group II patients (59.4 +/- 10.9) was qualified for the 4-week program. The basis for rehabilitation of patients accounted for interval training was performed using a bicycle ergometer. Group III--control, representing 22 patients (68.1 +/- 9.2) were excluded from the training groups because of the high risk. Used with them individually tailored program of cardiac rehabilitation. All patients were performed: submaximal exercise test, echocardiography and examined the concentration of NT-pro-BNP (N-terminal pro-B-type natriuretic peptide). After a period of 6 months from the end of the second phase of cardiac rehabilitation in 32 patients who agreed repeated the scope of clinical trials. RESULTS: In groups where physical training was conducted controlled noticed an improvement in EF and reduction of NT pro-BNP. It was also a significant, negative correlation between the degree of damage to the left ventricle (EF), and the level of NT pro-BNP. After a period of 6 months from the end of the second stage of rehabilitation, the analysis showed a statistically significant further and improve. It was observed that the best results were obtained in the group with the longest period of rehabilitation. CONCLUSION: Rehabilitation, part of cardiac rehabilitation is an important component of therapy in patients with heart failure. By influencing the improvement actions cardiovascular favorable effect on the clinical course of the disease.

Infarct size as predictor of systolic functional recovery after myocardial infarction.

BACKGROUND: The effects of modern therapy on functional recovery after acute myocardial infarction (AMI) are unknown. OBJECTIVES: To evaluate the predictors of systolic functional recovery after anterior wall AMI in patients undergoing modern therapy (reperfusion, aggressive platelet antiaggregant therapy, angiotensin-converting enzyme inhibitors and beta-blockers). METHODS: A total of 94 consecutive patients with AMI with ST-segment elevation were enrolled. Echocardiograms were performed during the in-hospital phase and after 6 months. Systolic dysfunction was defined as ejection fraction value < 50%. RESULTS: In the initial echocardiogram, 64% of patients had systolic dysfunction. Patients with ventricular dysfunction had greater infarct size, assessed by the measurement of total and isoenzyme MB creatine kinase enzymes, than patients without dysfunction. Additionally, 24.5% of patients that initially had systolic dysfunction showed recovery within 6 months after AMI. Patients who recovered ventricular function had smaller infarct sizes, but larger values of ejection fraction and E-wave deceleration time than patients without recovery. At the multivariate analysis, it can be observed that infarct size was the only independent predictor of functional recovery after 6 months of AMI when adjusted for age, gender, ejection fraction and E-wave deceleration time. CONCLUSION: In spite of aggressive treatment, systolic ventricular dysfunction remains a frequent event after the anterior wall myocardial infarction. Additionally, 25% of patients show functional recovery. Finally, infarct size was the only significant predictor of functional recovery after six months of acute myocardial infarction.

Infarct Size as Predictor of Systolic Functional Recovery after Myocardial Infarction / Tamanho do Infarto como Preditor de Recuperação da Função Sistólica após Infarto do Miocárdio

Background: The effects of modern therapy on functional recovery after acute myocardial infarction (AMI) are unknown. Objectives: To evaluate the predictors of systolic functional recovery after anterior wall AMI in patients undergoing modern therapy (reperfusion, aggressive platelet antiaggregant therapy, angiotensin-converting enzyme inhibitors and beta-blockers). Methods: A total of 94 consecutive patients with AMI with ST-segment elevation were enrolled. Echocardiograms were performed during the in-hospital phase and after 6 months. Systolic dysfunction was defined as ejection fraction value < 50%. Results: In the initial echocardiogram, 64% of patients had systolic dysfunction. Patients with ventricular dysfunction had greater infarct size, assessed by the measurement of total and isoenzyme MB creatine kinase enzymes, than patients without dysfunction. Additionally, 24.5% of patients that initially had systolic dysfunction showed recovery within 6 months after AMI. Patients who recovered ventricular function had smaller infarct sizes, but larger values of ejection fraction and E-wave deceleration time than patients without recovery. At the multivariate analysis, it can be observed that infarct size was the only independent predictor of functional recovery after 6 months of AMI when adjusted for age, gender, ejection fraction and E-wave deceleration time. Conclusion: In spite of aggressive treatment, systolic ventricular dysfunction remains a frequent event after the anterior wall myocardial infarction. Additionally, 25% of patients show functional recovery. Finally, infarct size was the only significant predictor of functional recovery after six months of acute myocardial infarction. .

Fundamento: Os efeitos da terapêutica moderna na recuperação funcional após o infarto agudo do miocárdio não são conhecidos. Objetivos: Avaliar os fatores preditores da recuperação funcional sistólica após infarto agudo do miocárdio de parede anterior em pacientes submetidos à terapia moderna (reperfusão, antiagregação plaquetária agressiva, inibidores da enzima conversora da angiotensina e betabloqueadores). Métodos: Foram incluídos 94 pacientes consecutivos com infarto agudo do miocárdio com supradesnivelamento do segmento ST. Ecocardiogramas foram realizados na fase intra-hospitalar e após 6 meses. Disfunção sistólica foi definida pela presença de fração de ejeção de valor < 50%. Resultados: No ecocardiograma inicial, 64% dos pacientes apresentaram disfunção sistólica. Os pacientes com disfunção ventricular apresentaram tamanhos maiores de infarto, avaliados pelas enzimas creatinofosfoquinase total e isoenzima MB, que os pacientes sem disfunção. Adicionalmente, 24,5% dos pacientes inicialmente com disfunção sistólica apresentaram recuperação no período de 6 meses após o infarto agudo do miocárdio. Os pacientes que recuperaram a função ventricular apresentaram menores tamanhos de infarto, mas maiores valores da fração de ejeção e tempo de desaceleração da onda E que pacientes sem recuperação. Na análise multivariada, observa-se que o tamanho de infarto foi o único fator preditor independente de recuperação funcional após 6 meses de infarto, quando ajustado pela idade, sexo, fração de ejeção e tempo de desaceleração da onda E. Conclusão: Apesar do tratamento agressivo, a disfunção ventricular ...

Rehabilitation of a hemiplegic patient with cardiac assistive device.

INTRODUCTION: Possible admission to a PRM unit of a hemiplegic patient equipped with a left ventricular assistance device (LVAD) may constitute a cause for concern. We are reporting our observation on the subject. OBSERVATION: A 30-year-old hemiplegic patient presented with left hemiparesis secondary to a right middle cerebral artery (MCA) ischemic stroke having occurred during cardiopulmonary arrest. Persistence of major left ventricle dysfunction necessitated installation on 8 November 2011 of a mono-ventricular HEART-MATE II assistive device. Possible later recourse to cardiac transplantation would depend on clinical development. When admitted to a PRM unit on 18 January 2012, the patient presented with left hemiparesis and cognitive disorders. Virtually all members of the attendant medical and paramedical team were given instruction on the functioning of electrical power assistance systems. In spite of the complexity of the logistics, and notwithstanding the difficulty of managing potentially worrisome medical problems, multidisciplinary rehabilitation efforts were successful. The patient's improved condition led to the decision to undertake heart transplantation, which was carried out on 27 October 2012. DISCUSSION AND CONCLUSION: This observation illustrates the undeniable role of PRM in decision-making and, more generally, in the opportunities that may arise in sensitive and challenging situations.

Does cardiac rehabilitation improve left ventricular diastolic function of patients with acute myocardial infarction?

OBJECTIVES: We aimed to observe the effect of cardiac rehabilitation (CR) on left ventricular diastolic function in patients with acute myocardial infarction (AMI) and revascularization by percutaneous coronary intervention (PCI). STUDY DESIGN: 82 patients were enrolled the study; 42 who were participating in a CR program, and 40 who did not maintain the program as a control group. Measurements of mitral inflow included the peak early filling (E-wave) and late diastolic filling (A-wave) velocities, the E/A ratio, deceleration time (DT) of early filling velocity and mitral A-wave duration. The early diastolic annular velocity has been expressed as e' with PW tissue Doppler imaging. The mitral inflow E velocity to tissue Doppler e' (E/e') was calculated and isovolumic relaxation time (IVRT) was measured. Measurements of pulmonary venous waveforms included peak systolic (S) velocity, peak anterograde diastolic (D) velocity and the time difference between the duration of the atrial reversal (Ar) and mitral A-wave duration (Ar-A). RESULTS: E/A and septal e' were better with the CR group than the control group. (p=0.048 vs p=0.006 respectively). The difference between E/e' measurements were not statistically significant (p=0.138). The left ventricular diastolic function of patients were partially improved with cardiac rehabilitation. There was no association between infarct-related artery (IRA) and diastolic functional measurements of the left ventricle in the individuals. Only hypertension was found significantly associated with E/A (p=0.000). CONCLUSION: CR improves septal e' and E/A significantly in patients with AMI and revascularized successfully by PCI, especially in those with hypertension.

Is applying the same exercise-based inpatient program to normal and reduced left ventricular function patients the best strategy after coronary surgery? A focus on autonomic cardiac response.

PURPOSE: To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG). METHOD: Forty-four patients post-CABG, subgrouped according to normal LVF [LVFN: n = 23; left ventricular ejection fraction (LVEF) ≥ 55%] and reduced LVF (LVFR: n = 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation). RESULTS: During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group [standard deviation of all RR (STDRR; 6.1 ± 2.7 versus 8.9 ± 4.7 ms), baseline width of the RR histogram (TINN; 30.6 ± 14.8 versus 45.8 ± 24.9 ms), SD2 (14.8 ± 8.0 versus 21.3 ± 9.0 ms), Shannon entropy (3.6 ± 0.5 versus 3.9 ± 0.4) and correlation dimension (0.08 ± 0.2 versus 0.2 ± 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p < 0.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate. CONCLUSION: For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG. Implications for Rehabilitation Exercise-based inpatient program, performed by post-CABG patients who have normal left ventricular function, triggered a more attenuated cardiac autonomic response compared with patients with reduced left ventricular function. Volume of the inpatient exercises should be prescribed according to the left ventricular function in the early stages following recovery from CABG.

Efficacy and safety of early comprehensive cardiac rehabilitation following the implantation of cardioverter-defibrillator.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy is current the main approach to prevent sudden cardiac death. It was demonstrated that patients with ICD are characterised by worse quality of life (QOL) and exercise capacity and are prone to depressive symptoms. Thus, comprehensive rehabilitation is indicated in ICD recipients. AIM: To evaluate safety and benefits of comprehensive cardiac rehabilitation early after ICD implantation. METHODS: The study group consisted of 45 patients (28 males, mean age 62.2 years) in whom a program of comprehensive cardiac rehabilitation was initiated at 6 weeks after ICD implantation. Rehabilitation consisted of two phases: 2-week inpatient Phase I and 12-week outpatient Phase II. Before and after the rehabilitation program, all patients were evaluated with transthoracic echocardiography, treadmill spiroergometric exercise test according to the modified Naughton protocol, a Polish version of the SF-36 questionnaire to assess QOL, and the Beck Depression Inventory (BDI) for depressive symptoms. RESULTS: No deaths during the study and no complications or adverse events during rehabilitation or exercise testing were noted. Following comprehensive cardiac rehabilitation, we found an increase in left ventricular ejection fraction (30.09 ± 12.75 vs. 35.43 ± 13.4%; p = 0.002), peak oxygen uptake (VO2) (21.3 ± 9.2 vs. 24.2 ± 10.3 mL/kg/min; p = 0.007) and duration of exercise (9.14 ± 3.7 vs. 9.53 ± 3.8 min; p < 0.05). An improvement was also noted in terms of depressive symptoms, as BDI score decreased (14.81 ± 9.27 vs. 12.83 ± 10.75; p = 0.020). QOL improved (p < 0.05), particularly the physical index (p = 0.02), as was the New York Heart Association class (p < 0.001). Improvement in peak VO2 was associated with better QOL (SF-total, r = -0.34; and physical index, r = -0.36). We also found a correlation between alleviation of depressive symptoms (BDI score) and improvement of QOL (SF-total, r = 0.52). CONCLUSIONS: An improvement in left ventricular systolic function, exercise capacity and QOL and a reduction of depressive symptoms were observed in patients who took part in a program of early comprehensive cardiac rehabilitation after ICD implantation. No complications or side effects during rehabilitation sessions or exercise tests were observed in the study group.

Effectiveness of acute inpatient rehabilitation after left ventricular assist device placement.

Left ventricular assist device (LVAD) placement is becoming more common as a treatment of end-stage heart failure. People who have undergone placement of an LVAD typically have deficits with their activities of daily living as well as decreased strength from prolonged immobility. Patients often benefit from admission to acute inpatient rehabilitation before being discharged home. Few studies have examined the effectiveness of acute inpatient rehabilitation for people who have undergone placement of an LVAD. This study examines the admission and discharge functional independence measure scores of 20 people admitted to acute inpatient rehabilitation at an academic center after placement of an LVAD. Most patients had improved function after acute inpatient rehabilitation. The mean change in functional independence measure score was 22.05, and the mean length of stay was 11.6 days. This study shows that people who have undergone placement of an LVAD have improved function and ability to perform activities of daily living after admission to inpatient rehabilitation.