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Dehghani M, Cheragi M, Delfan B, Dehghani M, Shakarami A, Bagheri Y, Namdari P, Namdari M. Difference of cardiac rehabilitation in the morning or evening on indexes of left ventricular and N-terminal pro-brain natriuretic peptide: a randomized controlled trial. Ann Med Surg (Lond) 2023; 85:3482-3490. [PMID: 37427217 PMCID: PMC10328671 DOI: 10.1097/ms9.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/22/2023] [Indexed: 07/11/2023] Open
Abstract
The present study aimed to evaluate the effects a cardiac rehabilitation program (CRP) performed in the morning or evening on left ventricular (LV) filling indices and the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients undergoing percutaneous coronary angioplasty during the COVID-19 pandemic. Methods This was a randomized controlled single-blinded clinical trial. Ninety-six patients (mean age: 50.2 ± 8.1 years, 36 women and 44 men) with percutaneous coronary angioplasty were divided into two groups of intervention and control. In each group, the CRP was performed in either morning or evening. The CRP included walking and performing push-ups and sit-ups for 8 weeks. The participants of the control groups received routine care. The functional indices of LV, including LV ejection fraction, systolic function, and diastolic function (i.e. the transmitral flow), the E/e' to left atrium peak strain ratio (as an estimation for LA stiffness), and NT-proBNP level were measured in all participants before starting and at the end of the CRP. Results In the intervention group, the individuals performing the CRP in the evening had significantly higher E-wave (0.76±0.02 vs. 0.75±0.03; P=0.008), ejection fraction (52.5±5.64 vs. 55.5±3.59; P=0.011), and diastolic function velocity (E/A ratio, 1.03±0.06 vs. 1.05±0.03; P=0.014) and significantly lower A-wave (0.72±0.02 vs. 0.71±0.01; P=0.041), E/e' ratio (6.74±0.29 vs. 6.51±0.38; P=0.038), and NT-proBNP level (2007.9±214.24 vs. 1933.9±253.13; P=0.045) compared with those performing the program in the morning. Conclusions A supervised CRP performed in the evening compared with morning was more effective in improving LV functional indices. Therefore, such home-based interventions are recommended to be performed in the evening during the COVID-19 pandemic.
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Affiliation(s)
- Mostafa Dehghani
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Mostafa Cheragi
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Bahram Delfan
- Department of Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad
| | | | - Amir Shakarami
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Yagoob Bagheri
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
| | - Parsa Namdari
- Department of University of Debrecen, Debrecen, Faculty of Medicine, Hungary
| | - Mehrdad Namdari
- Department of Cardiovascular research Center, Shahid Rahimi Hospital
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2
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Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200166. [PMID: 36874040 PMCID: PMC9975236 DOI: 10.1016/j.ijcrp.2022.200166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023]
Abstract
Objective Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. Methods In this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened. Results 347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death. Conclusion HRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.
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Assaf Y, Barout A, Alhamid A, Al-Mouakeh A, Barillas-Lara MI, Fortin-Gamero S, Bonikowske AR, Pepine CJ, Allison TG. Peak Systolic Blood Pressure During the Exercise Test: Reference Values by Sex and Age and Association With Mortality. Hypertension 2021; 77:1906-1914. [PMID: 33866799 DOI: 10.1161/hypertensionaha.120.16570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yazan Assaf
- From the Department of Medicine, University of Florida, Gainesville (Y.A., C.J.P.)
| | - Ahmad Barout
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Department of General Internal Medicine, University of Massachusetts, Worcester (A.B.)
| | - Ahmad Alhamid
- Faculty of Medicine, University of Aleppo, Syrian Arab Republic (A.A., A.A.-M.)
| | - Ahmad Al-Mouakeh
- Faculty of Medicine, University of Aleppo, Syrian Arab Republic (A.A., A.A.-M.)
| | - Maria Irene Barillas-Lara
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Department of Medicine, Boston University, MA (M.I.B.-L.)
| | - Sonia Fortin-Gamero
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN
| | - Carl J Pepine
- From the Department of Medicine, University of Florida, Gainesville (Y.A., C.J.P.)
| | - Thomas G Allison
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine (T.G.A.), Mayo Clinic, Rochester, MN
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Susca MG, Hodas R, Benedek T, Benedek I, Chitu M, Opincariu D, Chiotoroiu A, Rezus C. Impact of cardiac rehabilitation programs on left ventricular remodeling after acute myocardial infarction: Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19759. [PMID: 32311978 PMCID: PMC7220465 DOI: 10.1097/md.0000000000019759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION While the role of early mobilization in the immediate postinfarction period has been well demonstrated, little is known in present about the link between early mobilization and reduction of systemic inflammation. At the same time, the impact of early mobilization on regression of left ventricular remodeling has not been elucidated so far. MATERIAL AND METHODS Here we present the study protocol of the REHAB trial, a clinical descriptive, prospective study, conducted in a single-center, with the purpose to analyze the impact of early mobilization in reducing left ventricular remodeling, the complication rates and mortality in patients who had suffered a recent acute myocardial infarction (AMI). At the same time, the study aims to demonstrate the contribution of early mobilization to reduction of systemic inflammation, thus reducing the inflammation-mediated ventricular remodeling. 100 patients with AMI in the last 12 hours, and successful revascularization of the culprit artery within the first 12 hours after the onset of symptoms in ST-segment elevation acute myocardial infarction or within first 48 hours in non ST-segment elevation AMI will be enrolled in the study. Based on the moment of mobilization after AMI patients will be distributed in 2 groups: group 1 - patients with early mobilization (<2 days after the onset of symptoms) and; group 2 - subjects with delayed mobilization after AMI (>2 days after the onset of symptoms). Study outcomes will consist in the impact of early mobilization after AMI on the ventricular remodeling in the post-infarction period, as assessed by cardiac magnetic resonance imaging, the rate of in-hospital mortality, the rate of repeated revascularization or MACE and the effect of early mobilization on systemic inflammation in the immediate postinfarction phase. CONCLUSION In conclusion, REHAB will be the first trial that will elucidate the impact of early mobilization in the first period after AMI, as a first step of a complex cardiac rehabilitation program, to reduce systemic inflammation and prevent deleterious ventricular remodeling in patients who suffered a recent AMI.
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Affiliation(s)
| | | | - Theodora Benedek
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Imre Benedek
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Monica Chitu
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Diana Opincariu
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Andreea Chiotoroiu
- University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Ciprian Rezus
- University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania
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Mobilization of Patients Suffering from Acute Myocardial Infarction – When Is It Too Early? JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The significant raise in the number of patients surviving an acute myocardial infarction (AMI) has increased the burden of morbidity and disability due to acute coronary events. This has led to an increasing awareness on the need to develop specific rehabilitation programs, both during the acute phase, as well as in out-patient settings. In the pre-revascularization era, AMI was treated in bed. Regardless of the known therapeutic benefits of bed rest, there are scarce data regarding a standardized protocol for the early rehabilitation of patients with AMI. An extensive group of AMI patients are still exposed to prolonged immobilization, with current data showing a disparity in the length of post-MI bed rest, with a time of immobilization reported to be from 2 to 12 days and 2 to 28 days. The growing body of evidence on the effects of early cardiac rehabilitation programs following an AMI suggests that early mobilization after the index event could improve the inflammatory response and further modulate the ventricular remodeling process. The timing, duration, and intensity of cardiac mobilization has not yet been established, and further research on the effects of mobilization as early as the first 12 to 24 hours after the acute event could be beneficial for both short- and long-term outcomes, inflammation, and ventricular remodeling with subsequent heart failure.
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Hernesniemi JA, Sipilä K, Tikkakoski A, Tynkkynen JT, Mishra PP, Lyytikäinen LP, Nikus K, Nieminen T, Lehtimaki T, Kähönen M. Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction. Heart 2019; 106:434-440. [PMID: 31422363 DOI: 10.1136/heartjnl-2019-315198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate whether cardiorespiratory fitness (CRF) and heart rate recovery (HRR) associate with the risk of sudden cardiac death (SCD) independently of left ventricular ejection fraction (LVEF). METHODS The Finnish Cardiovascular Study is a prospective clinical study of patients referred to clinical exercise testing in 2001-2008 and follow-up until December 2013. Patients without pacemakers undergoing first maximal or submaximal exercise testing with cycle ergometer were included (n=3776). CRF in metabolic equivalents (METs) was estimated by achieving maximal work level. HRR was defined as the reduction in heart rate 1 min after maximal exertion. Adjudication of SCD was based on death certificates. LVEF was measured for clinical indications in 71.4% of the patients (n=2697). RESULTS Population mean age was 55.7 years (SD 13.1; 61% men). 98 SCDs were recorded during a median follow-up of 9.1 years (6.9-10.7). Mean CRF and HRR were 7.7 (SD 2.9) METs and 25 (SD 12) beats/min/min. Both CRF and HRR were associated with the risk of SCD in the entire study population (HRCRF0.47 (0.37-0.59), p<0.001 and HRHRR0.57 (0.48-0.67), p<0.001 with HR estimates corresponding to one SD increase in the exposure variables) and with CRF, HRR and LVEF in the same model (HRCRF0.60 (0.45-0.79), p<0.001, HRHRR0.65 (0.51-0.82), p<0.001) or adjusting additionally for all significant risk factors for SCD (LVEF, sex, creatinine level, history of myocardial infarction and atrial fibrillation, corrected QT interval) (HRCRF0.69 (0.52-0.93), p<0.01, HRHRR0.74 (0.58-0.95) p=0.02). CONCLUSIONS CRF and HRR are significantly associated with the risk of SCD regardless of LVEF.
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Affiliation(s)
- Jussi A Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland .,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Juho T Tynkkynen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Department of Radiology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Pashupati P Mishra
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, Päijät-Häme Central-Hospital, Lahti, Finland
| | - Terho Lehtimaki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
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7
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Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, Daou-Kabboul T, Bielecki JM, Alter DA, Krahn M. Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis. J Clin Med 2018; 7:E514. [PMID: 30518047 PMCID: PMC6306907 DOI: 10.3390/jcm7120514] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 01/12/2023] Open
Abstract
A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of cardiac rehabilitation (CR), nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. Published RCTs were identified from database inception dates to April 2017, and risk of bias assessed using Cochrane's tool. Endpoints included mortality (all-cause and cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial infarction (MI), coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and hospitalization (all-cause and CV)). Meta-regression models decomposed treatment effects into the main effects of core components, and two-way or all-way interactions between them. Ultimately, 148 RCTs (50,965 participants) were included. Main effects models were best fitting for mortality (e.g., for all-cause, specifically PM (hazard ratio HR = 0.68, 95% credible interval CrI = 0.54⁻0.85) and ET (HR = 0.75, 95% CrI = 0.60⁻0.92) components effective), MI (e.g., for all-cause, specifically PM (hazard ratio HR = 0.76, 95% credible interval CrI = 0.57⁻0.99), ET (HR = 0.75, 95% CrI = 0.56⁻0.99) and PE (HR = 0.68, 95% CrI = 0.47⁻0.99) components effective) and hospitalization (e.g., all-cause, PM (HR = 0.76, 95% CrI = 0.58⁻0.96) effective). For revascularization (including CABG and PCI individually), the full interaction model was best-fitting. Given that each component, individual or in combination, was associated with mortality and/or morbidity, recommendations for comprehensive CR are warranted.
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Affiliation(s)
- Nader N Kabboul
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Troy A Francis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Sherry L Grace
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.
| | - Gabriela Chaves
- Department of Physical Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG 31270-901, Brazil.
| | - Valeria Rac
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Tamara Daou-Kabboul
- Human Nutrition, Bridgeport University, 126 Park Ave, Bridgeport, CT 06604, USA.
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - David A Alter
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
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Kazukauskiene N, Burkauskas J, Macijauskiene J, Duoneliene I, Gelziniene V, Jakumaite V, Brozaitiene J. Mental Distress Factors and Exercise Capacity in Patients with Coronary Artery Disease Attending Cardiac Rehabilitation Program. Int J Behav Med 2018; 25:38-48. [PMID: 28702757 DOI: 10.1007/s12529-017-9675-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR). METHODS Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR. RESULTS In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (β = -.186, p = .002) and BDI-II somatic/affective subscale (β = -.249, p < .001). EC after EBCR was associated with HADS anxiety and depression subscales (β = -.198, p < .001; β = -.170, p = .002, respectively) and BDI-II (β = -.258, p < .001). The BDI-II somatic/affective subscale was the best predictor of reduced EC before and after EBCR. CONCLUSIONS Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.
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Affiliation(s)
- Nijole Kazukauskiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Julius Burkauskas
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania.
| | - Jurate Macijauskiene
- Faculty of Nursing, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, LT-44313, Kaunas, Lithuania
| | - Inga Duoneliene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Vaidute Gelziniene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Vilija Jakumaite
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Julija Brozaitiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
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9
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Chen YC, Tsai JC, Liou YM, Chan P. Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials. Eur J Cardiovasc Nurs 2016; 16:397-408. [PMID: 28565969 DOI: 10.1177/1474515116684407] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise interventions apparently reduce the risks of and prevent coronary artery disease (CAD). Developing an exercise intervention for patients with CAD is a rapidly expanding focus worldwide. The results of previous studies are inconsistent and difficult to interpret across various types of exercise programme. AIM This study aimed to update prior systemic reviews and meta-analyses in order to determine the overall effects of endurance exercise training on patients with CAD. METHODS The databases (PubMed, Medline, CINAHL, EMBASE and Cochrane Library) were searched for the interventions published between January 1, 2000, and May 31, 2015. Comprehensive meta-analysis software was used to evaluate the heterogeneity of the selected studies and to calculate mean differences (MDs) while considering effect size. RESULTS A total of 18 studies with 1286 participants were included. Endurance exercise interventions at a moderate to high training intensity significantly reduced resting systolic blood pressure (MD: -3.8 mmHg, p = 0.01) and low-density lipoprotein cholesterol (MD: -5.5 mg/dL, p = 0.02), and increased high-density lipoprotein cholesterol (MD: 3.8 mg/dL, p < 0.001). There were also significant positive changes in peak oxygen consumption (MD: 3.47 mL/kg/min, p < 0.001) and left ventricular ejection fraction (MD: 2.6%, p = 0.03) after the interventions. Subgroup analysis results revealed that exercise interventions of 60-90 minutes per week with a programme duration of >12 weeks had beneficial effects on functional capacity, cardiac function and a number of cardiovascular risk factors. CONCLUSIONS Endurance exercise training has a positive effect on major modifiable cardiovascular risk factors and functional capacity. Nurses can develop endurance exercise recommendations for incorporation into care plans of clinically stable CAD patients following an acute cardiac event or revascularisation procedure.
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Affiliation(s)
- Yu-Chi Chen
- 1 Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Chen Tsai
- 2 School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yiing-Mei Liou
- 3 Institute of Community Care, Director of School Health Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Paul Chan
- 4 Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Balint EM, Gander M, Pokorny D, Funk A, Waller C, Buchheim A. High Prevalence of Insecure Attachment in Patients with Primary Hypertension. Front Psychol 2016; 7:1087. [PMID: 27536255 PMCID: PMC4971030 DOI: 10.3389/fpsyg.2016.01087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/04/2016] [Indexed: 12/23/2022] Open
Abstract
Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension, which implies the need for further investigations to evaluate attachment insecurity as a possible risk factor for hypertension.
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Affiliation(s)
- Elisabeth M Balint
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany
| | - Manuela Gander
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany
| | - Alexandra Funk
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
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11
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Garza MA, Wason EA, Zhang JQ. Cardiac remodeling and physical training post myocardial infarction. World J Cardiol 2015; 7:52-64. [PMID: 25717353 PMCID: PMC4325302 DOI: 10.4330/wjc.v7.i2.52] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/22/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
After myocardial infarction (MI), the heart undergoes extensive myocardial remodeling through the accumulation of fibrous tissue in both the infarcted and noninfarcted myocardium, which distorts tissue structure, increases tissue stiffness, and accounts for ventricular dysfunction. There is growing clinical consensus that exercise training may beneficially alter the course of post-MI myocardial remodeling and improve cardiac function. This review summarizes the present state of knowledge regarding the effect of post-MI exercise training on infarcted hearts. Due to the degree of difficulty to study a viable human heart at both protein and molecular levels, most of the detailed studies have been performed by using animal models. Although there are some negative reports indicating that post-MI exercise may further cause deterioration of the wounded hearts, a growing body of research from both human and animal experiments demonstrates that post-MI exercise may beneficially alter the course of wound healing and improve cardiac function. Furthermore, the improved function is likely due to exercise training-induced mitigation of renin-angiotensin-aldosterone system, improved balance between matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1, favorable myosin heavy chain isoform switch, diminished oxidative stress, enhanced antioxidant capacity, improved mitochondrial calcium handling, and boosted myocardial angiogenesis. Additionally, meta-analyses revealed that exercise-based cardiac rehabilitation has proven to be effective, and remains one of the least expensive therapies for both the prevention and treatment of cardiovascular disease, and prevents re-infarction.
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12
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Barlow PA, Otahal P, Schultz MG, Shing CM, Sharman JE. Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: systematic review and meta-analysis. Atherosclerosis 2014; 237:13-22. [PMID: 25190307 DOI: 10.1016/j.atherosclerosis.2014.08.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The independent prognostic significance of abnormally low systolic blood pressure (SBP) during exercise stress testing (LowExBP) across different clinical and exercise conditions is unknown. We sought by systematic review and meta-analysis to determine the association between cardiovascular/all-cause outcomes and LowExBP across different patient clinical presentations, exercise modes, exercise intensities and categories of LowExBP. METHODS Seven online databases were searched for longitudinal studies reporting the association of LowExBP with risk of fatal and non-fatal cardiovascular events and/or all-cause mortality. LowExBP was defined as either: SBP drop below baseline; failure to increase >10 mmHg from baseline or; lowest SBP quantile among reporting studies. RESULTS After review of 13,257 studies, 19 that adjusted for resting SBP were included in the meta-analysis, with a total of 45,895 participants (average follow-up, 4.4 ± 3.0 years). For the whole population, LowExBP was associated with increased risk for fatal and non-fatal cardiovascular events and all-cause mortality (hazard ratio [HR]: 2.01, 95% confidence interval [CI]: 1.59-2.53, p < 0.001). In continuous analyses, a 10 mmHg decrease in exercise SBP was associated with higher risk (n = 9 HR: 1.13, 95% CI: 1.06-1.20, p < 0.001). LowExBP was associated with increased risk regardless of clinical presentation (coronary artery disease, heart failure, hypertrophic cardiomyopathy or peripheral artery disease), exercise mode (treadmill or bike), exercise intensity (moderate or maximal), or LowExBP category (all p < 0.05). However, bias toward positive results was apparent (Eggers test p < 0.001 and p = 0.009). CONCLUSION Our data show that irrespective of clinical or exercise conditions, LowExBP independently predicts fatal and non-fatal cardiovascular events and all-cause mortality.
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Affiliation(s)
- Paul A Barlow
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, Liverpool Street, Hobart 7000, Tasmania, Australia; School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Petr Otahal
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Cecilia M Shing
- School of Human Life Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - James E Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, Liverpool Street, Hobart 7000, Tasmania, Australia.
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13
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van der Bom T, Winter MM, Groenink M, Vliegen HW, Pieper PG, van Dijk AP, Sieswerda GT, Roos-Hesselink JW, Zwinderman AH, Mulder BJ, Bouma BJ. Right Ventricular End-Diastolic Volume Combined With Peak Systolic Blood Pressure During Exercise Identifies Patients at Risk for Complications in Adults With a Systemic Right Ventricle. J Am Coll Cardiol 2013; 62:926-36. [DOI: 10.1016/j.jacc.2013.06.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/08/2013] [Accepted: 06/11/2013] [Indexed: 11/25/2022]
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A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psychosom Med 2013; 75:335-49. [PMID: 23630306 DOI: 10.1097/psy.0b013e318291d798] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD). METHODS Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials. RESULTS Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63). CONCLUSIONS Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation.
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15
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Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162:571-584.e2. [PMID: 21982647 DOI: 10.1016/j.ahj.2011.07.017] [Citation(s) in RCA: 410] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/21/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) remains an underused tool for secondary prevention post-myocardial infarction (MI). In part, this arises from uncertainty regarding the efficacy of CR, particularly with respect to reinfarction, where previous studies have failed to show consistent benefit. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) to (1) estimate the effect of CR on cardiovascular outcomes and (2) examine the effect of CR program characteristics on the magnitude of CR benefits. METHODS We systematically searched MEDLINE as well as relevant bibliographies to identify all English-language RCTs examining the effects of exercise-based CR among post-MI patients. Data were aggregated using random-effects models. Stratified analyses were conducted to examine the impact of RCT-level characteristics on treatment benefits. RESULTS We identified 34 RCTs (N = 6,111). Overall, patients randomized to exercise-based CR had a lower risk of reinfarction (odds ratio [OR] 0.53, 95% CI 0.38-0.76), cardiac mortality (OR 0.64, 95% CI 0.46-0.88), and all-cause mortality (OR 0.74, 95% CI 0.58-0.95). In stratified analyses, treatment effects were consistent regardless of study periods, duration of CR, or time beyond the active intervention. Exercise-based CR had favorable effects on cardiovascular risk factors, including smoking, blood pressure, body weight, and lipid profile. CONCLUSIONS Exercise-based CR is associated with reductions in mortality and reinfarction post-MI. Our secondary analyses suggest that even shorter CR programs may translate into improved long-term outcomes, although these results need to be confirmed in an RCT.
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Affiliation(s)
- Patrick R Lawler
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
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16
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Association of blood pressure and heart rate response during exercise with cardiovascular events in the Heart and Soul Study. J Hypertens 2010; 28:2236-42. [DOI: 10.1097/hjh.0b013e32833d455b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Assessment of exercise blood pressure and heart rate in patients with coronary artery disease: is it worth it? J Hypertens 2010; 28:2184-7. [PMID: 20948390 DOI: 10.1097/hjh.0b013e32833eae03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Le VV, Mitiku T, Sungar G, Myers J, Froelicher V. The Blood Pressure Response to Dynamic Exercise Testing: A Systematic Review. Prog Cardiovasc Dis 2008; 51:135-60. [PMID: 18774013 DOI: 10.1016/j.pcad.2008.07.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vy-Van Le
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304-1207, USA.
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Abstract
Recent studies addressing the role of exercise in the detection, prevention, and treatment of coronary heart disease have significantly expanded our knowledge base in this area. This therapeutic review is focused on physiologic parameters in exercise, electrocardiogram testing, and the preventive impact of low-intensity regular exercise and the role of exercise training in selected patient populations.
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Affiliation(s)
- R A Stein
- Department of Medicine, Division of Cardiology, The Brooklyn Hospital Center, Brooklyn, New York 11201, USA
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Dorn J, Naughton J, Imamura D, Trevisan M. Prognostic value of peak exercise systolic blood pressure on long-term survival after myocardial infarction. Am J Cardiol 2001; 87:213-6, A8. [PMID: 11152843 DOI: 10.1016/s0002-9149(00)01320-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study examined the association between peak exercise systolic blood pressure and other exercise test parameters and the long-term (19-year) survival of 625 patients with myocardial infarction who were original participants of the National Exercise and Heart Disease Project, a 3-year (1976 to 1979) multicenter randomized exercise clinical trial. Results show that low peak exercise systolic blood pressure (< or =140 mm Hg) was associated with increased mortality throughout the 19 years of follow-up, and men with this finding obtained no survival benefit from participating in an exercise program.
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Affiliation(s)
- J Dorn
- Department of Social and Preventive Medicine, University at Buffalo, New York, USA.
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